Assessing the Importance and Relevance in Your Own Life

 

 

 

 

 

Think about your last visit to the doctors. How was it? I bet most of you thought it was a decent visit. Most of you went for a specific reason, talked to the doctor, and left with somewhat of a resolution. That's good, right? To most people, the point of a doctor visit is to fix a problem, usually a physical one. However, given the increasing load of research addressing links between mental and physical health, should they not have addressed the mental component of it? For me, specifically, my last doctor's visit was to a dermatologist. I had gone in for a white patch that appeared a few months ago suddenly on my back and on my face. I did everything in my power to hide these spots of discoloration, knowing that if I didn't cover it up, a stranger's gaze would drift directly to the contrast between the spots and my deep brown skin. The onset of the white spots occurred around an extremely stressful period of my life - something I believed was suspicious. In addition, this discoloration took a mental toll on me cosmetically. Given the fact that my onset was over the summer, I felt so insecure seeing my friends freely wear swimsuits, dresses, etc. I  avoided going to the river with my friends, I avoided half of my wardrobe of tank tops, and I avoided face-to-face communication in broad daylight if I didn't have my mask on. At the appointment, the doctor held up a UV light to my skin patches and immediately told me "you have an autoimmune condition called vitiligo." I knew what vitiligo was, but hearing that I acquired an autoimmune condition at the age of 21 was a bit startling.  The doctor and I seemed to have very different agendas. He wanted to throw treatment at it and prescribed me three creams that "may not necessarily work." Oh yeah, they were $100 each and not covered by insurance. It didn't help that he was gathering his belongings to leave the room after a quick 5 minute interaction and happened to slip into the conversation "by the way, these creams have been linked to some cases of skin cancer, but I wouldn't worry too much about that." I had so many questions. Do autoimmune conditions occur because of stress? Do you know why I got this? Can you explain what is happening in my body? Do you think it will spread? What do I do if the treatment doesn't work? I did not get a single answer that day. I was shocked and confused at how he could visibly see the confusion on my face and proceed to walk out of the room. I was surprised that he didn't seem to care that I had the most intense anxiety-inducing summer of my entire life. I was confused when he didn't seem concerned that my vitiligo may spread and not be treated. I was astounded when he didn't ask if I was okay and what this experience was like for me. I felt like I had a story to tell as to why I was feeling the way I was and how that tied into my vitiligo diagnosis. I felt that I had nobody to tell it to after that visit. 

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Narrative competence goes beyond being able to hear your patient. It is about learning to use their story to guide the way their care is delivered to them. I urge everyone reading this to think about how many of their medical stories are left unheard. 

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Currently, I am a volunteer at the VA Hospital - Ann Arbor working on a project in Whole Health. Whole Health is a system newly implemented in the national VA Healthcare system and was spearheaded by the doctor I work with, Dr. Parekh. Whole Health is VA’s approach to care that supports a patient’s health and well-being while staying true to the values that mean the most to a patient. This means a patient’s health team will get to know them as a person to develop a personalized health plan based on their values, needs, and goals. Whole Health is not like the standard care that is expected and received today. Whole Health puts the patient in control of their care. It focuses on self-care, skill building and support. These services are not diagnosis or disease based all the time; they may support the personal health plan of each Veteran through approaches such as stress reduction, yoga, tai chi, mindfulness, nutrition, acupuncture, and health coaching. The model at the center of this approach is the Circle of Whole Health which focuses on vital parts of a person’s health (pictured below).

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This feeds into the topic of narrative medicine. It was my volunteering experience that first got me thinking about the current black and white nature of the medical field and led me to the idea of narrative medicine - I was immediately intrigued because this field put my ongoing thoughts into less of an abstract idea at the back of my mind. Narrative medicine is a clinical practice strengthened by complex narrative skills that equips healthcare professionals to recognize and interpret the physical and psychological states of their patients through intense absorption of every detail about the patient. I am extremely driven by this approach to medicine and seek to explore it in relation to women’s health. 

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My sophomore year of college, I read “A Good Birth,” a novel by Anne Lyerly; throughout the novel, Dr. Lyerly tries to bring a new perspective to childbirth. As a result of being a doctor who has given birth, she understands important aspects of birth that have been historically overlooked during and after labor. In hospital settings, there is this impeding tendency to focus on the outcome of birth from a purely success/failure standpoint. If the baby is healthy, it was a good birth; conversely, if the baby is not healthy, it was not a good birth. This fixation on the outcome undermines the mother’s emotional journey through pregnancy and childbirth and does not create a comfortable environment for her to share her experiences and stories. It can be, and often is, structurally invalidating. Dr. Lyerly did a 3-year study and asked what mattered most to expecting mothers, and the results showed that the most important facet went beyond the clinical outcome. Most expecting mothers wanted to feel “connected, safe, and respected.” This book was pretty novel in that it really built upon the core principles of narrative medicine and gave mothers a platform to share the complications and nuances of their birthing experiences. Ultimately, the book directs readers’ attention to what actually constitutes a good birth, beyond the clinical outcome. This book serves as my inspiration for this project. There is a deeper meaning to childbirth that I seek to capture. 

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I am doing my undergrad education in public health sciences. This background helped me piece together everything that makes up an individual’s health: physical factors, mental factors, emotional factors, socioeconomic standing, institutional barriers, built neighborhood and home environment, etc. These identities and experiences shape not only how a person experiences the medical system but how they are treated in the medical system. As someone who wishes to go to medical school and become a practicing OB/GYN, I want to bring my perspectives as a public health student into the way I learn about my patients and treat them. Currently, doctors are trained to view birth in terms of medical success. It makes sense in some regards. In a surgery, for example, the patient is often unconscious; thus, the emotional experience of the patient is nonexistent during the surgery, making the lack of emotional narrative surrounding surgical procedures relatively inconsequential. Post-surgery narratives are a whole different story. The process of birth, however, is inherently emotional. The medical community’s obsession with hyper fixating on the outcome is not warranted when discussing birth.

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