Narrative Medicine: Bringing Your Talents to Medicine

A Perspective with Rita Charon, Associate Professor of Clinical Medicine at Columbia University's College of Physicians and Surgeons

As a college student in the late '60s, Rita Charon, M.D., Ph.D, spent much of her time off-campus; there was, after all, a highly controversial war taking place halfway around the world, and Washington, D.C. was the destination for politically active individuals to affect change. While Dr. Charon has since moved on from her protest days, a bit of the renegade still remains - in 1996, Dr. Charon established the Narrative Medicine Program at Columbia University's College of Physicians and Surgeons. As the program's director, she champions reinterpretation of traditional notions of care-giving and treatment.

Her take on medicine is perhaps a result of her varied education and experiences. A non-traditional student in the classic sense, Dr. Charon spent several post-college years working as a teacher in a Manhattan grade school before making the switch to medical school. After a few years of practicing internal medicine, Dr. Charon sought to make sense of the various narrative strands she encountered as a physician, and her interest led to a Ph.D. from Columbia's English and Comparative Literature department.

Narrative medicine falls at the intersection between the humanities and scientific thought; it's a different framework for discussing and analyzing medical practice. In fusing left-brained and right-brained fields of thought, Dr. Charon hopes to unblock the channels of communication not merely between doctor and patient, but within each individual participant as well.

How did political activism and feminism turn into a career in medicine?

I guess it was a choice that I fought for a long time. My father was a doctor, my grandfather was a doctor... I went off to college, and I was not a pre-med - I was in college in the late '60s. I was very active, the revolution was on, we were stopping a war - which we did! And so I rather actively turned my back on the idea of medicine. It seemed at that point an elitist part of the establishment. The idea of medicine at that point was so - it seemed to us - part of what was wrong in the country. And there were injustices, when really all the doctors were men and most of them were white, and it was the culture of medicine. It was not terribly committed to giving power to patients, and to hearing what their desires were. And it was at that time, in the '50s and '60s, more common practice where doctors would decide things and impose them on patients. From that vantage point, the idea of going to medical school became sort of appealing in part because of its complexity. And by then, I think I had enough sense of how the power of the profession might work to know that we needed progressive people on the inside of it as well as on the outside shaking our fist. So it was with a very different set of hopes and expectations.

When did you get the idea to get an additional degree in English?

I knew fairly early into medical school that I would also end up going to graduate school and doing a Ph.D.s I went to Harvard Medical School - I did primary care training, still in a very progressive, politically oriented way. It was community medicine; it was training as essentially a GP. So all my training was very much of a piece with earlier feminist efforts to make health care more egalitarian. And primary care medicine - again, this is late '70s, early '80s - was community based and culturally responsive. We did our best to learn Spanish, to learn the neighborhood resources, and to develop ongoing therapeutic alliances with patients. We did our best to not deliver fragmented care, but to get to know patients and families. And make partnerships.

In my first year of medical school at Harvard, I worked with Elliot Mischler, who's a social psychologist and a sociolinguist, and [he] did some of the early, very influential work on doctor-patient communication. Tape recording routine medical visits and analyzing very carefully the conversations was able to teach us all how the conversations are not at all egalitarian. It was as if the patient was talking in one language and the doctor in another. It was actually very sad. And you look very carefully at these conversations - I was very much influenced by his work and the field of studying carefully the language of what goes on.

And when I came here [Columbia University] for a fellowship in general medicine, it wasn't long before - as soon as I wasn't staying up all night - I started reading again. And the vibrance came back. I hadn't been an English major - I was busy getting tear-gassed in Washington for most of my college years! I hadn't learned a lot of literary criticism, any of that stuff. But I was just a reader! I remember when I was a fellow - I was alternating Henry James with William Faulkner. So I taught myself some literary criticism and read my way through early 20th century American literature. But then, I'm in Columbia, here as a fellow and in junior faculty, and there were many opportunities to work with people from the English department, the history department. We had started an Ethics department. Quite a bit of back and forth. Happily, I was enough on the other campus, the main campus of Columbia, that when I said to someone you know what? I think I'm going to take an English course, isn't that a great idea? They said, don't take a course, take a Masters. It was as easy as that.

But the important thing, and certainly for premeds from the point of view of how do you envision a life in medicine, I think the important thing is that I didn't have to forsake a passion for reading and language. And my own sort of teaching myself how to read a novel and teaching myself what critics are more apt to be writing about Faulkner - what a great discovery that that belongs in my medicine, every much as the anatomy and the pharmacology. Because right from the beginning of medical school, I was paying attention to how we talk to patients, how we learn about what they're going through, how you need a real ear for what people are saying, and you really need to be attuned to the language, even as you get it orally. It just made sense to me, it was a natural thing to see that I had to become really good at interpreting and decoding the stories I was hearing. That's what I did as an intern. That was my job. So it made sense to say, well, people in the English department know about this - that's what they know about. I think it turns out that anything - passion, a curiosity, and interest, a gift that we might have - can contribute to the medicine. I'm sure of it. If it's music, if it's visual art, if it's athletics, if it's engineering, if it's law - I mean, the reason people like you and me end up in medicine is there's so much room! What I'm trying to convey is, even from the beginning, I always had the feeling that I would certainly be a doctor but that wouldn't be all. My research is in how developing skills in doctors and nurses and social workers and students - developing skills in listening for stories, being able to absorb them, interpret them, tell them, represent them - how these narrative skills can make us better at the medicine.