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

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Had you not had that political background in college, do you think you might have developed that broad vision for medicine?

No, I think it was related to seeing that medicine was not a simple thing. I think at the beginning I was more aware of its potential lapses... And thinking back, that was a pretty good way to come in. I wasn't star struck. I didn't think doctors were God, that they were all powerful. None of that. Quite the opposite. I went to medical school thinking and saying, I don't want to be like you. So I think it was a very good orientation to come in with skepticism. To come in with some even suspicion. To say, what is medicine doing that it shouldn't be doing? Or what should it be really doing?

Did you ever encounter any resistance from people who doubted your ideas?

I'm almost tempted to say no, but let me nuance that. First of all, this is not something I just cooked up myself. It's a whole field of studies - literary studies, history, philosophy, anthropology, religious studies - all the humanities - and how they contribute to medical practice. There are major professional societies, there are journals, grants to be made, colleagues, so it was not one sort of cranky lady. It's a field. I and a few other colleagues here at Columbia sort of championed it and built programs, and now we have quite a big program in Narrative Medicine, and we have required courses for medical students, seminars and trainings for doctors, nurses, social workers, trainees in medicine... I really just want to put everybody together! Why continue to treat them like they're separate? I think around here, anyway, it's not an odd thing to bring in literary texts or methods in the same way it's no longer odd to bring in health law for making decisions for patients. You have to. Or it's not odd to ask, how did they treat malaria 50 years ago? Nor yet is it odd to wonder about the social or cultural frame around health beliefs or faith related or spirituality related practices around health. We have a wider field of vision now than we had some time ago, in terms of what contributes to health, what contributes to disease and what contributes to good care.

It's interesting how your perspective of medicine was from a place of changing it, not joining it.

From the outside of medicine, a person might be clearer about what's wrong with it than from the inside. I recently had a couple of family members who were quite ill, and worked through the whole ordeal of surgery and being in the hospital and getting many tens of thousands of dollars worth of bills - all the sort of indignities of the healthcare system. You just say, God help us. Is this the best we can do? And sometimes it's the perspective of the outsider that's most helpful. So while you're still on the outside, figure out what's wrong with it! And I do think the skeptical, how could it be better is just overall a more energizing, a more empowering, a clearer way to come in.

What big changes do you anticipate?

Well, first of all, the biology is changing. But there are many other things, too. The relationships are changing. As general internists, my colleagues and I are far more aware of our duties to bear witness to suffering than we used to be. Not to fix it, even beyond diagnosing it, but when I'm in the office with someone who's chronically ill, part of my duty and part of my skill is in being a receiver for what that sick person must tell. That the urge to tell of illness or loss is very powerful, and that the telling itself is healing. It's not just fixing something and getting the right drugs. It's a rather daring thing, to be personally accountable and present in people's lives.

Christine Hsieh is in the Columbia University Postbaccalaureate Program with an undergraduate degree in English and Philosophy.