Medicine circles back to stories

Stethoscope

Doctor and patient in City Hospital Tuberculosis Division, 1927 (Item 2721, Engineering Department Photographic Negatives (Record Series 2613-07), Seattle Municipal Archives, from Flickr Creative Commons)

The invention of the stethoscope spelled the end of story-based medicine. That claim caught my attention when I was listening to White Coat Black Art on CBC. Dr. Brian Goldman, the show’s host, was interviewing Stanley Reiser, a medical historian.

In his 2009 book, Technological Medicine: The Changing World of Doctors and Patients, Reiser wrote, “Before stethoscopes, the coin of evaluation was words—the doctor learned about an illness from the patient’s story of the events and sensations marking its passage.”

Diagnoses were often made via letters. Patients wrote detailed descriptions of their symptoms, the remedies they had tried, and their emotional state. Not every physician was comfortable with this. Some complained of patients’ inabilities to accurately describe their illnesses. Others chided doctors for subtly guiding the narratives and missing the correct diagnosis.

In 1816 René Laennic, a 35-year-old French doctor, invented an instrument that would allow him to listen to a woman’s chest without violating her modesty. The stethoscope quickly became popular and “took the mantle of illness out of the hands of patients and placed it in the doctor’s orbit.” (Reiser)

When Dr. Goldman interviewed him for White Coat Black Art, Reiser said the stethoscope “led to a seismic shift in how doctors evaluated illness and their relationship with the patient, which changed as they became more interested in the evidence from the body and less interested in the evidence from the story.” The new technology “made doctors more interested in the physical findings of disease than in the life of the patient.”

Reiser is concerned that over-reliance on technology has lessened physicians’ openness to the patient as a whole person rather than a collection of symptoms. But there’s a movement toward storytelling in medicine, generally referred to as “narrative medicine”.

Narrative medicine is, in many ways, a return to pre-stethoscope days. Dr. Rita Charon, who coined the phrase in 2000, describes it as “medicine practised by someone who knows what to do with stories”. In “What to do with stories: The sciences of narrative medicine”, she writes, “Whether sick or well, the reader of an illness narrative is summoned by the author to join with the teller—to form community that can combat the isolation of illness.” [Canadian Family Physician August 2007 vol. 53 no. 8 1265-1267]

Illness is a lonely journey, particularly when it’s chronic or when the impact is life threatening. It’s lonely for the person who is ill and for those who are caretakers. Narrative medicine takes this into account, placing the illness in the context of a life rather than the narrow confines of symptoms.

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