James Poskett: What to do with patients’ stories?

Narrative is a hot topic in the medical humanities. It can also be bewildering. Over the years literary theory has helped to bring the relevance of patient’s stories to the forefront of medical practice. But, as Johanna Shapiro notes in her recent paper Illness narratives, critical approaches to such stories have also complicated the practical matter of listening and talking to patients.

http://mh.bmj.com/content/37/2/68.full

We now accept that first-hand accounts of illness cannot be accepted unproblematically. For one, there is always a tendency to recount stories in culturally familiar styles (meta-narratives in literary speak). Our conviction that the world is ‘just’ can lead us to tell stories which reconfigure bad situations as good: illness as a life-changing experience for the better. Third person accounts, told by physicians and written in case notes, are no less problematic. These stories, driven by clinical requirements such as diagnostic criteria, are equally biased in their portrayal of events.

All this might be instructive (and good fun!) for theorists but it leaves the healthcare professional in a jam. How are they to deal with the patient in front of them? They cannot disregard everything said as a suspect meta-narrative. Yet equally they cannot accept everything a patient recounts as a true representation of illness. The question is: what to do?

Practical advice in such a quagmire of theory is rare, hence why Shaprio’s paper is so useful. She argues that the best approach is one of ‘narrative humility’. What does this mean? Well, in a sense it means we should abandon the idea of stories as something to be interrogated, as a truth waiting to be uncovered by a canny theorist. Instead we should see stories as a way in which patients maintain some control over their lives. “The storyteller should be granted the privilege of poetic licence, which trades accuracy and precision for personal meaning.”

This does not relegate critical theory to irrelevance. Far from it. With a better understanding of the diversity of uses and misuses of narrative, healthcare professionals can tell stories with their patients rather than simply listening to them. Juxtapositions, such as that between first and third person, start to break down when narrative becomes collaborative. To achieve this we need more humility and less suspicion, both from patients and the world of healthcare.