Narrative Medicine the New Form of Self-Care

Narrative medicine for social and physician wellness

Physician wellness begins in realizing our identity in medicine and society. Shamans, priest, and healers have existed in ancient times and in small and large indigenous tribes since man began to gather together in social packs. The unique role of tribal and community leaders who guarded health and wellness was understood as important for the whole of society.

All doctors have degrees of empathy. We as an order select for this trait as much as spiritual leaders look for spirituality or politicians look for diplomacy. Society even measures doctors according to “bedside manners” which tells us this trait defines our order in a primary sense. We may be many things at once or as well but we are at our core empaths.

As empaths, we succumb to the failings of empaths. We misread. We take on too much energy of all kinds. We feel guilty when we don’t help. We feel burnt out when we haven’t recharged. We are alone except amongst other empaths. It is an infrequently admitted truth that we go to fix problems because the pain we feel doesn’t go away until we fix the problem. When we fail the pain that made us accountable, responsible, and moved stays with us. We fail when others suffer. We fail when people die. There will be things we cannot fix and those things add to the crux of what makes doctors unwell.

Physician wellness must take on a new paradigm.

Narrative medicine as a literary form that engages care providers including physicians to share their witnessed stories of humanity can be an instrumental tool to repeatedly resuscitate the physician. Relationship centered medicine has been considered a way to help doctors stay in love with doctoring and that premise is supported by narrative medicine to help refocus the efforts of medicine around relationships.

1. The paradigm starts with embracing our identity as learned healers: empathic intelligent leaders. That is what we are born to do and what society needs from our birth. Society expects doctors to be compassionate. Compassion defines doctoring. Empathy is the origin of compassion. We are empaths.

2. Refueling speaks to what we are. As empaths, we must recharge to then go out and give. Refueling includes time alone. Time with natural elements. Time with other empaths who happen to be our colleagues or aids. Time to grow our self-awareness and mature our natural skills. Security and self-wellness mean there is something to give from.

Running on empty when sick people are coming to you for help will lead to no healing. In fact, it will result in more pains. The patient is unheard. The physician fails and is further depleted. We don’t send broken solders to fight. That gets others killed. We don’t allow pilots to fly tired or stressed. That carries human cargo tangibly into danger. Unwell doctors will perpetuate suffering or create more.

3. Realization that healers are wounded by the pain around them and charged by the success around them. This realization explains why we must try to fix problems. Pain of any kind around us hurts us, and the resolution of conflict and pain is a personal relief to us. This awareness leads to solutions to achieve balance and wholeness despite the more often depleting rigors of being a healer.

4. Reconciliation that some pains don’t resolve neatly or timely so we harbor them. They weigh us down and tear into our ability and deplete our reserve. We must thus unload burden of suffering. We can share our pain by logging the journeys we are so privileged to make with others. We can tell those stories to embrace them and then release those details because they increasingly bog down the engine of empathy. Narrative medicine can bring about this. Even narrative medicine by proxy where another writes with or for someone can do this.

5. Releasing the good and bad that healers stockpile over a day or a week or a lifetime can allow for more encounters and dealings. This is what happens as we seek reconciliation. Currently, physician wellness is flooded with retreats, meditations, and spa relaxations. Narrative medicine is happening now as a medium to connect physicians with themselves, with medicine, with society. It provides to society an actual log of real intimate moments that define humanity and the human condition. Arguably, it is a discourse with healing that can create a conduit to healing the healer.

Writing an intimate story down or sharing an intimate story to be written down or reading an intimate story will all effectively release the healer into a place of renewed purpose and awareness. It will unbridle the empathy so the healer can go back and care again.

6. Remembering the impact healers make through logged stories and sharing can continue the orders’ main agenda and thus role in society.

Physician wellness is not just about security, work hours, time off, meditation, massages, retreats, recognition, resilience. It is about pushing to the forefront repeatedly who doctors are in society. We are healers. It is about realizing what that means and entails. We are empaths. It is about refueling the ability to care by nurturing our empathy with empathy. It is about releasing what we did and can’t do, what we fixed and can’t fix back into the whole society to own. It is about remembering we are here to help and to play our given gifted role. The area of narrative medicine can help create the paradigm shift to making well those that make society well through active reflection on the humanity in medicine.

The author: Jean Robey is a nephrologist who blogs at ethosofmedicine.

ARE WE HUMAN?

Society doesn’t allow doctors to be human

The other day while having my lunch in the doctor’s lounge, I ran into one of the older physicians who works at the hospital. He had a weary look on his face, and so I inquired if he had a tough call night.

“Actually, I haven’t slept well in a few months,” he quietly responded. It turns out he was being sued by a family who had only seen him once several years ago. This is a doctor that I highly respect and seek to emulate. His long and successful career has been exemplary in many ways. Unsurprisingly, both patients and peers love this person. As a result, it was jarring to see him involved in a lawsuit.

It turns out that the case has been going through the legal process for several years. With each year, his worry has grown to the point where he could no longer sleep well. This situation is clearly consuming his personal life.

Including residency, I have been a physician for almost nine years now (the gray hairs are increasing daily). Throughout this time, I have distressingly learned that practicing medicine in such a litigious society is like walking on eggshells. By certain estimates, 75 percent of primary care physicians are likely to be sued at least once by age 65. Regrettably in the health care field, we are all constantly walking on egg shells.

When I walk into a hospital room and see a newborn with a first-time mother, there is no way to properly describe how special it is to be part of that juncture. It is like I am constantly being invited to be part of the writing of the first chapter of a unique and beautiful book. Often during this first checkup, an effervescent mother will ask me, “Doc, is my baby healthy?” I am happy to report that my answer is usually an enthused,“Yes!”

 During these splendid moments, there is always apprehension in the pit of my heart. I worry a baby that appears healthy will go home and turn out to be sick. When I give a mother reassurance about her baby’s health, I do it based on the best of my knowledge and experience. My knowledge, however, is human. My emotions are also just as human; if a patient has an unexpected outcome, I become haunted by those circumstances.

I sometimes honestly question whether we live in a society that allows for our doctors to be human. With humanity’s advances in medicine, science, and technology some of us no longer accept that bad things can happen. And if bad things happen we must find someone to blame. This environment is toxic to the health care field. For the most part, the people I meet are wonderful and enrich my life. However, every once in a while I think every physician encounters a patient that is waiting for the doctor to do something wrong.

I am not arguing that we ought to be uncritical of mistakes. We can only become better at what we do by a constant critique of ourselves. However, when the pediatrician is making decisions based on what a lawyer might argue and not what the baby needs, I would certainly not describe that medical culture as flourishing.

Last week, I saw a 6-year-old child on Monday morning (the worst time of the week for all of us). We were having a debate about who was better: Batman or Spider-Man. I tried to convince him of Bruce Wayne’s superiority, after which I proceeded to examine him. As I was leaving the room, a faint whisper said, “I hate Batman.” I laughed as I walked down the hallway, it brightened up my Monday.

The most beautiful aspects of medicine are found in its humanity. Whether those moments come from a new birth or a conversation with a 6 year old, they enhance our days. As a physician I am grounded by my humanity; this means that no matter how hard I try, there will always be imperfections in my quest to be a better pediatrician. I can only hope that our culture moving forward values our qualities over our flaws; this is as important for the physician as it is for the patient.

Ahmad Bailony is a pediatrician who blogs at A Bunch of Bologna: Life Lessons in Pediatrics.