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PLOS BLOGS Speaking of Medicine and Health

A New “Vital Sign” — Patient Narratives as a Routine Part of Health Care Encounters

By guest contributors Jennifer E. Geller BS, Gloria A Bachmann MD

Narrative Medicine has been a well-documented tool used in undergraduate medical education. The integration of narrative medicine into medical curricula has been noted as effective for trainees — and thus ultimately future practitioners — to process their patient encounters and improve cultural humility, empathy, and professionalism, critical components in effective patient-centered care1. While medical-trainee-based writing has increased as a part of medical curricula, what is far less documented and utilized are the benefits of patient-provided narratives, despite encouraging preliminary data generated in the outpatient setting. Narrative-based medicine involving patients would translate into integrating narratives provided by patients, especially those dealing with life threatening and chronic illnesses, into their outpatient appointments and hospitalizations.  However, there is concurrently a lack of a clear definition of what it means to “use the patient’s story in care,” causing a lack of unified understanding as to its applicability3.

Given the rise of narrative medicine as an understood concept of the medical education system, we propose patient-based narratives as another “vital sign” both emphasizing its importance as well as traceability among subsequent patient visits. Much like having a pulse on the patient’s vitals sign, having the patient describe how they are feeling and in their own words over time and documenting their words is like another data point to trend. Noted at the individual level as used in individual general practioners’ (GP) offices, the ability for patients to write out these thoughts — pain, fears, hopes, etc… — and what they would like to discuss with their practitioner also may aid to break down the barrier that some patients perceive in the hierarchy of medicine leading to incomplete communication in office visits or hospital stays4. Expanding on GP, in surgical care, patients may have fears and anxiety prior to their operation and by having the patient write those out may allow the surgeon to gain a deeper sense of where their patient is at emotionally and physically. Given these feelings evolve over time, physicians are better equipped to take care of the entire patient as they will know their patients better. However, to offer this method of communication in patient care, technology must be adapted so that narratives can be uploaded to the electronic medical record (EMR) system. This should include prompts that can aid patients in expressing what they want to share with their practitioner.

General acceptance of this type of pulse on how a patient is feeling requires buy-in from practitioners which begins at the trainee level. Educating the next generation of practitioners about the importance of patients’ stories in informing their care will help build inter-professional trust that will transcend building trust with patients. It also allows for practioners across multiple specialties to understand how their patients are feeling in the various domains of their medical care — eg, the cardiologist can better understand how the patient feels about their obstetrical care. This fosters more collaborative medicine and can commence when students are taught the importance of such collaboration.

In summary, patient’s participating in therapeutic writing is the next step in getting a deeper understanding of their care that can be followed over time. Next steps should include 1) teaching trainees how they can go about encouraging their patients to put their thoughts on paper, 2) the ability for patients to upload these narratives into their charts, and 3) for practitioners to read and trace all of their patients’ narratives over time irrespective of what specialty appointment or hospitalization the narrative was written for. Much like one monitors a patient’s blood pressure over time, this is the next step in open-ended communication between patients and practitioners that increases trust and thus works toward team-based optimal patient outcomes.

Acknowledgement: Thank you to the Robert Wood Johnson Medical School Literature in Medicine Elective Class for fruitful discussion that contributed to this opinion piece.

About the authors:

Jennifer Geller is a fourth-year medical student at Rutgers Robert Wood Johnson Medical School. She has just matched into general surgery residency at Thomas Jefferson University in Philadelphia, PA. Her current research interests include improving surgical outcomes, injury prevention, and bioethics.

Dr. Gloria A. Bachmann is a nationally and internationally recognized physician who has moved health care to the next level in many areas. At Rutgers Robert Wood Johnson Medical School, she is a Professor of Ob/Gyn & Medicine, the Associate Dean for Women’s Health, the Co-director of the Women’s Health Institute and the Medical Director of the PROUD Gender Center of NJ.

Disclaimer: Views expressed by contributors are solely those of individual contributors, and not necessarily those of PLOS.

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