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    Sunday, April 18, 2004

    Doctor Stories: One of the greatest pleasures of being a doctor is listening to patients' stories. But this may be taking things too far:

    ''A 36-year-old Dominican man with a chief symptom of back pain comes to see me for the first time,'' she said. ''As his new internist, I tell him, I have to learn as much as I can about his health.''

    The familiarity, however, ended there. Charon described listening to her patients in markedly different terms than other physicians do. She did not -- as she told it -- interrupt the man with pesky questions about his pain but rather listened in an analytical way as if he were a character giving a soliloquy.

    ''I listen not only for the content of his narrative but for its form -- its temporal course, its images, its associated subplots, its silences, where he chooses to begin in telling of himself, how he sequences symptoms with other life events,'' she said. ''After a few minutes, he stops talking and begins to weep. I ask him why he cries. He says, 'No one has ever let me do this before.''

    You can read too much into a soliloquoy if you deconstruct it too much. You can also miss important details if you don't specifically ask about them. The job of a physician is less like a literature professor than a police detective. We have to sort through a patient's narrative for the important clues. And sometimes we have to help them give us those clues. And what do you know, in reality, that's how the professor of "narrative medicine" does things, too:

    Observing her for several days in a clinic in the hospital that serves the local low-income, mostly minority population, I was struck by the dynamic nature of the interaction. Far from sitting silently and absorbing patients' stories, as she described herself in the anecdote of the Dominican man, Charon was an active questioner. The patients volunteered little -- they were shy and sick -- but Charon led them to tell her what she needed to know by giving positive verbal and nonverbal feedback when they did. She did not dwell on anything, but elicited and responded to personal sorrows one minute and asked about smoking habits the next -- with no sense of disjuncture. The patients -- who, after all, had trekked to the hospital not to have their narratives analyzed, but to get better -- seemed to leave the brief 10- and 15-minute appointments with good care.


    posted by Sydney on 4/18/2004 11:15:00 PM 0 comments


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