Narrative Medicine

Narrative Medicine

In one sentence

Narrative medicine is a clinical practice and research method proposed by Rita Charon, which improves clinical judgement and empathy through careful listening and the written expression of patients’ stories.

Origins and key texts

Narrative medicine was developed by Rita Charon at Columbia University. She began using the term around the year 2000, and then established the field through the following publications:

Date	Text	Significance
January 2001	“Narrative Medicine: Form, Function, and Ethics”, Annals of Internal Medicine	First systematic formulation of the concept
October 2001	“Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust”, JAMA	The formal definition
2006	Narrative Medicine: Honoring the Stories of Illness, Oxford University Press	The foundational monograph
2017	Principles and Practice of Narrative Medicine (co-authored), OUP	Turns into a practice guide

Charon’s classic definition is medicine practised with narrative competence — the ability to recognise, absorb, interpret and be moved by stories of illness.

Her starting point was a plain observation: a great deal of clinically important information arrives in the form of stories. Experiences of pain, of attending an appointment, of dying, of worry about treatment — none of these compress into a lab result, yet they often determine whether treatment succeeds.

Four core domains

Rita Charon and Hurwitz summarise narrative medicine as four mutually supporting domains:

Domain	Meaning
Attentive listening	Not rushing to judge or advise; listening to completion first
Narrative rigor	Not storytelling as free association, but writing and reading closely using textual analysis
Honouring the patient	The patient is the expert on their own experience; professionals are fallible too
Self-reflection	Watching your own reactions: when am I interrupting, and why do I feel uncomfortable?

Narrative rigor is the most often misunderstood element. Narrative medicine does not invite clinicians to write emotively or to be moved by a story. It borrows the method of close reading from literary criticism — analysing structure, point of view, timeline and silence — rather than being persuaded by emotional intensity.

Three movements and four relationships

A second common framework describes the clinical process as three movements:

1. Attention — empty oneself first and receive the patient’s account in full
2. Representation — turn what was heard into something expressible; the parallel chart arises here
3. Affiliation — build trust on the basis of the first two

Charon also argued that narrative competence is exercised through four sets of relationships:

• clinician and patient
• clinician and self
• clinician and colleagues
• clinician and society

A frequent objection

“If a story counts as evidence, doesn’t this make clinical practice less rigorous?”

This is the challenge narrative medicine meets most often. The response is that it adds no efficacy evidence. What it adds is understanding of how evidence is used, and of its limits. The two serve different goals.

Relationship to evidence-based medicine

Narrative medicine does not oppose evidence-based medicine. Its proponents have been consistent on this point.

• Evidence-based medicine supplies population-level probabilistic judgements
• Narrative medicine supplies individual-level understanding of meaning

A treatment that works on average in a study population may still be wrong for a particular patient in a particular situation, or unwanted by them. The work of narrative medicine is to get that second question onto the clinical agenda.

Practice in China

Mainland China has seen considerable introduction and local adaptation since the 2010s:

• Narrative medicine courses and workshops in medical schools
• Parallel charts: clinicians write a second, narrative text centred on the patient’s voice alongside the standard medical record
• Narrative nursing: related methods applied to nursing communication and documentation
• Reading groups and case-sharing inside hospitals

These remain largely exploratory, and the methods for evaluating their effect are themselves still developing. Running a narrative medicine course should not be read as demonstrating improved patient satisfaction.

Further reading

• Charon’s founding papers (2001, Annals of Internal Medicine; 2001, JAMA)
• Charon, R. Narrative Medicine: Honoring the Stories of Illness. Oxford University Press, 2006
• Charon’s “three movements” framework (Narrative, 2005)

Related entries

• Rita Charon
• Medical Humanities

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Maintenance

• Status: Draft — unreviewed
• Maintainer: 医学人文百科 Editorial Team
• Licence: CC BY-NC 4.0