Narrative Medicine: A Physiotherapist’s Perspective
Before we launched NarrativeRx, Lissanthea Taylor and I embarked on a year-long qualitative research study of Narrative Medicine’s impact on pain care providers. During this time, we introduced five different groups of international providers to close reading, attentive listening, and reflective writing practices, and we asked them to report about the impact Narrative Medicine had on their professional and personal lives. Each group met over a two month span, but many students chose to continue their study, signing up for each group throughout the year.
The following story is written by one of those ambitious students, Physiotherapist Helen Davidson, after one year of Narrative Medicine study. I am honored to share Helen’s beautiful writing here.
Reflections On My Study So Far
by Helen Davison
No matter which clinical area you work in within Physiotherapy the therapeutic alliance is a focal point to our intervention. Whether it is compliance with rehab programmes, independence with home exercise programmes or health education, our ability to positively influence our connection with patients is a useful skill. Our focus within Physiotherapy is towards patient centred care, using our skills to connect with colleagues and patients to create this therapeutic alliance. However, improving our skills in this area can be a challenge.
Recently the popularity of Narrative Medicine appears to have taken an upturn and it was an area that sparked my interest. It has been heralded as being able to improve our empathy as clinicians and in turn improve quality of care. So, when an opportunity arose to be a part of a pilot study with fellow health professionals, I took it with both hands. What I didn’t realise at the time was the benefits I would gain from this decision. I am now over a year along this path and have attended four 8- week courses. The first three were part of the pilot study and the most recent one was the full official programme. So, I now reflect and share where this journey has taken me.
The courses are all online, on a private platform. Fellow students created an international group of health professionals with a common interest in working with people in pain. Each week we had a piece of art, literature or music to close read. Questions were to be answered to help us move into our close reading. Introductory texts were provided to help us in these tasks. Then, we responded to each other’s comments, and the discussions flowed. The coordinators carefully facilitated the discussions when needed, enabling us to hone our skills and explore further. The second task of the week was a writing prompt. A time limit of five minutes was recommended, no editing, no apologising. Followed by an invite to close read our fellow students’ words. The weeks progressed through different objectives.
This seems quite simple when described in this format. What actually evolved from this process involved both simplicity and complexity. The experience of being able to see something through others eyes, in itself, throws wide open the doors to our own biases. Why did I interpret this way? There is no right or wrong, but there is an abundance of self-awareness and acknowledgment of what we bring to the clinical table. Recognising the importance of grounding your observations in the material used in the patients’ narrative, improves our authentic connection. Exploring symbolism, metaphors and the potential for these to be interpreted differently, highlights the possibility of misunderstanding. The importance of an inquisitive mind, exploring and being open to clarification, allows for a clearer understanding. Exploring our creative selves with our writing tasks enriched our own practices of self-care.
Professionally and personally my skill set changed. Listening became driven by curiosity. I recognised we often talk about the third space within our clinical connection; but how good are we at creating this space? I had always been recognised as having a pretty good skill set in this area. However, following these courses, I discovered a whole new level of skill. This space needs to be able to evolve and the skills I learnt honed my ability to connect and discuss clearer goals and clinical paths. This improved negotiation, in turn enabling change and progress along the shared clinical path. Some of the work explored the illness narrative, how we express and possibly share the experience. With my new skills in close reading I am able to connect more to patterns and choices of language used in the clinical setting. In turn creating a much more detailed picture within that subjective history.The history we often listen to within our assessments can drive our perception and understanding of the clinical presentation. What I started to recognise was that history and time line can be influenced by so many factors. Reviewing the same material in different courses brought up very different close readings for me, challenging my own interpretations. Was one right and one wrong? I don’t believe so. What I would suggest is that my lived experience influenced my interpretation at that time. Which raised the question for me, how much does my lived experience influence my decisions in the clinical setting? Recognising the presence of this gave me a moment to check in on myself each day. To check in to see what I might be bringing into the clinical space. This process allows me to be flexible within my approach and helps foster that open space which in turn encourages the exploration of all the potential truths within it.
I would also suggest that working in health takes its toll and creating the balance between care giving and self-care can sometimes be a challenge. The more we discover our bias and self-awareness perhaps we can gain more connection to our work and ourselves. If we know ourselves well, we know when to possibly step back, recognise when we need a pause, a reset. By learning how to hear stories and truly listen with a focus of understanding and not answering, not fixing, then we may also allow us the space to not be in the state of ‘failure to fix’.
This takes times, but as using exploration of narratives allows us to hone our skills in the clinical field, it helps us to stay connected to our humanity.
I have the feeling that this is just my first steps into Narrative Medicine and continuing to practice these skills and study further will continue to reap its rewards. If you would like to know further about the course I took, the details can be found here: NarrativeRx.com.
