"Untitled" Kaza Faust, UCR Ph.D. student in archaeology
RIVERSIDE, Calif. — Every patient has a story to tell about their illness, their fears, and why a prescription for treatment may be difficult to follow. How doctors and patients understand and communicate those stories can be life-altering in making accurate diagnoses, adhering to treatment or accepting an unwelcome prognosis.
The National Endowment for the Humanities has awarded the University of California, Riverside $100,000 to develop a health humanities program focused on the role of stories in medicine and healing. The two-year, interdisciplinary grant will fund a collaboration of humanities scholars and School of Medicine faculty in an effort to identify how narrative can best be integrated into training medical students.
“Narrative medicine plays a role in creating empathy in doctor-patient encounters,” said Juliet McMullin, associate professor of anthropology and principal investigator of the research project. “If we’re trying to create physicians who are knowledgeable about the community, they need to have conversations with patients that get to the core of their needs.”
The grant is part of the NEH’s Humanities Initiatives at Hispanic-Serving Institutions (HSIs). HSIs are nonprofit, degree-granting institutions where at least 25 percent of full-time undergraduate students are Hispanic. The U.S. Department of Education named UCR an HSI in 2008, the first in the UC system to receive the honor.
“Latinos are a steadily evolving population in the U.S., and it is therefore crucial to foster a sense of cultural fluency among medical professionals and researchers,” said Tiffany Ana López, holder of the Tomás Rivera Endowed Chair, professor of theater and a co-principal investigator on the project. “The humanities play a crucial role in developing creative and agile approaches to communication that extends to health care, program development, and problem solving generally.”
Importance of narrative
Narrative is gaining recognition in medical schools to improve the effectiveness of health care, McMullin said.
“Stories are how we get to know each other and how we make sense of our world,” she explained. “It’s about how we communicate with each other in society. It’s about identity and how we tell stories about ourselves.”
Every medical school offers a communications course and many require their students to engage in reflective writing as a way to build empathy and trust, and engage more effectively with patients, said Dr. Paul Lyons, senior associate dean of the UCR School of Medicine and a co-principal investigator of the project. Many of those courses, however, are not based on the kind of communication research or best practices in reflective writing that UCR is known for, he added.
Said López, “When we understand our own personal histories and the ways someone else’s story compliments or challenges our own, we gain a level of clarity about receiving and processing information that enables us to become a more active listener, something absolutely crucial for medical doctors and other health care providers. “
The NEH grant supports development of a core group of faculty with specific expertise in medical narrative, drawing scholars from the departments of anthropology, creative writing, history, psychology, theater, and women’s studies, as well as the School of Medicine. This working group could become a national model for the use of medical narratives in medicine and in other disciplines, Dr. Lyons said.
“If I want to produce the highest functioning physicians I possibly can they would have deeper skills in understanding the different elements of narratives the patient, family and physician are producing,” he explained. “If physicians don’t understand what’s going on with the patient, they can’t treat. If physicians can’t explain what’s going on, patients don’t understand what needs to be done and why. Issues of medicines, tests, and family conversations about end-of-life issues become complicated. This is not a question of biology. The question is, why are we not speaking the same language? When you understand how you get to this discordance and disagreement, you will know what to do and you will give better medical care.”
Health humanities curriculum
The project, “Narrative in Tandem: Creating New Medical and Health Humanities Programming,” is organized around understanding and practicing narrative in the humanities and medicine through enacted communication, visualizing, and writing.
In the first year of the grant 12 faculty members will meet in workshops with experts known for telling stories around health and wellness and who have helped build health and humanities programs, McMullin said. Those speakers also will deliver a series of public lectures.
For example, several seminar topics involve working with performers or health educators to develop communications curricula or to devise better training of standardized patients around issues of diabetes, trauma and inequities in health care. Standardized patients are individuals who are trained to act as patients with specific ailments and personalities, and are used extensively during the first two years of medical school.
“How much more informed could these standardized patients be if theater arts faculty trained them, or if anthropologists or psychologists taught them to raise issues of ethnicity or culture that are important?” Dr. Lyons asked. “How much more prepared would our students be if standardized patients were more like real patients? It would make them more skilled when they start treating patients in their third year.”
A seminar on reflective writing is intended to develop the syllabus for a course that could be implemented for medical students this summer and for humanities students in the fall. Studies have shown that reflective writing about traumatic experiences improves health outcomes for patients, McMullin noted.
“It gives an opportunity for them to reflect back on the experience and rethink what happened. It’s an empowering position,” she said.
Reflective writing also helps physicians become aware of factors that influence their reactions to and ability to work with certain patients. That self-awareness is essential in conveying empathy, engaging with patients, and gathering information necessary to make an accurate diagnosis and to reach agreement with the patient about a treatment plan, Dr. Lyons said.
The second year of the grant will focus on issues such as diabetes in the community, trauma and health care disparities locally. The project will conclude with a conference in spring 2015 organized around the issues of health and medicine.