Narrative Medicine

Abstract

Good doctors do not simply treat diseases; they treat sick people to whom they listen closely. In consequence, the medical profession had, until recently, attracted as many recruits with pastoral as with scientific impulses. ''The Citadel'' by A. J. Cronin used to inspire as many of our students as did Sinclair Lewis's ''Arrowsmith.'' But, nowadays, [Howard Brody] and [Arthur Kleinman] suggest, the high-tech climate of molecular biology on the one hand and the marketplace strictures of the Reagan era on the other have diverted many in our profession to the sort of careers described in ''The Double Helix'' or ''Wall Street.'' The whine of the ultracentrifuge and the clack of the stock ticker make it hard for the doctor to hear the patient's ''Stories of Sickness'' or to attend ''The Illness Narratives.'' The doctor is deaf, our critics say. The patient tells a story, the doctor deciphers the plot. E. M. Forster has pointed out that when we are told ''the King died and then the Queen died,'' we are offered a story, but when a writer explains that ''the King died and then the Queen died of grief,'' we are given a plot. We might say that science provides the meaning to the plot; it answers the ''how?'' and ''why?'' of stories of illness in terms that permit doctor and patient to agree. In a strong discussion of medical ethics, Dr. Brody argues that these textual agreements between equals, these conversations, are the only responsible way of arriving at informed consent, since ''neither participant in a true conversation can properly be viewed as totally passive or totally lacking in responsibility for the outcome.''