The Scope E-Newsletter
From the Dean's Office
In the Spotlight
Dr. Lands Learns the Patient's Story Through Narrative Medicine
Ronald Lands, MD, Associate Professor, Medicine, has developed a narrative medicine elective for medical students and medicine residents using creative writing and literature to illustrate clinical concepts, in addition to more traditional training. Narrative medicine is a philosophy of medicine that says the patient has a story to tell and the physician has an obligation to hear it.
Traditional medical training teaches physicians to maintain a healthy distance in their relationships with patients. Dr. Lands believed this when he came home to practice oncology twenty years ago. Soon after he arrived, Dr. Lands's uncle asked him to take over treatment of his cancer. He tried to decline saying that he didn't think he could be objective. His uncle responded, "I don't want you to be. I want to matter." The experience that followed changed Dr. Lands's perspective forever.
"Prior to this, I thought my role was to douse my patients with chemotherapy and hope it treated the cancer. When my uncle's chemotherapy didn't work, I felt a painful, personal disappointment. I realized how little I understood about treating the person with the cancer and not just the disease. I learned that suffering ripples out from the patients to everyone who cares about them," he said.
Dr. Lands later wrote an essay, "The House Call," published by the Journal of the American Medical Association in 1996 describing a pre-dawn visit to the family farmhouse where his uncle was dying. "I was overwhelmed with the feeling that this old house had witnessed so much; weddings, funerals, babies being born, and now my uncle dying in the bedroom." The effort to capture that feeling in words rekindled an old desire to write.
Dr. Lands said he did not know that narrative medicine existed until after he completed his Master's in Fine Arts degree in 2004. "I recognized that the skills needed to read or write a story are similar to the ones I used to understand a patient's dilemma," he said. "Just as in reading a novel, the reading of the patient requires attention to context, point of view, reliability of the narrator, character analysis, metaphors and hidden meanings. I changed my approach. Instead of interrogating patients, I asked them to, 'Tell me your story.' I listened for clues to help identify their disease, and at the same time, I tried to hear what the symptoms meant to them. They are often very different."
Dr. Lands is quick to say that attention to the patient's story does not in any way dilute the importance of the science in medicine. "I'm just as enthralled with biology as I was when I was young," he said. "I study the pathophysiology of blood, but I love the idea that people have written hymns about it, too. There's room for both."
| Graduate School of Medicine
University of Tennessee