Narrative medicine is a term used with increasing frequency in the recent medical lexicon. It refers to a unique approach to medical care that emphasizes the use of narrative skills (e.g., writing, respectful listening, and storytelling) to relieve patient stress, encourage stronger bonds between patients and providers, and promote healing.

A growing list of academic health cen­ters, hospitals, and other facilities sponsor programs and trainings in narrative medi­cine. A master’s degree or other certification in narrative medicine is even available at institutions such as Columbia University and the University of Southern California.

A group of health care professionals at Advocate Children’s Hospital in Park Ridge, Illinois, have been incorporating narrative medicine concepts into patient care for several years now.

“Narrative medicine is already part of the medical system, under what we call history of present illness,” remarks David G. Thoele, MD, a pediatric cardiologist and founder of the hospital’s narrative medicine program. “But with our program’s expres­sive writing approach, we’re bringing out more of the stories that patients have. As clinicians, we’re also learning how to be better listeners to our patients. Our goal is to reduce stress for everyone and create a more healing environment for our patients.”

With colleague Marjorie Getz, PhD, a learning and behavior specialist, Dr. Thoele is a codirector of the narrative medicine program at Advocate Children’s Hospital. The group meets twice monthly via Zoom with participants, who include physicians, therapists, nurses, other staff members, patients, and community volunteers. The meetings and events the group sponsors feature a mix of writing, meditation, music, poetry, and topic presentations.

Three-Minute Mental Makeover

When Dr. Thoele first learned about narra­tive medicine, he was intrigued and felt challenged to find a practical way to introduce some of the concepts into his busy clinical practice. Consequently, he developed a short exercise called the Three-Minute Mental Makeover, or 3MMM. The exercise asks both the patient and practitioner to compose written responses to three prompts:

  • Write three things you are grateful for, and be specific.
  • Write the story of your life in six words.
  • Write three wishes that you have.

The participants write concurrently and then share what they have written. Dr. Thoele has learned from experience that some patients may be reluctant to do a writ­ing exercise on their own, but when done in conjunction with the practitioner, the exercise can be revelatory.

“Most patients respond well to this brief writing exercise,” says Dr. Thoele. “I’ve found it helps create a connection between us. For myself, as a doctor, I also get an insight into what makes a patient tick when they share what they’ve written.”

A peer-reviewed study in The Permanente Journal shows the benefits of the 3MMM. The study looked at survey responses from eight health care practitio­ners and 96 patients and family members at a children’s hospital over eight months in 2016–2017.1

Notably, 88% of the patients and family members found the 3MMM helpful, and participants reported noteworthy reduc­tions in stress after the 3MMM activity. Practitioners also reported improved com­munication with patients after the shared exercise. In the neonatal ICU particularly, families noted a significant improvement in communication.

Storied past, present, and future

“I’ve often found the most stressful situa­tions occur when families or patients are asking good questions, but I don’t have the answers,” observes Dr. Thoele. Using the 3MMM, he finds that even a brief foray into expressive writing can introduce a sense of reflection into uncertain moments, damp­ening the stress the patient or family may be experiencing.

Even when sharing his story during 3MMMs with patients, Dr. Thoele is careful to keep the focus on each patient. “First, I will make one of the things I’m grateful for be about the patient,” he explains. “I might say, ‘I’m grateful that your daughter has a mother who shows up every day and really loves her.’ I also share a little bit about myself, such as ‘I’m grateful that I got to ride my bike to work today.’ I share something they might not know about me. I also make one of the wishes about the patient. For instance, [I might say] ‘I hope I provide compassionate, competent care to your daughter, so she has a good chance of getting off the ventilator as soon as possible.’ As a brief exercise, the 3MMM allows me to express my compas­sion and care for the patient.”

Sigrun Hallmeyer, MD, an Advocate Health Care oncologist, has also found the 3MMM beneficial. She recalls an early expe­rience using the exercise with a young patient who was in her 20s with metastatic breast cancer. The circumstance required breaking the news to the patient that her disease had progressed despite significant treatment.

“I was dreading the appointment, as I had known since the evening before that the scans didn’t look good,” recalls Dr. Hallmeyer. “There was a lot of tension in the room that day, and I sensed the patient was ready to give up. She told me she didn’t even want to hear the results of the scans—that she knew it was bad.”

At that time, Dr. Hallmeyer had just completed her first meeting of the hospital’s narrative medicine group. On the spot, she asked the patient whether she would give the 3MMM a try. Dr. Hallmeyer shared how she was grateful for her teenage daughter, who, despite challenges, remained close to her. She shared how she had moved from East Germany as a young woman, hoping to become a physician.

But initially there was not much the patient was grateful for. Her six-word story was also bleak. “It was basically, ‘Born. Raised. Suffering. Suffering. Suffering. Death,’ ” says Dr. Hallmeyer. “This was the moment in the room when her mom started crying. I had to take a deep breath as well—so how do we disassemble that?”

The patient’s despair prompted Dr. Hallmeyer to speak to the patient about how the patient was born into a wonderful family and has parents who could not love her more and a brother who adores her. Dr. Hallmeyer mentioned her patient’s love of dancing, an activity she continued during her illness. In short, Dr. Hallmeyer counseled the young woman that “born, raised, and suffering” did not represent her complete story and that there was much more to her life. The few minutes for a different, more personal conversation made a difference.

“As an oncologist, there’s often little room for this kind of personal conversation with your patients,” observes Dr. Hallmeyer. “But I felt by opening up to her maybe she would also [open up more about her feel­ings]. I also had good news for her about qualifying for a promising new clinical trial. Ultimately, we were able to turn the moment around to her six-word story being, ‘Born. Raised. Fighting a lot. Hope.’

“It was extremely helpful to get from that devastation we both felt to putting a much larger frame around the moment,” concludes Dr. Hallmeyer. “Without this tool, I think the appointment would have ended in such a way that she would have left crying.”

In the busy health system, patients ben­efit from a wide array of clinical resources. But the system often operates as if on warp speed, strained by financial pressures, time constraints, and other pressures.

As a tool, narrative medicine helps patients and practitioners reflect, connect, and heal. It offers a simple antidote for often complex clinical moments and a way to ease the stress that comes with illness and medical care.