From Particularities to Context: Refining Our Thinking on Illness Narratives

Abstract

This paper examines how illness narratives are used in medical education and their implications for clinicians' thinking and care of patients. Ideally, collecting and reading illness narratives can enhance clinicians' sensitivity and contextual thinking. And yet these narratives have become part of institutionalizing cultural competency requirements in ways that tend to favor standardization. Stereotyping and reductionistic thinking can result from these pedagogic approaches and obscure structural inequities. We end by asking how we might best teach and read illness narratives to fulfill the ethical obligations of listening and asking more informative clinical interview questions that can better meet the needs of patients and the community. IntroductionIllness narratives are a genre wherein an illness and its effect on the patient's life are told as an autobiographical or biographical account. As Kleinman [1] and Frank [2] have argued, illness narratives are forms of meaning making. They provide insight into how patients and clinicians understand the why and how of illness causation and treatment, including how illness processes are linked to the broader social and structural contexts of patients, their communities, and their clinicians. As a form of meaning making, illness narratives can be created in a clinical encounter, wherein physicians and patients coconstruct a therapeutic agenda [1,3, 4] that weaves together what the patient and the clinician know about the illness and its context.

Between equilibrium and chaos, with little restitution: a narrative analysis of qualitative interviews with clinicians and parent carers of children with medical complexity

“…Analysing staff and parent/guardian interviews together allowed us to bring these narratives together, in the pursuit of common experience amongst these stakeholders, and to inform development of effective models of care [ 18 , 24 , 25 ]. This is of particular importance where the success and failure of integrated care interventions, including care coordination, have always been context dependent [ 26 – 28 ].…”

Moving beyond narrative archetypes among children with cancer

“…Fundamentally, however, every narrative consists of a person that constructs the narrative, a person that the narrative refers to, and an illness that is being integrated into biographical details (Hydén, 1997). Several important scholars have argued that illness narratives are forms of meaning-making, that allow patients, families and clinicians to understand how an illness manifests itself in a person and to situate the totality of the illness experience in reference to the broader relational and structural contexts of patients (Frank, 1995;Kleinman, 1988;Le et al, 2017). The role of community is particularly relevant in the case of children who are positioned as inherently relational, relying on their social circles to navigate the world they live in and contributing to the social circles in which they live (James & Prout, 1997).…”

“…Listening to the stories of patients also brings with it a potential for cultural competency and cultural sensitivity training so as to better understand the ways in which culture might shape the illness experience. Narrative also allows for reflections on the importance of critical reflection for practitioners (Le et al, 2017).…”

What Anansi Did for Us: Storytelling’s Value in Equitably Exploring Public Health

“…Studies covered topics such as advocacy, racial justice, health equity, health promotion, trauma research, chronic diseases, and palliative care (Appleton, 2008;Banks, 2012;Cueva et al, 2015;Davidson & Falola, 2020;Delker et al, 2020;Drew et al, 2010;Elk et al, 2020;Le et al, 2017;Marsters & Meaghan, 2019;Roche et al, 2005;Wipfli et al, 2015). Additionally, storytelling as the primary modality was found in communicable disease research in public health and medical anthropology (Frank et al, 2015;Gilliam et al, 2012;Kleinman & Benson, 2006;Le et al, 2017;Mohammadhosseini et al, 2016;Willis et al, 2014). Finally, the literature showed that primarily public health researchers and medical anthropologists implemented storytelling in their studies, with a few identified in criminology and agriculture (Bove & Tryon, 2018).…”