There is much dissatisfaction—from doctors, patients, and citizens—with the U.S. healthcare system. Dr. Rita Charon, Professor of Medicine at Columbia University, is using her research to demonstrate the power of narrative medicine methods to improve the training of healthcare professionals—doctors, nurses, social workers, administrators, therapists, and clerical persons—and thus improve the health of the patients they care for. A term coined by Dr. Charon, narrative medicine is a theory and practice in healthcare that implements powerful methods that re-dedicate clinicians to their callings, allowing them to creatively see, imagine, and wonder about all aspects of their patients' lives. This provides them the skills necessary to accurately understand what their patients are going through and provide them with the best treatment.

As a young doctor in residency, Dr. Charon soon realized in an epiphany that what her patients paid her to do was to listen very skillfully to their stories—and to the stories others told about them—and to cohere these often contradictory accounts of the patient's illness into something that helped her understand what to do for them. Dr. Charon is working to safeguard the tremendous gains that phenomenal science is producing, while improving patient care.

Her background as a writer helped Dr. Charon realize that we discover things when we write them down. By implementing narrative medicine, Dr. Charon gradually stopped interrupting patients and bombarding them with questions (i.e.: “What’s your pain level on a scale of 1-10?”). The more she learned to read and listen to her patients, the more they would disclose to her, allowing her to make sense of their ailment in a way that helped them. When she meets with a patient, Dr. Charon may not quite understand what ails them, so she writes down what they tell her in story-form, without technical language or abbreviations. Within ten minutes, she has a clearer understanding of what the situation is. When she gives the written story to her patient, a rich transaction results. The patient reads this account, and suddenly new information is divulged; they’ll remember the actual month the pain started, or they’ll say they left something out, such as a relevant occurrence of trauma, death, or violence.

Many doctors do not use their imagination extensively. They ask a patient, “Is the pain sharp or dull? ”When did it start?” Narrative medicine encourages the healthcare provider to improve their imagination and implement hypothesis-generation. Doctors and clinicians will now ask themselves, “What am I seeing? What does it look like? What could it mean?” They become invested in what they have tried to imagine, and they become forcefully on the patient's side. For the patient, this is a tremendous advantage. 

Dr. Charon—with her team of health professions students and colleagues in literature, arts, psychiatry, physics, clinical research, and medical education—aims to transform healthcare, using the skills of listening, hearing, and discovering to co-create the story of illness. Narrative medicine is a new discipline and still in its very fertile beginnings; Dr. Charon and her team are starting to broadcast it and train others on a wider scale. Stemming from internal medicine practices, her training is spreading to multiple facets of healthcare, including nursing, physical therapy, palliative care, trauma treatment, and many specialties in medicine. 

Current Projects include:

• Introducing Narrative Medicine to Medical Students - Dr. Charon and her team are introducing innovations in medical education at Columbia University. They are institutionalizing training in close reading and creative writing into the curriculum, expanding medical students' perceptions, curiosity, self-awareness, and even their sense of beauty. She and her team began a graduate program for students who come in as current doctors, nurses, or social workers and desire this training to improve their practice, or as students who wish to obtain a Master’s Degree in Narrative Medicine prior to attending medical/nursing school. Dr. Charon’s young students are floored to see that their creative powers are welcome in medicine and lead to better patient care. They don't have to put their music, writing, or painting in storage in order to become doctors. Students emerge from this training with a new sense of wholeness, an appreciation of their classmates, and a transformed understanding of what it means to listen to patients. Her extensive and unique program is attracting many medical students to Columbia University, because it allows medical students to explore literature and the arts. Her fourth-year medical students spend 4-6 months performing scholarly projects, such as writing fiction screenplays or creating art portraits, increasing the creativity and art of doctors and future doctors.
• Introducing Narrative Training in Clinics - On the clinical frontier, Dr. Charon’s research is designed to demonstrate how narratively competent clinicians deliver more effective health care: patients will return to see them, follow their recommendations, reveal information they would not tell less skilled clinicians, and are able to better understand how to care for themselves by virtue of the sturdy relationships formed through these narrative methods. Dr. Charon’s group is embarking on pilot projects introducing narrative training in clinics for all the health care professionals and staff who work there. They are tracking the consequences of this training on the staff members' outlook and the patients' satisfaction with their care, along with actual health measures. The long-term goal over a span of three to five years is to show—through careful study using standard clinical research procedures—that this approach improves the health of patients. Because many medical failures occur due to ineffective communication between a healthcare team, these transformative methods increase the power of the team to effectively take care of patients. Her team found that patients tend to develop trust with the clinicians who use this practice. Dr. Charon and her team will focus their research on disease entities that are affected by a patient’s behavior. They theorize that the partnerships between doctors trained in narrative medicine and their patients increase the likeliness that patients will, for instance, take their medicine, eat less salt, or stop smoking. These behaviors are noted as benchmarks when analyzing the results of this practice.
• Improve Effectiveness of Health Care Teams - Dr. Charon believes medicine is in crisis. She says is has become a “corporatized, revenue-hungry, and rigid system, with economic pressures trumping the need to deliver respectful and effective care to sick people.” Expert medicine does not require the production assembly line that many hospitals and clinics have become. The third direction of Dr. Charon’s research concerns narrative medicine's capacity to improve the effectiveness of the health care teams. For example, dysfunctional teams in emergency rooms or intensive care units can threaten patient safety. When faculty or students from multiple professions are taught together using narrative methods, they don't fall prey to the chronic hostilities that exist between "competing" health care disciplines. Rather, they come to value what one another knows and can do, which results in more cohesive teams who pool their knowledge, inevitably leading to improved care of patients. When the practice is instituted at the proper dose at sites such as clinics, hospitals, or hospices, healthcare providers are trained in ways of sophisticated listening (to both patients and one another), using writing to deepen their capacity to capture, recognize, comprehend, and be moved to action by what patients tell them. By comparing outcomes in settings that receive narrative training with those that do not, the team will learn about narrative medicine’s impact  on the health of patients and the wellbeing of staff.