Charon's description of the use of narrative in her medical practice  is registering with some thinking I've been doing lately.  I've been wondering what truly transformed medical practice looks like for the patient, the family, and the health care clinicians.  It has seemed to me that time for the patient's story is an integral part of this practice.

 I'm recalling working with Dr. Andrew Elliott, ND, a physician in Eugene, Oregon. This man has been one of my greatest teachers in the field of healthcare.  One thing that was integral part of Dr. Elliott's practice was listening compassionately, non judgmentally and intently to patient's stories.  Being a classical homeopath, gleaning the small details about symptoms, reactions, even states of mind was an essential part of his effective practice.  Andrew's compassionate and quiet listening approach almost always drew out very complete pictures of the patient's current state and also built a trusting relationship.  Part of the reason he was able to do this (and still does, in a thriving practice), is that he also respected and cared for his own physical, mental, and spiritual needs.

So how does a practice with established production demands take the time to listen to patients' stories? Isn't part of efficiency, trying to get just what you need out of a patient to make an accurate diagnosis, and move on to the next patient as quickly as possible?  How does one balance this with taking a comprehensive approach to patient care?

I certainly don't have the answers and I've never practiced medicine.  I keep coming back to the wisdom of another teacher:  David Cooperrider at Case Western University. http://connection.cwru.edu/ai/ David's quote, "We are made and imagined in each other's eyes." comes to me at least once a day.  

When I reflect upon my experience as a patient, I realize what matters more to me than the amount of time spent with me in the exam room, is how present the care provider is. Is she/he really there - really listening?  And, what are they doing with their judgments?  How is this person's belief about me impact how they imagine me, their presence with me, and, my response or reaction.    How does the image I hold about my care providers impact my presence and response to them?  How can we really see each other?

  Once my medical record got confused with someone else's at an office.  The other patient has a very complicated and challenging social history.  The assistant , thinking I was actually someone else, approached with an aura of suspicion, caution and judgment.  It wasn't until she began asking me questions that didn't make sense, that we identified the source of the confusion and her demeanor changed entirely.  As she shifted in her approach, my defenses began to drop and my responsiveness to her shifted back to what is normal for me.

So, it seems to me, if we believe that patient stories are a vital part of healing care, then we must help ourselves be in a state of mind in which patients feel comfortable sharing them.  Self awareness can help here.. recognizing one's own internal reactions,  keeping our intent and desire towards healing at the foremost of our approach, and therefore enhance our responsiveness.   And, remember healers need to take care of themselves, too!