Physician-patient co-construction of illness narratives in the medical interview

Researchers and medical educators in the area of physician-patient communication encourage physicians to elicit patient narratives during medical encounters to facilitate data collection, rapport building, and patient satisfaction. These scholars, however, provide little information about the nature of the narrative, especially in the context of the medical interview. This article reviews the multidisciplinary literature on narrative and reports the results of a narrative analysis of 21 physician-patient interviews. A set of criteria for defining narrative is derived from the literature and applied to these interviews, demonstrating the limitations of previous conceptions of narrative and suggesting an expanded definition. This expansion emphasizes the notion that narratives are co-constructed through the interaction of both participants in the conversation in which they occur. Application of the expanded definition to the same interviews reveals 3 new narrative forms: narratives that emerge through the co-constructed chronology of key events, the co-constructed repetition and elaboration of key events, and the coconstructed interpretation of the meaning of key events.