Regaining our humanity through story

In this issue of Innovations in Integrative Healthcare Education, we are departing from our usual format of spotlighting specific projects or programs in lieu of presenting a more extended piece by MacKenzie on relationship-centered care and narrative medicine. The importance of these topics cannot be overestimated in their role of humanizing the healthcare encounter, improving self-awareness of the practitioner, and creating a space in which the patient feels deeply listened to. A commentary by Dr Michelle Sierpina is also included in this special section to put into context the power of narrative in medicine and in patients' lives. Her recent PhD focused on the power of life stories told by seniors; that research and training enables her to provide a broad and scholarly review of the power of story in relation to MacKenzie's article. In the medical school at University of Texas Medical Branch, we send out first-year medical students in the first couple of months of the first semester to patients' homes to just get their story, not a medical history, as part of a required course on the practice of medicine. Many students find this immensely anxiety provoking, due to the lack of structure and familiar context. However, ultimately they find an opportunity to encounter a real person in a nonclinical setting. A scoring rubric based on the construction and quality of a short story allows us to grade the students objectively. However, a most interesting finding, which we expect to present at the Ottawa Conference in Australia next spring, is the process of personal transformation that such story writing has for students. This is also reported by MacKenzie in her article and in Sierpina's accompanying commentary. The importance of capturing and understanding the patient's story is also a major focus in nurse practitioner programs across the United States, where the art of listening and the importance of patient narratives have long been emphasized. In an integrative assessment of patients, we "make a history" rather than "take a history." This means that we coconstruct with the patient the reality of the medical encounter and the tone and timbre of the healing relationship. By bringing our own culture, beliefs, and values to the exam room and then allowing the patient to share theirs with us, we create a new kind of relationship-centered, patient-centered care model. This allows the strength of the linear standard medical history, chief complaint, history of present illness, past history, social/family history, review of systems, etc, to be informed and enriched by the nonlinear, perhaps circular, patient story. This story making further allows deeper exploration of the patient's life goals as well as their medical goals.(1) It creates increased personalization of the provider-patient relationship and moves from the "I-them" to Buber's "I-thou." Enjoy the article and the accompanying commentary and consider how to implement this kind of care and mindfulness into the education of health professional students and your practice.