University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository


Narrative-Based Medicine


Bernard Toney Jr., DMSc, PA-C


Discord can occur in the clinical encounter when the narrative paradigm of patient stories (i.e., “patient values and expectations”) is grossly limited, or worse, abandoned. The result is a disconcerting dissonance of trust and understanding between the patient and the clinician and this influences treatment compliance and outcomes. To avoid this pitfall, Sackett’s evidence-based medicine (EBM) model debuted in the 1980s and has increasingly been accepted as the standard practice approach of Western medicine. The model presupposes equal and complementary contributions by its three components: individual clinical expertise, best external evidence, and patient values and expectations (i.e., narrativity). Therefore, narrativity is a vital part of EBM, not an adjunct. To practice EBM to its fullest, clinicians must learn narrative skills. With modern medicine’s increasing emphasis on caring for people and not just curing diseases, narrativity has transformed into a new discipline, narrative-based medicine (NBM). This manuscript supports the argument that basic narrative-friendly skills (e.g., active listening and close reading) can be learned using an actionable framework that is synthesized from evidence-based literature and the author’s unique patient reflections. Holding these three EBM components firmly together, even the busiest of willing clinicians can skillfully help a patient understand an illness, deal with a loss of health, and find meaning in the suffering to achieve more humane, effective clinical care and better-informed decisions.


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