“Late that afternoon, Quentin jogged along the Crissy Field promenade without paying much attention to the dogs frolicking on the beach or the windsurfers leaning low on their boards off Fort Point. Since Ralph was on call and not coming home, he reheated leftover spaghetti for his dinner and curled up on their bed with a textbook to study the surgical management of hip fractures. He would have liked to read about the nonsurgical management of hip fractures as well or, more important, about how to approach patients who can’t talk, or what to do when you’ve made an inexcusable mistake, but his book didn’t have chapters on those topics.”
– A History of Present Illness [1], Louise Aronson
Clinical Relevance
One of the earliest and most essential skills we learn during our medical training is how to properly obtain a patient history, best known as the HPI (History of the Present Illness). We are taught a systematic approach beginning with open-ended questions and leading to more specific questions relevant to the patient’s complaint. We are advised to build rapport with our patients, and to probe them when needed. The patient’s responses are then condensed into a concise format and medical language, which is then used to guide our clinical reasoning and decision-making. With time we become comfortable gathering and reporting HPI’s.
Yet, it is the stories we acquire beyond what is documented in our charts that we most remember. These are stories from every day interactions and experiences, stories of our patients and their families, of our own struggles and triumphs. By the end of our training, many of us feel we have enough stories to write a book!
Brief Synopsis
A History of the Present Illness is an incredible collection of sixteen beautifully crafted stories, intended to immerse the reader into the lives of patients and physicians. Through a diverse line-up of characters, Dr. Louise Aronson (@LouiseAronson) delves deep into the heart of medicine. Among these stories, we meet an immigrant man coping with end-of-life decisions for his dying wife; a female medical student finding her way in medicine despite many distractions; a young veteran with debilitating injuries but a strong will to live. Through the characters and emotionally wrought stories, Aronson makes a compelling argument for the value of narratives in medicine. Medicine is rich in stories. How we acknowledge and make meaning of these stories matters for our patients and our profession. As the reader, we are drawn to reflect on our own experiences in the health field, both in and outside the hospital walls, and share our stories.
***We are very fortunate to have the author, Dr. Louise Aronson, join us in our discussion.***
Narrative Medicine
Central to narrative medicine is the ability to absorb, reflect, interpret, and act on our own experiences and the stories of others. Narrative medicine includes developing skills in reading literature, and reflective writing. In the article, Narrative Medicine: A Model of Empathy, Reflection, Profession, and Trust, Dr. Charon summarizes “with narrative competence, physicians can reach and join their patients in illness, recognize their own personal journeys through medicine, acknowledge kinship with and duties toward other health care professionals, and inaugurate consequential discourse with the public about health care [2].” Many medical schools recognize the benefits of the narrative model and have incorporated such courses into their curriculum. In addition, literary groups and book clubs also provide a platform to interpret stories and discuss the human aspects of medicine.
Book Club Question
- Historically, there has been a separation between science and the arts. Incorporating humanities into medical training is now gaining popularity. What are your thoughts on this? Could reading fiction make us better physicians?
- At the end of the book, Dr. Aronson talks about her experience writing medical stories. What is the role of narratives in medical education? Do you think it is important for physicians to achieve narrative competency? Should reflective writing be a mandatory part of the medical training experience?
- In the book, there are several stories that disclose a medical student’s or resident’s feelings of inadequacy, fear, and hopelessness. What factors in the medical culture contribute to this phenomenon? Have you had similar experiences during your training? How do you think we can we improve the current experience?
- The book is filled with stories. Which story most resonated with you and why?
HOW TO JOIN IN THE DISCUSSION
There are two main way to join our ALiEM Book club discussion this month:
- You can comment directly below in the comment section.
- Tweet us directly at @ALiEMBook, use hashtag #ALiEMbook.
- Don’t forget to tag your questions/responses Q1, Q2,Q3, and Q4.
- You can write us a few words in the comment section below.
References
- Aronson L. A History of the Present Illness. Bloomsbury Publishing, 2013. [Amazon]
- Charon R. The patient-physician relationship. Narrative medicine: a model for empathy, reflection, profession, and trust. JAMA. 2001 Oct 17;286(15):1897-902. PMID: 11597295.
* Disclaimer: We have no affiliations financial or otherwise with the authors, the books, or Amazon
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