Walking into Rita Charon’s studio in a Jazz Age building in Greenwich Village, I get a quick impression of a white-walled space bathed in sunlight from two large windows that offer sweeping views of the Lower Manhattan skyline. Everything in the room feels thoughtful, from the Bach playing in the background to the paintings on the walls. One of them, “The Doctor,” is an idealized Victorian depiction of a devoted medic ministering to a child while anxious parents look on. It used to hang in Charon’s father’s study.
My encounter with Charon, the founder of the narrative medicine movement, which trains healthcare professionals to use the power of storytelling in their work, is one I’ve been thinking about for 20 years. I have wondered how such a humane approach fits into the time- and money-constrained world of 21st century healthcare? And who is this woman who, sometimes unsung, has done so much to change the way we think about the doctor-patient relationship?
Then, as we sit down, I realize I’m going to tell the story of a practiced assimilator of other people’s stories. He says that the focus of his work is “what is actually happening [moment of] two people are sitting, communicating with each other with language and the embodied self. So here we go.
Charon graduated from Harvard Medical School in 1978 and began practicing general medicine. In the late 1980s, he began doctoral studies at Columbia University, focusing on Henry James and the role of literature in medicine. The work of the second half of his life has been to bring these two superficially opposed fields together. She believes that the emotional and imaginative insights found in literature, art and music can transform the way healthcare professionals treat patients and each other. Around 1990, he began teaching narrative medicine at Columbia, and in 2009 he opened a master’s degree, the first of its kind. Since then, his approach has been used by healthcare professionals across the United States and abroad, from Greece to China. Official evaluations have shown that it improves the thinking ability of participants, even reducing racial bias in one study.
His father, a physician in Providence, Rhode Island, was an important influence. At one point, she goes to a file cabinet that contains all of his medical records that she acquired after his husband’s death. This part of his life was always closed to her; the close-knit community in which they lived meant confidentiality was particularly important. But it turned out that his files combined ordinary medical signs with much more personal references. This seemed to reflect the recognition that ailments cannot be separated from the wider context of the lives of those suffering from them. Inspired, Charon began taking more detailed and impressionistic notes on his patients.
An experienced narratologist can cover a lot in a short amount of time, he says, even at a time when doctors are under pressure to keep appointments as short as possible. “When you develop your attention span, you notice things about your patients. You listen at a much higher pitch.” As doctors, he says, the human body is “our material . . . I’m sitting here looking at you and I notice you sitting in the chair.
Emboldened, I ask what else he has found about me. He has noticed that my purple overcoat tones my jacket with a pink lining, “You have taste, because you’re not just a bastard who doesn’t water with olive green.” He has noticed my eyes, “Mostly the expression is full of curiosity.” My sense of her, which deepens over the next three and a half hours, is of a woman of immense compassion, illuminated by righteous fury at the inequity of US health care. “In Yiddish, we call it Shanda, which is ‘shame.’ Shame on the system,” he says. “More and more doctors . . . feel their employers are taking advantage of them. They know they’re doing a poor job . . . They’re getting tired of saying, ‘Sorry, I can only hear one complaint per session.’ Bring it up next time.’ “
Truly listening to patients can be transformative, she says. “Patients generally know what they need.” He recalls a young woman with poorly treated diabetes who arrived at his consultation room angry and frustrated. “I did my routine, which is to get away from the computer, hands on lap. Don’t write. Just say, “I’ll be your doctor. Tell me what you think I should know.” She looked like she was going to cry, but she pulled herself together and looked, “Do you really want to know what I need? I need a new set of teeth.”
Only then did Charon notice that she had her hand over her mouth as she spoke. He had no upper teeth. Instead of messing with her insulin levels, Charon set up an appointment with her at the university’s dental clinic. “He’ll show up in a couple of months and he’s dazzling. He started a [catering] business in his house. He [blood] the sugars were better than they had been in a while. And he was much more active — he goes to parties, dances! That was such a lesson for me. Why on earth would you start anywhere but “Tell me where we should start”?”
I am interested in the extent to which such an approach requires a reversal of the traditional power relationship between physician and patient. For decades, he tells me, doctors were trained to conform to the “detached concern” model. In fact, “engaged worry will get you further than detached worry. The separation looks an awful lot like a cold. Instead, Charon believes in giving space to the imagination. “The more you use your creativity, the better your medicine is. It makes leaps. . . . I don’t like the word intuition because it sounds like magic. But the ability to see the known from the unknown — that’s what poetry does.
In the early 2000s, Charon tried something new. After completing the consultation and taking notes like any doctor, “I would turn around the keyboard and the monitor and say, ‘I know what I saw. But please stop remarking. I’d leave them alone for five minutes and they’d write the damnedest things!
One college professor wrote that “he knew he was a good teacher and that made him proud.” This feeling surprised Charon because it hadn’t come up during their conversations, which were dominated by her health problems and complicated relationship with her daughter.
An idea arises. When I finish our conversation, I ask him to finish this interview. Is there anything else I should know? He admits that after he left his practice in 2015 to focus on running his program at Columbia, he felt a huge sense of relief to be able to hand over responsibility for his patients. (“Someone else is going to worry about Lucy.”) It took several weeks for her to recognize the void in her life: “I felt terribly deprived of the opportunity to do random acts of kindness.”
As a doctor, the range of moments of generosity is “drastic,” he says, whether it’s calling a patient’s nurse to update them, helping put on someone’s socks after an exam, or rubbing the feet of a terminally ill patient. There’s something heartbreaking about the disproportionate gratitude these interventions evoke, he says. “I think their expectations for us are so low.”
Narrative medicine can give doctors the ability to see a problem from multiple perspectives, a power he likens to “the compound eye of a fly.” It can help them understand and value those they care about in all their uniqueness and complexity. “We should treat each patient as the deepest mystery,” he says.
Sarah Neville is the FT’s global health editor
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