The rapid evolution of modern medicine tends to contribute to the challenges posed to narrative medicine due to the requirement of profound attitudinal and technical modifications. These changes are of great significance and are difficult to apply. During its initial stages, the practices of narrative medicine can be converted into a destabilization phase, which, in turn, position a capable healthcare practitioner in doubt about his or her practices [ 46 ]. Another major challenge that can be encountered during the integration of narrative medicine include is acknowledging when to discontinue.
Healthcare practitioners who closely associated themselves with the notion of narratives often forget to realize that their position is not safe [ 46 ]. The ethics required for medical narratives are considered as the act of evaluating language that is aligned with perceptions, thoughts, and sensations experienced by the teller so that others can relate to what he or she is trying to describe [ 14 ]. The individual who receives narrative of another person also receives virtue of the teller, which, in turn, plays the role of an inter-subjective bridge to the ethics of narrative medicine.
On the other hand, the major ethical problem associated with patient narratives is the use of data with intention other than treatment which may result in maleficence [ 14 ]. Simultaneously, the critical aspects underpinned by the identity of a healthcare professional are operating within the formal prospects in more subtle way. Moreover, any attempt that is put forth for the development of comprehensive syllabus of ethics must allow the manifestation of wider setting of different cultures within which the syllabus must be implemented. For the purpose of fostering ethics among students, formal as well as informal syllabus must be addressed through the aid of syllabus planners.
However, Goldie states that without an adequate consideration, physicians may be in danger of objectifying and manipulating patients in accordance with an egocentric self-interest [ 49 ].
The current form of narrative medicine provides a small space for aligning the properties of critical reflection or examination of larger inequities and violence. The violence is of structural nature that takes place within a healthcare setting in the light of which feelings of people are neglected. Marini illustrates that narrative medicine lacks consideration of the narrative limits, particularly ignoring the contexts related to suffering, trauma, and oppression. In other words, people are often bounded by certain experiences due to which their assimilation with the storyline does not match.
Experiences gained by a human cannot be narrated in a single story as a result of which gesture and metaphor can be integrated as an effective means for the development of better communication between patient and healthcare professional [ 26 ]. Of course, confidentiality protections play a fundamental role in the practices of patient narratives for patients and people who are involved in the process of writing.
In this context, a number of questions have been raised such as, does patient narrative lead to the promotion of new learning and self-understanding or is it the procedural intention toward self-justification? However, regarding the ethical concerns, the practices of patient narratives entail alteration or removal of personal data through which an individual can be identified.
Several healthcare professionals have encountered resistance from patient as they fear that their personal information could be used for other purposes or personal benefits of the healthcare settings [ 48 ]. The pitfall of data breaching is assured by several national regulations i. On the other hand, the International Conference on Harmonization ICH has proposed a set of guidelines regarding the content and structure of patient narratives. According to their guidelines, it is mandatory to provide an explanation of possible adverse events or other adverse effects that can be investigated for clinical importance [ 22 ].
The notion of ethical concerns related to patient narratives is responsible for contributing to complications in decision-making process, which is the essential step in designing a treatment plan. It is necessary for the healthcare professionals to maintain significant balance between narratives of patient and their decisions [ 14 ]. Simultaneously, narrative is presented with the requirement of developing a relationship of confidentiality through respecting privacy of patients so that they can be encouraged to seek care services.
Narrative medicine is largely utilized in health care for the promotion of the integrated, systemic, and multidisciplinary development of an approach through which populations can be facilitated with care, regardless of their age groups [ 11 , 14 ]. The stories illustrated by patients and healthcare professionals, along with their way of representing, perceiving, and experiencing can lead to the reduction in the risk associated with inappropriate clinical tests and treatments [ 14 ]. The area of health care has always been encountered with significant saturation, alongside the presence of narrative knowledge.
- Emergency admissions from care homes.
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Over the past few decades, an increase assimilation of writing into research and teaching has been observed in the form of narrative medicine [ 19 , 23 , 45 ]. In addition to this, the most commonly occurring ethical concerns is encompassed with barriers and uncertainties associated with truth elaborating, along with cultural and familial conflict, as well as futility [ 40 ]. In the context of the current practices of narrative medicine, different types of narratives are incorporating the power of appreciation and analysis in the clinical studies by the aid of storytelling [ 43 ].
Team of healthcare professionals is at the forefront for facilitating with information based on prognosis. Shortly, narrative medicine would be able to separate its root from assumptions and methods utilized during the process of history taking as well as for eliminating the possibility of several conflicts. Medical practitioners and educators are gradually including many approaches and techniques that are underpinned by literary studies, philosophy, history, along with other disciplines of humanities for bridging the gap that projects a lack of recognition and understanding a particular illness and the pathological dimension associated with it.
However, there is a profound need of educating students of narrative medicine about potential ethical concerns, which can lead to negative outcomes of health. Ethical concerns mostly deal with information breaching as a result of which several patients avoid to participate in the process of narrative writing. Therefore, it is the fundamental responsibility of the healthcare practitioners to develop a therapeutic relationship with their patients so that the flow of information can be maintained [ 40 , 47 , 48 , 52 ].
Narrative medicine has contributed greatly by aligning trustworthiness and compassion with medical ethics. Competency of practicing narrative medicine and a framework of narrative for medical ethics can lead to the enhancement of ethical considerations at various stages including recognizing an ethical issue, oral or written form of the issue, ethical case interpretation, and selected interpretation with its validation.
Ideally, narrative medicine would assist healthcare professionals in the prevention of ethical dilemmas by increasing the chances of recognizing the issue at its initial stage and resolving it [ 40 , 49 ].
Narrative medicine should be explored more deeply to decode techniques through which clinical conversations can be shaped. The noticeable proliferation of writings in the past years has emanated a new perceptive of health as well as social care and different situations associated with it. The narrative medicine not only sheds light on metaphors possessed by various clinical conditions but also provides direction to imagery presentation of diseases in a graphic novel and films.
Relating experience: stories from health and social care
The best possible health outcomes are obtained when health care and social work are combined with ethical narrative medicine practice. The resultant of narrative medicine is capable of eliciting and functioning with illness stories and worlds depicting the fractured life of a person by acknowledging the importance of communication through telling and listening to stories [ 11 , 14 , 40 , 53 ]. The author wishes to cordially thank Dr. Hale Zerrin Toklu for critically proof-reading this chapter.
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Built by scientists, for scientists. Our readership spans scientists, professors, researchers, librarians, and students, as well as business professionals. Downloaded: Abstract Narrative medicine is of great significance in the area of health care, which underpins the ability of acknowledgment, absorption, and interpretation according to which plights and stories of patients are extensively considered for the commencement of actions.
Keywords narrative medicine patient narrative narrative ethic ethical concerns patient-physician relationship. Introduction Patient-centered medicine is an approach that has been greatly integrated into the area of evidence-based medicine and is regarded as an essential attribute underpinned by health care [ 1 , 2 ]. Narrative medicine Narrative medicine has been developed by a combination of theoretical and operational approaches that have been increasingly applied in the current practices of health care.
Medical interview Medical interview is the type of narrative medicine which is coined as the most adaptable and beneficial tool for diagnosis and treatment. You should also not take Diclegis in combination with medicines called monoamine oxidase inhibitors MAOIs , as these medicines can intensify and prolong the adverse CNS effects of Diclegis.
Patient narratives 1: using patient stories to reflect on care
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