On Medical School, Story-Telling, and Narrative Medicine
Dr. Shannon Arntfield is an obstetrician/gynecologist and assistant professor at the Schulich School of Medicine & Dentistry at Western University in London, Ontario. She is the founder and director of the Narrative Medicine Initiative at Western.
Dr. Arntfield's medical training was largely completed at Western, after which she pursued a Masters in Narrative Medicine at Columbia University before returning to Western University to practice as a clinician-educator. She is married and a mother to two young children. She was the keynote speaker for Ontario Medical Students Weekend 2014, hosted by McMaster University in Niagara Falls in November, who spoke on theme of "A Personal Touch to Medicine".
We followed up with Dr. Arntfield to discuss her thoughts on narrative medicine and its role in medical school.
What sparked your interest in narrative medicine?
Two significant things happened. First, during one week at the beginning of my residency, I witnessed three catastrophic obstetrical cases – a mother who lost her life during labor, a mother who lost the life of her child and nearly her own during labor, and a mother who became almost paralyzed by a very rare problem during pregnancy. I was almost undone by the end of the week, and realized that I lacked skills to deal with what I had seen. This was a huge wake-up call for me as to how little the system prepares the provider for dealing with and navigating the consequences of caring for others. Secondly, when I was pregnant with my own daughter and encountered complications, I realized that medical training does not train doctors to understand what people go through when they are ill. Having gone through a personal illness experience changed the way I come alongside patients, and I wanted to learn more about how to do that aspect of medical care better. For this reason, once I finished my residency, I decided to pursue a Masters in Narrative Medicine rather than a clinical fellowship.
Why narrative medicine?
Training in Narrative Medicine supports the development and maintenance of a relational approach to medicine. Although one would think medical school and residency would prepare you for this, the focus of medical training leans heavily towards the recognition and treatment of diseases rather than how to interact with the people who have those diseases. I had no idea, when I started medicine, that my ability to engage relationally was as important as my expert knowledge and skill. Through exposure to narratives and reflective practice, Narrative medicine provides access to the inner dimensions of illness, and helps teach that how care is delivered (the process) is just as important as what care is delivered (the content).
What are the benefits for students to become more engaged with narrative medicine?
Narrative medicine gives you a practical skillset to navigate the powerful experiences you will have during medical training. By developing reflective capacity and close reading skills, you will be able to reflect on difficult experiences and navigate what happens to you more effectively, as well as engage with patients and form therapeutic alliances more easily. Narrative Medicine gives you a resilience for continuing to be engaged with patients even when you are witnessing very difficult things that are tempting you to close off and become emotionally detached, as well as when you are caring for patients who have no potential for 'cure'. It also leads you to interact with your colleagues in a very different way because you are more equipped to connect with and understand one another's perspectives. By providing a means of training oneself for the relational side of medicine, Narrative Medicine can help you find more satisfaction with your career because your goals will broaden from managing medical problems to supporting the people who have those problems.
Are there any challenges or risks if you open yourself to the patient experience?
Yes, when you open up and engage with the aspects of practice that you would rather shy away from because it is uncomfortable, there is a risk of being overwhelmed. To me however, I have learned that I am much better at what I do when I am authentically engaged in what I do. To cope with this, however, you need to take care of yourself. Offering yourself fully to others and being open has to go hand-in-hand with being able to rejuvenate yourself. Otherwise you can get burnt out. You need to have a touchdown point where you can put the burden of what you see and feel and refresh yourself in a way that you can face it all again. For me, I rely on the close relationships in my life, my faith, as well as yoga and reflective writing.
Another challenge of approaching medicine with a relational mindset is that it's not necessarily supported by medical culture, which encourages providers to be 'tough', 'objective' and to treat patients with 'detached concern'. Engaging authentically (and having to deal with the consequences of doing so) can therefore be perceived (by you and others) as a liability. It’s taken me a long time to see that being open to the experiences of others requires courage, and that the choice to do so is a marker of strength rather than weakness.
What can medical students do to better engage with narrative medicine?
Find some ways outside of a textbook to connect with the patient experience. Seek out opportunities to better develop this skill set. There are mentors out there that actively engage relationally. Many schools also offer interest groups and electives in narrative medicine for interested students to pursue. Be aware that the relational side of medicine is often pushed aside in medical school curricula in favour of educating students about more of the hard facts and sciences. Also be aware of and actively challenge the prevailing culture that de-emphasizes these sorts of skills and views vulnerability as a weakness – "the hidden curriculum". Faculties will respond to and listen to student voices that call for more emphasis on these competencies in their education.
What is one last message you can leave us with?
Try to remember that sometimes, the most therapeutic thing you can offer to a patient is yourself.
Interview performed by Ali Damji, Class of 2017, University of Toronto