Stepping into Rita Charon’s studio, in a Jazz Age building in Greenwich Village, I get a quick glimpse of the white-walled space bathed in sunlight from two large windows that offer a stunning view of the Lower Manhattan skyline. Everything in the room seems to be considered, 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 ministering medic devoted to the child while the anxious parents look on. Used to hang out in Charon’s father’s office.
My meeting with Charon, the founder of the “narrative medicine” movement that trains health professionals to use the power of stories in their work, is one that I’ve thought about for 20 years. How, I wonder, can such a humane approach fit into the time- and cash-constrained world of 21st century healthcare? And who is this woman who, sometimes without credit, has done so much to change the way we think about the doctor-patient relationship?
Then, as soon as we sat down, I realized that I was going to tell a story about a practiced assimilator from other people’s stories. The core of his work, he says, is “what actually happened [moment of] two human beings sit, contact each other with language, and the self that forms”. So we begin.
Charon graduated from Harvard Medical School in 1978 and began practicing general medicine. In the late 1980s, he began his 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 was to unite these two opposing worlds. He believes the emotional and imaginative insights found in literature, art and music can change the way healthcare providers treat patients and others. Around 1990, he began teaching narrative medicine at Columbia and in 2009 launched a master’s degree in the subject, the first of its kind. Since then, the approach has been spread by health care practitioners in the United States and abroad, from Greece to China. Formal evaluation has shown that it increases the participants’ capacity for reflection, in one study it even reduces racial bias.
His father, a physician in Providence, Rhode Island, was an important influence. At one point, he went to the filing cabinet that contained all his medical records, which he acquired after his death. This part of his life has always been shut off to himself; the close community in which they live means that confidentiality is particularly vital. But it turns out that the file combines ordinary medical notation with a much more personal reference. It seems to reflect the recognition that illness cannot be separated from the wider context of its sufferer’s life. Inspired, Charon began to make more detailed and impressionistic notes about his own patients.
A practicing narratologist, he says, can take in a lot in a short amount of time, even when there is pressure on doctors to keep appointments for a while. “When you develop your attention skills, you will notice things about your patients. You will listen in a higher tone.” As a doctor, the human body is, he says, “our material . . . I’m sitting here watching you, notice how you sit in the chair.”
Emboldened, I asked what else he had taken about me. He saw that my purple outer coat and the pink lining of my jacket: “You have taste because you don’t just put aqua and olive green.” He noticed my eyes: “Most of the expressions were full of curiosity.” My sense of her, which deepened over the next three-and-a-half hours, was that of a woman with a well of compassion, lit by righteous anger about US health care inequities. “In Yiddish, we call it Shanda, which is ‘shame’. Shame on the system,” he said. “More and more doctors. . . feel they are being used by their employer. They know they are doing a bad job. . . They get tired of saying, ‘I’m sorry, I can only listen to one complaint per session. Bring it back.’”
Really listening to patients can be transformative, she says. “Patients generally know what they need.” He recalls a young woman with poorly managed diabetes who came to his consulting room angry and frustrated. “I do my routine, which is away from the computer, put my hands in my lap. Don’t write. Just say, ‘I’ll be your doctor. Tell me what you think I need to know.'” The woman looked like she was going to cry but pulled it back. self and glare. “You really want to know what I need? I need a new set of teeth.”
Charon’s children noticed that his hands were covering his mouth as he spoke. She has no upper teeth. Instead of fussing with the woman’s insulin levels, Charon arranged for her to be seen at the university’s dental clinic. “He appeared in a few months, and he was terrible. He started a [catering] business at home. his [blood] sugar is better than they have been in a while. And he is more active – he goes to parties, he dances! That was a lesson for me. Are you going to start anywhere else but ‘Tell me where we should start’?
I am interested in the extent to which this approach requires an inversion of the traditional power relationship between doctor and patient. He told me that for years doctors were taught to conform to the “detached attention” model. In fact, “concerns involved will take you further than undivided concerns. Detachment looks like a lot of cold.” Instead, Charon believes in making room for imagination. “The more you exercise your creativity, the better your medicine. It’s jumping. . . 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 making notes like a doctor would, “I’ll turn on the keyboard and the monitor and say, ‘I know what I saw. But please finish the notes.’ I’ll leave them alone for five minutes, and they write damn things!”
The college professor wrote “he knew that he was a good teacher and that this really gave him pride.” That sentiment surprised Charon because it didn’t come up during their conversation, which was dominated by the woman’s health condition and her difficult relationship with her daughter.
An idea occurred. As I close our conversation, I ask him to finish this interview. Is there anything else I should know? He believes that after he left his practice in 2015 to concentrate on running his program at Columbia, he felt relieved to be able to give responsibility to his patients. (“Someone’s going to worry about Lucy.”) It was weeks before she identified the chasm that had opened up in her life: “I lost the opportunity to do a random act of kindness.”
As a doctor, the scope for moments of generosity is “drastic”, he says, whether calling the patient’s sister to update her, helping to put on someone’s socks after an examination or rubbing the feet of a terminally ill patient. There was something heartbreaking about the disproportionate gratitude of this intervention, he said. “I think their expectations for us are very low.”
Narrative medicine can, he suggests, provide doctors with the ability to see a problem from multiple perspectives, a power he likens to the “compound eyes of a fly”. It can help them understand and appreciate the person they care for in all their uniqueness and complexity. “We must treat each patient as the deepest mystery,” he said.
Sarah Neville is the FT’s global health editor
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