This year, the Board of Governors is taking up the theme of “Restoring the Narrative” to medical note-writing. I think most of us recognize adoption of the EHR as a factor accelerating the loss of narrative, although this process was already well underway. In fact, the time pressures placed on clinicians have probably done as much, or more, to erode the narrative from the medical record. But templated EHR documentation, with its discrete inputs and generic presentation, has effectively buried the narrative. If we hope to improve patient care through better communication, restoring narrative will be an important factor. Eliminating extraneous content to truly achieve EHR use that is meaningful (as opposed to Meaningful Use) should be an objective worth striving for.
A related theme is that of the patient’s voice. In addition to the factors mentioned above, the rise of data has also inadvertently minimized the patient’s voice in construction of the medical history. As Bradby et al state: “There is no suggestion that medical professionals intend to disregard patients’ narratives or to deem them inadmissible to clinical decision-making, particularly given that medical students continue to be taught to listen to their patients. Rather, the epistemology of epidemiologically-informed, statistically significant evidence that underpins the interpretation of results from tests and assays trumps the nature of patients’ stories as a form of knowledge at almost every turn.”(1)
Every day, we encounter and try to reconstruct patient stories. Communicating these stories in a manner that is more pertinent and relevant will lead to better patient care. I welcome your comments about “Restoring the Narrative”!
1) Bradby H, Hargreaves J, Robson M. Story in health and social care. Health Care Anal. 2009 Dec;17(4):331-44.