Does Your Facility Value “Narrative Medicine”?

Two years ago, I retired from an internal medicine practice in the SNF setting with emphasis on Medical Direction, Geriatrics, and Palliative Care.  Last month, I worked 3 weeks providing vacation relief and noticed how “depersonalized” the medical records have become at the acute hospital and SNF levels.  I suspect this is a reflection of our adaptation to EHRs and the perceived need for providers to become more time-efficient.  One of the things I reintroduced into these facilities was the value of the patient’s story.  This is fundamental to establishing working relationships with our patients and their families.  The story is also fundamental to the diagnostic process and leads us away from prescribing more drugs for new symptoms to a more-cost effective and better understanding of the potential causes of the patient’s symptoms.  

I’m not alone in seeing the value of narrative medicine.  On a recent GeriPal podcast, I was introduced to Dr. Wes Ely, an academic intensivist, who in the 1990s began following his ICU patients after saving them in the ICU with state-of-the-art sedation, muscle paralysis, heavy analgesics, and ventilator use.  Over the next decade, he discovered that this emphasis on saving the lungs ignored the damage done to the patient’s brain and body with what we would now call PICS (Post Intensive Care Syndrome), PTSD, and post-delirium MCI or even dementia.  This discovery led he and others to focus on ways of minimizing the adverse impact of traditional ICU care, which led to the development of the CAM-ICU tool for daily assessing for delirium and then the A-F2 Bundle for reducing the adverse effects of traditional ICU care.  

This bundle has become common practice in ICUs throughout the world.  Part of it emphasizes learning the patient’s story and creating a daily story about what happened in the ICU.  This has led to medical schools and residencies creating curriculum for developing expertise in “Narrative Medicine”.   Many ICUs now are also capturing the daily story by promoting development of a digital diary at the bedside for staff, providers, and families to document not only verbally, but also with videos, of what they think is important for the patient’s care now and in the future.  

Dr. Ely published a book on his journey of discovery in 2021 called, Every Deep Drawn Breath.  I believe you will find this journey toward rediscovering the humanity in medicine to be very inspiring.  In addition, the last chapter on Resources for Patients, Families, Caregivers, and Medical Professionals is a practical treasure trove with ideas that can easily be adapted to the SNF and senior living settings.  

I know we are in yet a 5th surge of COVID and time-crunched this month, but encourage you to put this podcast on your to-do list.  Eventually, this pandemic will become endemic with predictable management strategies.  This will again allow us to refocus on discovering and supporting “What Matters Most” to our patients and their families.

Hoping with you for a better 2022!

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Comments on "Does Your Facility Value “Narrative Medicine”?"

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Pete Patterson - Tuesday, January 18, 2022

Hi Tim, Thanks for writing a great piece on Narrative Medicine. Bravo! I listened to the GeriPal podcast and watched a live ICU Covid case video on Dr. Wes' Twitter feed. Listening to and documenting a person's story brings home a critical aspect of taking care of people - taking care of their human spirit. These days, I am pouring out a 4-part curriculum on Whole-person Wellbeing: Body, Mind and Spirit at a large CCRC here. To my mind, the themes of Narrative Medicine, CAM-ICU, PICS and Care for the Spirit are all interconnected. Looking forward to more. Blessings! /Dr. Pete, still holding the flag of CALTCM in AZ.

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