Narrative Medicine

I am taking an elective this quarter called Narrative Medicine which seeks to use short stories from and about underserved and "underheard" communities to understand narrative approaches to health, illness, and medical practice. The first story we read was not directly health-related but a wonderful story called "The First Day" by Edward P. Jones. One question that came up about this story is context. Knowing background on the author changed people's perception of the story. Some found that the story was less genuine because the author was male and the perspective in the story is from a female. This was fascinating to me. Should stories be evaluated solely on their own merit? How much should external context affect our reading of a story? In my experience, academics like to critically analyze stories in relation to their author, the historic setting, and the cultural backdrop of the time. How can you teach or read "Everything That Rises Must Converge" or "Parker's Back" without knowing Flannery O'Connor's Southern, Roman Catholic background? How can you interpret Joyce without referencing Dublin? Nevertheless, when I read stories, I never look up the author or the sociocultural context. I am sure subconsciously, I am aware of the author's name and perhaps other works, but I enjoy stories and find them noteworthy solely based on the text.

I find this interesting in medicine because we always see patients in a context. Whether I am seeing a patient in the emergency department, at a homeless clinic, as a consult in a tertiary care center, or in a home visit, the location makes a difference. I almost always have some pre-existing information about the patient. In clinic or the emergency department, it may be nothing more than a name and age. On the other hand, volumes of records may accompany patients, and even if I don't read a single word, the fact that volumes of records exist influences me. If I get a "one-liner," that can change everything. "A 25 year old intravenous drug user who is a frequent flier in the emergency department" is different than "an 80 year old recent immigrant" which is different than "a 40 year old businessman." Even before I get the story from the patient's mouth, I think I know a lot about them, and I may already have a list of diagnoses in my head. Is this fair? Is this right? Am I typecasting people before I have even met them? I think context will always be important in patient care, but like stories, I must evaluate the story based on what the patient tells me because after all, he or she is the person I am treating.