English Professor Urges Pain Doctors to Improve Narrative Skills

Newswise — What does an English professor have to say to a group of pain management specialists? Plenty. Noted writer, teacher and scholar, David Morris, PhD, addressed a plenary session of the American Pain Society Annual Scientific Meeting here and urged his audience to become proficient at using narrative skills. He emphasized that narrative skills should be learned just like other medical abilities, and outcomes from an unskilled approach to narrative can adversely impact both pain treatment and research.

"Chronic pain patients often can feel out of control and hopeless," said Morris, who recently retired from a joint appointment at the University of Virginia in the English Department and UVa Medical School's Center for Bioethics and Humanities. "Narrative competence serves medical professionals beyond treatment of illness. It can provide knowledge about lifestyles and preferences as vital as numerical data on cholesterol levels or blood pressure. I believe clinicians with strong narrative abilities can help reduce their patients' fear, lower perceived pain intensity, and improve overall quality of life," he said.

Morris reported that one study of 100 patients showed that patient beliefs about pain correlated directly with treatment outcomes. He observed that dialogue can help patients replace or revise harmful forms of narrative, such as catastrophizing, in which pain patients feel anxious, fearful and hopeless, as if disaster were imminent.

"Every patient has a story, and narrative medicine allows clinicians to work with patients to expose beliefs that may create barriers to effective treatment," he said. "There surely are benefits to helping patients replace counter-therapeutic narratives with a new narrative focused on supportive beliefs that promote health and sustain wellness. Patients want a narrative model for hope."

What happens in the narrative process if patients aren't telling the truth? Morris said that patients may say what they think a doctor wants to hear, or they may withhold critical information. A focus on narrative begins a communicative process that leads to meaningful engagement and to clarifications. "Like a serve in tennis, a physician's question launches a dialogical encounter that can lessen patient frustrations through flexible person-to-person interaction," he said. "An open-ended narrative can serve the patient better than a list of standard questions. It's like the difference between asking where does it hurt and what is the matter. The first question can be answered with your index finger. It may shut down communication."

Morris said he believes that narrative medicine holds potential benefits for physicians as well. Using narrative skills, doctors can minimize the impersonal factors that separate them from patients. "Narrative medicine might be most successful in allowing physicians to return to what drew them to medicine in the first place " a desire to help patients and to improve their quality of life," said Morris. "But quality of life matters for clinicians, too. Are they really happy or are their medical desires fulfilled with a five-minute encounter with patients as mandated by a far-off insurance company?"

About the American Pain SocietyBased in Glenview, Ill., the American Pain Society (APS) is a multidisciplinary community that brings together a diverse group of scientists, clinicians and other professionals to increase the knowledge of pain and transform public policy and clinical practice to reduce pain-related suffering. APS was founded in 1978 with 510 charter members. From the outset, the group was conceived as a multidisciplinary organization. APS has enjoyed solid growth since its early days and today has approximately 3,200 members. The Board of Directors includes physicians, nurses, psychologists, basic scientists, pharmacists, policy analysts and more.