Dr. Margaret KayMBBS(Hons),FRACGP, Dip.RACOG
The University of Queensland
TRANSFORMATIVE NARRATIVES
IN DOCTORS’ HEALTH: POSITIVE
REPRESENTATIONS OF THE
WOUNDED HEALER
Defining narratives
• “ method of recapitulating past experience by matching a verbal sequence of clauses to the sequence of events that actually occurred”
(Labov)
• constructed• orientation, complication, evaluation, resolution (coda)
•Stories are dialogic • Bakhtin - Co-construction
troublewhere/when unfolding sorted out
Wounded Healer• Ancient mythology
• Chiron• Teacher /Healer– Asklepios• Arrow wound – poison of the hydra
• Jungian – analytical psychology – archetypal images• Mental health
Narratives included:
• Authored by the doctor with the illness• Published in a medical journal• Or anthology of ‘articles’ on doctors’ health• Excluded – memoire/biographies for lay community• 160 narratives (>250)• Saturation
MedlineCinahlPsychinfoGrey literatureAnthologies
•Typologies - Arthur Frank
• Restitution • being sick getting treatment and being
healed
• Chaos• no meaningful response to illness
• Quest• ill person finds meaning in illness, • works with illness• move forward in life
Illness Narratives
Themes
“aversion to the hospital that embodies the "faustian soul of modern technology".”
"I have lived most of my life with the certainty
that a "big illness" was waiting for me. Not an
ordinary illness, but something obscure...”
Themes
•Becoming a patient
•Care received
•Effect of the illness
Becoming a patient•Crossing the ‘thin red line’ • Crossing the border, ‘changing hats’
•Want to be a normal patient / a good patient
“Although I had passed the examinations put out by the American Board of
Internal Medicine, she [the patient in the next bed
with [Hodgkin's disease] seemed to know a lot more about being sick and being
a patient than I did...”
Care received•Disappointment•Changed doctor / Self-treatment
•Shared-decision making•Need for hope•Rapport /empathy / trust
Effect of illness•Blow to omnipotence
•Altered outlook on life• Positive work-life balance
•Altered outlook on medical practice• Better doctor• Value the art
“Suffering had
sensitized me to
the human
condition.”
“I am sure my illness has made me a better physician”
“given me confidence that caring and
encouragement can go a long way in
helping”
Narratives guide to our listeningorientation, complication, evaluation, resolution (coda)
• Content • Construction • How it is told – the emplotment• Association, Causation• Meaning
Narratives guide to our listening • Professional stories – Restitution• being sick, getting treatment, and being healed
• Chaos – Avoid
• Personal stories – Quest• Healing lies in finding the meaning
Transformation •We can choose our narrative
•Reflection – enables the writing of the narrative
•Chaos can be transformed
•Assist through Co-construction • rapport / trust / relationship• enables shared-decision making• allows the patient to be a good patient
Transformation •We can choose our narrative
•Reflection – enables the writing of the narrative
•Chaos can be transformed
•Assist through Co-construction • rapport / trust / relationship• enables shared-decision making• allows the patient to be a good patient
Transformation •We can choose our narrative
•Reflection – enables the writing of the narrative
•Chaos can be transformed
•Assist through Co-construction • rapport / trust / relationship• enables shared-decision making• allows the patient to be a good patient
Transformation •We can choose our narrative
•Reflection – enables the writing of the narrative
•Chaos can be transformed
•Assist through Co-construction • Treating-doctor / Doctor-patient• rapport / trust / relationship• Patient-centred medicine