Embracing stories in the practice of veterinary medicine
As veterinary professionals, we are responsible for processing and retaining so much information: the signalment and clinical signs of our patients, the latest standards of care for treating many diseases in different species, and all the metrics of practice, including time spent in an exam room and average client transaction.
In our efforts to improve efficiency and standardize care while fighting burnout and personnel shortages, it can feel overwhelming to have to consider all the intricate details of our patients' and their owners' lives and to bring our own experiences into the mix.
Yet embracing the stories of our patients and clients, as well as our own, is at the heart of narrative medicine, a long-practiced but only more recently studied skill that emphasizes empathy, reflection, and self-compassion.
What is narrative medicine?
Karen Fine, DVM, is the author of the textbook Narrative Medicine in Veterinary Practice: Improving Client Communication, Patient Care, and Veterinary Well-Being, published by CRC Press. She defines narrative medicine as “a medical approach which maintains that a patient should be viewed as an individual rather than an example of a disease process,” which can be done using a narrative. By using this approach, she explains, “we are better able to provide customized, effective care.”
Although many of the aspects of this practice have long been part of veterinary medicine, narrative medicine was first officially documented in 2001 by Rita Charon, MD, PhD. She describes narrative medicine in human medicine as “the ability to acknowledge, absorb, interpret, and act on the stories and plights of others” as part of patient care.
Charon continues, “sick people need physicians who can understand their diseases, treat their medical problems, and accompany them through their illnesses.” This involves examining a patient’s health status and treatment options in the context of their life circumstances.
Only by understanding their story, she writes, can a physician really determine what the patient needs in terms of asking helpful questions, determining differential diagnoses, selecting appropriate diagnostic testing, interpreting their results, and recommending effective treatment options.
She eloquently continues, “it may be that the physician’s most potent therapeutic instrument is the self, which is attuned to the patient through engagement, on the side of the patient through compassion, and available to the patient through reflection.”
Fine came across the topic while doing research for her memoir, The Other Family Doctor: A Veterinarian Explores What Animals Can Teach Us About Love, Life, and Mortality, to be released March 14, 2023 by Anchor Press/Random House.
She wrote an article on the topic and was then asked to author the textbook. While doing her research, she realized that many of the techniques she was already using in her practice had been named and studied in human medicine.
Sharing our own stories with clients
These strategies include self-disclosure, which is “sharing our own stories with clients.” It can help pet owners relate better to us as veterinary professionals to know that we also sometimes struggle to get medication into our pets or brush our dog’s teeth.
“On a deeper level,” Fine explains, we can help clients with decisionmaking by “revealing how we’ve made euthanasia decisions” with our own pets. While we often dread being asked by our clients what we would do in their shoes, it can be a little easier to sometimes explain what we have done or what we are currently doing in the care of our own pets.
Seeking the “real narrative”
An example in Fine’s book quoted from John Launer, MBBS, a physician in the United Kingdom, applies to both human and veterinary medicine. Two parents bring their 2-year-old human child to the doctor for treatment of severe eczema. The parents are described as being “frantic” because they cannot stop their son from scratching himself, and everyone is losing sleep over it. Sound familiar?
The nurse practitioner on the case sees that daily bathing and topical therapy, including topical steroids, have already been recommended. The parents respond with “despondency,” indicating that there is no way they can fit that kind of care into their daily routine, since they have two other young children. They also have a negative opinion of steroids and want to avoid them. They would prefer to see a specialist over even trying the previously recommended therapy.
While it would be easy to either judge the parents as unwilling to do what is needed or refer them on to avoid struggling with their noncompliance, Launer suggests that another approach is to evaluate the real narrative of the parents, which centers around their exhaustion and perceived inability to perform the recommended care.
By taking some time to validate the parents’ feelings and explore where they are coming from, the nurse practitioner may be able to help the parents change their own narrative to one where they feel more capable of attempting some or all of the recommended treatment, with or without the referral.
Stories help fight burnout
Not only does narrative medicine have a role in enriching patient care and the client experience, but it can also help support and improve the wellbeing of the whole veterinary team.
Fine states that “narrative medicine provides practical strategies to improve communication skills and help mitigate burnout, perfectionism, and imposter syndrome.” In her book, Fine explores the importance of boundaries to protect the mental health and wellbeing of veterinary professionals.
“Compassion fatigue,” she explains, “can be addressed by using narrative medicine to set emotional boundaries and recognize where our stories begin and those of our patients and clients end.”
Another important strategy for veterinary professionals, one that Fine believes is not practiced routinely, is reflection. While reflection could be described as looking back on a case to see what went right, what could have been done differently, and what might have been missed, Fine defines it differently.
“The goal of reflection,” she counters, “is to try to find perspective on our individual narratives, to put them in context, and to accept that we cannot understand or know everything.” She points out that it is only meaningful when it is practiced with self-compassion.
Through reflection, we can create more reasonable expectations of ourselves and fight perfectionism. Through self-compassion, we can be kinder in the way we speak to ourselves. Through empathy, we can be more understanding of the needs of our patients. We can be more attuned to our clients’ previous experiences, limitations, and emotions, all of which can affect our ability to successfully treat their pets.
Many of us have already been practicing these techniques. As we learn to do so more intentionally, may we feel fulfillment and inspiration in listening to and sharing stories.
Dr. Charon’s article introducing narrative medicine:
Dr. Fine’s article on narrative medicine
Dr. Fine’s website, including links to her books:
Dr. Fine’s new online journalabout narrative medicine, Reflections:
Emily Singler, VMD, is a 2001 graduate of Penn State University and a 2005 graduate of University of Pennsylvania School of Veterinary Medicine. She has worked in shelter medicine, private practice, and as a relief veterinarian. She currently works as a veterinary writer and consultant and has her own blog, www.vetmedbaby.com.
Photo credit: © vladans E+ via Getty Images Plus