In many ways, stories are at the heart of medicine. They are present at the start of all illnesses, sometimes even long before the patient is aware. The setting, characters, plot, conflict, and even point of view: all elements of a story may come into play during the process of disease manifestation. In health care, stories are a powerful tool that not only helps the clinician and patient enter into a meaningful discussion but also provides the clinician with key clues into the development and manifestation of disease processes.
The term “narrative medicine” was coined in 2001 by Rita Charon, MD, PhD, as “medicine practiced with the skills of recognizing, absorbing, interpreting, and being moved by the stories of illness.”1 In an interview featured in Columbia University’s Insight into Diversity, she said that, too often, medical training ingrains a singular focus on the body, dismissing other patient concerns as small talk: “Physicians are trained to zero in as quickly as possible on the physical problem,” but they can provide better care if they consider the patient’s experiences and connect with them.2
A core component of Functional Medicine is the use of the Functional Medicine Timeline to record the patient’s story. This tool is intended to help organize the patient’s experience into a history that helps both patient and clinician better understand the causes of their illness.
“The key [with all patients] is taking the Functional Medicine Timeline and receiving the individual’s story,” says IFM educator Henri Roca, MD.
Receiving the richness of that person’s life- whatever it is they choose to give to you- is actually therapeutic in and of itself, and it leads you to understanding how to help the individual unwind their set of circumstances.
In the following video, Dr. Roca further discusses the importance of the Functional Medicine Timeline and how it helps the patient and practitioner on their path toward healing.
What makes the FM Timeline different from other tools is that it has the effect of giving the patient insight into previous life events and validates for them that their story has been heard. Both of these elements help to motivate the patient to make lifestyle modifications and engage more fully in the treatment plan. The timeline is patient-centered because it places central importance on the patient’s experience, not just the clinician’s interpretation of the patient’s symptoms.
It doesn’t matter who you are working with, what system you are working within, or what the income or educational level of the individual is. If you honor their story and are able to tell it back to them in a way that makes sense to them, they can work to unwind their complex collection of symptoms and return to health.
The Functional Medicine Timeline is a graphical representation that allows clinicians to identify factors that predispose, provoke, and contribute to pathological changes and dysfunctional processes in the patient’s physiology. In this way, both practitioners and patients can identify cause-effect relationships that might otherwise go unnoticed. By covering the period from preconception to the present, the timeline reflects the connection between the whole lifespan and one’s current health.
In a systematic review of the literature, Christy DiFrances Remein, et al., writing in BMJ Open, found that the practice of narrative medicine leads to high participant satisfaction and positive outcomes across various competencies.1 “Narrative-based education shows promise for promoting communication, cultural competence, empathy, and professionalism as well as for enhancing vitality and mitigating burnout,” the authors write.1
The importance of empathy in healthcare professionals has been a subject of study in recent years.3 Compassion for others has been widely recognized as an integral part of patient-centered care,4 and patients who perceive a lack of empathy and compassion in their care have poorer clinical outcomes, are less likely to return for care, and even sue for malpractice at a higher rate.5
A mutually empowering patient-practitioner relationship is a key element in Functional Medicine and one that is enhanced by the use of the FM Timeline along with an empathetic approach. To learn more about this and the power of the therapeutic partnership, please explore the IFM-authored articles and podcast below.
- Remein CD, Childs E, Pasco JC, et al. Content and outcomes of narrative medicine programmes: a systematic review of the literature through 2019. BMJ Open. 2020;10(1):e031568. doi:1136/bmjopen-2019-031568.
- Bohanon M. The evolving field of narrative medicine reaches the ‘core of the human condition.’ Insight Into Diversity. https://www.insightintodiversity.com/the-evolving-field-of-narrative-medicine-reaches-the-core-of-the-human-condition. Published April 19, 2019. Accessed February 18, 2020.
- Moudatsou M, Stravopoulou A, Philalithis A, Koukouli S. The role of empathy in health and social care professionals. Healthcare (Basel). 2020;8(1)pii:E26. doi:3390/healthcare8010026.
- Sinclair S, Russell LB, Hack TF, Kondejewski J, Sawatzky R. Measuring compassion in healthcare: a comprehensive and critical review. Patient. 2017;10(4):389-405. doi:1007/s40271-016-0209-5.
- Perez-Bret E, Altisent R, Rocafort J. Definition of compassion in healthcare: a systematic literature review. Int J Palliat Nurs. 2016;22(12):599-606. doi:12968/ijpn.2016.22.12.599.
In an IFM video, Elizabeth Boham, MD, talks about how she combined an undergraduate degree in nutritional chemistry with a degree in family medicine and Functional Medicine certification so that she could help patients navigate chronic disease. Dr. Boham is also a registered dietitian.Read More
This IFM “Clinical Spotlight” showcases David Brady, ND, who describes what it’s like to practice Functional Medicine in a group clinical practice. “I think, in the IFM paradigm, it’s essential to get to know that patient; to connect with them and to really get a detailed history on where it all started,” says Dr. Brady. “So I will learn the antecedents and triggers, and all parts of their chronic disease process.”Read More