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Narrative Medicine in Practice

katherinechretien2Katherine Chretien, MD is chief hospitalist at the Washington DC VA Medical Center and assistant dean for student affairs and associate professor of medicine at George Washington University School of Medicine and Health Sciences (SMHS). At SMHS, where she completed the Master Teacher Leadership Development Program, she developed and led a new narrative medicine course for medical students at going through their clerkship year. She is also the editor and founder of the blog Mothers in Medicine, a group blog of physician mothers telling stories about their experiences and creating a community of support. Katherine is an associate editor at Journal of Graduate Medical Education. She is interested in social media and the way physicians can use it for positive impact.

I spoke with Dr. Chretien about how she has balanced writing and medicine throughout her career, and what inspired her to get interested in narrative medicine, and start a group blog:

VV: What drew you to medicine?

Dr. Chretien: In high school, my first ambition was to be a writer. I had a freshman English teacher who said I should be a writer some day, and that was what I thought maybe I’d like to do. However, I also really liked the sciences and loved my AP biology class, and started really thinking about medicine and putting off the writing to the side. I shadowed my family physician who was this amazing person who connected with all of his patients. He would run around wearing sneakers in the clinic because he was trying to keep up with all his appointments. He was just so dedicated and committed to medicine, and I was really inspired by him to possibly pursue that. During college, when I had experiences with the medical field, or shadowing, or working in the ER, I just felt like medicine was what I was supposed to do, that medicine was a calling. While I always loved writing, it seemed more peripheral.

VV: I know you have piloted a narrative medicine curriculum at GWU. What sparked your interest in narrative medicine, and how are you using it to change medical education?

Dr. Chretien: I attended a narrative medicine workshop at Columbia University many years ago, and I was really inspired by it. We had an activity that was like an icebreaker in our small groups there, which is what our narrative medicine activity that we do with the medical students is based off of. You were paired with someone, and this was someone you didn’t really know, just someone in the small group, and we took turns telling a story of something important in our lives. The listener would just intently listen, not interrupt, and allow the narrative flow to occur. You had to really be able to witness this other person’s story in all aspects, and then write the story down as you understood it, and then read it back to the whole group. We had a group of 8 people in this small group at the workshop, and listening to the stories that were written about our partners was so empowering and eye opening in showing how you can authentically take in and produce someone’s story. I was so impacted by that and thought, our patients hospitalized in our hospital are suffering in ways that sometimes we don’t fully take the time to understand. Could we have benefit for them and ourselves as care providers by being able to witness their stories and give voice to their stories? And, would those stories help us to grow as physicians and/or trainees, and maybe even contribute to patient care decisions? So that’s how the curriculum was born, in trying to translate that activity to patients, which had never been done before, and give them the opportunity to share these stories. When doing this with patients, students have said that they feel on the same team, they seem part of things and more responsibility towards the patient now, and a deeper relationship in some cases.

VV: What was your motivation in starting the group blog Mothers in Medicine?

Dr. Chretien: Prior to that, I had been very involved with the blogging world. I had a personal blog that I was very active on, and I was writing for other blogs. I had started a reflective writing blog for the medical students on the medicine clerkship, as a first innovation in using social media in the curriculum. Meanwhile, I had my first child, and as a young physician in my group, and the only mother, I had lots of challenges. I felt like a pioneer of sorts in my workplace, and was really not seeing a place, either in person or online, where there was a community of support for mothers in medicine. I wrote an essay in 2008 that was published in Annals of Internal Medicine on pumping while at work and how crazy it was to juggle that and balance, and how it was like a different world that I was entering. I started to get this influx of emails and responses to the article, from women and also men, from all ages and all over the country, who said things like, “Thank you for writing about this, we need to hear more about this, we need to share more in medicine.” And so I thought, we should have a place where people can get together and talk about these things and share their stories. I remember having this idea while my husband and I were driving home from some event. I had models to look at from other group blogs that I was a part of, and that weekend I just set about emailing some people that I knew that were bloggers and physician mothers, and the response I received was immediate interest. It was encouraging to me to keep building it, and I think it was launched that same week—it was very quick.

VV: What advice do you have for students starting medical school and thinking about how to integrate creativity into their medical career?

Dr. Chretien: Never lose sight of that. Find ways throughout medical school to nurture that side and experience it. It could be extracurricular or curricular ways of developing that creative side. I had some students in their third year doing narrative medicine or reflective blogging, saying they hadn’t done something this creative since college. I hope they can find ways to keep engaged in that creative world, keep thinking of how to innovate and make new things, that’s what we need in medicine.

 

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