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Narrative in medicine

Submitted by Lizzie Crouch
18 July 2013

On 9 July renowned neurologist and author Oliver Sacks celebrated his 80th birthday. In honour of the occasion, Radiolab produced a half hour podcast to celebrate ‘one of [their] favorite human beings.’

In a captivating interview, Radiolab’s Robert Krulwich explored Sacks’ career, learning how a motorbike accident led him to switch from studying worms to becoming a neurologist. This turn of fate led to an incredible writing career but, as well as exploring his career, the podcast also highlights why Sacks’ writing has had such a lasting impact.

During the interview Sacks and Krulwich discuss how, in the earlier days of medicine, many doctors’ accounts of patients are ‘vivid and descriptive’ but that ‘as medical machines got better numbers became more reliable, gradually pushing out description.’ Sacks noticed, through working with his neurology patients, that the numbers just weren’t enough to capture the range of human experience; he recognised that it was vitally important to bring the human factor, the descriptive narrative, back into medicine.

In 1973 Sacks published Awakenings; with vivid in-depth descriptions of a group of sleeping sickness patients who underwent a remarkable ‘awakening’ when Sacks had given them the then new drug, L-DOPA. Although Awakenings was initially met with huge criticism from the medical community, over time people began to realise the power of Sacks’ gift for narrative.

Sacks acknowledged during the interview that, ‘I think now that narrative has come back into medicine’. The importance of narrative in medicine for communicating medical facts between peers is made apparent through Sacks’ work, but its importance for communicating medical information to patients is also vital.

Dr David Pao, from University College London, has examined, among other things, the psychology behind why some patients find it difficult to adhere to antiretroviral therapy and medical care when they are diagnosed with HIV. He writes:

The objectivity of reductionist medicine is often cited as the main reason for its success. Conversely, the inherent restriction to the 3rd person perspective, coupled with the difficulty of measuring the phenomenology of illness (the 1st person “lived experience”), is a major criticism and frustration.

Recognizing what Sacks also did, Pao is trying to put the human factor back into medicine. By reintroducing narrative and description, through writing and art, he was able to explore the reasons behind a 40-year-old woman’s reluctance to stick to her antiretroviral therapy, where less expressive approaches had failed. Whilst a medical approach that records patient outcomes in check boxes and numbers may seem more logical to some, examples such as this show that it is also highly limited.

Through examples such as these, it is clear from these examples that two-way communication and descriptive narrative is an essential part of modern medicine. Oliver Sacks’ work, such as Awakenings, was important in demonstrating this when descriptive medical accounts were dwindling.

  • Oliver Sacks