I think
that meeting someone
who comes to us,
sharing a burning issue,
is also a privilege to hear something like that from
someone. It's a close connection;
we're with them often in crisis
situations,
often at the most important moments in their lives.
In some way, we're embedded in this universe,
and it seems
to be a narrative process.
I recommend reflecting on your own narrative.
If you're a doctor,
I recommend reflecting on your patients' narratives.
It can be truly interesting, and
it can also contribute to your own lives.
You can also begin to see these difficult moments as
a privilege of accompanying someone through
moments in life
that are difficult,
important,
and somehow change their attitude and
perspective on the world.
We invite you to listen to episodes of the new
podcast series on the Polish Studies Newsletter's Meetings, titled
"Engaged Polish Studies".
Polish studies aren't a helpless observation
of the world.
They provide tools
to navigate it,
help understand it, and
prevent exclusion and loneliness.
This is the Polish studies
we want to showcase through our project.
Engaged Polish Studies.
Good morning Adrianna.
Good morning Marta.
Thank you
for accepting the invitation to this conversation
about narrative medicine.
Perhaps
I could first introduce you to our listeners.
Dear Sirs and Madams,
Ms. Adrianna Beczek,
a doctor
who graduated from medical school at
the Jagiellonian University Medical College,
is also a humanities scholar.
After completing her bachelor's degree in ethnology and
cultural anthropology and her master's degree
within the interfaculty individual
humanities studies program at the Jagiellonian University,
it's a difficult,
long, and complicated title,
so Adrianna, you're both a doctor
and a humanities scholar.
Since November 2021, you've also been a
teaching assistant at the Medical Communication Center at
the Medical University of Warsaw and are currently
specializing
in psychiatry.
It was at the Medical University of Warsaw that we had the opportunity to meet
for the first time and get to know each other during a
conference on communication in medicine.
But,
importantly,
in 2019, you participated in the
narrative medicine workshops led by Rita Sharon.
Milan,
so it's closer,
so you didn't have to go
all the way across the ocean.
All the way to New York.
Exactly.
Just before COVID, we had
the pleasure of visiting Milan,
just before the pandemic broke out.
We were in Milan,
we met with Rita Sharon.
A wonderful opportunity,
so we'll talk about that later.
Yes, indeed.
And in general, you've been involved in working
on the methodology of narrative medicine for many years.
You consulted, among other things, on the Polish edition of
a rather important book
by Rita Charon and her team,
a textbook, in fact,
Narrative Medicine,
Theory and Practice.
The book was published in Polish in 2020,
translated by Maria Świątkowska, and
was created and edited by Hubert Systek and
Mateusz Potoniec.
You were part of this work.
The chapter on cultural anthropology,
concerning cultural anthropology.
Well, they dreamed of what
you know.
Adrianna,
perhaps you could add something to this list of
certain biographical facts?
Thank you very much for inviting me to the conversation.
I hope
that somehow my perspective, which is a bit too close to
the clinic,
because I won't say
that it's some great,
deep clinical practice of narrative medicine,
can add something to the understanding of this topic and to
the discussion about it, which,
I have a feeling, is currently
taking place
in Poland.
Could you tell me a bit more about
how you combined medical studies with
humanities studies?
Because I think
it's incredibly difficult.
Medical studies seem so
engaging,
and here,
it's like
ethnography,
anthropology, and then there's this whole thing, all in parallel.
How did you manage to do all this, and
where did the idea
to intertwine these two paths come from?
How did I do it?
It was difficult,
I won't say
it was easy, and I also remember that
period as difficult,
but only possible thanks to the goodwill and
commitment of many of my lecturers and assistants.
Maybe this is a good platform
to thank everyone for
remembering this and really appreciating
that it was made possible for me through individual
study plans and the possibility of taking credits at different
times,
so many people
who somehow understood my mission.
They were involved and made it possible for me as
part of my studies at the Jagiellonian University.
I don't want to create any
false legend here,
because I studied longer because
I studied these two fields,
combining them during my leave periods.
In one field,
in the other, I followed individual plans.
That's how I managed. I completed
the last year of my studies,
my master's degree as part of the
inter-faculty humanities program, while
working as a doctor at a detention center in
Krakow.
So I worked at the detention center with hours
that allowed me to study a few blocks
away, finish my master's degree,
and then defend my thesis.
Where did the idea for this combination come from?
Unfortunately, there's no other way
to describe it than disillusionment with medicine and the
way it works.
I don't come from a medical family.
My first contact with the medical field wasn't
until my third year of studies,
when clinical classes begin.
The first two years,
three years in the past,
two years now, I think,
were theoretical classes,
more like university.
No patient contact.
No patient contact,
yes. First, there are all four basic sciences,
then you continue with
seminars and lectures,
and from the third year on, clinical sciences began,
meaning teaching medicine.
Where there's an assistant,
you have classes in smaller groups with the assistant,
you follow the assistant around,
observe their work, and
they explain
why they do things
this way
. These are very practical classes.
And when these classes started,
I was overwhelmed by
the way things were.
I didn't really like it and even
considered giving up medicine altogether and switching
to another field.
Then I started studying cultural anthropology.
But after a year of student leave, I returned and
completed my medical degree.
This was also thanks to the fact
that I learned
about approaches like narrative medicine,
that there were people
trying to combine them,
who tried to incorporate
insights from the humanities and social sciences into their practice, and
somehow managed to do so.
And that seemed inspiring to me, and I thought
that maybe it doesn't necessarily have to look
like the way
I observe it during classes.
So I finished it and I'm working on it, somehow,
it's working.
But these,
how should I put it,
these insights from the humanities seem
I feel
like they're adding to my practice, and I'm not sure
if, personally,
it would even be possible for me to continue practicing
medicine
if it weren't for these humanities-based insights.
So, it wasn't easy,
but you had the impression when combining
these different fields of study
that it somehow made things easier,
that you saw them
complementing the view of humanity,
right? This medical perspective,
this ethnographic,
anthropological perspective
that humanities studies offer.
Were there moments
when you felt,
yes, this somehow complements me and helps me
pursue both paths?
Yes.
Definitely.
However, I know
that this is my individual perspective,
stemming from some predispositions,
perhaps innate,
or perhaps acquired later in life,
before I started studying medicine.
I know that not everyone needs this to
practice well.
But for me, it does.
I think
an important aspect
that these humanities studies have given me
is understanding
why patients are sometimes dissatisfied with their care,
why doctors are sometimes confused, thinking,
"Well,
I cured them,
right?" So why does the guy still leave dissatisfied?
Thanks to the topics discussed,
for example, during cultural anthropology classes,
understanding social processes,
or the cultural perception of medicine,
perhaps it was easier for me to understand.
This made me feel less stressed;
I simply expected it
to be this way more.
That people are complex.
Specifically,
that it's not quite like that,
that I have the impression
we'll get to that in the course of our conversations,
that this mechanistic concept of the human being,
where we divide them into the body and the rest,
isn't entirely accurate.
Maybe that's why
the body is sometimes cured,
but the person is still unhappy and dissatisfied.
Maybe it's not so unexpected.
Right?
Exactly.
Thank you.
So, let's move on to
narrative medicine,
to its methodological foundations.
Could you explain to us what
you consider the most important assumptions of narrative medicine?
What are its foundations?
What does it involve in general?
And here, I'd also be interested in your perspective
on the relationship between medicine and narrative,
wouldn't you? In this idea
of ​​narrative medicine.
How do these two powerful categories,
somewhat from different worlds, relate to each other?
That is, how does medicine draw from narrative and
the humanities, and what do these humanities offer medicine?
If we're talking
about narrative medicine itself,
it's impossible not to mention
that it's a term coined by Rita Sharon,
a professor at Columbia University
in New York,
a specialist in family medicine
who also experienced a similar crisis and
disillusionment with medicine at a certain point in her
life.
She began studying literary studies and
noticed points of contact—
where
medicine lacked in certain respects,
perhaps
literary studies could fill that gap.
This is also evident in her practice.
It's interesting to me, for example,
that she
approaches the topic from a humanities perspective in such a literary scholarly way.
I see a slight difference in her approach,
because cultural anthropology is already somewhat different
from literary studies,
even though it's a group of disciplines.
The same disciplines,
similar,
perhaps not the same,
Maybe it's to some extent,
the same,
yet similar.
And yet, her humanities context is a bit
different, and from the workshops she
held in Milan,
I got the impression
that she understands this, too,
that you see
that people approaching the humanities from different angles
also bring their own perspectives.
That's also the value of combining these different
perspectives.
I hope
so.
I think
we see it that way too.
She approached the topic this way and began
to fill those gaps with literary studies,
methods drawn from her
literary studies.
And somehow it began to take root as
narrative medicine.
I also heard an anecdote
that she came up with the term
because she had to include something in a grant application,
so she quickly came up with it, and it
stuck.
And this was happening at the end of the previous
century,
and at the beginning of the 21st century, the methodology began
to become more established, and
more researchers began working on it.
They started writing
down these rough rules,
speaking of narrative,
writing, and
understanding. This team, from what
I understand,
also emphasizes that
these rules aren't rigid and set
in stone;
they're constantly subject to influences ,
depending on
how the world changes .
But they also observe
how these rules shape their
narrative practice, and this practice returns to these rules.
So it's not some set of rigid commandments,
but rather a set of guidelines.
I have the impression
that, because
Rita Sharon comes from a literary studies background,
the methodology of narrative medicine draws heavily from
literary studies, and the aspect
that is perhaps most emphasized in this
methodology
is close reading.
Careful reading,
also related to attentive listening,
is a practice from literary studies
in which
each word,
each sentence, is given great importance,
its context is discussed,
its effect on the overall message
is then translated into
the practice of attentive listening with the patient in the office.
It's also worth mentioning
that narrative medicine is taught not only to practicing
clinicians
but also to patients,
so it has its various facets,
images, and
various applications in practice.
We could talk at length about this methodology.
The book
I have in front of me
is a good few hundred pages long.
I invite you to read it.
However, this very brief introduction, and I think
the thing
that most struck me,
whether I've ever read
or studied this field,
was this important reading.
However, when I think about narrative medicine,
I also think that
this isn't something
Rita Sharon de facto invented.
She somehow codified it,
drew attention to it in academic discourse,
in medicine.
Medicine, however, began as
a global phenomenon,
as something holistic.
And initially, it didn't treat the mind and body
separately.
And we moved away from this
combined treatment of mind and body
in favor of a mechanistic approach,
because the industrial revolution gave us vast possibilities
in terms of treating individual organs,
of viewing everything under a microscope.
And let's not say
I'm criticizing this,
it was very good
at the time.
But we've been doing this for 100-150 years.
Perhaps we're ready
to return to a more holistic view
of the human being,
because I feel
that many of the problems in modern medicine
stem from
our disjoint approach.
This is my own personal theory,
a null hypothesis,
yes, testable,
but I observe
that because
we start from a Cartesian assumption—
that the body is a machine,
and the spirit is somewhere out there,
driving this machine,
or not driving it,
or driving its parts in different versions—
this then leads to some of our problems,
namely the low patient satisfaction with treatment—
I'm putting it roughly,
low,
lower than we'd like—perhaps
simply stems from the fact
that the patient
who comes to a doctor and seeks help
generally lacks medical training.
Exactly.
And they often want
to be seen as a whole person.
Sometimes they have trouble accepting
that a doctor sees them as an organ or as
something broken
that needs to be fixed.
I also don't want
this to sound so critical,
like, wow,
bad doctors,
they just sit behind that desk and just
tighten that screw and that's it,
that's it,
because very often it's not,
and it stems from the context
in which we practice medicine.
But I think I would agree
that narrative medicine is perhaps emerging as a
voice of protest against
where medicine has gone.
Because it's as if this turn in this very
technical,
precise,
biological direction, at a certain point, no longer
brings any good.
I've also heard such comments from people,
experienced
professors, right,
who are familiar with narrative medicine and say,
"Well, that's nothing new,
right?"
Well, that's it,
because it's nothing new
when you look at the essence of things that way,
right?
But perhaps it needed to be given a name,
a formal framework,
right?
For the world to know,
for people to suddenly realize,
okay,
so we need to somehow return to this holistic
approach.
Try to combine this strictly medical approach with
what was missing,
precisely to see the human being in its entirety.
So perhaps these formal accents were necessary here.
Exactly.
And perhaps just one comment:
perhaps it's not
that this mechanistic medicine brings us
no benefits,
but rather that it brings us fewer and fewer benefits,
simply because of its natural development over
time,
through history.
And I have the impression
that there's more and more room
to supplement it with this return to
the roots,
because sometimes,
when we say this holism to medical students or
medical practitioners,
it causes a stir
because it's associated with so-called alternative medicine over
non-medical treatment.
The popularity of non-medical treatment may be related
to the neglect of
evidence-based medicine.
It seems to be based on facts
that good communication and good rapport with the patient
are also beneficial
and contribute to good treatment outcomes.
And the popularity of these non-medical practices
stems from the fact
that we perhaps focus too much on
targeting individual receptors, operating on them, and
affecting organs,
and less on
seeing the person in the context of their
problem,
what they're dealing with,
and that this problem is also conditioned perhaps by their style.
Life,
or perhaps some relationships,
that the response to treatment is also determined
by a whole range of factors.
There are also psychosomatic illnesses—a completely
different,
completely separate group of illnesses.
So let's reassure everyone.
Narrative medicine isn't some sort of isolated,
new medicine,
right? It's just an approach
that allows us to supplement evidence-based medicine,
right?
It's precisely this more human,
subjective element,
to
see the person as a whole.
Besides, I thought
it wasn't a coincidence
that Rita Sharon is a family doctor,
right, because that's also such a specific specialization,
this direct contact with many
patients
where you basically follow one patient throughout
their life,
the entire family, right,
right, and you hear the stories,
right,
that the person comes to you with.
I couldn't imagine
an orthopedic surgeon suddenly deciding
they lacked the humanities in their interactions with patients.
It's good
that it happened.
Indeed, I think
the very nature of this specialization may provide less
room for narrative,
but an orthopedic surgeon, on the other hand,
might be more suited to
narrative medicine.
My subjective experience,
I'll emphasize it again,
is that
during my postgraduate internship,
when I had the orthopedic residency,
I saw patients at the outpatient clinic with a specialist,
and the orthopedic specialist at the National Health Fund
outpatient clinic
saw fifty patients
in five or six hours.
I was very impressed by the mental resilience
of this person,
especially their knowledge,
because it's a problem to solve,
a problem to solve,
and that's it, for five hours.
But also by the mental resilience of this person,
because after a day like that,
as an extra person who,
I don't know,
examines
something
or types something into the computer,
I felt like I'd been run over by a combine harvester.
And these doctors had a day like that, a marathon of seeing patients at that clinic
once or twice a week.
So I have a feeling
that if I were an orthopedist,
I'd want to pursue narrative medicine so
I could have more time,
simply to think about a patient's problem,
to sit down,
more time to type that concentration into
the computer,
instead of just "patient" and "next,"
and "next," and "next,
" and "next," and "next,
" and so on, all day long.
A truly traumatic experience.
How can you delve into fifty stories,
right?
Well,
I guess you can't.
I
guess there's a limit somewhere. And you can somehow do it with fifty broken bones,
right?
Well,
because Szalan reached for literary studies
to become a better doctor.
I wonder
if, besides literary studies ,
there's room in narrative medicine for other areas
of the humanities?
Is there a place for language researchers,
or, more precisely, culture researchers?
Because you say
you feel
that your perspective as an anthropologist is slightly
different from the literary perspective,
like Richard Sharon's.
What would that difference
be?
Even the textbook on narrative medicine has
chapters devoted to specific branches of medicine.
There is a section devoted to literary studies,
Philosophy, and also cultural anthropology,
a whole field.
I think
that this contribution of cultural anthropology to narrative medicine
is primarily visible in the study of
embodiment practices,
various social phenomena.
A more social approach,
to certain health phenomena,
is one thing. The fact
that Rita Sharon is a family medicine physician
is also important.
But it's also true
that she operates in an American context,
where healthcare is not
publicly funded.
She encounters, for example, the impact of
poverty on treatment processes.
Because here, as we
know,
poverty also affects treatment processes,
right?
Not long ago, people might not have been able to
afford medications after leaving the doctor's office.
Now, this has been somewhat limited by these
reimbursements for medications for people under 85,
those over a certain age.
We also have reimbursements for
some medications, completely
free of charge,
the whole process is complicated,
reimbursed.
However, there,
if you don't have appropriate
insurance,
you can be left either completely without access to healthcare
or
unable to purchase medications.
I remember
once reading
a piece, though not by Rita Sharon,
about a patient
who died because
he couldn't afford insulin.
This was a few years ago,
because it seems
there are some reforms
related to this in the United States now.
I don't want to go into detail
because I don't know enough about it,
but American doctors also operate in
a different context,
where access to healthcare isn't a given.
It's not assumed
that it's for everyone,
that it should be equally accessible.
So these are also social issues
that anthropology grapples with.
The problem of inequality,
which is widely discussed.
And participant observation,
for example,
what I mentioned about the principles
formulated regarding
how narrative medicine should be understood and
practiced,
is this principle of reciprocity,
this feedback,
that we form the principles,
observe how they work in our practice,
then return to these principles,
reformulate them.
This also draws from methodology,
cultural anthropology,
which is the flagship method.
Participant observation is
where you enter a given environment.
You experience
how a given social group functions
based on your own experiences,
then you create,
write,
and act on what
you've experienced.
This also resonates in narrative medicine.
Well, that's all I can say about my
field,
cultural anthropology, for example,
but also the influence of philosophy,
in other words,
what I mentioned,
that unfortunate
Cartesian dualism,
which I'm so terribly attached to.
This, in turn,
involves a philosophical approach to
how medical practice was shaped.
Let's face it,
every reflection on the world
has its origins in philosophy,
right? So medicine also has its origins in philosophy,
because it is a science for this simple reason.
And philosophical approaches also shape the way
a given science develops in a given region.
Because we are also dealing with a type of medicine
that developed here in Europe for some
social and
cultural reasons.
Not, of course, as language experts.
I'm happy with all the fragments,
Where does anything about linguistics appear?
Although there's not much of it.
I was glad, of course,
that there was talk of conceptual metaphor,
notional metaphor, and so on,
perhaps a bit of cognitive poetics,
so it's like these areas don't really
represent the achievements of linguistics to a great extent.
But I'm thinking, well,
maybe the specificity of
Rita Sharon's studies,
right? And also that
the United States is dominated by a different kind
of linguistics,
perhaps less cognitive.
It's more accepted in Europe,
so that's how I answered it myself.
But those moments
when we talk about close reading, when
we look at the formal structure of the text,
at word-by-word
contact with the word
—that's my area of ​​expertise, is
n't it? So we're kind of looking at the form of the word from every angle,
wondering,
right, in what tense form, and so on,
what significance it has.
So I have the impression
that for a linguist there's something there too.
Absolutely,
not more so.
But these are also things that border on psychoanalysis,
and some methods,
but also serve precisely through linguistics and
the study of words to release such
tensions,
to reveal contexts,
illnesses.
Identifying metaphors.
Sure,
right?
Exactly.
Here we have linguistic tools
that can also be useful.
What if we were to organize
the terminology a bit more,
or the scope of such broad concepts
as narrative medicine,
humanistic medicine,
medical humanities?
I don't know,
would you perhaps try to pinpoint
what narrative medicine is?
Is it part of humanistic medicine,
or can it be seen as part of
medical humanities?
I'm actually drawn to these two concepts
because they're very similar.
Yes,
but they emphasize different things,
right?
Humanistic medicine,
as I understand it,
is the kind of medicine
that suddenly stumbles upon itself and says,
no, we're missing something here,
right? We want to complement our practice with some
humanistic components, and I think
that's where narrative medicine emerged,
right? But beyond that, we also have this vast field
to which our project is devoted—
the whole medical humanities thing,
right?
And it's like,
"A bit of a different angle,
" right? We look at
medical problems from a humanities perspective.
You have access to both perspectives,
so you'd know that.
I hope
I do.
I'll say right away
that these distinctions
aren't my cup of tea ,
because for me, these are concepts
that overlap significantly and have many
common elements.
I don't know if I'm seeing this correctly,
but I'll say it right away.
Narrative medicine is a formalized concept
introduced by Rita Sharon,
who studied it at Columbia,
and can be used for master's and
postgraduate degrees.
Courses in this field are taught
in Poland,
Italy,
and various places around the world,
drawing on Rita Sharon's practice.
They're inspired by
what's being done at Columbia.
Humanistic medicine.
This is a broader concept,
which I feel encompasses
narrative medicine.
Humanistic medicine,
as you've already said,
is medical practice
that has shifted its focus to the humanities due
to a sense of deficiency.
Psychiatry is a specific example here,
but then again, Kempiński is the whole story,
isn't it?
Yes.
This is medicine,
humanistic psychiatry,
which looks at social and cultural
contexts,
at the patient.
It wants to see the patient holistically,
not just biologically—
these are such attempts.
But there's also Władysław Biegański,
who was an internist,
perhaps even an infectious disease specialist, and a philosopher as well.
He also pondered
what philosophical insights could offer medicine as
a science,
simply as an exact science.
He only drew from philosophy some reflections,
contextualizing exact practice,
medical practice, and
research.
This is Biegański,
this is Szczeklik,
right?
Also humanistic medicine,
even though he was also a scientist
closely connected to exact sciences,
because he also undertook research on prostacyclin at
the Department of Pharmacology—
in other words, exact exactness.
And yet,
the life contexts of his patients also provoked considerable reflection.
He was known for his
interest, after all,
he founded this entire clinic,
which was once located on Skawińska Street,
where he treated pulmonary patients.
And in a more humanistic way, he had
his piano,
which he supposedly played.
Unfortunately, I didn't meet Professor Szczeklik,
as
he died a few months before
I had the opportunity to begin my studies in Krakow.
But his legacy lives on.
Definitely.
And these are the contexts of humanistic medicine.
And medical humanities,
or, as we could very simply
put,
writing about medicine and illness.
So, reflections on
how we use language in medicine.
Do we say "surgeon"
or "female surgeon,
" or "surgeonwoman,"
or "surgeonwoman"?
Or how we position it?
Because this also somehow resonates with, for example,
the Polish women in medicine initiative.
How do girls see themselves,
what are their specific characteristics?
Do they feel invisible?
Do they feel visible
or invisible?
Exactly.
Whether they prefer one
way or another.
And if they prefer one way,
why?
After all, that's important too.
It adds to
how we function.
It somehow determines
how we function in medicine.
As women,
as doctors,
as people
working under contract with a fund.
As people
working privately.
After all, all of this matters.
So all of this is medical humanities,
which allows us to better understand our roles.
Our role for each other,
our role towards the people
we provide our services to.
Perhaps we should also try
to think about narrative medicine,
what it looks like in clinical practice.
We've already mentioned
that the relationship in the United States is different than
here. Here, access to medical care is indeed
guaranteed for everyone,
but we also have private medical care.
You can sometimes feel the difference between the quality
and duration of care
in the private sector.
What does a doctor's daily practice look like, and
is there a place for narrative medicine here,
in our country?
Because our system is so organized,
isn't it?
It's impossible,
there's not enough time,
and so on.
Is there even a place for narrative,
for the practice of narrative medicine here?
So we're getting closer to a topic
I consider my passion,
That is, physician burnout.
And I'd like to talk more about
the professional performance of medical workers,
but I might not go into detail
because I simply know more about doctors;
I've been more interested in them,
I've read about them,
and that's my environment,
so I know them,
but I think
nurses, for example, are also familiar with them,
right?
Probably.
I don't
think there's no place for narrative medicine in the Polish
healthcare system.
I think there is.
However, implementing it,
even if it were to exist,
would be difficult.
Because, de facto, there's no
place for it today,
because there are time limits,
patient admission limits, and
billing with the National Health Fund (NFZ) is handled in a particular
way.
And right now, there's no room to
see a patient through primary care and
talk to them for half an hour.
Because there's a line of snotty people in the hallway,
nervous
about whether they'll get to see the doctor
or not,
whether the doctor will stay after hours
to see them
or not.
They're already arguing with each other about
who was first in line.
A queue,
yes.
Queue philosophy.
Exactly.
Then they argue with the doctor about
who was first in line,
so that's how it is at the moment.
And we're faced with a moral dilemma here.
Should we devote as much time to the patient
as they would like, and how much would be good
for the patient, for the patient and for us as well,
for our own mental health?
Or should we admit all 30 people
standing outside the door,
because that's an ethical issue,
right?
One decision has its advantages and the other has its
advantages.
Should we admit 10 people during the day and do it
well,
or admit 30
so that their needs are met,
so that they're met somehow,
at least somewhat,
but still.
Should we issue sick leave certificates to these people.
And so that the system continues to run.
Exactly.
And I do
n't think there's a good answer to this right now
. But I think
there's room for implementing narrative medicine
, it
just requires systemic changes.
Because in the system
as it is,
I don't really see it happening.
However, considering the burnout of
healthcare workers,
the flight to other sectors,
the flight from the public sector to the private sector, and
this exodus of specialists, especially
since residents are generally bound by an employment contract
and must be in the public system—
not always in that way,
but in the vast majority of cases—
I think
that if we don't do something
to start encouraging people to work in
medicine,
we'll wake up in a bad state in,
I don't know, say 10 years from now,
right?
So I see a role for narrative medicine in preventing
this burnout.
Narrative medicine serves not only to recognize
the needs of patients
but also of medical staff.
It's about recognizing not only the patient's role in
their family,
social,
and cultural context,
their life story,
but also seeing my relationship—
me and the patient
sitting across from me.
So I also add to this understanding, perhaps
medical practitioners themselves—
understanding:
Why do I feel more tired lately?
Or why don't I feel like coming to work?
Why are these patients starting to annoy me?
For example,
why do I feel like sending them out the door?
Instead of snapping at them, like,
"I don't have the energy anymore and you can go away,"
maybe we should just pause
because the system doesn't give us the space.
So if we feel
the system isn't giving us the space,
then we don't give ourselves the space either.
It's a domino effect.
I see narrative medicine as a tool
that could help
counteract this,
even if only to a small extent, and I'll also say right away
that it's probably not the optimal solution for everyone
.
I'd like to see systemic shifts
that would allow for the implementation of these solutions.
That's how I would put it.
But how do we do it,
right? I feel it's primarily about long-term success.
But I think it's
about stimulating that mountain
that can make a difference.
Well, yes, yes.
As a medical community, we raise many issues.
Burnout is one of them.
No one yet proposes narrative medicine as
such, using that phrase. For example
,
the issue of documentation is often raised
.
And I have the impression
that when we talk about
filling out documentation,
which takes more time, and we don't have time for
the patient
because we have to look at paperwork,
we're talking about this lack of time to
understand ourselves better in this relationship.
And the practice of narrative medicine assumes somewhere
that
the doctor can take these
parallel notes,
right? So how do I even think about
where else I can squeeze in time to
take parallel notes during this visit ?
And I also have the impression
that sometimes when I talk to doctors about
narrative medicine,
they laugh a little at me.
They say,
"Where else am I supposed to take mindful notes?"
This is also a good time
to say
that's not what I mean,
to squeeze that into those seven minutes,
because that would be terrible,
I think.
It's just to change the system so
there's at least a little more space for it.
But to start practicing,
you have to learn,
right?
And maybe we could talk about those narrative medicine workshops
for a while,
because it's amazing
that you attended one.
Please
tell me, and all of us,
what it's like,
right? What do these workshops look like?
How long do they last?
Is it one day,
two hours,
maybe a two-day meeting?
And what do you do during them?
The fact
that we attended the Milan
workshop with the book editor,
Hubert, and Mateusz,
not just once,
but later Mateusz and Hubert also led a
working group
where they led,
we conducted our own work on
how to manage this.
The workshops with Rita were our model,
but also, drawing from the practice of narrative medicine,
we conducted participant observation of these workshops
within our own working group,
also with people involved in this practice and
disseminating this approach in Krakow.
As for Rita,
Professor Sharon had a phase for discussing
works of art and led several
workshops
in a row where paintings were discussed.
We focused on paintings,
so we shared our observations and
feelings about the painting.
Then we wrote a short text related to the painting.
People
who wanted to read the text
had this phase.
Was that creative writing?
Yes, yes.
They had a chance to share
their text.
Those
who didn't feel like it
didn't have to.
The professor offered her own comments.
Participants could also share,
but we were doing a close reading of a painting.
So it's possible too.
Mateusz and Hubert, I also once pored over
a musical work.
So this close inquiry takes on various forms.
Not just literary texts,
as it turns out.
Cultural texts. Cultural texts,
more broadly speaking.
Paintings,
musical works,
and,
I don't know, theater performances could also be included here.
Probably yes,
although I don't know from my own photography.
Well, some
other codes, right ?
Because it's all about this methodology of
mindfulness,
drawn from literary studies,
but also from mindfulness practice.
We began these Krakow narrative medicine meetings
with a short mindfulness practice.
A strictly mindful
mindfulness practice.
Where in Poland can you get into a
narrative medicine workshop,
or perhaps these narrative meetings?
Krakow is certainly one such place.
It's the Medical Humanities Club,
right? At the Jagiellonian University.
It's now called the
Medical Humanities Laboratory,
right?
Because
we finished our studies and stopped being a club.
Yes,
yes.
But the idea persists,
right? The idea persists,
yes.
There will be a three-day meeting in Leńcze near Krakow,
with several narrative sessions.
It also seems
that bringing together people
who are already working on this
isn't a criterion;
it just happens
that those
focused on working on methodology and
refining this methodology somehow
meet.
We're certainly not the only ones.
Is there a source
where one can learn about such
planned events?
There is.
I think
there's a website called narrativemedicine.less.pl
There's also a website for the Medical Humanities Laboratory
right here in Krakowska Street.
Our Medical Communication Studies also sometimes
engage in such things,
but rarely, only occasionally.
However, we encourage you to contact
us personally. That doesn't mean
it's not happening,
but you have to let us know
what you'll organize.
Exactly
We're committed to this, and we're constantly on the subject,
so you can simply
contact us directly, using different names.
And call a meeting.
Yes,
the meeting with Rita Sharon, for example, consisted of
two such hour-long meetings with a break.
So, if you don't have to go to university,
but for a master's degree, no.
You can also look for such places in our country.
Definitely yes.
But you don't even have to go overseas,
because some of the courses offered by Colombia
are online.
And you can sign up for such courses and participate
in meetings with the founders of this field.
A lot is happening in Sweden too,
right? As you said,
right? Or in Germany, I suspect
it will be established in Europe.
In Italy.
In Italy, yes,
yes.
There's a strong group in Italy.
Exactly.
Also centered around adepts.
So maybe it will slowly move further east and
It will also encompass us here,
increasingly.
So,
let's finally return to teaching.
In the medical communication program, you teach future
physicians, right,
because you have courses focused on
patient communication. Do you,
I don't know, manage to consider elements of
narrative
medicine in this curriculum?
Is there even room
to incorporate such elements of narrative?
Developing communication skills.
It seems like
it could be done,
right? I think
that when teaching communication , we
inevitably touch upon narrative medicine,
because these are interconnected topics, and some of these
issues overlap.
Within the program, we teach communication skills—
what I'd call
evidence-based medicine—
because we rely heavily on
how
research shows
it's beneficial.
Research clearly shows
that good communication skills are beneficial in
practice.
This applies not only to communication skills with
patients,
but also between colleagues.
Medicine is specializing,
expanding,
more and more consultations are being requested,
more and more consultations are being held.
In the emergency department, sometimes several specialist consultations
are held.
So we teach these strictly communication skills,
but good communication requires some
consideration of the other.
Yes,
of the participant in this communication,
at least one.
And of
how I
present myself , in what light, when sending a given
message,
so I think they are closely interconnected.
If we want to develop the methodology of
narrative medicine,
communication is an excellent foundation, and we have this foundation,
because there is a communication program at the
Medical University of Warsaw.
Communication is also studied very intensively at
the Medical College of the Jagiellonian University,
as part of the Department of Didactics and Medical Education.
And when it comes to specifically teaching
narrative medicine at the University,
there were elective courses at the Jagiellonian University,
I think last academic year.
Registration was open, and those classes have already started.
Two years in a row, I offered this
option to medical students at
the Medical University of Warsaw, and each
time, two people signed up.
So, interest isn't zero,
but it's low.
But it's also another example
of Krakow having a different kind of ground.
Maybe.
Maybe,
but I also think
that practical aspects also come into play,
because it also depends on
the percentage of e-learning courses
versus in-person courses.
Various factors come into play.
However, I'm not devastated.
I'm very happy
that these two people signed up.
I think we'll meet again
somewhere down the road.
I don't know,
nothing just yet.
These weren't random people.
Yes, and for me, it's also an exercise,
because I have to construct a goal or reflect
on
what I want to teach,
why I want to teach it,
not just,
oh,
here's narrative medicine,
get this.
Why am I offering this to students?
Why as a doctor?
I think it could be valuable.
The name itself is still on my mind,
right?
Narrative medicine.
So if we give,
well,
a subject with that name to medical students,
Well, they might not know
what to expect,
right?
A separate subject with that name,
in itself.
Maybe we're not ready for it yet,
as, I don't know,
a community,
but maybe we could connect these elements,
right? With developing communication skills,
right?
And incorporate elements of narrative medicine as such,
yes,
as supporting tools,
because I think the feeling
of communicating well is important.
It's almost like we already have it.
So, if there's a readiness for communication education,
and in this way, we could even
broaden the horizon and show
that there are spaces,
like narrative medicine,
that elegantly support us in communication.
This expression has a narrative element to it,
which is treated by many people,
confused with fiction,
right?
That it's actually medicine,
some kind of invented medicine.
What is that,
right?
That was interesting.
Oh, exactly.
I hadn't even thought about
that there actually was such a connection,
right? That he associated narrative with fiction.
Because we associate narrative with literary fiction,
right?
So,
what's that?
I don't have time to listen to some delusions,
right?
A patient and so on.
He'll be talking
nonsense ,
and I have to sift through
what's true
and what's not.
I've encountered those kinds of voices somewhere,
haven't I?
Critical ones,
sort of resisting.
So I don't know,
maybe there's something to the name itself.
You see,
I've been involved in this so long
that it seems to have stopped resonating with me.
So I no longer think about the fact
that narrative actually stands very close to fiction
And it's about a certain context of
how we speak,
why we speak that way.
A narrative.
Each of us has some kind of narrative.
We have a narrative of our own life.
Although I've read
that not everyone has an internal narrator.
That surprised me.
I've read
that not everyone has an internal narrator.
I do.
But I think
it's fair to say
that most people have this inner narrator, and
that's how we go through life,
maintaining our own internal narrative and placing
events in a chronological order or
in terms of importance.
Returning to certain events,
restoring them.
In some way, we're embedded in this universe,
and it seems
to be a narrative approach.
I recommend considering your own narrative.
If you're a doctor,
I recommend considering your patient's narrative.
It can be truly interesting.
It can also contribute to our lives.
I think
meeting someone
who comes to us,
sharing a burning issue,
is also a privilege.
To hear something like that from someone.
It's a close connection;
we're often with these people in crisis
situations,
often at the most important moments in their lives,
depending on their specialization,
I think.
But many people are—
for example, an emergency medicine specialist,
when they save someone after an accident,
it can be the most burdensome
event of their entire life.
And it's a psychological burden
that we often don't recognize.
I'm learning to avoid generalizations,
but it's hard.
I also gained a sense from my studies,
That we pretend
it doesn't burden us,
that we're so resilient, and we're also
taught
to be resilient or we can go find
another profession,
to that extent.
Maybe it's changing,
maybe,
I don't know.
I have the impression
that in my day it was like that.
I think
many people would agree with me.
This can be a bit difficult,
because these difficult emotions
don't disappear;
they tend to linger in most people,
maybe not everyone,
but I think
in many,
certainly in me.
And that's one thing,
and two,
too,
and two,
well, it's that
you can learn to tell the story of your life
as a doctor in a different way,
because you can also begin to see these difficult moments
as a privilege of being with someone through
moments in life
that are difficult,
important,
that somehow change their attitude,
their perspective on the world.
And often, being that companion is very
significant for that person.
I think we,
as the years go by,
when you practice this profession,
you see it less and less.
I have the impression
that it's becoming a daily occurrence,
that this is my job,
right?
An accountant fills out Excel spreadsheets,
and I have a job
where I'm a companion.
I'm not saying
it has to be a duty,
but it can simply be beneficial,
sometimes to look at it and think,
but damn, what I do
is important.
Maybe I'm important to my community,
to my hospital,
to these people.
Maybe I've contributed something good to their lives.
Great,
so this kind of mindfulness, also for myself.
For myself.
Focused on myself.
And for things
that become obvious,
or maybe it would be better
if they didn't.
Wow,
beautiful.
And do you think
narrative medicine is a space
where humanities scholars can somehow find their feet,
give something of themselves,
to the world.
Well,
I think
the very fact
that this came into being
is thanks to the fact
that people are conducting research on literature,
culture,
art,
music—
it's thanks to you,
so to speak.
People say
the humanities are in crisis,
that they're unnecessary to society,
but with this project we also want to show
that this isn't the case at all. That
the humanities also address difficult topics and can
provide certain tools,
inspiration,
for representatives of more useful specialties
to work together.
I wouldn't want to be the voice of the community,
because I don't know what the mood is on this aspect in
my community,
but I can speak for myself and for
the group of doctors
I know and who are also close to me,
that there is a place for this.
There is a place for this in our practice.
I certainly see
that my life would have been less valuable
if I had never come to the Faculty of History and
the Institute of Ecynology and Cultural Anthropology.
I think
my practice would also have suffered
because my practice,
whether I like it
or not,
is rooted in the
person I am.
Medical practice,
my medical practice.
Maybe it's a bit specific,
because I specialize in psychiatry,
so in psychiatry, you can't escape
narrative,
no matter
how hard you try.
Perhaps in other fields, you can try.
So I definitely see it too.
People
who want to pursue humanities,
medical humanities, certainly have a place for them
in narrative medicine,
in narrative sessions,
or sessions conducted, for example, for patients,
where perhaps,
if a doctor doesn't have time
to grasp certain aspects of the narrative,
perhaps a literary scholar could do it
Are there such sessions for patients in Polish
hospitals?
I don't think there are any in Polish hospitals.
At least, I'm not aware of any.
I was surprised.
However, I know
they are abroad. Authors
who have dedicated their practice to narrative medicine
are organizing them in this book .
They write about
such narrative sessions being organized,
for example, they are very common and
especially appreciated in oncology wards,
where treatment is long-term,
involves life-threatening situations and
there is a risk of death.
And there, it has its place.
I think
it can be an extremely important
experience for these patients.
Well,
maybe a doctor doesn't have to be involved in everything.
Perhaps this could be part of some kind of oversight,
just as
a nurse or
a laboratory diagnostician is part of a therapeutic team.
I think
there's a place for that.
I do.
It would be wonderful
if such a therapeutic team also had
a place for a humanist,
a philologist,
who is everything,
a philosopher,
yes. But isn't it somehow fundamental that
ethics are inherently linked to medicine
?
And you can't deny that,
what ethics are.
The humanities in their purest form.
So people
who say
it's unnecessary...
I don't know.
Exactly, because we think of medicine
as being more on the side of the exact sciences,
but then again, there's probably no other field that
touches people so deeply
, and doesn't take as much interest in them as,
well, medicine.
So, in a sense, it's immersed in
the humanities.
I also wonder
how much of this is an expression of certain frustrations and
needs.
People practicing medicine—
this is also a hypothetical,
perhaps psychoanalytical, consideration,
but perhaps it's somehow important
to understand how these needs of people practicing medicine
have been frustrated time and time again,
for many years,
that we've become so entrenched in this approach,
that we don't need the humanities
because we don't even want to think about it anymore.
Perhaps if we loosen it up a bit,
there might be more space.
I think
this view can absolutely be justified in a very
fundamental way:
that there is a place for it, and I would like
there to be, and I know at least a few
people
who agree with me,
that's how we say it.
I agree too,
I'm joining the ranks of those people.
Thank you, Adrianna.
Thank you very much.
For the conversation,
for the meeting.
A very pleasant meeting.
We could continue
like this.
And we will probably continue somehow.
And we will continue somehow.
There is hope,
there are people in this country
who believe in narrative medicine and believe in
some kind of change,
so I think
we're on the right track.
Thank you for this appreciation of the humanities,
for recognizing their components in various spheres
of our lives,
for the fact that they too have something to say.
But to put it in perspective,
to impress everyone,
That this is important,
that we are here
to make a difference.
So thank you again, and see you soon.
See you soon.
The "Engaged Polish Studies" podcast series was produced
as part of the "Polish Studies and the Challenges
of the Modern World" project.
Co-financed from the state budget under
the "Science for Society 2"
program of the Minister of Education and Science.
The project number is in the description.
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