Narrative Diagnosis
Narrative Diagnosis
Since 2008, coroners' courts in the UK have allowed 'narrative verdicts'. They now accept that it is sometimes impossible to assign any single cause to a death, such as natural or accidental death. Instead of forcing juries to strive for the illusion of certainty, or to try and squeeze all the evidence into pre-ordained categories, the law now allows them to describe what has happened, to set out what is known and unknown, and to express their views in narrative form. This is such a sensible option, and so clearly fits with all the complexities and ambiguities of real life that it seems surprising that it took so long for anyone to come up with the idea.
It also makes one wonder why a parallel concept of 'narrative diagnosis' hasn't become established in medicine. Complexity and uncertainty are surely as common in medical practice as in the law, if not more so. As doctors, we often find ourselves having to try to name things for which there are no easy names, or struggling to pretend that something can be described by a single label when in reality it cannot. We are all probably guilty of offering a firmer diagnosis than the circumstances sometimes warrant, simply because we believe that is what we are required to do. As a profession we commonly invent labels for dubious 'grey area' conditions that we cannot fully understand or that refuse to fit into existing boxes. A narrative diagnosis would fit these circumstances very well.
Narrative concepts are of course already familiar in medicine. The whole field of 'narrative medicine' has expanded greatly in recent years, with a number of different schools of thought and practice flying under that banner. All of them share the same fundamental belief, namely that telling stories lies at the heart of human endeavour, and that patients and doctors—like everyone else—engage in continuous story-telling to make sense of their own experiences. Although no-one seems to have named the concept of narrative diagnosis before, many authors in the field of narrative medicine have addressed related topics, including the benefits and disadvantages of giving a medical name to someone's condition, and why we sometimes give names to problems that might be better off without any.
Abstract and Introduction
Introduction
Since 2008, coroners' courts in the UK have allowed 'narrative verdicts'. They now accept that it is sometimes impossible to assign any single cause to a death, such as natural or accidental death. Instead of forcing juries to strive for the illusion of certainty, or to try and squeeze all the evidence into pre-ordained categories, the law now allows them to describe what has happened, to set out what is known and unknown, and to express their views in narrative form. This is such a sensible option, and so clearly fits with all the complexities and ambiguities of real life that it seems surprising that it took so long for anyone to come up with the idea.
It also makes one wonder why a parallel concept of 'narrative diagnosis' hasn't become established in medicine. Complexity and uncertainty are surely as common in medical practice as in the law, if not more so. As doctors, we often find ourselves having to try to name things for which there are no easy names, or struggling to pretend that something can be described by a single label when in reality it cannot. We are all probably guilty of offering a firmer diagnosis than the circumstances sometimes warrant, simply because we believe that is what we are required to do. As a profession we commonly invent labels for dubious 'grey area' conditions that we cannot fully understand or that refuse to fit into existing boxes. A narrative diagnosis would fit these circumstances very well.
Narrative concepts are of course already familiar in medicine. The whole field of 'narrative medicine' has expanded greatly in recent years, with a number of different schools of thought and practice flying under that banner. All of them share the same fundamental belief, namely that telling stories lies at the heart of human endeavour, and that patients and doctors—like everyone else—engage in continuous story-telling to make sense of their own experiences. Although no-one seems to have named the concept of narrative diagnosis before, many authors in the field of narrative medicine have addressed related topics, including the benefits and disadvantages of giving a medical name to someone's condition, and why we sometimes give names to problems that might be better off without any.
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