insights

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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 help the clinician and patient enter into a meaningful discussion but also provide 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 a clinical framework that recognizes, values, and uses an individual’s health story to deliver the most effective health care.¹ In an interview featured in Columbia University’s Insight into Diversity, Dr. Charon emphasized the importance of considering the individual patient’s life and health experiences as part of their clinical assessment in order to connect with the patient and provide better care.²

A core component of functional medicine is the use of the functional medicine timeline to record and reflect 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.

—Dr. Roca

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 functional medicine 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 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.

—Dr. Roca

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.

A systematic review of the literature published in BMJ Open found that narrative medicine educational programs in academic medicine and health sciences had high participant satisfaction as well as positive outcomes across various competencies.¹ For example, the evaluated programs were found to improve several skills such as relationship building, empathy, resilience and burnout detection, and narrative competence.¹

The importance of empathy in healthcare professionals has been a subject of study in recent years.^3,4 Compassion continues to be recognized as an integral part of patient-centered care,^5,6 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.⁷

A mutually empowering patient-practitioner relationship is a key element in functional medicine and one that is enhanced by the use of the functional medicine timeline along with an empathetic approach. Learn more about the power of the therapeutic partnership during IFM’s Applying Functional Medicine in Clinical Practice (AFMCP) course and explore the IFM-authored articles below.

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References

1. 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
2. Bohanon M. The evolving field of narrative medicine reaches the ‘core of the human condition.’ Insight Into Diversity. Published April 19, 2019. Accessed June 6, 2023. https://www.insightintodiversity.com/the-evolving-field-of-narrative-medicine-reaches-the-core-of-the-human-condition
3. Moudatsou M, Stravopoulou A, Philalithis A, Koukouli S. The role of empathy in health and social care professionals. Healthcare (Basel). 2020;8(1):E26. doi:3390/healthcare8010026
4. Zmijewski P, Lynch KA Jr, Lindeman B, Vetter TR. Narrative medicine: perioperative opportunities and applicable health services research methods. Anesth Analg. 2022;134(3):564-572. doi:1213/ane.0000000000005867
5. 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
6. Fan YC, Hsiao FH, Hsieh CC. The effectiveness of compassion-based interventions among cancer patients: a systematic review and meta-analysis. Palliat Support Care. 2023;21(3):534-546. doi:1017/S1478951522001316
7. 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
8. 12.599