Koki Kato

Narrative based medicine in an evidence based world An official website of the United States government

The full text here.

pmc.ncbi.nlm.nih.gov/articles/PMC...

Refining one's approach to engaging with narratives contributes to the diagnosis. I believe that no matter how thoroughly one examines physical findings or test results, relying solely on these can sometimes fail to convey the meaning in a way that resonates with the patient.

Narrative based medicine in an evidence based world This is the last in a series of five articles on narrative based medicine In a widely quoted riposte to critics who accused them of naive empiricism, Sackett and colleagues claimed that “the practice...

Greenhalgh T. (1999). Narrative based medicine: narrative based medicine in an evidence based world. BMJ (Clinical research ed.), 318(7179), 323–325. doi.org/10.1136/bmj....

That might wound and shatter the authentic voice. Instead, one must work upon the outer shell so that it can emerge from within. One works to enable its emergence, yet whether it comes forth is left to the inner voice. Otherwise, no one can know what has emerged.

To hear the genuine voice, one must listen within the other. Yet to hear the inner voice, one must act from without. But this is not a method of digging something out from the outside.

Ultimately, if one insists on adhering strictly to objective observation, the information that can be incorporated into it becomes nothing more than the commonplace. While depicting a rose using a ruler might be objectively demonstrable, much information would be lost in the process.

However, when one instead treats the observer's subjectivity as information, the information content of that observation increases further by also noting what that subjectivity is based upon.

When attempting to be objective in observation, the observer's subjectivity becomes a bias, so one strives to exclude it.

Could it not be said that the meaning of illness is a kind of creation by the patient? And the listener who is there is also there as a creator. A new narrative is born when the listener asks questions to 'fill in the gaps'.

From ‘How to Read Literature Like a Professor’ Japanese edition by Thomas Foster

The figure is drawn like a sketch in the writer's invention, but in the second reader's invention, the gaps are filled by taking on that figure. So we sometimes, without realising it ourselves, fill in the gaps with elements not in the text.’

The writer invents a character using memory, observation and creativity, and the reader - not the reader as a set, but the individual reader of the book - reinvents the character using their own memory, observation and creativity.

'Characters are the product of the writer's imagination - and the reader's. These two strong dynamics create characters in literature.

This is why neutrality is essential here: an Intentional stance of not knowing.

Intertextual awareness is essential, but whereas with a literary work in the public domain, it is possible to find out if we have read it or not, with a biography, the connection is only possible in a dialogue with the patient.

It is essential to explore how the patient's past experiences and predictions for the future are connected to the present, but this is a task that only the patient can do for themselves.

How is the present state of affairs connected to what we are discussing? Asking questions in the dark does not reveal meaningful connections.

Inductive Foraging.

The first part of the medical interview is to let the patient narrate and retain the information that comes out of it.

So we explore context. Context comprises ‘con’ and ‘text’, whose origin is in weaving together (of back and forth). The narrative approach is sometimes described as 'weaving a beautiful tapestry', which is aptly put.

Intertextuality means that works in the present are imbued with specific meanings in relation to works in the past. When we think about narratives, we are searching for this intertextuality.

Temporality in phenomenology (how one is anchored within the present, which is imbued with specific meaning by past experiences and an anticipated future) is related to intertextuality in literary theory.

clinicaterapeutica.it/ojs/index.ph...

GPs are not ‘things’ ‘People are not things’   is a memorable mantra, sometimes attributed to the late Lord David ‘Rambo’ Ramsbotham (1934–2022), a former British army general and outspoken chief inspector of prisons. The...

bjgp.org/content/73/7...

Ferrara, V., Pozzilli, P., De Gara, L., Mancuso, T., La Torre, G., & Guarino, M. (2025). The Art of Observation - How Art Enhances Healthcare Professionals' Skills. La Clinica terapeutica, 176(5), 672–674.

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@syjameel.bsky.social

doi.org/10.1093/jmp/...

Here is where Eric Cassell, Joanne Reeve, John Gabby & Andreē Le May, Sabena Jameel and Aristotle come in. I can also see where the narrative approach is positioned within it. I feel like I have found a missing piece.

Sabena Yasmin Jameel, A Critical Interpretive Literature Review of Phronesis in Medicine, -The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine, Volume 50, Issue 2, April 2025, Pages 117-132.

I recommend this paper to GENERALISTS. It is about PRACTICAL WISDOM, which is not often written about coherently.

Whether technē (doing) or phronesis (being) is more important in medicine depends on the goal: whether the goal is the treatment of disease or the healing of illness.