Righting the Medical Record

Narratives of illness in medical records and case presentations in teaching hospitals say surprisingly little about an important matter: what patients understand and feel. Nowadays, medical narratives tend to neglect or objectify subjective experience, including symptoms. Such narratives concentrate, in the manner of chronicles, on events in the exterior, objective world rather than the interior world of the sick. Medical students and physicians will construct more balanced accounts of human illness once they envision these accounts as "story", a form of narrative that traditionally accesses subjective experience as well as objective events. One can effectively begin the process of transforming medical chronicles into stories simply by asking patients what they know and how they feel about their situation and by documenting the response, using some of the patient's words, in the history of present illness. These actions will identify and preserve important information, facilitate empathy in all care givers who hear or read the history, and signal to everyone the physician's serious interest in patients as persons. Getting the voice of the patient into the history of present illness will not only help to right the medical record, but also help to right the relationship of physician and patient.