Narrative based medicine: dialogue and discourse in clinical practice.

T Greenhagh, B Hurwitz (eds). (304 pages, £19.95.) BMJ Publishing Group, 1998. ISBN 0-7279-1223-2. When we practice medicine, we should listen to the stories that our patients tell and offer our understanding. Or we should help our patients re-tell their stories in a way that both patient and doctor can agree to be useful in understanding what is happening. Or we should help distressed patients write down about themselves, so that they can feel some fulfilment in knowing that at least what they have written will live on after them. There are so many different ways of hearing and understanding the developing sagas that patients and their carers experience. The editors of this interesting book clearly feel that it is time to wrap some academic respectability around the activity that every true clinician enjoys more than any other—that of listening to patients and struggling to make sense of it all. This book is published now in order to promote this old-fashioned stuff about essential listening skills in facing up to the current highly fashionable vogue for evidence-based medicine (EBM). Politicians and health economists are already looking to EBM to rationalize the use of scarce resources and to clinical guidelines to control clinicians' profligacy. We need this well-presented case, which argues for clinical freedom and idiosyncratic but highly personal professional caring. Each of the many contributors to this volume ap-proaches the task from a different point of view. Patients describe their experience. Physicians, surgeons, GPs and psychiatrists all have a turn and we get ethical, legal, electronic and anthropological angles in short succession. It is impossible not to find sections that are a joy to read as well as having plenty with which to argue. Ruth Richardson's wonderfully eerie envoi ends the main text in yet another totally different shift of gear. It all makes for a stimulating, thought-provoking polemic, ending with important chapters by each of the editors and arguing for the prime place for narrative within clinical practice in a working relationship with epidemiology and scientific research. But I wish they had given more space to how you teach all this to young doctors trying to work under intolerable time pressure. The recommended reading lists of the classical literature are fun but a long way from where most exhausted youngsters are. I think that the next generation will need to re-invent something like a Balint group in which they can work out still newer solutions for themselves.