Can Narrative-Based Medicine Improve Canadian Healthcare? – Medscape

Report on Narrative-Based Medicine and its Alignment with Sustainable Development Goals

Introduction to Narrative-Based Medicine (NBM)

Narrative-Based Medicine (NBM) is an evolving clinical practice that utilizes the stories of patients and clinicians to improve healthcare outcomes. It functions as a framework to restore empathy, build trust, and strengthen the patient-provider connection. The practice is founded on the principle that understanding health and illness is a collaborative narrative co-authored by all individuals involved in a patient’s care. This approach is gaining global interest for its potential to humanize medical practice.

• Core Principle: NBM centers the patient’s story, giving all participants equal agency in healthcare discussions.
• Key Techniques: The practice emphasizes skills such as “close listening,” “reflective thinking,” and “generous listening” to understand both spoken and unspoken aspects of a patient’s experience.
• Methodology: NBM can be delivered through various mediums, including art, music, movement, and writing, to facilitate expression and communication without judgment.

Contribution to SDG 3: Good Health and Well-being

NBM directly supports the achievement of Sustainable Development Goal 3 by promoting holistic health for both patients and healthcare providers. Its implementation strengthens health systems from the foundational level of the clinical encounter.

1. Improved Patient Care and Outcomes: By fostering authentic engagement and “engaged concern,” NBM ensures that clinicians are more present and conscious during patient interactions. This leads to a deeper understanding of the patient’s condition within their unique life context, contributing to more effective and compassionate care.
2. Enhanced Well-being of Healthcare Professionals: NBM offers a critical tool to combat physician burnout, a significant challenge to workforce sustainability, with rates affecting at least 46% of Canadian physicians. By creating supportive spaces for sharing and processing challenging experiences, NBM helps clinicians metabolize the stresses of their work, preventing the emotional exhaustion that leads to burnout.
3. Strengthened Health Systems: The practice reinforces the relational aspect of medicine, building trust and improving communication. This strengthens the patient-provider relationship, which is fundamental to a resilient and effective healthcare system.

Advancing SDG 4: Quality Education

The integration of NBM into medical school curricula is a significant step toward advancing SDG 4 by enhancing the quality and scope of medical education. It aims to develop physicians who are not only clinically proficient but also deeply humanistic.

• Holistic Medical Training: NBM embeds “not biomedicine” elements into medical training, teaching future practitioners the essential relational and reflective skills needed for their work. It is currently offered in approximately 80% of U.S. medical schools.
• Development of Core Competencies: The practice supports the development of crucial capabilities for effective healers, including caring, emotional resonance, attunement, and interpersonal skills.
• Preventing Professional Detachment: By incorporating NBM early in training, medical students are encouraged to retain the empathetic parts of themselves that are vital to their role, ensuring they develop into “fully fledged physicians” rather than detached technicians.

Supporting Broader Sustainable Development Goals

Beyond health and education, the principles of NBM contribute to a wider range of Sustainable Development Goals by fostering equity, decent work, and stronger institutions.

• SDG 8 (Decent Work and Economic Growth): By providing a mechanism to address and prevent burnout, NBM contributes to creating a safer, healthier, and more sustainable work environment for healthcare professionals, aligning with the goal of decent work for all.
• SDG 10 (Reduced Inequalities): NBM requires clinicians to consider the environmental, social, and cultural influences on a patient’s narrative. This focus on individual context helps practitioners provide more equitable care that is sensitive to the diverse experiences and vulnerabilities of different populations.
• SDG 16 (Peace, Justice and Strong Institutions): By promoting trust, empathy, and mutual understanding, NBM strengthens the integrity of healthcare institutions. It fosters a more just and people-centered approach to medicine, enhancing the accountability and effectiveness of the healthcare system.

Analysis of the Article in Relation to Sustainable Development Goals

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 3: Good Health and Well-being
   • The article focuses on Narrative-Based Medicine (NBM) as a practice to improve the quality of healthcare. It aims to “restore empathy and trust and strengthen personal connections” between clinicians and patients, which directly contributes to better health outcomes and patient well-being. Furthermore, it addresses the well-being of healthcare providers by offering a potential solution to physician burnout, a significant issue affecting the health workforce.
2. SDG 4: Quality Education
   • The article explicitly discusses the integration of NBM into medical training. It states that NBM is “currently offered in approximately 80% of US medical schools” and that the goal in Canada is to “embed the things that I call ‘not biomedicine’ into the training and practice of medicine.” This highlights a shift in medical education towards developing capabilities like “caring, reflection, emotional resonance, attunement,” which are essential for creating well-rounded and effective physicians, thereby improving the quality of education for health professionals.
3. SDG 8: Decent Work and Economic Growth
   • The issue of physician burnout is a central theme, with the article noting it “affects at least 46% of Canadian physicians.” NBM is presented as a tool to create “supportive spaces for sharing stories” which can “help with burnout.” By addressing the mental and emotional strain on clinicians, NBM contributes to creating a safer, more secure, and sustainable working environment for the healthcare workforce, which is a key aspect of decent work.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.c: Substantially increase health financing and the recruitment, development, training and retention of the health workforce, especially in developing countries and small island developing States.
   • While the article is set in a developed country context, the principle of developing and retaining the health workforce is directly relevant. NBM is discussed as a method for the professional development of clinicians (“what practitioners need to know about to do their work better”) and as a crucial tool for retention by addressing burnout, which is a major factor in physicians leaving the profession.
2. Target 4.7: By 2030, ensure that all learners acquire the knowledge and skills needed to promote sustainable development, including, among others, through education for sustainable development and sustainable lifestyles, human rights, gender equality, promotion of a culture of peace and non-violence, global citizenship and appreciation of cultural diversity and of culture’s contribution to sustainable development.
   • NBM, as described in the article, equips medical students with skills that align with the ethos of this target. It fosters “empathy,” “engaged concern,” and an “appreciative understanding of the world and the complex experiences that we all live through.” By teaching clinicians to listen to and value individual patient stories, which are “influenced through society, culture, and family,” it promotes an appreciation for cultural diversity and strengthens interpersonal understanding, which are core skills for global citizenship.
3. Target 8.8: Protect labour rights and promote safe and secure working environments for all workers, including migrant workers, in particular women migrants, and those in precarious employment.
   • The article highlights the challenging working environment for physicians, leading to high rates of burnout. It states that NBM can “help clinicians metabolize the challenging experiences that they face” and address the “unprocessed, difficult experiences” that contribute to burnout. This directly relates to promoting a psychologically safe and secure working environment for healthcare professionals.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Rate of physician burnout.
   • The article provides a specific statistic: “physician burnout, which affects at least 46% of Canadian physicians.” This figure serves as a direct, measurable indicator. Progress towards Targets 3.c and 8.8 could be measured by tracking the reduction in this rate over time as practices like NBM are implemented.
2. Percentage of medical schools incorporating NBM or humanities into the curriculum.
   • The article mentions that NBM is “currently offered in approximately 80% of US medical schools” and that “Canada is slowly catching up.” This suggests that the prevalence of such programs in medical education is a key indicator of progress towards Target 4.7. Measuring the percentage of medical training institutions that have formally integrated these humanities-based practices would quantify this progress.
3. Physician retention rates.
   • While not explicitly stated with a number, this indicator is strongly implied. The discussion of NBM as a tool to combat burnout, a major reason for attrition in the medical field, suggests that an improvement in physician retention would be a key outcome. Measuring the retention rate of clinicians in health systems that actively promote NBM would be an effective way to gauge progress towards Target 3.c.

4. Summary Table of SDGs, Targets, and Indicators

Source: medscape.com