An Overview of Narrative Medicine in China

This paper sketches the history and the author’s involvement in the development of narrative medicine in China.It also describes“narrative medicine with Chinese characteristics,”explaining why narrative medicine is regarded as a tool to materialize the medical humanities in clinical practice,and detailing the features of narrative medicine in China.The features include the wide acceptance of the“22334 model”of narrative medicine,and borrowing theories and practice from Traditional Chinese Medicine.Finally,the author argues that the medical humanities should be given a“Class-A discipline”status,and narrative medicine should be a class-B discipline under the medical humanities.

The Inheritance and Development of Chinese Narrative Medicine Practice to the Philosophical Wisdom of Traditional Chinese Medicine

Starting from the inheritance and promotion of Chinese life philosophy and traditional Chinese medicine wisdom by Chinese narrative medicine practice,this paper discusses the inheritance and echo relationship between the“close textual reading ability”in Chinese narrative medicine practice and the“four diagnoses”in traditional Chinese medicine wisdom,narrative mediation and the“mind-body holistic philosophy”in traditional Chinese medicine,and narrative wisdom and Dao Sheng in Chinese life philosophy.Meanwhile,by analyzing the stories of contemporary doctors’practice of narrative intelligence,this paper expounds that Chinese narrative medicine is a new model of medical education and clinical practice based on the absorption of Chinese traditional life wisdom and the essence of traditional Chinese medicine culture,and the integration of western narrative medicine concepts.It also advocates Chinese scholars to actively build the discipline of“narrative traditional Chinese medicine,”constantly translate the academic achievements to foreign countries,and create a good narrative ecology of traditional Chinese medicine.

Narrative Medicine Under the Guidance of Traditional Chinese Medicine Theory

This paper is an exploration into the practice of narrative medicine in the clinical setting guided by the theory and approaches of traditional Chinese medicine(TCM).By adopting the theory of TCM,the author attempted to provide the patients with systematic treatment from the perspective of society-psychology-biology under the guidance of both the unity of Heaven and Man,and the unity of Xing(Body)and Shen(Mind/Spirit)through his clinical practice.Guided by yin-yang and Wu Xing(Five Elements)theory and focusing on the social relations of the patients for any possible relationships between patients’social,psychological and biological state,the author took the patients’emotion management as a point of departure and helped the patients recover both physically and psychologically by promoting positive transformation in patients’social,psychological,and biological state.A clinical case was provided at the end of this paper to demonstrate how the above theory was put into practice.Narrative medicine under the guidance of TCM theory can supplement modern medical humanity practices as well as extend the scope of modern medical treatment from the perspective of the unity of Heaven and Man,by enriching the content of narrative medicine,and promoting the medical model from biological medical model toward social-psychological-biological model.

Rethinking Yi’an(Medical Cases)as a Tool for Narrative Medicine in China

When narrative medicine(NM)was introduced into China,traditional Chinese medicine scholars found that the core concepts advocated by NM are manifested in Chinese yi’an.But why NM echoes with ancient Chinese yi’an?How can we better integrate NM into Chinese medical practices?To answer those questions,this article first investigates how NM establishes itself as a remedy to biomedicine by taking traditional healing models including TCM as its ideal Other.Then,the narrative traditions of both case histories and yi’an are examined respectively.This article argues that NM is searching for a lost tradition of narrative case histories,but yi’an functions as a living tradition of TCM.The Parallel Chart in NM,designed as a complement to the dehumanized hospital chart,is still based on a dichotomy of science and art and a conflictual doctor-patient model.But yi’an exemplifies the holistic and humane healthcare that NM hopes to achieve.A comparison of both genres also inspired us to rethink the genre of yi’an in NM.Thus,it is concluded that yi’an should be viewed as an epistemic genre integrating individualization and generalization,a bridge linking medicine and literature.And narrative yi’an can well serve as a tool for NM in China.It is also proposed that a thick description of yi’an be encouraged to further promote a pluralistic NM in China.

Roles of Case Studies and Case Reports in US East Asian Medicine:A Narrative-Medicine Perspective

Recorded stories of the clinical encounter stretch back to ancient times.Throughout their history,these narratives have been called by different names,reflecting changes in format,function,and audience.This paper examines and explains the differences in two related forms of clinical writing as practiced by East Asian Medicine clinicians in the United States today-the case study and the case report.Each has its strengths and weaknesses;each is suited to different roles.The case study is ideal for education and the practice of narrative medicine,whereas the case report has played a vital role in propelling East Asian Medicine into the arena of modern scientific research.

AfterWards:A Narrative Medicine Program at Johns Hopkins Medicine and in China

Narrative medicine is a multidisciplinary field of inquiry and practice based on the premise that medical care takes place in the context of stories.Research on narrative medicine training suggests that it conveys benefits such as improved communication skills and personal and professional growth to physicians,medical students,and other health care providers.Narrative medicine can promote empathy and trust between patients and physicians and foster self-care.In 2014,the author and a colleague started an ongoing inter-disciplinary narrative medicine program in the Children’s Center of the Johns Hopkins Hospital called AfterWards.The program,which meets monthly,is open to all on a volunteer basis.Through literature,art,and writing,AfterWards nurtures empathy,encourages reflective practice,and builds community among a diverse group of health care providers.Through a series of lectures and workshops at Johns Hopkins Medicine,Peking Union Medical College,and Fudan Hospital in Shanghai,the author has introduced AfterWards to Chinese medical educators and clinicians.Working with Dr.Marta Hanson,she created an AfterWards Facilitator’s Guide for the use of Chinese practitioners.A recent White Paper on Chinese health care indicates that an infusion of humanities-based education,of which narrative medicine forms a part,can help rebuild patient-physician trust.Recently,there has been an increase in interest in narrative medicine in the United States and China.However,more research is needed to demonstrate the impact of programs like AfterWards.Challenges to the implementation of narrative medicine programs remain,most significantly in terms of expertise,resources,and time.

Under the narrative medicine theory to establish the evidence-based medical record written by doctors and patients through integrated therapy of traditional Chinese and western on digestive system diseases

Objective:The aim of this article was to discuss the theory of doctor-patient co-operated evidence-based medical record and set up the preliminary frame of the doctor-patient co-operated evidence-based medical record following the concept of narrative evidence-based medicine.Methods:The information was searched from Pubmed,Embase,CBMdisc,CNKI.A preliminary agreement was reached by referring to the principles of narrative medicine and advises given by experts of digestive system and evidence-based medicine in both Traditional Chinese Medicine and Western Medicine.Result:This research is a useful attempt to discuss the establishment of doctor-patient co-operated evidence-based medical record guided by the direction of narrative evidence-based medicine.Reflection and outlook:Doctor-patient co-operated medical record can be a key factor of the curative effect evaluation methodology system of integrated therapy of Tradition Chinese Medicine and Western Medicine on spleen and stomach diseases.

The concept of narrative evidence-based medicine and shared decision-making in traditional Chinese medical practice

For the explosive development of emerging diagnostic and therapeutic technologies brought by the advancement of precision medicine strategy, shared decision-making could improve the quality of clinical decision-making and promote the transformation of clinical research evidence in TCM. Paying attention to patients＇ narrative needs and strengthening medical humanistic concerns could improve clinical outcome and patient satisfaction. We described the origins and development of evidence-based medicine, narrative medicine and shared decision-making, and analyzed the existing problems in TCM clinical decision-making. Further, we put forward the model of shared decision-making between clinicians and patients under the guidance of narrative evidence-based medicine concepts and methods.

Addressing Burnout: A Narrative Medicine Curriculum for Millennial Medical Students

Medical school is a stressful time for physicians in training and correlates with an increase in rates of burnout.In addition to typical stressors,millennial students in particular may face additional challenges as studies suggest they tend to learn differently than their older counterparts.Teaching medical students’techniques to address burnout,and developing curriculum that addresses social media in medicine,may help students build skills to mitigate burnout during their future careers.Medical educators at the Stritch School of Medicine created a narrative medicine elective for students in their clinical years with this philosophy in mind.Evaluation of the curriculum from pre-and post-elective surveys showed that the elective was effective in addressing symptoms of burnout,specifically emotional exhaustion and depersonalization,and improved student comfort with social media as a medical professional.

Discussion on the role and practice of narrative medicine in China's COVID-19 epidemic

Narrative medicine is an important practice form of medical humanistic care.In COVID-19,the concept and practice of narrative medicine played an important role.This paper makes a distinction between the narrow sense and the broad sense of narrative medicine,and expounds in detail the characteristics and influence of the broad sense of narrative medicine in the epidemic situation,as well as the possible practice forms of the narrow sense of narrative medicine in the special period of the epidemic situation.Through reviewing the narrative medicine during the COVID-19,we hope to provide ideas for further expanding the connotation and application boundaries of narrative medicine.

Doctors’Dilemma in Auspicious Pulse Diagnosis Represented in Ming-Qing Fiction

Auspicious pulse diagnosis/pregnancy diagnosis in traditional Chinese medicine involves such issues as medical skills,narrative skills,family decency,and ethics.It is an excellent case for the exploration of ethical dilemmas in traditional Chinese medical practice.The early classical medical texts such as Su Wen(Basic Questions)and Ling Shu Jing(Spiritual Pivot Canon)provide a principle-based ethical guide for doctor-patient communication,while popular fiction such as Hong Lou Meng(A Dream of Red Mansions),Yu Mu Xing Xin Bian(Stories:Entertain to Enlighten),and Feng Yue Meng(Courtesans and Opium)in the Ming and Qing dynasties present literary examples for solving ethical dilemmas.This article will analyze these texts from three perspectives.First,the doctors in the text were subject to gender order and other delicate etiquette and customs,therefore were unable to make the diagnosis without embarrassing the patients and jeopardizing family decency.Second,the narrator tends to attribute pregnancy misdiagnosis to three reasons:incomplete patient information,doctors’poor narrative competence,and doctors’corrupted medical ethics.Finally,the Ming-Qing fiction proposes three methods to solve this moral dilemma:clear pulse reading,tactful speech,and taboo challenging.This discussion of moral dilemmas in pregnancy diagnosis in traditional Chinese medical practice can be used as a reference for the localization of narrative medicine.

Chinese Sources for AfterWards:From Premodern Poetry,Paintings,and Medical Texts to Modern Novels,Film,and Documentaries

This paper focuses on Chinese sources suggested for a narrative medicine(NM)program,called AfterWards.Dr Lauren Small established AfterWards in 2014 and has been coordinating it since out of the Pediatrics Department at Johns Hopkins Medicine.In early 2019,she started giving a series of lectures and workshops about AfterWards to Chinese medical educators and clinicians in Beijing and Shanghai.She created an AfterWards Facilitator’s Guide based on Western-language sources for workshop participants.She also started to organize with Jiang Yuhong(Peking Union Medical College)a workshop for Chinese colleagues to be held at Johns Hopkins Medicine in October 2019.They invited the author to participate.The idea was hatched then to develop Chinese source materials following the AfterWards structure for an updated Facilitator’s Guide that Dr Small had initially written.A typical one-hour AfterWards session consists of a specific five-part structure:a literary text or artwork,an associated theme,discussion topics,a writing exercise,and shared reflection.While the content of the program always changes from session to session,the basic structure remains the same.This paper summarizes the types of Chinese sources and their related narrative-medicine themes that were originally selected for inclusion in the updated AfterWards Facilitator’s Guide intended for Chinese colleagues.These sources about coping with sick family members,aging,and illness ranged from the textual(classical Chinese poems on aging and diagnostic forms for training students)and visual(premodern Chinese paintings and murals of medical encounters)to the fictive(novels)and performative(contemporary Asian-American film in English and Chinese-language film and documentaries).

A review on the International Patient Decision Aid Standards （IPDAS）： history, development and application

A Patient Decision Aid （PtDA） is an important means in TCM practice to promote shared decision-making between doctor and patient, which is developed based on evidence-based and narrative medicine concepts. It is also an important tool for individualized diagnosis and treatment in the context of precision medical care. With the rapid increase of interest on the PtDA, it is important to establish a unified quality evaluation standard and standardize the development process. This article aims to introduce the main content, development history and application of International Patient Decision Aid Standards （IPDAS）, and provide reference for the application of the evaluation standard in China.

Patient decision aids for cardiovascular disease： the status-quo and prospects

This article introduced the development and application of patient decision aid （PtDA） for cardiovascular disease. There are many risk factors for cardiovascular disease, and the mortality rate is high. Therefore, continuous management in symptoms, risk factors and lifestyle behaviors is needed for a good prognosis. PtDA can improve the patient＇s understanding of cardiovascular disease and the potential risk of perception of cardiovascular disease, as well as improve the communication between doctors and patients. The emergence of narrative evidence-based medicine provided a new opportunity for the further development of PtDA. At present, there were demands for domestic cardiovascular decision aids, but the researches were extremely limited.

Deeper inside the Experience of Pediatric Headache: A Narrative Study

Objective: To explore meanings, perspectives and points of view of the subjective experience of paediatric patients with headache (PPwH) and create a first-person narrative for clinical practice. Methods: We conducted a qualitative, narrative research study with PPwH, 11 - 17 years old. Data were collected through narratives interviews and a twofold narrative analysis was performed: a narrative and a thematic analysis. Results: Twenty-three patients (14 girls;mean age 14.5;median duration of illness of 5.8 years) were recruited. Through narrative analysis and close reading, narratives revealed different ways to organize illness experience: PPwH can use 1) narrative sequences of recurrent events in order a) to describe the continuing living-through of the experience of headache, b) to define operative script or c) to characterize the illness experience generally as a “controlled” routine;or 2) a storied account of events, with well-defined characters, plot and evaluation of contingency and correlation between events to express a personal point of view and a moral standpoint about the illness experience. Through thematic analysis 5 main themes and 22 subthemes about the significance of being a PPwH emerged: a) disease dimension (description of pain), b) illness dimension, c) sickness, d) causality, e) coping and f) future perception. Then, a first-person narrative story was created as a tool enabling reflection and conversation during clinical consultation. Conclusions: Results suggest that promoting narrative dialogue can be an opportunity for the neurologist: the prototypical narrative developed from story analysis might be a tool to apply for the narrative-based medicine in the clinical setting.

Joint Development of Evidence-Based Medical Record by Doctors and Patients through Integrated Chinese and Western Medicine on Digestive System Diseases

Building the clinical therapeutic evaluation system by combing the evaluation given by doctors and patients can form a more comprehensive and objective evaluation system.A literature search on the practice of evidence-based evaluation was conducted in key biomedical databases,i.e.PubMed,Excerpt Medica Database,China Biology Medicine disc and China National Knowledge Infrastructure.However,no relevant study on the subjects of interest was identified.Therefore,drawing on the principles of narrative medicine and expert opinion from systems of Chinese medicine and Western medicine,we propose to develop and pilot-test a novel evidence-based medical record format that captures the perspectives of both patients and doctors in a clinical trial.Further,we seek to evaluate a strategic therapeutic approach that integrates the wisdom of Chinese medicine with the scientific basis of Western medicine in the treatment of digestive system disorders.Evaluation of therapeutic efficacy of remedies under the system of Chinese medicine is an imperative ongoing research.The present study intends to identify a novel approach to assess the synergistic benefits achievable from an integrated therapeutic approach combining Chinese and Western system of medicine to treat digestive system disorders.