Narrative Medicine in practice
When we think about the heart of oncology, we often find ourselves in the deep with our patients guiding them through many of the most difficult times of their lives. I’ve been an oncology nurse practitioner for 25+ years and found myself as caregiver to my brother during his intense cancer journey. During that time, none of his care team asked him who he was and what was going on outside of his diagnosis. All they saw was a metastatic cancer patient in his 40s. That was when it really hit me; I realized that “nice is not enough”. I learned that, although they go a long way, our patients often need more than a smile and a pat on the back and more than superficial conversations that barely skim the surface of their distress. So, several years ago, I began cultivating the skills needed to address the human side of cancer, and it’s transformed my practice.
Think about the state of oncology today. All the innovations are exciting. However, as we navigate the burgeoning field of cancer diagnostics and treatments, we risk leaving the people suffering with the illness behind. We risk making our patients’ personhood an afterthought as we focus our minds and money on cancer cure and control. This is not just my conclusion. The Lancet Oncology Commission wrote about their concerns in an article entitled “The human crisis in cancer care”.1
Dr. Victor Montori of The Patient Revolution coined this phrase “biography next to biology” and speaks of it as part of the drive toward “careful and kind care”.2 This juxtaposition is essentially what the emerging field of Narrative Medicine is about. It focuses on learning and understanding each person’s story as it relates to health and illness.
In narrative medicine, there are two sides of the story, as the saying goes. The first is the study of the arts and humanities to help us better comprehend lived experiences. Dr. Rita Charon, founder of Narrative Medicine, describes this as close reading, which is accomplished by studying literature, music, dance, and the visual arts. It is then followed by reflective writing and discussion among colleagues.3 As an
everyday example, think of looking at a photo or text message sent to you on your phone and then analyzing what feelings it brings up for you and the sender.
The second side of narrative medicine is the art of interviewing and listening to learn pieces of each personal story. These therapeutic conversations can help us to better appreciate each person’s experience of being a patient with cancer, helping them to feel that we see them as more than just “a cancer patient”, “a dementia patient”, “the MI”. The benefit of empathic interviewing to get the story extends to building meaningful relationships, stronger connections and deeper trust.2 Furthermore, the open-ended nature of the questions supports inclusivity and equity by allowing us access to details related to social determinants of health and to what makes each of us unique. I liken this part of narrative medicine to sitting down and beginning to read the book that is each person’s life, not just hastily flipping through the pages.
After “reading”, I have found that writing parts of patients’ stories in the clinical note, positioned right beside the specifics of the cancer and treatment regimen, helps me to reflect more holistically on their lived experiences. The practice of placing life narratives in the chart helps me to “see” my patients and compose a plan that goes beyond biology alone. The process of writing short biographies in the chart (usually in multiple phrases instead of sentences or paragraphs) also allows me to confront any biases I may have as I write. Important themes about each person surface bit by bit.
As an added benefit, sharing these details in notes can help other clinicians to better understand our patients instead of starting from scratch with every new referral, consult, or change in covering teams. As an example, I cared for a hospitalized gentleman with prostate cancer who refused an MRI ordered to evaluate significant back pain. I discovered by attentive listening that the reason he refused the MRI was that he had severe claustrophobia. You see, several years ago, his eighteen-wheeler had been crumpled in a multi-vehicle pile-up, and he had been trapped in a crushed cab. It was important for me to tell that story for him, in the chart, so other clinical teams could understand as well. We cannot exercise our
clinical expertise in a vacuum. It is imperative we incorporate stories - each person’s expertise in their own life, values, and goals. The result is a shared, individualized cancer treatment plan AND a humanized one.
Walt Whitman wrote in one of his soul-stirring poems: “I am large; I contain multitudes.”4 With these six words, we can imagine how our patients’ worlds are much wider than the one that involves illness. With narrative practice, we have an opportunity to see how illness pervades each piece of their worlds and how the aspects of each person influence how they respond. If one were to encapsulate the effect of integrating narrative medicine into our work, the word that comes to mind is more than clinician, it is HEALER.
If you’re ready to take action to improve patient-clinician relationships, join me in the quest to humanize healthcare. Read on to get tips on how to start your own narrative practice.
Warmest regards,
Rosalie El-Rady, AOCNP®
Moffitt Cancer Center Senior Adult Oncology Nurse Practitioner
Vital Talk Faculty
Serious Illness Conversation Communication Guide Instructor
Fellow in The Patient Revolution
Comfort Communication, ELNEC (End of Life Nursing Education Consortium), & ICC (Interprofessional Communication Course) Trainer
To start advancing your skills, check out the following Narrative Practice Tips:
If you want to start simply, do so by writing in your chart the names of any friends/family/caregivers who come with your patient. Include their relationship to your patient. This allows you to start understanding their network of support and build connection.
It also helps you and other clinicians to avoid the embarrassing assumptions we make. For example, assuming someone is a spouse when they are actually a sibling; or thinking someone is an adult child when they are actually a spouse.
If you are ready to take a bold step, pick 1-2 patients per week and start recording in charts what you have discovered about them. Many clinicians tell me they put these details in the “sticky notes” section, an unofficial section of the chart, or in a separate notebook. If one does not already exist, do this instead. Create a section in your note called “Patient Story” or “Patient Narrative” to emphasize its importance. A good place for it might be below the Social History or at the end of your History of Present Illness. Another option is to record in your interval history. Build the story slowly-little by little; each visit, add something new you’ve learned or provide an update on something discovered previously.
Consider that the action of recording some of each story in your notes can be a sacred practice that allows you to honor each person while serving to provide more meaning and less burnout in your work.
Consider how it may also help your entire team, consultants, hospitalists and many more carers to see the person behind the patient in the bed or clinic room. ▪
Writing short phrases helps us SEE the patient the same way test results help us see cancer and treatment effects. As examples: SEE - the middle-aged father going through a divorce with child custody struggles, who feels let down by his spiritual beliefs; SEE - the young woman diagnosed with metastatic cancer at age 23 and accused of making up her diagnosis because she did not lose her hair (cold cap treatment in a social influencer, Sydney Towle); SEE - the immigrant who moved to pursue his dreams express how he believes he fell short of achieving them; SEE - the non-English speaker who wonders if radiology did not use an interpreter to help her because of her minority status; SEE - the person who has a spouse of the same gender worry if that may affect the care they receive)
Ask these starter questions to learn the story (Some documentation examples included):
Who else is part of your support system? Do you take care of anyone? Who are the most important people in your life? (examples - staying with daughter during treatment AND caring for spouse who has Lewy-body dementia; adopted 5 year-old grandson and is concerned what will happen when she dies; single parent of 4 children including one with special needs, with no family in-state)
I know a lot about your health from reading your chart; tell me a little about yourself as a person. (examples – prayer important; built game room for church then went to Guiana with son to build 2 for local youth; [son sitting with withdrawn and frail parent describes how] his parent was once a high-ranking attorney and very active in community service; real estate agent most proud of helping a young woman with low income find an affordable house in a safe neighborhood)
What helps you through stressful times? (examples – spending time with family; no longer religious but still prays; enjoys walking in nature; caring for pondful of ducks behind house)
Tell me about some things you enjoy/any hobbies? (examples – singing to self while doing chores; watching British TV shows; researching family genealogy back to 1700s; mentoring a young person from community youth group; youngest great-grandchild who has autism and a lot of joy)
What are some goals you have for your health and general life in the next months/year? (examples – watching son play HS football; continue picking up grandkids after school; hope to be able to live 10 more years to watch daughter grow; finish writing music for short movie friend is making; finish writing family history)
If the patient mentions any personal experience with caring for a loved one who was sick, record what they found stressful or good. (This information can be recorded in special goals of care section of chart or in narrative; examples – reports their parent suffered after choosing to continue chemo after they were already very weakened; their friend’s family did not honor wishes and friend ended up on dialysis; never want to be on ventilator after they witnessed partner’s experience with the breathing tube then tracheostomy)
If your patient mentions something sensitive in nature, record that there are “significant stressors” they are dealing with and refer to Social Work and/or Behavioral Medicine, Spiritual Care.
Happy Humanizing!
References
Charon, R, DasGupta, S, Hermann, N, Irvine, C, Marcus, E. R., Rivera Colon, E, Spencer, D, & Spiegel, M. (2016). The Principles and Practice of Narrative Medicine (2ND Ed.). Oxford.
Montori, V. (2023, February 1) The Patient Revolution: A movement for care. https://www.youtube.com/watch?v=_gCnZakbH8U accessed 10/24/2026
Rodin, G, Feldman, A, Trapani, D, Skelton, M, Unger-Saldañ,a K, Essue, B, Pihlak, R, Walshe, C, Rosa, W. E., Banegas, M. P., Zambrano-Lucio, M, Salah Daood, R, Aggarwal, A, Dewachi, O, Shapiro, G. K., Munisamy, M, Rajah, H. D. A., Atreya, S, Dhyani, V. S., Kong, Y. C., Mathew, M, Ochoa-Dominguez, C. Y., Rao, A. P., Rao, S. R., Simha, S, Preston, N, Lam W. W. T., Davis, H, Zimmermann, C, Namisango, E, Ntizimira, C, Smyth, E, Li, M, Salins, N, Bhoo-Pathy, N, & Sullivan, R. (2025). The human crisis in cancer: a Lancet Oncology Commission. Lancet Oncol, 26(12), e628-e670. doi: 10.1016/S1470-2045(25)00530-3
Whitman, W. (1892) Song of Myself, 51. https://poets.org/poem/song-myself-51 accessed 10/24/2026