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Narrative Based Medicine.
  1. G C COOK
  1. Wellcome Trust Centre for the History of Medicine
  2. London, UK

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    Narrative Based Medicine. Edited by Trisha Greenhalgh and Brian Hurwitz. (Pp xvi + 286; £19.95.) BMJ Books, 1998. ISBN 0-7279-1223-2.***

    After two introductory contributions, the remaining 23 chapters (written by 29 contributors) are arranged under the following section headings: “Illness stories”, “Narrative in medicine”, “Learning and teaching narrative”, “Understanding narrative in health care”, and “Broader perspectives on narrative in health care”. There is also an appendix (by the editors) which contains valuable suggestions for further reading, followed by an adequate index.

    But what is narrative based medicine, and what has it to offer? The subheading of the book (“Dialogue and discourse in clinical practice”) is probably more revealing in this context than the main title. In a foreword (written by H Brody) the reader is told (and this is reiterated in chapter 1) that ... “after two and a half years of being taught on the assumption that everyone is the same (my italics) the student has to find out for himself that everyone is different...”. “Most people (the reader is also told) would have said as recently as 1982 that stories are an unimportant and uninteresting feature of medicine”.

    The contents of this book (one writer assures his readership) “allow us to see both sides of the bridge with equal vividness”. What if any is the relevance of median longevity to the individual? What is it like to suffer from cancer or a stroke, or survive to the age of 78 with haemophilia? Narratives are also included of an epileptic and a sufferer from angina. The importance of literature in medicine, and the value of dialogue between doctor and patient, is highlighted. The role of anecdotes is rightly stressed. “The sick, like the poor, leave few archives behind them”.

    So diffuse are the contributions that this text is almost impossible to review adequately in 250 words. There is clearly much to be gained, however; but the book should be read alongside systematic texts of medicine, and not as an alternative to them!

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