Dr. Rita Charon believes that narrative medicine is essential for effective doctor-patient relationship. She developed the phenomena called the Parallel Chart. Medical students and doctors are expected to write patients’ stories in the form of medical charts, concise and coherent notes, e.g. SOAP notes, in medical charts. However, Dr. Charon took it a step further and asked her interns to learn to write parallel charts in addition to their medical charts.
Parallel Chart are written in plain language, about patient’s current complaints, results of the physical exam, laboratory findings, opinions of consultants, care plan and how it all affects or resonates to the health care practitioner. Charon has reflected on how her students have written about their deep connection to patients, feelings of helplessness in the clinical encounter in their role as mere medical students, the rage, shame, and humiliation they experience in the face of disease as well as their awe at patients’ courage.
She states that students who practice keeping a Parallel Chart have found that they are more in touch with their own emotions during the clinical encounter, feel deeper empathy for their patients and fellow colleagues, and are able to understand their patients more fully. Likewise, physicians who engage in this practice are more proficient and effective at conducting medical interviews, performing medical procedures, and developing doctor-patient relationships with patients (Charon, 2006, pp. 155-174).
Here are my personal experiences with Parallel Charting:
In working with individuals with intellectual and developmental disabilities, part of my job duties entails teaching them to practice healthy behaviors such as, proper nutrition, physical activity, and hydration etc. Now, it is hard enough to teach the general population about healthy behavior, but imagine having to teach it to those with limited ability to learn. We are expected to chart weekly class sessions, but I keep my own parallel chart during each encounter. I want to know what they feel during each class sessions; I want to learn what exact methods I could use to really teach/drive home what I expect them to learn/retain.
While reading my notes from various class sessions, I learned that on certain days, some of them would display frustration, agitation and would not want to hear the teachers at all. When this happens, I ask the teachers to shift from the lesson plan and talk about what they are feeling. We normally hear fragmented stories about what is going on at home, their worries about mom and dad not coming to see them at their group homes, crushes, and other social issues. I often hear about how they feel about their physical appearances and their hopelessness about changes etc. On other days, they are very engaged, competitive, and strive to outdo one another during class interactions. Because of my notes, I found that repetition, images, and sensory communications are very effective in teaching them. Overall, I keep a parallel chart to connect with them, understand their needs, desires, and effective methods for learning—I keep these notes to help me develop the best suitable/effective programs that will have a lasting impact in their lives.
I really enjoyed reading Rita Charon’s book; I have learned a lot. I hope that all health care professionals are practicing this concept in order to better connect with their patients and serve them.
Charon, R. (2006) Narrative medicine: Honoring the stories of illness. New York, NY: Oxford University Press, Inc.