Lost in Translation: Reflecting on Narrative Medicine and Language
Narrative medicine is a framework for clinical practice that aims to incorporate and understand patient experiences, beliefs, and emotions in order to provide holistic and improved care. This model encourages us to become more reflective when interacting with the stories we read and see, more active in employing close analysis, and strengthening the interaction of humanities, science, art, and medicine. Not only does this approach emphasize the enhancement of the patient-doctor relationship, but centers the uniqueness of each patient and their goals to diagnose and treat illnesses more effectively. However, for narrative medicine to succeed, clear communication between the patient and the healthcare provider is essential. This model has faced resistance and systemic limitations, such as the prioritization of an objective biomedical approach, time constraints, and linguistic-cultural barriers. Ultimately, narrative medicine is an effort to contribute to the humanization of healthcare—for patients and providers alike.
It's within these limitations that we see the necessity for encouraging narrative medicine and initiatives to make it a possibility for various populations we care for. Health care equity relies on our ability to seek out and hold stories, bear witness, and write our own. It is critical that providers have access to the tools necessary to do this with groups most at risk of being unheard.
I had an early opportunity as a pre-clerk to shadow emergency medicine physicians over the course of a week. One of my first encounters was with a patient who presented with stomach pain and vomiting. They had come in with a family member who spoke only marginally more English, as they were both recent immigrants to Canada. I found myself in charades of history taking, pointing to different body parts to ask clarifying questions to the patient, trying to gather enough detail in the most straightforward way I could. For children who grew up in non-English speaking households— translating, miming, and distilling speech was common practice. Though this process was something that I was familiar with, I found myself overwhelmed—navigating not speaking the patient's language alongside my own initial attempts to learn the language of medicine.
After cobbling together a patient presentation to the physician, we went in together, this time, using a language tool. This can look different depending on workplace and access, in this case: composed of a tablet to video call an interpreter. Though the facts of the encounter were recounted through the conversation with the interpreter, and the accuracy of the details confirmed, the patient's perception and engagement was markedly different. I noticed the patient would shift his gaze between the screen and myself—a subtle, non-verbal invitation to be a part of this conversation. While the interpreter provided the necessary linguistic link between us, there was something inherently impersonal about the interaction. The patient’s emotional engagement was filtered through multiple layers: the interpreter, the technology, and my own status as a trainee.
This is not to suggest that technology or interpretation services are not valuable—they absolutely are. However, it underscores the importance of recognizing how these tools may alter the dynamics of the patient-provider relationship. We exist in a world that values precision across a myriad of disciplines, crucially important in medicine. Yet, on the hunt for accuracy, considerations of the patient's sense of their illness and priorities may elude the details we fixate on. Medicine can be reductionist, focused on breaking down presentations into discrete elements, symptoms and signs to direct a diagnosis. Sometimes, this can obscure the lived experiences of patients, experiences that are paramount to delivering truly compassionate care.
Confronted with the barrier of language, we are reminded of the distance that can exist in any clinical scenario, even when able to communicate sans-interpreter. This seems like a problem with no solution, and this piece isn't a criticism of either the system or the limitations inherent to any healthcare encounter. There are systemic limitations—such as lack of time and the physical distance created by technology—and human limitations, we cannot possibly learn every language or all cultural nuances. Narrative medicine finds itself in this gap, and as providers we have an incredible opportunity to change someone’s interaction with the system and subsequent care outcomes by just listening.
Learning to translate—whether it’s medical jargon into language that makes sense to the patient or understanding cultural differences that influence perceptions of care—is another crucial part of this work. Furthermore, our narrative competence relies on the prioritization of reading, writing, and reflecting upon perspectives that differ from our own. This is where the humanities and the social sciences offer invaluable insight, providing tools to interpret the human side of healthcare, to be attuned to the emotional, cultural, and social contexts that shape each patient’s experience. These principles especially resonate when caring for immigrant and refugee patients, who are often experiencing a spectrum of social determinants of health that we may not be able to uncover without pursuing each encounter with such considerations.
For me, practicing narrative medicine is a continual process of self-reflection and growth. It requires an openness to learning from our patients, as well as from ourselves, and that vulnerability can be initially discomforting, yet necessary. Every patient encounter is an opportunity to connect, to understand, and to refine our approach to care. It's not always easy, but it’s incredibly rewarding—both for our patients and for ourselves as providers
