Transformative narratives in doctors’ health : positive representations of the wounded healer

1. Transformative narratives in doctors’ health: positive representations of the wounded healer Dr. Margaret Kay MBBS(Hons),FRACGP, Dip.RACOG The University of Queensland

2. Defining narratives • “ method of recapitulating past experience by matching a verbal sequence of clauses to the sequence of events that actually occurred” (Labov) • constructed • orientation, complication, evaluation, resolution (coda) • Stories are dialogic • Bakhtin - Co-construction where/when trouble unfolding sorted out

3. Wounded Healer • Ancient mythology • Chiron • Teacher /Healer– Asklepios • Arrow wound – poison of the hydra • Jungian – analytical psychology – archetypal images • Mental health

4. Narratives included: • Authored by the doctor with the illness • Published in a medical journal • Or anthology of ‘articles’ on doctors’ health • Excluded – memoire/biographies for lay community • 160 narratives (>250) • Saturation Medline Cinahl Psychinfo Grey literature Anthologies

5. Illness Narratives • Typologies - Arthur Frank • Restitution • being sick getting treatment and being healed • Chaos • no meaningful response to illness • Quest • ill person finds meaning in illness, • works with illness • move forward in life

6. Themes "I have lived most of my life with the certainty that a "big illness" was waiting for me. Not an ordinary illness, but something obscure...” “aversion to the hospital that embodies the "faustian soul of modern technology".”

7. Themes • Becoming a patient • Care received • Effect of the illness

8. Becoming a patient • Crossing the ‘thin red line’ • Crossing the border, ‘changing hats’ • Want to be a normal patient / a good patient “Although I had passed the examinations put out by the American Board of Internal Medicine, she [the patient in the next bed with [Hodgkin's disease] seemed to know a lot more about being sick and being a patient than I did...”

9. Care received • Disappointment • Changed doctor / Self-treatment • Shared-decision making • Need for hope • Rapport /empathy / trust

10. Effect of illness • Blow to omnipotence • Altered outlook on life • Positive work-life balance • Altered outlook on medical practice • Better doctor • Value the art “I am sure my illness has made me a better physician” “given me confidence that caring and encouragement can go a long way in helping” “Suffering had sensitized me to the human condition.”

11. Narratives guide to our listening orientation, complication, evaluation, resolution (coda) Content Construction How it is told – the emplotment Association, Causation Meaning

12. Narratives guide to our listening Professional stories – Restitution being sick, getting treatment, and being healed Chaos – Avoid Personal stories – Quest Healing lies in finding the meaning

13. Transformation We can choose our narrative Reflection – enables the writing of the narrative Chaos can be transformed Assist through Co-construction rapport / trust / relationship enables shared-decision making allows the patient to be a good patient

14. Transformation We can choose our narrative Reflection – enables the writing of the narrative Chaos can be transformed Assist through Co-construction rapport / trust / relationship enables shared-decision making allows the patient to be a good patient

15. Transformation We can choose our narrative Reflection – enables the writing of the narrative Chaos can be transformed Assist through Co-construction rapport / trust / relationship enables shared-decision making allows the patient to be a good patient

16. Transformation We can choose our narrative Reflection – enables the writing of the narrative Chaos can be transformed Assist through Co-construction Treating-doctor / Doctor-patient rapport / trust / relationship Patient-centred medicine