KPSOM Spotlight

Envisioning the Future of Healthcare through Narrative Medicine

Students learn skills of empathy and close observation through creative works

August 20, 2024

KPSOM Students w/ Nikki High, Founder of Octavia’s Bookshelf — KPSOM students w/ Nikki High, Founder of Octavia’s Bookshelf

How do we foster future doctors who are also empathetic listeners and observant healers? What societal or systemic stories impact how patient care is distributed or received, and how can we write new stories for the type of healthcare we envision? These are the kinds of questions Deepu Gowda, MD, MPH, MS, Kaiser Permanente Bernard J. Tyson School of Medicine (KPSOM) Assistant Dean for Medical Education, and Nicole Lawson, PhD, Faculty Director of Inclusive Curriculum, have helped our students to explore this year during their Narrative Medicine coursework. “It is a kind of curricular experience that leverages arts, humanities, community partnership, and the power of narrative to highlight inequities and advocate for belonging,” said Dr. Lawson.

“Narrative Medicine is my favorite aspect of REACH [Reflection, Education, Assessment, Coaching, and Health and well-being curriculum],” said KPSOM student Juliette Dowe. “It is really wonderful to be at a medical school where I’m able to draw back on my humanities major from undergrad and discuss things like poetry and art, and how that relates to being a physician. Whether that’s now as a medical student, or what I see myself doing in the future.”

KPSOM Student Juliette Dowe — KPSOM student Juliette Dowe

Throughout the course students engage with four different types of narratives. These narratives will be important to their work as a doctor some day and are deeply connected to how they approach patient care in the future. “EID is foundational to what it means to be a caring, person-centered physician,” said Dr. Lawson. “I believe the best physicians see their patients as people, and therefore must take into account how broader social systems and structures affect, often inequitably, a person’s lived experience, their health, and treatment options.”

At the start of the course, one might wonder how discussing works of art could possibly help develop core skills needed for doctoring.

“Yes, [in medical school] we’re giving you a whole lot of knowledge about how the body works—anatomy, biochemistry, pharmacology, we’re teaching you clinical skills, we’re teaching you evidence-based medicine,” said Dr. Gowda. “But it’s your powers of imagination that is going to allow you to then go into the world to observe the problems that you’re seeing and generate solutions for those problems in your clinic, in your community, maybe even nationally or globally. The solutions for today’s problems don’t come from an algorithm. They have to be generated through your own powers of imagination, collaboration, and problem-solving.”

First, students delve into this work by observing stock narratives. These are stories in society that might maintain social structures and consider individuals whose voices and perspectives are not being heard. “Because this work is so steeped in pain and loss and inequity, I find it critical for us to find and center those pockets of hope and joy,” said Dr. Lawson. “Without them, it is hard for students to see how they can make an impact. How even the briefest conversation can have a lasting impact on them and on the people and communities they engage with.”

Next, they look at concealed narratives. For this session students are encouraged to look at different creative works while also examining their own lives and clinical settings. They are then asked to think about those in their clinical settings whose stories are not being heard.

“We have deep conversations about power and how that affects a person’s voice,” said Dr. Gowda. “What are the consequences of the patient's preferences, values, and perspectives not being heard in decisions about their care plan?”

This is part of the reason why the third session of the narrative medicine work is centered on resistance narratives. The students get to explore communities around Los Angeles that have advocated for better healthcare and change within their own communities. Through these experiences students are asked to think about what stories help us to understand when people have fought for change and why.

KPSOM Students participate in Narrative Medicine REACH session — KPSOM students participate in Narrative Medicine REACH session

Left to Right: Joyce Wong Taur, MD, MPH (REACH Coach), Brian-Linh Nguyen, MD, MBA, MTOM (Faculty Director, REACH Course), Colleen Wittenberg, MD, FACOG (REACH Coach), Nicole Lawson, PhD (Faculty Director, Inclusive Curriculum), Deepthiman (Deepu) Gowda, MD, MPH, MS (Assistant Dean, Medical Education), Nikki High (Founder, Octavia's Bookshelf), Jereme Patricia Butler, MD (REACH Coach), Rolando Kuo-Yang Tang, MD (REACH Coach), Fady N. Mikhael, DO, FAAP (REACH Coach), Garo K. Balkian, MD, FAAEM (REACH Coach) Shakir E. Emel, MD (REACH Coach)

“I partner with Dr. Lawson to develop a curriculum across the year that explores how stories function at the societal level,” said Dr. Gowda. “Not only one-on-one, but how stories are also functioning at a meta level. What I mean by that is, if you really think about it, racism is a story. It's a narrative of how this concept of race configures the distribution of power—even configures our conversation of humanity. And this is a very old story that's really structured the way our world has been organized. Sexism is a story. Ageism is a story. It’s structured how people have been given access to power and have been disempowered.

“We want our students to see themselves as agents of change,” he continued. “We want to train our students in understanding health systems and equity, inclusion, and diversity so they can go out there and make health systems more effective and more equitable. To do that, we want to open their eyes to how stories can actually be a part of the problem and can potentially be part of the solution.”

In the fourth and final session of the four-part Narrative Medicine storytelling curriculum, students are asked to reimagine the future of healthcare. Yes, we inherit stories, but we can also create new ones. So, when it came time to discuss this idea of creating new worlds for a more equitable future in healthcare and society, Dr. Gowda felt it was perfect to focus on speculative fiction—a genre that is all about world-building.

Naturally, he thought of a well-regarded speculative fiction writer from Pasadena—Octavia Butler, whose archives have been held at the Huntington Library since her passing. And right in the heart of Pasadena is a local woman named Nikki High who is a scholar of Octavia Butler’s work. High so admired Butler that she named her bookstore that features a collection of works by BIPOC writers after the author, affectionately calling it Octavia’s Bookshelf.

Parable of the Sower by Octavia Butler (left), Octavia’s Bookshelf Founder, Nikki High (Right) — *Parable of the Sower* by Octavia Butler (left), Octavia’s Bookshelf Founder, Nikki High (right)

Drs. Lawson and Gowda invited High to the school to engage in a conversation with KPSOM medical students about building new worlds, while they explored excerpts from the book Parable of the Sower by Butler. Each student also received a copy of the book from High’s Pasadena bookstore. “Having a community partner like Nikki High, the first Black female bookstore owner in Pasadena, is so powerful because she demonstrates the power of stories, through the works of Octavia Butler and other BIPOC authors that she centers in her store, and via her own experience with how stories can move communities to action,” said Dr. Lawson. “And of course, much of EID work is about connecting with people and working in community—we can’t teach about that without actually partnering with community members.”

KPSOM students receive copies of the book Parable of the Sower by Octavia Butler — KPSOM students receive copies of the book *Parable of the Sower* by Octavia Butler

At the end of the REACH narrative medicine session, the students were given a prompt. They were asked to write about a scene from the future where healthcare is bigger and more magnificent than it’s ever been.

KPSOM student Alex Argame shares his narrative from the last REACH Narrative Medicine session for his class

Student Alex Argame wrote:

Health goes beyond medicine. There is an aspect that no longer goes unnoticed. Self-identity.

It delves into reflection, introspection, society standards and pressures, cultural influence, history, stories of oppression, racism, institutionalization.

Reflecting on ways things have always been. What’s been reflected/accepted upon. And from there determining, what does this person need?

What is a physician? What is their role in healthcare?

To prescribe? To treat? To cure? To care? To advocate? It seems like a lot to do it all.

It feels hard. It feels like burnout. Exhaustion. That’s because it is.

Is it to provide space? We provide space for one. But who gets left out? Why are they left out?

The majority matter? The most pressing health issue/cause of death matters?

The chronic diseases we can physically see or measure matter?

Healers matter.
Core values matter.
Community matters.
How to make that matter.