Postmodern Narrative Therapy and Shadowing

While at Cambridge Health Alliance, Hilary Worthen, MD, recommended the following piece, written by Kaethe Weingarten, Ph.D., to me based on my work shadowing practices at his institution:

The Small and the Ordinary: The Daily Practice of a Postmodern Narrative Therapy Family Process 37 (1), 3–15.

This is an area that I’m very interested in because I see the work that I am doing (going into individual practices, shadowing visits) as different that what is traditionally expected of someone who does what I do.

When I do what I do, people ask, “what are you doing when you are observing providers and patients?” and my answer tends to be diffuse. I know what I am looking for, but I can’t really express it in words – it is something along the lines of “how are the actors in the relationship perceiving what is happening to them?” To me, this is different than, “are the actors conforming to an expectation, such as the adherent patient or the knowledgeable physician?” I am truly not focusing on what kind of treatment is prescribed or if there is a correct way to use the EHR or PHR. The discussion in the article helped ground that thinking for me. I really do feel like an approach that is postmodern in character and localized to individual interactions is the right way for me to ask “why?” in the case of a health system that at times seems at cross purposes with the people it is serving.

During this experience, I am not functioning in the role of therapist. However, I love incorporating new knowledge into everything I do, and I think there are similarities here. The work I have been able to do is about looking at the stories of people working to get and stay healthy. The comment “life is more prism than road,” rings true as I listen/observe to interactions between care providers, patients, and a health system. In a way, we have constructed a story about how we should carry ourselves as a profession, and I am interested in the “exception” to the traditional story – the part where we all went to medical school with the intent of providing great care to the people we serve. As I have remarked elsewhere, the exception to the traditional story is easy to find – when we ask. I have said that people who choose to work in health care are outstanding individuals – they have to be – and always want to do what’s right for patients. This is what I get to watch in exam rooms, and is what makes this work so enjoyable.

I think one of our tasks is to take this seeming exception and make it the norm. Thanks to Dr.’s Worthen and Weingarten for the support along the way.

Ted Eytan, MD