How to Treat a Patient Like a Work of Art
By Sharon Tregaskis
"'Medicine is my lawful wife, and literature my mistress,’” says obstetrician-gynecologist Christopher Travis’19, paraphrasing the Russian writer and physician Anton Chekhov. “‘When I grow tired of the one, I go to bed with the other.’”
As an undergraduate at Columbia—majoring in English and completing the prerequisites he’d need to apply for medical school—Dr. Travis lived Chekhov’s sentiment. “Boy howdy, if I didn’t sometimes put away my chemistry textbook and pull out Shakespeare,” he says. “I love them both, but one was nicer to me.”
As his English literature studies progressed, however, a philosophical question plagued him. “As an undergraduate, I was an English major, but I struggled with the ‘so what?’” says Dr. Travis. “Shakespeare is really cool, Milton’s poems are amazing, but does it really matter?”
Then, in his senior year, he attended an information session on narrative medicine, a humanities-infused field founded at VP&S that invites health care providers to adopt habits common to literary analysis. By learning to acknowledge, absorb, interpret, and act on the stories of others, practitioners of narrative medicine seek to improve their relationships with patients, fellow healers and scientists, the public, and even themselves. In effect, narrative medicine teaches its students to approach art with certain sensibilities— from intense focus to careful reflection—then bring those well-developed powers of attention to patients.
“Narrative medicine gets at the soul of what we’re trying to do,” says Dr. Travis, who went on to earn a master’s in narrative medicine at Columbia—and another in medical physiology at Ohio’s Case Western Reserve University—before enrolling as a medical student at VP&S in 2015. “Med school is really hard; you struggle, the hours are terrible—all the things,” he says. “If you stay anchored to ‘I’m doing this for patients,’ even when studying for the USMLE Step exam, it keeps you grounded. Narrative medicine is very anti-burnout—it’s a north star.”
Birth of a Movement
This year marks the 25th anniversary of Columbia’s Program in Narrative Medicine, founded by general internist Rita Charon, MD, PhD, who introduced the phrase “narrative medicine” into the lexicon of medical education.
Now the Bernard Schoenberg Professor of Social Medicine, Dr. Charon traces the genesis of narrative medicine to her own arrival at Columbia in 1981 as a fellow in general medicine.
“I happened to be a very enthusiastic, lifelong reader,” she says. “This was always what I did for pleasure and growth.” Interested in formal study, she garnered the blessing of Steven Marcus, PhD, then Columbia’s George Delacorte Professor in the Humanities, to enroll in a graduate seminar in comparative literature. That first class paved the way for a master’s, and in 1999 she earned a PhD. Her dissertation explored intersubjectivity—the process of building shared meaning through communication and interaction— both in the works of 19th century American British author Henry James and in literary studies of medicine. “Every step of the way,” she says, “my medical practice was transformed.”
As her capacity to perceive details and their meaning in a literary work deepened throughout the 1980s and ’90s, says Dr. Charon, so, too, did her powers of attention and empathy in patient encounters. In the 2001 JAMA essay in which she coined the phrase “narrative medicine,” the physician reflected on her experience caring for a 33-year-old patient with Charcot-Marie-Tooth disease, and the woman’s report that her young son had begun displaying symptoms of the congenital nerve disorder. “The physician grieves along with the patient, aware anew of how disease changes everything,” Dr. Charon wrote. “Sick people need physicians who can understand their diseases, treat their medical problems, and accompany them through their illnesses.”
Today, scores of papers authored by Dr. Charon and her Columbia colleagues articulate the foundational principles and pedagogy of narrative medicine and delve into its application in clinical ethics, oncology, pediatrics, and interprofessional patient care. The 2016 textbook “Principles and Practice of Narrative Medicine,” co-authored by Dr. Charon with Columbia colleagues Sayantani DasGupta, MD, MPH; Nellie Hermann, MFA; Craig Irvine, PhD; Eric R. Marcus, MD; Edgar Rivera Colón, PhD; Danielle Spencer, MS’12 (in narrative medicine)/PhD; and Maura Spiegel, PhD, was awarded the 2017 Perkins Book Prize and has since been translated into simplified Chinese, as well as French, Greek, Japanese, and Polish. “Narrative medicine is a practice whereby the practitioner—the clinician—is equipped with sophisticated skills derived from the study of texts or images: the skills of the close reader,” she says.
In 2009, the University established the nation’s first MS degree in narrative medicine, in the School of Professional Studies, with coursework on phenomenology; literary theory; the illness experience; the tools of close reading and writing; and narrative in fields like genetics, social justice advocacy, and palliative care.
In 2011, graduates of the program launched Intima: A Journal of Narrative Medicine. “The idea that people want to be seen and heard is consistent across the health care continuum,” says journal co-founder Mario de la Cruz, MS’11, who is also a lecturer in the master’s program and an associate director of Columbia University Irving Medical Center’s (CUIMC’s) Division of Narrative Medicine. “Narrative medicine aims to help providers be more observant, better listeners, to be more tolerant of ambiguity or circumstances that need further clarification; all of those skills directly impact the way that they can interact with their patients more effectively.”
As founding chair, since 2018, of the Department of Medical Humanities and Ethics, which includes the Division of Narrative Medicine, Dr. Charon oversees a suite of programming for medical students, as well as offerings for students throughout CUIMC, established clinicians, and the general public. Columbia Commons Interprofessional Education, which Dr. Charon directs, brings together small groups of students and faculty from the clinical pastoral education program, College of Dental Medicine, Institute of Human Nutrition, Mailman School of Public Health, Physical and Occupational Therapy programs, Program in Genetic Counseling, and schools of Nursing and of Social Work to explore themes such as aging and end-of-life care, caregiving relationships, and health care justice. Literature at Work: The Robert Braham Seminar welcomes employees of CUIMC and NewYork-Presbyterian, as well as alumni of the Columbia professional health and narrative medicine programs, to a twice-a-month online graduate-level literature seminar that has discussed the short stories of Jorge Luis Borges, Isabella Hammad, Nathaniel Hawthorne, Haruki Murakami, and others. Monthly online narrative rounds—open to anyone who registers and archived on the division’s YouTube channel—have featured authors, journalists, novelists, activists, and thought leaders, each in conversation with a scholar affiliated with the division.
In narrative medicine, there is no right or wrong. Rather, the field cultivates practitioners’ capacity for self-reflection and self-awareness and embraces the shared insights that emerge through discussion. “Narrative medicine very much values your affective response,” explains Dr. Travis, who serves as assistant education director for narrative medicine in the Department of OB/GYN at University Hospitals/ Case Western Reserve University. “It’s not just about the structure of a poem. It asks: How does it feel in your ears? How does it feel in your mouth? How do all of these things make you respond?”
Such deep attention and self-knowledge can be critical to tolerating the ambiguity and ambivalence that patients and clinicians alike experience when working through difficult scenarios. “The habits of narrative medicine encourage openness, and I hope they help me accept patients as they are,” says Dr. Travis. “It’s being open to: What is the story going to do? What is the patient saying that I might not be expecting, and how am I reacting?” In his own practice, Dr. Travis has seen patients choose pregnancy despite harrowing odds for their own survival, while others agonize over how treatment options for a severe gynecologic disorder might affect their sense of self. Building empathy with pregnant patients who don’t achieve— or even prioritize—strict sobriety, yet make significant reductions to their typical alcohol or heroin use, can be particularly intense. “How do you take that situation and say, ‘There’s a lot I want you to do differently, and also I don’t want to treat you like garbage—I love and accept you, and I have some ideas if you’re interested?’”
From the Classroom to the Exam Room
At VP&S, every first-year medical student chooses a half-semester seminar in narrative medicine. In groups of a dozen or fewer participants, they explore the philosophy and practice of aesthetic engagement as they delve into written works, photography, choreography, and music. Most of the seminars feature a practicum—students compose musical works, participate in theatrical improvisation, shoot photography, and workshop one another’s poetry.
In Spring 2025, New Yorker magazine staff cartoonist Benjamin Schwartz’08—an assistant professor of medicine (in surgery) who uses comics and narrative strategies to develop more empathetic communications with patients, train future physicians, and support educators—led a workshop on the modes of storytelling exemplified in comic books. He introduced students to such storytelling fundamentals as clarity, pacing, and mood, and they tried their hand at figure drawing, perspective, and caricature.
Barbara Lock, MD, an assistant professor of emergency medicine, fiction writer, and essayist, invited students to produce short works of fiction. In Works of Art and Wide-Awakeness to the World, art historian Rika Burnham—previously head of education at the Frick Collection, museum educator at the Metropolitan Museum of Art, and project director at the School of the Art Institute of Chicago—convened students in art museums throughout New York City to engage in conversation about great works of art in public spaces.
By design, few of the aesthetic works featured in the seminars engage directly with health and disease; it’s the quality of the engagement—rather than the content of the art—that matters to this curriculum. “The simple way I explain the training is: ‘You’ve gotta pay attention,’” says Dr. Charon. The same skills of scrutiny and reflection used by a sophisticated reader empower a clinician to engage more deeply with their patients’ perspectives. “When a practitioner trained in narrative medicine listens to a patient talking about her illness, they are hearing things, registering things, that someone without this training is just not going to notice,” she says. “It could be the words, the facial expression, the moment of silence, how one shifts in one’s chair, something the daughter who came along to the appointment might pipe up and say.”
As a first-year medical student, Dan Pacella’28 enrolled in a special narrative medicine project to collect the origin stories of the most cited papers produced by Columbia scientists over the last decade. Dr. Charon co-leads the course with Associate Dean for Student Research Anil Lalwani, MD, and Benjamin Mueller, a medical science reporter for The New York Times. “What better way is there than to learn from the experts how to translate complex information into accessible terms for the public?” says Mr. Pacella, who interviewed Nathalie Moise, MD, director of implementation science research for Columbia’s Center for Behavioral Cardiovascular Health, about her 2022 report on the association between depression and heart disease among women for the journal Current Atherosclerosis Reports.
Mr. Pacella has already seen narrative medicine inform the mindset he brings to his work as a junior clinician with Columbia Student Medical Outreach (CoSMO). “I’m learning that the way someone describes their experience with illness is really the key to being able to serve them properly,” he says. “By treating someone as the expert of their own scenario, you can become a better partner in their health care.” He notes that he’s learned to think more expansively about patient insights, whether collecting a patient’s personal medical history, or in pursuit of operational quality improvement. When CoSMO’s social work team developed a survey to better understand patient needs, Mr. Pacella and his colleagues initially planned a quantitative approach—checkboxes or the like. Then they shifted gears. “We decided to make it open-ended so patients could respond in whatever way they would like; maybe we would get more meaningful information.”
Meghan Perez’26 used her first-year narrative medicine seminar to get out of her comfort zone. Although she has no formal dance training, Ms. Perez registered for Movement as Story: An Exploration of Dance and the Spectrum of Physical Narrative, taught by a dancer who works with people experiencing movement disorders. For their final projects, each student choreographed and performed a one- to two-minute dance. “That was a lot,” says Ms. Perez, “but I liked the idea of trying something new and making the most of the experience.”
Now preparing to apply for residency in anesthesiology, Ms. Perez resumed her studies in narrative medicine for her scholarly project. A hobbyist painter and distance runner who had herself suffered a slow-to-heal hamstring injury, Ms. Perez is exploring the limitations of spoken language and whether visual arts might bridge gaps in how clinicians understand what their patients are trying to communicate about their pain. “My hypothesis is that language is insufficient to fully convey the lived experience of chronic pain,” says Ms. Perez. She plans to observe patient-clinician encounters at NewYork-Presbyterian’s Pain Management Center, conduct a literature review focused on the limitations of commonly used pain assessment tools, and interview a professional artist whose works explore the value of visual images to clinician-patient interactions and the communication of pain. Ms. Perez is also creating acrylic paintings based on her own pain experiences. “I think that art and visual representations might help providers understand how pain ebbs and flows and affects their patients’ lived experience,” Ms. Perez says.
An Anchor as Technologies Advance
Judith Simmons, MD, founder of Lion Head Advisors, trained at VP&S as a fellow in gastroenterology in the late 1980s, then spent a decade on the faculty as an assistant clinical professor of medicine. She now works as a consultant, and her patients are health care systems, nonprofits, academic medical centers, and early-stage health care ventures. As COVID-19 accelerated the adoption of telemedicine, Dr. Simmons found herself returning to similar issues she had encountered earlier in her career when electronic health records were going mainstream. In 2022, she began taking graduate courses in narrative medicine, motivated to think more deeply and strategically about the role of technology in the doctor-patient relationship. “I was interested in how the patient encounter is changing and what might be important to retain,” says Dr. Simmons.
As we adapt to new technology, she notes, it’s easy to forget what’s been lost. Through her narrative medicine training, Dr. Simmons delved into philosophy as a tool for understanding the meaning of the patient-clinician interaction, studied digital and immersive storytelling, and designed a chatbot. “Our needs as humans haven’t changed that much,” she says. “The discipline of narrative medicine helps us think about the impact of technology and identify aspects of care we must hold on to; it provides context for the questions: What is essential for better outcomes, satisfaction, and health for people, and how can we design tools to help deliver that?”
Like Dr. Simmons, Dr. Charon has seen health care transformed by technology and market forces, the reputation of mainstream medicine hanging in the balance. “We have to be careful not to be nostalgic about the old days,” she says. “But there must continue to be ways to practice humble, affiliative partnership with patients, despite the inevitable topsy-turviness of the marketplace world.”
Narrative medicine anchors practitioners in human connection— a stabilizer that could matter more now than ever. “What I owe to this person seeking my care is a capacity to perceive as clearly as I can their perspective, to know how to ask what they need, what they want. And I need to not only hear their answer, but be guided by their answer,” says Dr. Charon. “These are the moral dimensions of the work.”