Table 3 Physicians’ beliefs about the practice of narrative medicine

Division within all specialties about what wording to use with patients

“If I'm in the clinic I try to make it more directed, kind of like you know, ‘I'm interested in getting to know you as a patient and a person. I’d love for you to tell me something about your life’ or ‘I’d love to tell me little bit about you, not from being a patient’” (Internist)

“I don’t think that I explicitly do, what I typically try and find [the patient’s narrative] out more indirectly through the course of responses to more standard questions that I would ask related to their past medical history so if there are things that come up related to changing jobs or moving, but I don't typically try set that out as a specific part of their narrative.” (Internist)

Internists generally collect a patient's narrative over time

“So I can collect this kind of information over periods of visits and I remember things about patients. You know I’ve had patients for 25 years…and you get little things every time you see somebody… I start to know these kind of details but would I get all of this in one sitting, just the way that medicine is practiced right now? That would be difficult.” (Internist)

"…as I look at my own patients and the ones that I’ve had really great longitudinal relationships with, I think some of that naturally comes out of getting to know someone over time." (Internist)

Surgeons generally collect a patient's narrative in the initial visit

“…in that initial visit I'll ask all patients what they do for a living. I allow other elements of personal life to come out just in the flow of conversation, but I definitely try to elicit specific personal information so that I can…just allow personal details to dictate the flow of the interview as it, as it proceeds.” (Surgeon)

[In response to when the narrative is collected] "Oh it would be at the first office [visit] because the, I’ll tell you that most of the time I see a patient one time before their operation, and one time after their operation." (Surgeon)

Factors involving the patient's emotional readiness were often described as barriers to collecting the narrative by primary care physicians

“Sometimes, if it's the first time I’m meeting them there isn't that level of trust where they’re gonna tell me everything right away, and in my particular case, there are some things parents don't want to share about their past in front of their child.” (Pediatrician)

“I’ll occasionally run into someone who wasn't quite expecting [collecting the patient’s narrative]. Maybe they aren’t looking for that in their relationship with their doctor, so they are kind of maybe either off-put or kind of surprised by the question, but for the most part I feel like that doesn't happen.” (Internist)

Factors involving logistics and patient data were often described as barriers to collecting the narrative by surgeons

“Well time is part of it, and I don't know how to better say that, but meeting a patient in clinic and wanting to understand the life story to sort of get focused and relatively concise assessment or feeling like I understand their life a little better within the time constraints…I think that’s the biggest barrier” (Surgeon)

"…then you're essentially relying on the family to tell their story which obviously may not be as the patient would tell story to you." (Surgeon)