Dr. Margaret Kay MBBS(Hons),FRACGP, Dip.RACOG The University of Queensland TRANSFORMATIVE NARRATIVES IN DOCTORS’ HEALTH: POSITIVE REPRESENTATIONS OF THE WOUNDED HEALER

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 troublewhere/whenunfoldingsorted out

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

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

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 Illness Narratives

Themes “aversion to the hospital that embodies the "faustian soul of modern technology".” "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...”

Themes Becoming a patient Care received Effect of the illness

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...”

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

Effect of illness Blow to omnipotence Altered outlook on life Positive work-life balance Altered outlook on medical practice Better doctor Value the art “Suffering had sensitized me to the human condition.” “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”

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

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

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

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

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

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