Narrative-based Primary Care - A Practical Guide
Author: John Launer
The patient’s definition of their own problem is presented in the story that they bring to the consultation. Traditional, doctor-centred, medicine attempts to define the patient’s story in terms of pathological illness, while more modern, patient-centred, medicine may allow the doctor to adopt a more passive role in attempting to understand the patient’s ideas, concerns and expectations. In this book, we are invited to consider a different view of the consultation by adopting a "story-centred" approach.
John Launer, a Senior Lecturer in General Practice and Primary Care, presents his ideas, which are based on the principles of family therapy, that the patient comes to the consultation with a story, and that the doctor and patient then enter into a dialogue, which allows the patient’s story to evolve. This may in itself produce a satisfactory conclusion for the patient or may help to patient to adopt a "different" story, which is deemed by the patient to be more comfortable. Launer sees the doctor and patient as being on an equal footing, and sees the consultation as being a shared experience, which becomes the "treatment". There are similarities between this narrative-based approach and the approach to the consultation suggested by Balint, i.e. that the consultation itself is therapeutic. However, Launer suggests that Balint-ism (for want of a better word!) may produce spontaneous or unexpected results whereas the narrative approach seeks to achieve change in the patient through the focussed questions asked by the clinician.
The book is split into three sections: Practice, Teaching and Theory, and although the sections appear in that order, they may in fact be read in any sequence according the reader’s preference. There are lots of examples and Case studies to illustrate points, and the Chapters are split into smaller sections to aid their digestion. My only criticism is that in some places the book is more like an advertisement for the Narrative-based course, which is run at the Tavistock Clinic. This said, though, I learned a huge amount from it, in a relatively short space of reading time, and it has certainly given me ideas about my own consultation technique. To use Launer’s own words, the narrative approach "invites practitioners to transform their view of their encounters with patients, from an observational one involving the search for objectivity, to one involving the interaction of two subjective stories, each determined by its own contexts."
| Publisher: | Radcliffe Medical Press
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| ISBN: 1-85775-539-1
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| Reviewer: | Dr Adrian Boonin
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