The Patient Narrative (Person & Population Heath; Human Behaviour)

Question 1

Explain the importance of the patient’s narrative and understanding the patient’s perspective

Answer 1

Provides Context and Meaning: The patient’s narrative gives context to their condition, offering insights into how they perceive their illness and what it means to them beyond the clinical symptoms. This deeper understanding allows healthcare professionals to tailor care that is both effective and empathetic

Holistic Understanding: Listening to the patient’s story ensures that their emotional, psychological, and social factors are considered, not just their medical condition. This promotes a holistic approach to care, where treatment plans are personalised to fit the patient’s life and circumstances, rather than solely focusing on the medical diagnosis

Improves Communication and Trust: By actively listening to the patient’s narrative, healthcare providers build trust and rapport, which are more likely to share important details about their symptoms, lifestyle, concerns, which might otherwise be missed in a standard medical interview

Enhances Empathy: Engaging with a patient’s story helps healthcare providers develop empathy. Empathy is crucial for understand how the illness affects the patient emotionally and socially, which improves the overall quality of care and supports patient satisfaction.

Foster Shared Decision-Making: When clinicians understand the patient’s perspective, they can collaborate with the patient to make informed decisions about their care. This shared decision-making process leads to more meaningful and patient-centred outcomes, where the patient feels valued as an active participant in their health journey.

Shifts from “Taking” to “Building” a History: The concept of building rather than taking a history emphasises collaboration. The narrative approach respects the patient as the expert of their own experience, while the clinician is a guide in helping manage their health. This shift fosters a partnership in care, making the history more comprehensive and personalised

Supports Lifelong Learning: Listening to patient narratives is a continuous process that enhances a clinician’s skills throughout their career. Each story provides new lessons about disease, recovery and individual differences in patient care, contributing to a clinician’s lifelong development

‘building a history vs taking a history - (Haidet & Paterniti, 2003), check powerpoint slide for expansion

• What patients say and what doctors hear is sometimes different (Ofri, 2017)

Question 2

Appreciate how the patient narrative is central to person-centred care

Question 3

Understand how listening to the patient’s story can help your learning

Question 4

Historical narrative teachers

Answer 4

Boethius wrote Consolation of Philosophy for a dialogue with himself in prison however the dialogue describes depression and that perhaps depression is when a person temporarily loses himself

Question 5

Notes from Patient Engagement

Answer 5

colostomy

diverticula disease

symptoms:

• abdominal pain
• stinging when urinating

Lead to a telephone appointment, suspected UTI, prescribed antibiotics

• Cloudy urine
• Bladder problems
• pain

Face to face GP consultation

• antibiotics
• Hard lump on the abdomin
• poo in urine

Same day appointment

• 39.5 temperature
• 139 pulse point
• Red flag to A&E for sepsis
• hard mass felt was a suspected abscess

God to A&E with a fast tract

• Required incision and drainage
• Required emergency surgery
• Sent for CT scan, showed diverticulitis
• Showed 2 type of fistula
• colo-cutaneous fistula, colo-vesical fistula

Consent form:

• Treat sepsis, cut and drain abscess, drain and proceed
• 3am, dosed off, fuzzy, when discussing the consent form
• The consultant was not providing personal care
• Operating on the doctrine of necessity, the bare minimal to save life
• Stoma is reversible

PostOP

• High dependency unit for 2 days
• Family was not informed regarding the management
• canula in the neck
• Opened up colo-cutaneous fistula = drain
• Drainage tube on the stoma
• Too dangerous to take out diseased bowel, wait for heal then another operation

On the ward for 12 days after

Care plan:

• Daily nurses to clean abscess bag
• Stoma nurse for the colostomy bag
• For 2 months

Transferred to GP nurses

14 months of wound care

• 6 months of daily care

No time to digest what is happening, to research

Felling anxious, angry, doubt, scared; affecting sleep, flashbacks, bad dreams

Nurses recommended GP consultation

GP listening to the sob, okay to not be okay, validating their concerns

Suspected PTSD

GP support for 6 years and onwards
- one of the most important part of the team, having the ability to listen and support

• helping to avoid medication

Keeping colostomy bag over more operations to remove disease bowl, no guarantee of recovery

• consultant supports decision and decision can be reversed at any time

Annual review by stoma nurse

social support, destigmatising illness to support patients

emergency and elective surgery, no time to taking anything in, results may not differ however it allows patient to be more informed and research about their care

Having an illness is alright

Shared decision making

Most important quality was listening, understanding, empathy

Delay in healthcare