Narrative Medicine Brings Empathy to Treating Opioid Use Disorder

Date: 09/25/2019

Patients Sharing Life Stories to Shape Recovery, Strengthen Bonds with Providers

Recovery from opioid use disorder rarely takes a straight path. Most patients have lapses as they deal with severe withdrawal symptoms and the strained relationships with family and friends that often result from opioid use.

The stop-start nature of recovery makes it more difficult for providers to connect with opioid use disorder patients. A physician at Northern Light Eastern Maine Medical Center is using a medical approach that uses a patient’s life story to support healing holistically: narrative medicine.

Lewis Mehl-Madrona MD, PhD, who practices both family medicine and psychiatry, is a nationally-recognized expert on narrative medicine. He’s been leading an initiative with Northern Light Family Medicine and Residency to incorporate patients’ life stories in care, especially for patients with opioid use disorder.

“Physicians and other clinicians become more empathetic when they know a patient’s story,” Dr. Mehl-Madrona says. “This is particularly important with opioid use disorder (patients) because many of them have difficult life stories and a lot of trauma from childhood. Knowing what a patient has been through helps us have more compassion.”

That compassion helps overcome one of the medication-assisted barriers to treatment: stigmatization.

“Often, if a patient feels like they’re going to be judged, they won’t seek treatment, especially for medication-assisted treatment (MAT),” Dr. Mehl-Madrona says.

The patient participates in a two-hour life story interview with a medical resident who maps important milestones and adverse events throughout the patient’s lifespan. This life story is then uploaded to the patient’s electronic medical record, where it’s shared with their care team.

While it helps identify potential triggers for opioid use, the real value is in strengthening the patient-physician relationship and building trust.

“My goal is to know every patient’s life story,” Dr. Mehl-Madrona says. “Once upon a time, the town doctor did know everyone’s life story because he knew all of his patients well. A side effect of modernity is we don’t know these stories, and we need to do something to recreate the connectedness people had with their doctors.”

Narrative medicine has improved outcomes for patients within the practice. Dr. Mehl-Madrona’s team conducted a study that followed patients who had their life stories collected and completed. Over time, patients reported their levels of perceived pain had decreased, and the ratings for patient satisfaction and physician empathy increased. 

The inclusion of narrative medicine has also shaped the culture of the residency clinic.

“Often, residents, when they come out of medical school, are thinking about procedures, but now they’re thinking more holistically and saying things like, ‘This patient needs a life story interview. We need to know more about them,’” Dr. Mehl-Madrona says. “Sometimes, their health makes sense in the context of their life story, and we can be more helpful to them in treating and preventing disease.”

Ultimately, narrative medicine is about using the power of stories to heal.

“As a physician, even our presence can be healing,” he went on to say. “We need to embrace that and think about the stories we’re telling our patients all day long. But it’s meaningful when two people sit down to explore a person’s life. It’s positive.”

Pictured: Lewis Mehl-Madrona MD, PhD