Discussion on the role and practice of narrative medicine in China's COVlD-19 epidemic

Zeyu Li,Bo Li

1 Beijing Hospital of Traditional Chinese Medicine,Beijing 100010,China;

2 Evidence based medicine center,Beijing Hospital of Traditional Chinese Medicine,Beijing 100010,China.

Abstract Narrative medicine is an important practice form of medical humanistic care.In COVID-19,the concept and practice of narrative medicine played an important role.This paper makes a distinction between the narrow sense and the broad sense of narrative medicine,and expounds in detail the characteristics and influence of the broad sense of narrative medicine in the epidemic situation,as well as the possible practice forms of the narrow sense of narrative medicine in the special period of the epidemic situation.Through reviewing the narrative medicine during the COVID-19,we hope to provide ideas for further expanding the connotation and application boundaries of narrative medicine.

Keywords:COVID-19,Narrative medicine,Narrow sense,Broad sense,TCM

Background

Coronavirus Disease 2019(COVID-19)is an acute respiratory infectious disease caused by SARS coronavirus 2(SARS-CoV-2).Narrative medicine plays a very important role in China's fight against the epidemic.Through this experience,people further realized the important influence of narrative medicine in major public health events,and also tried the practice of narrative medicine in the special period of epidemic situation.If we want to clearly sort out the important role of narrative medicine in the epidemic situation,we must first clarify the multiple meanings of narrative medicine itself and its manifestations in different contexts.

The broad and narrow sense of narrative medicine

At the 2ndpecking University International Conference on medical Humanities held in November 2018,Professor Guo Liping proposed that China's narrative medicine research can be divided into two categories,including narrow sense narrative medicine research and broad sense narrative medicine research[1].There are differences between the two in terms of definition,characteristics,purpose and function.To clarify the relationship between the two is necessary to discuss the value of narrative medicine during the epidemic period.

In a narrow sense,narrative medicine refers to the medical practice that medical personnel with certain narrative ability take the initiative to patients,focusing on the specific application of narrative medicine in clinical practice.The main body of practice are medical staff and medical students.In 2001,Rita Charon,a physician and literary scholar at the Presbyterian School of medicine at Columbia University,put forward the practice model of narrative medicine,which laid the foundation for the narrow sense of narrative medicine.The ultimate goal of narrative medicine is to break the long-standing rigid procedure in the current medical environment,add humanistic color and emotional communication to the routine inspection,inquiry and treatment process,and provide the possibility for doctors to express their emotions,patients to release their emotions and respect the emotions of both sides.Therefore,Rita Charon's invention of "parallel medical records" has become an important method to practice narrative medicine.

In a broad sense,narrative medicine refers to the narration,sharing and research on the experience of doctor-patient encounter and illness experience in the form and content of spontaneous by medical related groups with the participation of multi disciplines.The subject of practice can be anyone,and most of its researchers come from the fields of linguistics and sociology.Narrative medicine in the broad sense pays more attention to the research and the exploration on the connotation of medical narrative texts.Only with the transformation of medical humanities scholars and narrative medicine scholars can its achievements be applied to the training and practice of narrative medicine.However,the broad sense of narrative medicine can broaden the boundary of narrow sense of narrative medicine,provide valuable narrative texts and cases for the latter,and further enrich the educational materials and academic depth of narrative medicine.

Narrative medicine in broad sense under COVID-19

The emergence and wide spread of COVID-19 broke the normal working and living conditions of all members of society.No matter whether they were infected or not,all people became the first-hand participants of the epidemic situation of COVID-19.In this case,a large number of generalized narrative medicine came into being,showing the distinctive characteristics of the epidemic situation,and also played an indispensable role in China's anti epidemic period.During the epidemic period,narrative medicine in a broad sense has the following characteristics:

The number and scope of narrative subjects have expanded rapidlyIn the early stage of the outbreak of COVID-19,the number of infected people showed an explosive growth,the spread of the disease has not been effectively controlled and blocked,and the number of infected people in various provinces and cities in China is increasing day by day.All social groups except medical personnel and public service personnel have to accept home isolation to wait for the epidemic to ease.The increasing of infections and death data,the fear caused by the future which is unpredictable,the huge changes in life,and the emotional depression caused by home isolation,make the most social members have potential anxiety and desire to express.However,the medical staff on the front line of anti epidemic,the patients unfortunately infected with COVID-19,the members of the supporting medical teams in other provinces and cities,the public service providers and volunteers who provide support for material supply and social security during the epidemic period,become the people who face the risk of COVID-19 infection and death.Their high-intensity work,pressure of facing the death and the rich and unique anti epidemic experience provide more abundant medical narrative materials and impulses.

The media of medical narrative shows a tendency of diversificationThe arrival of we media era broadens the channels for people to voice,express their views and share their experiences,and greatly enriches the forms and media of generalized narrative medicine during the epidemic period.Besides traditional media such as TV,radio and news portal,many media platforms such as WeChat official account,Sina microblog,WeChat circle of friends,tiktok and so on are becoming important channels for individual medical narration.Such a rich information release platform also makes it possible to diversify narrative genres.At each time node,the public medical narrative documentary,which is composed of countless individual narrative fragments,includes text,pictures,videos,music,paintings and other genres[2],presenting the most vivid and three-dimensional narrative expression under the epidemic situation,so that the narrative receiver can be personally aware of the narrator's experience,resulting in more profound empathy,compassion and moving.

The content of medical narrative has been sublimatedThe unprecedented influence of the spread of COVID-19 has rarely placed so many individuals in the same crisis context.It also provides a prerequisite for deep empathy among individuals.For a time,the sense of community of destiny has been transmitted to all people.In this case,the narrative content can easily go beyond the micro perspective focusing on the individual itself,and focus on the joys and sorrows of all individuals under the epidemic situation:its theme not only includes pessimism such as fear,escape,loneliness and death,but also highlights the noble qualities of great love,mutual assistance,compassion,hope,selfless dedication and sacrifice,which truly and profoundly shows the reaction,thinking and action of human beings to the disappearance of life under the epidemic situation.

The role of medical narrativeNarrative medicine in a broad sense plays a very important role in the special period of epidemic situation:first of all,everyone's narrative content conveys the most real life under the influence of epidemic situation,in which there are many narrators begging for help because they are in trouble.With the wide spread of these contents,under the grand background of fighting against the epidemic situation,every small individual's plight and needs have the opportunity to get attention.Secondly,during the epidemic period,Self-isolation has forced normal social interactions to be interrupted.The scattered individuals are like isolated islands.The wide spread and mutual echo of medical narrative make people get full empathy and comfort in other people's narratives.With a relaxed attitude and rich posture,they can eliminate the current anxiety and individual loneliness and fear in the face of the unknown.In the face of the epidemic situation,doctors have a very special identity.Like ordinary people,they may suffer from COVID-19,but they have to shoulder the burden of fighting the epidemic in the front line.As doctors,their sense of responsibility and mission,as well as ordinary people's regret for the loss of life and worry about their own diseases,are intertwined in the medical narratives of doctors.The widespread spread of these medical narratives is of great significance to bridging the gap between doctors and patients.It is of great significance to strengthen the relationship between doctors and patients,enhance the understanding between doctors and patients,and convey the confidence and strength of fighting against the epidemic.

Narrow medical narrative practice under the epidemic situation

Narrow narrative medicine emphasizes the specific application in clinical practice,and requires medical staff to have the ability to “understand,absorb and respond to patient narratives”.By listening to patient narratives in depth,collecting the details and clues in order to grasp the patient's current situation and desires,and respond to these desires to enhance the understanding,trust and emotion between doctors and patients,to lay a good psychological foundation for the patient’s recovery,and to promote disease recovery.

However,when COVID-19 suddenly strikes,the sudden increase in the number of patients will lead to an extreme shortage of medical resources.Each medical staff may be responsible for the treatment of more than ten patients at the same time in a short period of time.Therefore,sufficient time cannot be obtained to practice the practical methods required by narrative medicine.In the face of sudden physical shock and the possibility of death for patients infected with COVID-19,whether the patient can continue to maintain a calm mood,a firm belief in recovery and strong spiritual support has a very important impact on the patient's condition.Therefore,it is undoubtedly necessary to practice narrative medicine for patients during the epidemic.However,under such unconventional conditions,what form of the narrow narrative medical practice should be taken is a question,that we need to think about.The author believes that the practice of narrative medicine in a special period should focus on its spirit and ultimate purpose,and be flexible in form.The most important thing is to relieve the tension and fear of patients through various forms of communication and contact between doctors and patients.The belief and desire to overcome the disease and provide emotional support for patients are the ultimate goal of realizing medical humanistic care.As a TCM physician,the author hopes to combine the medical practice experience of Jiangxia mobile cabin hospital[3],the only hospital in Hubei that focuses on traditional Chinese medicine during the epidemic,and propose possible ways to practice narrative medicine during the epidemic.

Use traditional Chinese medicine exercise methods to create a good recovery atmosphereChinese medicine is not only good at using oral drugs to treat diseases,but also creates and inherits many exercises to improve patients' physical functions and enhance disease resistance.In the treatment of COVID-19,these exercise methods can give full play to their effects.According to the condition,age,and physical condition of patients with COVID-19 pneumonia,select exercise programs with TCM characteristics in layers.For example,for young patients with better physique and mild illness,the doctors on duty will teach Tai Chi and Baduanjin in a timely manner;for patients with more complicated illnesses(mainly patients admitted to the second stage),older,and weaker physiques,timely teaching "Tai Chi Six Qi Method" and "Breathing Method" and other exercises with small exercise volume,to delight the mood,reduce anxiety,and recover from illness.In the process of teaching and practicing exercises,patients have more opportunities to get familiar with,contact and communicate with doctors,and relax their mind and body in a pleasant exercise atmosphere.physical exercises not only effectively enhance the patient's physical fitness and disease resistance,but also help relieve the patient's nervousness and anxiety,and promote the recovery of the disease at the psychological level.

Develop exclusive diagnosis and treatment plans for the diseaseThe core of Chinese medicine lies in the differentiation of symptoms and signs.Even if they are all suffering from COVID-19,patients will show very different clinical symptoms due to their different physiques.In order to give full play to the advantages of TCM syndrome differentiation and treatment,individual diagnosis and treatment,traditional Chinese medicine methods such as acupuncture,moxibustion,acupoint massage,ear acupoint application,meridian patting,etc.can be flexibly applied based on the patient's condition and symptoms and on the basis of common prescription.This kind of targeted diagnosis and treatment plan for individual patients can not only improve the patient's condition in a targeted manner,but also make the patients deeply feel the attention,respect and care they have received.In the process of moxibustion,acupoint massage,and ear acupoint application,patients can have in-depth contact and communication with doctors to increase their confidence in healing from the disease.

Give gifts to convey the affection between doctors and patientsSachets have a long history in China.Every traditional Chinese festival Dragon Boat Festival,wearing sachets made by family members has a good vision of exorcising evil spirits,avoiding filth and protecting safety.The sachet is closely related to the culture of traditional Chinese medicine.The plants filled in it are Chinese herbal medicines,which are selected under the guidance of the theory of traditional Chinese medicine.When the patient is admitted to the hospital,the doctor can give a self-made sachet.The aromatic Chinese medicine in the sachet can increase the appetite of patients,and more importantly,through gift giving behaviors like this,doctors have a more concrete expression vector for the care and blessing of patients.When the heavy protective clothing hinders communication,an inexpensive but affectionate gift can allow the affection between doctors and patients to be communicated silently.When the patient struggles with the disease alone,give the patient a warm company.

Future and Prospect

The broad sense and narrow sense of narrative medicine are actually based on narratives with different purposes and needs to be integrated into different scenarios to promote the realization of medical humanistic spirit and moral care.They are complementary to each other,that is,they are distinguished,mutually influencing,and mutually reinforcing.Broad narrative medicine explores medical narrative materials that are easily overlooked from a broad cross-disciplinary and multi-field perspective to enrich the philosophical meaning,depth of thought and emotional value of the theme of medical narration.Narrative medicine in the narrow sense focuses on the realization of the role of narrative.It cultivates the"narrative ability" of doctors and medical students through medical education,and makes the rich value of medical narrative benefit patients in clinical practice through specific and feasible practical methods.Narrative medicine is no longer limited to academic discussion,but has the possibility of returning to reality.During the COVID-19 epidemic,the huge changes in social life and the relative lack of medical resources have posed new challenges for the research of broad narrative medicine and the practice of narrow narrative medicine.For the former,if you want to clarify clues,find rules,and dig out the hidden meanings in the rich and vast narrative materials,you may need the help of big data technology and artificial intelligence algorithms.As for the latter,humanistic care and narrative assistance under the huge public health crisis not only need to refine experience in the practice of such an epidemic,but also should explore and design a relatively complete treatment plan in advance to respond to the crisis.In order to execute the preparatory plan in an orderly manner in the crisis response process,the medical humanistic care can withstand the test of emergencies at any time.