Narratives of Patient Care

Patient Narratives

Every patient has a story. Recent trends in physical therapy focus on patient narratives. Greenfield, Jensen, Delany, Mostrom, Knab, and Jampel (2015) explain, “an initial goal of introducing narrative, therefore, is to demonstrate how narrative can be meaningful and relevant to physical therapy practitioners” (p. 928). To learn more about writing narratives, physical therapists can borrow methods from English teachers. English teachers encourage students to write in journals because first drafts of writing capture the writer’s truest thoughts. Writing teacher Goldberg (1986) explains, “first thoughts are present. They are not a cover-up of what is actually happening or being felt” (p. 10). Writing opens a window to the stories people tell themselves, which can be beneficial for helping not only students in a writing classroom but also patients in a physical therapy clinic. By having insight into a patient’s thoughts, the medical practitioner can learn insights about the patient’s narrative that will enhance the development of a successful treatment plan.

Journal writing provides an outlet of expression, thus allowing for the emergence of writing voice. Greenfield and Jensen (2010) discuss the value of patients’ voices and elaborate, “imagine what we may find out about the work of physical therapists if we developed clinical case knowledge that is based on understanding the patient’s voice? How could we better hear that voice?” (p. 1195). English teachers hear their students’ voices through writing as well as speaking, so writing can provide information for physical therapists that patients may forget to share during a conversation. Writing teacher Tom Romano (2004) describes, “one of the great things about writing is that by doing it, we can construct a persona. We can craft an authentic voice” (p. 218). When students share their authentic voices, writing teachers help them discuss their emotions; similarly, when patients share their authentic voices, physical therapists help them discuss their symptoms.

Research studies demonstrating that expressing emotional writing can lead to physical healing began with Pennebaker (1997), who conducted a research study that showed “people who wrote about their deepest thoughts and feelings surrounding a trauma evidenced an impressive drop in illness visits after the study compared with the other groups” (p. 34). More studies confirmed the results of the original, and Files (2016) advises, “so, patients, get out thy notebooks and heal thyselves” (p. 102). While written responses by a patient cannot cure a condition that requires physical therapy, writing does show contributing factors for the cause of the pain. A patient’s narrative can provide a clinician with additional information that, connected to the data from existing objective physical therapy measures, can lead to a diagnosis. Bezner (2015) discusses the value of the emerging field of health coaching and explains, “the American Physical Therapy Association (APTA) has recently undertaken an effort to identify and create resources to support physical therapists and physical therapist assistants to incorporate approaches that promote health and enhance wellness into physical therapist practice” (p. 1436). Resources include health coaches to focus on the emotional side of healing and goal setting for patients. Journal writing, often used by health coaches, provides an additional resource for both patients and physical therapists. Journaling can also have healing benefits if a person is experiencing medical symptoms.

Patients do not need to write a long essay in a physical therapy clinic or write a significant amount of words at home in a journal to remember what to tell their physical therapist about their pain levels. Short answer response questions, whether they are on a survey used in a clinic or in a notebook to write out steps for goals, are effective in leading to the processing of emotions. Wilkerson Miller (2017) describes the recent trend of dot journals, also known as bullet journals, as, “a dot journal is a system for writing down all the things you want to remember in a single notebook” (p. 4). Patients can use this method to write down questions or information they want to remember to share with their physical therapist.