Using Narrative Medicine to Establish Care: Inviting the Patient Story into the Exam Room

Context: The patient-physician relationship plays a crucial role in patient satisfaction and clinical outcomes. Narrative Medicine seeks to improve the experience of providing and receiving healthcare by engaging with patient stories and developing narrative competence. Its potential role in establishing care with a Primary Care Provider (PCP) has not been previously studied.

Objective: To assess patient reactions to and engagement with an invitation to share about themselves personally via electronic messaging through the healthcare record (MyChart) as part of establishing care with a new PCP.

Study Design and Analysis: Over a 7-week period, patients who met the inclusion criteria (age > 18, English speaking, active on MyChart, scheduled for a first visit with a new PCP) were sent a MyChart message asking what they wanted their healthcare team to know about them as a person. Responses were discussed during the office visit and patients who viewed the message were given a survey about their experience with receiving the message and its impact on their clinic visit. Patient responses to the MyChart messages were analyzed for themes using NVivo.

Setting: Family Medicine clinic in Cottage Grove, Wisconsin Population Studied: Adult outpatients at a family medicine clinic Intervention: MyChart message from the study provider asking “What do you want your healthcare team to know about you as a person?”

Outcome Measures: Percentage of patients reading and responding to the MyChart message; Themes of patient responses as coded by two raters; Survey responses about patient experience of being asked this question

Results: Of 57 MyChart messages sent to new patients, 40 (70%) were read. Of those read, 15 (38%) responded. Major response themes included Health, Personal information, and Reactions to the message. Of 24 surveys collected, 95% of patients had a positive or neutral response to receiving the MyChart message; 86% felt it positively impacted their visit, and 93% felt it increased their comfort level with their new PCP.

Conclusions: This pilot project suggests that most patients appreciate the opportunity to share something about themselves when establishing care with a new PCP, and that MyChart is one viable way to facilitate this communication. Potential future areas of study include exploring the most effective protocol for inviting patients to share personal narrative, and how these narratives impact patient and physician experience of establishing care.