WTF Wednesday: Master’s Degree in Narrative Medicine

Here is our inaugural entry for what I like to call WTF Wednesday:

The Narrative Medicine master’s program seeks to strengthen the overarching goals of medicine, public health, and social justice, as well as the intimate, interpersonal experiences of the clinical encounter. The program fulfills these objectives by educating a leadership corps of health professionals and scholars from the humanities and social sciences who will imbue patient care and professional education with the skills and values of narrative understanding.

Health care and the illness experience are marked by uneasy and costly divides: between those in need who can access care and those who cannot, between health care professionals and patients, and between and among health care professionals themselves. Narrative medicine is an interdisciplinary field that challenges those divisions and seeks to bridge those divides. It addresses the need of patients and caregivers to voice their experience, to be heard and to be valued, and it acknowledges the power of narrative to change the way care is given and received.

The study of narrative medicine is profoundly multidisciplinary. The curriculum for the master’s program in Narrative Medicine includes core courses in narrative understanding, the illness experience, the tools of close reading and writing; focused courses on narrative in fields like genetics, social justice advocacy, and palliative care; electives in a discipline of the student’s choosing; and fieldwork.

The above is from the Columbia University program. Would anyone like to tell me WTF this is or means?  Feel free to answer it seriously, sarcastically or pathologically.

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  31 comments for “WTF Wednesday: Master’s Degree in Narrative Medicine

  1. Sir Sneezalot.
    June 2, 2018 at 8:41 pm

    I can only look at this as the latest avant-garde trend such is six sigma and lean principles etc., meant to solve some problems in a politically correct way with mumbo jumbo which, in reality, makes no sense at all. In other words, the emperor has no flipping clothes. I read the description twice and, nowhere does it state that intention is to help the intellectually challenged. Apparently making that assumption is giving this program too much credit. And don’t think for a moment that the ultimate intention is not to place another layer of “managers“ over us physicians to let us know that we are somehow not meeting their satisfaction, Neanderthals that we are. SMH.

  2. Gabriela Eyal
    May 31, 2018 at 8:42 am

    Actually, graduates of this program can be hired as patient advocates or navigators. Although I definitely do not believe in income distribution, low income and disadvantaged populations have more difficulty accessing care. That has been the conclusion of many studies. Having someone trained to help ease the process is not such a bad idea. Why the system is so bad that we need navigarors is another question. Change will happen slowly though. Providing assistance to all patients to literally survive this monstrosity in the meantime through trained professionals can help.

    • Sir Lance-a-lot
      May 31, 2018 at 10:28 am

      And you are?

    • Pat
      May 31, 2018 at 11:27 am

      This is nothing but a rationale for parasites. Providing “advocates and navigators” is merely a jobs program paid for by actually productive citizens; if some patients are too dumb, poor, or apathetic to access care, then institutionalized enabling will only further the problem. It is supporters of this sort of idiocy that WANT a complex health system, so that they are needed.

      In essence, we have cloned ICD’s and CPT’s into semi-human conductors.

      • Sir Lance-a-lot
        May 31, 2018 at 12:22 pm

        Now, now, Pat. Perhaps it’s just my urban background, and history as a city worker, but I believe there is a place for jobs programs with little to no productivity. Two garbage men on a truck where you could get away with one, a conductor as well as a motorman on the train, a few extra clerks her and there are just fine with me. I’d rather they be earning money by actually showing up every day and doing *something* than costing a similar amount of money for welfare, Medicaid, and, quite often, prison (Grandma wasn’t kidding when she said “Idle hands do the Devil’s work”), not to mention the top-heavy administration of the above bureaucracies.

        That being said, while I have no problem with padding the janitorial or the front office staff of the local hospital (provided that they then do an exemplary job), or with providing adequate clinical staff (is there ever a nurse when you really need one?) I am as opposed as you are to padding the clinical staff. The last thing I need is someone who is not a doc or a nurse (and, yes, I include medical assistants in the group I can do without) getting in my way as I try to practice medicine.

        The world would benefit from having fewer aides, assistants, scribes, coördinators, directors, managers, navigators, etc. in the medical office, and more Registered Nurses.

        But I have no problem with a few inefficient job positions her and there outside the doctor’s office.

        • Pat
          May 31, 2018 at 6:05 pm


        • Alan
          June 4, 2018 at 9:27 pm

          You forgot to mention administrators

          • Sir Lance-a-lot
            June 4, 2018 at 10:20 pm

            They do not deserve mention.

      • Gabi
        May 31, 2018 at 7:47 pm

        Yes, we should do as much as we can to simplify the system but patients with modest cognitive skills (what is referred here as dumb) do need help. For the person who asked, I am a doctoral level clinical psychologist who has done hundreds of psychological evaluations for DHHS and the court system. Within that context, we talk about it often. Life in the Western world has become too complicated for individuals who have what we refer to as borderline intellectual capacity. While they were able to function in a rural/agrarian environment, today’s modern life is too much for them. It’s not their fault and they deserve help to navigate a society that we created. Same about the elderly with no family nearby. By the way, individuals who you describe as apathetic most ofen suffer from depression. So what are we supposed to do in your oppinion? Just dump them?
        This has absolutely nothing to do with physician autonomy. In a hospital managed the best way, 100% by physicians, segments of the population will still need patient advocates and navigators.

        • Steve O'
          June 1, 2018 at 8:54 am

          This touches on a hard social question.

          Jordan Peterson offers a discussion about the 10% of persons with the lowest intelligence in society. He offers the US Army threshold of IQ of 85 as a cutoff for persons who have the capacity to be functional soldiers in any capacity. Lugging, lifting and dragging are parts of any Army function.
          Bureaucracies avoid providing services by creating complexity of access to these services. Those who cannot run the maze, are ignored. The concept of scope of medical services is catchment – the percentage of eligible persons who receive services. In many cases, the ones who do are a rare and privileged few who have learned how to maneuver their way in. The system rewards those who are entitled, narcissistic and abrasive, sadly. The poor grandmother doesn’t have a chance.
          The “navigators” become gatekeepers. Patient advocates become fixers – getting in those whom they choose, even unconsciously, to merit access.
          The problem is one of bureaucracy and its deliberate attempts to decrease the number of people to whom it provides services. MediCal, for instance, around 2000, found out that if it offered $5 for clinic visits and $20 for hospital visits to physicians, the number of physicians billing went way down. Many would not even bother to bill the patients whom they chose to care for. But MediCal suffered the ultimate embarrassment – it made money in state government. You never want to end the fiscal year with a surplus, they take it away. MediCal found out that providing no services for no cost is the ultimate government bureaucratic solution.

        • Pat
          June 1, 2018 at 11:17 am

          The growth of unwieldy, depersonalizing insurance systems, and the myriad drones to support and profit from them, do exactly target physician autonomy. It’s insufficient for me to suture a cut; I have to describe, categorize, add in pointless data regarding review of systems and social history, and some one is paid to look up obscure codes to submit the bill for work already done. That is parasitic drag.

          And you resort to the tiresome reflex of sob story i.e. whatever are we to do with the intellectually challenged? The answer always becomes, “let’s drag everyone down with increased burdens.” Oh the poor elderly, spare me; it was the misbegotten promise of “free” care to them that launched us all into this mess.
          What to do with them all?? For starters, not drag down everyone else.
          In a hospital managed solely by physicians … that will NEVER happen now, because of the majority of the population which thinks we need vast complex mazes and advocates to navigate them. That supports the system which is by nature, the opponent of physician – or patient – autonomy.

          • Gabi.
            June 1, 2018 at 11:55 am

            I absolutely do not believe in dragging everyone down or in a bureaucracy. You again mix two categories here. Helping those who are chllenged by genetics or life circumstances is one issue. Reducing administration, eliminate that idiocy otherwise known as MACRA, is a totally different one. They can be addressed independently of one another.
            Steve and the military are more stringent than the DSM. An IQ between 70 and 80 is defined as borderline intellectual function. With a Standard Deviation of fifteen, individuals who are just one SD below the mean would have difficulty negotiating the demands of modern life. That is a scary thought.

        • Sir Lance-a-lot
          June 1, 2018 at 11:17 pm

          “I am a doctoral level clinical psychologist.”

          I respect that, Dr. Eyal. It’s not an easy credential to earn.

          And I agree wholeheartedly with your thesis that we in the Western world have, essentially, overcomplicated our world to the point where probably half of our people are destined to fail in some meaningful way, because it is just too much for them.
          Between the stress, anxiety, and depression caused by the way our lives are structured, to the way that the insane and the drug-addicted end up on the streets, to the fact that huge numbers would be on the streets if not for government welfare programs (which we all pay for), to the fact that to do the simplest things, such as get home or go shopping, you have to be operating a a very high cognitive level every second, because if you get distracted for even a second during your drive, or you may kill or be killed.
          None of this is natural, and all of it is detrimental to our entire society.

          That being said, I believe that your suggestion about “navigators” is misguided.
          The medical world used to have very effective navigators. They were called “Registered Nurses.” They would care for patients, spend time with them, ascertain their needs, and help to guide them through the system. Now, they are trapped giving out meds to dozens of people and “documenting” their most minute activities, almost completely unable to provide the care that their forbears considered to be routine.
          Adding qualified nurses, and removing dead-weight administrators, is the way to improve the medical system, with no need to invent new jobs that only complicate things further.

  3. Steve O'
    May 31, 2018 at 8:37 am

    In some ways this direction is good. It threatens to be another example of treating the symptom.
    Talking was the way to do medicine for most of its history. Then mankind invented writing, which the gods disfavored and punished mankind by giving them the Electronic Medical Record.
    Talking has vanished from medicine. It is replaced by the Great Digital Trash Vortex, a stately whirl of words without thoughts or meaning, but having been transformed by HIPAA, can no longer be erased.
    In the five-minute “motivational interview,” or whatever the technique du jour offers, the quality of talking’s mighty poor. And leave it to the Ivory Tower to address it by the proven technique of:
    1) You are stupid.
    2) We know what we are talking about.
    3) We will tell you the right way of doing this.
    It’s as though they set up an interdisciplinary specialty about “The Leg In Society.” One can study the anatomy, neurology and kinesthesia of the leg, the History of the Leg, the Leg in Other Species, as well as the leg in Marxist Literature, the Leg in Cinema, the Leg in other Cultures, the Queer Leg, etc.
    The Narrative In Medicine is a symptom. It has been killed off, as it does not pay. Direct primary care has nothing but the narrative. No checklists, no distractions, nothing to help protect the physician from intensely concentrating on the patient in a professional manner, examining what might be suspicious, and discussing remedy. How scary!

  4. David
    May 30, 2018 at 6:28 pm

    This is Marxism.

  5. RRiley
    May 30, 2018 at 6:21 pm

    The medical-industrial complex has the patient-doctor relationship FUBAR. This has resulted in an infinite number of piggies at the trough of said medical-industrial complex, many of whom have a bewildering array of groups of letters affixed to their names. This is yet another avenue for the piggies to nudge their way up to the trough.

  6. Lawrence Kutner, Ph.D.
    May 30, 2018 at 4:06 pm

    Thank god the program is “profoundly multidisciplinary.” If it were merely eclectically diverse, recursively informed or even indigenously exogenous, it wouldn’t be nearly as valuable.

    Next up: Mechanical engineering as an emotional substrate.

  7. Bill Ameen
    May 30, 2018 at 10:56 am

    If any of the faculty were medical doctors, wouldn’t they have “MD” after their names? Therefore, I have to believe they are training more occupants of the “Mahogany Hall” (as we call the executive suite of our local megalithic hospital) to dictate to working doctors how to be more productive for the system (aka “The Man”). What degree do they “earn”…M.S. F.T. (Master of Science in Feces Tauri)?

    • David Taylor, MD, PhD
      June 2, 2018 at 12:44 pm

      At least two of the core faculty are physicians.

  8. Sir Lance-a-lot
    May 30, 2018 at 10:55 am

    From my personal perspective (perhaps a result of the Irish part of my ancestry), I see all of medicine as story, which just seems obvious to me, and is certainly not something to make a bullshit course out of.
    When I walk into a room, I ask the patient “What happened?” or “What’s going on?” and they tell me a story, then I ask a few questions and examine them, then I tell them a story (“The Story of Bacteria and Viruses” or “The Story of Sprains versus Fractures” for instance, or sometimes a personal story, like “I Was Out Cutting Wood Last Week and Look at All the Bug Bites ** I ** Got, and I’m Still Alive”), and then they leave.
    It’s just like being a bartender, really. We tell stories, I give them something to make them feel better, and they leave.

    The thing that amazes me is that P&S and that lengthy roster of highfalutin’ “academics” has found a way to make people pay them thousands of dollars to take a course in something this obvious.
    Next up: “Drug Seekers: They Try to Get Drugs From You.”

    • Steve O'
      May 31, 2018 at 8:41 am

      You touch on a great theme. Humor and entertainment in Irish American culture such as I have enjoyed, is marked by skillful and engaging storytelling. Irish jokes take ten minutes, and need to.
      What makes the medical visit different from other engagement is that I have skill in the matters of medicine, and the patient seeks to find an answer in their path of their existence. One of the first things to learn about the patient is whether they ask “What is this?” or “I don’t give a damn what this is, make it go away.” If we aren’t given the time, we can’t do the magic.

    • Sir Hakum of Hugo
      May 31, 2018 at 1:03 pm

      I have always made the bartender reference in describing proper primary care interactions. I just wish I had a tip jar…and access to a diverse private stock of 80 proof medications…I think my patients would actually feel better.

  9. Steve O'
    May 30, 2018 at 10:50 am

    It is a master’s in how to teach a fish to swim, taught by scorpions and other desert creatures who have never seen water.
    Medicine fundamentally communicates in an oral storytelling method. To use a cruelly tormented word, it is a dialectic.
    The vanity of the jesters and hangers-on have created such a din that the actual care of the patient is drowned in the noise.

  10. May 30, 2018 at 9:35 am

    “Social justice” = “Income redistribution”

    • Sir Lance-a-lot
      May 30, 2018 at 10:57 am

      I don’t mind “Income redistribution,” so long as it comes along with “Debt redistribution.”

  11. Perry
    May 30, 2018 at 8:58 am

    If the idiots in power would allow caring family doctors to return to treating individual patients, none of this BS would be necessary. Not that it is really necessary or helpful anyway.

  12. Pat
    May 30, 2018 at 8:46 am

    This word salad included the phrase “social justice” twice. Medicine continues to degrade in direct relation to its use as a collective force. Anyone combining health care and arbitrary notions of “social justice” is a fool at best, and will be used to harmful ends.

  13. Theresa
    May 30, 2018 at 8:33 am

    I think you write in a lot of fancy phrases why doctors are idiots who can’t imagine what it is like to be anything but white, male and rich, even those that started out female, black and poor (med school changes them all into male, white and rich). The one who makes the most compelling case for “Doctors are Uncaring Idiots” in the most profound sounding words, gets the A.

  14. George Voigtlander
    May 30, 2018 at 7:56 am

    I think it is the winning submission in a contest to use as many buzzwords as possible in three paragraphs. One of the rules is that there is no coherent message.
    Probably is Columbia’s version of the Bulworth-Litton contest for the worst opening line.

  15. May 30, 2018 at 7:40 am

    Can we talk about this?

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