Listening to “How the Patient Presents Herself”: A Case Study of a Doctor–Patient Interaction in an Emergency Room

Abstract

This is a case-study based on a micro-ethnography analyzing a doctor-patient interaction in an emergency room (ER) in New York City. Drawing on the framework of narrative medicine (Charon, 2006), the study examines how a phenomenological approach to listening to the patient facilitated the patient’s narrative orientation not only to relevant clinical information (her kidney transplant) but also to the construction of her identity as a “responsible patient.” The influence of the so-called “prior context” (i.e., triage interview and the electronic medical record, EMR) is observed as constituting an institutional narrative that may shape patients’ (clinical) identities. This case study illustrates how a narrative medicine approach based on attention, representation, and affiliation helps balance the heteroglossia of voices to which the doctor is exposed. It is also argued that this approach restores patients’ own personal narratives while contributing to patients’ agency in building their own storytelling and identities. This study may hold educational value for patients, medical students, and health care practitioners in general.