Life on the receiving end: A qualitative analysis of health providers' illness narratives

PURPOSE: Clinical empathy is integral to forging therapeutic patient-physician relationships. Illness narratives are a potentially rich source of insight into what it feels like to be a patient or patient's family member. The authors performed a qualitative analysis of illness narratives to develop an explicit framework for understanding what it feels like to be a health care recipient and to explore how providers' behaviors influence that experience. METHOD: The authors used consensual qualitative research, a methodology based on principles of grounded theory, to analyze 24 illness narratives found in that number of essays from the Annals of Internal Medicine's "On Being a Patient" series published between January 1, 1999, and December 31, 2003. Trustworthiness was demonstrated via essayists' feedback on the analysis. RESULTS: Patients and their families faced formidable physical and psychosocial challenges. Providers' behaviors influenced the illness experience in profoundly positive and negative ways, independent of the technical quality of care. Consistent with previous studies of patient-physician relationships, providers' advocacy for patients and expressions of compassion were prominent determinants of patients' satisfaction. The experience of simultaneously being a health care provider and consumer was an additional source of stress for essayists, but it positively influenced their subsequent practice. CONCLUSIONS: Illness narratives vividly illustrate fundamental aspects of the illness experience and are a potentially rich resource for cultivating empathy. The authors' analysis provides a framework for enhancing trainees' and practitioners' ability to understand and meet patients' and families' psychosocial needs. The experiences of health care recipients with medical backgrounds are uniquely challenging and beneficial.