NARRATIVE AND MEDICINE 2012

Title of the paper:

“Patient narrative, witness and clinical interpretation: lessons from a brain disease”

Abstract: It was usual during training in Neurology to learn that listen the patient was the best approach to know what kind of health problem he/she had. This approach was usual and determinant to the diagnosis. At the time clinical judgment was ahead from any complementary examination. Training in Neurology was, at that time, a rather elegant opportunity to discuss brain function and brain diseases. The trainers, recognized as excellent neurologists, teach us that patient history of illness (Anamnesis) was the most relevant factor for neurological diagnosis. In more clear terms: a neurologist as Corino de Andrade, that was at that time “our director” tell us that “to know what happens in a patient with a neurological disorder was necessary and fundamental to know the anamnesis”.

In present times, and in everyday practice, neurologists go back to the patient anamnesis to find out a good diagnosis. But, because doctors are driving patient narrative, more and more the doctor does not pay attention to what the patient says.

Doctors lose witness and patient narratives. Doctors commitment is more and more with “the things they can see” as imaging diagnostics than on “the things they tell me” – the patient and witness – the history of disease. Because doctors, more and more, adapt such narrative to the possible solution found on extremely powerful complementary examinations. Doctors are not thinking about what they listen. More and more doctors are thinking about what they see. And they see a lot of things on the exams that explore brain diseases.

A brain disease in which the narrative is many times the only key for the diagnosis - type or categorization and location or origin of the phenomena on a brain region – is the epilepsy. The narratives of seizure occurrence from patients with epilepsy – what they know and they feel on the development of epileptic seizure are splendid examples of narratives that we cannot miss. If we miss such narratives we also miss the diagnosis in terms of seizure description and classification and of seizure origin.

We took examples of such narratives from the literature. Narratives that are different if they belong from writers (such as Dostoevsky) or from renamed epileptologists (such as Hughlings Jackson). We will see how seizures description from patient (feelings, evolution), are different and most definitive to interpret patient behaviour and establish the location of the brain dysfunction.