Abstract
Objectives: The purpose of this report is to show a key concept of Narrative-Based Medicine (NBM) through qualitative analysis of interactions between the patient, a doctor and a third person. We will now need to consider a plasticity of illness narratives more closely to understand this interactive relationship. Subjects and method: Illness narratives were collected from 20 outpatients at a clinic in Tokyo. From March 2000 to August 2000, we conducted non-structured interviews intensively to examine illness narratives. The subjects of this study were 5 patients who were placed in the 3rd stage of the Four-stage model (Table 1). This study adopted the qualitative research method from an anthropological point of view because it was necessary to mention the influence of researchers upon their subjects. Results: It has been recognized by our research that there is a process to refine illness narrative (Fig. 1). In the 3rd stage of the Four-stage model, patients become an expert of illness experience while medical doctors remain as a specialist of disease. Furthermore, we examined a key concept in NBM. We found that there are 3 aspects of witness in the 3rd stage (Fig. 2); (I) illness narratives of witness, (II) medical doctor as a witness person for their illness narratives, (III) researcher or family member as a second witness person for doctor-patient relationship. Conclusion: We found that each interaction among 3 aspects could be considered indispensable in order to conduct NBM effectively. It is sure that to witness a patient's daily life is one of the most important elements in NBM. Therefore, we named the interaction among 3 aspects Witness-Based Medicine.
