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The Lancet
PERSPECTIVES
The art of medicine
Volume 406, Issue 10508
P1080-1081September 13, 2025
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Narrative means to normative ends: story-centred practice in statutory contexts
Jens Foell<a>a</a> jensfoell@nhs.net ∙ John Launer<a>b</a>Affiliations & NotesArticle InfoLinked Articles (1)
aPlas Menai Health Centre, Llanfairfechan LL33 0PE, UK
bUniversity College London Medical School, London, UK
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Narrative medicine places the patient's story at the centre of health care. It assumes that, in almost every clinical encounter, patients need to tell their stories, feel that these have been heard attentively, and go away with new narratives that make sense to them. These may or may not include elements of explanation, advice, or treatment. However, if the development of their stories has not been effective, patients are unlikely to feel satisfied.
We are both teachers of narrative medicine. One of the commonest reservations we meet is that clinicians find a narrative approach helpful for consultations that invite a non-directive, exploratory approach—for example, in myalgic encephalomyelitis/chronic fatigue syndrome—but they usually cannot imagine using it in encounters where the doctor is obliged to give advice, make a strong recommendation, or even to act against the person's wishes. Typical cases cited in this context involve child safeguarding or assessments carried out under the Mental Health Act that may result in compulsory admission to a psychiatric unit. We disagree with this view. One advantage of a narrative approach is that it enables the doctor to act in a way that is curious and humane when a clinical assessment might otherwise be experienced as only judgemental and oppressive. This approach can potentially give patients an opportunity to find meaning and some sense of agency even when the outcome may not concur with their wishes.
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