Join us on Tuesday, May 12th, from 6:30–7:30 pm EDT on Zoom to discuss Rachel Weaver's memoir, Dizzy (2026). Weaver recently received her CPA in Narrative Medicine from Columbia University.

Hosted by Wendy Nielsen PhD. 

Dizzy is a medical mystery and a cautionary tale about our broken healthcare system. It is a story about learning to live with life's uncertainty, persevering in the pursuit of answers, and finding joy in an imperfect yet beautiful world.

Dizzy is available to purchase online through https://bookshop.org and https://wvupressonline.com/dizzy

When: May 12th, 6:30 - 7:30 pm EDT

How: Click here to register for this Zoom meeting

If you'd like an email reminder, please reach out to me at niElsEnw@montclair.edu

Meeting ID: 878 3791 4945, Passcode: 911965

Who: Free to Members of Narrative Mindworks

All are welcome!

Image: Prexels

Narrative Mindworks recently conducted an education and training program for the American Public Health Association by creating specialized video stories to help public health professionals communicate more effectively about sensitive issues like domestic violence and suicide risk. These videos depict the real‑world contexts in which people make decisions, face challenges, or seek help. By engaging with these video‑based narrative vignettes, paired with narrative‑medicine prompt protocols, public health professionals gained deeper insight into how culture, language, and personal history shape the way individuals interpret health messages. The goal of this project was to support public health practitioners in crafting communication that is not only accurate, but also compassionate, culturally grounded, and more likely to reach the people who need it most.

-Lauren Manning

How are you currently using video or digital storytelling in your own narrative work, and what challenges, or breakthroughs have you experienced in trying to capture authentic voices on screen? Share your thoughts on the feed, or for more extensive pieces email us at info@narrativemindworks.org

Wieland et al¹ reported findings from a randomized clinical multicenter trial that assessed the use of patient digital narratives on glycemic control among Hispanic adults with type 2 diabetes. The study included a large patient population, had a high retention rate, and was conducted in primary care clinical settings in 2 states. The study team used a community-based participatory research approach to partner with community members in developing digital narratives that described individuals’ experiences living with diabetes. Patients in the intervention group watched the digital narrative video in their preferred language and were provided access to the video on their own devices. Compared with patients in the control group, those in the intervention group had a small improvement in glycemic control; the intervention was highly acceptable.

Hispanic individuals in the United States have high rates of diabetes prevalence and diabetes-related complications,² with only 48% achieving adequate glycemic control.³ These disparities in diabetes prevalence and outcomes are multifactorial. The National Healthcare Disparities Report⁴ notes that Hispanic patients receive a lower quality of diabetes care. Structural and social determinants of health, such as access to healthy food, safe environments for exercise, and cost of medication, impede a person’s ability to manage their diabetes.⁵ Lack of access to culturally tailored and linguistically appropriate care can pose barriers to effective patient-physician communication and the receipt of self-management education and can lead to poor glycemic control.⁶ While many interventions have aimed to improve outcomes among Hispanic patients living with diabetes, many need further cultural tailoring and grounding in the community.

The use of digital narratives is a promising approach, and its engagement with community partnership in this study is novel. Community-partnered participatory research is an approach to collaborative research that emphasizes partnership with community for the design and evaluation of interventions and conduct of research studies.⁷ Recently funders, including the Patient-Centered Outcomes Research Institute and the Robert Wood Johnson Foundation, have encouraged partnership with community, stakeholders, and patients in clinical and translation studies. Engaging communities increases the likelihood that interventions are culturally tailored to patients and sustainable after the research is complete. The storytellers in this study played a key role in the production of their narratives through workshops conducted with the Rochester Healthy Community Partnership. The narratives from the workshop highlighted community members’ challenges and success in managing their diabetes. The study highlights the importance of academic and community partnership in codesigning interventions and ensuring that the stories told are ones that depict the reality of people in the community, tailored to patients’ culture, and told in their language.

Managing diabetes includes multiple daily behavioral self-management tasks, such as modifying diet and exercise habits, taking medications, checking blood glucoses, and engaging in regular health care visits. Adults with diabetes may lack support from family or friends in diabetes self-management. There is longstanding literature on the role of peer support in chronic disease management. Peers living with chronic conditions can share their knowledge, experience, and resources to support others living with diabetes. While not a direct peer support intervention, the use of digital technologies in this study provided a way for Hispanic adults living with diabetes to hear the stories of others living with the condition and how they navigated family, community, culture, and societal barriers in diabetes self-management. And as noted in the study results, the study team found that patients in the intervention group increased their confidence in managing their disease and were motivated to make behavior change after viewing the 4 narratives.

The US Hispanic population is diverse and includes people from a range of countries and with a range of educational attainment, socioeconomics, acculturation, and language preferences. Oftentimes we find that Hispanic individuals are aggregated into 1 ethnic group, which disregards this community’s rich diversity. We have seen this heterogeneity represented in diabetes prevalence: Cuban Americans have lower rates of diabetes prevalence compared with Mexican Americans and Puerto Ricans in the United States.² The study team intentionally included storytellers who were women and men and those from different regions of Latin America to better reflect the richness of the US Hispanic population in their narratives. This representation of diverse voices increased the chance that the stories would resonate with individual Hispanic patients and their individual lived experience with diabetes.

The study provides evidence that a digital narrative intervention that is done in partnership with community can have an impact on clinical outcomes. The stories were developed with and for Hispanic adults with diabetes and helped normalize the challenges of living with diabetes and highlighted a way to overcome them. This digital intervention is portable and can serve as a supplement to clinical care. Future studies can further delineate the mechanisms by which digital narratives can improve diabetes self-care and impact long-term diabetes outcomes. Tailoring interventions to individual patients and their cultures is necessary to address health disparities. Patients do not live in silos. They bring with them their language, their culture, their beliefs, and their community. Addressing disparities among Hispanic patients living with diabetes involves first understanding their lives through their own authentic voices.

First published 08.2024

Click here for full article

But the results also show the limits of a system that tries to read distress from text alone. The models performed unevenly, especially when it came to suicide risk. Our lives are defined by ambiguity; sometimes, a slightly inside-out sentence, indirect imagery, awkward rigidity, or a double metaphor can slip by an algorithm that has yet to master those elements of nuance.

What this research offers is a reminder of the limits and responsibilities by those of us working with story. Narratives aren't just additional data points to the biomedical profile; they are sometimes messaging portals and lifelines, and they demand context, a well-trained, close listener and reader who can process the overall presentation. In workshop or clinical-adjacent settings, we might consider using AI as an assistive device that generates prompts, offers structural suggestions, or helps workshop participants explore alternative framings. But the interpretive, ethical, and relational responsibilities of the facilitator remain irreplaceable. LLMs operate only on text, which means it will inevitably miss the embodied, contextual, and relational dimension of the person and what most fully animates meaning in story.

For those of us working in narrative‑practice, specifically narrative medicine, a core principle is that the work may be therapeutic, but it is not therapy. Anyone who presents with elevated risk is referred to a licensed mental‑health professional. At the same time, many narrative practitioners also hold clinical credentials, and in those blended roles, the boundary between narrative work and clinical intervention can become ethically complicated. Some clinicians have begun using AI as an informal “second opinion,” either to reinforce an existing interpretation or to challenge it, adding another layer of complexity to those boundaries. 

As written language styles ishaped by AI influence communication and writing styles, how do we as practitioners address this flattening input? Have you thought about using AI as a type of third object when conducting a workshop?

Importance  Large language models (LLMs) and text-embedding models have shown potential in assessing mental health risks based on narrative data from psychiatric patients.

Objective  To assess whether LLMs and text-embedding models can identify depression and suicide risk based on sentence completion test (SCT) narratives of psychiatric patients.

Design, Setting, and Participants  This cross-sectional study, conducted at Seoul Metropolitan Government-Seoul National University Boramae Medical Center, analyzed SCT data collected from April 1, 2016, to September 30, 2021. Participants included psychiatric patients aged 18 to 39 years who completed SCT and self-assessments for depression (Beck Depression Inventory–II or Zung Self-Rating Depression Scale) and/or suicide (Beck Scale for Suicidal Ideation). Patients confirmed to have an IQ below 70 were excluded, leaving 1064 eligible SCT datasets (52 627 completed responses). Data processing with LLMs (GPT-4o, May 13, 2024, version; OpenAI [hereafter, LLM1]; gemini-1.0-pro, February 2024 version; Google DeepMind [hereafter, LLM2]; and GPT-3.5-turbo-16k, January 25, 2024, version; OpenAI) and text-embedding models (text-embedding-3-large, OpenAI [hereafter, text-embedding 1]; text-embedding3-small; OpenAI; and text-embedding-ada-002; OpenAI) was performed between July 4 and September 30, 2024.

Main Outcomes and Measures  Outcomes included the performance of LLMs and text-embedding models in detecting depression and suicide, as measured by the area under the receiver operating characteristic curve (AUROC), balanced accuracy, and macro F1-score. Performance was evaluated across concatenated narratives of SCT, including self-concept, family, gender perception, and interpersonal relations narratives.

Results  Based on SCT narratives from 1064 patients (mean [SD] age, 25.4 [5.5] years; 673 men [63.3%]), LLM1 showed strong performance in zero-shot learning, with an AUROC of 0.720 (95% CI, 0.689-0.752) for depression and 0.731 (95% CI, 0.704-0.762) for suicide risk using self-concept narratives. Few-shot learning for depression further improved the performance of LLM1 (AUROC, 0.754 [95% CI, 0.721-0.784]) and LLM2 (AUROC, 0.736 [95% CI, 0.704-0.770]). The text-embedding 1 model paired with extreme gradient boosting outperformed other models, achieving an AUROC of 0.841 (95% CI, 0.783-0.897) for depression and 0.724 (95% CI, 0.650-0.795) for suicide risk. Overall, self-concept narratives showed the most accurate detections across all models.

Conclusions and Relevance  This cross-sectional study of SCT narratives from psychiatric patients suggests that LLMs and text-embedding models may effectively detect depression and suicide risk, particularly using self-concept narratives. However, while these models demonstrated potential for detecting mental health risks, further improvements in performance and safety are essential before clinical application.

First published May 23, 2025. doi:10.1001/jamanetworkopen.2025.11922

 Click here to read the full study

Rooted in narrative assessement, this approach treats the patient as the expert of their inner world, allowing meaning to emerge through shared reflection. As evidence grows, we’re reminded that stories can heal as much as strategies. The narrative becomes a bridge, one that helps patients make sense of moments that once felt chaotic, and helps clinicians witness suffering with clarity rather than control. In that shared space, hope often begins to take shape.

For those combining clinical and narrative practices: how do you create room for a person's full story before addressing potential interventions?

Let us know what you're thinking: info@narrativemindworks.org

Image: afsp.org

A Narrative Approach to Assess Suicide—Tell Me Your Story

Justin C. Baker, PhD, ABPP¹

First published: November 20, 2025

2025;8;(11):e2544639. doi:10.1001/jamanetworkopen.2025.44639

Cognitive behavioral therapies (CBTs) are considered impactful psychotherapies for reducing suicide attempts.¹ However, not all CBT interventions are equivalent. Janssen et al² found that CBTs that include a narrative assessment were associated with reducing suicide attempts compared with controls, whereas no association was found for CBTs that do not include a narrative assessment. The meta-analysis included 23 randomized clinical trials (14 with a narrative assessment; 9 without a narrative assessment) published through April 2025.² As suicide rates continue to rise, seemingly unfettered, knowing which treatment interventions are most promising for reducing suicide attempts is paramount. But what exactly is a narrative assessment?

The narrative assessment is a suicide risk assessment approach used in brief cognitive behavioral therapy that uses storytelling to assess suicide risk while fostering therapeutic alliance. This is contrasted with a more traditional suicide risk assessment approach that uses a set of standardized or templated questions to assess risk. When doing a narrative assessment, the clinician invites the patient to tell the story of the recent suicidal crisis, focusing on their thoughts, emotions, behaviors, and physical sensations experienced during the crisis. The clinician, using empathic reflection, focuses on collaborative understanding and shared insight to identify what transpired during the patient’s crisis. The narrative assessment draws inspiration from and remains consistent with what is known as the Aeschi approach.³

In 2000, suicide clinician-researchers from around the world gathered in Aeschi, Switzerland, in a thinktank format to reconsider how suicide risk is assessed and treated.⁴ The meeting primarily consisted of watching clinical assessments of patients with suicidal ideation or behavior that had been videotaped in various academic clinical settings. Some videos appeared more like interrogations of the person with suicidal behavior, who ultimately cowered in response to the authority of the clinician.³ Other clinical vignettes unfolded more gently, with the clinician guiding the patient through telling their story of their suicidal crisis in rich detail and allowing for collaborative and mkenutual reflection and understanding.³

Out of this first meeting came the Aeschi Working Group Guidelines for Clinicians, which suggested clinicians should foster therapeutic alliance through empathic and reflective listening and recognize the importance of learning from the individual with suicidal ideation.⁴ In this way, 2 experts emerge in the therapeutic dyad, the patient as an expert in their story, history, and current circumstances and the clinician as expert in seeing the patient’s world from their point of view. The Aeschi approach is uncompromisingly founded upon equal respect between the patient and clinician, fostering compassion and wisdom, and is the foundation for building a life worth living.

The Aeschi approach is not aligned with any one theoretical orientation; however, cognitive therapists around this same time began to reconceptualize the emergence of suicidal thoughts and behaviors as a nonlinear, transactional process via the suicidal mode.⁵ The suicidal mode is a network of interconnected constructs that includes predisposed vulnerabilities for suicide, an activating stressor (internal or external), and core cognitive, emotional, behavioral, and physical schemas that contribute to an individual’s overall suicide risk. Once the suicidal mode is activated by an internal or external stressor, the net result is an active suicidal state or episode. Activation of a suicidal state is often rapid and unpredictable as the suicidal mode follows a nonlinear time course making it difficult for patients to identify how their suicidal state came to be. The narrative assessment allows the patient, in their own words, to reflect on what transpired during this distressing time. With helpful and nonjudgmental reflections from the clinician, the patient begins to piece together a clearer picture of what occurred.

It is important to note that while the results of the meta-analysis by Janssen et al² are encouraging, the findings that CBTs with a narrative assessment are associated with greater reductions in suicide attempts remain correlational.² There exists only one randomized clinical trial designed to isolate the unique effects of the narrative assessment, which did show the narrative assessment as most impactful in reducing suicidal ideation compared with a structured suicide risk assessment, when followed by either a safety plan or a crisis response plan.⁶ However, additional research is warranted to better understand the unique contributions of the narrative assessment in reducing both suicidal thoughts and behaviors. Moreover, the suicide intervention literature continues to lack sufficient mechanistic studies that would allow improved understanding of what treatment components specifically are responsible for reducing suicide risk.

Even with these limitations, there remains mounting evidence to suggest that patient-centered collaborative assessment approaches are impactful in reducing suicide risk as well as subjective distress. Recent work by Oakey-Frost et al⁷ demonstrated that psychiatric inpatient participants who received the Suicide Status Form-4 (SSF-4), a semistructured collaborative suicide risk assessment consistent with the Aeschi approach, reported substantial reductions in subjective distress. The SSF-4 is typically administered as part of the Collaborative Assessment and Management of Suicidality, which has been repeatedly shown to reliably reduce suicidal ideations in clinical trials.⁸ Collectively, the evidence is convincing that using patient-centered, collaboratively developed suicide risk assessment models contributes to reductions in suicide risk and distress. This is good news for clinicians seeking to integrate simple interventions that can have a real impact on inspiring hope, reduce the risk of suicide attempts, and improve the lives of their patients.

References

1. van Ballegooijen  W , Rawee J , Palantza C , et al. Suicidal ideation and suicide attempts after direct or indirect psychotherapy: a systematic review and meta-analysis.  JAMA Psychiatry. 2025;82(1):31-37. doi: 10.1001/jamapsychiatry.2024.2854

ArticlePubMedGoogle ScholarCrossref

2. Janssen  WC , Mè relle SYM , van Ballegooijen W , Gilissen R , Bockting CLH . Cognitive behavior therapy with and without narrative assessment and suicide attempts: a systematic and meta-analysis.  JAMA Netw Open. 2025;8(11):e2544632. doi:10.1001/jamanetworkopen.2025.44632

ArticleGoogle Scholar

3. Michel  K , Jobes DA , eds. Building a Therapeutic Alliance With the Suicidal Patient . American Psychological Association; 2011. doi:10.1037/12303-000

4. Michel  K , Maltsberger JT , Jobes DA , et al. Discovering the truth in attempted suicide.  Am J Psychother. 2002;56(3):424-437.doi: 10.1176/appi.psychotherapy.2002.56.3.424Google ScholarCrossref

5. Rudd  MD , Brown GK . A cognitive theory of suicide: building hope in treatment and strengthening the therapeutic relationship. In: Michel K , Jobes DA , eds. Building a Therapeutic Alliance with the Suicidal Patient. American Psychological Association; 2011:169-181. doi: 10.1037/12303-010

6. Lohani  M , Bryan CJ , Elsey JS , et al. Collaboration matters: a randomized controlled trial of patient-clinician collaboration in suicide risk assessment and intervention.  J Affect Disord. 2024;360:387-393. doi: 10.1016/j.jad.2024.06.004PubMedGoogle ScholarCrossref

7. Oakey-Frost  N , Moscardini EH , Cowan T , et al. The Suicide Status Form-4 (SSF-IV) as a potentially therapeutic suicide risk assessment tool.  Suicide Life Threat Behav . 2025;55(1):e13128. doi: 10.1111/sltb.13128PubMedGoogle ScholarCrossref

8. Swift  JK , Trusty WT , Penix EA . The effectiveness of the Collaborative Assessment and Management of Suicidality (CAMS) compared to alternative treatment conditions: a meta-analysis.  Suicide Life Threat Behav . 2021;51(5):882-896. doi: 10.1111/sltb.12765PubMedGoogle ScholarCrossref

This randomized clinical trial evaluated a digital conversational platform among university students reporting psychological distress. The intervention produced significant reductions in anxiety and depression and improvements in well‑being and life satisfaction. PTSD symptoms showed no differential change across conditions. But the study noted, “participants perceived the platform as possessing relational qualities typically associated with human therapists,” and “a stronger perceived alliance was associated with increased engagement and improved psychological outcomes.” The findings highlight a burgeoning relevance of relational processes within technologically mediated care.

For narrative medicine practitioners: How do you feel such digitally mediated alliances challenge prevailing assumptions about therapeutic presence and relational depth in clinical practice? Do you think they belong in the practice toolkit?

What do you think: info@narrativemindworks.org, or post to the feed.

Read an excerpt below. Click here for full article

-Lauren Manning

Question  Does a conversational artificial intelligence (AI)-based platform reduce psychiatric symptoms compared with face-to-face group therapy or a waiting list control?

Findings  In this randomized clinical trial of 995 university students, the AI intervention was associated with greater reduction in anxiety and improvement in well-being than both comparators, and greater reductions in depression and life satisfaction than the waiting list control; no significant differences were observed for posttraumatic stress disorder symptoms.

Meaning  The findings of this study suggest that conversational AI interventions may represent scalable adjuncts to mental health care.

The AI-Driven Physician: Redefining the Practice of Medicine

Akshat jain MD, MPH

The introduction of the internet, personal computers, and smartphones has reshaped how medicine is practiced, each innovation redefining what it means to deliver care. Artificial intelligence now enters that continuum as the next force prompting both excitement and unease. It is difficult to ignore the steady stream of reports and commentary examining how AI will influence the future of medicine. As a clinician and clinical scientist, I find myself reflecting on what this shift will mean in the context of daily practice.

By 2026, more than 80 percent of physicians report using AI in their professional work, a figure that has doubled since 2023. More than three-quarters say it enhances their ability to care for patients. The most common applications include literature search, used by 35 percent of physicians, followed by voice-based documentation tools such as AI scribes and ambient listening. Growth has been especially notable in areas tied to administrative burden, including prior authorizations, insurance correspondence, and the summarization of lengthy patient records.

These are not small gains. They represent a gradual removal of tasks that have accumulated over time, many introduced by systems that placed increasing operational demands on physicians. In the process, time once available for patient interaction has steadily eroded. AI offers the possibility of restoring some of that time.

The burden is not theoretical. Studies show that 77 percent of healthcare professionals lose time due to incomplete or inaccessible data, while nurses spend 15 to 20 minutes of every hour on administrative work. AI’s most immediate opportunity lies in reducing this friction by automating repetitive processes and delivering the right information at the right time.

Early concerns that AI would replace physicians have given way to a more nuanced understanding. The future is not one of substitution but of integration. Institutions such as Stanford, Harvard, and the American Medical Association increasingly describe a model in which AI reshapes the structure of the physician’s day rather than eliminates the role altogether.

Image: Freepik

A decade from now, physicians will likely spend less time on documentation, pattern recognition, and routine differential generation. More of their focus will shift toward patient relationships, complex clinical judgment, procedural work, and oversight of AI-driven outputs. The technology will support rapid access to information, enable analysis of large datasets, and surface rare diagnoses or less obvious treatment pathways.

Primary care may experience some of the most meaningful benefits. AI scribes can reduce documentation burden, while clinical decision tools may assist in identifying uncommon conditions. Intake and triage processes can be partially automated, allowing physicians to direct more attention to the patient in front of them. This shift has implications for access as well. With ongoing shortages in primary care, AI-supported models may help extend reach, particularly in resource-limited settings. Even in 2026, securing a timely appointment can remain a challenge, underscoring the need for solutions that improve both efficiency and availability.

Image: Freepik

From a specialty perspective, the impact is already visible. In oncology, AI models designed to analyze genomic data can identify driver mutations and match tumor profiles with targeted therapies, advancing the promise of precision medicine. Surgical fields remain grounded in the physical and cognitive demands of procedural work. Psychiatry and pediatrics continue to rely heavily on nuanced human interaction, making them less susceptible to automation. Neurology offers an example of early adoption, with applications in stroke detection, EEG interpretation, and disease progression modeling.

Other specialties face greater disruption. Radiology and pathology are often cited as leading indicators of how AI may alter clinical workflows. Advances in imaging analysis have produced tools capable of high diagnostic accuracy across a range of conditions. Some mammography systems now demonstrate sensitivity comparable to experienced radiologists, in certain cases with lower false-positive rates. At the same time, variability remains, and real-world performance continues to evolve. Personal experience with diagnostic imaging highlights both the promise and the current limitations of these systems.

Pathology is also undergoing transformation. AI-assisted slide analysis has the potential to streamline workflows, improve diagnostic speed, and enhance precision in areas such as blood banking and antigen matching. These developments will likely integrate into practice over time, contingent on both technological refinement and institutional readiness.

For physicians navigating this landscape, the question is not whether to engage with AI but how. The most effective approach will involve treating these tools as clinical partners. This requires developing the ability to interpret outputs critically, recognizing when to rely on them and when to override them. It also involves leaning into the aspects of medicine that remain distinctly human, including communication, ethical decision-making, and procedural expertise.

Approximately 40 percent of physicians report feeling both optimistic and concerned about AI’s role in healthcare. Key concerns include patient privacy and the preservation of the patient-physician relationship. This tension reflects a thoughtful engagement with the technology rather than resistance to it.

The future of medicine will be shaped by those who can integrate efficiency with judgment, technology with humanity. AI may redefine how care is delivered, yet the responsibility of care will remain grounded in the physician.

Acting the Patient: What Medicine Can Learn from the Stage

Click here to listen to a conversation with Mary Illes that explores the intersection of performance art and medical education. A central theme is the transferability of artistic skills—particularly voice, physical presence, and emotional authenticity—into clinical training. Illes emphasizes that first impressions, posture, and vocal tone shape how patients perceive clinicians, much like an audience interprets a character within seconds on stage. She frames clinical encounters as a kind of performance, where medical students must “set the stage” quickly, establish trust, and communicate effectively under time pressure. Her coaching approach draws directly from acting techniques, encouraging students to ground themselves, project confidence, and remain responsive in the moment.

Another key point is the complementary relationship between artists and clinicians. Illes highlights how actors bring strengths in communication, empathy, and improvisation, while medical students contribute technical knowledge and diagnostic skill. The SP encounter becomes a space where these domains meet: students learn to navigate difficult or ambiguous patient interactions (e.g., reticent or overly talkative patients), while SPs simultaneously perform, evaluate and debrief the learners. Illes also reflects on the dual role of SPs as both actors and critics, noting the importance of balancing immersion in character with the ability to step back and provide constructive feedback. Her feedback style prioritizes self-reflection, encouraging students to identify what went well before addressing areas for improvement.

Finally, the interview underscores authenticity as the core value across both acting and medicine. Illes seeks authenticity in performance—whether on stage or in simulation—and encourages students to move beyond checklist-driven interactions toward genuine human connection. Her preparation process reflects this philosophy: internalizing key details through repetition and physical embodiment so that responses feel natural rather than scripted. She also touches on the emotional boundaries of SP work, describing it as similar to theater—intense but contained, with a clear “curtain down” moment that allows separation from the role. Overall, the conversation positions SP methodology as a form of applied performance, where narrative, embodiment, and relational awareness are essential to effective clinical practice.

How a health literacy and child life specialist is rewriting the language of healing

Image: Clare Kelley, child life specialist, heatlh literacy & narrative informed specialist

He was 12 years old, autistic, and had burns across most of his chest. The night before, while his family slept, he had been playing with a lighter. He didn't mean to hurt himself. The lighter just dropped.

By the time Clare Kelley met him the next morning at Vanderbilt University Medical Center's inpatient burn unit, he had already absorbed the story he was telling himself: “I got burned because I broke the rules.”

It was a story that needed to be gently, carefully rewritten in order for the young boy to heal externally and internally, says Clare, a child life and health literacy specialist in Nashville.

"You got burned because you dropped the lighter," Clare told him. "Sure, you weren't supposed to play with a lighter, but kids make mistakes all the time, and usually nothing this bad happens. This was an accident, not a sign that you’re a bad kid not a result of who you are."

Her words sound simple. But they are far from that.

For a 12-year-old processing the sensory chaos of burn wounds, wound care, and a hospital stay — by the particular way his autistic brain was experiencing all of it — the words she chose and the way she listened before speaking were doing something clinical and critical. They were reshaping the narrative he would carry out of that room.

By helping the child mirror his thoughts and reframe his self-blame, Clare was bringing to life her dual roles as a child life specialist and at time. She would also add  health literacy studies and the title of specialist to her toolkit.  In the intersection of those dual roles, Clare describes how she helps turn complex medical and health jargon into clear, human-centered language, supported by accessible design.

Her experience with this child speaks volumes about the work she does in improving patient/clinician communication, which ultimately leads to improved outcomes and overall healthcare.

“Everyone deserves health information they can understand and act on,” she says. ”It was important to help this boy and all patients explore their stories and dig deeper into what they perceive is happening to them.”

What Health Literacy Actually Means

Clare is quick to define what health literacy is. Health literacy is not simply about reading level. It’s not about whether a patient is educated or articulate or sharp.

In the field, two forms are recognized. Personal health literacy, how well a patient can access, understand, and act on the health information they receive. And organizational health literacy, how well a healthcare system or provider is actually delivering that information.

“I like that framing,” Clare says, “because the responsibility is on the organization. I don’t know what my patient knows. It’s really our job to make understanding possible for them.”

Perhaps counterintuitively, she notes, research suggests that people with higher general literacy, but low health literacy may actually be at greater risk for poor health outcomes and more likely, in some cases, to have repeat hospitalizations. The hypothesis: educated people may assume they understand medical instructions. Health information, Clare says, is “really its own monster.” The confidence that you’ve understood something is not the same as having understood it, she says.

Clare and her partner, Becca, hiking

The Merger of Two Fields

Clare came to this intersection the long way around. She grew up north of Atlanta, one of four sisters. Her father is a pediatric emergency room doctor who quietly pointed her toward child life when she was in college casting about for direction.

Clare volunteered, discovered a vocation, and eventually found herself doing graduate work and clinical child life practice, first at Mass General Hospital for Children, then at Monroe Carell Jr. Children’s Hospital at Vanderbilt, and most recently as a member of the patient education team at Vanderbilt University Medical Center. Unfortunately, like many in the transitioning field of healthcare, she was laid off in early 2025 amid federal budget cuts.

With years of experience years in the thick of it: preparing kids for procedures, explaining new diagnoses, sitting with families during some of the hardest moments of their lives, she learned early that clear communication wasn’t a nicety — it was clinical care.

“Being a patient is a vulnerable and overwhelming experience,” she says. “When a patient doesn’t understand their care, that sense of vulnerability and overwhelm grow even larger. And the anxiety and stress of that can cause health issues of their own.”

That insight eventually drew her toward health literacy as a formal discipline. She earned her Health Literacy Specialist certificate and built a practice grounded in plain language, accessible design, and the conviction that everyone deserves health information they can act on.

The patient education role at Vanderbilt was, she says, a revelation, and by her own account, the happiest chapter of her professional career. She wrote and edited materials spanning hematology/oncology, psychiatry, weight loss surgery, developmental medicine, and LGBTQ health, working with clinicians, designers, and subject matter experts to translate complex medical content into something a real person could read, understand, and use. These days, she continues to do much of this work as a freelancer for several organizations.

Image: Clare and her nephew, Noah

The Story That Heals

Back in the room with the 12-year-old, Clare was doing something else alongside the wound care preparation. She was listening to him narrate his own injury, and then carefully, without judgment, offering edits. On the burn unit, there was no such luxury as a slow introduction. New patients arrived having often spent their first night alone, medicated, and disoriented, and by 8 a.m., wound care had already begun. Clare would have perhaps two minutes to introduce herself before the medical team descended.

That two-minute window, letting a child touch a sponge, smell the soap, hold the gauze, was crucial to care. It was care.

“Everyone else in the room is moving fast,” Clare says. “My only job is to crouch down, talk slow, take my time with it.”

This, she explains, is where the disciplines she now brings together,  child life and health literacy, find their deepest common ground. Child life specialists are trained to understand not just what children know, but how they know it: developmentally, emotionally, through play, through narrative. Health literacy asks a parallel question of the systems around them: are we offering information in a way that is actually accessible to the person in front of us?

For the boy with the burns, both were necessary. The education piece helped - showing him what would happen, explaining each step so the sensory experience didn’t arrive as ambush. But he also needed something else, something that lived in the space between information and understanding. He needed someone to hear his story, reflect it back, and reshape the parts that were harming him as much as the burns were.

“I was not there in a therapy capacity,” Clare says. “But I could repeat his words back to him when they seemed like an appropriate narrative — and that helped him cope.”

But the core message, she says, is simpler than any of those categories.

“The moment of connection is the most important thing. You slow down. You look your patient in the eyes. You pick up on their signs, and they feel like you’re really there to answer their questions. And then they’re more willing to engage.”

She is also wary of what is being lost as AI note-taking tools proliferate through clinical encounters. When a provider’s attention is partly directed at a transcription device, who is noticing that the child is curled at the foot of the bed, not making eye contact? Who records the fact that a patient was visibly shaking from anxiety, and makes sure the next provider in the room knows?

“If AI is taking your notes,” she says quietly, “I don’t get to know that the kid was shaking.”

What she brings to this work is something not everyone in the field combines: deep clinical empathy and a writer’s instinct for language. She knows what it feels like to sit across from a frightened child and search for exactly the right words. She also knows that those words need to be backed up by thoughtful structure, visual clarity, and design that meets readers where they are.

“Effective communication goes beyond words,” she says. “I design patient education materials with accessibility in mind — using layout, visuals, and formatting strategies that support readability for a wide range of audiences.”

Now, in the aftermath of her layoff, Clare is building something she hadn’t quite planned, a freelance practice at the intersection of child life, health literacy, and narrative. She is developing a workshop on health literacy principles for child life specialists and for anyone working in patient care, regardless of role. She is creating sleep guides for parents for Hatch, the baby alarm clock company. She is co-authoring a psychosocial support book for parents of children newly diagnosed with achondroplasia, the most common form of dwarfism, a resource designed to help families navigate complicated emotions, boundary-setting, and the particular grief and joy of bringing home a child whose life will look different than they had imagined.

Each project is, in a different key, the same song: how do we give people the words they need to understand what is happening to them, and the agency to act on that understanding?

Narrative as Medicine

That question found its fullest expression in her recent workshop, using Narrative Video to Promote Health Literacy, developed and presented in collaboration with Narrative Mindworks and the Boston University School of Medicine.

On Tuesday, March 24th, Clare used an animated patient education video to demonstrate how visual storytelling, narrative structure, and health literacy principles can work together. The goal: to make medical information not just understandable, but resonant, something a patient can hold onto and act on long after they’ve left the exam room.

The workshop waa designed for anyone working in patient care, regardless of role. Whether you’re a nurse, a health educator, a social worker, or an administrator, Clare’s approach offers practical strategies you can bring back to your practice.

.

Clare and her dog, Lucy

The Narrative Mindworks Questionnaire

1. What is your idea of perfect happiness? Sitting in the grass, with my dog, without my phone.

2. Which living person do you most admire? At this moment, the people of Minneapolis and St. Paul.

3. What do you consider your greatest achievement? Becoming a certified child life specialist and getting to support patients and families in that role.

4. What are you most grateful for? My family! Especially my 3 wild nieces and sweet newborn nephew.

5. What’s next on your bucket list? This summer, my partner and I are hiking the Ozarks in Arizona! I’m looking forward to mountain views and hot springs.

Credit image: iStock

• Hosted by Beth Israel Deaconess Medical Center and supported by a Parkinson’s Foundation Community Grant.

• Led by Dr. Sneha Mantri (Duke University) and Lissa Kapust, LICSW, who guide participants in shaping concise, powerful narratives about their lived experiences.

• The video shows how storytelling helps individuals feel heard and helps clinicians better understand patient needs, strengthening therapeutic relationships.

 Watch here

We encourage you to read the research in its entirety and let us know if you’d like to attend (or host) a discussion on Zoom. Much of the work here seems applicable to narrative medicine and narrative practices writ large. Happy reading! Anu and Derek, Narrative Mindworks

Some fundamental questions that this study addresses are:
• What does a high-quality health humanities academic program look like?
• Are there consensus areas with regards to knowledge, skills and practices in these programs?
• How does learner level impact the intellectual rigor and outcomes of these programs?
• How might such programs be assessed and evaluated, and consequently can we compile a set of best educational practices for these programs?

This three-year study involved fourteen focus groups and interviews with eighty-nine participants (current students, faculty at both undergrad and graduate levels, and administrators.)

1. Several participants asserted the importance of real-world application for these programs. There were differences about how knowledge or concepts should translate into practices but active engagement, and even advocacy was a high focus. However there remains a lack of consensus to define the domain of values and skills.

2. The benefit as well as challenge of many health humanities programs was the breadth and diversity of texts, educational needs, and participating faculty.

3. Despite the differences I find Volpe et al (2012) articulation of humanistic practice as useful and valuable: ‘an intentional process of applying humanities knowledge and skills to a clinical scenario.” (p. 3, qtd p.5).

4. Regarding methodological approaches to curricular design and learning, there is a discussion for new methods to teach health humanities but no consensus on what those might be. Some ubiquitous skills were perspective-taking and reflexivity. As a writing teacher, I was thrilled that the ability to self-reflect was critical.

5. This focus of understanding of self, necessitates attention to ethics and “moral imagination” (p. 18). One quote from a faculty focus group explain this further: “When it comes to moral imagination, its mostly about inspiring them [the students] to believe that the system can improve, and that they can do something about it, right? That activism is possible…It’s about training them to act [in] certain ways so that they can be part of this elite profession, and we need to inspire them to push back, to imagine themselves as people who can make change and be activists (p.19).

6. The emphasis on change highlights how to “market” health humanities, a struggle that I faced too when I was presenting my certificate in Narrative medicine to the college administration for approval. Several faculty focus groups discussed “the struggle of instrumentalism of using the humanities.”

7. Another noteworthy point for me as a member of the English dept as well as an advocate for Narrative Medicine, raised by this study was, where Health Humanities should live as an educational program? Traditional dept like English can claim that health humanities is “taking away their students.” This study highlights “the resistance from other humanities faculty” (p. 28).

8. The lack of institutional home underscores how “health humanities programs often do not have a champion such as a department chair who can advocate for resources and provide a buffer when budgets necessitate cutting.” (p. 26)

9. Despite the robust discussions put forth in this study, one clearly emerging focus is “…social justice- and a passion for addressing current, urgent, complex concerns around health writ broadly… One participant [emphasized] about the understanding of health care as a human right as being an essential learning outcome…I think it’s at the very core of health humanities.” [p.25]

10. Health humanities education is a cohesive field with field-wide agreement about the central priorities of a health humanities education. While our study shows there is no consensus about a canon within the field and the disciplines that comprise the field, clear priorities spanned all levels of health humanities education. The inability of health humanities educator participants to identify a health humanities canon is a curiosity that deserves further investigation. The lack of a canon may have implications for the field, both favorable and unfavorable.

11. Regardless of the topic or type of knowledge under discussion, focus group participants asserted the importance of Real-world Application. We defined this theme as graduates of health humanities programs should utilize health humanities knowledge outside of academia.

12. The theme of Structural Competence brings the focus from self and other to a systems perspective. This theme signals that graduates of health humanities programs should understand the inter-relationships and influences among individual behaviors and attitudes with system-level factors within healthcare and society. This understanding should extend to patients, healthcare workers, health policy, healthcare legislation, and society.

The NMW Career Center is designed to support active and passive job seekers who are looking to advance their careers.

Instead of navigating broad, generic job boards, you’ll find opportunities from employers who intentionally seek candidates connected to the NMW Career Center for their specialized skillset and qualifications.

The NMW Career Center features:
Relevant opportunities curated for a diverse audience.
Employers who value qualified talent in your industry.
A trusted, profession-focused destination for all job seekers.
New opportunities are added continuously, making this a reliable resource whether you’re actively searching or simply exploring what’s available.

Explore Career Opportunities

Narrative Mindworks Career Center
1216 Broadway 2nd Floor, New York, NY 10001

Available here 

An Introduction to Houston's Innovations in Arts and Health

Excerpt:

Welcome to Houston, where we indulge in a delicious fusion of health and the arts. Here, despite endless concrete and heavy heat, the fields of medicine and the arts flourish—and cross to yield intriguing hybrids. This book parades our passion for wedding these two worlds in and across medical education, community-based nonprofits, hospitals, and other spaces. Bearing the subtitle, “A Field Guide to Local Collaborations between Healthcare, Academia, and Community Organizations,” this book’s emphasis is on the between. For that reason, its chapters are not easily clustered under subheadings like “Arts and Health in Healthcare” or “Arts and Health in Academia.” Instead, almost every chapter showcases the strong links an institution from one sphere forges with “outsiders,” leading to something new that interweaves us and them.

While varied, the partnerships this book presents all share a common aim: to nurture more caring and effective healthcare professionals and to improve the wellbeing of patients and communities. My hope is that these collaborations will inspire you to bolster or create similar alliances, wherever you are.

Chapter image

Because the chapters do not interact with each other, feel free to dive in anywhere. Swim around long enough, and you will discover:

• a powerhouse arts program in a top-ranked children’s hospital
• a public-facing medical storytelling event, followed by three exemplary stories
• the insightful contributions the Museum of Fine Arts, Houston makes to medical education
• a student-driven research lab that explored how grassroots clinics support their patients’ migration and religious journeys
• a dance performance designed to address one group’s mental health challenges
• arts ventures in collaboration with immigrants and refugees, to support social integration
• a training track in Arts Leadership, preparing graduates to thrive in arts-and-health settings
• a drawing-oriented pairing of older adults in assisted living with medical students
• a full play that explores moral dimensions of caring for a hospitalized patient who is blind and has advanced Alzheimer’s disease—complete with materials to aid in staging the play and assigning it to students
• a one-of-a-kind collaboration between a university’s medical school and its creative writing program, now also supported by Inprint, a Houston-based literary nonprofit.

Andrew Childress

Excerpt:

Despite medicine’s technological advances and multibillion-dollar revenue streams, healthcare would not function without stories. Yet, too often in clinical spaces and in the podcasts, social media posts, and news reports that amplify medicine’s achievements, certain stories are told while others are neglected. To create a space for sharing stories from all corners of healthcare, three Houston medical schools joined with undergraduate programs and others to lead a storytelling event. Off Script: Stories from the Heart of Medicine is a twice-yearly storytelling event that helps build healthier communities through creative writing and public performance of diverse stories. Physicians who participate in Off Script report improvements in patient care and self-care behaviors. Students and others report positive effects on their professional development. Through Off Script, narrative approaches to medicine are shared with the community, which may improve patient-physician communication and affect health outcomes.

-Lauren Manning

When the Listener Becomes the Record: What Ambient AI is Really Changing in Medicine

Arthur Lazarus, MD, MBA

January 26, 2026

When the listener becomes the record” describes an unobtrusive yet meaningful change taking place in exam rooms across medicine.

Until recently, the listener in a clinical encounter has been the physician or a physician extender. Clinicians listen, reflect, and later translate the encounter into a medical record. That record reflects judgment: what mattered most, what was uncertain, what needed context. The note has always come after human interpretation.

Ambient AI, an automatic note-taker that works quietly in the background, changes that order. This always-on system now listens during the visit and produces the record directly. Conversations are transcribed and summarized in near real time. The clinician’s role shifts from author to editor. That shift matters—for patients as much as clinicians.

First, authority subtly changes. When the record is machine-generated, it can begin to feel more “official” than a doctor’s judgment, especially during disputes or reviews. Over time, transcripts may carry more weight than interpretation. When memories of events differ, an AI-generated record may not be an ally.

Image: i-Stock

Second, reflection is compressed. Writing a note has never been just paperwork. It forces clinicians to pause and synthesize what they heard. When documentation is automated, that reflective moment risks disappearing. Care may become faster, but the record may become thinner.

Third, storytelling is altered. Illness is not just a set of facts; it is a story unfolding in real time. Nuance survives only if clinicians actively protect it—by editing, adding context, and sometimes pushing back. Otherwise, a patient’s story can be flattened into efficient language. I’ve seen mental health notes reduced to nothing more than transactional summaries.

Trust is also affected. Patients may reasonably ask: Who is really listening to me? My doctor or the system recording us? Even with strong privacy protections, an unseen listener changes the emotional feel and tenor of the room.

The real risk is not that AI will replace physicians. It is that it will reshape how medicine views itself. Documentation has long been where clinical judgment meets narrative. If that space becomes fully automated, clinicians must intentionally preserve reflection or risk losing something essential.

Many patients are uneasy with the idea of artificial intelligence listening in on deeply personal conversations. That discomfort deserves respect. The exam room has always been a protected space, not just legally but symbolically. It is where people say things they may not say anywhere else. An invisible listener, even one designed to help, can feel intrusive.

At the same time, clinicians who use ambient documentation tools often notice real benefits. For decades, documentation has been the hidden cost of medical care. Notes are written late at night, between visits, or on weekends. In training, staying late to chart was expected. At their best, ambient AI tools remove burden rather than add novelty. They give time back: time that can be spent listening more closely, maintaining eye contact, or simply being present. Important conversations about goals, fears, and uncertainty are often captured more accurately than they would be hours or days later.

However, efficiency also carries risk. When documentation becomes faster, reclaimed time is rarely returned as reflection. It is often converted into seeing more patients. Many clinicians worry AI scribes will accelerate already crowded schedules rather than relieve them.

Image: i-Stock

This moment resembles the early days of electronic medical records. EMRs were not designed primarily for clinicians or patients; they were built for billing, compliance, and scale. Opting out was never truly possible. Ambient AI may follow a similar path. These tools may ultimately serve systems more than individuals. Pretending this shift can be avoided is wishful thinking, as history demonstrates that the patient-doctor relationship is not always at the center of administrative decisions.

Patients themselves hold varied views. Some are uncomfortable with AI listening in; others welcome tools that reduce errors or bias. Many already record visits or share health information online. Still, medicine cannot lower its standards simply because data sharing is common elsewhere.

What patients consistently ask for is transparency. A clear explanation goes a long way: why an ambient scribe is being used, how privacy is protected, how long information is kept, and who to contact with concerns. Consent does not need to be elaborate. It needs to be honest.

Even if privacy is handled well, another change is harder to measure. Medicine is a narrative profession. Doctors are not just problem-solvers; they are witnesses to people’s lives. Writing notes has always helped clinicians understand what they hear. It forces synthesis and reflection. Many psychotherapists keep separate private process notes (often called psychotherapy notes) alongside the official medical record, typically for reflection, supervision, and meaning-making rather than billing or legal purposes.

When notes are drafted automatically, clinicians may never review them, or they may simply skim, correct, and move on. The subtle moments (the hesitation before a diagnosis, the metaphor a patient uses, the silence that carries emotion) may never appear in transcripts, and even if they do, they may not be held in the same way.

This is not an argument against ambient AI. These tools can reduce screen distraction and restore eye contact. That is important. But presence is more than posture. It is attention, memory, and interpretation. Efficiency alone is not the same as care.

The future of ambient AI in medicine does not hinge on whether the technology works. It already does. It hinges on how thoughtfully it is used. Clear boundaries, limited data retention, accountability for misuse, and genuine patient choice are not optional. Neither is resisting the urge to turn every efficiency gain into volume.

Technology will keep advancing. Medicine must evolve with it, but not passively. The heart of care does not live in transcripts or summaries. It lives in the relationship between two people in a room. Ambient AI can support that relationship, or gradually erode it. The difference will be decided not by algorithms, but by whether clinicians and patients value humanism and insist on protecting it.

Photo: i-Stock

From our new series exploring changes in the clinical encounter and what they mean for narrative medicine, clinicians, and patient care, read Dr. Chin‑Yee’s reflection on the end of dictation and how the pause, the thinking, and the conversational process of understanding a patient’s story have diminished. Templates and AI have made documentation efficient, but are they producing meaning that matters? 

At Narrative Mindworks, we see communication shifts as a critical issue in healthcare and for narrative practices.  What do you think? Share a blog post, add to the feed, or send us your thoughts at info@narrativemindworks.org.

— Lauren Manning

The Death of the Consult Note

Benjamin Chin-Yee, MD, PhD^1,2

^{January, 2026 from JAMA}

My hospital is finally phasing out human transcription. I’ll admit, relying on a person to decode my ramblings, to sift “ums” and spell out acronyms amid background chatter and overhead alarms, feels archaic. In an age when we dictate shopping lists to our phones and ask artificial intelligence (AI) chatbots for parenting advice, manual transcription seems a relic of a bygone era. It is costly, inefficient, and increasingly incompatible with any institution eager to partake in health care’s “digital transformation.”¹

Predictably, some clinicians were reluctant to change. When the phaseout grew imminent, a few threatened early retirement—the same people, I suspect, who once vowed to resign when paper charts disappeared. But resistance proved futile; it was no match for the inexorable march of technological progress. Human transcription has been dying a slow, quiet death for years. And in the coming months, it will be officially laid to rest. When the last dictation line goes silent and the final phone is hung up, we’ll say goodbye to the human transcribers who faithfully populated our medical records and helped turn clinical encounters into coherent stories.

Image: Freepik

I still remember the awkwardness of learning to dictate early in my medical career. For years, I struggled to dictate in front of others, retreating to a quiet nursing station or vacant call room while I tried to process the patient encounter. I’d press the phone tightly to my ear and speak slowly and softly, praying no one would hear me. Except, of course, for the trusted transcriptionist. My unseen partner, companion in uncertainty. They—and they alone—could take my hesitant, timid words and somehow, as if by magic, return them as a confident, authoritative consult note.

Whenever someone drifted within earshot, I’d stiffen with self-consciousness. I’d imagine the overhearer peering straight into my thoughts, watching me wrestle with raw, unfiltered observations as I worked to make sense of the case. They’d witness every hesitation and misstep in my reasoning, leaving me exposed and embarrassed. I struggled with dictation in the same way many writers struggle with a blank page—my relentless inner critic, turned imaginary eavesdropper, scrutinizing every detail and quickly shouting down any semblance of emerging narrative.

What I didn’t appreciate then—but understand now—is that this discomfort was not a flaw in the process. Rather, it was the process. Dictation forced me to gather my messy, scattered thoughts and shape them into a story. It forced me to make choices about what mattered, to hear the logic of a case spoken in my own voice. It was clinical reasoning in action. And that is why the end of human transcription feels like more than a change in workflow. It marks the quiet fading of an artform that once trained physicians to think—before AutoText, SmartPhrases, and now AI offered the appearance of a consult note without the cognitive work of creating one.

In place of the dictated consultation, we now have the templated note built for the demands of modern medicine. Growing patient volumes, documentation requirements, and billing needs² combined with the insatiable appetite for administrative data have prioritized speed and standardization. In this environment, documentation feels peripheral to the real work of doctoring. The result is a note that is quick, efficient—and wholly unremarkable. A document dense with detail yet devoid of any real sense of the encounter itself.

There was a time when reading a seasoned consultant’s note felt like being guided through their reasoning—an elegant arc punctuated by astute observation, rising through a crisp differential, and culminating in coherent synthesis—all with distinctive flair. What it lacked in data, it more than made up for in meaning. Now, our eyes glaze over at the sight of endless lists and prefabricated blocks of text, the narrative drowned beneath a rising tide of autopopulated content.

Today, trainees are spared the fear of a blank page, starting instead with a screen half-filled. The Problem List arrives prepopulated with every diagnosis ever attached to a patient’s name—acne beside acute leukemia beside ankle sprain—salience be damned. A single click completes a flawless Review of Systems, often rendering patients improbably symptom free. Physical examinations replicate themselves with such confidence that a patient may be credited with “no hepatosplenomegaly” without a single abdomen ever being examined. And as for laboratory results, there’s no need to review them: they unfurl automatically into the note, page after page of values, as if sheer volume obviates the need to make sense of it all.

But medicine has always been in the business of sense making—turning symptoms into stories, information into insight. Dictation offered a natural pause for that work, a moment to gather one’s thoughts and hear one’s own reasoning aloud. Optimists might argue that nothing prevents us from doing the same now, simply dictating to an algorithm instead of a person. But as speech-to-text dictation becomes embedded within templated workflows and as newer tools like automated scribes and ambient AI “listen” and draft notes in the background, the mental work of shaping a narrative subtly slips away. What fades is not just the human transcriptionist but the type of thinking the human transcriptionist once required.

Image: iStock

So what can be done? Templates and AI are here to stay. They solve real problems for overburdened clinicians working in an overstretched system.³ Some tools may even open new spaces for reflection; some hope ambient AI will capture the patient’s story while freeing the clinician to share their reasoning aloud at the bedside.

Railing against the tides of technology may be futile. But preserving the cognitive pause that dictation demanded is not. Even in an era of templated notes, we can still teach trainees to voice their assessments before they document: to treat the Impression not as a box to complete but as space for making sense of everything that came before. We can also safeguard the remaining arenas where reasoning still happens in real time, such as morning report, oral case presentations, or clinical rounds. The tools may evolve, but the art of pausing, thinking, and telling a story is still ours to preserve.

Because a consult note is, at its core, a form of storytelling—an attempt to give shape to uncertainty, to show what makes sense and what does not. Dictation once helped that work along, forcing the clinician to select details, impose order, and listen aloud to their own reasoning. The question now is whether we will continue to see ourselves as storytellers and sense makers or hand that work to systems that document flawlessly yet illuminate nothing. The chart will swell with information but, amid the deluge, will it retain an ounce of knowledge, or—dare I ask—a measure of wisdom? When the last dictation line goes silent, we may find that it was not only transcription that died, but also the consult note as a space where thinking once lived.

References

1.

Angus  DC , Khera R , Lieu T , et al; JAMA Summit on AI. AI, health, and health care today and tomorrow: the JAMA summit report on artificial intelligence.  JAMA. 2025;334(18):1650-1664. doi:10.1001/jama.2025.18490
Article PubMedGoogle ScholarCrossref

2.

Gaffney  A , Woolhandler S , Cai C , et al. Medical documentation burden among US office-based physicians in 2019: a national study.  JAMA Intern Med. 2022;182(5):564-566. doi:10.1001/jamainternmed.2022.0372
Article PubMedGoogle ScholarCrossref

3.

Apathy  NC , Holmgren AJ , Cross DA . Physician EHR time and visit volume following adoption of team-based documentation support.  JAMA Intern Med. 2024;184(10):1212-1221. doi:10.1001/jamainternmed.2024.4123
Article PubMedGoogle ScholarCrossre

To Apply go to Narrative Mindworks Career Center for more information

Apply through Narrative Mindworks Career Center

Novartis

These are the words of artist and environmentalist Nathalie Latham who in the face of physical and emotional devastation, found refuge in art and her faith. Now 16 years cancer free, Nathalie chronicled her seven-year journey through radiation treatment and PTSD in the recently-published visual memoir, I Am Alive - Creating Resilience and Healing Trauma Through Art.The 184-page book of story and artdepicts the healing journey that returned Nathalie to her life.

“The doctor clicks her pen, looks down at the worn carpet where her feet follow the swivel of the chair. She doesn’t look me in the eye. ‘You have Stage 3 cervical cancer.’ Then she tells me in a matter-of-fact manner, ‘We do not know yet if the cancer has spread to your lymph nodes. If it has, the survival rate is low.’ I can no longer feel the chair beneath me. What else is she saying? A roaring silence fills me. I am free-falling through the sky. No parachute. Nothing to hold onto. Is this it? I am 39 years old.”

“Up until that moment (of diagnosis), I had been under the delusion that I maintained a certain control of my life,” she says. “It was a life that was rich in friendships, work and travel. But I was also trapped by my perfectionism.” Many of her writings are featured in her Substack.

Nathalie explains that “my life pivoted” the moment she was diagnosed with Stage 3 cancer. The partner she expected to stand beside her through every challenge was suddenly gone, too. “The life I had built collapsed,” she reflects, “leaving me to face the stark reality of the illness and the painful truth that I was on my own.

Cancer: A New Journey of Prayer and Pastels

The night before radiation began, she found herself alone in the brachytherapy radiation room filled with terror for the pending treatment. Unable to find language to write about her experience, she reached into her bag of art supplies which she brought to treatment and began to draw all her fears. For the following seven days and nights as she was radiated, she continued to draw while lying on her back. “The act of drawing was a focus point for me, a way to not lose my mind. I continued to draw after treatment as I struggled with PTSD and depression.” Every mark evidence and proof as Nathalie says, “I am alive.”

A decade later, the oil pastels have grown into a collection she describes as, “a prayer for the observer and for the world.”

After treatment, Nathalie found her way to Tamil Nadu, in rural South India at the temple of her spiritual teacher where she began the slow work of healing—and where she continued to draw as lifeline and as a way to unravel a complex emotional landscape in order to heal. She continues to live there today.

“I knew it was the right place to heal but I was in grief of having had to give up ‘my life’ in Paris… and my work as a photographer/ film maker. I yearned for all I had lost: my vitality, my health, my joy, my strength, my courage, my ease of navigating life, my sexual being, my sense of humor... I was worn out.” Everything. Absolutely everything felt hard. Each day was a struggle. And I didn’t know if I was ever going to get better. “

Throughout her cancer journey, Nathalie says, “Art became my expression, my salvation, providing a rare and precious outlet where words alone could not suffice. Drawing offered a path to express the inexpressible—a way to channel pain, confusion, and the slow, delicate work of healing into something tangible. Through this creative processing, I found a way to reflect, transform, and, ultimately, heal.”

That Was Then. This is Now.

Born in Australia, Nathalie's teen years were marked by visits to France where her mother lived.  After earning her Masters in Japanese from Sydney University at 22, she moved to Paris, embarking on a career that would take her across continents.

A polyglot and accomplished photographer, Nathalie lived the life of an internationally acclaimed artist and filmmaker. Her work appeared in Le Monde 2, Domus, and The Australian Financial Review. She spent five years traveling the world for her project Love It & Leave It: Australia's Creative Diaspora, photographing and interviewing expatriate artists from Paris to Berlin, which culminated in a celebrated 2007 solo exhibition at the Australian National Portrait Gallery. She produced and directed documentaries for Arte, BBC, and Mezzo earned prestigious residencies including Künstlerhaus Bethanien in Berlin (2007-2008) and received the Best Portfolio Award at the Art Photo Biennale in Bucharest (2005).

When Healing Becomes Action

But healing, she discovered, wasn't just personal—it was planetary. As Nathalie tended to her own recovery, she began tending to the earth itself. At the Sri Narayani Peedam campus where she lives, Nathalie is a committed environmentalist and supporter of women’s empowerment. The campus is part of Sripuram, the Golden Temple which is the main temple. The forestry work is one part of the temple’s larger onsite programs The complex includes two schools, a hospital and a feeding program that offers free meals to 5,000 people daily.

A committed environmentalist and supporter of women’s empowerment. Nathalie plays a key role in a wide range of philanthropic initiatives, including  Green Sakthi, a leading afforestation program in Tamil Nadu (India) where she lives. Sakthi (pronounced  shakti ) is a Sanskrit word that means feminine energy or power. Twenty-five years ago, she says, the land had no trees. Now more than two million trees have been planted or donated locally to farmers and villagers.

There, in the same soil where she returned to life, Nathalie now plants trees, and as Director of Programs for Green Sakthi, the temple’s environmental program helps model the journey for others seeking to connect to their souls.

“Trees saved my life,” she says. “I’m so privileged to hang out in nature every day and am profoundly grateful to Mother Nature.”

The work, she says, is both metaphor and matter: roots going down, branches reaching up, life insisting on itself. What began as personal survival has become something larger—a practice of regeneration that refuses to separate the healing of a body from the healing of a landscape. Her hands, which once held cameras and then pastels, now hold seedlings. Each one planted is another way of saying: I am alive. We are alive.

“This book isn't just about my journey; it's about reaching out to others facing their own struggles,” says Nathalie. “I want to offer a sense of solidarity and hope, reminding people they aren't alone and that healing is possible, even when it feels out of reach. For those caring for someone with a serious illness or working in the medical field, these pages offer insight into the long-term realities of recovery beyond the clinical charts and hospital visits. My story shows that no matter how dark the journey may become, finding light, reclaiming joy, and rediscovering the will to live fully again is possible.”

Learn more about Nathalie at her website.

Narrative Mindworks Questionnaire

 1. What is your idea of perfect happiness?

Feeling well rested and having time to create. 

 2.  Which living person do you most admire?

My spiritual teacher, Sri Sakthi Amma.

 3. What do you consider your greatest achievement?

Staying alive after cancer treatment.

4. Who are your favorite writers?

Mary Oliver

Rainer Maria Rilke

Lou Andreas Solomé

Albert Camus

5. Describe yourself in six words.

Creative. Resilient. Loving. Sensitive. Courageous. Humorous.

 6.  What are you most grateful for?

Being alive.

 7. What’s next on your bucket list?

I don't have a bucket list, but I would like to visit Bhutan this year. 

If you have a study, paper, or viewpoint to share, please send it to your fellow members at info@narrativemindworks.org, or post it to the feed or blog.

-Lauren Manning

Credit: iStock

Read the full study here.

An exploratory study of addressing bias for child abuse teams: the role of narrative medicine

Jocelyn Brown, Talea Cornelius, Gabriella Farland, Philip Gialopsos and Rita Charon

Excerpt from Abstract

Methods: Using members of a Columbia University Irving Medical Center (CUIMC) Department of Pediatrics Child Abuse Bias Mitigation Task Force (CAB-MTF)  this study tests the hypothesis that narrative medicine workshops provide a space where conversations of race and bias in the context of child abuse evaluations can take place.

Results: Workshops participants noted the unique group experience that, through sharing and communal support, helped build compassion, function more effectively as a team, and even find confidence in their own voice. Intertwined with the ability to connect with and support each other as a team was the common thread of understanding differences in perspectives and personal histories. Most participants agree that the workshops increased their ease in having conversations about privilege and bias in clinical assessment.

Conclusion: We conclude that the use of art and creativity allows for personal and structural insights on racism and social advocacy with significant promise for reducing bias in child abuse evaluations.