Tuesday, October 28, 2014

Narrative information sources for medicinal care and the implications for LIS

For those who have been following up on my blog for some time, you might already be aware that I am interested in narrative research. Well recently, my university staged a lecture where an author, Dr. Vincent Lam, presented on the topic "Narrative in Medicine – Why We Need Stories in an Age of Evidence". The event was held in the University Hospital | Auditorium A, Room B3-246.

So I attended the lecture by Dr. Vincent Lam staged at my university's hospital. Unfortunately, due to my mix up with the time, I arrived when the lecture was already in progress. Nevertheless, I was still able to get what I needed to hear and even got the opportunity ask Dr. Lam a question. In the next few paragraphs, I outline some of my take away points from Dr. Lam's talk. 

Before outlining what I got from the talk, it is important to indicate my particular interest in the narrative turn in patient care and medicine. I particularly see this new emphasis on narrative based information sources as being important to libraries and information science. This narrative turn in the medical sciences has implications for librarianship, especially in terms of how we go about serving health related information sources. I also see the importance in this for those working as hospital librarians, as they too need to consider supplying biographical or narrative sources to health care providers. (Now back to Dr. Lam's talk.)

Dr Lam indicated that during the encounter between a patient and a health practitioner, the patient brings a story. Usually, the story is "something happened to me". Lam suggests that the health practitioner is then expected to hear and listen carefully to the client's story, and then to use his or her special knowledge and tools to explain the story. Lam also suggests that the health provider is also expected to tell the patient "what will happen next". As such, Lam suggests that doctors and health practitioners have a role to play as story interpreters as well as storytellers. In his words, "doctors are story interpreters" and "third party storytellers", offering story interpretations and storytelling to patients like the shamans and spiritual doctors of the age before modern medicine.

Dr. Lam also argued that health care providers can also benefit from being educated in the literary arts. He cited a study that indicates that reading literary fiction promoted empathy. In general, Lam stated that reading tough, difficult and challenging books was good for medical professionals as it would enable them to become more empathetic. This is needed as medical professionals tend to rely a lot on statistics and hard scientific numerical facts that make them less empathetic and understanding of their clients' needs. 

He said that sometimes doctors need to put down their scientific spectacles in treating patients, and see the world through a different set of eyes. Lam suggests that it is really "easy to miss something about your tools because that is what you work with". It is always good to get outsider perspectives. And narrative information from patients who experience illness are as important as the scholarly or evidence based medical literature for this.

Lam also makes the point that patients rarely present information about what is happening to them in an easy form for doctors to use to make a diagnosis. Patients often do not use the medical terms and jargon when presenting their health problem. Instead, doctors have to collect, interpret and put the fragments of information presented by the patient together into a medical narrative, in order to make sense of it and to arrive at a diagnosis. Hence, in this regard, doctors also need the skill of understanding patient narratives and being able to convert such narratives into a medical narrative.

At the end of his talk, I asked him about his position on doctors reading autobiographies,watching YouTube videos and reading blogs of those who experience illness. His response was "very valuable" and that doctors should read these to supplement their scholarly readings.

My question was motivated from my recent discovery of a Masters thesis in the University of Western Ontario's institutional repository entitled:
Women's Stories of Breast Cancer: Sharing Information Through YouTube Video Blogs  - Jenna Kressler, Health and Rehabilitation Sciences, MSc http://ir.lib.uwo.ca/etd/2095/
This interesting thesis title seems to suggest that a blog is not a medium,but a way of presenting information (genre). Hence YouTube Video blogs! (Or vlogs). The article also touches on the storytelling idea for sharing health-related information. The author also used narrative analysis to conduct her research, similar to the type of analysis that I am doing for my research on blogs and tweets. Finally, she conducted her analysis on the personal narratives of women victims and/or survivors of breast cancer.

The narrative turn in medicine could spell hope for the value of the humanities in academia, Medicine is realizing and awakening to the idea that narrative and storytelling skills are important to its practice. Further, librarians have a role to play in serving medical practitioners with not just scholarly and scientific literature, but also biographies and other personal narratives of the persons that experience illness. Finally, librarians also have a role in not just providing the published sources of narratives, but also considering social media sources such as blogs and YouTube videos. Curating these may also be valuable to medical practitioners who need to supplement their professional understanding of illness with a deeper understanding of the patient's side of the story.

Blogging dilemma for an academic

One of the challenges that I have discovered about blogging about my research or research interests as an academic is the potential problem of compromising the peer review process of academia. While I not sure if it happens in practice, I suspect it is quite possible that academics or practitioners who review papers that I submit to journals are able to discover that I am the author if they:

  1. have been following up on my blog or status  updates on social networks 
  2. are curious enough to Google search or snoop on the Web to discover the possible author of the paper they are reviewing or come across the information by accident while googling the topic.

Any of these will compromise the blind peer review process as it will remove anonymity about the author of the paper. As such, this raises a dilemma for me as an academic passionate about blogging and sharing my research with my online social and electronic networks. This reduces what I can blog about. I have to avoid blogging about my research until after it has been published, which can take some time. Hence, I can not post weekly or even monthly updates on my ongoing research findings or even any part of the research process.

This leaves me to consider what else can an academic safely blog about?

While I currently see some of my Jamaican academic colleagues blogging commentaries about current events in Jamaica, to me this seems quite risky as an untenured faculty. Unless one is providing scholarly analysis, one risks alienating university administration, politicians and potential donors to the university and to one's research. In this era of academic capitalism and the corporate university, it seems that an untenured faculty  member needs to remain publicly neutral on issues, as an employee of an institution that seeks capital investment from various sources. In this new era, everyone in society is a stakeholder or potential stakeholder for the university.  This includes:

  • Politicians (who may or may not be in power)
  • Students and alumni from all religions, political affiliations, sexual orientations, ethnic groups, race, etc. who are both customers and potential donors (or contributors to the university's endowment fund)
  • various non-profit entities and corporations who have funding, donations or other investment to contribute to the university's development or research.

Consequently, the university, just like the secular state, must be inclusive, while at the same time, upholding traditional academic principles. Principles such as free speech, intellectual freedom, and diversity of thought, opinions and perspectives must coexist with an environment where all stakeholders feel that the university is serving their varied interests.

As such, it seems safer for academics to blog about pedagogy (how to teach their subject). But even blogging about pedagogy publicly is challenging, because we have to preserve the privacy of our students and what goes on in the classroom from the public.

Perhaps it is safer to blog one's reaction to information disseminated. This includes news, news articles, research papers or events such as video or conference presentations. Yet, it seems that academics may still need to be careful in selecting which issue published to react to, avoiding controversial topics. Blogging about hobbies seems safest. However, many times, our hobbies are not connected to our research.

As such, I wonder if in an era where blogging can land one in trouble with the law, do blogs give academics (especially the untenured ones) any voice? We are the university employees of  a new era. An era where tenure is no longer guaranteed. An era where the university is adjusting to a new institutional status as an institution that seeks to attract capital investment from all stakeholders in society in order to maintain its survival.

Second, our own peers can victimize us during the blind peer review process if we blog about our research, depending on whether or not they like us. Even if they do not victimize us (especially in cases where they like us), blogging about our research potentially compromises the blind peer review process. This it does by making it easier to identify the author of a manuscript submitted for publication.