N of 1
At a time of atrophying patient-provider relationships, exponential technological evolution in the field of medicine, and growing dissatisfaction of clinicians, N of 1 becomes a platform for the exorcism of silent pain and suffering.
Here, patients and doctors humbly disrobe and come together in sickness and in health, in collaboration, instead of opposition and antagonism.
Here, learning is a two-way street.
Here, the experience of the individual matters. The sample size of one is significant. The case study of the lived experience, the outlier, carries esteem.
Here, you have more than 8 minutes to be heard.
Inspire and be inspired. Revel in this narrative space of wild togetherness.
The Origin of N of 1
Of course, it started one summer at Stanford.
In summer of 2014, I was invited to visit a professor and writer at Stanford Medicine for a paid summer fellowship sponsored by Brandeis University, the Lerman-Neubauer Fellowship. There, I spent the summer writing about medicine and learning about bedside medicine, bedside manner, the ritual of patient storytelling and listening, and thought about what it might look like to bring patient and provider stories together.
Fast forward to 2018. Having worked at a consulting firm with the privilege to see the pain points of hospitals and health systems and their partners at the bird's eye view, and having also worked at a children's hospital strategy department, I realized that bringing stories together in a compendium of sorts, to not only honor these stories, but also perform careful analysis to surface key strategic insights could be very valuable. I thought about what kind of problems it could solve. I thought about problems like, why architects and hospital executives don't build labor and delivery rooms big enough for partners and siblings and doulas, or why there are no complimentary snacks and water in crowded ER waiting rooms for hungry family members and homeless patients. That year, I wrote to a health advocate and researcher as well as the founder of a popular health app at the time who provided mentorship and made me realize that this initiative needed an institutional home. It wasn't something I could do with limited funding, at least not to the degree I have imagined.
What followed were several years of pitching this idea to writing departments and writing mentors hoping to find n of 1 the home I felt it deserved. It would need not only the infrastructure to support a large, searchable database, but also the resources to collect, edit, publish, analyze, and deliver insights.
After several years, I realized that the world needs N of 1 now. I invite you to share your stories of hope, healing, and everything in between. If you are eager to support this work, please write.
Humbly, and in health,
Damiana
The value of a story
Open hearts and minds
Illness narratives and patient stories promote open-mindedness of healthcare professionals.
Cultivate ambiguity
Writing including poetry, builds negative capability, or the openness to ambiguity which is so prevalent in healthcare today.
Build empathy
Listening to patients' narratives can foster empathy, enhance clinical practice, and also enhance patient understanding of provider perspectives.
Increase cultural competence
Narrative medicine increases understanding of cultural diversity, racism, discrimination, prejudice, and bias.
Offer hope and healing
Reading patient and provider stories provides physical and psychological benefits.
Selected references. For a full bibliography, please inquire.
-
Charon, R. (2006). Narrative Medicine: Honoring the Stories of Illness. Oxford University Press. Coulter, A. (2012). Patient engagement—what works? Journal of Ambulatory Care Management, 35(2), 80-89.
-
Coulehan J. (2017). Negative Capability and the Art of Medicine. JAMA, 318(24), 2429–2430. https://doi.org/10.1001/jama.2017.19333
-
DasGupta, S., Meyer, D., Calero-Breckheimer, A., Costley, A. W., & Guillen, S. (2006). Teaching cultural competency through narrative medicine: intersections of classroom and community. Teaching and learning in medicine, 18(1), 14–17. https://doi.org/10.1207/s15328015tlm1801_4
-
Glass, O., Dreusicke, M., Evans, J., Bechard, E., & Wolever, R. Q. (2019). Expressive writing to improve resilience to trauma: A clinical feasibility trial. Complementary therapies in clinical practice, 34, 240–246. https://doi.org/10.1016/j.ctcp.2018.12.005
-
Greenhalgh, T. (2016). Cultural contexts of health: the use of narrative research in the health sector. Copenhagen, WHO Regional Office for Europe (Health Evidence Network synthesis report 49).
-
Pennebaker, J. W., & Seagal, J. D. (1999). Forming a story: The health benefits of narrative. Journal of Clinical Psychology, 55(10), 1243-1254.
Join the effort
It is said that St. Damian and Cosmas traveled the Mediterranean healing the sick without expectation of compensation. They were thought to be the "silverless", for they would only accept a meal or a bed to stay the night. Similarly, collecting and honoring patient and provider stories is healing work. Academics, writers and poets, health providers, and students of these professions are invited to join the effort to help review submissions and contribute to the future of N of 1. Web developers, data scientists, biostatisticians, marketing, and publishing professionals are also invited to support N of 1.
What lies ahead...
Spring 2024
Getting Started
We will be collecting the first batch of patient and provider stories and building a team of volunteers and growing our editorial board.
Fall of 2024
First Iteration
Stories will be made available online in a searchable database with the look and feel of a journal. The first Insights report with "narrative as data" analytics will be compiled and shared Winter of 2024.
2025
Published anthology and gathering
N of 1 will seek to publish the "best of the best" in a print anthology every few years with an introduction from a leader in the field. N of 1 will also work to convene providers, patients, and writers together for a powerful gathering where everyone is equal. Consultants, health designers and architects, healthcare leaders, clinicians, and providers will be invited to hear our Insights and work to build a better future together.