A Lecture at a University

I went to the Division of Health Science of Osaka University Medical School to give a lecture. It is a school of the nurses. I graduated from the Division of Medical Science of the same school. The topic was the narrative based medicine (NBM). Eighty young students, most of them were girls, came to listen. The classroom was like a flower garden.

The NBM is recently introduced into Japan by Dr. Akira Nakagawa, one of my colleagues. In the latter half of the twentieth century, the biological medicine developed so much that humane communication between the patient and the medical staff became rather ignored. British physicians researched how to establish better communication in the clinical situation. They discovered many things. An example; linear questions and circular questions are distinguished. If a questioner predicts the answer of a respondent, the question is called linear, and if not, it is called circular. A sequence of linear questions makes linear conversation, which is often observed in doctor-patient relationship. Linear conversation is very efficient to gather information. Because it is constructed chiefly by the doctor’s interest, it sometimes disturbs the patient to talk freely what he/she thinks. A sequence of circular questions makes circular conversation. We can often observe it in daily chattering of family members or of friends. It has no purpose to go, no conclusion to be attained, and just enjoying the conversation. The NBM found that circular conversation is useful in the clinical situation to establish more humane relationship.

For example, a doctor explains to a patient: “The result of examination shows the problem of the heart. The diagnosis is angina pectoris. It is not so dangerous disease, and we have good medicine. But, it often recurs, if you do not take care of yourself. To prevent the attack, you should…” This is typical linear conversation. If some fragrance of circular conversation is added, the doctor will talk like this: “The result of examination shows the problem of the heart. The diagnosis is angina pectoris. Do you know something about the disease?” “Hum, may I add something to your knowledge?” “Do you have any idea to improve your daily life to prevent the attack?” “How do you explain to your family about your disease?” Linear conversation is “instructive” that gives knowledge to the patient, while circular conversation is “educative” that encourages the patient to think by him/herself. Anyway, circular conversation helps us to have more humane relationship with the patient.

It is somewhat an embarrassing experience to me to talk to young people. I do not know how much they know and what they are interested in. According to their teacher, however, the content of my lecture was highly beneficial for the students. Anyway, it is not bad experience for me to share a period of time with young people, as I can get fresh energy from them.