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Title: The influence of photographic narrative in healthcare dialogue
Author: Kolaiti, Christina
ISNI:       0000 0004 2707 0578
Awarding Body: Northumbria University
Current Institution: Northumbria University
Date of Award: 2010
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The Influence of Photographic Narrative in Healthcare Dialogue is a research project which developed within an interdisciplinary practice-led environment between arts and healthcare. The overall project aimed at employing photographic narrative to explore concepts that support a holistic approach to clinical interactions, for example empathy and reflective practice. The key proposition in this thesis is that communication between a doctor and his patient is enhanced when the medical practitioner recognises the shared narrative that develops as the process of diagnosis and treatment unfolds. From the medical practitioner's perspective, these narratives contribute to empathetic doctoring and this thesis reports on the author's interest in promoting an active sense of the visual narrative expression during the training of medical students. This project was developed in a series of experiments undertaken during a medical photography elective at Newcastle University Medical School (entitled The Camera Never Lies?) and the student's photographic stories uncover a range of attitudes to learning about 'good doctoring' during a conventional training in clinical practices, a process that demand that the students value professional detachment (Coulehan, 2008:56). My research was developed in response to the experience of teaching photographic practices to medical students within this module. In supporting the students' production of photographic artworks I was able to better understand the potential of non-verbal narrative in clinical environments (the types of professional medical contexts in which the students will apply their knowledge after they have graduated) and in medical training (the context into which I had been invited to transfer my knowledge of photographic portraiture in order to enhance the students' sensitivity to visual communication). In this sense, my thesis reports on the progress I have made as both a translator of visual arts ideas and as an artist exploring the narratological nature of taking portrait photographs (based on a range of influences from Jo Spence to Cindy Sherman). Moreover, my research provides an alternative approach to portraiture by producing photographic portraits with a method of renarration. My activities with the medical students were developed as a practice-led research project in which I used my personal experiences of creating sequences of photographic self-portraits to stimulate reflective practices amongst my students. Once they had learnt to make their own reflective portraits I was able to respond to their images with more of my own that interpreted and reflected their narratives back to them. The students clearly gained from this experience and over the past three years I have evolved the process into a teaching method specifically aimed at improving clinical skills. This photo-narratological interaction, and the benefits that the students experienced, became the basis of my research question and my methodology. My interest in finding solutions to the process of applying 're-narration', a concept I adapted from psychoanalysis (Josselson & Lieblich, 1996), to both my arts practice and my medical teaching became the central quest of my project. As with all practice-led research, I saw this exploratory journey as an opportunity for action research and my thesis considers this approach using Winch and Gingell's five stages: situation, concern, intervention, documentation and dissemination (Gingell & Winch, 1999). As a result, I am able to systematically shape my thesis around my entire journey: from the initial, open-ended phase embedded in the arts and health research project at Northumbria University to its later, more focussed period in which I am able to prepare my findings for conferences in the Medical Humanities sector. At this stage, the student projects have become case studies that are conceptualized and investigated within the framework of life narrative research, an interdisciplinary method that is used in sociology, psychoanalysis and anthropology (Czarniawska,2004). The central section of my thesis describes this part of my project in both practical and theoretical terms. All along, my aim has been to use photography as a vehicle for opening new lines of communication between arts and healthcare, two distinct fields of research that stand to gain from being brought into closer relations with one another (see the Wellcome Trust website in support of this claim, available at My conclusion is that the engagement of medical students with photography can facilitate reflective learning and encourage the development of visual skills that many commentators believe is absent in the structure of medical training yet necessary for the practice of good doctoring (Coulehan, 2008:56). The reflective use of photography through re-narration has resulted in the development of photographic narratives by the students which express their understanding of the different facets of the human condition and health in a range of subjects from self-portraiture to patients' health narratives. The photographic works illustrate an ongoing dialogue of trainee doctors within healthcare situations, the professional engagement with their subject of study and also their individual personal development. The medical students who attended the medical photography elective: The Camera Never Lies? developed an in-depth understanding of the concepts of self-reflection, empathy and also engaged with the important role of these concepts in their professional practice. Some medical students used photography to express their preoccupations with health related subjects by engaging with patients on the basis of photographic projects, whereas others engaged directly with their own personal experiences with eating and mental disorders. As a result the students deconstructed medical stereotypes, challenged their own preconceptions of illness and embraced empathy as the essential skill for the performing of good doctoring. The changing attitudes became evident in both the students' photographic work and their final assessment presentations. Additionally, the public exhibitions of the students' work revealed attitudes of a wider healthcare system. Where healthcare staff responded to the students' work in a controversial way, the hospital patients engaged very positively with the students' approach in the photographs. This contribution of photographic re-narration uncovered healthcare attitudes that respond to Coulehan's definition of gooddoctoring. Reflection through re-narration suggests that an empathetic engagement between medical practitioners and patients could result to a more valuable medical practice compared to the traditional professional detachment. In this sense, the doctor-patient empathetic engagement develops in a two-directional way both from the doctor's and patient's perspectives. As a result, the doctors have learnt to use their reflective skills to communicate better with their patients and in turn the patients have become more empathetic towards their doctors. The Influence of Photographic Narrative in Healthcare Dialogue was supported by an AHRC New Collaborations award hosted by Northumbria Healthcare NHS Foundation Trust and Northumbria University.
Supervisor: Bird, Nichola Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: W600 Cinematics and Photography