Who Tells The Story: Narrative Authority In Healthcare Systems

In this presentation, we will be looking at how narratives affect decision making in Medicine. We take the stance that the person who has narrative authority will eventually determine the manner in which care is delivered. While studies suggest that older people tend not to make decisions for themselves, this may not be due to power differentials within the family alone. Worldviews may be an important factor in determining how decisions are made. Healthcare institutions operate on a worldview that may invalidate other world views. We will explore why healthcare practitioners may find it difficult to recognise other worldviews. Lastly, we will explore how certain healthcare paradigms already work to incorporate other worldviews.

Learning Outcomes

By the end of the presentation, participants will be able to:

1. Define what are worldviews
2. Evaluate the worldview within decisions and conversations
3. Recognise the predominant worldview within the healthcare institution
4. Understand why healthcare practitioners may have difficulty deciphering the worldviews of their patients

Understand ways to apply various communication models to address opposing worldviews

This presentation will discuss two cases about medical decision-making in China. Though the degree of involvement of patients and family differs in the two cases, they point to one fact – the "best" decision from the doctor's perspectives is boycotted by silence or hesitation. The relationship between the narrative authority, the obligation to listen, and the power dynamics in medical decision will be discussed. 

Learning Outcomes:
Participants will have a better understanding of the situation of medical decision in China and will be able to reflect on the power dynamics of their own interaction with patients in medical decision-making. 

When a healthcare institution publishes a patient’s story, it assumes responsibility for how illness, vulnerability and care are represented in public. Such stories can support valuable aims, including public education, fundraising and trust-building, yet these purposes may favour clear narratives of recovery and gratitude. Preserving uncertainty means allowing ongoing illness, mixed outcomes, ambivalence and the limits of treatment to remain visible where they are part of the patient’s experience. This presentation examines how hospitals might balance the need to communicate compellingly with their responsibility to represent patients faithfully. It asks how much authority patients retain as their accounts are selected, edited and circulated. The presentation proposes that patient stories be treated as entrusted accounts whose complexity should not be lost in the process of making them publicly meaningful.

Learning outcomes:

1. Identify how institutional purposes can shape the selection, framing and circulation of patient stories.

2. Explain why preserving uncertainty, ambivalence and unresolved experience is important in ethical patient representation.

Evaluate how hospitals can balance effective communication with patients’ continuing authority over their own stories.