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There is an entire movement in medical documentation known as narrative-based medicine (NBM). The term was coined deliberately to mark its distinction from evidence-based medicine (EBM); in fact, NBM was propagated to counteract the shortcomings of EBM. While I am not advocating this approach in its entirety, there are some salient principles that can be incorporated in pre-admission screening and on-going documentation in the filed of medical rehabilitation. Proponents tell us, “Narratives have always been a vital part of medicine. Stories about patients, the experience of caring for them, and their recovery from illness have always been shared—among physicians as well as among patients and their relatives. With the evolution of “modern” medicine, narratives were increasingly neglected in favor of “facts and findings,” which were regarded as more scientific and objective”.

The development of NBM has to be understood in the context of patient-centered approaches—bringing the patient as a subject back into medicine. An illness narrative tells us not only about a specific medical case, but about the intensive, ultimate, and most authentic reality of life of a person. According to one writer, the illness narrative is not only a description of something pathological; it is the description of the life of the illness in that specific individual human being.

This approach to treatment and documentation may help rehabilitation clinicians justify “reasonable and necessary” care for IRF patients, in preadmission screening and in on-going documentation. It focuses attention on how a disease, disorder or injury has impacted the individual; how it has changed their ability to perform activities that provide quality of life. Further, narrative notes can explain how an inpatient rehabilitation program can benefit the individual (which also leads to an individualized care plan). The key to implementing this approach is learning to accomplish it efficiently. In a nutshell, the formula is: pre-admission functioning (how they were), current medical and functional status (how they are now) and prediction of functional status following IRF care (how they can be). Focus attention on describing the factors that impact the patient during each of those timeframes. For more detailed information, tips and recommendations contact Dr. Pam Smith at This email address is being protected from spambots. You need JavaScript enabled to view it.

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