Analyze

 “Under a 1986 federal law titled the Emergency Medical Treatment and Labor Act (EMTALA), hospitals are required to treat people who come to the ED presenting with an emergency medical condition, defined as a condition that, without treatment, will likely lead to serious impairment or death. … EMTALA is one of the largest federal mandates to provide services to have gone unfunded (Friedman 2011); costs instead fall on states and local health care systems.” 481

“In bringing ethnographic attention to hot spotting as a technique of governance, we find that it provides lifesaving humanitarian interventions while operating within the racialized structures of violence that produce continual life crises. The institutional rationality of hotspotting and the encounters of care that it produces illustrate the often-contradictory role of medicine in the lives of poor people: both caring and coercive, it intertwines care and violence.” 475; “we conclude by suggesting that economic investment and return are becoming a reigning logic in the governance of poverty, generating hot spots as sites of interest for both policing and health care and decentering normative assessments of deviance, illness, and social problems” 476; “Neoliberal social assistance, as it is practiced in the health care safety net, is conceptualized as an “investment “in the population, as a strategic and targeted deployment of basic resources, one that promises to generate a return on investment for the state or health system in the form of cost savings.“ 485

The authors examine the practice of “hot spotting,” a form of surveillance and intervention through which health care systems in the US intensively direct health and social services towards high-cost patients.  Health care hot spotting is seen as a way to improve population health while also reducing financial expenditures on healthcare for impoverished people. The authors argue that argue that ultimately hot spotting targets zones of racialized urban poverty—the same neighborhoods and individuals that have long been targeted by the police. These practices produce “a convergence of caring and punitive strategies of governance” (474). The boundaries between the spaces of healthcare and policing have shifted as a “financialized logic of governance has come to dominate both health and criminal justice” (474).

The purpose of this program is to help instill into nurses, doctors, social workers and more with the ability to mix their clinical practice with the ability to interpret, recognize and be moved by stories of illness according to their mission statement. This program is for those that want to improve the effectiveness of their care by increasing their familiarity with the skill of narrative medicine. 

Columbia University was one of the first medical schools to open a program in Narrative Medicine. This program was built within their College of Physicians and Surgeons. Rita Charon is the executive director of the program and is on the forefront of spreading the need for narrative medicine in the medical field. Colleagues of hers also believe that medicine has become too professional and clinical, and doctors focus on treating medical problems based off symptoms, not the patient. The educational program at Columbia created the opportunity to earn a Masters of Science degree in Narrative Medicine in 2009, making to one of the first programs devoted to only narrative medicine. 

This program is located within an institution, Columbia University's Medical Center and College of Physicians and Surgeons. 

This program is funded by tuition paid for my students (or maybe some form of scholarship, on a case by case basis.) Columbia University is a private institution, and those enrolled in this program pay a tuition for cost of the education and resources. 

This prgram is only offered in-camous adn takes roughtl 2-6 terms  to cp,plete. earnign the degree requires 38 points. Menaing fuill time studnes can copelte the program in one academic year and a summer. The degree requirements include  five Core Courses in Narrative Medicine (22 points) and the Research Methodology course (4 points), which is required for all students who have not taken a graduate-level course in research methodology. The other 12 to 16 points may include any combination of additional Topics in Narrative Medicine courses, elective courses chosen from other departments, Independent Study and/or Capstone (two to four points).

Requirements to apply are a Bachelor’s degree or its equivalent and demonstrable evidence of promise in the field of narrative medicine according to the admissions website. Ultimately, those looking to enter the medical field in any capacity are the main targeted demographic for this program. The goal is to instill into doctors, nurses, PAs, social workers, etc, the idea of incorporating narrative medicine into their clinical work. Those predisposed to healthcare fields are likely optimal candidates for this program. 

Those that complete the course requirements and achieve all their points will graduate with an MS in Narrative Medicine.