Enhancing doctor-patient communication through narrative competence: challenges and opportunities

Doctor-patient communication faces systemic barriers such as limited time and resources, differing role expectations, inadequate training, cultural and language differences, and ethical and practical challenges with technology, often resulting in lower patient satisfaction and poor clinical outcomes. This review conceptualizes narrative competence—which encompasses storytelling abilities, empathic engagement, and active listening—as a transformative framework for enhancing clinical communication. We outline three evidence-based implementation strategies: (1) storytelling abilities are developed through narrative-focused role-playing simulations, structured protocols such as the SPIKES model for conveying complex information, and digital storytelling workshops that utilize technology; (2) empathic engagement is enhanced through reflective narrative journaling, patient shadowing experiences, and emotion-mapping exercises employing visual tools to interpret affective cues; (3) active listening is refined through silent listening practices, non-verbal communication training (e.g., LISTEN/EMPATHY frameworks), and echoing techniques to affirm patient concerns. In addition, the review critically examines fundamental controversies, including debates regarding the definitional boundaries of narrative competence and the theory-practice gap within fast-paced clinical settings, where workload constraints frequently impede in-depth narrative engagement. Furthermore, we emphasize the necessity of tailoring training to the expertise level of learners, advocating for the use of simulation-based methods for students and just-in-time modules for practicing clinicians. Beyond the development of individual skills, we identify future opportunities in multidisciplinary narrative practices, policy-driven integration into medical curricula, and the application of artificial intelligence and virtual reality technologies to enhance personalized care. This review argues that the systematic development of narrative competence can address communication deficiencies and strengthen therapeutic alliances, although challenges related to measurement, scalability, and institutional support persist.