279 Vol. 35, No. 4 Since 1997, our family medicine clerkship has empha- sized patient-centered medicine. 1,2 Recognizing that writing can encourage students 3 and practitioners 4 to reflect on and enhance empathy in patient care, we as- sign writing exercises in which students identify mul- tiple dimensions of illness 5 and find common ground 6 with patients during clinical encounters and write about an illness episode within their own families. The overall purpose of the writing exercises is to improve the students’ appreciation of patient explana- tory models, 7 cross-cultural issues, the central role of narrative in patient care, 8 and, ultimately, to improve patient-doctor relationships. Methods Our medical school is a minority institution, with 25% Pacific Islanders and 61% Asians among its stu- dents. Between April 1997 and June 2002, 260 medi- cal students have participated in the writing assign- ments. The assignments are part of a four-session semi- nar on the patient-physician relationship conducted in our family medicine clerkship. Writing Assignments Students are instructed to portray their family dy- namics, outline their families’ beliefs about illness, note the influence of those beliefs on the course of the ill- ness or treatment, and delineate the influence of their families’ values on their views of the practice of medi- cine. The writing assignments range from two to five pages in length. The students then present their narra- tives in a small-group session of family practice clerks, led by the authors (a PhD faculty and Buddhist priest, two MD/ MPH clinicians, and a cultural anthropologist who has attended sessions as a participant-observer). Analysis Using a grounded research approach, all four authors met monthly over a period of 6 months to discuss themes that emerged as important from a medical edu- cation standpoint. Between the meetings, we reflected again on the contents of the narratives, applying a hermeneutical method of interpretation, moving from part to whole and back, to extract the most significant F a m il y N a rra t i v es , C ul t ure , a n d Pa t i en t -cen t er ed Me di cin e S eiji Y am ada, MD, MPH; Gregory G. Mas k arin ec, PhD; Gordon A. Green e, PhD; Kay A. Bau m an, MD, MPH From the Hawaii/Pacific Basin AHEC (Dr Yamada), the Office of Medical Education (Drs Yamada and Greene), the Department of Family Practice and Community Health (Dr Maskarinec), and the State of Hawaii Depart- ment of Public Safety (Dr Bauman), John A. Burns School of Medicine, University of Hawaii at Manoa. B a c k g r o u n d a n d O b j e c t i v e s : As part of our family medicine clerkship seminar on the patient-physician relationship, third-year students write about an illness episode within their own families. M e t h o d s : Using a grounded research approach, we examined 260 student narratives to extract the most significant mean- ings. R e s u l t s : Significant themes that emerged include the role of family members in illness episodes, specific influences resulting from the family’s ethnicity or religion, experiences with socially unaccept- able illnesses, experiences with death, appreciation of the moral trajectory of illness, and situations that display the fallibility and limitations of medicine. C o n c l u s i o n s : Writing exercises can help students recog- nize the centrality of narrative and of cultural values in medicine so they are better able to understand their patients and provide more patient-centered medical care. (Fam Med 2003;35(4):279-83.) Medical Student Education