Charon, a 54-year-old internist with a Ph.D. in literature, is the director of the pioneering Program in Narrative Medicine at Columbia University, which teaches literature, literary theory and creative writing to medical students and whose practices are rapidly being incorporated and adapted by schools across the country.

Narrative medicine imports terms from literature to describe the doctor-patient relationship. In describing his backache, Charon said, the Dominican man was actually telling an ''illness narrative,'' which can be interpreted just like a literary text: by examining the presentation of character, the structure of the tale and the plot of the disease. Regardless of the outcome -- the diagnosis or treatment (which Charon did not relate) -- what is central is the telling and receiving of the tale. Narrative medicine appears to answer a central paradox. Unlike other fields -- like literature -- medicine really is always getting better. Yet despite its ever-increasing efficacy, nearly half of patients seek out alternative care, and both patients and physicians voice increasing dissatisfaction with the practice of mainstream medicine.