“It Changed My Whole Entire Thinking”: Narrative Recommendations for Successful Medical Affidavits in Asylum Evaluation
Saturday, October 14, 2023
10:30 AM – 11:45 AM ET
Location: Bristol (Third Floor)
Background: The medical-legal affidavit is critically significant for asylum seekers. The success rate for attaining asylum doubles from 37.5% without an affidavit, to 89% with one. Practitioners who write medical affidavits must “close read” their patients— a known narrative medicine (NM) technique— and then represent their oral narrative in written form. Our objective was to identify the most common NM techniques in successful medical-legal affidavits of asylum seekers, and improve asylum clinic training curricula and success rates.
Methods: We focused on the most vulnerable clients: those applying after the one-year deadline. Using grounded theory, we examined twenty-two affidavits filed after the one-year deadline and identified embedded NM techniques. Sixty-eight techniques were identified within 19 categories and 3 themes consistent with the three primary movements of NM: attention, representation, and affiliation. We then compared the NM techniques present in affidavits filed on behalf of successful vs. unsuccessful asylum seekers.
Conclusions: We identified 8 NM techniques that were present more often in successful vs. unsuccessful cases: (1) Attending to the required legal grounds for asylum; (2) Recommending specific clinical interventions; (3) Quoting elevated diction by the client; (4) Using headlines; including anecdotes that describe (5) The client forming human connections, (6) Archetypal female characters, (7) Love stories, or (8) Moments of realization.
Conclusion: Fluency with NM can increase the odds of composing a successful medical-legal affidavit for asylum seekers. The eight techniques identified should be integrated into formal training for those who write such affidavits.
Rachel Kowalsky, MD MPH – Assistant Professor of Emergency Medicine and Pediatrics, New York - Presbyterian Weill Cornell Medicine; Radhika Sundararajan – Emergency Medicine – Weill Cornell Medicine; Andrew Milewski – Anesthesia – Weill Cornell Medicine; Mert Keceli – Emergency Medicine – Weill Cornell Medicine; Mohammed Alkhafaji – Emergency Medicine – Weill Cornell Medicine