At the Membranes of Care: Stories in Narrative Medicine
At the Membranes of Care: Stories in Narrative Medicine
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DOI：
10.1097/acm.0b013e3182446fbb
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发表时间：
2012-03-01
影响因子：
7.4
通讯作者：
Charon, Rita
中科院分区：
文献类型：
--
作者：
Charon, Rita
认识到临床医学是一种叙事性的事业，通过理解故事的可学习技能来加强，这有助于医生和教师在专业性、医学访谈、反思性实践、以病人为中心的护理和自我意识等领域的医疗实践和教育中面对其他令人烦恼的问题。叙事医学的新兴实践为临床医生提供了与患者接触并了解他们观点的新方法。本文简要回顾了有关故事结构的叙事理论，认为临床文本包含并能够揭示超出其情节的信息。通过对两篇临床文本的形式和内容的仔细阅读--一段医学图表的摘录和一段对医学生的录音采访的一部分--以及对一部现代主义小说的一小段的反思，作者提出了扩展传统医学惯例的方法，即认识病人情况的意义。近距离阅读和反思性写作对临床实践的贡献可能是通过增加感知能力，然后表现感知的能力，从而使作者能够获得否则可能会保持意识之外的东西。通过一个临床案例，说明了叙事医学在实践中的应用效果。激活的细胞膜的隐喻提出了一个有效的临床医生/患者接触的数字。
Recognizing clinical medicine as a narrative undertaking fortified by learnable skills in understanding stories has helped doctors and teachers to face otherwise vexing problems in medical practice and education in the areas of professionalism, medical interviewing, reflective practice, patient-centered care, and self-awareness. The emerging practices of narrative medicine give clinicians fresh methods with which to make contact with patients and to come to understand their points of view. This essay provides a brief review of narrative theory regarding the structure of stories, suggesting that clinical texts contain and can reveal information in excess of their plots. Through close reading of the form and content of two clinical texts-an excerpt from a medical chart and a portion of an audiotaped interview with a medical student-and a reflection on a short section of a modernist novel, the author suggests ways to expand conventional medical routines of recognizing the meanings of patients' situations. The contributions of close reading and reflective writing to clinical practice may occur by increasing the capacities to perceive and then to represent the perceived, thereby making available to a writer that which otherwise might remain out of awareness. A clinical case is given to exemplify the consequences in practice of adopting the methods of narrative medicine. A metaphor of the activated cellular membrane is proposed as a figure for the effective clinician/patient contact.