Integrating Narrative Medicine and Evidence-Based Medicine: The Everyday Social Practice of Healing PDF
Preview Integrating Narrative Medicine and Evidence-Based Medicine: The Everyday Social Practice of Healing
INTEGRATING NARRATIVE MEDICINE AND EVIDENCE-BASED MEDICINE Integrating Narrative Medicine and Evidence-based Medicine The everyday social practice of healing JAMES P MEZA MD and DANIEL S PASSERMAN DO Forewords by PETER WYER and RITA CHARON and MARK H EBELL Radcliffe Publishing London • New York Radcliffe Publishing Ltd 33–41 Dallington Street London EC1V 0BB United Kingdom www.radcliffepublishing.com Electronic catalogue and worldwide online ordering facility. © 2011 James P Meza and Daniel S Passerman Reprinted 2013 James P Meza and Daniel S Passerman have asserted their rights under the Copyright, Designs and Patents Act 1998 to be identified as the authors of this work. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the copyright owner. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library. ISBN-13: 978 184619 350 7 The paper used for the text pages of this book is FSC® certified. FSC (The Forest Stewardship Council®) is an international network to promote responsible management of the world’s forests. Typeset by Phoenix Photosetting, Chatham, Kent, UK Printed and bound by TJI Digital, Padstow, Cornwall, UK Contents Foreword by Peter Wyer and Rita Charon ix Foreword by Mark H Ebell x Preface xi About the Authors xxii Introduction xxiii Part I: The Process of Care for a Diagnostic Narrative Dilemma 1 Acquire Enough Information to Understand the Patient’s Concern 3 2 Ask a Clinically Appropriate Question Based on the Patient’s Concern 23 3 Access Information Relevant to the Question 34 4 Assess the Quality of the Information 59 5 Apply the Information to the Clinical Question 79 6 Assist the Patient in Making a Decision 96 Part II: The Process of Care for a Therapeutic Narrative Dilemma 7 Acquire Enough Information to Understand the Patient’s Concern 111 8 Ask a Clinically Appropriate Question Based on the Patient’s Concern 122 9 Access Information Relevant to the Question 127 10 Assess the Quality of the Information 137 11 Apply the Information to the Clinical Question 160 12 Assist the Patient in Making a Decision 169 Part III: Theoretical Considerations 13 Theoretical Issues Regarding the Everyday Social Practice of Healing 193 14 What is Healing and Who Needs it Anyway? 206 15 Commodification of Health Care and the New Professionalism of Translational Practice 210 vi INTEGRATING NARRATIVE MEDICINE AND EVIDENCE-BASED MEDICINE Part IV: Epilogue 16 Epilogue 221 Afterword 226 Part V: Appendices Introduction to Appendices 233 Appendix A 235 Appendix B 245 Appendix C 252 Index 253 Dedication Dedicated to our loving wives Carol and Tracy The Social Practice of Healing When doctors listen to patients’ stories, they merge the individual’s narrative with the cultural power of the medical profession and produce a co-constructed narrative within the context of an institutionalized social framework, creating coherence between the ‘inner experience’ of the individual and the socially authorized version of the same story. This practice harmonizes two stories, cre- ating personal meaning and reinforcing social norms. Foreword We appreciate the appearance of this book as evidence of the emergence into the clinical mainstream of a stereoscopic way of knowing in clinical medicine. In 2008, our group at Columbia University coined the name ‘Narrative Evi- dence Based Medicine,’ being careful to not insert hyphens between the words. We tried thereby to keep in play the concepts of ‘narrative evidence’ as well as ‘evidence based medicine’ and, by the long view, ‘narrative medicine’ as the encompassing or embracing concept. Evidence – of all kinds – sits at the center of what the overarching effort reaches for, that is, a scientifically informed nar- rative medicine. Dr Meza and Dr Passerman do a great service to clinical trainees and prac- titioners in this serious yet welcoming review of the practice of evidence based medicine along with the conceptual hints of the relational, social, and political aspects of narrative medicine. This young book helps us all to envision a time in clinical practice when doctors know how to listen to their patients’ narratives of illness while partnering with their patients to accurately answer the ques- tions they ask. We take heart from a book like this one, for its appearance now signals that the field of narrative medicine, which was inaugurated at Columbia in 2000, has had an impact on the mainstream practice of medicine, not only among the literary types but also among the ‘in-the-trenches’ doctors in practice. That two family medicine residencies in the Midwest teach narrative evidence based medicine grounds our own impression that mainstream clinical medicine needs the fruits of our work in narrative medicine and endorses our joining of narra- tive ways of thinking in medicine with the search, always, for the firmest and ‘truest’ thinking in the scientific foundations of clinical practice. Peter Wyer and Rita Charon Columbia University, New York, NY March 2011
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