Sobel R J
Soroka University Hospital, Ben-Gurion University of the Negev, School of Applied Health Sciences, Beer-Sheva, Israel.
Acad Med. 2000 Jan;75(1):85-9. doi: 10.1097/00001888-200001000-00021.
The medical case history is a proven tool for approaching the question "What is wrong with this person?" Its virtues, however, can become vices, in part as a consequence of the dehumanizing flight from sensitive subjectivity to sanitized objectivity, from human interest to "science." The case history, because it is so useful and effective, is not likely to be profoundly altered in the future, but medical educators can make themselves and their students more aware of the serious flaw in this form of discourse, i.e., the erasure of the unique individual from his or her disease. The exercise of asking medical students to abstract case histories from richly written short stories, novels, plays, or operas might heighten students' recognition of the poverty of the medical case history. To illustrate this idea, the story of Eva, a dying woman, is presented initially as a typical medical case history; it is then contrasted with excerpts from a novelist's narrative of Eva's life.
病史是解决“这个人怎么了？”这一问题的一种经过验证的工具。然而，它的优点可能会变成缺点，部分原因是从敏感的主观性向净化后的客观性、从人文关怀向“科学”的非人化转变。病史因其非常有用且有效，未来不太可能发生深刻改变，但医学教育工作者可以让自己和学生更加意识到这种话语形式的严重缺陷，即从患者的疾病中抹去了独特的个体。让医学生从丰富的短篇小说、长篇小说、戏剧或歌剧中提取病史的练习，可能会提高学生对病史局限性的认识。为了说明这一观点，先将垂死的伊娃的故事呈现为典型的病史；然后将其与小说家对伊娃生平的叙述片段进行对比。
