Hawkins A H
Department of Humanities, Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey.
Yale J Biol Med. 1992 May-Jun;65(3):173-81.
In the past few years, the medical case report has been studied as a document that evidences the way the patient and, by extension, the experiential and subjective aspects of an illness tend to be marginalized in contemporary medical theory and practice. First-person narratives about illness, our popular "pathographies," may in part represent our attempt as a culture to respond to this problem of "the vanishing patient." A rich source of information about patient experience, pathographies can be useful to us in locating specific issues in the medical enterprise that need understanding and perhaps require correction. Gilda Radner's It's Always Something demonstrates how two important issues--both neglected in the conventional medical history--powerfully affect the medical enterprise: the hopes, expectations, and wishes of the experiencing patient, and the perceived attitudes and demeanor of the patient's physicians. The restoration of patient and physician to the "history" is important not only because it reminds us of the personal dimension of the medical enterprise, but also because it alerts us to problems of attitude and action that bear directly on diagnosis, course of treatment, and the therapeutic transaction.
在过去几年里，医学病例报告被作为一种文献进行研究，它证明了在当代医学理论与实践中，患者以及由此延伸出的疾病的体验性和主观性方面往往被边缘化的方式。关于疾病的第一人称叙述，即我们流行的“病历传记”，可能部分代表了我们作为一种文化对“患者消失”这一问题的回应尝试。病历传记作为患者体验的丰富信息来源，对我们找出医疗行业中需要理解甚至可能需要纠正的具体问题可能会有所帮助。吉尔达·拉德纳的《总是有问题》展示了两个在传统病史中都被忽视的重要问题如何有力地影响医疗行业：患病患者的希望、期望和愿望，以及患者对医生态度和行为的认知。将患者和医生重新纳入“病史”很重要，不仅因为它让我们想起医疗行业的个人层面，还因为它提醒我们注意那些直接影响诊断、治疗过程和治疗互动的态度和行为问题。
