DasGupta Sayantani, Charon Rita
Program in Narrative Medicine, Columbia University College of Physicians and Surgeons, 622 West 168th Street, VC 402, New York, NY 10021, USA.
Acad Med. 2004 Apr;79(4):351-6. doi: 10.1097/00001888-200404000-00013.
Reflective writing is one established method for teaching medical students empathetic interactions with patients. Most such exercises rely on students' reflecting upon clinical experiences. To effectively elicit, interpret, and translate the patient's story, however, a reflective practitioner must also be self-aware, personally and professionally. Race, gender, and other embodied sources of identity of practitioners and patients have been shown to influence the nature of clinical communication. Yet, although medical practice is dedicated to examining, diagnosing, and treating bodies, the relationship of physicians to their own physicality is vexed. Medical training creates a dichotomy whereby patients are identified by their bodies while physicians' bodies are secondary to physicians' minds. As a result, little opportunity is afforded to physicians to deal with personal illness experiences, be they their own or those of loved ones. This article describes a reflective writing exercise conducted in a second-year medical student humanities seminar. The "personal illness narrative" exercise created a medium for students to elicit, interpret, and translate their personal illness experiences while witnessing their colleagues' stories. Qualitative analysis of students' evaluation comments indicated that the exercise, although emotionally challenging, was well received and highly recommended for other students and residents. The reflective writing exercise may be incorporated into medical curricula aimed at increasing trainees' empathy. Affording students and residents an opportunity to describe and share their illness experiences may counteract the traditional distancing of physicians' minds from their bodies and lead to more empathic and self-aware practice.
反思性写作是教授医学生与患者进行共情互动的一种既定方法。大多数此类练习都依赖于学生对临床经验的反思。然而,要有效地引出、解读并转化患者的故事,反思性实践者还必须在个人和职业方面具备自我意识。从业者和患者的种族、性别以及其他体现身份的因素已被证明会影响临床沟通的性质。然而,尽管医学实践致力于检查、诊断和治疗身体,但医生与其自身身体的关系却很复杂。医学培训造成了一种二分法,即患者通过其身体来识别,而医生的身体相对于医生的思维来说是次要的。结果,医生很少有机会处理个人疾病经历,无论是他们自己的还是亲人的。本文描述了在二年级医学生人文研讨会上进行的一项反思性写作练习。“个人疾病叙事”练习为学生创造了一种媒介,使他们能够在见证同事故事的同时引出、解读并转化自己的个人疾病经历。对学生评价意见的定性分析表明,该练习虽然在情感上具有挑战性,但受到好评,并被强烈推荐给其他学生和住院医生。反思性写作练习可纳入旨在提高受训者共情能力的医学课程中。让学生和住院医生有机会描述和分享他们的疾病经历,可能会抵消医生思维与身体传统上的疏离,并导致更具共情能力和自我意识的实践。