Baruch Jay M
Department of Emergency Medicine, Alpert Medical School at Brown University, 55 Claverick Street, 2nd floor, Providence, RI, 02903, USA,
J Med Humanit. 2013 Dec;34(4):459-69. doi: 10.1007/s10912-013-9243-7.
Listening and responding to patients' stories for over 20 years as an emergency physician has strengthened my appreciation for the many ways that the skills and principles drawn from writing fiction double as necessary clinical skills. The best medicine doesn't work on the wrong story, and the stories patients tell sometimes feel like first drafts-vital and fragile works-in-progress. Increasingly complex health challenges compounded by social, financial, and psychological burdens make for stories that are difficult to articulate and comprehend. In this essay, I argue that healthcare providers need to think like creative writers and the skills and sensitivities necessary to story construction deserve a vital space in medical education. A thorough understanding of story anatomy and the imaginative flexibility to work stories into open spaces serve as antidotes to the reductive nature of clinical decision making and have implications as patient safety and risk management strategies. The examples that I have selected demonstrate how thinking like a creative writer functions at the bedside, providing tools for clinical excellence and empathy. This approach asks that we re-imagine the importance of story in clinical care: from a vehicle to a diagnosis to its place as a critical destination.
作为一名急诊医生，二十多年来倾听并回应患者的故事，让我愈发认识到，从创作小说中汲取的技巧和原则在很多方面同样也是临床所需的必要技能。再好的药物如果用错了病情也无济于事，而患者讲述的故事有时就像初稿——充满生机却又脆弱，仍在不断完善之中。日益复杂的健康挑战，再加上社会、经济和心理负担，使得这些故事难以清晰表达和理解。在本文中，我认为医疗服务提供者需要像有创造力的作家一样思考，故事构建所需的技巧和敏感度在医学教育中应占有重要地位。深入理解故事结构以及灵活发挥想象力将故事融入各种情况，可作为应对临床决策简化本质的良方，对患者安全和风险管理策略也有启示作用。我所举的例子展示了像有创造力的作家那样思考在床边是如何发挥作用的，为卓越临床和共情提供了工具。这种方法要求我们重新认识故事在临床护理中的重要性：从作为诊断的一种手段，到成为关键的目标所在。
