Pentiado Jorge Alberto Martins, De Almeida Helcia Oliveira, Amorim Fábio Ferreira, Facioli Adriano Machado, Trindade Eliana Mendonça Vilar, De Almeida Karlo Jozefo Quadros
Neurologist in the Department of Neurosciences and Behavioral Science, Division of Neurology, School of Medicine of Ribeirão Preto, University of São Paulo, SP, Brazil.
Psychologist and Professor of Medicine in the Department of Research and Scientific Communication at Escola Superior de Ciências da Saúde in Brasília, DF, Brazil.
Perm J. 2016 Spring;20(2):98-102. doi: 10.7812/TPP/15-067. Epub 2016 Feb 15.
This case study is an example of narrative medicine applied to promote self-awareness and develop humanistic contents in medical education. The impact and the human appeal of the narrative lie in the maturity and empathy shown by a student when reporting his dramatic experience during the care given to a newborn (with Patau syndrome and multiple malformations diagnosed at birth) and to her mother. The narrative approach helped the student to be successful in bringing out the meaning behind the story and to position himself from the mother's and newborn's perspective. The student's introspection changed a seemingly scary interaction into a positive experience, overcoming many initial negative emotions, such as fear, disappointment, horror, hopelessness, and insecurity in the face of the unexpected. It is uplifting how the student was strengthened by the power of maternal love to the point of overcoming any remaining feelings of eugenics or rejection. Other important lessons emerging from the case study were the art of listening and the value of silence. This narrative shows how the development of narrative competence can help establish a good physician-patient relationship, because the physician or the student with such competence usually confirms the patient's value and demonstrates concern for them, focusing on what they say and allowing genuine contact to be established, which is necessary for effective therapeutic alliance. The student's interpretations of the meaning of love and value of life inspired him on his reframing process of a medical practice marked by vicarious suffering.
本案例研究是叙事医学应用于促进自我认知并在医学教育中培养人文内涵的一个实例。该叙事的影响力和人文感染力在于一名学生在讲述其在照顾一名新生儿（出生时被诊断患有帕陶氏综合征和多种畸形）及其母亲期间的戏剧性经历时所展现出的成熟和同理心。叙事方法帮助该学生成功挖掘出故事背后的意义，并从母亲和新生儿的角度看待问题。该学生的内省将一次看似可怕的互动转变为一次积极的经历，克服了许多最初的负面情绪，如面对意外时的恐惧、失望、恐惧、绝望和不安全感。令人振奋的是，母爱之力让这名学生得到了鼓舞，以至于克服了任何残留的优生学或排斥情绪。该案例研究还引出了其他重要的经验教训，即倾听的艺术和沉默的价值。这个叙事表明叙事能力的发展有助于建立良好的医患关系，因为具备这种能力的医生或学生通常会肯定患者的价值并表现出对他们的关心，专注于他们所说的话并建立真诚的联系，而这对于有效的治疗联盟来说是必要的。该学生对爱和生命价值的诠释激发了他对以替代性痛苦为特征的医疗实践进行重新构建的过程。
