Department of Social Work, Umeå University, Umeå, Sweden.
University of Exeter Medical School, Exeter, UK.
Sociol Health Illn. 2021 Jan;43(1):186-200. doi: 10.1111/1467-9566.13209. Epub 2020 Oct 28.
The increasing popularity of the term 'person-centred' in the healthcare literature and a wide range of ideals and practices it implies point to the need for a more inclusive and holistic healthcare provision. A framework developed in a Swedish context suggested narrative elicitation as a key practice in transition to person-centred care. Initiating clinical communication by inviting people to tell their stories makes persistent yet often subtle problems in clinical communication visible. By drawing upon an observational study on narrative elicitation and vignette-based focus group interviews with nurses, our aim is to trace 'credibility deficits' (Fricker 2007. Epistemic Injustice. Power and the Ethics of Knowing. Oxford: Oxford University Press) and 'credibility excesses' (Medina 2011, Social Epistemology, 25, 1, 15-35, 2013, The Epistemology of Resistance: Gender and Racial Oppression, Epistemic Injustice, and the Social Imagination. Oxford: Oxford University Press) in narrative elicitation. We argue that narrative elicitation may be one way to tackle epistemic injustices by giving voice to previously silenced groups, yet it is not enough to erase the effects of 'credibility deficits' in clinical communication. Rather than judging individual professionals' success or failure in eliciting narratives, we underline some extrinsic problems of narrative elicitation, namely structural and positional inequalities reflecting on narrative elicitation and the credibility of patients. 'Credibility excesses' can be useful and indicative to better understand where they are missing.
“以患者为中心”这一术语在医疗保健文献中的日益普及，以及它所隐含的广泛理想和实践，都指向了对更具包容性和整体性医疗保健服务的需求。一个在瑞典背景下开发的框架建议叙事启发作为向以患者为中心的护理过渡的关键实践。通过邀请人们讲述自己的故事来开启临床沟通，可以使临床沟通中持续存在但通常微妙的问题变得可见。本研究通过对叙事启发的观察性研究和基于情景的焦点小组访谈，旨在追踪“可信度缺陷”（弗里克 2007.知识论不公。权力与认识伦理。牛津：牛津大学出版社）和“可信度过剩”（梅迪纳 2011.社会认识论，25,1,15-35，2013.抵抗的认识论：性别和种族压迫、知识论不公和社会想象力。牛津：牛津大学出版社）在叙事启发中的表现。我们认为，叙事启发可能是通过赋予以前被忽视的群体发言权来解决知识论不公的一种方式，但仅仅消除临床沟通中“可信度缺陷”的影响是不够的。我们不是评判个别专业人士在启发叙事方面的成功或失败，而是强调叙事启发存在一些外在问题，即反映在叙事启发和患者可信度上的结构性和位置性不平等。“可信度过剩”可能是有用的，可以帮助我们更好地理解它们缺失的地方。
