Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Section of Palliative Care, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Philos Ethics Humanit Med. 2021 Oct 20;16(1):7. doi: 10.1186/s13010-021-00106-w.
Narrative medicine is a well-recognized and respected approach to care. It is now found in medical school curricula and widely implemented in practice. However, there has been no analysis of the perception and usage of narrative medicine across different medical specialties and whether there may be unique recommendations for implementation based upon specialty. The aims of this study were to explore these gaps in research.
Fifteen senior physicians who specialize in internal medicine, pediatrics, or surgery (5 physicians from each specialty) were interviewed in a semi-structured format about the utilization, benefits, drawbacks (i.e., negative consequences), and roles pertaining to narrative medicine. Qualitative content analysis of each interview was then performed.
Three themes emerged from our analysis: roles, practice, and outcomes. Through these themes we examined the importance, utilization, barriers, benefits, and drawbacks of narrative medicine. There was consensus that narrative medicine is an important tool in primary care. Primary care physicians (general internists and general pediatricians) also believed that narrative medicine is not as important for non-primary care providers. However, non-primary care providers (surgeons) generally believed narrative medicine is valuable in their practice as well. Within specialties, providers' choice of language varied when trying to obtain patients' narratives, but choice in when to practice narrative medicine did not differ greatly. Among specialties, there was more variability regarding when to practice narrative medicine and what barriers were present. Primary care physicians primarily described barriers to eliciting a patient's narrative to involve trust and emotional readiness, while surgeons primarily described factors involving logistics and patient data as barriers to obtaining patients' narratives. There was broad agreement among specialties regarding the benefits and drawbacks of narrative medicine.
This study sheds light on the shared and unique beliefs in different specialties about narrative medicine. It prompts important discussion around topics such as the stereotypes physicians may hold about their peers and concerns about time management. These data provide some possible ideas for crafting narrative medicine education specific to specialties as well as future directions of study.
叙事医学是一种公认且备受尊重的护理方法。它现在已经被纳入医学院课程，并在实践中得到广泛应用。然而，目前还没有对不同医学专业对叙事医学的认知和使用情况进行分析，也没有基于专业特点对实施叙事医学提出独特建议的分析。本研究旨在探讨这些研究空白。
对 15 名内科、儿科或外科的资深医生（每个专业 5 名医生）进行半结构化访谈，了解他们对叙事医学的使用、益处、弊端（即负面后果）和角色的看法。然后对每次访谈进行定性内容分析。
我们的分析得出了三个主题：角色、实践和结果。通过这些主题，我们考察了叙事医学的重要性、使用、障碍、益处和弊端。大家一致认为叙事医学是初级保健的重要工具。初级保健医生（普通内科医生和普通儿科医生）还认为叙事医学对非初级保健提供者并不那么重要。然而，非初级保健提供者（外科医生）普遍认为叙事医学在他们的实践中也很有价值。在专业内部，提供者在试图获取患者的叙述时选择的语言不同，但实践叙事医学的选择并没有太大差异。在不同的专业中，实践叙事医学的时间和存在的障碍存在更多的差异。初级保健医生主要描述了在获取患者叙述时遇到的障碍，包括信任和情感准备，而外科医生主要描述了与获取患者叙述相关的后勤和患者数据因素是障碍。不同专业对叙事医学的益处和弊端有广泛的共识。
本研究揭示了不同专业对叙事医学的共同信念和独特信念。它引发了一些重要的讨论，如医生对同行可能持有的刻板印象和对时间管理的担忧。这些数据为针对特定专业制定叙事医学教育以及未来研究方向提供了一些可能的思路。
