McWhinney I R
CMAJ. 1986 Oct 15;135(8):873-8.
The traditional clinical method, which has served medicine well for over 100 years, had its origins in the integration of physical examination with morbid anatomy in early 19th-century France. Now this method is showing signs of failing to meet some contemporary needs. In particular, there is no means for understanding the inner experience of patients. Previous models of a transformed method have not grappled with the problem of validation. Data on the inner experience of patients are not open to empiric validation in the same way as clinical data. The process of understanding the meaning of an illness is not, therefore, scientific in the conventional sense. There are, none the less, rigorous methods for validating the results of this form of inquiry, notably those of phenomenology. A transformed method should aim to understand the meaning of an illness for the patient as well as provide a clinical diagnosis. The transformation will require a change in the epistemology of medicine and an educational process that encourages reflection and growth of self-knowledge.
传统临床方法在100多年来一直很好地服务于医学领域，它起源于19世纪早期法国将体格检查与病理解剖学相结合的过程。如今，这种方法已显示出无法满足一些当代需求的迹象。特别是，它没有办法去理解患者的内心体验。以往关于变革方法的模式尚未解决验证问题。患者内心体验的数据无法像临床数据那样通过实证进行验证。因此，理解疾病意义的过程并非传统意义上的科学过程。然而，存在一些严格的方法来验证这种探究形式的结果，尤其是现象学方法。变革后的方法应旨在理解疾病对患者的意义，并提供临床诊断。这种变革将需要医学认识论的转变以及一个鼓励反思和自我认知成长的教育过程。
