Freeman T R
Department of Family Medicine, University of Western Ontario, London, Canada.
Fam Pract. 1994 Jun;11(2):164-70. doi: 10.1093/fampra/11.2.164.
The presentation of case histories is an important part of medical education, socialization and research. The traditional format of presentation, developed at the beginning of the century and based on disease-centred nosologies, has been criticized as minimizing the patient's story and subjective experience. It results in a separation of biological processes from the person. With the development of a patient-centred clinical method, it is desirable to have a patient-centred case presentation format that places the patient's subjective experience in the forefront, without sacrificing traditional biomedical aspects. This paper describes such a method and presents an example. This method is especially useful in the education of senior residents in family medicine, as it can serve to reinforce an attitude of 'patient-centredness'. The method can also serve as a useful bridge between the passive learning inherent in much of the education in medical schools and the active, adult learning necessary for graduate practitioners. By placing an emphasis on the person's subjective experience of illness, rather than solely on the disease, this way of presenting a case history readily suggests new questions and directions in research. The presentation of case histories is an underrecognized tool in family medicine. Changing the format of such presentations to be more consistent with the family medicine world view has implications for education and research.
病例史的呈现是医学教育、社会化和研究的重要组成部分。传统的呈现形式在本世纪初形成，基于以疾病为中心的疾病分类学，受到批评，认为它将患者的故事和主观体验最小化。这导致了生物过程与人的分离。随着以患者为中心的临床方法的发展，需要一种以患者为中心的病例呈现形式，将患者的主观体验置于首位，同时又不牺牲传统生物医学方面。本文描述了这样一种方法并给出了一个例子。这种方法在家庭医学高级住院医师的教育中特别有用，因为它可以强化“以患者为中心”的态度。该方法还可以作为医学院校许多被动学习与研究生从业者所需的主动、成人学习之间的有用桥梁。通过强调患者对疾病的主观体验，而不仅仅是疾病本身，这种呈现病例史的方式很容易在研究中提出新的问题和方向。病例史的呈现在家庭医学中是一种未得到充分认识的工具。改变这种呈现形式，使其更符合家庭医学的世界观，对教育和研究具有重要意义。
