— Downie, R. S. “Literature and Medicine.” Journal of Medical Ethics 17.2. (1991): 96
Jaye, C., Egan, T & Parker, S. (2006). ‘Do as I say, not as I do’: Medical Education and Foucault’s Normalizing Technologies of Self.Anthropology & MedicineVol. 13, No. 2, August 2006, pp. 141-155. (pp. 143 - 144). (via shrinkrants)
Wow. So I don’t know much about the context this quote came from, but it sounds so interesting that I’m going to go find the article and read it. If you’re interested, here’s the abstract of the paper:
But in the meantime, what do you all think and feel about this? I get the “fierce competitiveness” and “emotional detachment.” But the “maleness” I’m not so sure of, and isn’t “activism and antipathy for weakness” a paradox?
What do you all think?
(P.S. Go follow shrinkrants too, because he always has interesting posts!)
The article that goes with this abstract focuses on the importance of doctors listening to the stories that people want to tell as well as the more narrow and technical stories that standard medical education teaches doctors to gather, document, and focus their work around. For my taste, this is better than many narrative medicine articles because it emphasizes how doctors should listen rather that focusing on the doctor’s empathy and humaneness while taking the spotlight off the “patient.”
I posted a link to the video by Chimamanda Adichie yesterday.
Commentary: Narrative Lessons From a Nigerian Novelist: Implications for Medical Education and Care
Joseph Zarconi, MD
In her TED Talk entitled “The danger of a single story,” Nigerian novelist Chimamanda Adichie shares stories about her life that illustrate the natural human tendency to interpret the lives of others in the context of what she describes as narrowly constructed and often stereotypical “single stories.” These single-story views often portray others as wholly different from those constructing the stories, thereby diminishing the possibilities for genuine human connection. Referencing Adichie’s talk, the author describes the narrative dissonance that so often distances patients from their physicians. He illustrates the dangers to patients that can result from single-story caregiving by physicians, sharing an example from his own experience in which unnecessary harm came to his patient because of his own single-story thinking. The author argues that these single-story dangers must be openly and consciously addressed in the training of doctors to counteract the tendency for their clinical and educational experiences to inculcate single stories by which physicians come to interpret their patients. He offers suggestions as to why single-story thinking arises in clinical practice and how to mitigate these forces in medical education. The author concludes by contending that the education of physicians, and caring for the sick, should be aimed at preserving the dignity of those being served, and he argues for an “equal humanity” model of the patient– physician relationship that engages patients in all dimensions of their multiple stories.
Acad Med. 2012;87:1005–1007.
Cheryl Mattingly is an anthropologist who has spent her career studying the culture of occupational therapists who work in large inner city hospitals. This is “exoticizing the domestic” rather than the more traditional cultural anthropology which “domesticates the exotic.” She has a lot to say about the culture of hospitals in general, the politics of class and race in urban hospitals, and the poetics of encounters between professionals and patients. Reading her work gives me hope for the future of medicine. She sees “clinical encounters” as dramas in which each participant is actively and collaboratively making up the lived story of the meaning of what has come before and of what’s possible in the next moment. I am moved by this long paragraph from her book Healing dramas and clinical plots. She is talking about what she has learned in the course of her studies.
“There was more generosity than I was prepared for. I saw small kindnesses rather than life-saving interventions. These went almost unnoticed by the therapists themselves. Generosity and small attentions are not the stuff of the medical chart. Even when something more dramatic (trying to help a despairing person find a reason to stay alive), there is no place to formally record these actions. They are undocumented exchanges, not part of the official purview of the occupational therapist. Therapists personally valued their own kindness and their imaginative capacity to link their interventions to the lives of their patients, but because there is almost no language within biomedical discourse for recognizing and examining exchanges which address the illness experience and because this is not a “reimbursable” part of treatment, the phenomenological aspects of treatment are quite neglected, carried out almost furtively. these attentions to the illness experience constitute an “underground practice” in occupational therapy and doubtless many other health professions. Taking careful note of the narrative structure of clinical interventions reveals “hidden values” within biomedical practice which run counter to the dominant metaphor of body as machine that holds such persuasive force in Western medicine. Put differently, it reveals how some health professionals, some of the time, recognize a physiological body which is inextricable from the imagined and lived body, the body which carries a person through social space and time.”
-Mattingly, Cheryl (1998) Healing dramas and clinical plots: The narrative structure of experience. p 22. Cambridge University Press, New York.
I love Harlene Anderson.
Thanks to Christopher Kinman and Rhizome Network for making and sharing this excellently crafted video of Harlene explaining in clear, plain language one of the foundational principles of Collaborative Language Systems Therapy. In Narrative Therapy, we come at this same territory when we emphasize the importance of noticing (whenever possible) our assumptions and questioning them. We spend more time and effort in trying to unpack and understand the historical, social, cultural influences that support particular assumptions, but both not knowing and questioning our assumptions are stances that have the intention of supporting a non-impositional, client-centered, present-to-future kind of psychotherapy.
“You can’t learn ethics or compassion. You either have it or you don’t.”
I’ve often thought of her statement in the years since. Is bedside manner something we are born with, or is it something we can learn?
While most of medical education and training is about the nuts and bolts of clinical care — how to treat hypertension, how to manage a ventilator, how to take out a gallbladder — the process also involves learning how to be “a doctor.” As opposed to lessons covered in textbooks and classrooms, this kind of learning is done through modeling, or what medical sociologist F. W. Hafferty has called the “informal” or “hidden curriculum.”
- Autonomy - a patient has the right to have an opinion and be able to make decisions for themselves, as long as the patient is in a position to understand the relevant information in order to make an informed decision.
- Beneficence - a doctor must do good and act in the best interests of the…
It’s possible that a drug may help awake the minimally conscious. It affects the medical ethic debate of the vegetative state and pulling the pull. It’s a long article, but a short video worth watching! Amazing story.
Artificial Happiness: The Dark Side of the New Happy Class
Ronald Dworkin, Fellow at the Hudson Institute, has written a book of social commentary that combines the politics of healthcare and medical ethics with several momentous changes that have dramatically altered the relationship among…
Hi there, Stephen — thanks for writing. I’m not sure which of the 2-3 questions in your post you’re wanting my opinion on? Since I’ve written a post before about physician-assisted suicide and my thoughts on interventions that focus on “prolonging life” above “improving quality-of-life” for terminal/poor-prognosis patients, I’m gonna just talk about my definition of compassion in this reply.
To me, Compassion is:
- The Golden Rule in one word — Doing unto others as I would have them do unto me.
- An integral part of what makes a person a person. People who cannot feel compassion are not living up to their potential as an intelligent being. One of the scariest things about a sociopath is his/her inability to demonstrate compassion and empathy.
- One of the best clues to look for in another person, to tell you that they are worth spending time with (as a friend, romantic partner, boss, employee, etc).
- The most effective sermon I can live. (“Preach the gospel at all times — if necessary, use words.” St Francis of Assisi)
- Impossible to get reimbursed for in the healthcare system, yet probably the most valuable thing that a doctor can give to a suffering patient.
- A very worthwhile organization that provides child-sponsorship programs around the world (I’ve been sponsoring a boy in India for the past 10 years, and it has been SO enriching to my life. Consider it as a way to exercise your compassion muscles and practice daily giving.)
- Used liberally in the field of Palliative Medicine — I strongly encourage any future doctor with a tender heart to consider this as a future specialty!
***Pending Cranquis-Mails: 3; Ask Box: Closed***
Re-imagining medical education
“Never let your patients see you eating. Don’t let them know you’re human.”—
Advice from a surgeon
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wayfaringmd replied to your post: Your girl is back from Step 1!!!
Woo! Isn’t it a relief to be done?! I’m sure you did great!
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