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Scientific, evidence-based medicine is increasingly seen as fundamental to providing effective healthcare, but narrative-based medicine sheds light on social and interpersonal aspects of the practitioner-patient interaction which can also greatly affect healthcare outcomes. The philosophies underlying these two approaches seem to contrast, yet those who can integrate both into their practice are among the most successful medical professionals. Integrating Narrative Medicine and Evidence-based Medicine provides answers to the key question of how medical practitioners can best put both approaches into practice. It anticipates a future where evidence-based practice will be expected of all medical professionals, but contends that the integration of a narrative-based approach will also be crucial, presenting a unique perspective on structuring the patient-professional encounter for optimum results. It develops a cultural analysis and socio-cultural theory of the science of healing, and describes an efficient method by which medical practitioners can find and use medical research at the point of care with current technology and skills. This addresses the need for translational science - moving research into practice - identified by the National Institutes of Health. This book will be essential reading for educators of medical students and postgraduate trainees, behavioral scientists, psychologists, social scientists working in medical settings, and health managers and administrators. Medical students and postgraduate trainees will also find it useful in their learning.
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INTEGRATING NARRATIVE MEDICINE AND EVIDENCE-BASED MEDICINE
Integrating Narrative Medicine and Evidence-based Medicine The everyday social practice of healing JAMES P MEZA MD and
DANIEL S PASSERMAN DO Forewords by PETER WYER and RITA CHARON and MARK H EBELL
Radcliffe Publishing London • New York
Radcliffe Publishing Ltd 33–41 Dallington Street London EC1V 0BB United Kingdom www.radcliffepublishing.com Electronic catalogue and worldwide online ordering facility. © 2011 James P Meza and Daniel S Passerman Reprinted 2013 James P Meza and Daniel S Passerman have asserted their rights under the Copyright, Designs and Patents Act 1998 to be identified as the authors of this work. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the copyright owner. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library. ISBN-13: 978 184619 350 7
The paper used for the text pages of this book is FSC® certified. FSC (The Forest Stewardship Council®) is an international network to promote responsible management of the world’s forests.
Typeset by Phoenix Photosetting, Chatham, Kent, UK Printed and bound by TJI Digital, Padstow, Cornwall, UK
Contents Foreword by Peter Wyer and Rita Charon
ix
Foreword by Mark H Ebell
x
Preface
xi
About the Authors
xxii
Introduction
xxiii
Part I: The Process of Care for a Diagnostic Narrative Dilemma 1 2 3 4 5 6
Acquire Enough Information to Understand the Patient’s Concern Ask a Clinically Appropriate Question Based on the Patient’s Concern Access Information Relevant to the Question Assess the Quality of the Information Apply the Information to the Clinical Question Assist the Patient in Making a Decision
3 23 34 59 79 96
Part II: The Process of Care for a Therapeutic Narrative Dilemma 7 8 9 10 11 12
Acquire Enough Information to Understand the Patient’s Concern Ask a Clinically Appropriate Question Based on the Patient’