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The art of medicine: narrative evidence-based medicine.

2009; Lippincott Williams & Wilkins; Volume: 23; Issue: 2 Linguagem: Inglês

10.1097/00001416-200907000-00010

1938-3533

Bruce Greenfield,

Empathy and Medical Education

Charon R, Wyer P. The art of medicine: narrative evidence-based medicine. Lancet. 2008; 371; 296-297. Rita Charon has written extensively about the use of narrative in health care. Charon, a physician and English scholar, argues persuasively that those traditional health care professionals trained in the systematic collection of data often miss the patients' experiences of illness. That is, what often goes unnoticed, Charon argues, is the lived experience of being ill from the perspective of the patient. The result is that health care professionals who fail to focus on their patients' experiences are often at a loss to understand the emotional, moral, and social perturbations that accompany patients' physical and functional impairments during an illness. Understanding the stories of patients is essential, according to Charon, for health care professionals to develop a deep therapeutic alliance with patients that characterizes the moral commitment of health care professionals. In this perspective article, Charon addresses the limitations of evidence-based practice to guide medical decision-making as another justification for the use of the narrative. According to Charon, evidence-based practice attempts to balance what is knowable and unknowable, what has been generalized for particular populations but not for particular cases, and what the effects of the physical interventions mean for the self. When unable to successfully balance these dichotomies, the health care professional may succumb to a paralysis of decision-making, or less dramatically, a roadmap of treatment without a particular, well-developed direction. To ameliorate the inherent tensions, or at least to countenance them, Charon points to the use of patient stories to ground evidence into the particularities of each patient case. Encouraging health care professionals and patients to write about their experiences opens up a rich course of dialogue that can help facilitate empathetic decisionmaking based on the patient's needs and desires. Coined "narrative evidence-based medicine," Charon has integrated this approach into the medical curriculum and training at Columbia University School of Medicine. For educators in physical therapist curriculum, this approach invites examination or reexamination of strategies used to develop aspects of reflective or mindful practice, phenomenological understanding, and ethics based on caring. This perspective article also invites interested educators to explore more of Charon's work on the use of narrative medicine. Bruce Greenfield PT, PhD, OCS Assistant Professor Division of Physical Therapy Department of Rehabilitation Medicine Emory University School of Medicine Atlanta, GA