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Doody's Review ServiceReviewer: Albert Liebman, MD (Medical College of Wisconsin)
Description: This soft-cover book consists of essays by multiple contributors on the narrative in healthcare. The editors, who also serve as contributors, are part-time general practitioners in London. The other 27 contributors are drawn from a variety of backgrounds, including history, psychiatry, epidemiology and public health, biology, computer science, the humanities, nursing, and anthropology. Three chapters consist of patient accounts of their illnesses.
Purpose: The introduction sets forth the proposition that the subject of narrative in medical education and practice has been neglected. In Chapter 1 the editors marshal the argument that the learned expertise of constructing a medical history and its emphasis on the "scientific" neglects skills that are "fundamentally linguistic, empathetic, and interpretive." The book represents the marshaling of evidence to turn attention to the interpretive aspect of the patient narrative. The worthy objective of the book is to once again bring the intricately woven fabric of disease and illness that includes the biologic, social, cultural, and experiential context of the patient to the attention of healthcare practitioners. The diverse backgrounds of the essayists highlight the theme from a variety of perspectives.
Audience: The editors state that it is intended for healthcare professionals. Hoever, it would appear that they are particularly addressing issues of the education and medical practice style of physicians, particularly general practitioners.
Features: The book is composed of 25 chapters divided into 6 sections. Some of the highlights include a previously published piece by Stephen Jay Gould on his illness and observations on variability in biology and statistics; a report from two of the teachers in the Michigan State course for medical students in literature; and the essay by one of the editors, entitled "Narrative Based Medicine in an Evidence Based World." The references at the end of each chapter are extensive and of high quality. The editors include an appendix of "some recommended readings" to "enliven the study of medicine or other health sciences."
Assessment: There have been many previous clarion calls for attention to the patient's story and the psycho-social context of medical practice. Among these are Balint's classic book, The Doctor, His Patient and the Illness, published in 1957, and his work with practitioners in that period emphasizing the patient's story in medical care. This book, however, applies post-modern forms of analyses to the issues of the subjective and science in medical practice.