Doctors' Stories: The Narrative Structure of Medical Knowledge

作者：Steven H. Miles · 发表于：JAMA · 年份：1991 · DOI：10.1001/jama.1991.03470090109047 · 被引用次数：161 · 研究领域：Empathy and Medical Education

This marvelous study of how doctors retell patients' stories comes at a critical time in medical history. The clinical interview, which has long suffered from too little teaching and too little time, faces a new challenge as medical diagnosis and causation descend from the clinical encounter with manifestations of diseased organs to technical probes of the microengineering of cells. The maturing of biological science poses a critical (and neglected) challenge for the doctor-patient encounter. For, even as patients get more powerful answers to what ails them, these answers are less likely to be derived from or related to their own experience. "Doctor, I have a lump in my breast, is it serious?" yields to "Our routine scans have located cells with an abnormal metabolic pattern that, though imperceptible to you, require excision and radiation." As this crevasse opens in the meeting ground of the patient's experience and the physician's inquiry,