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Biomedical subjects

R Charon

Publications and source records attributed to R Charon.

At least 19 recordsLinked to original sources
PubMed2001

The patient-physician relationship. Narrative medicine: a model for empathy, reflection, profession, and trust.

The effective practice of medicine requires narrative competence, that is, the ability to acknowledge, absorb, interpret, and act on the stories and plights of others. Medicine practiced with narrative competence, called narrative medicine, is proposed as a model for humane and effective medical practice. Adopting methods such as close reading of literature and reflective writing allows narrative medicine to examine and illuminate 4 of medicine's central narrative situations: physician and patient, physician and self, physician and colleagues, and physicians and society. With narrative competence, physicians can reach and join their patients in illness, recognize their own personal journeys through medicine, acknowledge kinship with and duties toward other health care professionals, and inaugurate consequential discourse with the public about health care. By bridging the divides that separate physicians from patients, themselves, colleagues, and society, narrative medicine offers fresh opportunities for respectful, empathic, and nourishing medical care.

Communication↗
PubMed2000

Medicine, the novel, and the passage of time.

Doctors and patients move together through time, humble in the face of its dictates. Novelists allow their characters to enter time, revealing in the characters' particular, ongoing lives some universal truths about living. Both the medical chart and the novel capture individual human lives as they change and as they age, finding some meaning in the random events that happen in them. Literary critics who write about the novel provide useful frameworks for doctors who reflect on their practice. In this essay, I examine the medical charts of two of my patients in detail and describe the experiences I shared with them. As a repository of detail not only about the patients but about the doctors and nurses who cared for them, the charts provide rich and powerful evidence about the insides of practice and the meanings that clinical relationships accrue. Doctors might discover underlying meaning in their practices that would otherwise elude them by reading their patients' charts as if they were novels, looking for patterns and movements throughout a patient's life, and recognizing the deep connections woven between their patients and themselves. By placing great novels-by Henry James, Virginia Woolf, and Thomas Mann-side by side with actual medical charts, I suggest the usefulness of close readings of medicine's texts. The juxtaposition suggests the utility of brooding about the seasons of our relationships with patients. Perhaps not a luxury but a necessity for effective care, reflection such as this on our patients may restore to medicine some of its passion, its meaning, and its joy.

Adult↗
PubMed2000

The seasons of the patient-physician relationship.

There are seasons in the geriatric patient-physician relationship. As they age together, doctors and patients see one another through crises, recoveries, uncertainties, and losses, slowly weaving between them at times tapestries of complex narrative richness. What is known about the patient-physician relationship from scientific research can be contemplated by what is known about intimate human relationships. This article turns to three poems, written by Charles Simic, Wallace Stevens, and T. S. Eliot, to understand how the passage of time might lead to human intersubjective understanding. A method of reflecting on individual clinical relationships, first through a close reading of the medical records of patients and then through narrative writing about the individual patient-physician relationship as illuminated by retrospection, is then introduced. Three patients in the practice of the author are described in detail within the frameworks suggested by the poems, and directions for future research are outlined.

Adaptation, Psychological↗
PubMed2000

Reading, writing, and doctoring: literature and medicine.

Literature and medicine share an inherently enduring relationship. Doctors turn to literature--both its plots and its forms--to understand what occurs in their patients' lives, to increase their own narrative competence, to interpret accurately the texts of medicine, to develop empathy, and to deepen their capacities for reflection and self-knowledge. Together, these skills, attitudes, and bodies of knowledge contribute to the effective practice of medicine. Literature is now taught in almost three quarters of the medical schools in the United States. Different goals, agendas, and methods are appropriate at each developmental stage of a physician's training, from the premedical curriculum to the continuing education of a practicing physician. A vigorous and growing scholarship and body of experience is propelling the field of literature and medicine to understand all the more clearly how acts of reading and acts of writing might illuminate acts of doctoring.

Education, Medical↗
PubMed2000

Literature and medicine: origins and destinies.

Literature and medicine is a flourishing subdiscipline of literary studies that examines the many relations between literary acts and texts and medical acts and texts. The author examines the historical connections between these two fields and suggests that the growth and decline in medicine's attentiveness to the power of words can be used as a marker for medicine's degree of attentiveness to the individual patient's predicament. The recent explosive growth in medicine's interest in literature and narrative is taken as evidence that medicine's swing toward the reductionist and away from the narrative has ended. Patients and doctors have reason to await the return swing of the pendulum-if not the turn of the spiral-toward a medicine that is both technologically and narratively competent.

Education, Medical↗
PubMed1999

Stories for a humanistic medicine.

In this first article for the feature Humanism and Medicine, Rita Charon introduces an excerpt from Richard Selzer's introduction to his latest book, The Doctor Stories. In her introductory and concluding comments, Charon contemplates the role of stories in medicine and how both truth and healing can be found in both listening to and telling stories. In the excerpt presented, surgeon and writer Selzer muses on his twin crafts. As a writer, Selzer can fully appreciate that which he witnesses in his life as a doctor. His ruminations on his own dual citizenship suggests that all doctors, perhaps, can deepen their commitment to medicine, to their patients, and to themselves by strengthening their capacity to behold their patients and to grasp their predicaments. Selzer also traces his origins and, by implication, projects his future. As practicing physicians and medical educators, readers of Academic medicine might be inspired to do the same.

Humanism↗
PubMed1999

Global ratings of videotaped performance versus global ratings of actions recorded on checklists: a criterion for performance assessment with standardized patients.

PURPOSE: To test whether global ratings of checklists are a viable alternative to global ratings of actual clinical performance for use as a criterion for standardized-patient (SP) assessment. METHOD: Five faculty physicians independently observed and rated videotaped performances of 44 medical students on the seven SP cases that comprise the fourth-year assessment administered at The Morchand Center of Mount Sinai School of Medicine to students in the eight member schools in the New York City Consortium. A year later, the same panel of raters reviewed and rated checklists for the same 44 students on five of the same SP cases. RESULTS: The mean global ratings of clinical competence were higher with videotapes than checklists, whereas the mean global ratings of interpersonal and communication skills were lower with videotapes. The correlations for global ratings of clinical competence showed only moderate agreement between the videotape and checklist ratings; and for interpersonal and communication skills, the correlations were somewhat weaker. CONCLUSION: The results raise serious questions about the viability of global ratings of checklists as an alternative to ratings of observed clinical performance as a criterion for SP assessment.

Adult↗
PubMed1997

Validating the standardized-patient assessment administered to medical students in the New York City Consortium.

PURPOSE: To test the criterion validity of existing standardized-patient (SP)-examination scores using global ratings by a panel of faculty-physician observers as the gold-standard criterion; to determine whether such ratings can provide a reliable gold-standard criterion to be used for validity-related research; and to encourage the use of these gold-standard ratings for validation research and examination development, including scoring and standard setting, and for enhancing understanding of the clinical competence construct. METHOD: Five faculty physicians independently observed and rated videotaped performances of 44 students from one medical school on the seven SP cases that make up the fourth-year assessment administered at The Morchand Center of Mount Sinai School of Medicine to students in the eight member schools in the new York City Consortium. RESULTS: The validity coefficients showed correlations between scores on the examination and the overall ratings ranging from .60 to .70. The reliability coefficients for ratings of overall examination performance reached the commonly recommended .80 level and were very close at the case level, with interrater reliabilities generally in the .70 to .80 range. CONCLUSION: The results are encouraging, with validity coefficients high enough to warrant optimism about the possibility of increasing them to the recommended .80 level, based on further studies to identify those measurable performance characteristics that most reflect the gold-standard ratings. The high interrater reliabilities indicate that faculty-physician ratings of performance on SP cases and examinations can or may be able to provide a reliable gold standard for validating and refining SP assessment.

Clinical Clerkship↗
PubMed1996

Literature and ethical medicine: five cases from common practice.

This essay is composed of five stories written by practicing physicians about their patients. Each clinical story describes a challenging ethical condition-potential abuse of medical power, gravely ill and probably over-treated newborns, iatrogenic narcotic addiction, deceived dying people. Rather than singling out one ethical conflict to resolve or adjudicate, the authors attempt, through literary methods, to grasp the singular experiences of their patients and to act according to the deep structures of their patients' lives. Examining these five stories with simple literary tools-attention to narrative frames, time, plot, and desire-reveals the mechanisms through which acts of writing and reading contribute to clinical clarity and ethical actions.

Adult↗