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Biomedical subjects

R Charon

Publications and source records attributed to R Charon.

32 records · Page 2Linked to original sources
PubMed1995

Literature and medicine: contributions to clinical practice.

Introduced to U.S. medical schools in 1972, the field of literature and medicine contributes methods and texts that help physicians develop skills in the human dimensions of medical practice. Five broad goals are met by including the study of literature in medical education: 1) Literary accounts of illness can teach physicians concrete and powerful lessons about the lives of sick people; 2) great works of fiction about medicine enable physicians to recognize the power and implications of what they do; 3) through the study of narrative, the physician can better understand patients' stories of sickness and his or her own personal stake in medical practice; 4) literary study contributes to physicians' expertise in narrative ethics; and 5) literary theory offers new perspectives on the work and the genres of medicine. Particular texts and methods have been found to be well suited to the fulfillment of each of these goals. Chosen from the traditional literary canon and from among the works of contemporary and culturally diverse writers, novels, short stories, poetry, and drama can convey both the concrete particularity and the metaphorical richness of the predicaments of sick people and the challenges and rewards offered to their physicians. In more than 20 years of teaching literature to medical students and physicians, practitioners of literature and medicine have clarified its conceptual frameworks and have identified the means by which its studies strengthen the human competencies of doctoring, which are a central feature of the art of medicine.

Clinical Medicine↗
PubMed1995

The study of literature in medical education.

The study of literature encourages the development of otherwise hard-to-teach clinical competencies. It provides access to the values and experiences of physicians, patients, and families; it calls for the exercise of skill in observation and interpretation, develops clinical imagination, and, especially through writing, preserves fluency in ordinary language and promotes clarity of observation, expression, and self-knowledge. Faculty in one-third of U.S. medical schools teach literature in courses that, although concentrated in the preclinical years, range from the first day of school, through residency programs. Once focused on the work of physician-authors and realist fiction about illness that encouraged moral reflection about the practice of medicine, literary study in medicine now encompasses a wide range of literature and narrative types, including the patient history and the clinical case. Literary study is intended not only to enrich students' moral education but also to increase their narrative competence, to foster a tolerance for the uncertainties of clinical practice, and to provide a grounding for empathic attention to patients. Literature may be included in medical humanities courses, and it may provide rich cases for ethics courses or introductions to the patient-physician relationship; it also may be the focus of small, elective, or selective courses, frequently on particular social issues or on the experience of illness. Reading, discussion, writing, and role-play rather than lectures are the methods employed; faculty include those with PhDs in literature and MDs who have strong interests in the contributions of literature to practice.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Competence↗
PubMed1994

Older patient satisfaction with communication during an initial medical encounter.

There has been extensive research on the factors associated with patient satisfaction with communication during medical encounters, however, little attention has been paid to satisfaction among subgroups of patients, including the elderly. It is inappropriate to assume that all patients have the same physician-patient relationship needs, and thus, they will all be satisfied with the same communication approaches during medical visits. In this study, we examine the interactional correlates of older patient satisfaction with an initial visit with a general internist. A multidisciplinary team composed of social scientists and physicians used the Multi-dimensional Interaction Analysis system to code audiotapes. Patients and physicians completed post-visit satisfaction questionnaires. Older patient satisfaction was positively correlated with the following variables: physician questioning and supportiveness on patient-raised topics; patient information-giving on patient-raised topics; the length of the visit; the physician's use of questions worded in the negative; shared laughter between the physician and the patient; and physician satisfaction. These findings suggest that older patients prefer encounters in which: (1) there is physician supportiveness and shared laughter; (2) they are questioned about and given an opportunity to provide information on their own agenda items; and (3) physicians provide some structure for the first meeting through their use of questions worded in the negative. The authors caution that although this sample of older patients appears to be satisfied with a communication style usually considered characteristic of the traditional model of the physician-patient relationship (i.e. a warm interpersonal style and physician-generated structure for the visit), older patients in other settings and future cohorts of elderly patients may prefer other communication approaches. It is also suggested that aspects of communication which provide satisfaction to patients in first visits may be different than aspects of communication associated with patient satisfaction in follow-up visits.

Adult↗
PubMed1994

Multi-dimensional interaction analysis: a collaborative approach to the study of medical discourse.

This paper reviews the conceptual frameworks of several research approaches to the study of medical interactions. Two methods are discussed: process analysis and microanalysis. Adapted from Robert Bales's study of the behavior of small groups, process analysis sorts and tallies such interviewing processes as questioning and informing, achieving analysis of large numbers of interviews at the expense of attention to the content or context of the interview. When used in medical interaction research, process analysis seeks correlation between processes documented in the interview and outcomes of the interview. The methods of conversation analysts and discourse analysts, microanalyses subject medical conversations to close linguistic study and contextualization. This review focuses on the underlying assumptions, generalizability of findings, and the types of subjective judgment applied by the methods. It then describes the Multi-Dimensional Interaction Analysis (MDIA) system, a linguistic analytic instrument that combines features of process analysis and microanalysis to capture content, process, and context of medical conversations. The MDIA's validity and reliability are reported and implications for future research are outlined.

Communication↗
PubMed1990

The great empty cup of attention: the doctor and the illness in the Wings of the Dove.

James confers on his characters his deepest fears and truths. He incorporates within his writing both his stunning and at times crippling intellectual powers and his dark inchoate mournful passion and remorse. The very events that made him a casualty are the experiences he grants to his characters to endure, to grapple with, and to master. In Wings James settles with his characters and with his readers the effects of these two deaths in his life. He was flattened by Minny's and Fenimore's deaths. He, like Marcher, cannot grasp the extent of his paralysis. It dawns on him like the sadness of a winter dawn but also like the explosive epiphany of Marcher at the grave that he has not lived. The words of Howell quoted by Sturges, the events of Wings, The Ambassadors, "The Beast in the Jungle" all reinforce what he knows to be true. He has not lived, he has not had what that man had to make him, by the loss of it, so bleed and yet live. What, after all, is more important in any life than the ability to love and the capacity to face death? This is the heart of the matter that James takes on in Wings. In the structure of the novel, to become conscious is to be in danger. Milly, the patient, achieves what eludes the other characters. Kate, Maud, Densher, Susan all are unable to raise their heads above their own lives. Only Milly is aware of herself within and beyond the book. Perhaps Densher begins in the very end to raise his head similarly, and in the sequel of "Beast," he achieves it.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude to Health↗
PubMed1989

Concordance between physicians and their older and younger patients in the primary care medical encounter.

To test the hypothesis that less concordance exists between older patients and their physicians than between younger patients and their physicians, we examined agreements between physicians and patients on the major goals and topics discussed during an outpatient medical encounter. Using coded audiotapes of the medical visit, patient postvisit interviews, and physician questionnaires, concordance was found to be significantly greater for younger patients and their physicians than for older patients and their physician on the major goals and major medical topics discussed during the primary care interview. This paper explores possible explanations for these findings.

Age Factors↗