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The concept of therapeutic 'emplotment'.

This paper considers the narrative structure of clinical action. I argue that clinical encounters involve clinician and patient in the creation and negotiation of a plot structure within clinical time. This clinical plot gives meaning to particular therapeutic actions by placing them within a larger therapeutic story. No therapeutic plot is completely pre-ordained, however. Improvisation and revision are necessary to its creation. In making a case for the narrative construction of lived time, of narratives that are created before they are told, this paper departs from the predominant mode of narrative analysis within medical anthropology that has focused on narrative discourse. Therapeutic emplotment is concretely considered through an interpretation of a single case, a clinical interaction between an occupational therapist and a head-injured patient.

Anecdotes as Topic↗

The Rashomon approach to dealing with chronic pain.

This paper discusses a kind of interview whose narrative structure has the interviewee-narrator assuming different personas during its course. In these kinds of interviews the narrator not only reflects on experience, but uses the interview situation to actively configure future experience, in this case to change a frustrating, overwhelming experience of mysterious, intractable pain into something more meaningful. The paper links narrative to experience by examining certain dialogic processes in narratives that engage in, as well as reflect on, practice, in this case, a kind of self-therapy.

Anecdotes as Topic↗

In the subjunctive mode: epilepsy narratives in Turkey.

Careful analysis of transcripts of interviews we conducted with a sample of persons identified as suffering epilepsy or seizure disorders in an epidemiological study in Turkey revealed not only that life stories of illness have an overall narrative structure but that the interviews were composed as a corpus of shorter stories. Analytic concepts from reader response theory bring attention to aspects of both the overall life story and the stories told about illness. In particular, we identify 'subjunctivizing tactics' present in the narrative representation of illness that allow sufferers and their families to justify continued care-seeking and to maintain hope for positive, even 'miraculous,' outcomes. In particular, these narratives maintain multiple perspectives and the potential for multiple readings, suggesting alternative plots about source and outcome of illness, and they represent potency and the possibilities for healing through stories of encounters with the mysterious.

Anecdotes as Topic↗

Oncology and narrative time.

Oncologists encounter the uncertainty of time horizons in their patients' lives. Although American oncologists are given a cultural mandate to instill hope in the therapeutic narratives they create with patients, uncertainty leads them to expressions of time without horizons or of time with highly foreshortened horizons as they seek to create for patients an experience of immediacy rather than of chronology. The distinctiveness of the American pattern is highlighted through comparison with Japanese exemplar cases and stories of therapeutic practices in oncology. Concepts drawn from narrative analysis of temporality and the construction of the therapeutic plot are employed.

Anecdotes as Topic↗

On the relation of injury to pain. The John J. Bonica lecture.

Pain is better classified as an awareness of a need-state than as a sensation. It serves more to promote healing than to avoid injury. It has more in common with the phenomena of hunger and thirst than it has with seeing or hearing. The period after injury is divided into the immediate, acute and chronic stages. In each stage it is shown that pain has only a weak connection to injury but a strong connection to the body state.

Acute Disease↗

Puncture wounds to the foot.

Puncture wounds to the foot are common presenting problems in most busy emergency departments. Although seemingly benign, the sequelae after simple puncture wounds to the foot can include cellulitis, retained foreign bodies, or even osteomyelitis. Inadequate scientific research on this topic has left only anecdotal or retrospective reports for review in the medical literature. Antibiotics, radiographs, or surgical exploration in the management of puncture wounds to the foot all lack clinical studies to support their use. This review summarizes the literature and points to the inconsistencies in the management of puncture wounds to the foot.

Cellulitis↗

The staple.

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Anecdotes as Topic↗

Experiences of nurse-researchers in gaining access to subjects for clinical nursing research.

This study investigated the experiences of nurse researchers in gaining access to potential research subjects within health care agencies. Responders were nurse researchers who were primary authors of clinical nursing research studies that had been published in nursing research journals between the years 1985 and 1989. A survey was mailed to 211 responders and returned by 99 (47 per cent). Eighty-six were employed primarily by educational institutions. Responses to the survey indicated that these nurse researchers experienced political and procedural obstacles in gaining access to potential research subjects within health care agencies.

Anecdotes as Topic↗

La farmacia.

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Anecdotes as Topic↗

Who does know?

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Anecdotes as Topic↗

Radiotherapy in the treatment of breast cancer: a personal retrospective.

Allan Langlands commenced training as a radiation oncologist in 1960 and has continued to treat patients with breast cancer for over 30 years. Moved to Westmead Hospital in Sydney he played a role in the development of radiation oncology in Australia. With an extensive research record (authoring over 200 peer-reviewed papers) this article reflects the changes in breast cancer treatment which have occurred over this period. The incorporation of evidence from the clinical trials in breast cancer management, changes in radiation therapy techniques and incorporation of patient choice in treatment decisions are discussed.

Anecdotes as Topic↗

A qualitative study of pharmacists' perspectives on the supply of emergency hormonal contraception via patient group direction in the UK.

AIM: To investigate pharmacists' views and experiences of supplying emergency hormonal contraception (EHC) via a group prescribing protocol in community pharmacies in the UK. DESIGN: Qualitative study using depth interviews. SETTING: Community pharmacists in Manchester, Salford and Trafford (Greater Manchester), and Lambeth, Southwark and Lewisham (London) Health Action Zones in the UK. PARTICIPANTS: Forty-four community pharmacists supplying EHC in Manchester, Salford and Trafford, and Lambeth, Southwark and Lewisham (London). RESULTS: Pharmacists were broadly very positive about their experiences supplying EHC via the group prescribing protocol. Pharmacists identified many benefits of the EHC schemes for clients, in particular, improved access to EHC at no cost to clients. The confidential nature of the scheme was also seen as an advantage as was the scope for referral to other service providers. Pharmacists also believed that the scheme had benefits for the profession in terms of enhanced professional standing. However, their concerns included the extent of repeated use of EHC, the possible impact on contraceptive behaviors and sexually transmitted infections and its impact on male coercive sexual behavior. CONCLUSIONS: Although pharmacy supply of EHC may improve access for some clients and is perceived as a popular service, research into the implications of the schemes as identified in this study need to be conducted.

Anecdotes as Topic↗