Narrative Medicine, literature and family medicine education

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Narrative Medicine literatureand family medicine educationDr Leonard BloomDr Denice LewisDr Alan Ng.
Faculty Retreat Department of Family Medicine University of OttawaCalabogie ON October 21 2018 Questions and Intended Learning OutcomesWhy are medical humanities important Why is narrative medicine important .
How can close reading of short stories help meas a teacher of family medicine Doree is a 23 year old woman who is being seenfor the first time by your resident Dr Ash Shepresents to the urgent care clinic that your.
practice runs to see same day issues theappointment system is designed to be brief with10 minutes allowed for each appointment Doree comes in with central abdominal pain and Dr Ash looks at the chart and notes Doree has.
never been seen here before Dr Ash takes abrief history and learns that she has had thesesymptoms for about a year and a half they arequite troubling and now interfering with herability to work She also mentions she has been.
to walk in clinics on three previous occasionswith this problem and had an ultrasoundordered which showed nothing significant There are no obvious red flag symptoms weightloss blood in stool vomiting She was given.
pantoprazole by the walk in doctor but 2months later she still feels the same Herexamination is unremarkable Dr Ash sits back in her chair wondering what todo next She is already running 20 minutes.
behind and the waiting room is full As her preceptor how would advise Dr Ash Shoba is a 35 year old woman with chest pain andpalpitations She presents to the urgent careclinic and is being seen by Dr Ash your resident .
She does not attend frequently but in her chartyou see two notes from the ER both visits withinthe last 2 weeks The first note concluded she had non cardiac chest pain and she was sent home but she returned to the ER 4 days later with the.
same symptoms and was seen by cardiology She had a number of tests including and ECGand stress test blood work and the diagnosiswas non cardiac chest pain She was put on atrial of omeprazole and asked to follow up with.
her family physician Dr Ash takes a brief history Shoba appearsanxious but denies any major stress Cardiovascular examination is normal Shoba isworried about her heart Dr Ash sits back in her.
chair wondering what to do next Now she isreally running further behind As Dr Ash s preceptor what would you advise Narrative medicine and the curriculumCANMEDs Roles and competencies.
Communication skills Patient centred care Biopsychosocial paradigms Patient concerns Doctors don t listen.
Doctors appear disinterested Doctors interrupt Doctors make assumptions Doctors don t address patient concerns The doctor s defence.
Complaining about difficult patients Pressures of time Pressures of numbers list size Travesties of consumer medicine The role of narrative medicine.
Rita Charron the 4 dividesThere are 4 divides that contribute to thedisconnection that might occur between thedoctor and the patient Rita Charron 4 four divides.
Relation to mortality patient s illnessexperience vs doctor perspective The context of illness biological phenomenonrequiring intervention vs illness within theframework of a patient s life.
Beliefs about disease causality Shame blame and fear John Launer the 7 Cs Conversations Curiosity.
Context Complexity Challenge Caution 7 Cs of Narrative Medicine.
Conversations a true two way dialogue to help you both tounderstand things better and hopefully developnew insights and not just to collate facts the conversation process in itself can be.
therapeutic in its own right getting people tothink reflect reframe and redefine their Curiosity genuinely being interested and curious queries you raise will help the other to think.
and reflect and perhaps helping them toreframe and redefine their stories context of their families friends community beliefs values and so on how have they decided to frame their story .
Complexity Life is not simple So why do we doctors alwaystry to fix life s problems with concrete and rigidsolutions A sense of complexity gets away from fixed ideas.
of cause and effect unchangeable positions andover concrete solutions Complexity in primary care Three dimensions overtime with people and.
conversations instead of The patient centred clinical method Creativity challenge Can you help patient create a better accountof what s going on for them .
Can you help them make a better story Better stories create better realities Sometimes patients come in withstraightforward problems questions for whichthey want straight forward answers .
You have to show genuine care for thenarrative approach to work That means being truly listening showingrespect treating others as equal and showinga true genuine interest in wanting to help the.
Close reading why bother Complex texts Close reading helps residents to read texts that maybe above their comfort level complex patients Gist Reading Close reading defends against gist reading a termreferring to understanding the main idea of a text and discussing it.
there is more to a text than just the main idea disease vs illnessexperience Language sensitivity Close reading develops language sensitivity syntax rhythm and structure like number sense in math or patient sense when communicating with patients reading sense .
develops an ear for tone and the subtle moves that create it Further reading Charon R Narrative Medicine OxfordUniversity Press 2006 Stewart M Brown JB et al Patient Centred.
Medicine Radcliffe 2014 Freeman T McWhinney s Textbook of FamilyMedicine 4th ed Oxford University Press 2016 Launer J Narrative based primary care Radcliffe 2002.
Charon R. Narrative Medicine. Oxford University Press 2006. Stewart M, Brown JB et al. Patient Centred Medicine. Radcliffe 2014. Freeman T, McWhinney’s Textbook of Family Medicine 4th ed. Oxford University Press 2016. Launer J. Narrative-based primary care> Radcliffe 2002

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