Medical Interpretation: Implications of Literary Theory of Narrative for Clinical Work

1993 ◽  
Vol 3 (1) ◽  
pp. 79-97 ◽  
Author(s):  
Rita Charon
Keyword(s):  
Literary Theory ◽  
Narrative Theory ◽  
Clinical Medicine ◽  
Clinical Work ◽  
Medical Interpretation ◽  
General Internal ◽  
Theoretical Approaches ◽  
Medicine And Literature ◽  
Doctor's Office ◽  
Literary Narrative

Abstract Literary narrative theory offers robust conceptual frameworks for understand-ing the act of writing, the act of reading, the configuration of plot, and the narrative contract that binds writer and reader together. This article applies some current theoretical approaches used in studying literary storytelling to the storytelling that takes place in the doctor's office, conceptualizing the patient as the writer or teller and the doctor as the reader or listener. By inspecting clinical medicine as a narrative enterprise, shot through with the ambiguities and language-borne allusiveness of the fictional text, this study demonstrates ways in which patients and doctors may better understand their complex and often unsuccessful attempts to hear one another to the end. (General Internal Medicine and Literature)

The Role of Gait Analysis in Clinical Medicine: A Survey of UK Centres

1987 ◽  
Vol 16 (4) ◽  
pp. 221-227 ◽  
Author(s):  
N Messenger ◽  
P Bowker
Keyword(s):  
Gait Analysis ◽  
Clinical Medicine ◽  
Final Analysis ◽  
Clinical Work ◽  
Clinical Context ◽  
Clinical Value ◽  
Analysis Techniques ◽  
Subjective Views ◽  
The Uk

This paper reports the results of a survey carried out to assess the clinical usage currently being made of gait analysis facilities within the UK. Thirty-five centres were circulated with a questionnaire which requested information under four main headings: (i) equipment, (ii) research projects, (iii) clinical service commitments, and (iv) subjective views of the ultimate clinical value of the service. Of the 25 completed questionnaires returned, 16 were suitable for inclusion in the final analysis of data. The survey provided useful data on the equipment and facilities available in each centre together with details of the service available to prospective referring clinicians. Ten centres were considered as being currently involved in some clinical work, with six of these being routinely involved. The respondents generally felt that gait analysis techniques have a clinical context, if not yet routinely, but the numbers of referrals to the centres is still quite small. A number of areas worthy of further work were identified by the respondents. It is hoped that presentation of these results will stimulate dialogue between centres and between clinicians and bioengineers.

scholarly journals An Empirical Examination of Nursing Units in China Based on Nurse Experience

2018 ◽  
Vol 12 (1) ◽  
pp. 108-123 ◽  
Author(s):  
Xiaodong Xuan ◽  
Zongfei Li ◽  
Xixi Chen
Keyword(s):  
Clinical Work ◽  
Patient Room ◽  
Empirical Examination ◽  
Nursing Unit ◽  
Spatial Design ◽  
Work Spaces ◽  
Physical Environments ◽  
Unit Design ◽  
Nurse Experience ◽  
Doctor's Office

Objectives: To create opportunities to increase nursing staff’s satisfaction and operational efficiency and eventually improve nurses’ experiences through better design in unit layout. Background: The majority of research performed on nursing units in China only focused on the spatial design itself, and few studies examined the nursing unit empirically based on nurses’ experience. Nursing units need to be designed with understanding nurses’ behavior and experience in China. Method: A mixed-method approach was conducted in four double-corridor nursing units in China. Observation and interview data were collected to explore how physical environments for managing administrative duties, medications, and caring patient were used in nursing units. Results: The most frequent activities were communication, medication, and patient-care activities. The places in which nurses spent the most of theirs working times were the nurse station (NS), patient room, workstation on wheels (WoW), and medication room. The important clinical work spaces were the patient room, NS, WoW, medication room, doctor’s office, disposal room, examining room, and back corridor. The important traffic linkages were between NS and medication room, patient room and WoW, and medication room and patient room. Conclusions: This article revealed the frequency of nurse activities; how they spent their time; how they use the clinical spaces; identified important clinical spaces, linkages, and driver of inefficiency in nursing work and nursing unit design; and finally generated recommendations for double-corridor nursing unit design in China which can be used by medical planner, hospital administrator.

scholarly journals Medycyna w ujęciu Jędrzeja Śniadeckiego

2019 ◽  
Vol 26 ◽  
pp. 7-19
Author(s):  
Ryszard W. Gryglewski
Keyword(s):  
Clinical Medicine ◽  
Clinical Work ◽  
Convincing Evidence ◽  
Clinical Model ◽  
Highly Educated ◽  
Pathological Model ◽  
The Subject ◽  
The 19Th Century ◽  
Derived Data

Medicine in terms of Jędrzej Śniadecki Jędrzej Śniadecki (1768–1838) remains one of most eminent scholars of his times. Remembered as a founder of modern chemistry in Poland, one of early pioneers in anthropology and social sciences, and author of the two volume book Theory of organic being (Teoria jestestw organicznych), in which the modern metabolic concept of life processes can be considered as grounded; he was also a highly educated and gifted physician. This paper aims to show the importance of medicine in Śniadecki’s theory of life, in its physiological and pathological manifestations in regard to the clinical model and the medical practice which he followed. It deals with the concept of illness as described in Śniadecki’s writings, focusing on the role of irritation and organic reaction as the major components of his proposed pathological model. The dynamic and variable conditions of diseases are explained by means of metabolic changes, which was a truly pioneering concept, already described in Śniadecki’s earlier theoretical works on the subject of life and nature. The paper discusses the problem of influence in terms of the leading medical doctrines at the end of the 18th and the beginning of the 19th century, namely those of John Brown (1735–1788) and François Broussais (1772–1838), on Śniadecki as a researcher and practitioner. For practical (clinical) medicine his reserve towards auscultation and percussion, then a slowly gaining field in clinical subjects, is clearly present in Śniadecki’s writings and teaching. His passive and, as far as we can tell, sceptical attitude is explained by the lack of convincing evidence, based on empirical and experimental data, which would enable to connect the physical signs of a diagnosis fulfilled by means of stethoscope to that of the percussion process. It must be remembered that the books by Adam Raciborski (1809–1871) and Joseph Škoda (1805–1881) were both published in the 1830s, where modern diagnosing methods were established using a suitable scientific background to explain their importance. This was too late to influence the clinical work of Śniadecki. The same scepticism, with an obvious demand for strict and experimentally derived data, is probably responsible for the conservative therapy present in Śniadecki’s teaching.

Digital Communication

2019 ◽  
pp. 55-112
Author(s):  
Terry L. Schraeder
Keyword(s):  
Digital Communication ◽  
Clinical Medicine ◽  
Physiological Data ◽  
Patient Portals ◽  
Face To Face ◽  
Healthcare Data ◽  
Medical Apps ◽  
Exam Room ◽  
Data Points ◽  
Doctor's Office

There are few aspects of society, including clinical medicine, still untouched by digital communication and the Internet. It would seem that the important and intimate conversations in a doctor’s office or at the bedside should be one of the last refuges to provide private and exclusive face-to-face discourse between two humans, free of the distraction and distance of the computer. But that is changing. From computers in the exam room to electronic medical records, to email exchanges with patients and medical apps, computers are ever present in the delivery of healthcare. Of course, information technology has revolutionized medicine, and the advantages for patients and physicians are numerous. Through patient portals, patients can now look at their lab results, learn more about their diagnosis, and ask relevant questions; physicians can respond quickly to emailed questions; and patients can inform themselves about surgery by watching online videos. Apps monitor physiological data points; robots deliver medications and perform surgery; and artificial intelligence plays a bigger role in the analysis of complex healthcare data. Many physicians have jumped on board with social media, where they can have a variety of professional and personal interactions. It seems that those in medicine have readily adapted to the electronic universe. But how has it affected physicians’ behavior, expectations for access and processing of information, and most important, relationships with their patients? This chapter explores those topics and takes a closer look at the different ways in which medical professionals are communicating and interacting in the digital universe.

scholarly journals The Application of Intelligent Control in Clinical Medicine

2019 ◽  
Vol 267 ◽  
pp. 02006
Author(s):  
Na Wang ◽  
Jinguo Wang ◽  
Yuanyuan Wang
Keyword(s):  
Information Technology ◽  
Intelligent Control ◽  
New Technologies ◽  
Clinical Medicine ◽  
Clinical Work ◽  
New Wave ◽  
Medical Field ◽  
Clinical Departments

Since the emergence of intelligent control, it has continuously developed and been applied to various fields, which has also greatly promoted the progress of clinical medicine and solved some difficult problems in clinical work. The development of intelligent control pushes the emergence and development of new technologies and new industries. It promotes a new wave of information technology, which continuously penetrates medicine. Intelligent control plays an increasingly important role, and its application in medical field is an inevitable trend. This article mainly gives examples of intelligent control in some clinical departments.

scholarly journals Advantages and Challenges of Working as a Clinician in an Academic Department of Medicine: Academic Clinicians' Perspectives

2010 ◽  
Vol 2 (3) ◽  
pp. 478-484 ◽  
Author(s):  
Colleen Christmas ◽  
Samuel C. Durso ◽  
Steven J. Kravet ◽  
Scott M. Wright
Keyword(s):  
Internal Medicine ◽  
Clinical Medicine ◽  
Clinical Care ◽  
Clinical Work ◽  
Academic Institutions ◽  
Academic Setting ◽  
Academic Leaders ◽  
Wide Range ◽  
Academic Settings ◽  
Excellent Care

Abstract Background The provision of high-quality clinical care is critical to the mission of academic and nonacademic clinical settings and is of foremost importance to academic and nonacademic physicians. Concern has been increasingly raised that the rewards systems at most academic institutions may discourage those with a passion for clinical care over research or teaching from staying in academia. In addition to the advantages afforded by academic institutions, academic physicians may perceive important challenges, disincentives, and limitations to providing excellent clinical care. To better understand these views, we conducted a qualitative study to explore the perspectives of clinical faculty in prominent departments of medicine. Methods Between March and May 2007, 2 investigators conducted in-depth, semistructured interviews with 24 clinically excellent internal medicine physicians at 8 academic institutions across the nation. Transcripts were independently coded by 2 investigators and compared for agreement. Content analysis was performed to identify emerging themes. Results Twenty interviewees (83%) were associate professors or professors, 33% were women, and participants represented a wide range of internal medicine subspecialties. Mean time currently spent in clinical care by the physicians was 48%. Domains that emerged related to faculty's perception of clinical care in the academic setting included competing obligations, teamwork and collaboration, types of patients and productivity expectations, resources for clinical services, emphasis on discovery, and bureaucratic challenges. Conclusions Expert clinicians at academic medical centers perceive barriers to providing excellent patient care related to competing demands on their time, competing academic missions, and bureaucratic challenges. They also believe there are differences in the types of patients seen in academic settings compared with those in the private sector, that there is a “public” nature in their clinical work, that productivity expectations are likely different from those of private practitioners, and that resource allocation both facilitates and limits excellent care in the academic setting. These findings have important implications for patients, learners, and faculty and academic leaders, and suggest challenges as well as opportunities in fostering clinical medicine at academic institutions.

“And there's Always this Great Hole Inside that Hurts”: An Empirical Study of Bereavement in Later Life

2001 ◽  
Vol 42 (3) ◽  
pp. 237-251 ◽  
Author(s):  
Kate M. Bennett ◽  
Gillian Bennett
Keyword(s):  
Empirical Study ◽  
Later Life ◽  
Clinical Work ◽  
One Stage ◽  
Theoretical Approaches ◽  
Women's Narratives ◽  
Lay Understanding ◽  
Physical Effects ◽  
Experiences Of Women ◽  
Stage Theories

Stage theoretical approaches to bereavement have long been used in both academic and clinical work. Their impact has been so great that they have permeated lay understanding of bereavement, to become, as Tony Walter puts it, the “clinical lore” of bereavement. This paper examines this clinical lore from the perspective of older women's narratives of widowhood. We suggest that, though these widows experience the sorts of emotions stage theories predict, there is little evidence to support the notion of steady progression from one stage to another. Nor is there evidence to support the idea that widows “recover” from their loss in the sense of surrendering their attachment to the dead, nor that “renewal” equates with a fully restored sense of wellbeing. The widows themselves argue cogently that the idea of “recovery” is an inappropriate (and indeed insensitive) aim for them to strive for. They feel uncomfortable with the pathologizing of lasting grief; they also express strong views about those who try to “help” them. It concludes that, though stage theories are useful in identifying some of the physical effects and emotions associated with bereavement, they do not adequately reflect the experiences of women widowed in later life.

Interdisciplinary Opera Studies

PMLA ◽  
2006 ◽  
Vol 121 (3) ◽  
pp. 802-810
Author(s):  
Linda Hutcheon
Keyword(s):  
Literary Theory ◽  
Narrative Theory ◽  
Musical Theater ◽  
Literary Text ◽  
Interdisciplinary Studies ◽  
Cultural Form ◽  
Art Form ◽  
Dramatic Text ◽  
Opening Up

I hold this truth to be self-evident: that an art form consisting of a literary text, a dramatic stage performance, and music should be studied in all its multimedia and “multimediated” dimensions (Kramer, Opera 25). Today I can make this statement with confidence because the academic study of opera indeed covers all those aesthetic bases, but that has not always been the case. So long as opera fell primarily within the domain of musicology, it was studied first and foremost as music alone. The fact that the music was written for a specific dramatic text was not deemed particularly significant. The very name given to that text betrayed a belief in its secondariness: the diminutive libretto. But things have been changing: in recent years, some musicologists have challenged the dominant positivistic historicism and formalism of their discipline; some have even looked to literary theory for inspiration, bringing new approaches to the music of opera through narratology (e.g., Abbate) or semiotics (e.g., Nattiez). But just as important for opening up the study of opera as an aesthetic and cultural form has been the attention of scholars working in other disciplines. To take but one example, Peter Rabinowitz's rhetorical narrative theory introduced new ways of thinking about opera as narrative, not only as drama and, more pointedly, not only as drama with the composer in the role of dramatist (Kerman). It was opera, not dance, for example, that became a focus for interdisciplinary studies; already multimediated, it attracted diverse lines of inquiry. To cite the title of David Levin's groundbreaking 1994 volume, we can now see “opera through other eyes.” (Musical theater too has been seen through other—especially literary—eyes, but that is not the focus of this piece [see, e.g., Most; Miller; Rabinowitz].)

Literary theorists in and beyond French academic space (1960–1970s)

2020 ◽  
Vol 68 (5) ◽  
pp. 1108-1123
Author(s):  
Lucile Dumont
Keyword(s):  
Literary Theory ◽  
Public Engagement ◽  
Literary Texts ◽  
French History ◽  
Social Strategies ◽  
Avant Garde ◽  
Theoretical Approaches ◽  
1960S And 1970S ◽  
The 1960S ◽  
Collective Strategy

This article demonstrates how social strategies deployed at the margins of French academic space to legitimize theoretical approaches to literary texts (semiology, semantics, structural analysis of narratives) in the 1960s and 1970s strongly relied on the interventions of their promoters beyond the academy. It specifically examines two strategies privileged by promoters of literary theory which allowed some of them to bypass several requirements for academic careers in taking advantage of the transformations of higher education, of the absence of stable and strong disciplinary frames, and of their own integration into the intellectual and literary fields. First, either through the alliance with literary avant-gardes or by the temporary constitution as one, the collective strategy of the literary avant-garde became a way to engage both politically and aesthetically. Second, the investment of transnational networks and internationalization allowed the critics and theorists to get around the national path to symbolic and academic consecration, and to reframe the modalities of their public engagement. Ultimately, this article offers an understanding of how, for aspirant or marginalized academics, interventions beyond the perimeter of the academic space have, at a certain point in French history, helped their acquisition of academic legitimacy.

The Impact of Suspension of Dermatology On-Call Services

2020 ◽  
Vol 24 (4) ◽  
pp. 380-385
Author(s):  
Annie Langley ◽  
Mark G. Kirchhof
Keyword(s):  
Internal Medicine ◽  
Emergency Department ◽  
Clinical Work ◽  
Descriptive Statistics ◽  
Ottawa Hospital ◽  
General Internal ◽  
Life Threatening ◽  
Survey Results ◽  
Survey Responses ◽  
The Impact

Background Dermatological conditions are commonly seen in the emergency department and inpatient wards. The ability to access dermatology on-call services improves the accuracy of diagnosis and management of common and sometimes life-threatening conditions. Limitations of dermatologist availability led to the suspension of the dermatology on-call service for 3 months in Ottawa, Canada. Objectives Our objective was to assess the impact of this call suspension on patient care and the need for a dermatology on-call service at our hospital, as perceived by nondermatologist physicians at our center. Methods A survey was sent to all departments at The Ottawa Hospital, addressed to staff physicians and residents. Participation was entirely voluntary. Descriptive statistics were used to analyze survey responses. Results A total of 105 physicians completed the survey including staff physicians (85%) and resident trainees (15%). The most represented specialties were emergency medicine ( N = 21), general internal medicine ( N = 19), nephrology ( N = 17), neurology ( N = 13), and plastic surgery ( N = 13). Over half of the respondents felt that the lack of dermatology on-call service impacted the care of their patients by a moderate or great extent. Over half reported performing dermatology-related clinical work during the call suspension and two-thirds of these individuals reported feeling uncomfortable or very uncomfortable doing so. Most (94%) participants felt that an on-call dermatology service was useful and 57% deemed it essential. Conclusion Our survey results demonstrate a significant impact of the suspension of a dermatology on-call service, as perceived by nondermatologist physicians. Hospitals need to recognize the importance of on-call dermatology consultations and provide support for divisions to enable this service to continue.

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