Thursday Review: “Patients as Story-Tellers of Healthcare Journeys”

Klay Lamprell and Jeffrey Braithwaite use one of my favorite words when talking about stories: “structure”. Writing in Medical Humanities, the authors discuss two complimentary ways to help patients express their own story. The first is a structural approach, and the second is more character-driven.

The purpose of the article is to bring these techniques to light. The authors do briefly discuss what makes these stories powerful, though. Stories can be longitudinal: they reach experiences across silos of care over periods of time.

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Thursday Review: “Suffering and the Goals of Medicine”

We have a consciously dualistic view of ourselves. The mind and the body are separate things. One is subjective, the other is objective. One is a source of psychological “suffering” and the other is a source of biomedical “pain”.

If this is true, how can healthcare professionals—specifically those in medical fields—have any responsibility to their patients as human beings, and not just as complicated biomedical machinery?

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Thursday Review: “The Nurse and the Use of Narrative: An Approach to Caring.”

How do we understand our own illness, and how does it affect us? When a patient is ill, how can healthcare professionals—especially nurses—help shape a positive understanding of what is happening?

In the Journal of Psychiatric and Mental Health Nursing, J. A. Aloi discusses techniques to help patients edit their own story. Although focused on mental health, the author includes how the generalist nurse in all areas of nursing can help patients create multiple perspectives.

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Thursday Review: “Can the Future of Medicine Be Saved from the Success of Science?”

The title of Dr. Samuel LeBaron’s article is intriguing enough. The fact that the author quotes three separate poems in a journal called Academic Medicine makes it even more alluring.

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“I look up and there’s this robot at the door.”

Whenever there’s a discussion of efficiency or immediacy, the next question always has to be, “Efficient or immediate for whom?”

Last weekend, a news story broke of a woman named Annalisa Wilharm in Northern California whose grandfather, Ernest Quintana, was hospitalized with COPD. A mobile, videoconferencing “robot” came into the room, displaying a two-way video feed of a physician who had just read the latest MRI results.

Mr. Quintana was given bad news: that there was little of his lungs left, and that all the hospital could do was make him comfortable. He passed away the next day.
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Thursday Review: “Physician and Nursing Perceptions Concerning Interprofessional Communication and Collaboration”

There is no single profession which can meet all patients’ needs, Vasiliki Matziou et al. begin. The authors later explain it’s quite the opposite: when healthcare professionals collaborate, there are better health outcomes, higher patient satisfaction, and lower costs.1, 2

This much is known, but what influences how well nurses and physicians communicate? What exactly does each side feel they bring to each other?

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Thursday Review: “Reducing Hospital Readmission Rates: Current Strategies and Future Directions”

In 2012, Burke et al. published an article describing an ideal process to transition patients from hospital care and avoid readmission.

About a year later, two of the four authors of that paper, Dr. Sunil Kripalani and Dr. Eduard E. Vasilevskis, together with Dr. Cecelia N. Theobald and Beth Anctil, published a follow-up in the Annual Review of Medicine. The available data states that their original model was correct.

The best way to reduce hospital readmissions appears to be a process, and not an event.

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Thursday Review: “The Effect of Physician Behavior on the Collection of Data”

I love patient stories, and know how important they are to good care. The fact remains that patients are usually going to tell stories… badly. Physicians and other providers need to let them tell those ineffective stories, and be prepared for it.

Dr. Howard B. Beckman and Dr. Richard M. Frankel wrote an article in the Annals of Internal Medicine on how physicians’ verbal cues influence how and how much medical information is collected.

Beckman and Frankel help us realize how much control providers have over the patient encounter, and why narrative competence is so important.
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Thursday Review: “Moving Beyond Readmission Penalties: Creating an Ideal Process to Improve Transitional Care”

As a quantitative metric, write Dr. Robert E. Burke et al., readmisssions can be problematic. In the Journal of Hospital Medicine, the authors write that one difficulty is the lack of an intentional process of discharging a patient to avoid readmission.

The authors lay out an ideal process for a care transition. I’d like to look briefly at how this idealized transition is like and unlike a story, and comment on how story can intervene at a few key points.
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Thursday Review: “Getting Personal: Can Systems Medicine Integrate Scientific and Humanistic Conceptions of the Patient?”

In medicine, just like in other disciplines, there is a distinction between “art” and “science”. A line is drawn between the humanistic and data, between subjective and objective, between mind and body, and what is personal and what is verifiable.

In the Journal of Evaluation in Clinical Practice Henrik Vogt et al. want to answer if systems medicine can bridge the gap between them.
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