The Study of Man. By Michael Polanyi. Price, $1.75. Pp. 102. University of Chicago Press, 5750 Ellis Ave., Chicago 37, 1959. One subtitle to Polanyi's challenging and fascinating book might be The Evolution and Natural History of Error , for Polanyi is at pains to expunge what he believes to be the false notion contained in the contemporary view of science which treats it as an object and basically impersonal discipline. According to Polanyi not only is this a radical and important error, but it is harmful to the objectives of science itself. Another subtitle could be Farewell to Detachment , for in place of cold objectivity he develops the idea that science is necessarily intensely personal. It is a human endeavor and human point of view which cannot be divorced from nor uprooted out of the human matrix from which it arises and in which it works. For a good while

Personal Knowledge: Towards a Post-Critical Philosophy

“North Star” goals toward an ideal integrated behavioral health and ambulatory care setting Tips, resources, and real-world examples of how others are doing it What not to do, or the pitfalls to avoid when integrating behavioral health An interactive integration self-assessment checklist with immediate feedback linked to guidance Access to the Academy Community, an online forum for peer-topeer networking and sharing

Agency for Healthcare Research and Quality (AHRQ)

BACKGROUND Narrative inquiry is a form of qualitative research that takes story as either its raw data or its product. Science and narrative can be seen as two kinds of knowing, reflected in the distinction between evidence-based medicine derived from population studies and narrative-based medicine focused upon the single case. A similar tension exists in the field of narrative inquiry between cognitiveorientated analytical methods and affective-orientated methods of synthesis. AIMS This paper aims to make sense of narrative inquiry in clinical education through definition of narrative, articulation of a typology of narrative research approaches, and critical examination in particular of analytical methods, the dominant approach in the literature. The typology is illustrated by research examples, and the role of medical education in developing expertise in narrative inquiry is discussed. An argument is made that the tension between analysis of the structure of stories and empathic use of stories can be seen as productive, stimulating expertise encompassing both approaches. DISCUSSION Analytical methods tend to lose the concrete story and its emotional impact to abstract categorisations, which may claim explanatory value but often remain descriptive. Stemming from discomfort with more integrative methods derived from the humanities, a science-orientated medical education may privilege analytical methods over approaches of synthesis. Medical education can redress this imbalance through attention to thinking with stories to gain empathy for a patient’s experience of illness. Such an approach can complement understanding of story as discourse ) how narratives may be used rhetorically to manage both social interactions and identity.

Stories as data, data as stories: making sense of narrative inquiry in clinical education*

The translator's "invisibility" has become a hot topic of translation studies in recent years.It concerns translation strategies,and it is also closely related to the translator's status.Lawrence Venuti has made systematic studies of the translator's "invisibility" problem,producing unique insights into its root causes and its influences on the translator's status.A critical analysis of Venuti's statements concerned can be inspiring to achieving correct understanding of the necessity,rationality and limitations of the translator's "invisibility",and to taking effective measures to promote the translator's status.

On the Translator's "Invisibility"

Medical students must be prepared for working in inter-professional and multi-disciplinary clinical teams centred on a patient’s care pathway. While there has been a good deal of rhetoric surrounding patient-centred medical education, there has been little attempt to conceptualise such a practice beyond the level of describing education of communication skills and empathy within a broad ‚professionalism’ framework. Paradoxically, while aiming to strengthen patient–student interactions, this approach tends to refocus on the role modelling of the physician, and opportunities for potentially deep collaborative working relationships between students and patients are missed. A radical overhaul of conventional doctor-led medical education may be necessary, that also challenges the orthodoxies of individualistic student-centred approaches, leading to an authentic patient-centred model that shifts the locus of learning from the relationship between doctor as educator and student to the relationship between patient and student, with expert doctor as resource. Drawing on contemporary poststructuralist theory of text and identity construction, and on innovative models of work-based learning, the potential quality of relationship between student and patient is articulated in terms of collaborative knowledge production, involving close reading with the patient as text, through dialogue. Here, a medical ‚education’ displaces traditional forms of medical ‚training’ that typically involve individual information reproduction. Students may, paradoxically, improve clinical acumen through consideration of silences, gaps, and contradictions in patients as texts, rather than treating communication as transparent. Such paradoxical effects have been systematically occluded or denied in traditional medical education.

Students learning from patients: let's get real in medical education.

CONTEXT There is increasing interest in establishing the medical humanities as core integrated provision in undergraduate medicine curricula, but sceptics point to the lack of evidence for their impact upon patient care. Further, the medical humanities culture has often failed to provide a convincing theoretical rationale for the inclusion of the arts and humanities in medical education.



DISCUSSION  Poor communication with colleagues and patients is the main factor in creating the conditions for medical error; this is grounded in a historically determined refusal of democracy within medical work. The medical humanities may play a critical role in educating for democracy in medical culture generally, and in improving communication in medical students specifically, as both demand high levels of empathy. Studies in the science of communication can provide a valuable evidence base justifying the inclusion of the medical humanities in the core curriculum. A case is made for the potential of the medical humanities – as a form of ‘adult play’– to educate for collaboration and tolerance of ambiguity or uncertainty, providing a key element of the longer-term democratising force necessary to change medical culture and promote safer practice.



CONCLUSION  The arts and humanities can provide important contextual media through which the lessons learned from the science of communication in medicine can be translated and promoted as forms of medical education.

Can the science of communication inform the art of the medical humanities

Empathy is thought a desirable quality in doctors as a key component of communication skills and professionalism. It is therefore thought desirable to teach it to medical students. Yet empathy is a quality whose essence is difficult to capture but easy to enact. We problematise empathy in an era where empathy has been literalised and instrumentalised, including its measurement. Even if we could agree a universally acceptable definition of empathy, engendering it in the student requires a more subtle approach than seems the case currently. We therefore examine this modern concept and compare it with others such as pity and compassion, using the medium of Homer's Iliad. Two famous scenes from the Iliad elicit pity in the characters and the audience. Pity and compassion are, however, given a complexity within the narrative that often seems lacking in modern ways of conceptualising and teaching empathy.

https://mh.bmj.com/content/medhum/35/1/7.full.pdf

The death of Hector: pity in Homer, empathy in medical education

Initial results are presented from an ongoing, work‐based collaborative inquiry between three medical consultants (a pathologist, a radiologist and a dermatologist) and three experienced visual artists into processes of clinical and aesthetic judgements in the visual domain. The doctors’ habitual conventions are challenged through the interventions of the artists, leading to a re‐education of the senses through a revitalised clinical imagination. Outcomes include self‐assessed improvement of clinical acumen through systematic review of the clinical reasoning process looking specifically at the aesthetic dimension. A central research interest is how forms and styles of judgement construct identities of the expert practitioner in work settings. The papers describes a change in practice from “looking” to “seeing” as the development of a “connoisseurship” of informational images informed by tolerance of ambiguity, creating a practice identity against the grain of the normative technical‐rational discourse of clinical reasoning.

Learning how to see: doctors making judgements in the visual domain

In a series of previous articles, we have considered how we might reconceptualise central themes in medicine and medical education through ‘thinking with Homer’. This has involved using textual approaches, scenes and characters from the Iliad and Odyssey for rethinking what is a ‘communication skill’, and what do we mean by ‘empathy’ in medical practice; in what sense is medical practice formulaic, like a Homeric ‘song’; and what is lyrical about medical practice. Our approach is not to historicise medicine and medical education, but to use thinking with Homer as a medium and metaphor for questioning the habitual and the taken-for-granted in contemporary practice. In this article, we tackle the complex theme of ‘translation’. We use the lens of translation studies to examine the process of turning the patient9s story into medical language. We address the questions: what makes a ‘good’ translation? What are the consequences of mistranslation and poor translation? And, while things are inevitably lost in translation, does this matter?

https://mh.bmj.com/content/medhum/39/1/47.full.pdf

Lost in translation. Homer in English; the patient's story in medicine.

Improving the quality of communication between doctors and their patients and colleagues is of vital importance. Poor communication, especially within and across clinical teams working around patients in pathways of care, leads to avoidable medical error, where an unacceptable number of patients are severely harmed or die each year. The figures from such iatrogenesis have now reached epidemic proportions, constituting one of the major killers of patients worldwide. Despite 30 years9 worth of explicit attention to teaching communication skills at undergraduate level, communication in medicine is failing to improve at an acceptable rate. The authors suggest a rather unusual approach to this dilemma of ‘communication hypocompetence’— thinking medicine lyrically —as an extension of thinking with Homer9s little-discussed lyrical aesthetic. A key part of the problem of communication hypocompetence is the well-researched phenomenon of ‘empathy decline’ in students, where ‘hardening’ and cynicism occur as over-determined ego defences. Empathy decline may be a symptom of the repression of the lyrical genre in medicine, where the epic, tragic and dark comic genres dominate. The lyrical genre emphasises coming to know the patient as a person and an individual. Importantly, central to performing the lyric genre is the heightened use of the senses in taking a history, physical examination and diagnostic work. Framing medicine as lyrical work challenges undue emphasis on ‘cure’ at the expense of humane ‘care’.

https://mh.bmj.com/content/medhum/38/1/50.full.pdf

The embodiment of lyricism in medicine and Homer

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