综述叙事医学的发展现状及前景 - northumbria research link.doc

A Critical Review of Narrative-based Medicine -- Its Recent Development and Prospective Outlook YE Yun-Jea, HUANG Mimib ( a. Lung Cancer Institute, Guangdong General Hospital, Guangzhou, 510080, China. b. Department of Humanities, Northumbria University, Newcastle upon Tyne, UK.) Abstract：Narrative-based medicine is a medical model that provides clinicians with a constructivist approach to understanding, empathizing and acting upon patients’ experience of pain and illness. This medical model can work parallel to, and can be integrated with, evidence-based medicine in clinical practice. This article provides a comprehensive review of narrative-based medicine, examining its theoretical background, its development and its implementation in recent medical practice. The dialectical relationship between narrative medicine and evidence-based medicine is discussed before an integrated framework is proposed that allows both medical models to work together in China’s medical care system. Finally, it argues that the narrative-based model can play an important role in China’s fast-moving translational medicine. Keywords: narrative-based medicine; doctor-patient relationship; narrative competence; social construction; translational medicine 综述叙事医学的发展现状及前景 叶云婕1， 黄紫薇2(1. 广东省人民医院、广东省肺癌研究所，广州 510080; 2.诺桑比亚大学、人文科学院，英国) [摘要] 叙事医学是一门以患者为中心的医学模式, 它可以帮助医务工作者了解患者对病痛的切身体验和感受，与患者共情，为患者提供更优质的医疗服务。在临床实践中，叙事医学可以与循证医学平行发展、并与之有效地整合。基于叙事医学在临床实践的重要性，本文对叙事医学的源起、发展及临床应用做一个综合的论述，并对叙事医学与循证医学的辩证关系和整合可能性进行分析评价。在此之上，笔者进一步讨论叙事医学对促进转化医学在中国医疗体系的发展的积极贡献。 [关键词] 叙事医学；医患关系；叙事能力；社会建构；转化医学 循证医学(evidence-based medicine) 无疑是当今主导医学科研、临床与科教的主要认知模式。作为逻辑实证主义 (logical positivism) 的一个现代分支，循证医学强调生理性的客观医学数据，将数据依照可靠度等级制订系统化、规范化的疾病检测指标和诊疗指南。虽然与传统的经验医学相比，循证医学能为患者提供更为系统化和科学化的诊疗；但是单一的循证路线却难以实现目前世界卫生组织所提倡的“生理－心理－社会”这一体现人性化理念的医学模式。在当今全球广泛推崇“以患者为中心”、“全人医疗”以及“鼓励患者参与”的社会环境下，医学界意识到对循证医学的盲目推崇可能会导致当代医学的人性丧失。针对这一问题，叙事医学（narrative-based medicine) -- 一门强调人文关怀和参与者主观能动性的理论 -- 在医学界得到不断的提升和认可。逾来逾多的学者们意识到循证医学与叙事医学这两种基于不同认识论的医疗模式应该并行发展、相辅相成,