Thursday, June 29, 2017
Narrative medicine as a framework for clinical work that can apply the concept of narrative and all existing knowledge about the narrative in order to provide skills, methods, and texts to "imbue the facts and objects of health and illness with their consequences and meanings for individual patients and physicians".
Narrative knowledge finds meaning and significance in stories through cognitive, symbolic, and affective means.
- particular understandings about one situation by one participant or observer
- illuminates the 'universally true' by revealing the particular.
- inter-subjective domains of human knowledge and activity
- teller and listener
- meaning is apprehended collaboratively, it's all about the "inter-subjective domain"
Complements logicoscientific knowledge.
- detached and replaceable observer comprehends replicable and generalizable knowledge.
- illuminates the 'universally true' by transcending the particular
Narrative competence = ability to acknowledge, absorb, interpret, and act on the stories of others. Sounds very similar to the definition of compassion.
Some of the central narrative situations:
1. physician and patient
- "to find the words to contain the disorder and its attendant worries gives shape to and control over the chaos of illness"
- "acts of witnessing"
2. physician and self: reflection in practice
- calibrating the physician, attunement to engagement and compassion.
- identification of my own emotional responses to patients
- make sense of my own life journey
- written pieces shared with patients
3. physician and colleagues
- "Only when physicians have the narrative skills to recognize medicine's ideals, swear to on another to be governed by them, and hold one another accountable to them" can they live up to society's expectations of the ideal physician.
4. physician and society
- healthcare reform depends upon grave and daring conversations about meaning, values, and courage.
5. physician and their family
6. patient and patient's family
7 patient and patient's self
- what is wrong with me? why did this happen to me? what will become of me?
8 patient and other patients
9 patient society
Can the narrative bridge the divide between physicians and their selves, patients, colleagues, and society?
Monday, June 26, 2017
Addition to the constitution's supremacy clause.
"This Constitution, and the Laws of the United States which shall be made in Pursuance thereof; and all Treaties made, or which shall be made, under the Authority of the United States, shall be the supreme Law of the Land; and the Judges and other public officials in every State shall be bound thereby, any Thing in the Constitution or Laws of any State to the Contrary notwithstanding."
"Districts represented by members of Congress, or by members of any state legislative body, shall be compact and composed of contiguous territory. The state shall have the burden of justifying any departures from this requirement by reference to neutral criteria such as natural, political, or historic boundaries or demographic changes. The interest in enhancing or preserving the political power of the party in control of the state government is not such a neutral criterion."
"Neither the First Amendment nor any other provision of this Constitution shall be construed to prohibit the Congress or any state from imposing reasonable limits on the amount of money that candidates for public office, or their supporters, may spend in election campaigns."
"Neither the Tenth Amendment, the Eleventh Amendment, nor any other provision of this Constitution, shall be construed to provide any state, state agency, or state officer with an immunity from liability for violating any act of Congress, or any provision of this Constitution."
Addition to 8th amendment
"Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments such as the death penalty inflicted."
Second amendment add 5 words
"A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms when serving in the Militia, shall not be infringed."
Sunday, May 1, 2016
What a page turner! I listened to this while driving across the country and almost didn't want to stop to eat or get gas or anything because it was so suspenseful. Saw what you will about whether or not it qualifies as literature, but it certainly made me think about sexual abuse, human trafficking, and the role of police in new ways that I may not have ever thought about if I had not read this series.
My absolute favorite book of the year. What an amazing ability Gawande has to write so clearly about such complicated and emotionally explosive topics. Unbelievable how he winds in the threads of his own life and experiences with careful research about experts in the field of aging and death.