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The Chief Concern of Medicine

The Integration of the Medical Humanities and Narrative Knowledge into Medical Practices

Ronald Schleifer

Publication Year: 2013

Unlike any existing studies of the medical humanities, The Chief Concern of Medicine brings to the examination of medical practices a thorough---and clearly articulated---exposition of the nature of narrative. The book builds on the work of linguistics,

Published by: University of Michigan Press


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p. 1-1

Title Page, Copyright, Dedication

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pp. 2-7

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pp. vii-xiv

The Chief Concern of Medicine aims at enlarging our sense of the profession of medicine and, more important, enlarging its effectiveness and service, by including a self- conscious awareness of the nature of narrative within a working definition of ...


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pp. 16-17

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Introduction: Medicine, Narrative, and Schema-Based Understanding

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pp. 1-32

For the past decade, we have been teaching a course on literature and medicine. Our purpose has been to make medical students and physicians more cognizant of the role of narrative in medical practice and to help them develop skills that make narrative knowledge a useful and important part of ..

Part 1. Phronetic Skills: The Technē of Medicine

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1. The Functional Realism of Medicine

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pp. 35-56

While efficacy of training for and utilizing “narrative knowledge” within the practices of medicine— something that Rita Charon has aptly called “narrative medicine”— has grown and continues to grow in medical education and professional practice (see Charon 2006a for a thorough account), defending its method and aims to the medical establishment remains a difficult task. it ...

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2. Modalities of Science: Narrative, Phronesis, and the Skills (Technē) of Medicine

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pp. 57-82

Near the beginning of the Nicomachean Ethics, Aristotle describes the nature of practical reason, or phronesis, particularly in relation to action rather than theoretical thought. “Since, then,” he writes, ...

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3. The Chief Concern of Medicine: Narrative Knowledge and Schema-Based Practice

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pp. 83-110

In this chapter, we examine the concept and function of “narrative knowledge,” both in general and in the practice of medicine. We focus on narrative knowledge in terms of not only the knowledge that a physician-listener can glean from narrative—knowledge that Rita Charon richly describes in her ...

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4. The Logic of Diagnosis: Peirce, Literary Narrative, and the History of Present Illness

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pp. 111-133

In chapters 2 and 3, we examined the practical wisdom of the physician in relation to narrative and, particularly, the chief concern of the narratives patients bring to their physicians. In this chapter, we will continue examining the role of narrative in the practices of medicine, but with particular focus on...

Part 2. The Work of Narrative in Practices of Medicine

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5. The Patient-Physician Relationship: The Scene of Narration

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p. 137-137

As we have seen, the patient brings to the clinical encounter a story, the History of Present Illness (HPI). As the physician listens and responds to this story, a special kind of relationship begins to develop between the patient and doctor. At its best, it is personal and professional at once. It is often...

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6. The Patient’s Story: The Apprehension of Narration

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pp. 168-210

In chapter 5, we examined the scene of narration; here, we examine the patient’s narration itself, the narrative knowledge it gives rise to, and the ways that knowledge fails to be apprehended by physicians. As we have already noted, the story a patient brings to the physician is usually among the first...

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7. Doctors Listening and Attending to Patients: Response and Engagement with Acts of Narration

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pp. 211-244

Listening to patients and the illness story is one of the most important skills (technē) a physician uses during a lifetime of practice. Because the patient history is the most important diagnostic information, listening carefully is of enormous importance. Patients commonly complain that their doctor does ...

Part 3. Schema-Based Medicine

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8. Narrative and Medicine: Schemas of Narration

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pp. 247-283

Throughout Part 2 of this book, we were concerned with storytelling and narrative—with the patient-physician relationship growing out of the encounter of storytelling, the patient’s narrative itself, and a doctor’s ability in listening to narrative. Many experienced physicians develop types of understanding—phronesis, narrative knowledge, and logic ...

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9. Narrative and Everyday Medical Ethics: Schemas of Action

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pp. 284-326

Ethical practices—behaviors and relationships that necessarily encompass “good” (versus “bad”) actions—are woven into every aspect of medical practices precisely because health care always is vitally concerned with issues of the nature of well-being (the good life, Aristotle’s eudaimonia), the nature of interpersonal care (responsibilities of behavior between people, especially in ...


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10. Reading The Death of Ivan Ilych

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pp. 329-356

Leo Tolstoy’s novella The Death of Ivan Ilych is a significant literary text that brings together many of the themes of The Chief Concern of Medicine. It is a story that resonates with the experience of health care workers—with the experience of physicians, nurses, and others confronted with suffering and ...

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Afterword: The Nexus of Literature and Medicine; The Interactions of Patient and Physician

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pp. 357-365

We began this book’s discussion with a philosophical argument that the objects of humanistic understanding obtained through narrative knowledge are real and that this reality is a result of narrative understanding and reflection. This reality is demonstrated in a pragmatic way by attending to the actions ...

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Appendix 1. Humanities as a Discipline

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pp. 367-373

In chapter 1 of this book, we described the resistance, in philosophical pragmatism, to the claims of positivism in the early twentieth century. That resistance, as we saw, took the form of pursuing a pragmatic conception of philosophy, one that assumed that particular human beings and societies of ...

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Appendix 2. Checklists for Skills in Listening, Interviewing, and Action

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pp. 374-381

The practice of medicine has become a highly complex activity. The facts of human biology and pathology have exploded to a point that the idea of remembering or knowing it all is clearly unpracticable. The World Health Organization has a list of thirteen thousand diseases, syndromes, and ...

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Appendix 3. A Compilation of Schemas for Medical Practices

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pp. 382-389

In this appendix, we list the schemas of medical practices that have been described in The Chief Concern of Medicine. They are a series of categories of (1) narrative structure, roles, genres, and overall meaning and of (2) actions, particularly the action taking place within the patient-physician ...


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pp. 391-418


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pp. 419-428


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pp. 429-456

E-ISBN-13: 9780472028863
E-ISBN-10: 0472028863
Print-ISBN-13: 9780472118595
Print-ISBN-10: 0472118595

Page Count: 480
Illustrations: 4 Figures
Publication Year: 2013