Nuevas definiciones de evidencia en la medicina contemporánea: aportes desde la antropología / New definitions of evidence in contemporary medicine: contributions from anthropology

Este artículo explora la importancia productiva de las Humanidades y de las Ciencias Sociales - en particular de la Antropología - a través de la revisión del "impacto" producido en un campo eminentemente empírico: la Medicina. El impacto de las Humanidades en general y la Antropología en particular tiene aquí una doble vertiente: 1) como base crítica epistemológica a una visión positivista "fundamentalista" - la enfermedad es algo meramente biológico - y 2) la incorporación de un nuevo repositorio humanístico en las prácticas contemporáneas. La creciente importancia de las Humanidades en la moderna medicina con la irrupción de la Medicina Basada en Narrativas, movimiento heredero de lo que se ha conocido como "Narrative Turn" en el campo de la Medicina - aquí ofrecemos un estudio de caso alrededor del Trastorno Límite de Persona lidad - cuestiona las aseveraciones que insisten en su falta de productividad y eficacia. Proponemos aquí un movimiento de apertura hacia definiciones de evidencia más incluyentes - en la epistemología y la academia, pero también en la práctica clínica.

This article explores the "productive" importance of the Humanities and Social Sciences - Anthropology particularly - through the revision of the "impact" produced in an eminently empirical field: Medicine, particularly after the hegemony of Evidence Based Medicine (EBM). The impact of the Humanities in general and Anthropology in particular has a two fold meaning: 1) as a critical foundation against the "fundamentalistic" positivist view - disease is something purely biological - and 2) the incorpora tion of a new humanistic repository - maybe better the recovery of many of contemporary practices. The increasing relevance of Humanities on modern medicine with the emergence of Narrative-Based Medicine (NBM), movement of what has become known as "Narrative Turn" in the field of medicine - we offer here a case-study about Borderline Person ality Disorder - challenges the assertions that insist on their lack of productivity and effectiveness. We suggest here an opening movement towards more inclusive definition of evidence-in epistemology and academia, but also in clinical practice.

Leituras holísticas: de Tchékhov à Medicina Narrativa / Lecturas holísticas: de Tchékhov a la Medicina Narrativa / Holistic readings: from Chekhov to narrative medicine

Neste artigo, procura-se evidenciar como, no conto “Um caso da prática médica”, o escritor russo, Anton Tchékhov, ele próprio médico, ficcionaliza e chama a atenção para aspetos da prática clínica hoje tantas vezes descurados, designadamente a observação e avaliação do ambiente em que vivem os doentes; e aspetos de índole familiar, social e até sexual, bem como a importância crucial da relação interpessoal de carácter dialógico entre médico e doente. Relacionar-se-á esta chamada de atenção indireta de Tchékhov com a situação atual no domínio da prática clínica, recorrendo-se ao conceito de Medicina Baseada na Prova (EBM), como paradigma atualmente dominante nas práticas médicas, e à necessidade de o complementar com o da Medicina Baseada na Narrativa (NBM) ou Medicina Narrativa...

The aim of this paper was to show how, in the short story “A Doctor’s Visit,” the Russian writer Anton Chekhov, himself a physician, creates a fictional narrative in which he draws attention to aspects of clinical practice that are rather overlooked today, namely: observation and evaluation of the environment in which patients live and aspects of their family, social and even sexual outlook, along with the crucial importance of the interpersonal dialogue-based relationship between doctor and patient. The attention indirectly drawn to this issue by Chekhov is here correlated with the current situation within the domain of clinical practice by invoking the concept of evidence-based medicine as the currently dominant paradigm in medical practice, and with the need for a complementary approach, namely by narrative-based medicine or narrative medicine...

En este artículo se busca mostrar como en el cuento “Un caso de práctica médica”, el escritor ruso Anton Tchékhov, que era médico, presenta como ficción y llama la atención para aspectos de la práctica clínica tantas veces descuidados, específicamente la observación y la evaluación del ambiente en que viven los enfermos y también sobre aspectos de índole familiar, social e incluso sexual, así como la importancia crucial de la relación inter-personal del carácter dialógico entre médico y paciente. Se relacionará esta llamada de atención indirecta de Tchékhov con la situación actual en el dominio de la práctica clínica, recurriéndose al concepto de EBM (Evidence based medicine) como paradigma dominante en la actualidad en las prácticas médicas y la necesidad de complementarlo con el de NBM (Narrative based medicine) o Medicina narrativa...

O silêncio dos inocentes: por um estudo narrativo da prática médica / The silence of the innocents: for a narrative study of medical practice / El silencio de los inocentes: por un estudio narrativo de la práctica médica

Embora absolutamente pertinente, a relação entre texto e medicina ainda é pouco pesquisada no meio acadêmico brasileiro. Não obstante, é fato que toda prática médica é permeada de narrativas, quer sejam as dos pacientes, que contam aos médicos as histórias de suas doenças, quer as dos médicos, que recontam essas histórias de acordo com modelos científicos aprendidos e com sua experiência clínica. Inspirado na Narrative-Based Medicine, campo teórico já consolidado no meio anglófono, e em algumas teorias provenientes dos Estudos Literários e das Ciências Sociais, este artigo busca discutir, introdutoriamente, algumas possibilidades para a consolidação de um estudo interdisciplinar das narrativas relacionadas à área médica no âmbito acadêmico brasileiro.

Although absolutely relevant, the research about the relationship between text and medicine is not well fund within the Brazilian academy yet. Nevertheless, the fact is that the medical practice is permeated with narratives, whether those by patients, who tell the doctors the stories of their diseases, whether those by physicians, who recount these stories according to their consolidated scientific models and to their clinic experience. Inspired by the theoretical field called Narrative-Based Medicine, which is already well established within the Anglophone academic environment, and by some theories from the Literary Studies and the Social Sciences, this article aims to introductorily discuss some possibilities for the consolidation of an interdisciplinary study of the medical narratives in Brazil.

Aunque absolutamente relevante, la relación entre texto y medicina es todavía objeto de poca investigación en el medio académico brasileño. Sin embargo, es un hecho que toda la práctica médica tiene sus relatos, ya se trate de pacientes que cuentan las historias clínicas de sus enfermedades a los médicos, o de los médicos, que cuentan estas historias de acuerdo a sus modelos científicos aprendidos y de su experiencia clínica. Inspirado por la Narrative-Based Medicine, campo teórico ya establecido en lengua inglesa, y por algunas teorías que vienen de los Estudios Literarios y de las Ciencias Sociales, este artículo pretende discutir, introductoriamente, algunas posibilidades para la consolidación de un estudio interdisciplinario de las narrativas médicas en el ámbito académico brasileño.

Curriculum development of narrative-based medicine in undergraduate medical education: The narrative-based medicine course at Sapporo Medical University / 医学教育

1)In the 2008 academic year, we developed a new narrative-based medicine (NBM) curriculum at Sapporo Medical University. <br>2) The program includes lectures on the concept of NBM, the clinical practice of NBM, and the illness narratives of patients' families, and exercises in narrative competence (significant event analysis, parallel chart, and life story).<br>3) Although some students had negative attitudes about the program, most students evaluated the course positively. We need to continuously improve the curriculum to develop narrative competence in medical students.

Undergraduate Medical Education in Narrative-Based Medicine by Small-Group Learning / 医学教育

Japanese primary-care physicians recognize that narrative-based medicine (NBM) is important in clinical practice, but there is no standard method for training physicians in NBM. We conducted small-group learning in NBM for medical students at Jichi Medical University in 2005.<BR>1) Our goals were to clarify what students learn and to investigate educational tools for teaching NBM.<BR>2) We qualitatively analyzed responses to a questionnaire composed of 3 questions that the students answered freely after small-group learning involving an actual scenario based on a patient's narrative of home-care service and including evidence-based medicine and medical communication skills.<BR>3) Students recognized that NBM is important in clinical practice. They also gained a deeper understanding of evidence-based medicine and medical communication skills, which are essential skills in primary care, and could integrate knowledge about primary care. Through discussion, they developed awareness of others and of themselves as doctors.<BR>4) Small-group learning with an actual scenario and NBM increased students' awareness and stimulated their imagination. We believe that small-group learning is useful as an educational method in NBM.