Medical residents' use of narrative templates in storytelling and diagnosis.

This paper examines the diagnostic storytelling that medical residents perform in order to situate patients in a story trajectory with an imputed past and future. It is a study of "ordinary" expertise, as practiced by a family practice medical team in a small urban community hospital in the United States. Narrative storytelling-an activity that is at once cognitive and practical-allows residents to identify the sort of disease, the kind of patient, and the likely outcome for this patient, based on what the resident knows about patients like these. Residents acquire a set of narrative templates, or rough outlines, that they deploy when they encounter a new patient or his or her information. Going into an admissions interview, a resident already has a set of "facts" about the patient and his or her complaint. In a process that is routine, habitual, and iterative, a resident starts from this set of facts and draws on his or her repertoire of narrative templates to pursue a line of questioning that starts to define relevance for this patient, a relevance that is revised as the physician begins to settle on a story. These templates make a first organizing pass at answering, "What's going on with this patient?" They provide the preliminary structure, the warp and weft, for building a patient story that holds together long enough to diagnose, treat, and discharge the patient. Diagnostic stories are shaped by what residents think they can do for the patient, practically speaking, and by habitual hospital activity.

Administration of auditory stimulation during recovery after REM sleep deprivation.

Rapid eye movement (REM) sleep deprivation and auditory stimulation (ADS), separately, increase REM sleep in rats, cats and humans. The main goal of the present study was to test whether administration of ADS during REM sleep rebound has a synergistic effect on REM sleep elicitation. Male Wistar rats were implanted with standard sleep recording electrodes. Following the recovery period, animals were randomly assigned to the following conditions: undeprived (i.e. control) and 24, 48, 96 and 120 hours of REM sleep deprivation by the platform method. Undeprived and REM sleep-deprived animals were divided into two groups, with and without ADS. ADS was a "beep" of 80 dB and 2,000 Hz, lasting 20 msec every 10 seconds. This stimulus was applied for the first 4 hours of sleep recordings after deprivation. After that, animals were recorded for another 4 hours. In the undeprived situation, the group that received ADS increased REM sleep approximately 70% above the group that did not receive ADS, as has been reported previously (REM sleep without ADS: 38.1 +/- 13.84 vs. with ADS: 64.6 +/- 11.8, p < 0.005). No synergistic effect was observed between REM sleep deprivation and ADS for any REM sleep-deprivation schedule. This result may be explained as an increase in the excitability pattern of pontine neurons and/or changes in the cholinergic system due to REM sleep deprivation that could not be further increased by ADS.