Pfi Sem4 Key Refs (Illness Narratives)

Front 1

Patients may deny their symptoms (think of Dad!) or re-phrase them in a nicer, less accusatory way.

Back 1

Kleinman talking about Alice Alcott

Front 2

Patient with leg paralysis - when he cried and let emotions out, the leg paralysis began to disappear

Back 2

Kleinman

The paralysis expressed grpahically the childlike helplessness in not being able to resist his father's dominance and choose an autonomous career

Front 3

*How psychophysiological processes work is a great mystery - there is enough to know that they exist and we can describe the symptoms as a literal embodiment of conflicted meanings and somatic symbols*

Back 3

Kleinman

Front 4

85% of patients in Bangalore with depression initially presented with some somatic symptoms (such as 'nerves' and 'excess heat')

Back 4

Raguram 2001

Think about how easy it would be for a busy GP to dismiss 'such trivial nonsense of excess heat'

Front 5

To treat depression effectively you have to understand the wider social and cultural issues

Back 5

Raguram

BUT note Kleinman's stuff on being overtly psychoanalytic

Front 6

Explaining how you got ill often takes the form of a narrative and a 'language of distress' (verbal/non-verbal)

Back 6

Helman 2007

Front 7

'Cultural documents' - narratives come into being at times of unexpected disruption to the flow of everyday life (which implies a state of 'normality' which is also culturally dependent)

Back 7

Becker

Front 8

Discourse between patient and doctor that informs the narrative provides insight and is almost like a 'gift' from doctor to patient

Back 8

Helman 2007 (Also Kleinman: A doctor listening to the story of an elderly patient is one of their greatest gifts)

Sometimes an explanation can provide more for the sufferer than pills (consider how you felt going through that difficult faith period

Front 9

Western narratives fit in with 'monochromic' time and the history is organised into a linear form with clear beginning, duration, and end

Back 9

Helman 2007

Front 10

In the west, patient does most of the talking - unusual and can make patients uneasy

Back 10

Helman 2007

Front 11

When we are busy and feel disordered, we make lists to gain a perspective. Verbalising the narrative helps us do a similar thing for illnesses, especially chronic illnesses

Back 11

Kleinman

Front 12

Chronic illnesses sock up personal and social significance from the world of the sick person

Back 12

Kleinman 1988

Front 13

We rarely question the fidelity of our bodies. Chronic illnesses are a betrayal of our trust in them

Back 13

Kleinman

Front 14

Chronic illnesses are so widespread (if not us, parents, grandparents, children). With such a ubiquitous problem, it is a marvel society denies chronic illnesses and keep this normal aspect of life so hidden

Back 14

Helman 2007

The person on the train next to you might have one

Front 15

Experience of chronic illness often converts the once born into the twice born

Back 15

Helman (2007)

Front 16

Most of us figure out our own thoughts by speaking them to the persons whose reactions are *as important to us as our own*

Back 16

Helman 2007

Front 17

The personal and professional (disease) interests of the clinician can strongly influence the illness interpretation

Back 17

Helman 2007

Front 18

HOW doctors listen to accounts CONSTRAIN THE TELLING AND THE HEARING

Minor head nods, fidgets or looks influence how the patient tells the illness story

Back 18

Helman 2007

(the busy surgeon, the private GP, the exhausted intern)

The priorities of the practitioner lead to selective attention of the patient's account

Front 19

Western doctors given an 'over literal' training.

Back 19

Helman 2007

Front 20

'From a hospital bed you can tell a good deal about the quality of a nurse within moments of her entering the room, the vague look round and nothing done, or the sharp eye for comfort, a full bottle or a strained look ARE CHARACTERISTICS WHICH ILL PEOPLE WITH TIME ON THEIR HANDS TAKE IN AT A GLANCE

Back 20

David Waldron Smithers

There is huge appreciation in the doctor who has time for you, the porter who has a line in friendly back chat, THE ABSENCE OF TOO MANY REGULATIONS

Front 21

Often pts described as 'your typical type of patient' a 'bad historian' and doctors resent and wish to rush the emotional features of the narrative - culture needs changing

Back 21

Kleinman 1988

Front 22

Liza in Checkov's story has somatic symptoms because she is unable to voice her narrative

Back 22

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Front 23

Prof. Kirby (leading prostate surgeon) on being diagnosed with prostate cancer

Back 23

• Told colleagues about his diagnosis: He told his colleagues during a weekly team meeting the day after his biopsy results. "They were interested," he says. "Nobody was emotional. It was just another case, although it was a bit weird that it was me."

I think I'll be much more careful about explaining things to patients now," he reflects. "Dealing with the catheter can be pretty uncomfortable, and then waiting for the pathology, and for this PSA result – these are proper anxieties

Maybe if we could force doctors to be ill...