'A local habitation and a name': how narrative evidence-based medicine transforms the translational research paradigm

Rishi K Goyal, Rita Charon, Helen-Maria Lekas, Mindy T Fullilove, Michael J Devlin, Louise Falzon, Peter C Wyer
Journal of Evaluation in Clinical Practice 2008, 14 (5): 732-41

RATIONALE: We propose narrative evidence-based medicine as a necessary elaboration of the NIH translational research roadmap. The roadmap defined two complex obstacles, T1 and T2, to the progress of research from the 'bench' or basic laboratory science to the 'bedside' or clinical application, the traversal of which requires emergence of complex transformative relationships between the parties and stakeholders. It fails to encompass patient interactions, hesitancies and alliances with medical care.

AIMS AND OBJECTIVES: We suggest a third transformative or translational step, T3, that begins at the point that practitioners have themselves elected to adopt and recommend strategies and interventions based on high-level evidence and guidelines. In our model, T3 encompasses all aspects of care that converge on the practitioner-patient relationship and ultimately determine what therapies and choices patients actually make regarding their care.

RESULTS: Learning from the biopsychosocial model, patient-centred care and shared decision making while attending to the ethical injunction of Emmanuel Levinas to know the other, we have developed a medical practice and theory that unites the local and specific concerns of narrative medicine with the generalizability and power of evidence-based medicine.

CONCLUSIONS: We offer innovative approaches to study, teach and improve the therapeutic intimacy and integrative effectiveness of the practitioner-patient relationship.


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