Integrated narrative and evidence based case report: Case report of paroxysmal atrial fibrillation and anticoagulation

doi:10.1136/bmj.325.7371.1018

BMJ 2002;325:1018-1020 ( 2 November )

Clinical review

Integrated narrative and evidence based case report

Case report of paroxysmal atrial fibrillation and anticoagulation

Shmuel Reis, chairperson ^a, Doron Hermoni, director ^b, Pnina Livingstone, bibliotherapist ^c, Jeffrey Borkan, vice chairman ^d.

^a Section of Family Medicine, B Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel, ^b Department of Family Medicine, B Rappaport Faculty of Medicine and Clalit Health Services, Haifa and Western Galilee District, Haifa, ^c Department of Child and Adolescent Psychiatry, R Sieff Hospital, Safed, Israel, ^d Division of Behavioral Sciences, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Correspondence to: S Reis Reis@netvision.net.il

The first 150 words of the full text of this article appear below.

Evidence based medicine and narrative based medicine rarely meet, and they may conflict, ¹ ² but in clinical care theyare complementary.^3-5 Some attempts to integrate the two approacheshave not considered the doctor's story, which is often criticalto understanding a case. ⁶ ⁷

This paper tries to bridge gaps between a patient's and doctor's narratives and the evidence. It is the story of a patientin our practice (see box) who has produced written narrativesabout her illness and shared them with her family physician (SR).We use the narratives to decide on the best evidence based treatmentfor paroxysmal atrial fibrillation after corrected tetralogy ofFallot.

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We searched Medline between December 1999 and May 2000 with the keywords atrial fibrillation (paroxysmal), tetralogy of Fallot,atrial arrhythmia, anticoagulation, primary care, family medicine,general practice, and ambulatory medicine. We also searched www.goldenhour.co.il(an Israeli website that includes evidence basedmedicine).

We found no important evidence . . . [Full text of this article]

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Syncope after repair of Fallot's tetralogy: David E Ward
bmj.com, 6 Nov 2002 [Full text]
Paroxysmal atrial fibrillation and fainting: Mark L Mallet
bmj.com, 9 Nov 2002 [Full text]
Evidence based practice DOES incorporate patients' values: Kevork Hopayian, et al.
bmj.com, 10 Nov 2002 [Full text]
Narrative medicine doesn't reflect evidence for anticoagulation: Christopher I. Price
bmj.com, 23 Nov 2002 [Full text]