Intended for healthcare professionals

Rapid response to:

Education And Debate Narrative based medicine

Why study narrative?

BMJ 1999; 318 doi: (Published 02 January 1999) Cite this as: BMJ 1999;318:48

Rapid Response:

The Lost Tradition

Greenhalgh and Hurwitz are to be commended for bringing forth to the
general medical audience the concepts of narrative and interpretation.
This series is part of a growing recognition of the interpretive aspects
of medical practice. A recent article by Richard Horton in the Canadian
Medical Association Journal makes a similar argument for the need for
physicians to be cognizant of the interpretive elements of medical
practice.(1) Horton emphasizes the need for reasoning skills and attention
to the importance of argumentation in medical practice.

There is a unifying theme to these papers. Evidence based approaches
are a necessary but not sufficient basis for the adequate training of
physicians. The lost tradition alluded to by Greenhalgh and Hurwitz is not
so deeply hidden. The skills of interpretation and careful conceptual
reasoning are at the heart of humanities training and of philosophy in
particular. Thus far, the contribution of philosophy to medicine has
largely been confined to ethics. However, epistemology(or theory of
knowledge), informal logic and argument analysis and hermeneutics (or
theory of interpretation) have much to contribute to modern medical
training. The tradition is lost largely because most physicians have
little exposure to serious humanities scholarship either prior to medical
school or in the medical curriculum itself.

In so far as evidence based medicine is defined in terms of such
virtues such as judiciousness, conscientiousness and explicitness it is
clear that the time has come for a more robust dialogue on the
relationship between philosophy and medicine.

1.) Horton R. The grammar of interpretive medicine. CMAJ 1998;159:

Competing interests: No competing interests

06 January 1999
Ross Upshur
Assistant Professor Department of Family and Community Medicine
Suunybrook Site, Sunnybrook and Women's College Health Science Centre, Toronto Ontario