Director Ang Lee comments on Ms Chen's accomplishment as the following: "What's so wonderful about Chen's achievement is not its extraordinariness but that it is so simple and matter of fact in its generosity. "Money serves its purpose only when it is used for those who need it,""
Words rather than drugs are the efficacious remedy. Careful history-taking actually saves time.
The first touch, when doctor meets patient, should be the handshake-a greeting of welcome.
Doctor's oldest skill was the laying-on of hands. with the passage of time, this simple act of compassion was transformed into an art. Eventually it grew into a scientific skill, and the hand became an important diagnostic instrument.
Further helping to connect doctor and patient, it was a confidence-promoting measure.
Every affection of the mind that is attended with either pain or pleasure, hope or fear, is the cause of an agitation whose influence extends to the heart.
How true healers use sympathetic listening and touch to hone their diagnostic skills, how language affects the perception of illness, how doctors and patients can cultivate a relationship of trust, and how patients can obtain the most complete and beneficial care through a combination of healing techniques and conventional practices.
The art of healing does not mean abandoning the spectacular advances of modern science, but rather incorporating them into a sensitive, humane, enlightened approach to medical care. With its urgent message and poignant, fascinating vignettes, the art of healing is vital.
《The Lost Art of Healing》Bernard Lown, M.D / winner of the Nobel peace prize
Acknowledgments
I learned that a story charged with human interest is far more educational than a disembodied fact.
My ultimate educators have been numerous patients, many of whom populate this book. They continue to inspire and sustain me. An institution’s dedication to innovative medical research need not diminish its capacity to provide excellent care for the sick.
My association with the HSPH (Harvard School of Public Health) enlarged my perspective on health and the primacy of its social dimension. The HSPH above all provided me with a favorable environment for carrying out extensive research, some of which is reported in this book. These investigations would not have been possible without the unstinting support of Dr. Fredrick Stare, chairman of the Department of Nutrition, where all my investigative work was conducted.
Introduction
Patients will not acquiesce to the ultimate alienation of being reduced to standardized objects. No one will accept for long being merely identified by their illness, as nothing but an assemblage of broken down biologic parts. Patients crave a partnership with their physicians who are as sensitive to their aching souls as to their malfunctioning anatomy. They yearn not for a tautly drafted business contract but for a covenant of trust between equals earned by the doctor while exercising the art of caring.
The book provides a compass, a way out of the thick underbrush or confusing hype by depicting a type of medicine in which the human presence is central to scientific ministrations-modern health care with a human face.
Preface
What is ailing our health care system?
May I never forget that the patient is a fellow creature in pain? May I never consider him merely a vessel of disease?
The doctor is a spectator to a sweeping panorama of events that constitutes a mirror of the social and cultural history of an era. I have often felt guilty about billing patients. Rarely is one permitted to gain such intimate insight. No pleasure is quite akin to the joy of helping other human beings secure and lengthen their hold on life. This book is a small recompense to my patients, ultimately my greatest teachers, who helped me to become a doctor.
Ⅰ Hearing the Patient: The Art of Diagnosis 1. The Science of History-Taking and the Art of Listening 2. Listening through Touching 3. Mind and Heart 4. Münchausen’s Syndrome
Ⅱ Healing the Patient: The Art of Doctoring 5. Words That Maim 6. Words That Heal 7. Hearts of Darkness, Words of Light 8. The Power of Certainty 9. Extraordinary Healing Techniques 10.Malpractice Corrupts Healing
Ⅲ Healing the Patient: Science 11.Digitalis: The Price of Invention 12.A New Medical Tradition 13.The Shock That Cures: DC and Cardioversion 14.The Coronary Care Unit 15.The Ventricular Extrasystole: Heartthrob or Harbinger?
Ⅳ Incurable Problems 16.Caring for the Elderly: Problems and Challenges 17.Death and Dying
Ⅴ The Rewards of Doctoring 18.A Modern Hasidic Tale
VI The Art of Being a Patient 19.Getting Doctors to Listen
1. The Science of History-Taking and the Art of Listening
- Staring at the ceiling Listening is not passive. A doctor’s history-taking is a carefully structured interview that systematically reviews the present illness, family history, then encountering a new patient, the doctor is taught to focus on the chief complaint, namely, what brings the patient to the doctor.
- The Chief Complaint Words rather than drugs are the efficacious remedy. Careful history-taking actually saves time.
Doctors focus on the chief complaint primarily because medical schools do not train students in the art of listening. If everything else fails, talk to the patient. Probing beyond the chief complaint requires time. The history provides soft data while a doctor craves solid facts.
Technology is regarded as an effective substitute for time.
Limiting history-taking to the chief complaint often initiates fruitless pursuit of irrelevant matters that are quite tangential to the main problems.
The Hidden Clue
I am convinced that listening beyond the chief complaint is the most effective, quickest, and least costly way to get to the bottom of most medical problems. A British study showed that 75 percent of the information leading to a correct diagnosis comes from a detailed history.
The solution would never have been unearthed without the information the patient provided.
Words of Wives
Without the spouse, vital information is often forgotten; embarrassing issues are evaded.
- Chest Pain from Heartache Attentive history-taking does more than add details. It is the most important aspect of doctoring. While obtaining a history takes time, no time is more productively spent. Ultimately it lays the foundation for a human relationship between patient and doctor based on mutual respect. The time invested is but a small sacrifice for curing as well as healing.
2. Listening through Touching
Touching is the oldest and most effective tool in doctoring. Touching is a means for gaining significant insights.
A stranger a few minutes earlier opens up with intimacies usually earned only through long and trusting friendship.
The first touch, when doctor meets patient, should be the handshake-a greeting of welcome.
Doctor's oldest skill was the laying-on of hands. with the passage of time, this simple act of compassion was transformed into an art. Eventually it grew into a scientific skill, and the hand became an important diagnostic instrument.
Further helping to connect doctor and patient, it was a confidence-promoting measure. Scientific progress and technological innovations do not mandate jettisoning those qualities which enhance intimacy and promote caring. “Medicine is no longer the laying on of hands, it is more like reading signals from machines. “ What must be deplored is the loss of the close bond between doctor and patient.
3. Mind and Heart Every affection of the mind that is attended with either pain or pleasure, hope or fear, is the cause of an agitation whose influence extends to the heart.
An encounter with a Münchausen patient is consistently chastening and disconcerting, leaving the deluded physician troubled about the workings of the human mind. Sam was a man with festering leg sores, ulcers of the foot, and bad phlebitis, which was the source of recurrent blood clots that propagated to the lungs, endangering his life. I ministered to him as a medical junior resident at the Montefiore Hospital in New York. Sam, yet so afflicted, tore at my vitals. His left leg looked as if he had stepped on a land mine. After weeks of soaks and local and intravenous antibiotics, healthy-looking granulation tissue covered the sores. No sooner did the leg heal than it would mysteriously break open again, streaming with smelly pus. During such recurrences he had a high fever, sharp rises in blood count, and shaking chills. Sam would then scream as though tortured, calming down only after receiving large doses of morphine to which he had grown addicted.
Far worse are the cases of Munchausen by proxy, in which small children are victimized with a simulated illness by a parent. In one such case, a mother brought a small baby to a hospital with the complaint of excessive drowsiness and fecal vomiting. An extensive examination found the baby to be normal; sleuthing revealed that the mother was feeding the baby sedatives and its own feces.
Perhaps it is a credit to medical practitioners that they are so often fooled by those with Müuncharsen’s syndrome, for the doctor should trust a patient’s tale, just as the law assumes a person is innocent until guilt is established beyond a reasonable doubt. Understandably, this can lead an unsuspecting well-trained physician to be caught in a web of incredible deception. As the art of listening atrophies, as medicine becomes increasingly beholden to technology that cannot possibly detect the warped working of the human mind, Munchausen patients will become more successful in the past.
6 則留言:
Director Ang Lee comments on Ms Chen's accomplishment as the following:
"What's so wonderful about Chen's achievement is not its extraordinariness but that it is so simple and matter of fact in its generosity. "Money serves its purpose only when it is used for those who need it,""
在水木書店隨手買了這本書、也讀了這本書：《Churchill》中譯本《邱吉爾─樂在危險的人生》。邱吉爾不太把時間和精力浪費在人生卑微、下等的一面：像是反控卸責、仇視敵意、睚眥必報、要陰險手段、散播謠言中傷、怨恨芥蒂、挾怨報復等等。怨恨是最消磨人心、精力的情緒。敵意則會蒙蔽判斷。他以德報怨，拿友誼代換仇恨。由於邱吉爾從來不懷怨懟，他的人生自然空出許多地方，可以填滿喜樂。邱吉爾感情豐富，容易掉淚，但眼淚掉一下就乾，歡樂就又重新湧入。他從世人的身上汲取力量，也用盡全力把力量奉還給世人。
靜靜閱讀幾段影片英雄不凡的光輝，心中自忖平日的庸俗與懦弱，願見賢思齊，向幾位英雄學習智慧與勇氣。將「思」的角度延伸到福門主人，看見主人落實「行」，傳遞寬大為懷與高度成就別人的正面力量。謝謝主人慈心，這慈心似如歌的行板，讓人如沐春風，又似天使靈糧，滋養人性之真善美。慈心，台灣最需要的健康心跳。
* Part of abstract:
Words rather than drugs are the efficacious remedy. Careful history-taking actually saves time.
The first touch, when doctor meets patient, should be the handshake-a greeting of welcome.
Doctor's oldest skill was the laying-on of hands. with the passage of time, this simple act of compassion was transformed into an art. Eventually it grew into a scientific skill, and the hand became an important diagnostic instrument.
Further helping to connect doctor and patient, it was a confidence-promoting measure.
Every affection of the mind that is attended with either pain or pleasure, hope or fear, is the cause of an agitation whose influence extends to the heart.
How true healers use sympathetic listening and touch to hone their diagnostic skills, how language affects the perception of illness, how doctors and patients can cultivate a relationship of trust, and how patients can obtain the most complete and beneficial care through a combination of healing techniques and conventional practices.
The art of healing does not mean abandoning the spectacular advances of modern science, but rather incorporating them into a sensitive, humane, enlightened approach to medical care. With its urgent message and poignant, fascinating vignettes, the art of healing is vital.
【閱讀筆記分享】
《The Lost Art of Healing》Bernard Lown, M.D / winner of the Nobel peace prize
Acknowledgments
I learned that a story charged with human interest is far more educational than a disembodied fact.
My ultimate educators have been numerous patients, many of whom populate this book. They continue to inspire and sustain me.
An institution’s dedication to innovative medical research need not diminish its capacity to provide excellent care for the sick.
My association with the HSPH (Harvard School of Public Health) enlarged my perspective on health and the primacy of its social dimension. The HSPH above all provided me with a favorable environment for carrying out extensive research, some of which is reported in this book. These investigations would not have been possible without the unstinting support of Dr. Fredrick Stare, chairman of the Department of Nutrition, where all my investigative work was conducted.
Introduction
Patients will not acquiesce to the ultimate alienation of being reduced to standardized objects. No one will accept for long being merely identified by their illness, as nothing but an assemblage of broken down biologic parts. Patients crave a partnership with their physicians who are as sensitive to their aching souls as to their malfunctioning anatomy. They yearn not for a tautly drafted business contract but for a covenant of trust between equals earned by the doctor while exercising the art of caring.
The book provides a compass, a way out of the thick underbrush or confusing hype by depicting a type of medicine in which the human presence is central to scientific ministrations-modern health care with a human face.
Preface
What is ailing our health care system?
May I never forget that the patient is a fellow creature in pain? May I never consider him merely a vessel of disease?
The doctor is a spectator to a sweeping panorama of events that constitutes a mirror of the social and cultural history of an era. I have often felt guilty about billing patients. Rarely is one permitted to gain such intimate insight. No pleasure is quite akin to the joy of helping other human beings secure and lengthen their hold on life. This book is a small recompense to my patients, ultimately my greatest teachers, who helped me to become a doctor.
Content
Ⅰ Hearing the Patient: The Art of Diagnosis
1. The Science of History-Taking and the Art of Listening
2. Listening through Touching
3. Mind and Heart
4. Münchausen’s Syndrome
Ⅱ Healing the Patient: The Art of Doctoring
5. Words That Maim
6. Words That Heal
7. Hearts of Darkness, Words of Light
8. The Power of Certainty
9. Extraordinary Healing Techniques
10.Malpractice Corrupts Healing
Ⅲ Healing the Patient: Science
11.Digitalis: The Price of Invention
12.A New Medical Tradition
13.The Shock That Cures: DC and Cardioversion
14.The Coronary Care Unit
15.The Ventricular Extrasystole: Heartthrob or Harbinger?
Ⅳ Incurable Problems
16.Caring for the Elderly: Problems and Challenges
17.Death and Dying
Ⅴ The Rewards of Doctoring
18.A Modern Hasidic Tale
VI The Art of Being a Patient
19.Getting Doctors to Listen
Ι Healing the Patient: The Art of Diagnosis
1. The Science of History-Taking and the Art of Listening
- Staring at the ceiling
Listening is not passive. A doctor’s history-taking is a carefully structured interview that systematically reviews the present illness, family history, then encountering a new patient, the doctor is taught to focus on the chief complaint, namely, what brings the patient to the doctor.
- The Chief Complaint
Words rather than drugs are the efficacious remedy. Careful history-taking actually saves time.
Doctors focus on the chief complaint primarily because medical schools do not train students in the art of listening. If everything else fails, talk to the patient. Probing beyond the chief complaint requires time. The history provides soft data while a doctor craves solid facts.
Technology is regarded as an effective substitute for time.
Limiting history-taking to the chief complaint often initiates fruitless pursuit of irrelevant matters that are quite tangential to the main problems.
The Hidden Clue
I am convinced that listening beyond the chief complaint is the most effective, quickest, and least costly way to get to the bottom of most medical problems. A British study showed that 75 percent of the information leading to a correct diagnosis comes from a detailed history.
The solution would never have been unearthed without the information the patient provided.
Words of Wives
Without the spouse, vital information is often forgotten; embarrassing issues are evaded.
- Chest Pain from Heartache
Attentive history-taking does more than add details. It is the most important aspect of doctoring. While obtaining a history takes time, no time is more productively spent. Ultimately it lays the foundation for a human relationship between patient and doctor based on mutual respect. The time invested is but a small sacrifice for curing as well as healing.
2. Listening through Touching
Touching is the oldest and most effective tool in doctoring. Touching is a means for gaining significant insights.
A stranger a few minutes earlier opens up with intimacies usually earned only through long and trusting friendship.
The first touch, when doctor meets patient, should be the handshake-a greeting of welcome.
Doctor's oldest skill was the laying-on of hands. with the passage of time, this simple act of compassion was transformed into an art. Eventually it grew into a scientific skill, and the hand became an important diagnostic instrument.
Further helping to connect doctor and patient, it was a confidence-promoting measure.
Scientific progress and technological innovations do not mandate jettisoning those qualities which enhance intimacy and promote caring. “Medicine is no longer the laying on of hands, it is more like reading signals from machines. “ What must be deplored is the loss of the close bond between doctor and patient.
3. Mind and Heart
Every affection of the mind that is attended with either pain or pleasure, hope or fear, is the cause of an agitation whose influence extends to the heart.
4. Münchausen’s Syndrome(孟喬森氏症候群)
這種患者會偽裝或製造自身的疾病來贏得同情照顧或控制他人，另外有一種是代理性孟喬森氏症候群或代理性佯病症，正式的定義是照顧者捏造或誘發被照顧者的身心疾病。通常是母親對子女是一種最複雜也最致命的的虐待形式，在美國通常在案例被發現時可能子女當中有人死亡，當同一個家庭有第二、三個孩子時，專業人員才會警覺到母親的愛也可能扭曲成怪異的致病性虐待，且這種虐待不似毆打或性侵害那麼容易歸類，孩子往往不是在父母親心中的遊樂場長大，而是不斷奔走於醫院，生活重心完全建立在虛構的疾病上，照顧者與醫師成了幫兇，醫師往往成為為不知情的幫兇他們往往相信家屬說的話，因此醫師必須在心態上有很大的調整才能看清事實。事實上，家長的敘述都可能不正確，檢查結果是正常的，任何治療都沒有效，而且再多的檢查也不夠，因為家長就是加害者，最高明的謊言未必是真假參半，有些孩子的確會表現出若干症狀，但引發的症狀通常被加害者隱匿。在美國曾經有一案例一名小孩從三歲開始不斷生病，母親發現當別人稱讚她很辛苦努力時，她從中獲得希望努力被人認同的感受，因之，開始不斷加害自己的女兒，像是給小孩吃不乾淨的食物讓小孩生病，這種情況持續將近十年，後來被醫護人員發現母親在餵食時是用餵食管打到胃，發現在餵食管中發現有病菌，後來才知道母親竟然把糞便打到餵食管內，造成小孩無數次開刀檢查都查不出病因。(資料查自網路，類似故事在本書中，網路之資料是否是取自本書？)
An encounter with a Münchausen patient is consistently chastening and disconcerting, leaving the deluded physician troubled about the workings of the human mind.
Sam was a man with festering leg sores, ulcers of the foot, and bad phlebitis, which was the source of recurrent blood clots that propagated to the lungs, endangering his life. I ministered to him as a medical junior resident at the Montefiore Hospital in New York. Sam, yet so afflicted, tore at my vitals. His left leg looked as if he had stepped on a land mine. After weeks of soaks and local and intravenous antibiotics, healthy-looking granulation tissue covered the sores. No sooner did the leg heal than it would mysteriously break open again, streaming with smelly pus. During such recurrences he had a high fever, sharp rises in blood count, and shaking chills. Sam would then scream as though tortured, calming down only after receiving large doses of morphine to which he had grown addicted.
Porphyrias紫質症
紫質症大部分是一種顯性的遺傳疾病，這種遺傳疾病的病因乃在於合成血紅素中心架構-血基質(heme)的脢出現了異常所致，造成血基質前趨物在體內堆積，而這些化合物對人體是具有毒性的，依照所缺乏脢的不同，紫質症可以大致分為三種。(資料查自網路)
Far worse are the cases of Munchausen by proxy, in which small children are victimized with a simulated illness by a parent. In one such case, a mother brought a small baby to a hospital with the complaint of excessive drowsiness and fecal vomiting. An extensive examination found the baby to be normal; sleuthing revealed that the mother was feeding the baby sedatives and its own feces.
Perhaps it is a credit to medical practitioners that they are so often fooled by those with Müuncharsen’s syndrome, for the doctor should trust a patient’s tale, just as the law assumes a person is innocent until guilt is established beyond a reasonable doubt. Understandably, this can lead an unsuspecting well-trained physician to be caught in a web of incredible deception. As the art of listening atrophies, as medicine becomes increasingly beholden to technology that cannot possibly detect the warped working of the human mind, Munchausen patients will become more successful in the past.
後記：不便占用太大篇幅，對本書有興趣的朋友，可在博客來購得本書。本書中譯本由畢業於國立台灣大學外國語文學系的李元春先生翻譯 / 台大醫院麻醉部心臟血管胸腔麻醉科主任暨台大醫學院專任副教授，王明鉅先生審訂。(然而，一個月前去電查詢，本書中譯本已不再出版。)
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