Medicina narrativa enfocada a la investigación empírica social: el contexto ruso

Vitaly Lekhtsier Doctor en Filosofía. Profesor, Departamento de Sociología, Universidad Nacional de Investigación de Samara, Federación Rusa. image/svg+xml , Anna Gotlib Doctora en Sociología. Profesora, Departamento de Sociología, Universidad Nacional de Investigación de Samara, Federación Rusa. image/svg+xml
Recibido: 27 September 2016, Aceptado: 21 March 2017, Publicado: 17 July 2017 Open Access
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Resumen


Este artículo presenta los resultados de un análisis empírico llevado a cabo entre 2012 y 2016, que buscó entender si las narrativas de los pacientes están presentes en la comunicación médico-paciente y si esta historia subjetiva es significativa para ambos lados de la comunicación médica en la medicina somática rusa. La investigación se realizó en cuatro etapas y combinó métodos cualitativos y cuantitativos, analizando las perspectivas de pacientes, médicos y estudiantes de medicina a través de encuestas y entrevistas e indagando además en la comunicación médico-paciente en foros virtuales. En las cuatro etapas, los resultados de la investigación mostraron que se otorga poco valor a la experiencia subjetiva de la enfermedad en las interacciones entre médicos y pacientes. El tema de la medicina narrativa es inexplorado en los estudios sociales rusos, por lo que los resultados de esta investigación constituyen una contribución importante en pos de establecer la medicina narrativa como una idea global que promueve el valor universal en términos terapéuticos y éticos de las historias de enfermedad en la “sociedad de remisión”, en el cual dominan las patologías crónicas.


Referencias bibliográficas


1. Mishler EG. The discourse of medicine: Dialectics of medical interviews. Norwood: Ablex Publishing Company; 1984.

2. Frank A. At the will of the body: Reflections on illness. New York: Mariner Books; 2002.

3. Frank A. Wounded storyteller: body, illness, and ethics. Chicago: University Of Chicago Press; 1997.

4. Brody H. Stories of sickness. New Haven: Yale University Press; 1997.

5. Kleinman A. The illness narratives: Suffering, healing, and the human condition. New York: Basic Books; 1988.

6. Hunter KM. Doctor's Stories: the narratives structure of medical knowledge. Princeton: Princeton University Press; 1991.

7. Hawkins AH. Reconstructing illness: Studies in pathography. 2nd ed. West Lafayyette: Purdue Univesity Press; 1998.

8. McClellan MF, Jones AH. Why literature and medicine? Lancet. 1996;348(9020):109-111.

9. Greenhalgh T, Hurwitz B. Narrative based medicine: Dialogue and discourse in clinical practice. London: BMJ; 1998.

10. Greenhalgh T, Hurwitz B. Narrative based medicine: why study narrative? BMJ. 1999;318(7175): 48-50.

11. Charon R, Montello M, (ed.) Stories matter: The role of narrative in medical ethics. New York: Routledge; 2002.

12. Paulsen JE. A narrative ethics of care. Health Care Analysis. 2011;19(1):28-40.

13. Eisenberg L. Disease and Illness: distinctions between professional and popular ideas of sickness. Culture, Medicine and Psychiatry. 1977;1(1):9-23.

14. Dyorner K. Horoshiy vrach: Uchebnik osnovnoy pozitsii vracha [A good doctor: The textbook of the main position of the doctor]. Saint Petersburg: Aletheia; 2006.

15. Charon R. Narrative medicine: Honoring the stories of illness. New York: Oxford University Press; 2006.

16. Doklad o sostoyanii zdorovya naseleniya i organizatsii zdravookhraneniya po itogam deyatelnosti organov ispolnitel'noi vlasti sub ektov Rossiyskoi Federatsii za 2014 god [The report on the state of health of the population and the organization of health care on the basis of the activities of the executive authorities of the constituent entities of the Russian Federation in 2014] [Internet]. 2015 [citado 15 sep 2015]. Disponible en: http://tinyurl.com/lwknsmd

17. Aronson P. Utrata institutsional'nogo doveriya v rossiiskom zdravookhranenii [Loss of institutional trust in Russian health care]. Zhurnal Sotsiologii i Sotsial'noi Antropologii. 2006;9(35):120-131.

18. Zdravomyslova E, Temkina A, (ed). Zdorov'e i doverie: gendernyj podhod k reproduktivnoj medicine [Health and trust: a gender approach to reproductive medicine]. Saint Petersburg: Izdatel'stvo Evropejskogo Universiteta v Sankt-Peterburge; 2009.

19. Kuz'min KV, Semenova EV, Petrova LE, Zakroeva AG. Kommunikatsiya vracha i patsienta: proshloe, nastoyashchee, budushchee (istoricheskiy i mediko-sotsiologicheskiy analiz) [Doctor-patient communication: the past, the present, the future (historical and medico-sociological analysis]. Ekaterinburg: Izdatel'stvo Ural'skogo gosudarstvennogo meditsinskogo universiteta; 2016.

20. Reshetnikov AV. Sotsiologiya meditsiny (vvedenie v nauchnuyu distsiplinu): Rukovodstvo [Sociology of Medicine (introduction to scientific discipline): Guidance]. Moscow: Meditsina; 2002.

21. Magazanik NA. Iskusstvo obshcheniya s bol'nym [The art of communicating with the sick]. Moscow: Meditsina; 1991.

22. Rogozhnikova RA, Dzaraeva NA, Gridina VO. Distsiplinirovannost' i konfliktnaya kompetentnost' vracha [Discipline and conflic competence of the doctor]. Moscow: Meditsinskaya kniga, Izd-vo ITMA; 2005.

23. Chirikova AE, Shishkin SV. Vzaimodeistvie vrachei i patsientov v sovremennoi Rossii: vektory izmenenii [Interaction of doctors and patients in modern Russia: the vectors of change]. Mir Rossii. 2014;2:154-182.

24. Zhura VV. Diskursivnaya kompetentsiya vracha v ustnom meditsinskom obshchenii. Monografiya [Discursive competence of a doctor in oral medical communication. Monograph]. Volgograd: Dar-Ko; 2008.

25. Barsukova MI. Meditsinskiy diskurs: strategii i taktiki rechevogo povedeniya vracha [Medical discourse: strategies and tactics of speech behavior of a doctor]. Saratov: Saratovskij gosudarstvennyj universitet im NG Chernyshevskogo; 2007.

26. Gotlib AS. Sub'ektivnyie smyislyi bolezni, ih realizatsiya v otechestvennyih meditsinskih praktikah: opyit empiricheskogo analiza [Subjective meanings of illness and thier realization in Russian medical practices: the experience of empirical analysis]. In: Obschestvo remissii: na puti k narrativnoy meditsine. Samara: Samarskiy universitet; 2012. p.169-191.

27. Gotlib AS. Proekt narrativnoy meditsiny: vozmozhnosti realizatsii v Rossii [The project of narrative medicine: opportunities of implementation in Russia]. In: IV Vserossiyskiy Cotsiologicheskiy Kongress "Sotsiologiya i obshchestvo: global'nye vyzovy i regional'noe razvitie", 23-25 oktyabrya. Ufa: Elektronnoy izdanie; 2012.

28. Lekhtsier VL. Narrativnaya meditsina: svetlaya utopiya doktora Rity Sheron? [Narrative medicine: is it Dr. Rita Sharon's bright utopia?]. In: Obschestvo remissii: na puti k narrativnoy meditsine. Samara: Samarskiy universitet; 2012. p. 110-121.

29. Lekhtsier VL. Narrativnyy povorot i aktual'nost' narrativnogo razuma [Narrative turn and the actuality of the narrative mind]. Mezhdunarodnyy Zhurnal issledovaniy Kul'tury. 2013;1(10):5-8.

30. Morgan DL. Integrative quantitative and qualitative methods: A pragmatic approach. Thousand Oaks: Sage Publications; 2014.

31. Cresswell JW. Research design: quantitative, qualitative, and mixed method approaches. 3rd ed. Thousand Oaks: Sage Publications; 2009.

32. Gotlib A. Kachestvennoe sociologicheskoe issledovanie: poznavatel'nye i jekzistencial'nye gorizonty [Qualitative sociological research: cognitive and existential horizons]. Samara: Univers-grupp; 2004.

33. Minzdrav Rossii. Statistika: Zabolevaemost' vsego naselenija Rossii v 2011 godu. [Russian Ministry of Health. Statistics: The sickness rate of the entire population of Russia in 2011] [Internet]. 17 2012 [citado 22 nov 2012]. Disponible en: http://tinyurl.com/maqhm5p

34. Gepatit forum [Hepatitis-forum] [Internet]. 2009 [citado 10 ene 2015]. Disponible en: http://tinyurl.com/lvjqxff

35. Forum zhizni. Forum obshcheniya bol'nykh lyudei [Forum of life. Forum for sick people communication] [Internet]. 2000 [citado 20 ene 2015]. Disponible en: http://forumjizni.ru/index.php

36. Forum dlya lyudei, zhivushchikh s VICh/SPID [Forum for people living with HIV/AIDS] [Internet]. 2006 [citado 7 oct 2015]. Disponible en: http://hivlife.info/forum.php

37. Forum VICh-infitsirovannykh [Forum of HIV people] [Internet]. [citado 18 oct 2015]. Disponible en: http://tinyurl.com/loleuhw

38. Hine C. Mixed methods and multimodal research and Internet technologies. In: Hesse-Biber SN, Johnson RB, (eds.). The Oxford Handbook of Multimethod and Mixed Methods Research Inquiry. New York: Oxford University Press; 2015. p. 503-521.

39. Polukhina E. Onlain-nablyudenie kak metod sbora dannykh [Online observation as a method of data collection]. INTER: Interaktsiya. Interv'yu. Interpretatsiya. 2014;7:95-106.

40. Kosmarskiy A. Kakovy granitsy vlasti vracha nad telom patsienta? [What are the limits of the physician's power over the patient's body?] [Internet]. 2 mar 2017 [citado 2 mar 2017]. Disponible en: http://tinyurl.com/l6u9eno

41. Mattingly C. The paradox of hope: Journeys through a clinical borderland. Berkeley: University of California Press; 2010.

42. Good B, Good MJ. "Learning Medicine": The constructing of medical knowledge at Harvard Medical School. In: Knowledge, power and practice: The anthropology of medicine and everyday life. Berkeley: University of California Press; 1993. p. 81-107.

43. Tarasenko EA. Patient 2.0: kommunikatsii patsientov i vrachei v sotsial'nykh setyakh [Patient 2.0: communication of patients and doctors in social networks]. In: XIII Mezhdunarodnaya nauchnaya konferentsiya po problemam razvitiya ekonomiki i obshchestva. Moskva: Izdatel'skiy dom Natsional'nyi issledovatel'skii universitet Vysshaya Shkola Ekonomiki; 2012. p. 203-210.