{"title":"少即是多:探索看 \"这个病人 \"而非 \"这样的病人 \"的意义。","authors":"M Bobbio, M Chiarlo, P Arcadi, E Kidd","doi":"10.1007/s11673-024-10378-4","DOIUrl":null,"url":null,"abstract":"<p><p>In the last decade literature focused on a \"less is more\" approach has been primarily represented by clinical cases describing the excesses of an aggressive, redundant, non-personalized, and non-respectful medicine. Most of these articles focus on a \"more is worse\" approach and centre around the downstream negative consequences of medical overuse. Having identified a gap in the literature on the experience and practice of less, rather than the harms of excess, we carried out an exploratory qualitative study into how a \"less is more\" approach works in practice. A hermeneutic phenomenological approach was adopted to allow us to examine the realm of lived experience as a valid data source and as a path from which to understand a \"less is more\" approach \"from the bedside.\" A Phenomenology of Practice was chosen as a more specific frame for this research because of its added focus on action and practical application in professional settings. Seventy stories written by physicians, patients, nurses, caregivers, and other health professionals have been received and analysed. These stories were gathered as part of a project called \"Slow Stories\" which aimed to collect clinical cases that have been positively resolved by adopting a \"less is more\" approach to patient care. After having conducted an in-depth analysis, separately and as a group, the researchers identified five key phenomenological themes; Time to relate is time to heal; Doing more does not mean doing better; Settings for a slow medicine; Slow care at the end of life; and Personalized vs. standardized treatment. Each of these themes offers insights into how a \"less is more\" approach can be used in practice and illustrates how a \"less is more\" strategy can play a significant role in positively resolving certain clinical cases.</p>","PeriodicalId":50252,"journal":{"name":"Journal of Bioethical Inquiry","volume":null,"pages":null},"PeriodicalIF":1.8000,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Practising Less is More: An Exploration of What it Means to See \\\"This Patient\\\" Not a \\\"Patient Like This\\\".\",\"authors\":\"M Bobbio, M Chiarlo, P Arcadi, E Kidd\",\"doi\":\"10.1007/s11673-024-10378-4\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>In the last decade literature focused on a \\\"less is more\\\" approach has been primarily represented by clinical cases describing the excesses of an aggressive, redundant, non-personalized, and non-respectful medicine. Most of these articles focus on a \\\"more is worse\\\" approach and centre around the downstream negative consequences of medical overuse. Having identified a gap in the literature on the experience and practice of less, rather than the harms of excess, we carried out an exploratory qualitative study into how a \\\"less is more\\\" approach works in practice. A hermeneutic phenomenological approach was adopted to allow us to examine the realm of lived experience as a valid data source and as a path from which to understand a \\\"less is more\\\" approach \\\"from the bedside.\\\" A Phenomenology of Practice was chosen as a more specific frame for this research because of its added focus on action and practical application in professional settings. Seventy stories written by physicians, patients, nurses, caregivers, and other health professionals have been received and analysed. These stories were gathered as part of a project called \\\"Slow Stories\\\" which aimed to collect clinical cases that have been positively resolved by adopting a \\\"less is more\\\" approach to patient care. After having conducted an in-depth analysis, separately and as a group, the researchers identified five key phenomenological themes; Time to relate is time to heal; Doing more does not mean doing better; Settings for a slow medicine; Slow care at the end of life; and Personalized vs. standardized treatment. Each of these themes offers insights into how a \\\"less is more\\\" approach can be used in practice and illustrates how a \\\"less is more\\\" strategy can play a significant role in positively resolving certain clinical cases.</p>\",\"PeriodicalId\":50252,\"journal\":{\"name\":\"Journal of Bioethical Inquiry\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2024-09-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Bioethical Inquiry\",\"FirstCategoryId\":\"98\",\"ListUrlMain\":\"https://doi.org/10.1007/s11673-024-10378-4\",\"RegionNum\":3,\"RegionCategory\":\"哲学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ETHICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Bioethical Inquiry","FirstCategoryId":"98","ListUrlMain":"https://doi.org/10.1007/s11673-024-10378-4","RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ETHICS","Score":null,"Total":0}
Practising Less is More: An Exploration of What it Means to See "This Patient" Not a "Patient Like This".
In the last decade literature focused on a "less is more" approach has been primarily represented by clinical cases describing the excesses of an aggressive, redundant, non-personalized, and non-respectful medicine. Most of these articles focus on a "more is worse" approach and centre around the downstream negative consequences of medical overuse. Having identified a gap in the literature on the experience and practice of less, rather than the harms of excess, we carried out an exploratory qualitative study into how a "less is more" approach works in practice. A hermeneutic phenomenological approach was adopted to allow us to examine the realm of lived experience as a valid data source and as a path from which to understand a "less is more" approach "from the bedside." A Phenomenology of Practice was chosen as a more specific frame for this research because of its added focus on action and practical application in professional settings. Seventy stories written by physicians, patients, nurses, caregivers, and other health professionals have been received and analysed. These stories were gathered as part of a project called "Slow Stories" which aimed to collect clinical cases that have been positively resolved by adopting a "less is more" approach to patient care. After having conducted an in-depth analysis, separately and as a group, the researchers identified five key phenomenological themes; Time to relate is time to heal; Doing more does not mean doing better; Settings for a slow medicine; Slow care at the end of life; and Personalized vs. standardized treatment. Each of these themes offers insights into how a "less is more" approach can be used in practice and illustrates how a "less is more" strategy can play a significant role in positively resolving certain clinical cases.
期刊介绍:
The JBI welcomes both reports of empirical research and articles that increase theoretical understanding of medicine and health care, the health professions and the biological sciences. The JBI is also open to critical reflections on medicine and conventional bioethics, the nature of health, illness and disability, the sources of ethics, the nature of ethical communities, and possible implications of new developments in science and technology for social and cultural life and human identity. We welcome contributions from perspectives that are less commonly published in existing journals in the field and reports of empirical research studies using both qualitative and quantitative methodologies.
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