Scientific medicine has been successful by ways of an ever more detailed understanding and mastering of bodily functions and dysfunctions. Biomedical research promises new triumphs, but discontent with medical practice is all around. Since several decades this has been acknowledged and discussed. The philosophical traditions of phenomenology and hermeneutics have been proposed as promising ways to approach medical practice, by ways of a richer understanding of the meaning structures of health and illness. In 2000, Swedish philosopher Fredrik Svenaeus published a book where he proposes that the phenomenological hermeneutics of Martin Heidegger and also the reflections on health and illness of Hans-Georg Gadamer offer important ways to approach the nature of medicine. In particular, Svenaeus argues that the goal of medicine is to promote and restore health, and that health ought to be seen as "homelike being-in-the-world". Unhealth, illness, consequently should be understood as a situation where a person's "being-in-the-world" in characterized by that lack of the rhythm, balance and "tune" of everyday living that characterizes not "being at home". In this article, Svenaeus' position is briefly outlined. Questions are raised whether "unhomelikeness" is to be seen as a metaphor, and, if so, if it is a fruitful such. Furthermore, I discuss whether or not a discourse on health and illness in these terms may be misleading in a situation where the ontological presuppositions of Heidegger are lost out of sight and the popular understanding of health psychology predominates. I also approach the question whether Svenaeus' assumptions may inadvertently lead us to an unjustifiably broad understanding of the tasks of medicine. It is finally concluded that Svenaeus phenomenological and hermeneutical approach is both interesting and promising. There are, however, several questions that ought to be pursued further, and the step from philosophical analysis to everyday clinical discourse may be unexpectedly long and risky.
The nature and scope of medical humanities are under debate. Some regard this field as consisting of those parts of the humanistic sciences that enhance our understanding of clinical practice and of medicine as historical phenomenon. In this article it is argued that aesthetic experience is as crucial to this project as are humanistic studies. To rightly understand what medicine is about we need to acknowledge the equal importance of two modes of understanding, intertwined and mutually reinforcing: the mode of aesthetic imagination and the mode of analytical reflection.
Is literary experience of any practical relevance to the clinician? This is the overall question addressed by this investigation, which starts by tracing the historical roots of scientific medicine. These are found to be intimately linked to a form of rationality associated with the scientific revolution of the 17th century and with “modernity”. Medical practice, however, is dependent also on another form of rationality associated with what Stephen Toulmin calls “the epistemology of the biographical”. The very core of clinical medicine is shown to be the clinical encounter, an interpretive meeting where the illness experience is at the centre of attention. The physician can reach the goals of medicine only by developing clinical judgement. Clinical judgement is subjected to close analysis and is assumed to be intimately connected to the form of knowledge Aristotle called phronesis.
In order to explore how literature – drama, novels, poetry – may be related to clinical judgement, a view of literature is presented that emphasizes literature as an invitation to the reader, to be met responsibly and responsively. Literature carries a potential for a widened experience, for a more nuanced perception of reality – and this potential is suggested to be ethically relevant to the practice of medicine. The “narrative rationality” of a literary text constitutes a complement to the rationality pervading scientific medicine.
The final step in my analysis is a closer exploration of the potential of the literary text to contribute to the growth of clinical judgement, in relation to the challenges of everyday clinical work. Some of the conditions that may facilitate such growth are outlined, but it is also shown that full empirical evidence for the beneficial effects of reading on the clinician reader is beyond reach.
When a person falls ill, their experience changes - sometimes in a very minor and transient way, sometimes in a decisive and lasting one. ‘Diagnosis’ is often seen as the process of scientifically and objectively identifying the causes of this subjective experience, but is the process and meaning of ‘diagnosis’ really as simple as this implies?
As this volume of The Medical Humanities Companion argues, diagnoses are an answer to complex human needs that spring from being ill, and are in turn a complex, culturally mediated interaction between individuals, scientific discoveries, social negotiation and historical change. This volume makes visible the complexities and ambiguities involved in giving and receiving diagnoses, and how they shape and are shaped by views on what is real and acceptable, and how people relate to the phenomena of illness.
SammanfattningSyftet med denna kartläggning har varit att ge en nulägesbild över hur riskanalyser, riskbedömningar och riskvärderingar sker i Räddningsverkets arbete med skydd mot olyckor. Ett syfte har också varit att beskriva de olika strategier för säkerhetsarbete som tillämpas i myndigheten.Kartläggningen har utförts genom gruppintervjuer under perioden oktober 2004 mars 2005 och har följts upp med hjälp av två seminarier i november 2005. Analysgruppen har bestått av medarbetare vid Räddningsverkets sekretariat för forskning och analys.Resultaten visar bland annat att:- verkets arbete utgår från en kompott av olyckor, skador och händelser, var och en med sin egen logik baserad på tradition, lagstiftning och politisk inriktning- arbetet bedrivs utifrån en mångfald av strategier som i många fall inte är produkten av genomtänkta analyser och medvetna val- verkets olika roller behöver närmare analyseras och kopplas till tydligarestrategier och metoder för arbetet med skydd mot olyckor- säkerhetsarbete och riskhantering är inte synonyma begrepp i myndigheten- det saknas myndighetsgemensamma begreppsdefinitioner inom det kartlagdaområdet- det råder en brist i myndigheten på djupare diskussioner och reflektioner kring värdegrunder och principer för riskvärdering.Rapporten behandlar många olika frågor som på olika sätt är relevanta för Räddningsverkets arbete på kort och lång sikt. I rapporten ges ett tiotal förslag till fortsatt arbete. Några förslag är att:- utarbeta en begreppspolicy för myndigheten- utarbeta information till privatpersoner som lagenliga skyldigheter inom det olycksförebyggande området- satsa på kompetensutveckling internt- starta ett utvecklingsarbete inom riskvärdering- utveckla analysförmåga för framtidens olycksrisk- starta en idéverkstad för framtida säkerhetsarbeteKartläggningen ska ligga till grund för fortsatt utvecklingsarbete inom Räddningsverket. Delar av materialet kan också komma att utgöra underlag förutveckling av läromedel för verkets utbildningsverksamhet. Rapporten utgör också en möjlig källa för fortsatt forskning och analys inom området
Kan man förebygga anlagda bränder och annan skadegörelse i skolor med miljöinriktade åtgärder? Den bedömningen gör man i Karlstads kommun med stöd i kriminologisk teori och erfarenheter från andra sektorer. Den traditionella ansatsen är annars är att kombinera brandtekniska åtgärder med ett mer individorienterat perspektiv riktat mot gärningspersoner. Syftet med föreliggande rapport är att ge en djupare belysning av den teoretiska grundvalen för en bredare miljöinriktad strategi, samt att peka på möjligheter att följa och utvärdera effekter av en lokal tillämpning. I bilaga redovisas även en forskningsöversikt kring den vetenskapliga evidens som idag föreligger beträffande miljöinriktad brottsprevention.
Objectives: The aim of this study was to investigate the associations between oral health measures and oral health-related quality of life as captured by OIDP (oral impacts on daily performances). Methods: The study was performed in three dental clinics in Sweden and included 204 patients, 43.8% men and 56.2% women (aged 20-86 years), consecutively recruited in connection with their routine dental examination. The patients were interviewed using the OIDP followed by a clinical examination. Four bite-wing radiographs were taken in two of the clinics (n = 154). A self-administered questionnaire provided information about socio-economic data. Results: Subjects 60 years had significantly more missing teeth, lesser maximal jaw opening, higher number of sites with alveolar bone loss and proportionally more filled teeth than younger individuals. Impacts related to the oral health that affected their daily life were reported in 39.7%. Multivariate logistic regressions analysis showed that missing teeth (>= 10) and a limited jaw opening (<40 mm) were significantly associated with having one or more impact as measured with the OIDP [odds ratio (OR) 6.50, 95% CI 1.48-28.43 and OR 2.87, 95% CI 1.03-7.96, respectively]. Conclusions: Individuals with diminished functional oral health status (missing teeth and limited jaw opening) had significantly more often one or more oral impacts on daily life than those with fewer than 10 missing teeth and a jaw opening >= 40 mm. The OIDP instrument may be valuable for use in routine dental check-ups in patients with related problems to determine possible oral impacts on daily life.