依托本土化叙事医学理论的临床典型叙事案例讨论模式构建与实践

Construction and Practice of Clinical Typical Narrative Cases Discussion Model Based on Narrative Medicine

摘要: 生物医学模式“重技术、轻人文”的短板导致患者叙事闭锁、叙事断裂等问题频发，制约诊疗效果与医患关系。本研究依托杨晓霖教授提出的本土化叙事医学理论体系，借鉴临床病例讨论机制，创新构建临床典型叙事案例讨论模式。该模式筛选存在多重困境的典型病例，组织开展多主体叙事互动，精准识别叙事障碍并实施专业化叙事统整干预。以医者叙事素养理论为框架，运用标准化量表开展量化评估。实践表明，干预后患者负性情绪缓解，疾病应对方式趋于积极，治疗依从性显著提升；医护人员叙事能力与共情水平明显改善。该模式实现了叙事医学向临床常态化实践的转化，提供了可复制的本土化实践范式。

Abstract: The biomedical model’s emphasis on technology at the expense of humanistic care has led to frequent issues such as patient narrative closure and narrative fragmentation, constraining clinical outcomes and doctor-patient relationships. Drawing on Professor Yang Xiaolin’s localized narrative medicine theoretical framework and incorporating mechanisms from clinical case discussions, this study innovatively develops a discussion model for typical clinical narrative cases. This model selects representative cases involving multiple challenges, organizes multi-stakeholder narrative interactions, accurately identifies narrative barriers, and implements professional narrative integration interventions. Using the theory of physicians’ narrative competence as a framework, standardized scales are applied for quantitative assessment. Practice shows that after intervention, patients experience reduced negative emotions, adopt more positive coping strategies, and demonstrate significantly improved treatment adherence; meanwhile, healthcare providers show marked improvements in narrative skills and empathy. The model successfully translates narrative medicine into routine clinical practice, offering a replicable, localized practical paradigm.