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      Today´s medical self and the other: Challenges and evolving solutions for enhanced humanization and quality of care

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          Abstract

          Background

          Recent scientific developments, along with growing awareness of cultural and social diversity, have led to a continuously growing range of available treatment options; however, such developments occasionally lead to an undesirable imbalance between science, technology and humanism in clinical practice. This study explores the understanding and practice of values and value clusters in real-life clinical settings, as well as their role in the humanization of medicine and its institutions. The research focuses on the values of clinical practice as a means of finding ways to enhance the pairing of Evidence-Based Medicine (EBM) with Values-based Medicine (VBM) in daily practice.

          Methods and findings

          The views and representations of clinical practice in 15 pre-CME and 15 post-CME interviews were obtained from a random sampling of active healthcare professionals. These views were then identified and qualitatively analyzed using a three-step hermeneutical approach.

          A clinical values space was identified in which ethical and epistemic values emerge, grow and develop within the biomedical, ethical, and socio-economic dimensions of everyday health care. Three main values—as well as the dynamic clusters and networks that they tend to form—were recognized: healthcare personnel-patient relationships, empathy, and respect. An examination of the interviews suggested that an adequate conceptualization of values leads to the formation of a wider axiological system. The role of clinician-as-consociate emerged as an ideal for achieving medical excellence.

          Conclusions

          By showing the intricate clusters and networks into which values are interwoven, our analysis suggests methods for fine-tuning educational interventions so they can lead to demonstrable changes in attitudes and practices.

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          Most cited references36

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          A phenomenological hermeneutical method for researching lived experience.

          This study describes a phenomenological hermeneutical method for interpreting interview texts inspired by the theory of interpretation presented by Paul Ricoeur. Narrative interviews are transcribed. A naïve understanding of the text is formulated from an initial reading. The text is then divided into meaning units that are condensed and abstracted to form sub-themes, themes and possibly main themes, which are compared with the naïve understanding for validation. Lastly the text is again read as a whole, the naïve understanding and the themes are reflected on in relation to the literature about the meaning of lived experience and a comprehensive understanding is formulated. The comprehensive understanding discloses new possibilities for being in the world. This world can be described as the prefigured life world of the interviewees as configured in the interview and refigured first in the researcher's interpretation and second in the interpretation of the readers of the research report. This may help the readers refigure their own life.
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            Distanciation in Ricoeur's theory of interpretation: narrations in a study of life experiences of living with chronic illness and home mechanical ventilation.

            Within the caring science paradigm, variations of a method of interpretation inspired by the French philosopher Paul Ricoeur's theory of interpretation are used. This method consists of several levels of interpretation: a naïve reading, a structural analysis, and a critical analysis and discussion. Within this paradigm, the aim of this article is to present and discuss a means of creating distance in the interpretation and the text structure by using narration in a poetic language linked to the meaning of the text. Ricoeur's 'Hermeneutical function of distanciation' will be introduced, and this concept of distanciation will be illustrated with reference to narrations from a study of patient's life experiences living with chronic illness and home mechanical ventilation in Denmark. Distanciation in the interpretation objectifies the text, and narration in a poetic language creates a particular kind of mediation in the interpretation. That narration represents an interpreted understanding of the whole, which facilitates an appropriate and evocative presentation of the interpreted data. This way of objectifying the text through narration can contribute yet another perspective to Ricoeur's rich and varied theory of interpretation.
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              Professionalism, profession and the virtues of the good physician.

              The putative loss of professionalism in medicine has of late become of serious concern to practitioners, educators, ethicists and the public. Impassioned pleas for its restitution abound. Serious ethical obligations are linked to the idea of a profession. Yet, most of the definitions have been socio-historical, political or legal. Important as these aspects may be, there is need for a firmly grounded ethical derivation of the moral dimensions of professionalism. This essay undertakes to provide a philosophical grounding for ethically responsible professionalism in the phenomena of clinical medicine, in the character of the professional, and in virtue theory.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: ValidationRole: Writing – original draft
                Role: Formal analysisRole: InvestigationRole: Methodology
                Role: Formal analysisRole: InvestigationRole: Methodology
                Role: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: SupervisionRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: Project administrationRole: Resources
                Role: Formal analysisRole: InvestigationRole: Methodology
                Role: InvestigationRole: ValidationRole: Writing – original draft
                Role: Funding acquisitionRole: InvestigationRole: Resources
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                31 July 2017
                2017
                : 12
                : 7
                : e0181514
                Affiliations
                [1 ] Grupo Transfuncional en Etica Clínica, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, Mexico
                [2 ] CIECAS, Instituto Politécnico Nacional, Lauro Aguirre 120, Agricultura, Miguel Hidalgo, Ciudad de México, México
                [3 ] Instituto de Salud Pública del Estado de Guanajuato, Tamazuca 4, Centro, Guanajuato, México
                [4 ] Center for Bioethics, New York University, New York, NY, United States of America
                [5 ] National Research Council for Science and Technology (CONACYT), Ciudad de México, México
                [6 ] Instituto Nacional de Pediatría, Secretaría de Salud, Insurgentes Sur 3700, Insurgentes Cuicuilco, Ciudad de México, México
                [7 ] Unidad de Investigación de Enfermedades Metabólicas, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, México
                Waseda University, JAPAN
                Author notes

                Competing Interests: The authors have declared that no competing interest exist.

                Author information
                http://orcid.org/0000-0001-7297-4689
                Article
                PONE-D-16-19579
                10.1371/journal.pone.0181514
                5536364
                28759585
                4fdf94b6-462e-474d-9855-32278c179464
                © 2017 Sueiras et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 14 May 2016
                : 3 July 2017
                Page count
                Figures: 7, Tables: 1, Pages: 23
                Funding
                Funded by: Conacyt
                Award ID: 068673
                Award Recipient :
                Funded by: SIP Multidisciplinary Project 17-15 in its 20160506 module at the Instituto Politecnico Nacional
                Award Recipient :
                Funding for this study was provided by Mexico's Council of Science and Technology (CONACYT) 068673 and the General Direction of Academic Personnel Affairs of UNAM (DGAPA) for the Papiit project, ID 400112, as well as the SIP Multidisciplinary Project 1715 in its 20160506 and 20171489 module at the Instituto Politécnico Nacional.
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