General Practice is undergoing the most major series of changes since the introduction of the National Health Service in 1948. They concern both concepts of care and practical details of the way care is delivered. In spite of the hostility generated by the changes most of the broad general concepts have been accepted. The principle of patients having more choice is widely sup ported, the inclusion of preventive medicine and antici patory care in the responsibilities of practice has few opponents, the introduction of audit as a way of im proving performance has been generally welcomed. Even the idea of putting GPs in better financial management of patients and drug budgets has had supporters in prin ciple. The antipathy has generally related to the method of introduction of these changes. One important con cern has been the time requirements of the New Con tract and the feeling that these will erode the real nature of our work: the close personal relationship with pa tients. If we improve the quality of our management this is less likely to happen. We shall be able to work within the New Contract and retain the quality of service we pro vide. If we improve the understanding of our staff of what we are trying to achieve we are more likely to reach the targets that we set whilst keeping people happy. vii This book sets out to explain the New Contract."

Einfuhrung zur psychosomatischen Frauenheilkunde; Zur Arzt-Patient-Beziehung in der Frauenheilkunde; Aspekte der psychosomatischen Geburtshilfe; Symptome in der Schwangerschaft mit einer moeglichen Psychogenese; Psychosomatische Aspekte der Geburt; Psychosomatische Aspekte des Wochenbetts; Psychosomatische Gynakologie; Symptome und Krankheitsbilder in der Psychosomatischen Gynakologie; Psychosomatische Aspekte kritischer Zeitabschnitte; Askekte der angwandten psychsomatischen Frauenheilkunde; Entwicklungen und Zukunftstendenzen in der psychosomatischen Geburtshilfe und Gynakologie

This book is about four ways of using the consultation in primary health care. One ofthem is very familiar, the other three a little less so. But they should all be as much a part of the repertoire of doctor or nurse as examining some system of the body or relieving pain and discomfort. If each is not used when appropriate, the full potential of the consultation is not achieved. This is the practical message of the book. Simultaneously it is concerned with the more theoretical problems of clarifying the role of the generalist in contemporary medicine and of relating it to the wider world of people's day-to-day lives and decisions and to their interest in seeking health for their children and themselves. Is primary care too broad and general to be manageable? Is it a pot-pourri derived from other disciplines or is it distinct? If distinct, exactly how does it differ and can its principles be stated in a clear and practical way? How can it respond effectively to people's wants and needs? The same four uses of the consultation, presented in a diagram which can be easily remembered, serve as a simple map for outlining the role of the doctor or nurse in primary care. The details of the map are filled in with clinical anecdotes and copious reference to studies from all over the world.

Psychosomatic Medicine (PM) is a rapidly developing subspecialty of psychiatry focusing on psychiatric care of patients with other medical disorders. PM specialists diagnose and manage psychiatric symptoms in a variety of medical settings, optimize their patients' medical care, and expand understanding regarding the role of psychological factors in health and disease. Dr. Kurt Ackerman and Dr. Andrea DiMartini presernt Psychosomatic Medicine , portable handbook geared to helping psychiatric and other medical practitioners and trainees to stay current in their understanding of the practice of psychosomatic medicine. Drawing practical techniques and wisdom from their team of contributors, Psychosomatic Medicine provides readers with historical background, key clinical information and guidelines, readily accessible charts and tables, exercises to aid in self-assestment, and suggestions for further reading to spark additional learning in this rapidly developing field of psychiatry.

As the focus of the health care delivery system continues to move toward a coordinated and accountable system, there is an increasing need for a single resource that focuses on analytics for population health. Population Health Analytics addresses that need by providing detailed information and a "how to" guide for achieving population health analytics. Comprehensive, current, and practical, this logically organized text builds from understanding data sources, to contextualizing data, modeling data, and gleaning insights from that data, which is a natural progression for organizations in progressing to higher levels of analytic capabilities. Furthermore, these frameworks for the population health process and analytics are grounded in an evidence base that is also aligned with theories and processes used in healthcare disciplines. A first of its kind text, Population Health Analytics, will prepare students to improve health outcomes, understand patterns of health behavior and behavior determinants, develop effective interventions, and track health and cost performance across populations. Key features: - Real world scenarios using case studies, use cases, critical thinking and discussion questions encourage readers to apply data and analytics to improve health. - Readers will learn to discern the intricacies and nuances of creating, preparing, contextualizing, tracking, and reporting data to support clinical quality and healthcare cost improvement. - Guiding principles and processes to develop a population health workforce are introduced, such as the Team Troika in Chapter 31. - Each application of healthcare data is supported with evidence, ample references, and ancillary resources - Navigate eBook Access (included with each printed text) enabling online or offline access to the text from a computer, tablet, or mobile device.

The past few years have witnessed the emergence of steroid hormones as the wonder molecules which generate as much discussion in the scientific literature as they do in a typical living room. This transition has been a result of the tremendous public and scientific interest in the normal functioning of the hor mones as well their suggested involvement in several clinical conditions. In the recent past, notable scientific and technological advances have been made in the areas of contraception and regulation of fertility. Steroid receptors are the indis pensable mediators of hormonal responses and are complex protein molecules which appear to exist in association with other, yet undefined, proteins and/or factors. Receptors for vitamin D, retinoic acid and the thyroid hormones share structural similarities with steroid receptors, and the roster of this superfamily is still expanding. While our knowledge of the diversity and magnitude of steroid effects has advanced, the precise mode of steroid hormone action has alluded investigators. This volume brings together an international team of prominent investigators who discuss their most recent work on the basic and clinical aspects of steroid/nuclear receptors. The contributions represent updated versions of the invited presentations made at The Second Meadow Brook Conference on Steroid Receptors in Health and Disease. I am grateful to my colleagues on the Scientific Committee: Etienne Baulieu, Jack Gorski, Benita Katzenellenbogen, David Toft and James WittJiff, who provided the vision and guidance in formulating an out standing program."

The growth of day surgery over the past 10 years has had an enormous impact on the experience of surgery for both patients and health professionals. The potential for quality, cost-effective services is enormous, but relies on the recognition and development of specific, appropriate nursing knowledge and skills. This book has been designed as a comprehensive textbook, specifically emphasising the crucial nursing role. It promotes a peri-operative approach to patient management and nursing organisation and development and explores in depth the knowledge, research-base and clinical skills on which successful day surgery depends. Key features include: Emphasis on patient perspective, including anxiety management Evidence-based, draws on current research Focus on pre-admission assessment and selection Comprehensive coverage of effects and interactions of anaesthesia Standards for care planning, admission protocols, discharge procedures Reflection points and case studies linking to practice For practising nurses in day surgery and students on specialist courses, this book will be an informative and stimulating resource for practice development in this expanding area of care. Features: * Focuses on nursing skills * Emphasises the importance of screening and selection * Includes material on audit * Multi-disciplinary context * Informed by current research * User friendly and accessible, encourages reflection on practice

Das bewahrte Fachbuch zum Kinderschutz in der Medizin bietet Strategien fur den Umgang mit Verdachtsfallen von Kindesmisshandlung und -vernachlassigung, fundierte fachliche Grundlagen fur die Diagnose, Sicherheit in Rechtsfragen und erprobte Konzepte fur die Intervention. Fundierte somatische Diagnostik Leitliniengerecht, hohe Evidenz Rationale diagnostische Strategien Forensische Befundsicherung Kindergynakologische Grundlagen Umsichtige Intervention & Pravention Gesprachsfuhrung mit Eltern Interdisziplinare Netzwerke schaffen und nutzen Fruhe Hilfen Umgang mit Missbrauch in Institutionen Gesellschaftliche und rechtliche Grundlagen Auszuge wichtigster Gesetze Gesetzlicher Opferschutz, psychosoziale Folgen Kompakt und praxisrelevant Korrekte Anamnese und Dokumentation Merkblatter, Checklisten, Internetadressen Praxistipps, Differenzialdiagnosen und Fallstricke Vom "unguten Gefuhl" zu evidenzbasiertem Handeln. Unter Berucksichtigung der neuesten internationalen Leitlinien, Literatur, Gesetze und Rechtsprechung. Das erste deutschsprachige Handbuch fur fachgerechte medizinische Diagnostik und Intervention. Das notwendige "Handwerkszeug" fur AErzte und andere Gesundheitsberufe, um in der taglic hen Praxis die richtigen Entscheidungen zu treffen. Als Leitfaden, Ratgeber und Nachschlagewerk fur AErzte, aber auch alle anderen beteiligten Fachleute im Kinderschutz: Juristen, Polizei, Jugendamter, Beratungsstellen ....

Selected for an International Impact Book award, 2022! Selected as a Doody's Core Title for 2022! New chapter on COVID-19 vaccines is available in the eBook version (free with purchase of the printed version) Engaging, accessible, and filled with practical communication advice, Let's Talk Vaccines helps you educate patients on the importance of life-saving vaccines using a patient-centered and empathetic approach. Covering everything from the science of vaccine safety to the psychology of risk communication, this essential guide includes real-life examples and thoughtful, evidence-based techniques that will help patients understand vaccines and make informed decisions. Ideal for primary care providers, pediatricians, family physicians, nurse practitioners, and public health advocates, it provides an excellent framework for how to approach difficult discussions, with the goal of improving the health of each patient as well as the community at large. Directly addresses the increasing trend of parents choosing not to vaccinate their children, including the history and psychology of the anti-vaccine movement. Examines the issues underlying vaccine hesitancy, answering the common questions and concerns that vaccine-hesitant patients may raise during office visits. Helps you dispel myths and fears that many patients have, with particular attention paid to misinformation and skepticism on social media. Covers the anti-vaccine movement's assertions about autism, autoimmune illnesses and allergies, toxic ingredients, overwhelming the immune system, conspiracies, and more - bringing you up to date with the most common issues and effective approaches to the vaccine discussion. Provides practical tips on approaching the vaccine-hesitant parent and how anti-vaccine patients change their minds, with a focus on remaining a positive partner in your patients' care and finding greater success in your vaccination efforts. Enrich Your eBook Reading Experience Read directly on your preferred device(s), such as computer, tablet, or smartphone. Easily convert to audiobook, powering your content with natural language text-to-speech. Awards/Honors: International Impact Book Award Indie Reader Discovery Award: Health/Medicine/Nutrition 2022 Book of the Year - Finalist Paris Book Awards: Honorable Mention - Nonfiction Reader's Favorites: Book Excellence

This indispensable resource provides primary care clinicians with a framework for addressing pediatric mental health problems in the primary care practice. Gain guidance on integrating healthy social-emotional development of children and adolescents with other aspects of health supervision. Obtain surveillance and screening tools to identify early signs and symptoms of mental health disorders and obtain evidence-based interventions to care for children and adolescents with mental health issues. Gain in-depth guidance on the care of special populations of children who may be at increased risk for mental health problems: those exposed to adverse childhood experiences; children in military families; lesbian, gay and bisexual youth; children with gender expression and identity issues; children affected by racism; adolescents who are pregnant or parenting, and much more. Topics include Strength-Based Approach to Promoting Healthy Child Development Healthy sleep, weight, use of media, and active living Children exposed to adverse childhood experiences Violence Prevention Caring for families new to the United States Children in foster or kinship care or involved with child welfare Children of divorce Adopted children Children with chronic medical conditions And more

Written specifically for the conventional medical healthcare provider, Medicinal Herbs in Primary Care forms an integral part of the primary care tool belt. Through a series of system-based disease tables, this unique title provides quick, authoritative guidance for the busy practitioner whose patient is requesting guidance on medicinal herbs. The disease tables are supported by herbal monographs that provide expanded details of the available preclinical and clinical evidence laid out in a system-based sequence. Together with the section on herbal basics, this practical reference contains the information today's medical healthcare providers need to develop familiarity with and confidence in the prescription of medicinal herbs. Provides quick answers and evidence-based prescribing guidance for medicinal herbs while also addressing complexities and co-morbidities in patient care. Features 48 system-based disease tables that identify herbs based on strength of evidence and indicate the scope of potential benefits for other conditions the patient may have. Includes 55 monographs for the most common medicinal herbs, with safety and precaution guidelines, summaries of preclinical and clinical trials, chemical constituents and actions, and prescription options for each. Contains an introductory section on the basics of medicinal herbs that dispels common misconceptions regarding herbal medicine. Discusses key topics such as herb-drug interactions, and includes information on SARS-COV-2 where appropriate. Uses typical medical abbreviations throughout for ease of use, and provides a glossary of terms for non-medical and alternative health care providers. Helps conventional medical practitioners partner with patients to determine safe herbal options when appropriate, and ensure safety and efficacy of herbal use. Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.

Fully revised for its third edition, the Oxford Handbook of Clinical Diagnosis provides a concise and practical summary of the reasoning processes behind clear and confident diagnosis. The handbook is set out systematically with symptoms and signs through each specialty, and includes a detailed description of the basis of logical evidence-based differential diagnosis. This new edition has been updated with more straightforward diagrams as well as brand new images to help aid understanding. Including rarer diagnoses alongside common conditions, and vital information about longer-term management alongside the initial treatments, this handbook will ensure your excellence and confidence no matter what signs and symptoms your patient presents with. Providing practical help when dealing with problems outside your area of expertise or with unforeseen situations, you can be sure that this handbook will be the reader's perfect companion to sharp and self-assured diagnoses throughout their medical career.

When faced with a challenging dermatologic problem, physicians are often required to perform a time-consuming search through large dermatologic texts in order to find information that will assist in the necessary differential diagnosis. This comprehensive and concise handbook is designed to simplify this process dramatically, permitting rapid identification of the correct diagnosis. Hundreds of dermatologic diagnoses, morphologic features, drug-induced disorders, extracutaneous manifestations, histologic findings, and random other findings are listed in alphabetical order and in a homogeneous, reader-friendly structure. The differential diagnoses are shown under each main diagnosis, sorted according to similarity with that diagnosis. Since the first edition, approaching 50 new diagnoses have been added, and many new images included. This easily portable book will be of great value for dermatologists and all who deal with dermatologic diseases.

Derived from protocols developed for the National Football League, Infection Prevention in Athletes outlines best practices and recommendations that are designed to minimize the risk of infections among athletes. This unique resource provides concise, authoritative guidance for athletic training facilities on applying infection prevention practices typically provided in hospitals and outpatient clinics. You'll find practical tips and real-world advice on preventing transmission of bacterial and viral infections in an environment of frequent skin injuries, close proximity of players, and frequent administration of routine medical care. Offers clear guidance for today's athletes, athletic trainers, and physicians from the team that teaches infection control and prevention to the NFL. Covers best practices and recommendations for key areas of education, infection prevention, and cleaning and maintenance. Assists teams in formulating policies related to player and staff education, hygiene, cleaning and disinfection, diagnosis and treatment of specific infections and conditions, and the management of infections among team members. Helps readers devise protocols for assessing suitability to return to full team activities following treatment of common infections-including scientific evidence and rationale for recommendations when available. Includes access to posters designed for display in the athletic training facility that promote best practices and infection prevention among athletes. Includes a set of educational "trading cards" highlighting essential stats and information about some of the most common infections. Enrich Your Ebook Reading Experience Read directly on your preferred device(s),such as computer, tablet, or smartphone. Easily convert to audiobook,powering your content with natural language text-to-speech.

A collection of 15 papers from The American Ceramic Society s 38th International Conference on Advanced Ceramics and Composites, held in Daytona Beach, Florida, January 26-31, 2014. This issue includes papers presented in Symposium 5 - Next Generation Bioceramics and Biocomposites and Symposium 9 - Porous Ceramics: Novel Developments and Applications.

For clinicians who see patients suffering from non-life-threatening crises, Minor Emergencies, 4th Edition, provides concise, expert guidance on what to do and what not to do for nearly 200 common presentations, including both the correct procedural and pharmaceutical treatments. Completely updated with the latest equipment, devices, dosages, and techniques, this award-winning reference delivers fast, efficient guidance just when you need it. Instructional videos clearly demonstrate pearls and pitfalls of a wide variety of procedures. Offers a practical approach to common minor emergencies, with brief, to-the-point guidance on everything from febrile seizures in children, foreign body removal, and initial management of epistaxis to rib fractures, sacroiliac joint injection, and patellar dislocation reduction. Includes new ultrasound examples throughout, plus new chapters on floaters, prophylaxis following sexual exposure, leg edema, piercing complications, Taser injuries, and more. Provides at-a-glance guidance with "What to Do" and "What NOT to Do" checklists. Presents information in a highly templated format, with each topic given 2-3 pages of coverage. Features a discussion box at the end of each chapter with a quick overview of clinical manifestations, differential diagnosis, and other points of consideration-with evidence. Includes access to 38 procedural videos such as removing foreign body from skin, upper facial injury-fracture examination, and more. Offers procedural sedation recommendations from Dr. Daniel Wolfson. Enhanced eBook version included with purchase, which allows you to access all of the text, figures, and references from the book on a variety of devices

Physician adoption of electronic medical records (EMRs) has become a national priority. It is said that EMRs have the potential to greatly improve patient care, to provide the data needed for more effective population management and quality assurance of both an individual practice's patients and well as patients of large health care systems, and the potential to create efficiencies that allow physicians to provide this improved care at a far lower cost than at present. There is currently a strong U.S. government push for physicians to adopt EMR technology, with the Obama administration emphasizing the use of EMRs as an important part of the future of health care and urging widespread adoption of this technology by 2014. This timely book for the primary care community offers a concise and easy to read guide for implementing an EMR system. Organized in six sections, this invaluable title details the general state of the EMR landscape, covering the government's incentive program, promises and pitfalls of EMR technology, issues related to standardization and the range of EMR vendors from which a provider can choose. Importantly, chapter two provides a detailed and highly instructional account of the experiences that a range of primary care providers have had in implementing EMR systems. Chapter three discusses how to effectively choose an EMR system, while chapters four and five cover all of the vital pre-implementation and implementation issues in establishing an EMR system in the primary care environment. Finally, chapter six discusses how to optimize and maintain a new EMR system to achieve the full cost savings desired. Concise, direct, but above all honest in recognizing the challenges in choosing and implementing an electronic health record in primary care, Electronic Medical Records: A Practical Guide for Primary Care has been written with the busy primary care physician in mind.

This book addresses the unmet needs of the medical community in dealing with the psychological problems, particularly anxiety and depression, of patients diagnosed with cancer. Providing a scholarly review of the impact of cancer diagnosis on patients' emotional and psychological status, as well as the evidence that psychological factors impact cancer occurrence and biological behavior, this book explores the therapeutic implications of such converse dynamics. Chapters review financial toxicity, eHealth, palliative care, mindfulness, sleep and cancer, social support and cancer, cultural diversity, pediatric and adolescent oncology, and geriatric oncology. While intended primarily for the professional readership of oncologists, psychologists, psychiatrists, social workers, and palliative care physicians, a final chapter also provides practical information on available resources for patients. This fully updated and expanded new edition of Psychological Aspects of Cancer: A Guide to Emotional and Psychological Consequences of Cancer, Their Causes, and Their Management provides practitioners with cutting edge knowledge as well as practical information that translates into better care for patients with cancer.

This book provides family doctors with a wealth of evidence-based indications and tips regarding geriatric medicine and approaches for the management of older patients, to be applied in daily practice. After discussing old and new features of healthy ageing and the approaches required in Family Medicine Consultation, the text introduces key elements of geriatric medicine such as frailty, sarcopenia, and the comprehensive geriatric assessment (CGA), before describing a range of characteristics unique to older patients in different contexts, with a dedicated section on Palliative Care. The role of polypharmacy and the importance of quaternary prevention and deprescribing are also addressed. Finally, the book emphasizes both the importance of a humanistic approach in caring and the approach of research and meta-research in geriatrics. Though many texts explore the role of primary care professionals in geriatric medicine, the role of family doctors in older people care has not yet been clearly addressed, despite the growing burden of ageing, which has been dubbed the "silver tsunami." Family physicians care for individuals in the context of their family, community, and culture, respecting the autonomy of their patients. In negotiating management plans with their patients, family doctors integrate physical, psychological, social, cultural and existential factors, utilizing the knowledge and trust engendered by repeated visits. They do so by promoting health, preventing disease, providing cures, care, or palliation and promoting patient empowerment and self-management. This will likely become all the more important, since we are witnessing a global demographic shift and family doctors will be responsible for and involved in caring for a growing population of older patients. This book is intended for family medicine trainees and professionals, but can also be a useful tool for geriatricians, helping them to better understand some features of primary care and to more fruitfully interact with family doctors.

Based upon a tried and tested framework of intervention, Health Behavior Change, third edition, brings together the field of communication, the study of motivation and how people change, and insights derived from listening to and observing patients over many years, to provide a helpful source of advice on how to encourage individuals to embrace behaviour change and then maintain it. This popular paperback is written in a friendly and accessible writing style, and contains an abundance of 'real-life' clinical cases, sample interviews, and the latest evidence-base regarding best practice. The book also contains information on learning the necessary techniques, overcoming personal barriers to success, and how to use the techniques in a wide variety of settings. Learning aids include 'Useful Questions' boxes, to help learners structure consultations, 'Key Points' boxes, to summarise the crucial 'take home' message, and 'What to Avoid' boxes, which give the benefit of extensive experience. The new edition now comes with an EVOLVE (c) website which contains a helpful video demonstration of a successful interview, an explanatory transcript of which is given within the book, and downloadable Patient Worksheets. Suitable for a wide-ranging readership ranging from primary care physicians and nurses to physiotherapists and sports therapists, this book will be perfect for use in the primary care setting, inpatient or outpatient departments, community health projects, the A&E department, leisure facilities and occupational health clinics. Perfect for brief consultations in the healthcare and sports setting Abundance of practical examples - showing both good and bad practice - illustrate how the techniques can be used to optimum effect even with patients who are 'difficult to reach' Useful 'dialogue' between practitioner and patient illustrate points of theory Contains a chapter on how to learn the technique, including potential barriers to success Discusses the frustrations encountered in practice and provides practical tips on how to control emotion Ideal for use in the primary care setting, inpatient or outpatient departments, community health projects, the A&E department, leisure facilities or occupational health clinics Fully updated throughout with the latest research and evidence base for best practice Updated clinical examples reflect recent developments in public health Now available with an EVOLVE (c) website containing a helpful video demonstration of the techniques being used and downloadable Patient Worksheets

Asylum medicine, a field encompassing medical forensic evaluations of asylum seekers, is an emerging discipline in healthcare. In a time of record global displacement due to human rights violations, conflict and persecution, interest in the medical and psychological evaluation of individuals subjected to torture and other ill-treatment is high. Health professionals are uniquely qualified to use their skills to make contributions to a group of vulnerable individuals fleeing danger and death in their home countries. Health professionals involved in asylum medicine perform medical and psychological forensic evaluations of asylum seekers. Their educational background prepares them to examine and describe physical and emotional scars related to trauma, and further training allows them to assess these scars in the context of persecution, describe them in a medical-legal affidavit and support these findings with testimony. Providers of asylum medicine are often involved in advocacy, as many governments become increasingly hostile to asylum seekers. Books on human rights exist, but there is no authoritative text of asylum medicine. This book presents a comprehensive overview of asylum medicine, with emphasis on the historical and legal background of asylum law, best practices for performing asylum examinations, challenges of examining detained asylum seekers, education of trainees and advocacy. Written by experts in the field, Asylum Medicine: A Clinician's Guide is a first of its kind resource for health care providers who practice asylum medicine.

Chronic kidney disease (CKD) is a major global public health problem, affecting nearly one in seven adults in the United States alone. It is a disease that integrates chronic illness at several levels, and the progressive condition is associated with high rates of co-morbidity. This text provides a comprehensive, current state-of-the art review of this field, serving as a valuable resource for primary care providers and non-nephrology clinicians that treat patients with CKD. It is comprised of 24 chapters focused on specific aspects of the disease. The first 2 chapters provide a bit of background on the disease, describing the anatomy and physiology of the kidney as well as the definition and epidemiology of the disease. The following 3 chapters discuss the detection, prevention and progression of the disease. The next 6 chapters describe the relationship of the disease with other conditions and most common co-morbidities such as diabetes and hypertension. The chapters, that follow focus on the CKD associated complications and the CKD within special populations such as the elderly and minorities as well as dietary restrictions and drug dosing. The book concludes with discussion on preparation for renal replacement therapy and preemptive organ transplantation as an alternative to dialysis in the management of the advanced CKD. Written by experts in the field, Approach to Chronic Kidney Disease is a comprehensive guide for clinicians, especially primary care providers including residents and fellows in training, who take care of chronic kidney disease patients. It is also a useful tool for researchers dealing with this challenging field.

A patient's job is to tell the physician what hurts, and the physician's job is to fix it. But how does the physician know what is wrong? What becomes of the patient's story when the patient becomes a case? Addressing readers on both sides of the patient-physician encounter, Kathryn Hunter looks at medicine as an art that relies heavily on telling and interpreting a story--the patient's story of illness and its symptoms.