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Clinical Scenario


Walking out of the hospital on Friday night, you reflect on your week of rounds with all of the patients for whom you provide care. You are a hospitalist and most of your patients are elderly, have multiple comorbidities, and live independently in a retirement home, apartment, or house. Although you strive to move them along the trajectory of their illness toward recovery, minimizing complications, and maintaining their prehospital function, some patients do not return home. This week, you admitted 3 patients whose hospitalization you predict is a terminal event. In conversations, a family member of one of these patients acknowledged that possibility. You pledge in the coming week to engage in advance care planning more directly, beginning by exploring your patients' awareness that they may not survive this hospital stay.

Finding the Evidence

It is Monday at noon and you are attending grand medical rounds in your hospital. The speaker visiting from a nearby institution is presenting the results of some recent studies on end-of-life care for hospital inpatients. A major message in her presentation is the importance of attending to language in patient encounters, and your interest is piqued. One slide summarizing an article seems directly relevant to your concerns because it describes the results of a qualitative study of physician-patient communication about serious illness and, in particular, how conversations “dance around death.”1 You record the author, journal, and year of publication in your smartphone and look it up later that afternoon in your office. Accessing the single citation matcher of PubMed (, you type the author's name and journal, quickly find the article, then download and read it.


Qualitative research addresses social rules and meanings germane to the “social” sciences rather than the natural and physical laws of the “natural” sciences. Qualitative research aims to discover, describe, and understand rather than to test or evaluate. Qualitative and quantitative studies address fundamentally different phenomena and questions about them. They are not interchangeable with respect to either goals or methods.

What are social phenomena, and how do they differ from natural or biomedical phenomena? Imagine you have never encountered a wristwatch before and want to research what it does. If you are a natural scientist approaching the watch as a natural phenomenon, you might observe its mechanics and discover what causes its arms to move. You would find that the watch, like all things, obeys immutable laws of physics. But can this evidence help you understand the watch's effect on human social life? No, because approaching it as a natural object cannot reveal the powerful social forces associated with a watch's function. Understanding these aspects requires meaningful description and interpretation of those descriptions. For instance, what do the numbers on the face of the watch do? Their power lies in their symbolic nature: they ...

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