Chloe Halsey and Travis Anderson, Philosophy Department
In the early 1900’s, medical practice shifted largely to a science-based study, which greatly changed the experiences of both physicians and patients. With a new method of explaining diseases in hand, physicians and scientists were able to more consistently and effectively treat patient ailments. Since this adoption of etiological methods, medicine has moved from a practice where human response is important to a domain where there is less and less of a need to rely on the subjectivity of the patient to treat disease. The goal of postmodern medicine has been to methodically rule out ambiguity, and due to the development of successful drugs and anatomical understanding, treatment has become more attainable and immediate. However, while the adoption of differential diagnoses and causal relations of diseases offers a systematic understanding of disease, there is a widespread call to reform the impersonal practice of medicine. My project was geared toward analyzing the development of the doctor-patient relationship over several hundred years and addressing the role hermeneutics has played throughout the advancement of medicine. After creating a brief account of this development, I sought to understand the disconnect that is believed to exist between doctors and their patients, and worked to apply hermeneutic theories in an attempt to reconcile, or at least verbalize, the problems health care faces today.
I spent a large portion of my time reading histories of medicine, analyses of conversations, and discussions about the direction medicine is currently heading. Because this project could have been approached from many different angles, I had to narrow my area of study to a period of about four hundred years, and I focused largely on doctor-patient dialogue. Establishing the differences between diseases and illnesses was central to my discussion, as I believe the different methods used to treat the two problems are keys to understanding why patients and doctors feel that it is more difficult to connect now than several hundred years ago. After conducting preliminary research, I developed a questionnaire directed to professionals currently in the medical field in hopes that I would gain first-hand accounts of the techniques, goals, and frustrations that exist for physicians. I spoke with over 100 professionals working in Health Care, including surgeons, anesthesiologists, dentists, psychologists, neurologists, and family care specialists, with experience ranging from 2 to 25 years of practice. Using the survey responses and my prior research, I worked to understand the disconnect and dissatisfaction that often exists between physicians and patients.
The large majority of health care professionals I spoke with held that the most important thing that they do is gaining the trust of their patients. Regardless of how the rest of the visit goes, or how the procedure turns out, forming a connection with the patient is one of their top priorities. One practitioner noted: “If they do [trust me], everything is easy from there. If they don’t, everything beyond that is a lot of work…if something goes wrong, it will always be attributed to the doctor regardless of circumstances or quality of work.” Based on some of the background research I had done regarding the overwhelming lack of time physicians spend with patients, I was not expecting to get such a unanimous agreement regarding developing good relationships and connections. If health care professionals largely seek to build relationships with patients, then from where does the dissatisfaction come? Are doctors over-confident in their ability to connect with patients? Are patient expectations in line with what physicians can provide? There seems to be a widening gap between doctors and patients that will not be reconciled without a complete overhaul of both the health care system and the mindsets of doctors and patients alike. I discussed my new findings and connections within the scientific, philosophical, and psychological areas of study in a paper that is to be presented to members of a medical practice in Southern Arizona.
On the deepest level, physicians do not create health—their main role is not even to maintain health—but to come together with the patient to restore it, and such a restoration cannot be reached by scientific expertise alone. For a patient to return to his or her personal state of health is to take part in a process that the standard biomedical model alone cannot account for, despite the advances made over the past several hundred years. It is clear that both the overwhelming number of patients seeking treatment and the way postmodern medical practice is set up restrict a useful doctor-patient relationship; it is as if modern thought and technique no longer possess the concepts to create both a favorable environment and provide effective treatment at the same time. Many studies today emphasize the importance that conversation and human bonding have on the healing process, but the average physician is able to spend less than six minutes with a patient per visit, which is hardly enough time to work through a dialogue that leaves both parties satisfied. Because becoming familiar with the ontological being of both the patient and the physician takes time—awareness from all parties involved—it is often unattainable in even the simplest of situations. The goal of medicine now is largely focused on “curing” a disease, getting rid of a pathogen, and bringing the body back into a normal state, but these things have little to do with understanding being. I incorporated theories about hermeneutics, assimilating “text” with the patient’s experience of his or her illness, which correlates to Heidegger’s concept of “unhomelike” being in the world. By way of analogy, the “text” that physicians read is the patient as a whole, and vice versa. How both the patient and physician read each other and are read contributes to the interaction that exists between them. An ideal conversation between a physician and patient is one that results in a fusion of horizons—a mutual consciousness of being—that allows both parties to come to a more productive understanding. Exactly how this happens, unfortunately, is not something easily examined.
Health, although entwined with scientific facts and figures, has roots in phenomenology: it is a certain way of being in the world, and not simply an absence of disease. To attain a more complete restoration of health, medicine should not seek only to recover health, but also find a way to approach socio-cultural forces and the unique situations of the human condition. Due to the scope of this problem, I was not able to come up with solutions, but did manage to discuss some of the issues that contribute to the disconnect between patients, physicians, and a state of well being.