Heroes Not Zombies

When you feel ill, you want to try and figure out what’s going on. If it’s not something simple and obvious then you might need to go and consult a doctor. It’s likely the doctor will ask some questions. These questions are not random. The doctor has been trained to ask them. In fact, the doctor will have a lot more questions in his or her head than the ones you are actually asked. It’s these “back questions” that interest me. The ones running continuously through the doctor’s mind which form the basis of the whole consultation.
Doctors are trained to think about illness in a particular way. The thinking model is known as the “biomedical model”. The biomedical “back question” is this –

“What is the diagnosis?”

By diagnosis, we mean, what is this disease? Of course, there are other “back questions” which become more important once the diagnosis is made – “What action do I need to take?” and “What’s the prognosis?” for example. However, those questions are completely dependent on the answer to “what is the diagnosis?”. In the biomedical model, the diagnosis is the identification and naming of the disease. Once that’s done, the treatments are applied with expectations wholly informed by the doctor’s understanding of disease.
But disease is only part of the problem. You don’t feel diseased, you feel ill. Illness involves both the disease and the person who has the disease. Illness is the whole experience of your suffering. We are not machines and no two of us are identical. If a doctor wants to more effectively treat a patient they should use a different model from the “biomedical” one. They need a model which helps them understand the person who has the disease. This other model has been given many names but let’s use the one “holistic”. To understand the whole of a person’s illness the doctor needs to have different “back questions”.
I think to do this a doctor needs to use these four key “back questions”

1. “What’s this person’s experience?” – the doctor needs to hear your story including a good clear description of what you are feeling, what sensations you have been experiencing, when you’ve had these sensations and in what circumstances. Your experience of illness is subjective. Nobody else can experience the pain, or nausea, or breathlessness, or distress, or whatever it is that you are experiencing. The doctor can only try to understand what your subjective experience is by enabling you to tell your story.
2. “What kind of world does this person live in?” – we all experience the world differently. We pay attention to different aspects of life and we are affected differently by them. To understand who the person is who has this illness, the doctor needs to know what you are affected by, what’s important to you and how you experience the world.
3. “How does this person cope?” – we all have different coping strategies. Some cope by retreating, hiding away, shutting down, whilst others cope by crying for help, needing company and support. There are many other patterns but if the doctor is going to figure out how best to help you he or she needs to find the treatments that will work best with your particular coping strategies.
4. “What sense does this person make of this?” – we are meaning-seeking creatures. We always want to make sense of our lives. Why has this happened to me? Have I done something wrong? Is it because of my diet, or a bug that’s infected me, or my genes, or is it God punishing me? The sense we make of our illness may not only influence our chances of recovery but can actually determine the prognosis.

If these four “back questions” continuously run through the doctor’s mind, the question “what is the diagnosis?” will fall into place, not as THE important question, but as AN important question. The disease can still be named, but it will now be understood within the context of the person who has the disease. Only then will this individual, will YOU, get the most appropriate help to restore your health.