This single distinct sunbeam pouring down from under the base of the cloud sitting atop Ben Ledi is beautiful. When I look at it I can’t help but see that it illuminates a particular area of the ground.
On a blue sky day the sunlight illuminates large areas of ground pretty equally but with weather like this where sunbeams drill down through gaps in the clouds we see certain parts, particular areas, more distinctly than the rest.
We do employ these two modes of attention all the time. We have a wide, open attention which takes in the whole scope with a broad brush. And we have narrow focused attention that emphasises certain parts.
I was taught the practice of Medicine in a particular sequence – the story, the physical examination, then the investigations.
Diagnosis begins by paying attention to the whole person, using both these modes to elicit particular aspects of the patient’s story whilst continuously contextualising every element.
I was taught that the bulk of diagnosis would emerge from the story. After that a “relevant” physical examination would allow the potential discovery of certain physical changes in the body. Finally, some tests might be needed to be more sure – blood tests, x rays, scans etc.
We were taught this process in a pretty linear manner. But the idea was that as you gained experience and skill you integrated the various approaches, no longer needing to stick to a rigid, linear sequence.
What I gradually came to realise was that this approach prioritised the subject, not the object. It shone the bright light of understanding on the unique person’s story, on the particulars of their experience and contexts. None of that could be measured.
The accessory elements were those which considered the person’s body as an object, to be examined, probed, observed and measured.
It was all important of course and not hierarchical….each aspect informed the whole, the understanding of the whole person.
The trouble, I think, emerges if we prioritise the object to the exclusion of the subject.
I’ve heard young doctors say they’ve learned “Don’t believe what the patient says. You can only trust the data” (by which they mean the measurements). This strikes me as seriously misguided. If the doctor doesn’t believe what the patient says how can they know them, how can they understand them, and how can they establish trust? In fact how can they even make a good diagnosis?
There’s a danger in putting too much attention onto the physical findings….especially when the physical findings don’t reveal the problem.
So much of what we experience can’t be observed and measured by another – pain, energy, nausea, dizziness, itch, hypersensitivity, emotions, thoughts, values and beliefs.
Only the unique human subject can express those experiences others. And they do that through their story, through their behaviour, and, ultimately through their body.
Funny how we need to pay attention to the invisible to know the human, huh?
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