Intelligently Approaching (vs keep Avoiding) Challenging Aspects of Health Care

     "The adoption of the biopsychosocial model of health has resulted in the use in medical education of concepts such as ‘holism’ and ‘connectedness’, yet medical educators struggle to convey these in a meaningful way to students. There is a growing interest in using techniques such as reflective writing, yet medical educators struggle to explain it and to justify its relevance to students. There is a growing appreciation that students trained exclusively in the scientific aspects of medicine make poor clinicians, yet medical educators cannot easily articulate the nature of the shortcomings. There is increasing pressure on medical experts to minimize their mistakes and on institutions to address the conditions that make mistakes more likely, yet there is no established understanding of what medical error is and how it and the related idea of medical uncertainty may be an inescapable part of the nature of medicine.

     This is not to deny that some form of explanation is forthcoming in each case; only to point out that what these explanations lack is a place in an integrating narrative."

       Wilson B. Metaphysics and medical education: taking holism seriously. J Eval Clin Pract 2013; 19(3): 478-84.
 
     A recent study provided "objective evidence that doctors face interactional challenges when they try to explain that symptoms are medically unexplained and suggest psychological treatment. Practice implications: Doctors may try to avoid provoking patients’ overt resistance because they perceive it as unpleasant. However, the display of overt resistance enables them to deal explicitly with the grounds on which patients reject their explanations and recommendations, and to address patients’ particular concerns."

       Monzoni CM, Duncan R, Grunewald R, Reuber M. Are there interactional reasons why doctors may find it hard to tell patients that their physical symptoms may have emotional causes? A conversation analytic study in neurology outpatients. Patient Education and Counseling 2011; 85(3): e189-e200.

 

Dale Chihuly http://www.chihulygardenandglass.com/