Health Care and Narrative

Friday, February 26th, 2010

This is a typical (real) story. S goes to the PCP for Ailment A and Ailment A proves too much for the PCP (Primary Care Physician). So the PCP refers S to a Specialist. Maybe it’s a hernia, maybe some strange growth inside or out. S goes to the Specialist and must tell the story from start to finish, with all the inaccuracies and hearsay (I say what I heard) this portends, as what’s really being conveyed (and this is the important part) are the observations of the PCP through the medium of the patient.

S wonders (not, where are the hypertexts) but where are the records and why weren’t they provided to all the people who need to know or should know.

The PCP’s Observations
The PCP knows the story and the narrative. The PCP has seen the evidence and has worked through a diagnosis. Diagnosis (Greek) means to discern, distinguish, and, more specifically, to take something apart for the purposes of knowing (gnosis). It implies, in medical application, lots of work and responsibility in the form of a narrative. It’s not conjecture, which is a toss, or interpretation, which is a specific kind of structured utterance, which is what patient’s bring the PCP in the first place, like a driver pushing their auto into the shop and sounding out the problem to the mechanic and the mechanic responding with nods.

The Patient’s Observations
The patient doesn’t really observe anything, as Ailment A is inside and can’t be seen.

The Solution
The PCP clicks a button and shoots “the narrative” to the Specialist with “backstory” in tow, so that simple questions, such as “what are you allergic to,” are ready at hand on the reading machine.

We don’t need to strive for efficiency. We just need to think with a healthy dose of theory, practicality, and humanism, and use the tools we have.

Disagreements?


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