learning outcomes what is philosophy? how to understand an encounter with a patient or registrar. a...
TRANSCRIPT
Learning Outcomes
• What is philosophy?• How to understand an encounter with a
patient or registrar. A philosophical perspective
• Why this works with the narrative based model.
• A realisation that this can improve your consultations and teaching.
“The unexamined life is not worth living.” Socrates
“As for me, all I know is that I know nothing”
“Philosophy begins with wonder”
Modern ideasPhilosophy is a way of thinking to
advance an argument or idea using reason
The Greeks
Philosophy was to be lived
It is not a science ,
not wisdomor knowledge
but a mediation around the available knowledge.
It is about the wisdom of life, about popular intelligence.
How does the mind construct our
knowledge of the objective world
Immanuel Kant (1724-1804)
What is the mind?
Kant argues that: “We cannot learn philosophy, only
learn how to philosophise.”
Philosophise!!
After a consultation how do you know if it’s been a good one?
If you were the patientIf you were the doctor.
Understanding
Just because I don’t care, doesn’t mean I don’t understand!
Homer Simpson.
Hans Georg Gadamer
Philosopher, Born February 11 1900;
Died March 14 2002
“Modern concepts of science are not adequate to understand people and our experience of art and even communication.”
“Truth and Method”
Philosophical Hermeneutics
Understanding and seeing things from some else’s perspective
How far can you see?
Understanding happens when our horizon is moved or changed.
The old horizon becoming the new one.
“Fusion of Horizons”
What factors affect understanding?
The patient’s
The registrar’s
• Pre-understanding
• Prejudices
• Fore-meanings
• “Bildung” or openness to meaning
• Language
• Imagination
Bildung, Open to meaning
Do you feel there are lots of possibilities for change / progress here?
Imagination
Do you have any ideas which might help?
How do you think it would feel if this turned out to be some sort of cancer?
Are you religious? How can this help
Present Horizon Whole
Partial Understanding
Pre- UnderstandingWhat do you think is happening? What have you done to deserve this? What has made this happen?Have you looked on the internet?
PrejudiceDo you have previous knowledge about this?What did you think we would be doing today?Did you expect me to do anything in particular today?
Fore meaningsChunk and checking. Let me get this right?After the examination: What do you think is going on here?
Circle of Understanding
LanguageWithout language we cannot transmit meaning.Wittgenstein. The limits of my language mean the limits of my world.
Patient’s UnderstandingNarrative
Doctor’s UnderstandingNormative
Jerome Bruner. PsychologistJohn Launer. Uniqueness and Conformity
Video of teaching
Discussion about patient centred medicine.
First consultation was about a mainly clinical topic.
Second video of a consultation with a patient who has cancer and almost certainly secondaries.
The best consultations involve careful listening, questioning and imaginative ideas taking them around the circle of understanding to alter horizons.
An ability to see what is questionable in the encounter and combine this with our experience of science.
Philosophy as a mediation of the truth.
“Understanding is not reconstruction but mediation”
“The unexamined life is not worth living.” Socrates
“The unexamined life is not worth living but a life too closely examined may not be lived at all!”
George Elliot
Saunton Sands 2008