Wilberg on Wednesday - The Illness Is The Cure pt 6/46

The Medical Consultation as a ‘Set Up’

A patient wishes to make sense of his or her symptoms and arranges to see a doctor. So an appointment is duly made. Yet what remains unspoken in the consultation is that it is tacitly expected to take as its starting point certain unquestioned assumptions which serve as expected ‘points of departure’ for all doctor-patient communication. Below I list some of the most basic tacit assumptions that ‘enframe’ the medical consultation and constitute expected points of departure for all communication that occurs within it.

1. It is tacitly understood that we all know what ‘illness’ and ‘health’ are, that they are opposites, and that ‘illness’ is something ‘bad’ and ‘health’ something ‘good’.

2. It is tacitly understood and agreed that the patient arranges the consultation because he is suffering symptoms of a possible ‘illness’ which he wishes to have identified and which he or she is therefore prepared to have diagnosed through examination and testing and be prescribed treatment for.

3. It is tacitly understood and agreed that the patient will describe their symptoms and that the physician will, directly or through further tests, arrive at a medical diagnosis of the disease, recommend a course of biomedical treatment aimed at relieving their symptoms or ‘curing’ the disease – based on knowledge of its biological ‘causes’.

4. It is tacitly understood and agreed that the patient has just happened to fall victim to their symptoms ‘out of the blue’ – in other words that there is no meaning to be attached to the specific timing of their appearance in the larger context of the patient’s life and life history.

5. It is tacitly understood and agreed therefore, that symptoms have no meaning at all beyond being mere signs of a possible biological disease or dysfunction.

6. It is tacitly understood and agreed therefore that ‘making sense’ of symptoms means nothing more than taking them as possible signs of some biomedical disease – and that in no case can a biological illness or disease be itself taken as a symptom of a life-disease – a hidden life problem that manifests in the patient feeling ‘ill-at-ease’ with their lives.

7. It is tacitly understood and agreed that the patient’s suffering – their felt pain, discomfort or ‘dis-ease’ – is a mere secondary and subjective ‘effect’ of an organic disorder or ‘disease’. The contrary notion, namely that symptoms, illness and disease may be a symbol ic embodiment of a subjectively felt dis-ease’ – and of particular ways in which the patient is ‘ill-at-ease’ with their life – is ruled out in advance. Indeed such a notion constitutes sheer heresy in terms of the unquestioned dogmas of biomedical ‘science’.

Should a patient reject any or all of these assumptions, or depart from any of the unspoken rules or points of departure in their communication with a doctor, the patient will be immediately classed as a ‘difficult’ or ‘incompliant’ patient or even as deluded. Yet together these tacitly agreed assumptions and points of departure for a biomedical consultation effectively constitute an unspoken ‘set up’ or ‘frame up’ – a framework the patient is expected to compliantly adhere to. The aim of this ‘frame up’ is to enframe the meaning of the patient’s symptoms in the terms of one framework only – that of biomedicine – excluding any other possible ways of making sense of those symptoms. Any attempt by a patient to question this framework – even if only by not immediately accepting certain types of routine biomedical tests or courses of treatment – will arouse indignation and bewilderment, be seen as a threat to the authority of biomedically trained doctors and a waste of the limited time they give to their patients. Instead it could be seen as an opportunity to give themselves more time to learn about the lives of their patients as human beings, to understand their symptoms in the larger context of their life and life world.

What Most Doctors Don’t Ask

What follows is a list of some of the questions that most doctors don’t ask – and yet which are key questions for both doctor and patient in coming to understand the life meaning of particular symptoms or a particular illness. They are the sort of questions central to Life Medicine and those that a Life Doctor will ask and discuss with you.

When did your symptoms first occur?

Is there anything else in your life that is bothering/distressing you right now?

What was going on in your life in the hours, days, weeks, months or years preceding the onset of your symptoms?

What were the most significant life encounters, events, experiences, dilemmas and decisions that faced you in the period preceding the onset of your symptoms?

What was the underlying mood you experienced in this period and how would you describe it?

What were the most dominant thoughts and emotions you experienced in this period?

What do you tend to think about most when you are most aware of your symptoms?

What feelings accompany these thoughts?

What do you do with those thoughts and feelings when you have them?

What do you tend to do in response to your symptoms themselves?

At what specific times or in what specific life situations do your symptoms tend to occur or intensify?

At what times or in what situations do your symptoms tend to disappear or diminish?

Have you experienced similar symptoms in the past, and if so at what times and in what circumstances?

How do your symptoms – and the thoughts you have around them – affect your emotional life, work and relationships?

What do your symptoms either force you to do or stop you from doing?

Is there any positive benefit you can see from the way your symptoms affect your life?

How would you describe the overall or underlying mood or state of consciousness accompanying your symptoms and/or the thoughts and emotions around them?

How do your symptoms make you feel? In what way does the mood that accompanies them affect not only what you think and how you feel but also who you are – your sense of ‘you’?

Is there any positive side to the different mood and sense of self accompanying your symptoms?

Are there any other ways you could give expression to it in your way of relating to life and other people?

Alternatively, what changes in your way of relating to life and other people do you feel would most help to alter this underlying mood and/or alleviate your symptoms?

What are the most important types of experience you miss or have missed in your life and relationships?

What are the most important potentials or abilities you feel are not or have not been fulfilled or realised in your life?

What are the biggest fears or concerns you have about your symptoms, your illness or its treatment?

What would make you most happy or content in your life – independently of any improvement in your condition?