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Arguably, the consequences of Dr. Launer’s thoughtful reflection on listening to patients as ‘the essence of medical practice’ extend even beyond what he rightly describes as ’a vital step in creating more humane and equitable interactions in medicine’ (1). For those stories of ‘individual sickness’ are what medical historian Temkin (1963) describes as one of two major ways of understanding disease itself (2). This ‘physiological’ process-based approach to disease treats patients as a unique combination of factors leading to individual episodes of sickness. It has stood in historical opposition to the ‘ontological’ approach, where disease is understood as a ‘specific entity’ in and of itself that befalls an otherwise healthy person, and it is up to the physician to pluck out a homogenous disease from a pre-established reality happening within a passive patient. It is not that one way is ‘right,’ but there are historical examples where validating stories of sickness has led to more mature insights about the origins, causes, and treatment of disease by placing the individual patient in their unique context. Doing so seems particularly important if we are to take into account health inequities. An adequate view of humanistic medicine does not stop at the patient-physician relationship (3) and thus Launer’s principle of ‘giving not taking’ should extend into health systems and policy.
1 Launer J. Is taking a history outmoded? Why doctors should listen...
1 Launer J. Is taking a history outmoded? Why doctors should listen to stories instead. Postgrad Med J. 2022 Mar;98(1157):236. doi: 10.1136/postgradmedj-2022-141516. PMID: 35181611.
2 Temkin O. The scientific approach to disease: Specific entity and individual sickness. In Scientific Change, ed. Crombie A. C., 1963, 629–47. New York/London: Heinemann (reprinted in Temkin 1977, 441–55).
3 Ferry-Danini J. A new path for humanistic medicine. Theor Med Bioeth. 2018 39(1):57-77. doi: 10.1007/s11017-018-9433-4. PMID: 29429022.