The intersubjective and the intrasubjective in the patient–physician dyad: implications for medical humanities education
- Ayelet Kuper, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Room A442, 2075 Bayview Avenue, Toronto, ON, M4N 3M5 Canada;
- Accepted 9 May 2007
At the heart of medicine is the patient, and the fundamental relationship in medicine is the patient–physician dyad. Smith’s argument for the intersubjective creation of knowledge, which is itself indebted to Bakhtin’s notion of the utterance and of the necessity of “the other” in the development of meaning, enables an exploration of the creation of meaning during the patient–physician encounter. The analysis is enriched by Haraway’s concepts of partial perspectives and of dispersion, which expose the many roles and voices in which the physician and patient may interact. This approach emphasises the use of the medical humanities as a tool to teach medical students about the ambiguities of clinical practice, in which there is often no “right answer” except what is appropriate for the individual patient.
Competing interests: None declared.
Support for this research was provided by the Clinician Educator Training Program, Department of Medicine, University of Toronto, and by a Fellowship for Studies in Medical Education from the Royal College of Physicians and Surgeons of Canada.
iWhile an existing chart is not often currently available for new clinic patients, previewing the chart prior to seeing the patient is the norm for inpatient consultations. With the impending advent of the centralized electronic health record in many jurisdictions, this practice will inevitably become increasingly common in the outpatient setting as well. This process is more efficient for health care personnel, as it provides details that patients often do not remember. Patients also often prefer it in order not to have to keep retelling the same “story” to multiple practitioners, and “experienced” patients may tell physicians to “read the chart” instead of answering repeated questions.