The missing person: The outcome of the rule-based totalitarianism of too much contemporary healthcare

https://doi.org/10.1016/j.pec.2017.03.030Get rights and content

Abstract

Objectives

Medicine has an obsession with scientific progress and a misplaced belief in the perfectibility of the human body and mind and, as a result, there seems never to be time for the necessary backward glance. If we in healthcare are to learn any of the lessons of history, it seems important that we pay attention to those who have suffered at the sharp end of historical events.

Methods and results

This paper invokes thinkers and writers who lived lives scarred by totalitarian politics. Their testimony emphasises the importance of paying attention to the particularity of individual experience and demonstrates the importance of story, listening, seeing, imagination, and attention.

Conclusion

If we are to resist the secular totalitarianism of contemporary healthcare and reinstate the missing person at the centre of what we do, we as healthcare professionals must find the courage to disregard the rules.

Practice implications

In every consultation it is important to be aware of the wider historical, political and social context that may direct and constrain the choices available to both patients and professionals.

Section snippets

Story

All healthcare begins with a story told by a patient. The British writer, Caryl Phillips, born in St Kitts in the Caribbean, understands the elemental nature of human stories:

The urge to tell a story is the oldest of human impulses, for it clarifies and orders the relationship between the private and the public, our inner and outer worlds, and it records the dissonance between these two spheres of existence. [13]

And this seems particularly relevant when we talk about the stories told by

Listening

So much in healthcare depends on how well healthcare professionals listen to each patient's story. The 19th century English novelist and poet Dinah Craik describes:

Oh, the comfort—the inexpressible comfort of feeling safe with a person—having neither to weigh thoughts nor measure words, but pouring them all right out, just as they are, chaff and grain together; certain that a faithful hand will take and sift them, keep what is worth keeping, and then with the breath of kindness blow the rest

Seeing

In his book A Fortunate Man about the work of a country doctor in England, John Berger wrote:

He does not believe in maintaining his imaginative distance: he must come close enough to recognise the patient fully. [21]

Most of the works of the Soviet Russian writer Andrei Platonov were banned in his lifetime and his son was sent to the Gulag as a “spy” aged only 15. He was also one of the writers most admired by John Berger. In his novel Soul, Platonov writes:

Only from a distance was it possible

Imagination

In A Seventh Man, John Berger insists on the necessity of imagination:

To try to understand the experience of another it is necessary to dismantle the world as seen from one's own place within it, and to reassemble it as seen from his. For example, to understand a given choice another makes, one must face in imagination the lack of choices which may confront and deny him. [23]

This describes a skill and a capacity which is essential to the effective practice of medicine, and there is no place

Attention

The philosopher Simone Weil writes repeatedly about the importance of moral concentration which she called attention:

– no true effort of attention is ever wasted even though it may never have any visible result, either direct or indirect. [25]

And in a world increasingly obsessed with measurement, recording, and faceless standardisation, this remains absolutely true.

Those who are unhappy have no need for anything in this world but people capable of giving them their attention. The capacity to

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