{"id":958,"date":"2014-07-24T20:27:52","date_gmt":"2014-07-24T19:27:52","guid":{"rendered":"https:\/\/blogs.bmj.com\/adc\/?p=958"},"modified":"2014-07-23T17:02:35","modified_gmt":"2014-07-23T16:02:35","slug":"words-listening-and-the-art-of-applying-the-general-to-the-specific","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/adc\/2014\/07\/24\/words-listening-and-the-art-of-applying-the-general-to-the-specific\/","title":{"rendered":"Words, listening, and the art of applying the general to the specific"},"content":{"rendered":"<p><a href=\"https:\/\/www.etsy.com\/uk\/listing\/184394189\/doctor-physician-typography-wooden?ref=market\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft\" src=\"https:\/\/img1.etsystatic.com\/032\/1\/6799458\/il_570xN.582885015_q58h.jpg\" alt=\"\" width=\"181\" height=\"166\" \/><\/a>A little bit of a swirl around a<a href=\"http:\/\/mh.bmj.com\/content\/27\/2\/64.full\"> decade-old paper\u00a0<\/a>by <a href=\"http:\/\/twitter.com\/iona_heath\">@iona_heath<\/a>\u00a0on the trouble with turning a patient&#8217;s experience into\u00a0something that might require medically fixing that was floated about twitter recently.<\/p>\n<p>The paper, which is densely written and has lots of lovely quotes from proper writers, and speak of many aspects of doctoring, holds to a thesis that the truth of the patient&#8217;s condition is their living of it, and as doctors, we mould and warp and misrepresent it to fit into a diagnosis, reject a diagnosis, or hold as an uncertainty.<!--more--><\/p>\n<p>It says of the process of evidence-based medicine:<\/p>\n<blockquote>\n<p id=\"p-65\">Of course it is essential that we seek to base our practice on the current state of scientific knowledge and unless we do this we betray our patients&#8217; trust and become quacks and charlatans. But we are bombarded by guidelines, which &#8230;\u00a0present medicine as an endeavour that is simple and straightforward. They offer the illusion that each situation can be precisely defined so that the appropriate treatment can be given and the best outcome for the patient and society guaranteed. &#8230;<\/p>\n<p>The complexity lies in the relationship between the population and the individual<\/p><\/blockquote>\n<p>Which is a superb description of <a title=\"Basics: Where\u2019s the art of medicine in EB medicine?\" href=\"https:\/\/blogs.bmj.com\/adc\/2013\/12\/22\/basics-wheres-the-art-of-medicine-in-eb-medicine\/\">practicing\u00a0EBM <\/a>that we&#8217;ve been banging on about since Archimedes was first born, just after the turn of the Millennium. Guidelines guide. To\u00a0see more is illusory. <a title=\"Basics. What is evidence based medicine?\" href=\"https:\/\/blogs.bmj.com\/adc\/2013\/12\/08\/basics-what-is-evidence-based-medicine\/\">EBM is tripartite<\/a>.<\/p>\n<p>We need to know good science from bad.<\/p>\n<blockquote><p><span style=\"color: #000000\">Wisdom enough to leech us of our ill<\/span><br style=\"color: #000000\" \/><span style=\"color: #000000\">Is daily spun; but there exists no loom<\/span><br style=\"color: #000000\" \/><span style=\"color: #000000\">To weave it into fabric; undefiled<\/span><\/p>\n<p style=\"text-align: right\">\n<\/blockquote>\n<p style=\"text-align: right\">(Upon This Age, Edna St. Vincent Millay)<\/p>\n<p>We need excellent clinical skills, so that the subtle illness of the seriously unwell\u00a0child is not lost.<\/p>\n<blockquote><p>&#8220;She wasn&#8217;t bouncy, she was very quiet, she seemed to be in pain actually, she was moaning, and she looked slightly swollen, her face was rounder than it should have been&#8221;<\/p>\n<p style=\"text-align: right\">(Clarke et al.\u00a0<a href=\"http:\/\/bmjopen.bmj.com\/content\/4\/2\/e004640.full\">BMJ Open 2014;4:e004640<\/a>)<\/p>\n<\/blockquote>\n<p>&nbsp;<\/p>\n<p>And we also need to know that we really need to listen to what the patients and their families bring to us, what they want from us, and supply what we can by answering &#8211; not always fulfilling &#8211; those requests. The quote\u00a0Heath brings from George Steiner sums it up beautifully:<\/p>\n<blockquote><p>\u201cthe two validating wonders of mortal existence are love and the future tense\u201d<\/p>\n<p style=\"text-align: right\">(Steiner G. Errata: an examined life, quoted by <a href=\"http:\/\/mh.bmj.com\/content\/27\/2\/64.full#ref.34\">Heath<\/a>)<\/p>\n<\/blockquote>\n<p>&nbsp;<\/p>\n<p>&#8211; Archi<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A little bit of a swirl around a decade-old paper\u00a0by @iona_heath\u00a0on the trouble with turning a patient&#8217;s experience into\u00a0something that might require medically fixing that was floated about twitter recently. The paper, which is densely written and has lots of lovely quotes from proper writers, and speak of many aspects of doctoring, holds to a [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/adc\/2014\/07\/24\/words-listening-and-the-art-of-applying-the-general-to-the-specific\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[79,2681],"tags":[],"class_list":["post-958","post","type-post","status-publish","format-standard","hentry","category-archimedes","category-practice-of-medicine"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Words, listening, and the art of applying the general to the specific - ADC Online Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/adc\/2014\/07\/24\/words-listening-and-the-art-of-applying-the-general-to-the-specific\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Words, listening, and the art of applying the general to the specific - ADC Online Blog\" \/>\n<meta property=\"og:description\" content=\"A little bit of a swirl around a decade-old paper\u00a0by @iona_heath\u00a0on the trouble with turning a patient&#8217;s experience into\u00a0something that might require medically fixing that was floated about twitter recently. The paper, which is densely written and has lots of lovely quotes from proper writers, and speak of many aspects of doctoring, holds to a [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/adc\/2014\/07\/24\/words-listening-and-the-art-of-applying-the-general-to-the-specific\/\" \/>\n<meta property=\"og:site_name\" content=\"ADC Online Blog\" \/>\n<meta property=\"article:published_time\" content=\"2014-07-24T19:27:52+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/img1.etsystatic.com\/032\/1\/6799458\/il_570xN.582885015_q58h.jpg\" \/>\n<meta name=\"author\" content=\"Bob Phillips\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Bob Phillips\" \/>\n\t<meta name=\"twitter:label2\" content=\"Estimated reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/2014\\\/07\\\/24\\\/words-listening-and-the-art-of-applying-the-general-to-the-specific\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/2014\\\/07\\\/24\\\/words-listening-and-the-art-of-applying-the-general-to-the-specific\\\/\"},\"author\":{\"name\":\"Bob Phillips\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/#\\\/schema\\\/person\\\/9e94029681ecf36e73bbd1eb2be2ef94\"},\"headline\":\"Words, listening, and the art of applying the general to the specific\",\"datePublished\":\"2014-07-24T19:27:52+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/2014\\\/07\\\/24\\\/words-listening-and-the-art-of-applying-the-general-to-the-specific\\\/\"},\"wordCount\":417,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/2014\\\/07\\\/24\\\/words-listening-and-the-art-of-applying-the-general-to-the-specific\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/img1.etsystatic.com\\\/032\\\/1\\\/6799458\\\/il_570xN.582885015_q58h.jpg\",\"articleSection\":[\"archimedes\",\"practice of medicine\"],\"inLanguage\":\"en-GB\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/2014\\\/07\\\/24\\\/words-listening-and-the-art-of-applying-the-general-to-the-specific\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/2014\\\/07\\\/24\\\/words-listening-and-the-art-of-applying-the-general-to-the-specific\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/2014\\\/07\\\/24\\\/words-listening-and-the-art-of-applying-the-general-to-the-specific\\\/\",\"name\":\"Words, listening, and the art of applying the general to the specific - 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