{"id":1709,"date":"2018-11-12T14:00:21","date_gmt":"2018-11-12T13:00:21","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-humanities\/?p=1709"},"modified":"2023-04-21T10:56:00","modified_gmt":"2023-04-21T09:56:00","slug":"when-horizons-intersect-reflections-on-collaborative-patient-centred-care","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-humanities\/2018\/11\/12\/when-horizons-intersect-reflections-on-collaborative-patient-centred-care\/","title":{"rendered":"When Horizons Intersect: Reflections on Collaborative, Patient-Centred Care"},"content":{"rendered":"

by Austin Lam<\/p>\n

While \u2018patient-centred care\u2019 is an often used phrase, the question bears asking: what underlies such a broad concept?<\/p>\n

As a medical student with a background in philosophy, I have endeavoured to integrate my journey in medicine with a philosophical sensibility. Part of that has led me to reflect on the meaning of the term patient-centred care.<\/p>\n

Professor Jennifer Gibson and Dr. Andreas Laupacis discussed patient-centred care<\/a> as having several different meanings depending on one\u2019s role in the health system. Patients, clinicians, hospitals, and organizations all bring their own points of view on the care experience. Notwithstanding the term\u2019s variable meanings, philosopher Hans-Georg Gadamer\u2019s<\/a> idea of a \u2018Fusion of Horizons\u2019 reveals an underlying thread, enriching our understanding of what we might more commonly refer to as perspective-taking.<\/p>\n

\u2018Fusion of Horizons\u2019 captures how our background, history, culture, education, language, and so forth enter into the conversations that we have with one another. Professor Fredrick Svenaeus elaborated<\/a> on this Gadamerian concept and applied it to the practice of medicine in insightful terms: the patient-physician encounter is one that is fundamentally carried by their communication with one another \u2013 a dialogue.<\/p>\n

A practice of perspective-taking (putting oneself in the patient\u2019s shoes), as contextualized by a fusion of world views, is critical in shaping meaningful dialogue with the patient at the centre of the conversation. Professor Fredrik Svenaeus says:<\/p>\n

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The clinical encounter can be viewed as a coming-together of the two different attitudes and lifeworlds of doctor and patient \u2013 in the language of Gadamer, of their different horizons of understanding \u2013 aimed at establishing a mutual understanding, which can benefit the health of the ill party. Doctors are thus not first and foremost scientists who apply biological knowledge, but rather interpreters of health and illness. Biological explanations and therapies can only be applied within the dialogical meeting, guided by the clinical understanding attained in service of the patient and [their] health.<\/p>\n<\/blockquote>\n<\/blockquote>\n

Vitally important to carrying out an effective perspective-taking approach is the recognition of the asymmetrical relationship between the patient and the physician. Professor Svenaeus rightly emphasized that: \u2018The patient is ill and seeks help, whereas the doctor is at home \u2013 in control by virtue of [their] knowledge and experience of disease and illness. This asymmetry necessitates empathy on the part of the doctor. [They] must try to understand the patient, not exclusively from [their] own point of view, but through trying to put [oneself] in the patient\u2019s situation.\u2019<\/p>\n

\"Duckrabbit\"<\/a>
Aspect seeing is the ability to see one thing in multiple ways. An example used by Wittgenstein in Philosophical Investigations is that we can see the \u2018duckrabbit\u2019 either as a duck or as a rabbit.<\/figcaption><\/figure>\n

Gadamer\u2019s \u2018Fusion of Horizons\u2019 enriches our understanding of what perspective-taking might look like because he viewed health as \u2018a condition of \u2018being there,\u2019 of being in the world, of being together with other people, of being taken in by an active and rewarding engagement with the things that matter in life. \u2026 It is the rhythm of life.\u2019<\/p>\n

Thus, when perspective-taking, informed by a \u2018Fusion of Horizons,\u2019 forms the underlying architecture of a patient-physician encounter, physicians might be better equipped to:<\/p>\n