Information Technology Reference
In-Depth Information
understanding of medical phenomena - thus challenging the medical sovereignty
of health, illness and disease interpretation. Furthermore, Martin Buber is rhetor-
ically invoked with his emphatic notion of encounter [Begegnung] in the context
of the physician-patient-interaction and trust is rightly stressed as a crucial compo-
nent of the clinical encounter; however it quickly gets clear that above all stands the
physicians ability to attain and structure information from the patient fitting into his
disease-knowledge. Disease is what the physician is concerned with; the explana-
tory model of the patient can largely be ignored. The anamnesis and diagnostic
processed as described with the fuzzy logic approach is primarily geared towards
knowledge generation that fits into the disease categorization. Although such cat-
egorization is important for proper diagnosis, it runs the risk of objectifying the
patient and not taking the patient's own illness narrative seriously enough. This
emphasis on the analytical skill is at the same time an undervaluation of the illness
experience.
The disease orientation (and illness ignorance) of orthodox medicine certainly is
of good service in many clinical cases, especially the severe ones. The success of
Western medicine and this system of diagnosis is all too evident; but the discontents
of this medical system have equally to be acknowledged. The focus, therefore, has
to be put on illness equally - not just for establishing trust but also for the simple
reason that “50% of visits to the doctor are for complaints without ascertainable
biological base” [6, p. 141]. Furthermore, about four out of five sickness episodes
are treated without looking for professional help. It is thus of great importance to
understand the way these sickness episodes are understood and interpreted, and to
gather knowledge about the therapeutic strategies to deal with illness in popular
medicine. An approach focusing exclusively on the underlying disease might lose
the importance of the illness narrative out of sight.
In addition, there is an increasing medical pluralism, i.e. patients carefully
choose between different medical traditions - Western, traditional Chinese, folk
etc. Understanding this medical pluralism only as a transitory phenomenon would
fail to grasp the desire of people to choose a medical approach which serves best
there need. Medical pluralism should not be understood in terms of a deficiency of
Western medicine to adequately diagnose diseases; rather it mirrors the inability to
address adequately illness narratives. It seems to me at least very doubtful whether a
further development of analytical skills would solve the trust issues that the medical
profession has to deal with and dissolve the choice of people of different medical
approaches. In this context, the popular medical treatments have to be stressed,
which are able to cope with four out of five sickness episodes.
There are a number of convergences in the two accounts, Kleinman's and Sadegh-
Zadeh's - compared. They both refute a simplistic opposition of health and disease,
and differentiate between illness and disease in similar ways. Furthermore, the con-
structivist thrust is common to both; Kleinman understanding illness and disease
as explanatory models rather than entities, Sadegh-Zadeh making it clear that the
“patient's true state is a construct of medical knowledge” [13, p. 274]. However,
they alter significantly in their focus. The examples in the preface of the Hand-
book illustrate already the disease focus attempting to avoid misdiagnosis, whereas
