Biomedical Engineering Reference
In-Depth Information
One central problem to researchers in this fi eld is the meaning and
consequences of the modern big and complex health care organizations
and systems. One of the most important features of these organizations and
systems is the increasingly specialized medical knowledge and technology
and its tight connection to specifi c professions and professional groups
(specialized medical doctors and registered nurses, and various equally
specialized paramedical professions).
The potential confl ict between the experiences and knowledge of the
patient and the health care system has been conceptualized as a confl ict
between the patient's
life world
and
the world of medicine
. These two central
concepts - the life world and the world of medicine - go back to ideas
introduced by the philosopher Edmund Husserl in his topic
The Crisis of
European Sciences
(1970). Husserl's idea was that all our human knowledge
is built on the lived everyday experience of the world - what he called the
'life world'. Due to practical needs and problems we start to contemplate
not only the world but our own experience of the world. We do this for
instance through an abstracting attitude towards our own experience - that
is, we become self-refl ective. Husserl used the example of geometry, and
argued that we, as human beings, over time have learnt to abstract more
general and recurrent spatial forms from the everyday practical experience
of the shapes of things in the world. As a consequence everyday knowledge
is to be regarded as a prerequisite for scientifi c knowledge. In a similar
way, the philosopher Georges Canguilhem (1991) has pointed out that the
everyday experience of the body, as well as its ailments, is a prerequisite for
the development of scientifi c medical knowledge about various diseases.
The ideas of Edmund Husserl were adapted to the fi eld of social science
fi rst of all by Alfred Schutz (1962) and Harold Garfi nkel (1967). They argued
that everyday world knowledge could be characterized by its uncritical,
practical-pragmatic and taken-for-granted attitude towards both the world
and experience. The knowledge of science on the other hand, is characterized
by opposite qualities: a critical, theoretical and systematic attitude towards
phenomena and experience.
These concepts were used by the social psychologist Elliot Mishler when
writing about the different attitudes of patients and doctors in medical
interviews in his topic
The Discourse of Medicine
(1984). More specifi cally,
patients and doctors relate to the complaints and problems that the patient
presents in the medical interview in two different ways. Elliot Mishler argued
that in medical interviews, two voices, that is, two ways of relating to and
talking about bodily problems could be discerned: what he called the voice
of the life world and the voice of medicine. These two voices will sometimes
be in confl ict in the medical encounter; the voice of the life world struggles
against the voice of medicine in order to be heard and recognized by the
doctor (see Mishler 2005 for an update of his views). The idea of the two
worlds are then used in order to point out that patients and doctors have
different kinds of knowledge and attitudes towards bodies and illnesses; and
