4th Global Conference
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Monday 4th July - Thursday 7th July 2005
Mansfield College, Oxford
Conference Programme, Abstracts & Papers
Session 3: Diagnosis and Dialogue
Chair: Stuart Oultram
Methods of Diagnosis: The Path Towards Dialogue
Imre Bard
Department of Philosophy,
Universität Wien, Vienna
and
Eötvös Loránd University of Sciences, Budapest
Written
with the help of a doctor of Traditional Chinese Medicine, this text presents
the eastern methods of diagnosis, stressing the general point of fundamental
interconnectedness in Chinese medicine as opposed to the isolating rationalism
characteristic of the West. Through this comparison, we find ourselves
confronted with the ancient philosophical problem of "truth" and
its value. Biomedicine, currently on the path of battling diseases with
laser-like accuracy, advocates the standpoint of a calculable universe
governed by causality. Within this universe, however small they may be,
seeds of truth, such as genes, can unambiguously be located.
The way we
diagnose reveals our general attitude towards health and disease. Though
immensely effective on a technical level, the biomedical methods of translating
human conditions into measurable quantities have a tendency to engender
a kind of alienation between patient and doctor. On the contrary to such
an approach, Chinese medicine lays almost no emphasis on the formulation
of universal truths. The examinations of TCM are founded in a close relationship
between doctor and patient, requiring the physician to consider such
subtle observations, which our medical tradition would never even notice.
In
my paper, I set out to elaborate this close patient-doctor relationship,
showing how the differences in the modes of medical treatment are rooted
within basic philosophical and cultural divergences. In the main, though,
I search for possibilities to integrate the more personal manner of diagnosis
and the less analytical but rather holistic attitude of TCM into our
own medical praxis.
The paper could be understood as a further exposition of the cultural
aspects of medicine, raised at last years’ conference by Vera Kalitzkus.
(Biomedicine and Culture: The Cultural Basis of Modern Medicine and its
Implications for Practice)
Living with Chronic Pain but not Talking about it: The
Significance of Having the Diagnosis of Rheumatoid Arthritis
Stella Howden*, M Nicol**, D
Martin*** and D Jones**
*Department of Physiotherapy, Queen Margaret University
College, Edinburgh
**Department of Occupational Therapy and Art Therapy,
Queen Margaret University College, Edinburgh
***
Principal Research Fellow,
Sheffield Hallum University, Sheffield, United Kingdom
Introduction
The chronic pain of rheumatoid arthritis
(RA) is said to shape the illness experience for individuals living with
the condition and is associated with having a negative impact on the
quality of life. Several studies have suggested that those living with
RA conceal their pain experiences and pain-related concerns from family,
friends and healthcare professionals. The reasons for this non-disclosure
have not been fully explored although work in other areas suggests that
notions of social and moral order may be influential. The aims of this
study were to explore the perspectives of individuals with RA regarding
pain-reporting and to consider what factors might shape these perspectives.
Method
This interpretive, qualitative study used individual
semi-structured interviews to generate findings. Twenty-nine adults with
RA were recruited from hospital rheumatology clinics and were purposively
sampled to select a heterogeneous group. Thematic analysis was used inductively
to generate key themes.
Results
Multiple accounts of the non-disclosure of pain
experiences/concerns were found; those relating to family and friends
were founded on beliefs that pain-talk may serve to burden and/or repel the
listener. In relation to concealing pain from the hospital doctor, key
themes were inter-connected with individuals’ understanding of
RA as a distinct illness entity. Respondents suggested that as RA was
incurable and medical treatments were not fully effective then they expected daily
pain and anticipated that pain would inevitably worsen with
time, hence, complaints about pain were unjustified. Respondents also
associated medical treatments for pain and RA with multiple adverse effects,
which also appeared to contribute to their non-report.
Conclusions
Pain is a personal and private experience
and needs to be communicated to others if they are to provide appropriate
and timely support. The findings from this study suggest that there are
multiple barriers to reporting pain in RA. Most notably, individuals’ perspectives
on RA, as a distinct illness entity, appear to act as significant barriers
to clinical pain reporting. These findings support the need for the healthcare
professional to actively invite and encourage pain reporting at the clinic
and to thoroughly explore the individual’s perspectives on the
relationship between their pain experiences and the condition with which
they have been diagnosed.
Grasping Smoke: An Exploration of Health
Care Professionals’ Perceptions
of the Concept of Spirituality as Applied to Palliative Care
Robert Murphy
Research Practitioner/Research Associate,
Trinity Hospice/St Georges Hospital Medical School. London, United Kingdom
Previous studies have
highlighted the requirements of health care professionals to consider the
whole person, including spirituality. The concept of spirituality in
the modern palliative health care paradigm remains elusive, and as a
consequence, spiritual care in practice is somewhat hampered by this
lack of clarity.
The aim of this study is to explore the concept of spirituality
and how it is perceived by health care professionals who are currently
engaged in the palliative health care paradigm, in order to discover
the factors which facilitate, or inhibit, the delivery of spiritual
care in the practice setting.
Using a qualitative interpretive (Verstehen)
approach, in-depth- interviews were conducted with nine health care professionals.
A thematic analysis of the participants’ accounts was then carried
out, post interview.
Four main categories emerged with a number of themes.
Category one, which focuses on the concept of spirituality, noted that
spirituality was a much broader concept than religion and was individually
self-expressed. Category two, which focused on the spirituality of health
care professionals, noted delivery of spiritual care was influenced by
their own personal biography. Category three, which focused on spiritual
care in practice, noted that health care professionals relied on their
own individualised subjective spiritual make-up and experiences to deliver
care. Category four, difficulties related to the delivery of spiritual
care, noted in the absence of a generally accepted definition of spirituality,
spiritual care will continue to be hampered.
The findings were analysed
in relation to the literature, and implications are then drawn as to
what this may mean for future practice and research.