What is a true “encounter”?

“Every present consciousness is discovered to be exceeded by a horizon of perceivability which confers on the world its strangeness and abundance.” –Paul Ricoeur

I am probably crazy.  I ride my motor scooter to and from work at the hospital.  Some consider it unsafe.  Perhaps it is, but feeling the wind and rain, the unfiltered elements, after 12 hours inside a controlled environment is too refreshing to pass up.  So at 2am Friday night I am zooming (you always zoom on a scooter…) through the industrial district after a tiring admitting shift.  I see some kids messing around on bicycles, one pulling a trailer, all laughing and yelling.  The road is otherwise deserted.  “Joyriders,” I think, “out for fun on Friday night.”

I passed them by and was soon home in bed.  But the late night encounter sticks with me because of the way it showed how my medical mind worked.  As a hospitalist I never know what patient encounter awaits me until the pager buzzes from the emergency room.  Similarly, zooming down dark streets, my mind is empty, receiving the unfiltered stimuli of breezes, smells, and lights.  A vision impinges on my consciousness, bicycles with trailers, screaming kids.  I have no idea what they are really doing there on a deserted street in the warehouse district at 2am.   Just so, the ED doctor presents a case: fevers and trouble breathing.  My brain reacts the same way to both phenomena, I categorize a direct experience into some digestible: joyriders and pneumonia.  The human brain does not deal with pure experience very well, or for very long.  We love to categorize and digest.  Once classified, I pigeonhole the experience and am able to keep moving down the dark street, or entering admission orders.

The phenomenologists were philosophers who worried a great deal about humans’ propensity to categorize prematurely.  Phenomenology can be seen as a reaction to Descartes’ proclamation, “I think, therefore I am.”  That phrase was intended to start philosophy with the only stable, unshakable, preconceived notion: rational thought.  Starting with a basis of a human as a rational, thinking machine, Descartes deduced the existence of God and a whole lot more as well.  According to Cartesian thinking, which dominated Western philosophy for two hundred years, pure reason alone will yield up truth.  Instead, the phenomenologists wanted to focus on what we have to do prior to using reason.  We have to confront the “things in themselves,” the experiences prior to interpretation.  “Perception never ceases to reveal how living goes beyond judging,” is the phrase used to describe this never-ending cycle of perceiving and judging.

Medical practice relies on the doctor’s ability to make judgments.  When I make a diagnosis and start treatment I have assembled a jumble of perceptions into a coherent judgment, a classification of some kind.  Without this act of labeling, my patient would remain a pure individual, with an uninterpretable unique set of occurrences and symptoms.  I would be powerless to act.  Yet, treating a person as a label is dehumanizing and objectifying.

Many healthcare workers are familiar with the AIDET tool, coined by the Studer group to help provide better patient experiences.  It is an acronym for Acknowledge, Introduce, Duration, Explain, Time, and functions as a mnemonic for us to remember to humanize interactions with patients.  Examples of using AIDET include greeting the patient, introducing yourself, explaining why you are interacting with them and how long it will take.  This tool eases patient anxiety about the uncomfortable experience of interacting with healthcare.  In truth, AIDET is nothing but a method of putting phenomenology into practice.  Instead of jumping straight to the categorization of a patient, labeling them as “the next xray,” or the “the diabetic,” we acknowledge the direct experience of the other person.  Rather than “joyriders,” the kids on their bikes and at night are left as simply that, kids on their bikes at night, a wonderment to tired eyes, surging up on a deserted street.  

Every patient — every human — needs to be first a welling up of an experience, a consciousness of an other without a judgment.  Everyone has had their moments of zooming down dark streets at night, with a tired rational brain at idle, directly feeling the wind without analyzing it.   How can we let patients surge up into our consciousness?  And after this pure experience of another human, how can we then move on to the categorization we need to do as medical professionals in order to diagnose and treat?

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