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Patients - from object to individuum

Dr. med. Wilfried Schmidt

Our immune system with all its facets of specific and non-specific defence mechanisms against diseases remains a mystery in many places in the 21st century, despite all scientific progress, which poses additional questions with every question answered.

Even the smallest detail of the hereditary traits of the present medical knowledge may not explain why someone gets sick and someone else doesn’t under similar living conditions. Neither are cures to be understood if the healed person suffered from an incurable disease, for example, a malignant tumour. 

Thus, in everyday life, the doctor contradicts know of his not omniscient knowledge on the one hand, but to meet patients who expect healing from him. Even the increasing knowledge of medicine cannot suppress this in the long run. 

The clinical picture 
To create the scientific clinical picture, it can distinguish four stages which interact with each other:

What is the disease? The aim is to identify the characteristic pattern of symptoms that differentiate this disease from others.

What are possible specific causes?

What is the most likely cause? The associations or hypotheses observed so far are tested.

Which pathogenic mechanisms are behind the identified causes?

This leads to “world views” of diseases, “incomplete models..., constructs for understanding real natural systems,” explains the gastroenterologist Prof. Dr. med. Ottmar Leiß. He compares them with detailed city maps that provide the most accurate orientation but do not cover the surrounding area. 

“... Last but not least, the recognition of the limits of knowledge is one of the decisive prerequisites for actual knowledge,” sums up the physician Prof. Dr. med. Dr. phil. Wolfgang Böcher. It also convinced him that it can record only partial aspects of knowledge about the processes of health and disease with the valid scientific instruments. With increasing progress, the partial aspects become more and more differentiated, more and more new insights are added - and many things that were still the truth yesterday are already declared invalid today because of new knowledge. Medicine has done an incredible amount in uncovering the causes of diseases and medical therapy concepts in the past century. The basis for this is the very successful application of scientific cause-effect thinking to medicine as a science. But is that enough for us to describe our reality with all the phenomena? 

The fictitious success 

The placebo effect shows that humans are much more than the sum of the measurable parts. When patients are given sham drugs, they often have the same effect as their “real” counterparts, provided that the doctor and patient know nothing about them. Influences that cannot be calculated, such as the doctor-patient relationship or the attitude towards therapy, play a decisive role in treating diseases. This means that medicine can never be an exact science, but always works only with probabilities of methodological knowledge gain. This is both an opportunity and a dilemma. 

Instead of number... 

Medicine, like all other sciences, is subject to the purposeful thinking: it must convert new knowledge into economic success. Findings must be measurable, with statistical tests and according to defined criteria. Statisticians have turned an individual into an average person, a simplified number with certain characteristics. 

This is where increasing criticism, from patients, comes in. They complain they are not taken, it does not take them seriously with their complaints, just “a number” whose diagnosis and therapy it has elicited from the computer. It becomes problematic for the patient if he feels ill, but the doctor cannot find a plausible clinical picture to explain his symptoms. This discrepancy between the state of health and the findings is everyday medical practice. 

... modern superstition 

Allowing the inexplicable to happen has always been difficult for humans. So “alternative” explanations are needed. Until the Middle Ages, they considered illness an expression of God’s punishment. We “enlightened and modern people” today only smile and prefer to explain our chronic tension headaches with heavy metal poisoning caused by amalgam. We then blame chronic gastrointestinal complaints with no tangible cause for an enigmatic infestation of intestinal fungi. 

We overhear that the evidence is often not successful and that it is not even certain whether intestinal fungi cause illness. Fashion diagnoses" emerge. The obscure healing methods of “alternative medicine” are called cleansing, draining and detoxification. Are we tired to our knowledge and return to superstition in a modern “outfit”? When “alternative medicine” thus distinguishes itself from “orthodox medicine”, its medieval argumentation leads it ad absurdum. 

Delimit or open? 

There is often something different behind it: it is man’s need for a deeper understanding of individual contexts of life. We want to understand why illness develops, why lifetime is limited, and we seek understanding for the questions. It is about looking beyond scientific knowledge. 

This is the great dilemma of scientific medicine and the root for criticism of its approach. As long as she remains stuck with the diagnosis and her therapeutic consequences are not holistic, she creates her own enemy images. If it does not meet the deeper expectations of the patient for healing, its valuable achievements will neither be appreciated nor implemented. Then modern superstition as “alternative medicine” will celebrate happy origins. 

Every medicine, whether conventional or alternative medicine, which is one-sided and makes partial truths dogmatic, risks no longer allowing constructive criticism. This reduces the value of her own (one-sided) insights. 

Healing is possible 

In epistemological terms, this is the interface for changing the level of perception and a solution to the dilemma. Then, as a doctor, when I seek the causes not only in medical knowledge but also open myself to holistic individual aspects, I leave either-or-thinking and turn to the level of a deeper understanding. Here, demarcations are unnecessary, since it is important to look at constitutional phenomena together. It is about complementarities, about relationships between health and illness, between life and death. 

A comprehensive anamnesis covers the biography of the disease, symptoms of the present, social environment and family disposition. The essential task of medical medicine is now to discover the individual physical and psychological situation of the patient (his constitution) together with him. This means that it is not the omnipotence and omniscience of the doctor, often caricatured as “demigod in white”, that determine the therapy, but mutual discussion and coordination about the procedure of treatment within the framework of a doctor-patient interaction based on trust. 

Scientific findings in medicine become an important tool, but not the content of therapy. It requires both professional and human competence from the physician in order to find out what is useful for the individual patient from the wealth of what is feasible. 

Whether healing happens is neither only in the doctor’s art or therapist nor in the will and ability of the patient. Daily practice shows this with countless examples. However, if the patient is given the opportunity to intervene in the healing process and his patterns of explanation and ideas about illness (no matter how contradictory to the supposed aim) are taken seriously, then his chances of recovery are much higher. 

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