The Clinical Encounter (eBook)

A Philosophical Analysis

Mathew Mercuri, Brian S. Baigrie, Steven K. Baker (Autoren)

eBook Download: EPUB

2025 | 1. Auflage
208 Seiten
Wiley (Verlag)
9781394217885 (ISBN)

Infos

In-depth philosophical analysis of conceptual issues and challenges in the clinical encounter

The Clinical Encounter enables readers to better understand the many facets of the clinical encounter, the challenges faced by its participants, and what it means to clinicians, patients, and the community. In approaching the clinical encounter as a social activity, the text examines how practical tasks of care interact with the experiences and values of participants, the environment of care, and healthcare policy.

Questions raised in The Clinical Encounter include:

• What do we mean by quality of care?
• How do we determine care to be effective?
• What is communicated in the encounter and how is it communicated (including presentation of risk and management of care options)?
• Who is (or ought to be) involved in decision-making about care and what are their perspectives and responsibilities?
• What is the role and impact of technology?

Intended for a broad audience, The Clinical Encounter is an essential thought-provoking resource for clinicians, students, managers, and researchers seeking to study and improve patient care, and for patients navigating the healthcare system.

Mathew Mercuri, PhD, PhD, is an Associate Professor in the Department of Medicine and an associate member of the Department of Philosophy at McMaster University and holds appointments at the University of Toronto and the University of Johannesburg.

Brian S. Baigrie, PhD, is an Associate Professor at the Institute for the History and Philosophy of Science and Technology and the Institute for Health Policy, Management & Evaluation at the University of Toronto.

Steven K. Baker, MSc, MD, FRCP(C), is an Associate Professor in the Department of Medicine and the HHAC Chair in Neuromuscular Rehabilitation at McMaster University.

Textauszug

2
The Clinical Encounter

2.1 The Clinical Encounter: What Is It?

At the core of the healthcare system and clinical practice is the clinical encounter. It is where those seeking care connect with healthcare services and service providers. It is doubtful that any reader of this book has not experienced a clinical encounter; for example, as a patient, a clinician, a healthcare worker, a family member or friend of someone seeking care, or in more than one of these roles. Despite the ubiquity of the clinical encounter, it seems to have received relatively little in the way of focused attention in the literature when compared with other aspects of medicine or healthcare, such as therapeutic effectiveness, quality of care, and affordability, among others (albeit, these topics do have relevance to the clinical encounter, as we see throughout this book). Some things that may be part of an encounter, such as decision making, have been the target of thoughtful analysis. The gap in attention is interesting, as the clinical encounter bears on, for example, diagnosis of the patient's condition, how care is managed, and if and when care can be considered high or low quality.

What do we mean by a clinical encounter? For anyone who has participated in an encounter, this question seems intuitive. As a question for formal analysis, the answer is less obvious. For example, philosophers interested in that question may be left with several additional questions. They might ask who must be involved for something to be considered a clinical encounter? They might also ask what activities must take place? Do a priori intentions and objectives define the encounter as clinical or is it rather an a posteriori label ascribed to a set of activities that transpired in a particular space and time? There may also be questions about location (e.g., must a clinical encounter take place in a “clinic,” such as at a hospital or doctor's office, and, if so, do all encounters in those spaces count as “clinical encounters”?). These questions are not trivial; how we define a clinical encounter bears on how we measure it, which includes how we know it took place. That measurement has implications on how we do research in healthcare, if and how clinicians receive remuneration, if and how patients are reimbursed by insurers, among other concerns.

In this chapter, we draw attention to the challenges in defining the clinical encounter. We suggest that there might be no single description that covers all interactions or activities our intuition tells us we should include in the category. We do not claim that our analysis is comprehensive. We cannot possibly cover (or know about) all the issues that might arise when a patient and clinician meet. Furthermore, both technological advances and shifts in social/cultural norms and practices may reveal additional considerations that must be accounted for in how we think about a clinical encounter. Some aspects may become irrelevant, and some roles or activities may change. This chapter highlights several aspects of the encounter that appear to play an important role in how we might consider when one has happened or operationalize our notion of it in educating clinicians, clinical practice, research, and so on. Our hope for this chapter is twofold: (1) to get the reader thinking more deeply about what is included in the clinical encounter, and (2) to provide a frame of the clinical encounter to help in our examination of it in later chapters.

To begin, let us consider the following encounter from circa 1900, as described by Arthur E. Hertzler, an American physician (taken from Porter, 1999; p. 678):

The usual procedure for a doctor when he reached the patient's house was to greet the grandmother and aunts effusively and pat all the kids on the head before approaching the bedside. He greeted the patient with a grave look and a pleasant joke. He felt the pulse and inspected the tongue, and asked where it hurt. This done, he was ready to deliver an opinion and prescribe his pet remedy. More modern men had a thermometer and a stethoscope. The temperature was gravely measured, and the chest listened to – or at.

I am sure the reader will agree that what is described constitutes a clinical encounter. Upon close examination, this account reveals much about the features of a clinical encounter, several of which speak to the context. First among them is the location of the encounter. This encounter takes place at the home of the patient rather than in healthcare facility; for example, a hospital or physician's office. That might suggest that location of the encounter is not a consideration in how we define a clinical encounter. That is, a clinical encounter might not require the existence of a formal clinic. However, consideration of the location may be relevant, as it could impose constraints on what may be done or impact what may be learned.

Second, the scenario also reveals something about who might be involved. The scenario is given from the point of view of a physician. Not only is there mention of a patient, but there is also explicit mention of a grandmother, aunts, and other children. What role these other people play and if they are indeed included in the encounter is not clear from this scenario, but their presence may be important. The mention of people present (other than the patient) as the “grandmother” and “aunts” seems to imply that the patient is a child. That could mean involvement of an adult in the part of the visit that constitutes the clinical encounter. Indeed, the clinical encounter might be particularized in accordance with whether the patient is pediatric, adult, or geriatric.

Finally, the scenario reveals several activities. Three activities stand out. First, a variety of tests are performed: assessing the pulse, inspecting the tongue, asking about location of pain. Second, the physician delivers an opinion; that is, there is a diagnosis. Third, the physician prescribes a pet remedy. That is, the encounter includes a decision or recommendation on how care is to be managed. There is mention of other activities, such as greeting the family and patient and offering an exordial joke. One cannot determine from a single scenario if any or all of these activities are required for a clinical encounter. However, the scenario suggests that the clinical encounter includes some meaningful engagement between the clinician and the patient (and perhaps others), which depends, in part, on the temperament and knowledge of both (each) participant(s).

What is not clear from the presented scenario are the goals of the encounter, or whether goals are an important aspect of how we define something as a clinical encounter. Looking first at the former, one might assume that the goal in the scenario was to find out what is ailing the child and provide some way to improve upon their condition. Mention of diagnostic tests and a prescription of remedy would support that assumption. However, there may be other goals, not limited to diagnosis and management of care. Determining whether goals are an integral feature in deciding what makes something a clinical encounter also requires much consideration. We may find that an encounter is defined by intention, a priori. For example, something may be considered a clinical encounter only if the patient or clinician enters the encounter pursuant to one of a set of predefined purposes, such as obtaining a diagnosis, administering therapy, or planning for care. On the other hand, it may be that goal setting by one or more participants is a core activity of a clinical encounter. In certain instances, a patient may equally wish to know what the disease is not, as to know what the disease is. Reassurance in this case would appear to be the objective, whether tacit or patent.

In our brief analysis of the presented scenario, we have identified several components that might help us in deciding what we mean by a clinical encounter. These include some consideration of location, who is involved, and what takes place. We also touched on the issue of goals. In the rest of the chapter, we turn our attention to examining each of these issues in more detail.

2.2 Who Is Involved in the Clinical Encounter?

At the core of any clinical encounter is the patient–clinician dyad. One could argue that participation of a patient and a clinician is a minimum requirement for a clinical encounter to take place. However, advancements in artificial intelligence (AI) might challenge that view in the future, as we briefly mention below (we discuss the role of technology in the clinical encounter in Chapter 9). The clinical encounter is not limited to a dyad. Various other parties may participate in some capacity or play a key role in specific activities. The participants in an encounter both shape its content and make possible different activities, which we discuss in Section 2.4 of this chapter.

Moving beyond the patient–clinician dyad, both the patient and the clinician may request additional participants. Some are brought in to play a specific role, whereas others may start as bystanders who are drawn into the encounter. Let us first look at who the patient might bring to the encounter. The patient may be accompanied by friends or family, for all kinds of reasons, who may assume a variety of roles (Laidsaar‐Powell et al., 2013). One reason could be that the patient may need someone to drive them to and/or from the appointment due to poor mobility or other health limitation, a lack of personal...

Produkt-Details

• Erscheint lt. Verlag: 10.12.2025
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Innere Medizin
• ISBN-13: 9781394217885 / 9781394217885