The Future of Education

Shared decision making (SDM) in general practice has recently been introduced as a means of conducting medical consultations with patients. However it is rarely observed in practice and indeed doctors appear to draw upon various conversational techniques to ensure that they remain firmly in charge of consultations (Roberstson, et al. 2011). Recent research also suggests the dominance of medical expertise as a model for consultations is persistent and that there is an urgent need to counter this (e.g., Cantaert, Smolderen & Van Hecke, 2019).  The aim of this paper is to put forward a case for going back to first principles by considering how medical students might learn about the nature of talk in consultations from an ordinary language philosophy perspective. It does so by considering a major aspect of clinician-patient conversation: talk about pain. This is considered from a Wittgenstinian perspective in terms of how pain is a managed discourse within these consultations. Medically speaking, pain is considered as a message, or a response, which is indicative of something being wrong in a part of the body and that an intervention is required. In this view it is regarded as a safety mechanism, a survival and a preservation device, that alerts us to something being wrong. However, talk about pain is also part of what Wittgenstein (1958) in his Philosophical Investigations refers to as the language-games that we engage in. In medical consultations there are ways of talking about pain either directly or indirectly which are part-and-parcel of an interactional event and which impact on the degree to which SDM is engaged in. The paper considers the extent to which diagnosis of pain is but one aspect of pain talk in medical consultations, and the extent to which it also figures as part of the management of these as time-bound interactional events. The argument is made that far from being tangential to medical education, selected aspects of philosophy may actually improve students’ understanding of the nature of consultations and enhance effective patient inclusion.   

Keywords: medical, consultations, education, pain, philosophy, Wittgenstein;

References:
[1] Cantaert, G., Smolderen, K., & Van Hecke, A. (2019). Perceptions of physicians, medical and nursing students concerning shared decision-making: a cross-sectional study. In CARE4 International Scientific Nursing and Midwifery Congress, Third Edition.
[2] Robertson, M., Moir, J., Skelton, J., Dowell, J. and Cowan, S. (2011) When the business of sharing treatment decisions is not the same as shared decision making: A discourse analysis of decision sharing in general practice, Health 15, 1: 78-95.
[3] Wittgenstein, L. (1953) Philosophical Investigations. Oxford: Blackwell.