Chocolate for GP

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Learning Outcomes

• What is philosophy?
• How to understand an encounter with a patient or
  registrar. A philosophical perspective
• Why this works with the narrative based model.
• A realisation that this can improve your
  consultations and teaching.

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The unexamined life is not worth living.
Socrates
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• As for me, all I know is that I know nothing
• Philosophy begins with wonder

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The Greeks Philosophy was to be lived
Modern ideas Philosophy is a way of thinking to
advance an argument or idea using reason
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•  

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• It is not a science ,
• not wisdom
• or knowledge
• but a mediation around the available knowledge.
• It is about the wisdom of life, about popular
  intelligence.

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How does the mind construct our knowledge of the
objective world
Immanuel Kant (1724-1804)
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What is the mind?
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Kant argues that We cannot learn
philosophy, only learn how to philosophise.
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Philosophise!!

• After a consultation how do you know if its been
  a good one?
• If you were the patient
• If you were the doctor.

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• Understanding

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Homer Simpson.
Just because I dont care, doesnt mean I dont
understand!
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Hans Georg Gadamer
Philosopher, Born February 11 1900 Died March
14 2002
Modern concepts of science are not adequate to
understand people and our experience of art and
even communication.
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Truth and Method

• Philosophical Hermeneutics
• Understanding and seeing things from some elses
  perspective

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How far can you see?
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Understanding happens when our horizon is moved
or changed.
The old horizon becoming the new one. Fusion
of Horizons
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• What factors affect understanding?
• The patients
• The registrars

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• Pre-understanding
• Prejudices
• Fore-meanings
• Bildung or openness to meaning
• Language
• Imagination

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Circle of Understanding
Present Horizon Whole
Pre- Understanding What do you think is
happening? What have you done to deserve this?
What has made this happen? Have you looked on
the internet?
Bildung, Open to meaning Do you feel
there are lots of possibilities for change /
progress here?
Imagination Do you have any ideas which might
help? How do you think it would feel if this
turned out to be some sort of cancer? Are you
religious? How can this help
Fore meanings Chunk and checking. Let me get this
right? After the examination What do you think
is going on here?
Prejudice Do you have previous knowledge about
this? What did you think we would be doing
today? Did you expect me to do anything in
particular today?
Language Without language we cannot transmit
meaning. Wittgenstein. The limits of my language
mean the limits of my world.
Partial Understanding
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Patients Understanding Narrative
Doctors Understanding Normative
Jerome Bruner. Psychologist John Launer.
Uniqueness and Conformity
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Video of teaching
Discussion about patient centred medicine. First
consultation was about a mainly clinical topic.
Second video of a consultation with a patient
who has cancer and almost certainly secondaries.
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The best consultations involve careful listening,
questioning and imaginative ideas taking them
around the circle of understanding to alter
horizons.
An ability to see what is questionable in the
encounter and combine this with our experience of
science.
Philosophy as a mediation of the truth.
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Understanding is not reconstruction but
mediation
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The unexamined life is not worth living.
Socrates
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The unexamined life is not worth living but a
life too closely examined may not be lived at
all! George Elliot
Saunton Sands 2008