Acknowledgement


Medicine, like Fashion, has its vogues, its conceits if you will. Admittedly less capricious, they are nonetheless as unpredictable. Think, say, of the menopause. Until relatively recently it was largely ignored. There were so many other health issues in a woman’s life, that if she was fortunate enough to survive to the menopause it was seen as propitious, not a condition that in and of itself required treatment. It was merely what happened when you got old, like failing memory or forgetfulness. Remember the riddle of the Sphinx that Oedipus solved: What has four legs in the morning, two at noon and three in the evening? The answer, of course, is Man -or in this case Woman. Menopause is merely the third stage -the evening stage- and as natural as the other two.

And then came Hormones. By replacing what was lost, it was hoped there wouldn’t be a stage three -or at least not for a while. True, Medicine was just responding to changing societal health and the revised expectations engendered by a longer life, but change it did. The hormone replacement therapy paradigm persisted until it became evident that the supposed benefits came with seemingly unanticipated risks. The hormones were not the hoped for panacea, helpful as they often were. So we’re currently in the interregnum, the uncomfortable time between one paradigm and the next.

Another topic in the shifting medical sands is attribution. Names. We keep renaming things, as if by doing so, we somehow expunge the past and wipe the slate clean. Take, for example, disease that is spread by sexual contact. Historically, of course it seemed appropriate to name it by its source. So the appearance of Syphilis in Naples after a fifteenth century French invasion naturally suggested the condition be termed the ‘French Disease’. Some offense was likely taken, so after a while, this and other ‘social diseases’ as they were also once called, were renamed venereal diseases -VD for short. And then, as people began to stigmatize that term, it was changed to Sexually Transmitted Disease -STD. Well, you guessed it: same result. So poof, it is now STI: sexually transmitted infection.  Of course, some terms clearly needed to be changed: Mongolism to Down Syndrome, for example. Or ‘retarded’ to something more politely descriptive such as ‘mentally challenged’.

Perhaps I am being too reductionist here, but you can see the changes: the wide to the narrow tie, the cuffed pants to… Well I’m sure you take my meaning. We are, as the curse has it, condemned to live in interesting times.

But as trivial as name changes might seem, and as revisionist as new attitudes to ageing could appear, there are some fundamental shifts occurring in Medicine that bespeak a new awareness of its role in patient care. There was a time when the doctor’s word was unquestioned -indeed unquestionable, given the hitherto arcane and unavailable sources of his knowledge. If you disagreed with the diagnosis you were free to leave and seek another opinion, but not to challenge. If mistakes were made, there was little hope of recourse or redress, little hope of discovering whether there had in fact been mistakes. Diseases take unexpected turns, surgical success is contingent: things are not always remediable.

This is still the case, obviously, but doctors are becoming more open about explanations and patients about asking for them. It is still a work in progress to be sure, but there is reason for hope. There was a time when pride of place ruled even more than today, when to explain an outcome -to have to explain it- was akin to a subliminal admission of guilt. This is perhaps too severe a judgement, and yet there is a thread to the argument that seems to hold even today. But the hope lies in apology: the acknowledgement of fault, however tenuous and however unintended. It’s an affirmation, of sorts, for both parties; it’s a recognition that we share a common trait: none of us is perfect. We know that of ourselves; why should we not expect it and accept in others when they admit it? Especially if they admit it.

“I’m sorry.” It may not solve the issue, but there’s a sort of resolution embedded within it. It may seem a faint hope that this will become the norm -naive perhaps- and yet I see it coming. It’s how one caring individual deals with another.  An apology is a first step and a big one. Alexander Pope assessed it the best, I think: ‘To err is human, to forgive divine’. I’d like to think that both the profferance of an apology and its acceptance is a characteristic of humanity as well. It is also a first move in the slow dance to understanding what it means to offer care, or to accept it from another.

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