Science or fiction
Blog Author: George Szasz, CM, MDPosted: Wednesday, December 7, 2016 - 16:14
During the past rainy days I have been re-reading some of my favorite science fiction books. One by Isaac Asimov, The Naked Sun, took me to Solaria, a planet the size of Earth with a human population of only 22 000. Millions of highly specialized robots do all the agricultural, engineering, and household tasks. The humans on this planet are genetically modified; each one lives alone (with the robots) thousands of kilometres apart from other human beings. On first reading they appear to be somewhat like autistic savants but, as it turns out, they are highly social—but only through holographic visual contact.
In that strange social setting a very clear distinction is being made between viewing and seeing. It is perfectly all right to communicate with another person while viewing him or her in a holographic projection, even in such intimate situation as showering, but it is abhorrent to be in the physical presence of a person (seeing them). In the story the physician is just about the only person who is compelled, from time to time, to see another person. Fortunately for the doctor, citizens of this planet are mostly free of ill health.
What made me laugh a bit while reading this was that earlier in my day I read a newspaper article about the stethoscope (requiring physical contact, i.e., seeing) going out of use in favor of using ultrasound technology for diagnosis (i.e., viewing). There goes our physical examination! Of course, Dr Laennec, the inventor of the stethoscope 200 years ago backed away from physical contact because, reportedly, he was annoyed by lice getting into his hair when he put his ear to a patient’s chest. In the teaching of anatomy, the anatomists of the middle ages did the reverse: after centuries of only viewing the human body, they started dissecting it, touching (seeing) each part. Today we are again backing away a bit from seeing (that is touching and feeling) in anatomy teaching: much learning about the body is done by viewing the cadavers with the help of the latest imaging technology. Our text and e-mail communications are also pushing us in the viewing direction, reducing face-to-face communication in general.
The practical applications of the concepts of viewing and seeing have now assumed some significance in our history-taking methods and in our approach to solving diagnostic difficulties as well. Asking patients to fill out personal-history forms (viewing) may save some time in a scheduled 15-minute visit, but it may also rob us of insight (seeing) into the complexities of our patients’ lives. Similarly, focusing on a multitude of laboratory reports (again, viewing) may ease (or complicate?) our diagnostic search, but excessively focusing on the multitude of results may rob us of that most valuable characteristic of the experienced physician—something that cannot be taught and can be achieved only after years of seeing: the application of the intuitive sixth sense in our search for and approach to the right diagnosis.
—George Szasz, CM, MD
This posting has not been peer reviewed by the BCMJ Editorial Board.