Semantics and the subversive doctor

An excerpt from The Communication Panacea: Pediatrics and General Semantics.

If one pays attention to the language used in the context of all of these developments, it is clear we have moved into an entirely new semantic environment. Just as in the civic realm the word “citizen” has almost entirely been replaced with the word “consumer,” so in medicine the word “patient” is slowly being replaced by the word “client.”

People now talk about how the technology will allow us to “micro-target consumers when they are on the go and at other times when they are open to brand communications.” One can also hear and read statements such as “the apps will give us a new way to build long-term relationships through offering high-value, client-focused content.” And similar to the trends in other industries, in medicine too, the talk is less about patient satisfaction and increasingly about “measuring success,” “initiatives translating into sales,” “meaningful PR metrics” and “good relationships with health care brands.” And “doctors” are now “medical providers.”

This rapid change and bureaucracy are responsible for patient dissatisfaction, for malpractice suits, and for the erosion of doctor-patient communication. There is an essential mindlessness about medical bureaucracy which, as in other areas, causes it to accelerate entropy rather than to avoid it. As Postman and Weingartner explain, bureaucracies are the repositories of conventional assumptions and standard practices — two of the greatest accelerators of entropy. And this makes the subversive role of doctors, necessary. Subversive doctors are flexible, they know the difference between the word and the thing — between the book diagnosis and the specific patient, they are skillful in making distinctions between statements of fact, inferences and judgments, they are skilled in all important language behaviors such as asking meaningful questions; they are persistent in examining their own assumptions; they use definitions and metaphors as instruments for their thinking but are not trapped by them; they can move comfortably up and down the ladder of abstraction, depending on the patient and the context. And they are creative in unearthing other people’s definitions and finding ways around them for the sake of their patients.

The attitudes of the subversive doctor are reflected in her behavior. Her basic mode of discourse with patients is questioning and listening. She practices “personalized semantic medicine” which means that her diagnoses stem from specific patients and their personal experience of illness, and not from an objective list of symptoms. And so do her prescriptions.

Subversive doctoring means treating the whole child. It means dealing not with the organ from which his illness stems, but with the child’s body, his intellect, his emotions and his spirit. It means seeing each child as the individual that he is and not as part of a category such as “children with cerebral palsy.” It means seeing that who the child was a few months ago on her previous visit, is not who she is now, in spite of the static nature of her name and of the word we use to call her disease or the combination of symptoms she displays, because things are always in a process of change — especially children. As Postman and Weingartner put it:

It means understanding that even the phrase “the whole child” is as static a metaphor; that “child” is a thing word, a process transformed into a thing by our naming into a noun, and there is no stage of human growth that is more visibly a process than “childhood.”

It means remembering, for example, that the word “psychosomatic” was coined to express a relationship and a process, explicitly to deter us from thinking that illness can always be categorized as either physical or mental. But that what happened eventually, is that we began to use it as a synonym for “mental,” dismissing suffering as “merely psychosomatic.”

Subversive doctors focus on the individuality and the uniqueness of every patient and abandon the assumption of sameness in all of them. They practice what is usually referred to as “patient-centered medicine” or “personal semantic medicine” in our terms, keeping in mind that just as knowledge does not exist outside the learner, so disease does not exist outside the patient. They try to avoid projecting as much as possible, and not to transfer their own feelings and evaluations to their patients and their parents.

Aware that language is our most profound and possibly least visible environment, the subversive doctor remains constantly aware of the process of abstraction, and adopting an extensional approach, talks to her patients and encourages them to talk to her, in language that has accurate correspondence with externally verifiable meanings.

Subversive doctors keep a clean semantic environment. They insist on communicating with their patients in all the ways that are becoming less and less obvious to the culture; on having real and not only virtual relationships with their patients: providing clear information, involving patients in decision-making, following up consistently and educating patients on their conditions, all face-to-face and all resulting in improved physiologic as well as emotional health.

In short, subversive doctors are general semanticists. They are not fanatics. Fanaticism begins, as Postman explains, when we fall in love with certain sentences; when we internalize sentences to which we are so attached, that they are immune to criticism — others’ and our own.  The subversive physician is willing to permit the sentences to be scrutinized, subjected to criticism, and revised as their deficiencies require. He is aware of his fallibility and assumes that it is not possible for anyone to know if he or she is in possession of the “truth.” This is important because the beliefs, feelings, and assumptions of doctors are the air of the medical environment; they determine the quality of life within it. If the air is polluted, the bronchitis may be cured, but the patient will have been poisoned and she will have contracted a new disease. When the air is polluted, the environment becomes useless, and, in Postman’s words, it stops serving the purposes it is supposed to serve.

Eva Berger and Isaac Berger are the authors of The Communication Panacea: Pediatrics and General Semantics.

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