Evidence does not reach the patient.

More accurately, it is that evidence alone is not enough.
A patient's "way of thinking" is not composed solely of their personal background.

Hello. I apologize for sounding so presumptuous all of a sudden.
I couldn't explain it well verbally when I was suddenly asked about it at a drinking party yesterday.
I am going to write about some complicated content.

It is about physical therapy and philosophy.

I used to think like this:
"Things that cannot be explained scientifically have little meaning."
Things that have evidence, are recommended by guidelines, have reproducibility, and can be explained properly.

I believed that was the very foundation for healthcare professionals, and that it was my responsibility to convey that to patients.

But recently, that way of thinking has been wavering a little. Or rather, the breadth of interpretation? Or, well...
Today, I will try to write about that wavering.

The moment when conveying "correctness" becomes an imposition

When working in clinical practice, I often encounter situations like this.

Telling patients hospitalized for heart disease or stroke to quit smoking or improve their lifestyle habits.
Medically, this is almost certainly correct.
If they continue, the risk of recurrence decreases, and there is a high possibility that future decline in QOL can be prevented.

There is also a clear duty to convey this.

But, still. When you deliver that "correctness" just as it is.

For some patients, it ends up being a direct denial of the way of life they desire.

"The way you have lived your life until now is wrong."There are moments when it feels close to saying that.

Medical correctness and happiness for that person do not necessarily coincide. I think the more responsible a healthcare professional is, the more they encounter this conflict. I cannot just say, "Do whatever you like," without reservation. But just hitting them with logical arguments won't move them. If anything, it makes them close their hearts.

In the first place, just by being in the hospital, I feel like they are being treated as "someone who is not healthy."

Thinking about this conflict, I realized one thing.

Patients are structurally placed on the "not healthy side" just by "being in the hospital."

I think there will be various opinions on this, so
I would like you to think about this separately from the talk of medical health and unhealthiness. It is a story about how the "place" determines the role, on a layer different from whether or not there is an illness.

Even the same person, the moment they enter the place called a hospital, is automatically assigned the roles of "patient receiving treatment" and "subject being managed."
While half-independent of the person's actual state and values, the environment itself creates the premise that "you are a person who is not healthy."

And the scary part here is that because we, as healthcare professionals, are inside that hospital structure, we tend to see the person in front of us only as a "patient."

In reality, that person has a face outside the hospital.
They work, support their family, have hobbies, and are important people to someone.
They should be a very multidimensional existence.
Yet, the structure of "being in the hospital" compresses that person into the one dimension of "patient."

I think this is a kind of extreme generalization. It paints over the entirety of a person with just one aspect, such as "this person = a sick person" or "this person = a subject for risk management."

A person's "way of thinking" is also built on a structure.

Let me take it a step further.

When a patient thinks, "I don't want to quit smoking" or "I'm fine as I am," I don't think it's because they have a weak will or lack knowledge. (Though those elements may exist.)

That person's values have been shaped over a long period within a "structure" consisting of the life they have led, the culture they were raised in, their relationships with family and community, and the environment they have been placed in.
A way of thinking is not something that just wells up from within a person on its own; it is determined in large part by the structure surrounding them.

If that is the case, even if you look only at the individual in front of you, you cannot truly understand them.

"Why did this person have no choice but to think that way?"

Unless you imagine the background and structure, you haven't truly understood that person.

It is very close to the Buddhist concept of "dependent origination" (engi). It is a perspective that everything does not exist independently, but arises within various connections (relationships and conditions). A person's way of thinking and their state of health are not things that belong solely to that person, but are born within the relationship with the surrounding structure. When you view it that way, I feel that your perspective on patients changes a little. (Please let me know if I am wrong, experts.)

That is why philosophy and liberal arts are needed.

Having come this far, I think about this.

Western medicine, which is our foundation, is basically a discipline that "draws a line between black and white." *Not everything is like that.
Is there evidence? Is there a significant difference? Is it correct or incorrect? That is a very important foothold, and I have no intention of denying it at all.

However, there are far more things about humans and the structures they are placed in that cannot be clearly defined as black or white.

Continuing to think in circles about questions that have no answer while they are right in front of you. I see philosophy as that kind of discipline—though I don't know for sure.
History, which looks at the background of human activities, and ethics, which pauses before judging good or evil. These liberal arts provide a foothold for enduring this "lack of black and white" and for viewing people in a multidimensional way.

If you are fixated only on specialized knowledge, your field of vision becomes closed within the "structure of Western medicine." I think you need the breadth of philosophical thinking to step outside that frame and see the patient as an individual living within a structure.

Summary

This time, I wrote about the reasons why I think philosophy is necessary for physical therapy.

Looking back at the points, it goes like this.

・Conveying medical correctness as it is can sometimes become an imposition that denies a person's way of life.

・Patients are easily generalized as being on the "unhealthy side" simply by the structure of "being in a hospital" (as a topic on a different layer from medical health/unhealth).

・A person's way of thinking and their state of health are not things that belong only to them, but arise within the surrounding structure.

Therefore, not only Western medicine, which draws a clear line between black and white, but also philosophy and the liberal arts, which can endure—or rather, coexist with—the ambiguity of not having a clear answer, are necessary to view people in a multidimensional way.

This is not about discarding medical correctness. It is about maintaining that correctness while having the breadth to deliver it in a way that fits 'that person's structure.' It means seeing the patient in front of you not as an isolated individual, but as someone living within a structure.

I think that kind of perspective might free us a little from the 'impositions of the industry.'

What kind of structures do you imagine in the background of your patients' 'ways of thinking'?

Thank you for reading until the end! See you next time!