Musculoskeletal suffering: diagnosis and a variant view

Abstract

What counts as relevant and valid information in a diagnosticcontext? A descriptive analysis of a first encounter from physiotherapy practice provides the background for a proposed response to this question. The encounter took place between a therapist and a patient suffering from muscular tension. It exemplifies the employment of dimensions of experience and knowledge other than those ordinarily accepted by scientific medicine. Prevailing notions of the body and the traditional distinction between 'objective' and 'subjective' knowledge are considered against this background. It is suggested that the tacitly accepted separation between the physical body and human experience be superseded by a new understanding. Conversely, the prevailing correlation between 'patient/ symptoms/subjectivity' and less valid information on the one hand, and *clinician/signs/objectivity' and valid information on the other, is shown to be counterproductive. Verbal and bodily information are not categorically different, belonging to the separate worlds of *res extensa' and *res cogitans'. In real livesand real bodies -they are complementary. It is argued that more complex interactional forms are better suited than standard diagnostic procedures to understand and deal adequately with patients' often complex ailments.

Homoeopathy as a Feminist Form of Medicine

“…On this point, the contrast between clinical biomedicine and most complementary and alternative therapies is stark (Atkinson 1988, Johannessen 1996, Thornquist 1995. Homoeopathy, in particular, is a symptomatically based therapy; subjective experience is central to its diagnostic procedures.…”

3. Bodies of knowledge: lay and biomedical understandings of musculoskeletal disorders

“…In particular, research has explored the complexity of lay beliefs about the causes of arthritis, and interpreted the models people develop in terms of a narrative reconstruction of the relationship between body, self, and society (Williams 1984). Studies have also examined the intricate strategies people with arthritis develop for managing the many dimensions of the impact of chronic illness on their roles and relationships in both private life and the public sphere (Bury 1991, Locker 1983, Thornquist 1995, Newman et al 1996.…”

How GPs in Norway conceptualise functional ability: a focus group study

“…Accordingly, the centre of attention was the patient as an experiencing subject. 15 Foucault claims that 'a medical gaze' was developed towards the end of the 18th century, which created a divergence between diagnosis and functioning. The medical gaze is best explained as the modern doctors' ability to observe and select relevant medical information, enabling them to see the patients 'objectively', and as physical units.…”

“…Over time, diagnoses have become a question of accuracy, while level of functioning is considered a matter of subjective opinion. 15 This background may help us understand why pathological findings leading to a diagnosis are a cornerstone of clinical practice.…”