“I don’t think they believed me…….. that my pain was real”
The words etched into my mind. Who knows if they did believe her. But it was her overwhelming impression of the consultation with her GP. Suspicion and scepticism undermined her experience. Disconnected her from her very own body. So what is a sceptic?
Evidence based practice has brought much needed critical thought, suspicion and scepticism to challenge healthcare gullibility. But do we need to be critical about possible destinations this could lead. So let’s be sceptical of scepticism for a moment. People are living longer and healthcare is left with a different sort of problem. Long term conditions. Characterised less by cure more by ACTIVE management. Traditional healthcare is focused around a test, result, treat paradigm. A paradigm seemingly not suited to many longterm conditions. Note the ACTIVE. This is vital. Passivity often leads to a negative cycle. With this in mind disconnecting people from their experience, condition and body are potentially devastating.
Elvis unintentionally summarised this difficulty well. We get “caught in a trap”. We can’t “walk out”. The patient thinks “why can’t you see, what you’re doing to me, when you don’t believe a word I say?!” The conclusion “we can’t go on together with suspicious minds”! (🎶We can’t build our dreams on suspicious minds🎶).
The question is do we trust humans? A tricky question to answer. Depends on the context who it is, what’s being entrusted. The problem with Sceptics is just this. If we distrust human experience we distrust patient experience. They feel the need to “prove it”. The connotation is “I don’t believe you”, “you have been mislead”, “your experience is not real”. There is no nuance. No actual critical thought. Just a blanket suspicion. On everyone and everything. It applies to patients, colleagues, books, blogs, journals, even family and friends! There is one exception. It seems sceptics are comfortable not being sceptical about scepticism. In both science and the humanities criticism has become synonymous with intelligence and even become ‘sexy’ (for those that way inclined😉). But it usually goes hand in hand with empiricism (due to length I will cover this in a future blog).
This critical focus often self-serves. What better way to confirm your own bias than being critical of others approach. To create a power gradient. Distinguishing between those that know and the rest. The critic is the knower. It allows them to speak from a position of ‘truth’. They stand detached from humanity so as to the see the truth. Oblivious to what the person or text might actually be saying. Objectivity reigns over subjectivity. Objectivity is required whilst subjectivity is to be minimised. How often should we take objective over subjective data in clinical decision making (and vice versa)?
There is however nothing automatically progressive about suspicion. Pierre Le Morvan advocates a third way. He calls this the Health Approach. This looks at when scepticism is healthy and when it is hurtful, when it is virtuous and when it is vicious. His metaphor is the immune system which protects the body (scepticism the mind). The immune system can function healthily but there is potential for both under and over reaction. The danger outlined is that scepticism becomes easily intertwined with agenda. The greater question for me is can we be post critical as opposed to uncritical? Felski outlines a process in which criticism is followed by composition. Not from scratch but by gathering and re-assembling. There is no more skill in blanket scepticism than blanket belief. It becomes a process of grinding down. The last thing anyone needs regardless of if they are patient, practitioner, friend.
I’m not sure being a sceptic made me a better human. I remember my wife pulling me up on this. How healthy or human was it to always suspicious? I had become dogmatic to the detriment of my relationships. This is when my search for something beyond scepticism began.
I started to notice the following symptoms: refusing to read contrary opinion or reading only to criticise, suspicion of everything outside your own beliefs, taking in other sceptic beliefs without evaluating position yourself. Loss of hope, trust, empathy, connection with yourself and others. It’s not always a case of what you gain but what might be lost. The other extremes are also possible although this hasn’t been my journey (the LeMorvan paper covers this very nicely with great examples). “These things matter if sceptics are really interested in changing peoples minds rather than getting together and having a good laugh at wacky beliefs. the etymology of scepticism implies enquiry and reflection not dismissiveness” (Higgitt 2012).
The lady featured felt the GP was underplaying the importance of her condition and being overly optimistic due to blood and scan results being normal. She was actually reassured that pain is poorly correlated to objective investigations a decent by the fact that we couldn’t guarantee an improvement in pain. She was determined however to do certain activities and we were able to help with this. I don’t think disconnecting the patient from their experience is the answer. From unhelpful beliefs or behaviours maybe but not their experience. It seems trust may be formed through previous experience of accuracy and benevolence (See here), whilst co-operation and helpfulness also seem to engender trust (and here). Are these things that characterise our humanity?
Suspicion can be ok. Blanket scepticism is for robots. Relationships are for humans.
Be more human. Be less robot.
Thanks for reading this far.
Le Morvan 2011. Excellent examples of scepticism gone wrong https://www.pdcnet.org/logos-episteme/content/logos-episteme_2011_0002_0001_0087_0102
Truzzi 1987 a nice read about what scepticism actually involves http://www.anomalist.com/commentaries/pseudo.html
Review of Felski 2015 “the limits of critique” looking at the effect of scepticism on humanity https://lareviewofbooks.org/review/are-we-postcritical/
Presley 1969 “Suspicious Minds”
Nguyen et al 2015 http://www.ncbi.nlm.nih.gov/pubmed/26704303
Robbins 2016 http://www.ncbi.nlm.nih.gov/pubmed/26680285