A self-employed patient has a long drive to attend a trade event. He has fallen and injured his wrist which is painful and swollen so he books an appointment with his GP for the following day. A common enough scenario.

The GP suspects a scaphoid fracture, but knows that an X-Ray is unlikely to reveal a sufficiently clear image the day after the fall-on-the-outstretched hand. There is no justification for a plaster-cast, but a wrist splint might be required until the patient’s injury can be re-assessed in 10 days’ time. 

In this scenario, there is what the patient knows - his left hand is stiff and painful (subtext: his gear-stick hand is going to hurt during this journey); and there is what the doctor is weighing up - is this a soft-tissue injury or has there been a fracture? (Subtext: the patient may not be safe to drive his car). 

If the GP has a moment to reflect on the situation - in the midst of his communication with and assessment of the patient - he might catch sight of the epistemic gradient between his own stance and that of his patient. He might take care to use language which his patient - expert in his own field of professionalism, but naïve about bones and injuries and possible consequences of occult scaphoid fractures – will understand. He might skilfully bring to the foreground the principal issue “at hand”. With a gentle touch to the anatomical snuffbox, eliciting tenderness in the patient, the GP might make manifest to the patient a comprehension of the risk of undertaking the long drive. 

By relating with the patient, the GP might find a way of opening up the possibility of not undertaking the drive - which was the only thing on the patient’s mind this morning, until he realised that he couldn’t use his gear-stick without pain. It is not, of course, the GP’s responsibility to consider the alternative ways the patient could make the journey. He doesn’t have to use up his energy on that. The point is that he took a moment to understand what was most meaningful for the patient, and he related to the patient with that in mind. 

In my next post...

I will elaborate on the way the doctor’s knowing touch helped the patient to make sense of his injury, by discussing a phenomenological model of embodied communication.