Accepted Paper:

What we can't rely on: patients and doctors facing medical uncertainty related to diagnosis and prognosis in chronic illness.  

Author:

Sébastien Moine (Département de recherche en éthique, EA 1610. Université Paris-Sud.)

Paper short abstract:

General practitioners operate mediations between biomedical data and the daily life of patients with chronic illness. As a shared experience, uncertainty helps to develop empathy in doctors and to restore what was broken by the onset of the disease: patients' biological and biographical historicity.

Paper long abstract:

General practitioners (GPs) encounter patients in a context located halfway between the scientifically overdetermined world of biomedicine, and the globally profane environment of daily life. Very quickly, we can observe that uncertainty present in various domains of medical practice is one of the most strongest basis of the doctor-patient relationship. Indeed, uncertainty is not just a medical situation: it is experienced both by the doctor who sometimes has trouble distinguishing between the limits of his own knowledge and the boundaries of the whole biomedical knowledge, but also by the patient confronted with an obscure diagnostic terminology, or struggling to envisage his future by means of statistical data.

Our survey is based on material from a participant observation, collected during medical consultations in France. Among the actions undertaken by the GP in accompanying and caring for the person living with a cancer, we have distinguished the translations made for the direct benefit of the patient, from the scientific vehicular towards the vernacular of the patient. More generally, these translations are part of the mediation procedures achieved by the physician between the biomedical objective data and the subjective experience of the patient. This intervention has at least two stakes: first, to restore the patient's double historicity (biological and biographical) that has been disrupted by the intrusion of chronic illness into his life, and second, to enable the doctor to develop his own empathic abilities in order to turn the doctor-patient relationship into a true partnership.

Panel W132
Uncertainty and trust in medicines and therapeutic techniques