Abstract
Hilary Putnam’s influential analysis of the ‘division of linguistic labour’ has a striking application in the area of doctor–patient interaction: patients typically think of themselves as consumers of technical medical terms in the sense that they normally defer to health professionals’ explanations of meaning. It is at the same time well documented that patients tend to think they are entitled to understand lay health terms like ‘sickness’ and ‘illness’ in ways that do not necessarily correspond to health professionals’ understanding. Drawing on recent philosophical theories of concept possession, the article argues that this disparity between medical and lay vocabulary implies that it is, in an important range of cases, easier for doctors to create a communicative platform of shared concepts by using and explaining special medical expressions than by using common lay expressions. This conclusion is contrasted with the view that doctors and patients typically understand each other when they use lay vocabulary. Obviously, use of expressions like ‘sickness’ or ‘illness’ does not necessarily lead to poor communication, but it is important that doctors have an awareness of how patients interpret such terms.
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Notes
The thought that arthritis is inflammation of joints is thus understood as a different attitude (the attitude of thinking) to the same proposition. For a more detailed explanation of this assumption about concept involving propositional attitudes, see [11].
It seems important to make the qualification ‘often.’ It seems reasonable to assume that satisfaction cannot always be used as a criterion for successful communication. Consider, for instance, a patient who thinks that a doctor gives a more positive prognosis than what the doctor intends to communicate. The patient may be satisfied, but communication has not been successful.
More generally, in this sense of ‘understand language’ two persons will very seldom have the same understanding of a language expression. This requires that they form exactly the same beliefs about the expression, but this is unlikely to happen as long as their beliefs are shaped by their individual histories and social and cultural background [26].
This will also depend on what one means by ’communication.’ As emphasised above, I do not presuppose that the idea of exchange of beliefs necessarily represents the only possible way of conceiving of successful doctor patient communication.
References
Ong, L., J. de Haes, A. Hoos, and F. Lammes. 1995. Doctor–patient communication: A review of the literature. Social Science and Medicine 40 (7): 903–918.
Silverman, J., S. Kurtz, and J. Draper. 2004. Skills for communicating with patients. Oxford: Radcliffe Publishers.
Tate, P. 2007. The doctor’s communication handbook. Oxford: Radcliffe Publishers.
Davidson, D. 1984. Inquires into truth and interpretation. Oxford: Clarendon Press.
Nordenfelt, L., and A. Twaddle. 1993. Disease, illness and sickness. Three central concepts in the theory of health. Linköping: Linköping University Press.
Hofmann, B. 2001. Complexity of the concept of disease as shown through rival theoretical frameworks. Theoretical Medicine and Bioethics 22: 211–236.
Nordenfelt, L. 2001. Health, science and ordinary language. Amsterdam: Rodopi.
Helman, C. 1984. Culture, health and illness. Oxford: Butterworth-Heinemann.
Lupton, D. 1994. Medicine as culture. London: Sage Publications.
Putnam, H. 1975. The meaning of “meaning.” Language, Mind and Knowledge: Minnesota Studies in the Philosophy of Science 7: 131–193.
Burge, T. 1979. Individualism and the mental. In Midwest studies in philosophy, ed. P. Uehling, 73–121. Minneapolis: Minneapolis University Press.
Peacocke, C. 1992. A study of concepts. Cambridge: MIT Press.
Radley, A. 1994. Making sense of illness. London: Sage Publications.
Nettleton, S. 1995. The sociology of health and illness. Cambridge: Polity Press.
Perloff, R., B. Blonder, G. Ray, E. Ray, and L. Siminoff. 2006. Doctor–patient communication, cultural competence and minority health. American Behavioral Scientist 49 (6): 835–852.
Pessin, A., and S. Goldberg. 1996. The twin Earth chronicles: Twenty years of reflections on Hilary Putnam’s “The Meaning of ‘Meaning’.” New York: M.E. Sharpe.
Todd, A., and S. Fisher. 1993. The social organization of doctor–patient communication. Portsmouth: Greenwood.
Gannik, D., and L. Launso, eds. 2000. Disease, knowledge and society. Copenhagen: Samfundslitteratur.
Evans, G. 1982. The varieties of reference. Oxford: Clarendon Press.
Guttenplan, S., ed. 1996. A companion to the philosophy of mind. Oxford: Blackwell.
Putnam, H. 1981. Reason, truth and history. Cambridge: Cambridge University Press.
Wittgenstein, L. 1953. Philosophical investigations. Oxford: Blackwell.
Wittgenstein, L. 1967. On certainty. Oxford: Blackwell.
Worhall, J., and J. Worhall. 2001. Defining disease: Much ado about nothing? Analecta Husserliana 72: 33–55.
Nordby, H. 2006. Nurse–patient communication: Language mastery and concept possession. Nursing Inquiry 13 (1): 64–72.
Fodor, J. 1998. Concepts. Oxford: Oxford University Press.
Villanueva, E. 1998. Concepts: Philosophical issues. Atascadero: Ridgeview Publishing Press.
Bezuidenhout, A. 1997. The communication of de re thoughts. Nous 31 (2): 197–225.
Cappelen, H., and E. Lepore. 2005. Insensitive semantics. Oxford: Blackwell.
Nordby, H. 2004. Concept possession and incorrect understanding. Philosophical Explorations 7 (1): 55–72.
Gadamer, H.G. 1975. Truth and method. New York: Continuum.
Crawford, P., B. Brown, and P. Nolan. 1998. Communicating care. Cheltenham: Stanley Thornes.
Pendleton, D., P. Tate, and T. Schofield. The new consultation: Developing doctor–patient communication. Oxford: Oxford University Press.
Downie, R., and J. Macnaughton. 2000. Clinical judgement: Evidence in practice. Oxford: Oxford University Press.
Nordenfelt, L. 1987. On the nature of health. Dordrecht: Klüwer Academic Publishers.
Nordby, H. 2006. The analytic-synthetic distinction and conceptual analyses of basic health concepts. Medicine, Health Care and Philosophy 9 (3): 169–180.
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I would like to thank anonymous referees for this journal for very helpful comments.
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Nordby, H. Medical explanations and lay conceptions of disease and illness in doctor–patient interaction. Theor Med Bioeth 29, 357–370 (2008). https://doi.org/10.1007/s11017-008-9080-2
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DOI: https://doi.org/10.1007/s11017-008-9080-2