A Doctor’s Note

With illness experience rather than the facts of disease at its centre, this book has raised a question for me, and possibly for you. What is a doctor for, beyond the management of disease? I have been making a distinction between Scene 1, where unwellness is first felt, and Scene 2, in which a person ‘offers’ the idea of illness to someone like me (or you). ¹ The medical encounter is a version of Scene 2. Kirmayer ² envisions an encounter in which the doctor’s overall aim is ‘to subdue or settle the issue, seeking coherence’. The patient’s aim is ‘to break through, seeking relief’. In what circumstances, Kirmayer asks, ‘does one person’s coherence become another person’s relief?’ There are times when ‘settling’ someone’s difficulties can take a simple, problem-solving approach. In some situations, however, especially in chronic or incurable illness, the settling process must go further than technical explanations and interventions.