Leaven #4

‘Encounter’ -- one of those everyday words in medicine.

To ‘encounter’ is to come upon another face to face, often unexpectedly. To encounter is to meet another suddenly, even violently. Each day is a series of encounters – turning a hallway corner, crossing a lane of traffic, reaching for an object, finding a place in line, looking up from a table, chasing a prize, competing for a position, . . . Encounters reveal the set of values and the sense of purpose out of which we each decide how to proceed.

The most efficient schema I have found in the history of ideas for framing what is at stake in every encounter is the ‘I-It’ and ‘I-Thou’ schema put forward by the highly respected philosopher, Martin Buber (1878-1965). Born in Vienna and raised by his grandparents, Buber studied philosophy and the history of art at the Universities of Vienna, Berlin, Leipzig, and Zurich. Buber’s classic I and Thou was published in 1923, the year he accepted the chair of Jewish History of Religion and Ethics at Frankfurt University. Buber lost that post soon after Hitler came to power in 1933. By 1938 he had been completely silenced by the Nazis and had reluctantly emigrated to Jerusalem where he accepted the position of Professor of Social Philosophy at Hebrew University. He worked tirelessly to life’s end for a peaceful solution to Israeli-Palestinian relations. Buber’s core proposition is found in two linked statements:

“I-Thou” can only be uttered with the whole of our being;
“I-It” can never be uttered with the whole of our being.

How might Buber’s core proposition be transposed into healthcare terms? I think it would be:

“I-Thou” is only defining for caregivers who are centered by a grand humanizing idea;
“I-It” is never defining for caregivers who are centered by a grand humanizing idea.

To treat someone as a ‘Thou’ is to be gentle, subjective, freeing, reciprocal, engaged, artistic, holistic, attentive, reconciling, patient, modest, trusting, graceful. In short, to be treated as a ‘Thou’ is to be respected.

To treat someone as an ‘It’ is to be scientific, objective, detached. Or to treat someone as an ‘It’ is to be rough, indifferent, curt, suspicious, selfish, alienating, dehumanizing. This distinction reaches into the ethical complexity of patient encounters and coworker encounters in a large teaching hospital.

Excellent care of patients is scientific, grounded in research results. Statistical associations and concentration on damaged/diseased body parts objectify the patient. Differential diagnoses reflect plausible cause-and-effect explanations. The patient’s immediate problem receives more attention than does the patient’s larger story. The medical team must be sufficiently detached to achieve aequanimitas or balance.

However, at some point, ‘I-It’ encounters and ‘I-Thou’ encounters become mutually exclusive in the care of patients. Only by keeping the ‘aim eye’ fixed on patients as individuals worthy of respect, compassion, and fairness can we avoid the indifference that degrades patient encounters into self-serving alienation . . . the indifference that leaves patients bruised, manipulated, exploited.

Think about it. Perhaps talk to a co-worker.