Medical Humanities Companion VOLUME TWO Medical Humanities Companion VOLUME TWO Diagnosis Edited by Rolf Ahlzén Martyn Evans Pekka Louhiala and Raimo Puustinen Series Editors Rolf Ahlzén, Martyn Evans, Pekka Louhiala and Raimo Puustinen Radcliffe Publishing Oxford • New York Radcliffe Publishing Ltd 18 Marcham Road Abingdon Oxon OX14 1AA United Kingdom www.radcliffe- oxford.com Electronic catalogue and worldwide online ordering facility. © 2010 Rolf Ahlzén, Martyn Evans, Pekka Louhiala and Raimo Puustinen Rolf Ahlzén, Martyn Evans, Pekka Louhiala and Raimo Puustinen have asserted their right under the Copyright, Designs and Patents Act 1998 to be identifified as the authors of this work. All rights reserved. No part of this publication may be reproduced, stored in a retrieval sys- tem or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the copyright owner. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library. ISBN- 13: 978 184619 464 1 The paper used for the text pages of this book is FSC certififi ed. FSC (The Forest Stewardship Council) is an international network to promote responsible management of the world’s forests. Typeset by Pindar NZ, Auckland, New Zealand Printed and bound by TJI Digital, Padstow, Cornwall, UK Contents About the series editors vii List of contributors viii Acknowledgements ix Introduction x 1 Narratives 1 Anne MacLeod 2 Diagnosis: an introduction 11 Rolf Ahlzén 3 Diagnosis: telling and hearing 28 Jill Gordon 4 The dialogue of the clinical encounter 47 Raimo Puustinen 5 The double face of diagnosis 62 Iona Heath 6 What do diagnoses mean, and does it matter? 76 Pekka Louhiala 7 Intimacy and distance in the clinical examination 89 Martyn Evans and Jane Macnaughton 8 The physician’s understanding of the patient’s bodily meaning 108 Carl-Edvard Rudebeck 9 A diagnostic jungle? Ambiguities in classifification 130 Jyrki Korkeila 10 Certainty 138 John Saunders Index 155 About the series editors Rolf Ahlzén is working part-t ime as a general practitioner outside Karlstad in south-west Sweden. He is also the chairman of the ethical committee in the region of Värmland. He holds a position as senior lecturer in public health at Karlstad University, focusing mainly on healthcare ethics and on the history of ideas and science. Martyn Evans joined Durham University in 2002 as Professor of Humanities in Medicine and Principal of John Snow College, and became Principal of Trevelyan College in 2008. He taught philosophy and ethics of medicine at the University of Wales for several years. He was founding joint editor of the Medical Humanities edition of the Journal of Medical Ethics from 2000 to 2008. He has published variously on the aesthetics of music, ethics and philosophy of medicine, and the role of humanities in medical education. His current interests include music and medicine, the nature and role of humanities in medicine, and philosophical problems in medicine. In 2005 he was made an honorary Fellow of the Royal College of General Practitioners. Pekka Louhiala is a lecturer in medical ethics at the University of Helsinki, Finland. He has degrees in both medicine and philosophy, and he also works as a part-t ime paediatrician in private practice. He has published on various topics in medical ethics, philosophy of medicine and epidemiology. His current academic interests include conceptual and philosophical issues in medicine, such as evidence-based medicine and placebo effects. Raimo Puustinen is a full-time general practitioner and a senior consultant at Pihlajalinna Medical Centre, Tampere, Finland. He has published articles and books on general practice, medical ethics and philosophy of medicine. When not practising medicine or contemplating theoretical issues in medical practice, he tries to play jazz with tenor saxophone. He is married, and has four children and two grandchildren. vii List of contributors Jill Gordon Honorary Associate Professor, Centre for Values Ethics and the Law in Medicine, University of Sydney Iona Heath General practitioner, Kentish Town, London Jyrki Korkeila Professor of Psychiatry, University of Turku, Finland Consultant, Harjavalta Hospital, Satakunta Hospital District, Finland Anne MacLeod Dermatologist and writer from the North of Scotland Jane Macnaughton Director of the Centre for Arts and Humanities in Health and Medicine (CAHHM) Clinical Senior Lecturer, Durham University Carl-Edvard Rudebeck Research Adviser, Kalmar County Council Professor, Institute for Community Medicine, Tromsö University, Norway General practitioner, Esplanaden Health Centre, Västervik John Saunders Honorary Professor, Centre for Philosophy, Humanities and Law in Healthcare, School of Health Science, University of Wales, Swansea Honorary Senior Lecturer, College of Medicine, University of Wales, Cardiff Consultant Physician, Nevill Hall Hospital, Abergavenny viii Acknowledgements The Editors of this second volume of Medical Humanities Companion again want to thank Radcliffe Publishing for its continued belief in this project. We are also very thankful for the support that we have received from the Signe and Ane Gyllenberg Foundation, who funded our meeting in Hämeenlinna in Finland, where the shape of this book took its fifi nal form. Finally, it has also been a pleasure for us to have Professor Jyrki Korkeila as guest contributor. ix