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Getting to Know You

In the The King and I, Anna sings her joy at

"Getting to know you
Getting to feel free and easy
When I am with you,
Getting to know what to say"

As I discussed here "knowing" a patient can improve outcomes of medical treatment, but what does knowing a patient really mean? When do you know the patient adequately? How do you know that you know them adequately? And how do you obtain the knowledge? 

We cannot avoid tradeoffs and compromises. At one end of the spectrum an emergency room doctor may have to make split second decisions in treating life-threatening trauma in an unconscious patient knowing nothing about the patient as a person. At the other end of the spectrum a psychoanalyst may have the luxury of hearing from a patient for months or even years before crafting an intervention which may come too late.

The artificial office setting and professional relationship limit the professional's experience of the person they treat. Involvement of family may help by providing other points of view, but reports from patient or family still suffer from biases, secrets and hidden agendas.

The "observer effect" may further confound accumulation of knowledge about the patient. This theory derived from physical science holds that the act of observation alters the system under observation. For example, placing a thermometer in a roasting turkey slightly cools the surrounding meat. In similar fashion a patient reacts to the office environment and to qualities of the professional in ways that simultaneously provide and confound data.

The psychiatric pharmacotherapist gathers data about symptoms that may respond to drugs and side effects the drugs may cause.

In an ideal world we would know the patient well enough to tailor each intervention accordingly, before making the intervention, but in the real world we may have to guess, intervene, then learn from the result.

What does "Getting to know what to say" mean to you in your work with patients, and how do you balance the amount of knowing against the urgency of intervention and the risk that lack of knowing will lead to an intervention that flops? Do you ever "feel free and easy" like Anna?


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