We need to understand the impact context has on our reasoning and be aware there are different ways of looking at things. In my practice I used to see patients - usually young ladies - with vague neurological symptoms e.g. numbness or tingling of part of the face or a limb. They all get an MRI scan. But the explanation they get varies considerably depending on what doctor they see. A friend of mine went to see a neurologist with such symptoms. 'Well,' the neurologist said. 'You've either got migraine or MS - we'll do an MRI scan.' And that was it - a purely biological way of looking at things, followed by lots of anxiety and lots more symptoms!
The last patient I saw with similar symptoms attended an emergency acute medicine clinic following her scan. I had not seen her before. The MRI was normal. 'So,' I said. 'I've seen lots of patients with these symptoms before. By far the most common reason is doing too much, stress, overwork, poor sleep etc. Does that resonate with you? What's going on in your life right now?' Her husband looked at her knowingly, and we had a fruitful conversation about how the body sometimes manifests symptoms of 'stress', lifestyle and so on.
Which reminds me of a story from when I worked in New Zealand. The Maori have a clear view of health which differs from the typical western way of looking at things. A person is like a meeting house with four walls. If any of those walls is dis-eased, the whole person will be unwell - the walls are the body, mind, spirit and whanau (family). There are deep cultural meanings to these words that are difficult for us to grasp. But one day an elderly Maori lady came in to hospital. She had stopped eating and drinking and had taken to her bed. A Kiwi house officer stopped me in the corridor (as I was the geriatric medicine specialist) to ask my advice. Her bloods were normal, a CT brain was normal, and the team was considering doing a lumbar puncture. I was shocked. 'Mate,' I said. 'Go and talk to her family. She might be unwell in her spirit.' He looked at me for a few moments before it dawned on him. Kiwi doctors are taught the Maori model of health at medical school. The next day he caught me in the corridor again. 'You were right' he said. We talked to the family. There were things going on at home. As soon as we got the Maori social worker in to help, the patient started behaving normally!'
Although I do spend a lot of my time working on a medical admissions unit stopping lumbar punctures from happening, that was one of the most memorable ones!