Philosophy, understanding and the consultation: a fusion of horizons

Abstract

Early models of the consultation were ‘disease’ centred with little consideration of the patients perspective. Later models advised we should gain the ‘patients understanding’ or better ‘shared understanding’ as used by Pendleton, Schofield, Tate, and Havelock.1 The profession is now developing the idea of patient-centred medicine; it is gaining popularity but still practised infrequently even when looked for in the MRCGP video examination.2 For the consultation process to be successful the patient needs to feel heard and understood. Philosophical thought can offer ideas to describe this task of understanding. The works of the German philosopher Hans-Georg Gadamer (1900–2002) explain that ‘the modern concepts of science are not adequate to understand people and our experience of art and even communication’.3 He developed a philosophical perspective in his work ‘Truth and Method’ and explained a process of philosophical hermeneutics. Hermeneutics is a process which helps interpretation and understanding things from someone else's perspective. It can be applied to situations where we encounter meanings that are not easily understood but require some effort to interpret. He originally applied this to an interpreter and a religious text but in a later essay he describes ‘its (hermeneutics) fundamental significance for our entire understanding of the world and thus for all the various forms in which this understanding manifests itself: from inter-human communication to manipulation of society’.4 A recent example of applying this hermeneutic process to human processes was to understand ‘hope’ in a teenage population, which on first hearing sounds an impossible task. Gadamer's hermeneutics provides insight into this very human process and an interesting research method.5 I would like to suggest that this process could be applied to a consultation between patient and doctor. When applying hermeneutics to the human process of interpretation Gadamer talks of a ‘horizon’ as …