Monday, November 18, 2013
Magical History Taking
An Esoteric Art in Taking A History
One of the most esoteric arts of taking a perfect medical history is to subtly move the patient’s consciousness to that tranquil and highly perceptive level. In this state, they will tell you exactly what you need to hear to make the correct diagnosis. They will know and tell you what is relevant to the diagnosis even when it appears unconnected or an irrelevant detail. Suddenly they will forget all of the details that they previously thought were important.
I have seen a true master of the clinical arts use this on a patient to suddenly be able to think clearly and know their own diagnosis. Without the doctor saying anything, the patient had been guided to a realisation of inner knowledge. Suddenly, they knew exactly what was wrong with them and what to do about it.
After a short silence, the patient stood up and apologised for wasting the doctor’s time. They admitted that there was nothing really wrong with them that a healthy life of a careful diet, exercise and avoiding certain foods, activities and stresses would not cure. They knew exactly what to do and they left.
The master smiled his approval. He also approved of the fact that I was left open-mouthed and agog. He winked cheekily.
He knew that at some level, I had comprehended what he had just done. A part of me had understood what he had just done. One day I might even learn to do it myself.
It takes patient participation in the decision making process and their empowerment to another, inconceivable level. And this master of the clinical arts had hardly guided the patient at all in words. He had let the patient do most of the talking. He had let the patient talk themselves out and into catharsis and then to talk themselves into a deep and positive realisation.
A mundane version of this can be practiced by carefully guiding a patient to self-realisation through the guidance of specific questions that makes the patient think anew about themselves, their lives and their health. It is a process of questioning that leads to self-questioning, careful clarity of thought and answers. Fragments of missing knowledge are filled in and the patient is asked to think about how that new understanding rearranges their knowledge and suggests new explanations and solutions.
It is the same as an educationalist’s use of the independent learning process. In modern workshops, it is called ‘ownership of knowledge’. The process of history taking becomes self-diagnostic. It becomes therapeutic. When the patient has come to their own understanding and taken ownership of it, they do not resist change as they do if they are ordered to do something that they do not really understand. They change willingly, which is becoming increasingly important in health as the importance of lifestyle, diet and exercise become more evident.
This process is a major ethical concern in medicine in terms of the modern psychological understanding and ethics of consultation dynamics. It transfers power and responsibility back to the patient.
Some clinicians just seem to have knack or gift for it. It just seems to naturally happen in their presence.
Some clinicians have this powerful gift without being taught it or knowing how they did it. However, it can be taught and learned by any clinician if it is understood. In part, it comes as an inevitable response to practicing deliberate guidance of the patient towards their own diagnosis. Eventually, the miracle happens.
It also requires that the doctor wants the patient to make their own diagnosis, which contradicts usual, mundane medical teaching. It is the doctor’s responsibility to make the diagnosis not the patient’s. The doctor is supposed to be the diagnostic genius and not the patient.
That belief is the socially acceptable, even desirable tip of the iceberg of medical dependency. The danger below the water line is powerlessness and a lack of responsibility in lifestyle with over-medicalisation. The deepest danger is the sick role where patients use their symptoms and diagnoses to attract attention and sympathy. They do not want to let go of their symptoms and diagnoses and get better. They block that process at a subconscious level.
Patient participation, empowerment and the ownership of knowledge is the gold standard of medical practice for objective reasons of hard health outcomes. Done right, any convergence with the subjective motivation of keeping the customer satisfied is merely happy coincidence. It is a part of a complete mindset where everything consistently falls into place to perfection.
This is true Emotional Intelligence. It is the only way to resolve the conflict between the objective and the subjective. It is not to try to change objective reality to conform to unrealistic, subjective and emotional expectations and desires. Reality cannot be changed by the subjective expectations and desires but those expectations and desires can be changed to conform to reality. Emotions can be reprogrammed by example, experience and consciousness so that they do not cause conflict with reality. Harmony is assured.
The doctor is guiding the patient to realistic, objective, rational and informed decision making. In effect, they are teaching the patient to think as a doctor does using their applied knowledge and understanding. The patient is subtly guided to agree with the doctor’s diagnosis and therapeutic decisions without the doctor ever mentioning what they think. Done right, the patient hardly notices the hand that has guided them. They believe that they are a genius for working it out all by themselves.
So this comes from the doctor’s humility. They have no inner need for the patient to look up to them as a hyper-intelligent, all curing hero. They have the self-assurance not to need to be propped up in that way. They must also have absolute inner confidence that they are guiding the patient towards the right diagnosis and decision.
The clinician must take unequivocal responsibility for the decision that they are guiding the patient towards. There must be no sense of wanting to delegate that responsibility to the patient so that it is somehow the patient’s fault if the outcome is suboptimal. If that happens, the clinician will be compromised in their objectives. They will be half-hearted.
Only the wholehearted clinician can practice and succeed at these wondrous techniques. That is the mindset that is required to even start learning these techniques. They are practiced by the clinician who practices with heart and soul. They do not come from the confused uncertainty of the ego or mind.
The deepest magic where the patient’s level of consciousness can be moved to make this possible without words of guidance is an explicable mystery of the clinician’s heart and soul. It comes from the clinician adopting the mindset of inner silence where they can be intuitive and inspired. They pro-actively share that mindset and silence with their patient. They actively and deliberately infect their patients with inner silence so that they can hear their own intuition and inspiration.
The outwardly visible signs that this is being done are a relaxed but pensive clinician. Their every word, expression and tone is that of an open-minded listener. Their facial gestures, head movements and posture are interested yet at peace.
And the actively, passively and innately react to what is being said to them in both words and actions, rewarding the patient’s inner thought processes with signals of approval and subtly discouraging undesirable mindsets. It is so subtle, even disguised, that it passes straight past the conscious mind of the patient.
This might be nothing more than non-verbal communication between subconscious minds. Effectively, non-verbal communication is how subconscious minds talk to one another and affect each other. The subconscious is involved with actions not words. It is involved with subconscious emotions not thoughts. Thoughts are left to the conscious mind.
And what subconscious minds are good at is copying. Whenever two subconscious minds see one another’s emotions expressed in the tone of voice, gestures and postures, each tries to align itself to the other. It tries to pull the other into its subconscious point of view and worldview. Face to face, this is what makes subconscious mindsets and emotions infectious. In person, it creates a collective subconscious mind.
Nobody knows that they are doing this except those with a deep and practical understanding of psychology. It is not a conscious process. It is beyond their conscious control. It is an unconscious and subconscious process.
A deeply committed, whole hearted clinician can stay firm in this tug of war. Their subconscious mind must be convinced or it will communicate its doubts and fold. It will be dragged towards the patient’s subconscious perspective or fears, confusion and chaos that disguise the obvious conclusion. They will lose their inspiration and intuition. They will no longer be able to pull the patient towards their silent tranquillity.
That may be the whole of the mystery. It may be nothing more than a subconscious tug of war where non-verbal communication is the rope joining the clinician to the patient. This infective inner silence that makes intuition and inspiration possible is only effectively communicated when the clinician has this abstract mindset.
Non-verbal communication is the physical expression of this inner process. The mindset behind it is the abstract side of the same process. They both conform with one another and simultaneously co-exist. They are both interdependent and one cannot exist without the other.
The pragmatic question is whether it is easier to learn and practice absolute conscious control over non-verbal communication knowing that the mindset will be learned or whether it is easier to adopt the abstract mindset and subconscious mind that control the non-verbal communication. The answer is to do both simultaneously. Moving both thought and action towards a shared and consistent goal under the direction of informed consciousness is the most effective method of learning this deepest art of history taking in clinical practice. It is the harmonious way.
This approach prevents conflict between the conscious and subconscious mind. It stops one fighting against the other and resisting the process through mental blocks.
One of the chief mental blocks is to believe that such feats are possible and that anybody can learn them if they know how. Those that practice them are not exceptionally and mystically gifted. In fact, they simply stumbled upon the secrets without understanding how they achieved such magnificent. Any healthcare worker, doctor, nurse, psychologist can become so talented if they open their mind to the possibilities and the outer skills and inner mindset practice diligently.