From Truth-Telling To Truth-Making In Medicine
By Antonella Surbone, M.D., F.A.C.P.
Director: Dr. Dominic Balestra
By exploring the nature of truth in the context of the patient-doctor relationship, this project argues that a new conceptualization of truth as truth-making in clinical medicine is needed as an alternative to the more traditional truth-telling conception based on a biomedical notion of disease. The patient-doctor relationship is at the same time a professional relationship based on a public covenant, and a relationship of care, based on the special, intimate involvement of the care giver, the physician, with a particular other, the patient. In this project, originated from my twenty years of clinical practice of medical oncology, I define the patient-doctor relationship as an asymmetrical relation of help with a specific epistemic intentionality and a pragmatic commitment toward a therapeutic telos. The asymmetry in the patient-doctor relationship is existential, social and epistemic, as the patient and the doctor are two different knowing subjects, whose interests for, and objects of, knowledge are different. The patient knows by direct personal corporeal experience what the physician knows by generalization and abstraction. Together they know the patient’s illness.
I contend that the notion of illness is a complex multi-layered one, encompassing objective, subjective, and intersubjective dimensions. It goes beyond the biomedical notion of disease, based on a positivistic empiricist understanding of reified science. Thus, the patient’s illness is not a static object merely waiting to be described and verbalized in a unidirectional truth-telling from the doctor to the patient. Accordingly, I argue that the truth about the patient’s illness is a truth in the making within the patient-doctor relationship, which contributes to making sense of the patient’s life with an illness. Such truth is partial, particular, ambiguous, provisional, dynamic, situated, committed, and relational.
This conceptualization of truth-making in the patient-doctor relationship, based on shared creativity and praxis, potentially uproots the existing power imbalances in western clinical medicine, which surround and sustain the more traditional views of truth and truth-telling. I use the "genetic case" as an illustration of truth-making at work in contemporary clinical medicine, vis-à-vis the epistemic and ethical challenges of genetic knowledge.