Open Journal of Philosophy
2013. Vol.3, No.4A, 18-23
Published Online November 2013 in SciRes (http://www.scirp.org/journal/ojpp) http://dx.doi.org/10.4236/ojpp.2013.34A004
Open Access
Quantification is Incapable of Directly Enhancing Life Quality
through Healthcare*
Peter A. Moskovitz
Departments of Orthopaedic Surgery and Neurological Surgery, George Washington University,
Washington, DC, USA
Received February 14th, 2013; revised March 14th, 2013; accepted March 21st, 2013
Copyright © 2013 Peter A. Moskovitz. This is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.
Quantification, the measurement and representational modeling of objects, events and relationships, can-
not enhance life quality, not directly. Illustrative is Sydenham’s model of disease (Sydenham, 1848-1850)
and its spawn: the checklist quantification that is contained in the DSM (Diagnostic and Statistical Man-
ual of Mental Disorders, now in its fifth edition) and ICD (International Classification of Diseases, now in
its ninth edition). The use of these diagnostic catalogs is incapable of directly enhancing health, a compo-
nent of life quality; because health is not the control or absence of disease, and practitioners do not think
in checklists. Healthcare practitioners have adopted the methods of the airline industry in imposing
checklists that are unnatural to nonlinear cognition. At first instance and finally, the subjectivity of ex-
perience and the intersubjectivity of communication create the diagnostic and therapeutic relationship that
enhances health and life quality. Health is the capacity to cope and to adapt to the experience of suffering,
regardless of its cause or context, and to pursue salutary experience. Society will effectively develop, im-
plement and “reform” healthcare only when it accepts positive, noncircular definitions of health and
“Quality of Life.” The ethical obligation of the practitioner is to honor and trust the patient’s narrative of
illness, the story of suffering.
Keywords: Health; Healthcare; Quantification; Quality-of-Life; Suffering
Quantification, the Measurement and
Representational Modeling of Objects, Events
and Relationships, Cannot Enhance Life
Quality, Not Directly.
To demonstrate how quantification enhances life quality, one
assumes that quantification is, in fact, capable of enhancing life
quality. Regarding the relationship of health to life quality one
might begin with the assumption that health is a good and a
component of life quality. Quantification enhances the delivery
of healthcare, because proper diagnosis and treatment require
statistical, analytical problem solving—Daniel Kahneman’s
“system 2” think ing (Kahneman, 2011)1. By this argument quan-
tification enhances life quality . The conclusion is false. Assump-
tions grounded in the intuitively obvious are not always correct2.
I begin this essay with three assumptions that I hold as justi-
fiable. First, “quantification” means expressing and revealing
the nature of objects, events or relationships in symbolic repre-
sentation, the foundation of “system 2” thinking. The symbols
may be linguistic, pictorial, sculptural, structural or numerical
—the media of art and science. For example, we measure the
state of a person’s diabetes by measuring blood sugar and A1C
hemoglobin. The numbers are not the thing itself—the state of
her3 diabetes; the numbers are a symbolic representation of that
disease, and an incomplete one, to be sure.
Second, life quality, or, as it is known in the literature, qual-
ity of life (QOL hereafter) is entirely subjective and incapable
of precise measurement using numerical, or any other symbols.
There are, of course, many instruments intended to measure
QOL. They tend to be specific for the discipline for which they
were developed (Costanza, 2008). That is, the social sciences,
economics, medicine, psychiatry, aid organizations and devel-
opment agencies use different instruments to measure QOL.
*Disclaimer: The author has no financial or competing interests to de-
clare.
1I would be imprudent were I to omit a reference to Kahneman’s im-
p
ortant work, Thinking, fast and slow. It is exceptional in that it is both
important and popular (The excellent is rarely found, more rarely val-
ued (von Goethe, 1917)). Also, it easily comes to mind with an essay
such as this. Kahneman’s book is about how cognitive bias affects the
apparatus of consciousness in problem solving and prediction. Deduc-
tion and objectivity, as well as induction, intuition and subjectivity are
the subjects of his book. Intersubjectivity, a subject of this essay, is not
among them .
There is a general agreement that quantification of material
well-being is related to QOL only in a preliminary, superficial
and limited way (Kahneman & Deaton, 2010). Quantification
2The proposition that it is both necessary and sufficient to ground one’s
assumptions in the intuitively obvious appears to be a staple of phi-
losophical discourse. It qualifies as a cognitive bias (see above). I do
not pretend to understand the language of philosophical discourse.
3In this essay I use the feminine pronoun to “subvert the dominant para-
digm” that favors the masculine pronoun when the antecedent is not a spe-
cific person.

P. A. MOSKOVITZ
of emotional well-being takes various forms, including, but not
limited to, measurements of situational and overall “satisfac-
tion” and states of “contentment” or “happiness”. The satisfac-
tion of healthcare consumers (patients) appears to be inde-
pendent of the quality of their healthcare (Xiao & Barber, 2008).
Either there is something wrong with healthcare or there is
something wrong with the quantification of “satisfaction”, with
the quantification of “healthcare quality” or both.
QOL, well-being, satisfaction, contentment and happiness
are “irreducible concepts”4 (Casebeer, 2003). These expressions
cannot be reduced to finite elements for measurement. Later in
this essay, I introduce the expression “salutary experience”, the
pursuit of which is perilously close to a “pursuit of happiness”.
Neither can be measured with an instrument subject to external
validation.
And, third, quantification as a process, an art or a method can
do nothing. It is humans who might be capable of using quanti-
fication to enhance their own or another’s QOL. The technol-
ogy of quantification, no matter how sophisticated it is, cannot
measure what is central to health, to satisfaction and to QOL,
that is, the experience of it.
A Negative Example of the Relationship between
Quantification and Life Quality Is Sydenham’s
Model of Disease and Its Spawn: The Checklist
Quantification Contained in the DSM
(Diagnostic and Statistical Manual of Mental
Disorders) and ICD (International
Classification of Diseases).
It is intuitively obvious that medical and mental disorders
and diseases commonly degrade QOL. Thus, we conclude that
the control and cure of disorders and diseases enhances QOL.
Safe and effective treatment requires accurate diagnosis. The
model of Sydenham provides for diagnostic classifications of
disorders and diseases according to specific symptoms, signs,
laboratory findings and imaging data (Scadding, 1988) (King,
1970) (Blashfield & Draguns, 1996).
Stanley J. Reiser proposed that the advent of modern, scien-
tific medicine was the moment when Laennec first used his
stethoscope to listen to the sound of disease, the measurable
sounds of asthmatic lungs or of a defective heart that was the
cause of his patient’s sickness (Reiser, 2009: pp. 6-7). The
cause of illness became an object capable of measurement. The
practitioner reports the measurements, shares them with others,
analyzes them and studies their relationship to other objects,
events and relationships. This is science, the foundation of
nosology—the study of noxious events. (Sedler, 1994) (Stengel,
1959).
Practitioners measure anatomy, physiology, chemistry and
function to categorize the state of a patient into specific condi-
tions or diseases. The practitioner catalogs her perceptions of
her patient’s condition within the model’s matrix of symptoms
and signs—the objects and events of the patient’s condition and
the relationships among them. Nosologic catalogs, such as the
DSM (American Psychiatric Association, 2005) and the ICD
(Buck, (Ed.), 2013) make sense of the myriad variables that the
practitioner con fronts.
The Use of Diagnostic Catalogs, such as the DSM
and the ICD, Is Incapable of Directly
Enhancing Health, a Component of Life
Quality, because Health Is Not the Control or
Absence of Disease and because Practitioners
Do Not Think in Checklists.
The World Health Organization defined “health” in 1946:
“Health is a state of complete physical, mental and social well-
being and not merely the absence of disease or infirmity”
(WHO, June, 1946). The definition avoids the negative “ab-
sence of disease” by specifically excluding it. A proper defini-
tion must state what the thing is, not what it is not. But,
“well-being” and “health” are synonyms. I maintain, therefore,
the definition is circular. Furthermore, practitioners generally
strive for the control and cure of disease, injury, and deformity;
and in doing so, enhance the “well-being” of their patients.
They do so, in part, because insurers who compensate health-
care practitioners do not pay for well-being. Healthcare payers
compensate practitioners for either procedures (including the
process of “evaluation and management”) or for “health-re-
lated” outcomes, and seldom the latter. For example, the proc-
ess of evaluating and treating hypertension (measuring blood
pressure and prescribing medication, etc.) is easier to measure
than the longitudinal outcome of lowered blood pressure over
time; and, even such an “outcome measure” is an order of mag-
nitude easier to measure than the effect of the treatment on the
patient’s QOL. “Health maintenance organizations” (HMO’s)
that appear to compensate practitioners for enhancing the
well-being of their patients obtain mixed popularity (Rossiter,
Langwell, Wan, & Rivnyak, 1989), except, in my view, with
healthcare economists and administrators.
Beyond the problem of how practitioners are paid, the quan-
tification model of Sydenham fails to enhance QOL because it
does not comport with how practitioners think. The encounter
between patient and practitioner is not, at first, a deductive
process; it is primarily inductive and immeasurable. Intuitive
experience precedes deductive analysis. For the practitioner,
that is as it should be. Much has been written about “how doc-
tors think” (Groopman, 2007). I’m persuaded to think that
much of it misses or obscures the point.
Healthcare Practitioners Have Adopted the
Methods of the Airline Industry in Imposing
Checklists that are Unnatural to Nonlinear
Cognition.
Imposing linear checklists (“system 2 thinking”) upon sub-
jectivity (“system 1”) requires analytical thought. The process
is necessary to prevent errors and adverse outcomes that result
from the cognitive bias of induction. We measure objects,
events and relationships with symbols that we manipulate with
linear organization and calculation. Checklists for the diagnos-
tic criteria that produce classifications of medical and psychiat-
ric disorders are linear, like those that ground and flight per-
sonnel use to maintain and fly airplanes. The practitioner
represents a positive finding (an object, event or relationship)
on the checklist with an appropriate symbol that can be digi-
tized. Diagnostic and therapeutic algorithms are capable of
computerization and automation. Many consider this an ideal
model of healthcare (Wang et al., 2003) (Agency of Health
Care Policy and Research, 1996).
The practitioner decides what checklist to use, what ques-
tions to ask and how to interpret the responses to complete
4Not to be confused with “irreducible complexity”, which is self-contradic-
tory. All “comple xity” is reducible. (Moskovitz, 2013).
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P. A. MOSKOVITZ
appropriate diagnostic or therapeutic algorithms5. Intuitively we
understand the process as deduction, “thinking”. The neurobi-
ology of how the practitioner “thinks” about clinical problem
solving may not be important to her patient. Why and when she
does so, using the proper checklist, is important and the process
derives from the inductive products of the narrative encounter.
Deduction, and the checklists to which it applies, are properly
imposed upon the practitioner-patient relationship, but that’s
not how the practitioner-patient encounter starts.
Practitioners don’t initially think in linear algorithms capable
of digitization and computational analysis by Aristotelian and
Quinian logic, like the ICD and the DSM. How the practitioner
thinks about her patient begins with her subjective experience,
not with her linear, checklist objectivity. The perceptual, asso-
ciative and motivational apparatus of the body-brain is nonlin-
ear. Cognition, or consciousness, in or out of awareness, is
nonlinear. That is, the mind is oscillatory (Crick & Koch, 1990)
(Llinas, 2001) (Singer, 2005) (Singer, 2001).
Subjective experience happens in the objective, measurable,
physical body-brain by the process of reverberating, resonant,
re c u r sive oscillation of bi oelectrical activity . A computer performs
linear operations and calculations: electrons flow along branch-
ing pathways switched with linear controls. The physical brain,
however, is capable of spontaneous and induced oscillation;
and when stimuli trigger or direct oscillation among disparate
circuits, networks and systems of the body-brain, consciousness
ha p p e n s. That is how mind happens and decisions are made. Cog-
nitive bias occurs because the process is not under linear control.
The foregoing and what follows constitutes a theory of con-
sciousness and, for the present case, of how practitioners think.
It is, in the main, speculative, controversial, and deeply coun-
terintuitive. The theory is not new, and my personal statement
of it derives, predominantly from the work of Francis Krick and
Christof Koch (Crick & Koch, 1990), Wolf Singer (Singer,
2001), Rodolfo Llinas (Llinas, 2001) and Henry Markram
(Markram, 2006). Jonah Lehrer (Lehrer, 2007), like the writers
and artists about whom he wrote, along with countless others,
could not accept that “mind”, “experience”, “subjectivity” and
“consciousness” are synonyms, as I propose they are, and that
they happen in the physical body-brain.
My interpretation of the theory proposes that the process by
which we know what is “out there” and by which we know that
we are certain of what we know in clinical problem-solving, or
in any endeavor, is nonlinear, iterative, “dynamical” and oscil-
latory (Singer, 2005). The oscillatory process of mind, of con-
sciousness is described as “emergent” (Morowitz, 2002) or
“supervenient” (Chalmers, 1996). Mind “emerges” in and from
the physical body-brain as oscillation. “What” oscillates enters
consciousness, either in awareness or out of awareness6.
Consciousness is the subjectivity of the human condition7.
What’s “out there” is real, but the experience of it, like the first
person experience of the redness of a red, ripe tomato (Jackson,
1982)8, or the sweetness of its taste, is unique and subjective.
No one else can know what it is like for another to experience
that redness. Consciousness is “the feeling of what happens”, as
Antonio Damasio put it (Damasio, 1994). It is the experience of
“the remembered present” according to Gerald Edelman
(Edelman, 1989). Consciousness is the experience of perceptual
contents. Be not deceived, consciousness is not “the contents of
perceptual experience” as you might read in the literature
(McDowell, 1994).
Consciousness is all subjectivity without objectifiable con-
tents. Perceptions and their bioelectrical representation have
contents; our experience of them has none. John Searle un-
derstood that consciousness is “about something” but it has no
objective contents. (Searle, 1983) There are no “qualia” that
some philos ophers thi nk ought to be the gr anularity of subje c-
tive experience (Jackson, 1982). Unfortunately, Searle gave
the “aboutness” of subjectivity the ungainly name of “inten-
tionality”, opposed to “extensionality”. Intentionality has
nothing to do with intent, and the ambiguity prompts phi-
losophers to say “intentionality, with a capital I” to distin-
guish it from intentionality, meaning intended motivation in
awareness9.
According to the present theory, consciousness is the totality
of the individual’s momentary experience and subjectivity.
Some of it enters awareness, most of it does not, but the neuro-
biological process by which it happens is the same, except for
the frequency of oscillation. That some perceptual contents in
consciousness enter awareness while most do not is confusing,
even for neurophilosophers. What enters awareness is often
called “phenomenal consciousness”, implying that there are
other, separate realms of consciousness. Investigators call these
realms of consciousness out of awareness, variously, pre-con-
sciousness, sub-consciousness, access consciousness or sub-
liminal consciousness. Freud initially called them collectively
“the unconscious”, which might be confused with Jung’s char-
acterization of experiences shared across cultures and across
languages as the “collective unconscious”10.
Perceptual contents that oscillate in consciousness, whether
in or out of awareness, affect behavior, affect the perception of
other stimuli and how they enter consciousness and permit the
storage of perceptual contents so that they can enter awareness
later, when the stimulus is remote. Therefore, the theory I’ve
presented implies that consciousness is a unitary phenomenon.
Thinking and deduction that we hold so dear are no more nor
less than being aware of being aware.
5Airlines use written checklists. Practitioners often use checklists retained in
memory according to their education, training and experience. Memorized
checklists, memory being nonlinear, are predictably less reliable.
6Because the non-linear, oscillatory model is not new, many neuroscientists
contributed important concepts to it, e.g. Bernard Baars’ “global neuronal
workspace” (Baars, 1998). Still, a coherent oscillatory model has been slow
to “emerge”. The problem of neurophilosophy is more troublesome, in my
view. An example is Paul Churchland’s discussion of recursive information
systems (Churchland, 2007). The medium of philosophy is language (the
linear representation of thought in linguistic symbols), and, I propose, no
p
hilosophical discourse, no matter how rigorous, can equate a subjective
state with its caus ativ e ph ysi cal, n eural event ; ju st as phi loso phi cal d iscou rs e
cannot describe what a hypercube looks like, or what are the boundaries o
f
an imaginary number. Yet, oscillatory, iterative, chaotic systems are multi-
dimentional and the mathematics that describes oscillatory systems invaria-
bly contains imaginary numbers (Kelso, 2006). A review of the 2500 year
polemic o n t h e nature o f conscious ness is not within the scope of this essay.
7This personal definition does not exclude non-human animal con-
sciousness, which limitations in expressive capacities obscures.I infer
from Markram’s work (Markram, 2006) that machines can mimic
consciousness but not reproduce or obtain it. The work of nanotech-
nology scientists, such as Alice Parker, may change that (Eshaghian-
Wilner, 2007).
8I apologized to Frank Jackson for using his coinage (Jackson, 1982) once
before. I’m obl iged to do so again.
9Philosophers do that sort of thing. Intentionality, being the obverse o
f
extensionality and distinct from intent, should be spelled differently.I do
not pretend to understand the langu age of philosophical discourse .
10The ways in whi ch perceptual contents out o f awareness affect p erceptual
content s in awareness is the subject of Thinking, fast and slow (Kahneman,
2011), to w hi ch I alluded earlier.
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P. A. MOSKOVITZ
At First Instance and Finally, the Subjectivity of
Experience and the Intersubjectivity of
Communication Create the Diagnostic
and Therapeutic Relationship That
Enhances Health and Life Quality11.
The reader, no doubt, asks what this speculative theory has to
do with the practitioner who endeavors to understand the ex-
perience of her patient and who endeavors to enhance that pa-
tient’s health, welfare and quality of life. Practitioners are in-
terested in illness, what happens when a disease, injury or de-
formity evokes the experience of suffering12. Illness and suf-
fering are states of consciousness. They evoke emotions but
they are not themselves emotions, nor are they physical abnor-
malities of the body-brain. Suffering and illness are states of
consciousness, subjective, immeasurable and incapable of being
digitized, characterized or catalogued in any ICD or DSM.
Subjective experience (all experience is subjective) is im-
measurable—nonlinear. And yet, consciousness feels substan-
tive. It is “real” because it is our first person experience and
ours alone. Subjectivity defines the “self”, sometimes called
“the autobiographical self” as if there were any other kind
(Damasio, 1994). Because the “self” is subjective and existen-
tially unique, we assiduously protect it from damage or loss.
The experience of loss or threat of loss of the integrity of “self”
is what we call suffering (Cassell, 2004). Scholars and scien-
tists have tried to measure and quantify suffering and they can-
not (Meyerfield, 1999) (Siu, 1993).
The practitioner serves her patient best who focuses her
awareness on her patient’s experience as much as, if not more
than, on the objective characteristics of the patient’s condition.
And, the vast majority of the practitioner’s experience of her
patient is initially outside of her awareness. Perceptions of the
patient’s behavior, expressions of mood, emotion or pain, often
evoke in the observer similar experience to that which evoked
the patient’s behavior. The process derives from the confluence
of the perceptual and motor apparatus that might be called
“motor mirroring”, involving as it does specialized nerve cells
that are called mirror neurons (Rizzolatti & Craighero, 2005)
(Oberman & Ramachandran, 2007). The process is integral to
experiences that we variously call sympathy, compassion, iden-
tification, fellow feeling and empathy (Shirtcliff, 2009). Motor
mirroring begins out of awareness where, in my view, for the
practitioner, it can be both a blessing and a curse13.
The practitioner first understands her patient intersubjec-
tively14. Ultimately she does so through the practice of what has
come to be known as “narrative medicine” (Charon, 2006)
(Kleinmann, 1988). The practitioner’s understanding of her
patient’s experience comes from the patient’s narrative of ill-
ness, the patient’s story of suffering. Health, like illness, is
subjective, immeasurable and narrative.
The theory presented here suggests how the practitioner fo-
cuses her awareness on experience of perceptual contents
“about” her patient—multidimensional experience that is ini-
tially out of her awareness and fleeting. The difference between
a linear model of consciousness and an oscillatory model of
consciousness informs our understanding of the difference be-
tween the checklist mentality of evaluating and treating disease
and the subjective understanding of a person’s experience of
that disease. I accept that there are many who hold that the
former is central to good healthcare and that the latter is a lux-
ury that modern healthcare can no longer afford—perhaps.
Health Is the Capacity to Cope and to Adapt to
the Experience of Suffering, Regardless of Its
Cause or Context, and to Pursue Salutary
Experience.
I proposed this definition of health in collaboration with Stan
Reiser. It is a positive definition, avoiding negation. Although it
avo ids circularity, the critical, defining expressions, i.e.: “the expe-
rience of suffering” and “salutary experience” are subjective and
cannot be reduced to finite elements for measurement. It is axiomatic
that subjective experience, positive or negative, is irreducible.
No objective measurement will ever demonstrate what it is
like to experience illness or health. Quantification can never
demonstrate what it is like to experience that redness of that red,
ripe tomato, or the yellowness of a field of daffodils. Such is
the nature of subjectivity. The state of a person’s health is un-
derstandable only in the narrative of the experience of it.
Resilience is another component of life quality. Resilience
and health, though not synonyms, inform our understanding of
both. Each is a capacity. One definition of resilience15 includes
the “ability [capacity] to recover readily from illness, depres-
sion, adversity, or the like; buoyancy” (Random House, 2013).
“… To recover readily from… adversity …” is acceptably similar
to the concept: “… to cope and adapt to the experience of suf-
fering”. Some of the properties of resilience, such as, time and
completeness of recovery, may be reduced to finite elements for
measurement, as when they are used in materials science. Time
and completeness of recovery from a disease or after an injury
to the point of “restoring health” are not so easy to measure.
Health, like resilience, apart from being a capacity, is also a
property or state. For example, one can be in a state of good
health as one can have good fortune. Normative good health—
that is, what constitutes the symptoms and signs of “good
health” according to experts or opinion polls—might be reduc-
ed to measurable elements. The outcome of health, the experi-
ence of good health or of bad health, however, is subjective, for
which quantification remains an illusion.
11Cognitive bias underlies any discussion of induction and the subjec-
tivity of how practitioners and the rest of us think. Checklists are nec-
essary because they help to avoid error to which cognitive bias is a
universal, ever-present predisposition.The problem of cognitive bias is
not the subject of this essay .
12A disease, in j u r y or deformity th at d oes not evoke t he experience of suffer-
ing may be an annoyance, but it does not rise to the level of illness or dis-
ability.
13The process of “identification” includes both perceptual and motor inter-
subjectivity. It is in her motivation and behavior that the practitioner must
remain scrupulously separate from her patient. Empathizing with a patient
is good practice, “identifying” with a patient breaches critical boundaries
and is dangerous. Since empathy is subjective, on e cannot teach empathy.
14Any barrier between the practitioner and the patient, such as a computer,
internet consultation or the telephone, limits the capacity of both patient and
practitioner to experience each other inter-subjectively. That is an important
part of my “complaint”. It is only one of the many dangers of EMR—elec-
tronic medical records. These barriers are not insurmountable ones; but,
unless practitioners hold them in awareness, the dangers damage both rela-
tionship and judgment.
Society Will Effectively Develop, Implement
and “Reform” Healthcare Only When It Accepts
Positive, Noncircular Definitions of Health
and “Quality of Life”.
The Patient Protection and Affordable Care Act of 2010 (P.L.
15The first definition of resilience, “the power or ability to return to the
original form, position, etc., after being bent, compressed, or stretched;
elasticity”, used in mate rials science , is a nice metaphor for health.
Open Access 21

P. A. MOSKOVITZ
111-148) and the subsequent Healthcare and Education Recon-
ciliation Act of 2010 (H.R. 4872) remain controversial and, in
the view of many, either excessive or insufficient (DePinto,
2012). There remains a crushing irony in the debate over the
legislation. The Acts are at once operational definitions of
healthcare yet ones developed without a coherent and cogent
definition of health. The reasons for this lapse or, at best, con-
cession, are understandable. First, practitioners (providers)
intuitively associate good health with the prevention, treatment
and cure of disease, injury and deformity, as do their patients
(consumers). Second, healthcare administrators and payers
require documentation and accountability from providers. The
documentation must be expressed in symbols that are capable
of measurement, digitization and automated processing.
Healthcare is dependent on quantification and a checklist men-
tality.
And, third, it is the natural manure of every institution that it
will eventually require reform, a process that requires quantifi-
cation of its ongoing state. No healthcare system will long sur-
vive if it is based only on a subjective definition of health, even
if there is no scientific and ethically correct alternative. It is,
therefore, inevitable that such a healthcare system will fall short
of the sort of QOL enhancement that really matters, one that
enhances resilience in the face of suffering and that enhances
the “pursuit of salutary experience”.
But, Even If Health Is Erroneously Defined by
Objective Process and Outcome, It Is the Ethical
Obligation of Practitioners, at First Instance, to
Honor and Trust Their Patients’ Narratives of
Illness.
Only by hearing each patient’s story of suffering in a unique
personal and social context (Engel, 1997) will the practitioner
understand what it is like for that patient to be ill or to be “in
health” (Svenaeus, 2010). The ability to guide the diagnostic
and therapeutic alliance, including the objective assessment of
the patient’s condition, with an intuitive, inductive and inter-
subjective understanding of the patient’s experience separates
the life-enhancing practitioner from the merely competent.
Quantification cannot provide understanding of the patient’s
narrative. Society must choose how it will regard health and
healthcare to best enhance life quality.
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