Perspective in Medicine and Ethics

Perspective is how one looks at objects or concepts.

 In medicine, a physician's perspective of a cluster of symptoms or physical findings leading to a final diagnosis of an illness for treatment can vary by many factors, three of which might be the physician's specialty, physician's gender and physician's culture. Perspective can also be affected by the amount of information in terms of history or physical findings: inadequate information can limit the number of possible diagnoses, whereas excessive details, many of which turn out not to be related to the illness under consideration may actually divert attention from considering a more common and less complex disorder. The skill in medicine is for the physician to develop a way of broadening the making of a diagnosis by looking at the symptoms and findings from different viewpoints: that they represent all part of a single disease or that actually multiple diseases are present simultaneously. Even the symptoms presented by the patient must be individually considered as to what the patient is meaning or trying to express by naming that symptom. For example, "constipated" may be a symptom used by a patient but what the patient is trying to express may be different from patient to patient and may in reality, on further questioning, the patient's use of the word may not represent some abnormality in bowel function. For a physician to accept the patient's word "constipated", assuming the word represents the medical meaning without clarifying how the patient uses the word can lead the doctor's perspective of the illness off into the wrong direction.  The similar erroneous viewpoint may occur by the doctor rushing through a physical examination in a routine fashion without simultaneously trying to correlate each part of the examination with the suspected diagnoses and not repeating parts of the exam that appeared abnormal thus missing the chance to verify the abnormal finding.

In ethical analysis and decision-making, perspective can be very important since decisions can significantly affect one or many individuals. Again, the one making the decision, past experience, gender and culture or general moral beliefs or religion can play a role in how that person decides. What perspective to take on an ethical issue, when applied to a specific case or developing a generalized ethical view, should primarily be based on obtaining pertinent facts. What seems like a situation which calls for a specific response on fragmentary, incomplete information will often take on a whole new perspective as the facts become available.  Something which might be considered morally bad may become morally indeterminate or good when all the facts are considered.  For example, facts in recent years demonstrating increasing numbers of death row inmates who have been found innocent of their alleged crimes by DNA testing may change the view of some people who have been advocates of the death penalty.

There is nothing wrong in being able to actively attempt to look for a different view or perspective. Such an attempt may in fact promote and provide a more valid decision and conclusion.

To cover something I didn't detail above, I would like to read comments from my visitors regarding what they would consider examples of how the viewpoints and actions of physicians can be affected by their specialty, gender or culture and whether these perspectives need to or even can be, if necessary, changed in order to improve the diagnosis and care of patients.  Also, do you think that ethical decision making can be improved for all the stakeholders in a decision by attempting to override the effects of past experience, gender, culture and held moral or religious beliefs? ..Maurice.

GRAPHICS: Photographs taken by me December 2012 at Towsley Canyon, Santa Clarita, California.