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WONCA EUROPE 2014

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Interview with
Carl Rudebeck

“Bodily empathy – the process by which individuals communicate body experience – is crucial in medicine”

Carl Edvard Rudebeck, general practitioner in Sweden, research supervisor in Kalmar county and professor in General Practice at the Department for Community Medicine of the University of Tromsø (Norway), will be in Lisbon to present a lecture about personalized and comprehensive care, entitled “The physicians understanding of the patient's bodily meaning”.
In a brief interview, he explains his ideas and his research efforts related to doctor/patient interaction.

How has medical technology changed the doctor-patient relationship? How can the family physician maintain a balanced relationship with the patient?
Carl Edvard Rudebeck – Today, there are many more options of investigation and treatment. At the same time, there is a decreased acceptance for mistakes in society, which some patients share and express. As a GP, you have to be explicit about these matters with your patients, and you have to live with a certain level of risk, otherwise you will probably do more harm than good. 
Such discussions with patients may sometimes be very interesting and rewarding. The problem as such, is a matter not only for individual GPs to deal with, but for the profession as a whole and should, therefore, be discussed and analyzed on the collegial level and in public. 

What exactly does the concept of intersubjectivity mean in the doctor/patient relationship and what are the main research lines developed by you, in this area?
Intersubjectivity is the process by which individuals come to share experience and ideas. This sharing is never absolute, rather it is approximate, and varying by situation and context. But, still, it is the glue of relations and society and probably the most human of human capabilities. Empathy is another word, more specifically confined to experience. In psychology, and also in medicine, empathy has primarily been associated with emotions. But in the history of hermeneutics and phenomenology, it is about experience as a whole. The weight of emotions corresponds to the weight emotions have in experience. Bodily empathy – the process by which individuals communicate body experience – is crucial in medicine, and bodily empathetic skills may be developed to a professional level by physicians. It is a pre-diagnostic skill of a certain importance to GPs who, when judging symptom presentations, often have to rely on the interaction and personal knowledge, rather than on algorithms. 
My research line in the area has predominantly been writing about the subject. Together with a colleague, I have also conducted a study where we investigated and compared the body experience among GPs. I believe body empathetic skill to be dependent on the access to our own body experience, since this experience is the reference for the concepts designating body experience, at large. But the purely social and communicative talent is probably also important.    

Do family doctors value the person, in particular, rather than the somatic or psychosocial problems he or she presents? What do the results of your research show?
I have taken part in a qualitative study where GPs were observed in action, and interviewed about their way of practicing. The person/patient was paramount, but the body and the context could not be separated from the person. Body examination was important, but body examination contained also relational and communicative dimensions. When face to face with patients, the whole person medicine is the immediate reality.

How do these different relational approaches condition the consultation of the family physician and the relationship with the patient?
At the outset, there are no different relational approaches. The main thing is to encourage the patient to tell us about his or her problems, in a way that becomes valid to the original experience – however odd this may appear – and from there on to tell us about the feelings, thoughts and expectations. The challenge to the GP is to stay with this commitment long enough to make the patient feel that the important things were said, and that this first narrative or symptom presentation reflected the patient’s need to tell, rather than the doctor’s need to get the essential facts, as effectively as possible. With a good start, the choice of relational approach seldom becomes an issue. The platform of the relation is human existence; bodily, relational, imaginative, reflective, and vulnerable. The specific diseases define a secondary level. But on this level, once again, it appears that the disease has no existence of its own. The patient is always there in full figure, hither to the disease, from the GP’s point of view. The body has its existential anatomy, the mix of experiences and capabilities, general and specific, gross and minute, well or diseased, that set the conditions for partaking in the physical and social world. In psychiatric symptoms, consciousness is its own suffering. The person and the disease are, in either case, constructions of language.

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