Table Of Content“A book with deep roots, captivating and inspiring, able to elicit the interest of someone who, just like me, has S
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laid the foundations of her profession in classical medicine. A true challenge which Dr. Tomasi has been able to d
take up, offering us an absolutely new perspective and pushing us to look beyond what we are used to know.” ies
Ilaria Rubbo, MD, University of Verona / Central Hospital of Bozen-South Tyrol, Internal Medicine in
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is trying to teach, learning, if it happens at all, will be quite accidental. This, I think, is equally applicable to the ica
practice of medicine. And it is precisely this sort of phenomenological and existential dimension that David l P
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Låg Tomasi calls for in this seminal work.” Louis M. Colasanti, MA, Community College of Vermont, Educator and Writer ilo
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diverse topics—such as patient self-perception, the mind-brain problem, the limitations of evidence-based , v
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medicine, the role of complementary and alternative medicine, and the impact of patients’ faith and/or connec- l. 1
tion to a higher purpose on healing—demonstrates how Medical Philosophy can help to shape our understand- D
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David Låg Tomasi
Medical Philosophy
A Philosophical Analysis of Patient Self-
Perception in Diagnostics and Therapy
S M P
TUDIES IN EDICAL HILOSOPHY
Edited by Alexander Gungov and Friedrich Luft
ISSN 2367‐4377
1 David Låg Tomasi
Medical Philosophy
A Philosophical Analysis of Patient Self‐Perception in Diagnostics and
Therapy
ISBN 978‐3‐8382‐0975‐3
David Låg Tomasi
MEDICAL PHILOSOPHY
A Philosophical Analysis of Patient Self-
Perception in Diagnostics and Therapy
ibidem- # Verlag
Stuttgart
Bibliographic information published by the Deutsche Nationalbibliothek
Die Deutsche Nationalbibliothek lists this publication in the Deutsche Nationalbibliografie;
detailed bibliographic data are available in the Internet at http://dnb.d-nb.de.
Bibliografische Information der Deutschen Nationalbibliothek
Die Deutsche Nationalbibliothek verzeichnet diese Publikation in der Deutschen
Nationalbibliografie; detaillierte bibliografische Daten sind im Internet über http://dnb.d-nb.de
abrufbar.
Cover picture: © David Låg Tomasi, 2016.
ISSN: 2367-4377
ISBN-13: 978-3-8382-6935-1
© ibidem-Verlag / ibidem Press
Stuttgart, Germany 2016
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Acknowledgments
Making sure to list all the people without whom this book would not have been
possible is indeed a very difficult task. It is my hope that my memory will not
fail me and that all the great experiences I cherish in my heart and my mind
will leave a mark, at least in part, in the writing for this thesis.
Firstly, I would like to acknowledge all the professors and academic staff
at the University of Sofia "St. Kliment Ohridski" and the Bulgarian Academy
of Sciences for all the great conversations and learning opportunities through
the years: Prof. Maria Dimitrova, Prof. Valeri Dinev, Prof. Julia Vaseva-
Dikova, Prof. Asen Dimitrov, Prof. Aneta Karageorgieva, Prof. Plamen Ma-
kariev, Prof. Nedyalka Videva, Dr. Elena Tsenkova, Ms. Deyana Andonova,
Ms. Irena Cheresharova, and Ms. Sasha Nikolova-Livsey. I also want to thank
all the participants, the patients, the multidisciplinary treatment team and all
the staff on the Inpatient Psychiatry Unit, Shepardson 3 and Shepardson 6, as
well as all the staff at the University of Vermont Medical Center and College
of Medicine. I am especially grateful to Dr. William Tobey Horn and Prof.
Lou Colasanti for their assistance and supervision, and to Prof. Friedrich Luft
as well as Dr. Ilaria Rubbo for their work and contributions. I also want to
acknowledge the wonderful example of Dr. Dietfried Schönemann and Ms.
Margarethe Wiedenhofer in helping me discover a true passion for medicine.
Furthermore, a big thank you goes to the Inpatient Psychiatry Group
Therapists Carol Clawson, John Derivan, Lindsay Enman, Sheri Gates, Kevin
Melo, Annie Rapaport, Emily Reyns, Joshua Shupp-Star, Adoria Tudor, and
Alixandra West. I want to acknowledge the great support of the University of
Vermont College of Medicine, the University of Vermont College of Medicine
and the University of Vermont Medical Center, especially Dr. Robert Pieratti-
ni, Dr. Alan Rubin, Lauren Tronsgard-Scott, Katharine Monje, Stacey Ward,
David Hunt, Denise Quint and Gale Weld. This has been a wonderful journey
and I am grateful for all the beautiful people who were very generous in giving
up some of their time to take part in our surveys and questionnaires, and the
academic, research, and medical professionals who helped me with their
knowledge, their insights, and their experiences.
A special благодаря Ви много goes to my Professor Dr. Alexander
Gungov. He has been an incredible source of academic strength, interesting
and passionate debates, and constant encouragement. I am grateful and truly
5
privileged to be receiving the attention of such a noble person and wonderful
teacher.
Last but not least I would like to acknowledge the understanding, the sup-
port and the encouragement of my family both in Europe and the USA, espe-
cially my wife Livija and my son Lucas Andrej.
This study is dedicated to you.
David Låg Tomasi
6
Table of Contents
Acknowledgments................................................................................. 5
List of Figures .................................................................................... 11
List of Tables...................................................................................... 13
Foreword ........................................................................................... 15
Introduction by William Tobey Horn................................................... 21
Introduction ....................................................................................... 23
Chapter 1 A brief history of Medical Philosophy .................................... 27
1.1 General Aspects ........................................................................ 27
1.2 Application and epistemological considerations ............................. 33
a) Defining the questions ............................................................ 33
b) Medicine as art, science, and technology ................................... 42
c) Self-Image, Academic Achievement, Healing Process ................. 45
Chapter 2 Philosophy as basic approach to Medicine .............................. 55
2.1 Hermeneutics and Evidence-Based Medicine................................. 55
2.2 Truth in Method ........................................................................ 74
a) Understanding the Language ................................................... 74
b) Clinical Reasoning ................................................................. 78
c) Medicine and Psychology:
philosophical background and scientific method ............................ 81
Chapter 3 Between Neuroscience and Phenomenology ........................... 89
3.1 Hegel, Merleau-Ponty and Natural Religion: where are we now?...... 89
3.2 Theoretically grounded, empirically supported:
The mind-brain problem ............................................................. 99
a) An analysis of terms ............................................................... 99
b) Suggesting a model .............................................................. 105
c) Explanation of the goal ......................................................... 114
7
Chapter 4 The patient at the center of therapy...................................... 119
4.1 Patient's communication, perception and self-perception ............... 119
4.2 The search for meaning ............................................................ 131
a) Human, All Too Human........................................................ 131
b) Experimental Philosophy ...................................................... 141
c) Mirror, Mirror on the Wall .................................................... 147
Chapter 5 Complementary, Alternative, Traditional Medicine ............... 153
5.1 I shall please, I will please ........................................................ 153
5.2 Integrating, complementing, completing ..................................... 163
a) A logical examination: Central Medicine................................. 163
b) Efficacy, Efficiency, Effectiveness ......................................... 168
c) Culture and Identity.............................................................. 176
Chapter 6 Beyond the realms of this world........................................... 187
6.1 Camus, Sartre, and God: where are we now? ............................... 187
6.2 Alfa et Omega, Diagnosis et Prognosis: ...................................... 201
a) The time of our life .............................................................. 201
b) Multiple perspectives ........................................................... 213
c) Near Death Experience and a Mindful Awareness..................... 225
Chapter 7 Translational science ......................................................... 237
7.1 Taxonomic considerations ........................................................ 237
7.2 Applied Medical Philosophy ..................................................... 240
a) The Third Way .................................................................... 240
b) Finding Balance................................................................... 242
c) Research and beyond ............................................................ 246
Conclusion ....................................................................................... 251
Afterword ........................................................................................ 267
8
Appendix Empirical Research at the University of Vermont Medical Center ... 271
1. Introduction ............................................................................ 271
2. Objective................................................................................ 271
3. Methods ................................................................................. 271
4. Protocol ................................................................................. 272
5. Approvals............................................................................... 272
6. Structure ................................................................................ 273
7. Subject Selection ..................................................................... 273
8. Administration ........................................................................ 274
9. Personnel involved in the Study ................................................. 275
10. Presenting the Data .................................................................. 275
a) General Considerations ......................................................... 275
b) Views on Life's Meaning and Purpose .................................... 279
c) Patient Perception in Diagnostics and Therapy ......................... 287
11. Survey & Questionnaires, Original Format .................................. 295
Part 1: Patient Satisfaction Focus Group Survey........................... 295
Part 2: Health Perception Survey ............................................... 299
12. Selection of Comments............................................................. 301
Part 1: Patient Satisfaction Focus Group Survey........................... 301
Part 2: Health Perception Survey ............................................... 306
13. Conclusions ............................................................................ 307
References and Further Readings ...................................................... 309
1. Bibliography ........................................................................... 309
2. Quoted Works ......................................................................... 335
3. Other Sources ......................................................................... 351
9
