Listening-touch, Affect and the Crafting of Medical Bodies through Percussion

Body work and body meanings in patient-centered care: Health care professionals and patients with disabilities in Italian hospitals

BACKGROUND

This study integrates patient-centered care (PCC) research and body work studies to understand how a focus on physical and sensorial aspects in the relationship between health care professionals (HPs) and patients contribute to the implementation of PCC.

PURPOSE

To understand how HPs' body work practices contribute to the implementation of PCC, we investigate the meanings HPs ascribe to their and to patients' bodies. The goal is to grasp how these practices and meanings, rooted in unexplored sensorial perceptions, account for the emergence of a relationship of mutual acknowledgment between HPs and patients.

METHODOLOGY

Thirty-nine in-depth interviews were carried out with HPs, who interact with patients with disabilities in Italian hospitals.

RESULTS

HPs engage in different body work practices: adopting a diagnostic gaze and an empathetic gaze, touching, and playing. The diagnostic gaze concurs to create a feeling of promptness between HPs and patients, but also a stronger distance with respect to other practices. The empathetic gaze, touching, and playing are associated with feelings of shared vulnerability and resilience. These shared perceptions and emotions build a common ground and shape a relationship focused on patients' involvement.

PRACTICE IMPLICATIONS

Voicing and feedback sessions can be arranged to listen to how HPs interpret their own and patients' bodies. An organizational culture acknowledging emotions should be promoted to sponsor among HPs the consideration of the sensorial aspects of their connection with patients. The value of bricolage should be observed, where the HPs feel free to readjust tools, spaces, and routines. Sensitivity training exercises should be arranged to understand the interactions with patients with disabilities.

Expanding Medical Semiotics

This special issue explores the evolving landscape of medical semiotics of conventional biomedicine. With expansion we refer to the range of phenomena considered signs or symptoms of underlying disease, but also the growing anthropological attention to the medical sign system in ways which reach beyond classic semiotic analysis. The articles testify to the expansion in terms of empirical foci and theoretical contributions. As part of the introduction, we discuss three modes of reading symptoms within medical anthropology: the hermeneutic, material, and critical readings, all highlighting the crucial role of medical anthropology in understanding the biosocial and cultural dimensions of medical semiotics.

Turning Towards the Affective: Medical Semiotics of Child Maltreatment in Denmark

Signs of child maltreatment may be physical and detectable by clinical examination but may also arise as a feeling of strangeness that sparks uncertainty. Based on fieldwork in Danish general practice, and thinking along recent discussions around semiotics and affect, the article explores how feelings of "strangeness" arise in child consultations. It focuses on how subjective, embodied, and interpersonal reactions arise, how signs, however tactile and arbitrary, are felt and experienced, and how engaging with affective aspects when doing diagnosis, could expand the medical semiotics of child maltreatment.

The (commercialised) experience of operating: Embodied preferences, ambiguous variations and explaining widespread patient harm

This article provides a detailed account of how surgeons perceived and used a device-procedure that caused widespread patient harm: transvaginal mesh for the treatment of pelvic floor disorders in women. Drawing from interviews with 27 surgeons in Canada, the UK, the United States and France and observations of major international medical conferences in North America and Europe between 2015 and 2018, we describe the commercially driven array of operative variations in the use of transvaginal mesh and show that surgeons' understanding of their hands-on, sensory experience with these variations is central to explaining patient harm. Surgeons often developed preferences for how to manage actual and anticipated dangers of transvaginal mesh procedures through embodied operative adjustments, but collectively the meaning of these preferences was fragmented, contested and deferred. We critically reflect on surgeons' understandings of their operative experience, including the view that such experience is not evidence. The harm in this case poses a challenge to some ways of thinking about uncertainty and errors in medical sociology, and calls for attention to a specific feature of surgical work: the extent and persistence of operative practices that elude classification as right or wrong but are still most certainly better and worse.

Technology Complements Physical Examination and Facilitates Skills Development among Health Sciences Clerkship Students: An Integrative Literature Review

Background

Technology is increasingly present in the clinical environment. There is a dearth of investigation of the relationship between technology and touch concerning student learning of physical examination practices.

Method

Integrative review methods were used to synthesise empirical literature to provide a comprehensive understanding of the relationship between physical examination, learning and technology in the context of health professional student clerkships.

Results

Three databases including MEDLINE, CINAHL and Eric were searched for all articles published from 2014 to 2021 using terms relating to (i) physical examination, (ii) technology, and (iii) student clerkships. Thirty-three studies met the inclusion criteria. From the analysis, it is evident that technologies that intersect with learning of physical examination may broadly be apportioned into two categories: 1) technologies that mediate physical examination practices; and 2) technologies that mediate the learning of physical examination.

Conclusions

This review indicates that technologies may have multiple roles in the student learning of physical examination, including technology mediating increased diagnostic accuracy and access to supplementary learning material relating to physical examination that is integrated for the clinical clerkship environment. It highlights a need to further understand the touch versus technology relationship and explore the dynamic intersection.

Senses of Touch: The Absence and Presence of Touch in Health Care Encounters of Patients with Mental Illness

Touch is a fundamental sense and the most unexplored of the five senses, despite its significance for everything we do in relation to ourselves and others. Studies have shown that touch generates trust, care and comfort and is essential for constituting the body. Based on ethnographic fieldwork, this study explores the absence and presence of touch in interactions between people with mental illness and professionals, in health care encounters with general practitioners, neurologists and physiotherapists, as well as masseurs. We found that touch and physical examination of patients with mental illness is absent in health care encounters, leaving the patients with feelings of being out of place, misunderstood, less socially approved and less worthy of trust. Drawing on Honneth and Guenther, we conclude that touch and being touched is an essential dimension of recognition-both of the patients' bodily sensations and symptoms and of them as human beings, detached from the psychiatric label-as well as contributing to the constitution of self and personhood. These findings confirm that touch works as an existential hinge that affirms a connection between the patient, the body and others and gives a sense of time, space and existence.

Becoming a diagnostic agent: A collated ethnography of digital-sensory work in caregiving intra-actions

Sociological contributions on digital health have acknowledged the enduring significance of sensory work in diagnosis and practices of care. Previous explorations of these digital and sensory entanglements have focused separately on healthcare providers or patients/caregivers, rarely bringing these worlds together. Our analysis, based on the collation of ethnographic fieldwork in clinics, medical schools, and homes in Australia, offers rare insights into caregiver and practitioner perspectives. We interrogate the work involved in digital-sensory becoming, as caregivers (in our case parents) learn to assign diagnostic meaning to potential childhood disease. Working with Karen Barad's concept of 'intra-action', we demonstrate how diagnostic knowing is enacted between practitioners, parents, senses, and devices. We identify seven aspects of digital-sensory learning: attention to the change from normal; testing/searching for signs and symptoms; confirmation and direction from more experienced others; mimicry; analogy/metaphor; digital archiving; and reference to validated digitised signs. We found that this learning does not take place discretely in the clinic or at home. Doctors and parents both do digital-sensory work to register, co-witness, and mutually enact disease by interpreting signs and symptoms together in their caregiving intra-actions. Our article also champions collated ethnography as a methodological approach for making sense of complex assemblages in healthcare.

Interdisciplinary Perspectives on Breath, Body and World

Breath, the ephemeral materialization of air at the interface of body and world, engages with and alters the quality of both. As a process of inhalation and exhalation that signals its physiological universality, breath is an invisible prerequisite for life, an automated and functional necessity. Yet it is more than simply a reflexive action and can at times be controlled or manipulated. It can also affect or be affected by experiences, environments and relationships. In this essay, like the contributors to the special issue it prefaces, we aim to address the lacuna that exists in the examination of the meanings and embodiment of breath as a central theme in the humanitics and social sciences. Interdisciplinary perspectives that explore breath as a multifaceted phenomenon, both intrinsically shared and contextually distinct, open new directions in the field of breath and body studies.

Beyond Messiaen's birds: the post-verbal world of dementia

This paper investigates the use of verbatim musical transcription as a research method in dementia care. It reports on an art-based ethnographic study (Aesthetic Research in Everyday Life (Aeriel)) in which verbatim transcription was applied to everyday interactions in dementia care, making use of musical-instead of verbal-notation. Starting from the notion that medical and healthcare settings can be sites of 'found performance', the paper reviews literature relating to artistic methodologies within medical humanities, music, ethnography and dementia care. From this review, it proposes a research design and method of verbatim musical transcription as a potential avenue of investigating communication between carer and cared for in dementia care. The paper offers an illustrative example from Aeriel and draws conclusions from the synthesis of verbal and musical data analysis. Findings indicate an important advance in studies of dementia care communication towards a concept of the 'post-verbal' enabled by a musical research method and the clinical applications that it offers.

Effective Deep Brain Stimulation for Obsessive-Compulsive Disorder Requires Clinical Expertise

BACKGROUND

Deep brain stimulation (DBS) is an innovative treatment for severe obsessive-compulsive disorder (OCD). Electrodes implanted in specific brain areas allow clinicians to directly modulate neural activity. DBS affects symptomatology in a completely different way than established forms of treatment for OCD, such as psychotherapy or medication.

OBJECTIVE

To understand the process of improvement with DBS in patients with severe OCD.

METHODS

By means of open-ended interviews and participant observation we explore how expert clinicians involved in the post-operative process of DBS optimization evaluate DBS effects.

RESULTS

Evaluating DBS effect is an interactive and context-sensitive process that gradually unfolds over time and requires integration of different sources of knowledge. Clinicians direct DBS optimization toward a critical point where they sense that patients are being moved with regard to behavior, emotion, and active engagement, opening up possibilities for additional cognitive behavioral therapy (CBT).

DISCUSSION

Based on the theoretical framework of radical embodied cognitive science (RECS), we assume that clinical expertise manifests itself in the pattern of interaction between patient and clinician. To the expert clinician, this pattern reflects the patient's openness to possibilities for action ("affordances") offered by their environment. OCD patients' improvement with DBS can be understood as a change in openness to their environment. The threshold for patients to engage in activities is decreased and a broader range of daily life and therapeutic activities becomes attractive. Movement is improvement.

Body pedagogics: embodied learning for the health professions

MEDICINE AS EMBODIED PRACTICE

Bodily dysfunctions bring patients to their doctors and even diseases of the mind can originate in patients' bodies. Doctors respond by using their own bodies - hands, eyes, ears and sometimes noses - to make diagnoses and treat diseases. Yet, despite the embodied nature of practice, medicine typically treats the body as an object, paying scant attention to the subjective embodied experiences of patients and doctors. Much health professions education (HPE) reflects this, prioritising cognition over learners' sense of embodiment. Hence there is a gap between the embodied realities of practice and the disembodied nature of medical education. This article introduces readers to 'body pedagogics' as a framework that can help to re-establish embodiment as a central principle of HPE.

BODY PEDAGOGICS

This embodiment theory, drawn from sociology, anthropology and phenomenology, has informed such disparate fields as glassblowing education and military training. Body pedagogics emphasises learning as a physically embodied process. It illustrates how multisensory experience causes embodied changes that become an automatic part of physician expertise. We introduce core body pedagogic concepts using physical examination as an example, examining the bodily means of HPE, students' bodily experiences and the resulting bodily changes.

IMPLICATIONS

Body pedagogics can help us to focus attention on embodiment as a central principle of HPE that transcends the discipline-specific teaching of clinical skills. Moreover, it provides a set of conceptual foundations for an interdisciplinary practice within HPE with implications for instructional design. Body pedagogics can also help us to make strange the habits and disregarded aspects of embodied learning and in so doing help us to consider embodiment more critically and directly in practice and education, and in the ways we research them.

Music and Medicine: being in the moment

This article was migrated. The article was marked as recommended. This article reviews the relationship between music and medicine, informed by our own personal experiences, and by leading scholars who have opened up music and medicine for critical reflection. Performing music, we suggest, is a state of being, in the moment, with fellow musicians and audience members. This establishes bidirectional communication, which can transport both parties to better places. Medicine is, likewise, an act of being with patients, whether or not performing a technical act (a clinical procedure, for example) is part of the interaction. Subjective, non-verbal, dimensions of the interaction engage both parties' senses. Good doctors, like good musicians, tune in to patients at a personal level. The limited research that has examined the relationship between music and medicine shows that music can help students develop auditory skills. Of potentially greater interest is the existential contribution music could make to medical education. We suggest that this could help students and doctors reflect on their experiences of being in the world, and how shared experience can relieve suffering.

How does health feel? Towards research on the affective atmospheres of digital health

The concept of affective atmospheres has recently emerged in cultural geography to refer to the feelings that are generated by the interactions and movements of human and nonhuman actors in specific spaces and places. Affective atmospheres can have profound effects on the ways in which people think and feel about and sense the spaces they inhabit and through which they move and the other actors in those spaces. Thus far, very little research has adopted this concept to explore the ways in which digital health technologies are used. As part of seeking to redress this lacuna, in this essay I draw on previously published literature on affective atmospheres to demonstrate and explain the implications of this scholarship for future theoretical and empirical scholarship about digital health practices that pays attention to their affective and sensory elements. The article is structured into six parts. The first part outlines the concepts and research practices underpinning affective atmospheres scholarship. In the second part, I review some of the research that looks at place, space and mobilities in relation to affective atmospheres. In the third part I focus more specifically on the affective atmospheres of medical encounters, and then move on to digital technology use in the fourth part. I then address in the fifth part, some relevant scholarship on digital health technologies. I end the essay with some reflections of directions in which future research taking up the concept of affective atmospheres in the context of digital health technologies can go. The key research question that these topics all work towards is that asking ‘How does digital health feel?’