I concluded my last post emphasizing that the patient’s subjective presentation of symptoms does not exist in a vacuum. I pointed out that patients often describe what their condition based on what they “feel” is happening, or with fear of what they “think” is happening. These though are not feelings or thoughts from nowhere.

There’s always some source to them. What they “think” is happening is based on extrapolated knowledge, partial information, or familial genetic “expectations”  basically, interpretations of what might be going on.

This could be illustrated in a statement like, “I feel that there is a mass in the lower part of my abdomen. It is as if there is an obstruction.” Or “I feel like there is a gaping hole in my stomach and as if my stomach is being eaten away.” “My hips feel like they are being twisted and pulling my shoulders out of place.” Each of these patient accounts has a sensation and gives the impression of a process.

Accompanying this process is a framework of reference, based on conscious and unconscious extrapolations of possible etiologies and outcomes. The account of “reality” is the result of our personal experiences, which we make sense of by placing it in a conceptual framework. Further experiences continue to reinforce and confirm this framework, until, maybe one day something unexplained forces us out of this loop and causes us to question our assumptions.

The ”subjective” dimension is based on suppositions because what we perceive is woven out of the fabric of our reference points that determine how we interpret our experiences. How though does this extrapolated, unconscious, knowledge about one’s own health fare in the doctor’s office. We’ll look at this in my next post.