Leman's Lexicon

Sonoporation: The application of high frequency ultrasound to living cells in order to facilitate the injection into the cells of materials such as genes or drug molecules. The aim is to develop a relatively non-invasive method for gene therapy and drug therapy of various conditions (such as tumors). It is like firing a beneficial bullet right into diseased region while limiting toxicity for surrounding non-diseased tissues. Early days yet for this technology.

Fancy drug delivery
Would benefit you and me
Far better that a tumor die
Than either you or I.

Synesthesia: A neurological condition in which an object or concept perceived by one sense is accompanied by a perception in a different sense or in which a perception manifests as an additional perception in the same sense.

For example, a synesthete might contend that colors possess musical tones or that a letter is always a certain color.

An aria’s the loveliest thing that I have ever seen
And when I go aswimming the water tastes like green
And though you may say tis only in my head
I always think of Wednesday as being darkest red

Deontology: A philosophical school of thought that holds that behavior should be duty-based. Indeed, the word deontology basically means the study or science of duty. It emphasizes issues of moral obligations and rights.

So why does this matter in healthcare? Because it can lead to ethical dilemmas. Say a medical provider’s recommendation is based on her feeling that she has a moral obligation to treat a patient in a certain way. But what if her patient has a teleological worldview in which her fate has been predetermined by a higher being and feels that aggressive treatment may not be appropriate? An example would be the issue of cancer during pregnancy and whether abortion might be considered in order to save the life of the mother.

Conflict can also arise between medical providers who insist on the importance of deontological/principle-based ethics with those who argue from a utilitarian standpoint (e.g., health economists) when it comes to cost effectiveness. The deontologist would argue for the autonomy of the medical provider to determine a course of treatment based on the immediate good that would be rendered the patient. The utilitarian would take a broader view of the societal and economic implications of such matters.

A deontologist ne'er hesitates
To do what duty obligates.

Teleology: the belief that a phenomenon has been designed with a particular end in mind. Generally, this is associated with a religious/theological/metaphysical orientation, though there is a school of evolutionary biology that argues for a greater design, just not one necessarily imposed by God or a God-like being.

So how does any of this come into play in healthcare?

Imagine a patient from a background governed by a teleological worldview in which God has determined that patient’s fate and the course his or illness is going to take.

Now suppose that the patient is being treated by a healthcare provider who has been educated in a framework dominated by deontology (which argues that actions should be based on rules, duties or obligations).

Result: tension, frustration, and lack of comprehension on both sides. Medical and nursing ethics, for instance, often revolve around such issues.

All’s decreed by God divine
And determined by design
God is good; God is great
He alone decides my fate.

Semiotics: the study of signs and symbols. The term is commonly used in the fields of philosophy and linguistics. And what do we mean by signs and symbols? Well, they can include such things as words, images, and behaviors.

The research methodologies used in semiotics can include such things as linguistic, visual, and content analysis. Example: what an abused child’s drawings suggest to a child psychologist about what the child has been subjected to.

So why do we in healthcare need to know about semiotics? Because narrative approaches like semiotics (hermeneutics is another) are one way for healthcare providers (say those in mental health) and patients to make sense of feelings such as bereavement or trauma as reflected in recurring dreams or visions on the patient’s part or as expressed in narratives or art work produced by the patient.

The meaning of a sign is what
The scholars say is so.
Because they know they're awfully smart
They really ought to know.

Heuristics: Heuristic reasoning is the process of arriving at judgments and decisions in a sort of gut instinct/common sense fashion. Relying on common sense saves a lot of time when making decisions, but it can be problematic if important information has not been factored into the decision making process and bias leads to errors.

For example, assuming that someone has been bitten by a snake and treating that person for snakebite is all very well if that person has indeed been bitten by a snake that is indeed poisonous. But if the person has not, the consequences for patient and doctor can be less than desirable.

Thus, healthcare providers periodically examine how they are making decisions.

And public health policymakers and health educators have to think about how they craft public education on preventive health matters (e.g., safer sex practices, breast cancer screenings) by keeping in mind how various patient groups process information and act on it. Human beings, alas, tend to be somewhat irrational and unpredictable creatures who don’t always act in their own best interests.

It has generally been found
That all judgments that are sound
Are based in part on common sense,
But always backed by evidence.

Epistemology: The study of the nature of knowledge. That is, “How do we know we know that?” or “What is it that we think we know?” As you can see, it’s an arcane field of study and keeps philosophers pretty busy. They spend enormous amounts of time telling us that we may not really know something, that we only feel it to be true but don’t really know for sure.

So what does any of this have to do with healthcare and medicine? Well, think about the calls for evidence-based medicine and comparative effectiveness research. Both of those are predicated on the assumption that there may be one true answer, or at least an option that is clearly superior to the alternatives. Example: This drug will cure your illness and is cheap to boot. Case closed.

But what if there is doubt about the soundness of the methodology used to reach a certain conclusion? That is, how does one truly know when something has been proven? Here’s when the policymakers, insurers, activists and providers put on their epistemological hats and wrangle about whether we really know that the treatment works, whether insurers should cover it, and whether it will truly benefit patients.

Knowledge is a mental state
And personal spins of fact
Which means that I can think all day
And never have to act

Shared Decision Making: How involved is your patient in the management of her own health? Are you providing enough information so that she can make informed decisions about treatment options? Does she even want you to be actively involved or would she prefer to leave that pretty much to you? Shared decision making is a model of patient-provider communication in which providers encourage patients to play a role by providing with them enough understandable information for the patient to become an active player in her own treatment.Somewhat more provider-focused than Participatory Medicine.

Now, that seems pretty straightforward. But it can get pretty complicated and tense all round if there are second language problems between the provider and the patient or if there are health literacy issues or cultural/socioeconomic legacies of distrust between the backgrounds of provider and patient. And occasionally there is reluctance on the part of some providers to surrender the traditional prerogatives and status of the professional that prevailed before the “everybody is now an expert” Internet age.

Wouldn’t it be simply great
If I could just participate
Get the very best of care
And treated like I was really there.

Hermeneutics: Want to understand what patients are feeling before surgery or about an ongoing treatment for chronic illness? Hermeneutics might come in handy.

Hermeneutics is the interpretation of texts, such as biblical texts, laws, literary works such as poems, and accounts of dreams. It is a methodology used in such fields as literary studies, theology, and philosophy.

In healthcare, you can make a sort of methodological mash-up of phenomenology and hermeneutics: phenomenological hermeneutics. That is, you could study the lived experience and perceptions of patients or other subjects (e.g., family caregivers). That would be the phenomenology part. And source material could be data collected by interviews, surveys, diary entries by subjects that they provide to the researchers, etc. These would be examples of the texts that would constitute the hermeneutical aspect of the study.

The use of such methodologies as hermeneutics enables researchers to study the subjective perceptions of patients (e.g., feelings of hopelessness in the face of dire diagnoses such as AIDS or amyotrophic lateral sclerosis). Ideally, the study of texts produced by patients themselves will endow healthcare providers with a keener understanding of the fears and feelings of patients, thereby resulting in ever more compassionate, empathetic behavior by such providers.

Hermeneutics are just the thing
For understanding suffering
Ensuring those providing care
Address depression and despair

Phenomenology: Need to understand how people perceive the world around them and how such perceptions can lead to isolation and dysfunction or happiness and fulfillment? Then think like a phenomenologist.

Phenomenology is the study of consciousness and awareness of experience. It is a field of philosophy and psychology that examines how we perceive and experience phenomena (e.g., ourselves, the world, others, time), how those perceptions are manifested by us in memories, emotions, desires and forms of expressions and, for those unfortunate enough to be mentally ill, in the experiential dimensions of psychopathology. In the land of family life and the melodramas of adolescence, think of how your teenager might perceive a situation as catastrophic that you regard it as insignificant.

In the health sciences as a research method and treatment approach phenomenology can, for example, provide insights into the cognitive processes of people with autism spectrum disorders, obsessive-compulsive spectrum disorders, attention-deficit/hyperactivity disorder, and so on and thereby facilitate the development of treatments that address the particular fears and modes of perceptions of such populations.

Phenomenology’s major revelation:
We need objects of contemplation
For you can’t do thinking of any kind
With nothing particular on your mind.