2. Learning Outcomes What is philosophy? How to understand an encounter with a patient or registrar. A philosophical perspective Why this works with the narrative based model. A realisation that this can improve your consultations and teaching.

3. “The unexamined life is not worth living.” Socrates

4. “As for me, all I know is that I know nothing” “Philosophy begins with wonder”

5. Modern ideas Philosophy is a way of thinking to advance an argument or idea using reason The Greeks Philosophy was to be lived

7. It is not a science, not wisdom or knowledge but a mediation around the available knowledge. It is about the wisdom of life, about popular intelligence.

8. How does the mind construct our knowledge of the objective world Immanuel Kant (1724-1804)

9. What is the mind?

10. Kant argues that: “We cannot learn philosophy, only learn how to philosophise.”

11. Philosophise!! After a consultation how do you know if it’s been a good one? If you were the patient If you were the doctor.

12. Understanding

13. Just because I don’t care, doesn’t mean I don’t understand! Homer Simpson.

14. Hans Georg Gadamer Philosopher, Born February 11 1900; Died March 14 2002 “Modern concepts of science are not adequate to understand people and our experience of art and even communication.”

15. “Truth and Method” Philosophical Hermeneutics Understanding and seeing things from some else’s perspective

17. How far can you see?

20. Understanding happens when our horizon is moved or changed. The old horizon becoming the new one. “Fusion of Horizons”

22. What factors affect understanding? The patient’s The registrar’s

23. Pre-understanding Prejudices Fore-meanings “Bildung” or openness to meaning Language Imagination

24. Bildung, Open to meaning Do you feel there are lots of possibilities for change / progress here? Imagination Do you have any ideas which might help? How do you think it would feel if this turned out to be some sort of cancer? Are you religious? How can this help Present Horizon Whole Partial Understanding Pre- Understanding What do you think is happening? What have you done to deserve this? What has made this happen? Have you looked on the internet? Prejudice Do you have previous knowledge about this? What did you think we would be doing today? Did you expect me to do anything in particular today? Fore meanings Chunk and checking. Let me get this right? After the examination: What do you think is going on here? Circle of Understanding Language Without language we cannot transmit meaning. Wittgenstein. The limits of my language mean the limits of my world.

25. Patient’s Understanding Narrative Doctor’s Understanding Normative Jerome Bruner. Psychologist John Launer. Uniqueness and Conformity

26. Video of teaching Discussion about patient centred medicine. First consultation was about a mainly clinical topic. Second video of a consultation with a patient who has cancer and almost certainly secondaries.

27. The best consultations involve careful listening, questioning and imaginative ideas taking them around the circle of understanding to alter horizons. An ability to see what is questionable in the encounter and combine this with our experience of science. Philosophy as a mediation of the truth.

28. “Understanding is not reconstruction but mediation”

29. “The unexamined life is not worth living.” Socrates

30. “The unexamined life is not worth living but a life too closely examined may not be lived at all!” George Elliot Saunton Sands 2008