There is one concept in medicine which is prominent, the symptom. The omnipresence of the symptom seems, however, not to be reflected by an equally prominent curiosity aimed at investigating this concept as a phenomenon. In classic, traditional or conventional medical diagnostics and treatment, the lack of distinction with respect to the symptom represents a minor problem. Faced with enigmatic conditions and their accompanying labels such as chronic fatigue syndrome, fibromyalgia, medically unexplained symptoms, and functional somatic syndromes, the contestation of (...) the symptom and its origin is immediate and obvious and calls for further exploration. Based on a description of the diagnostic framework encompassing medically unexplained conditions and a brief introduction to how such symptoms are managed both within and outside of the medical clinic, we argue on one hand how unexplained conditions invite us to reconsider and re-think the concept we call a “symptom” and on the other hand how the concept “symptom” is no longer an adequate and necessary fulcrum and must be enriched by socio-cultural, phenomenological and existential dimensions. Consequently, our main aim is to expand both our interpretative horizon and the linguistic repertoire in the face of those appearances we label medically unexplained symptoms. (shrink)

The Covid-19 pandemic is a tragedy for those who have been hard hit worldwide. At the same time, it is also a test of concepts and practices of what good care is and requires, and how quality of care can be accounted for. In this paper, we present our Care-Ethical Model of Quality Enquiry and apply it to the case of residential care for older people in the Netherlands during the Covid-19 pandemic. Instead of thinking about care in healthcare and (...) social welfare as a set of separate care acts, we think about care as a complex practice of relational caring, crossed by other practices. Instead of thinking about professional caregivers as functionaries obeying external rules, we think about them as practically wise professionals. Instead of thinking about developing external quality criteria and systems, we think about cultivating reflective quality awareness. Instead of abstracting from societal forces that make care possible but also limit it, we acknowledge them and find ways to deal with them. Based on these critical insights, the CEMQUE model can be helpful to describe, interrogate, evaluate, and improve existing care practices. It has four entries: the care receiver considered from their humanness, the caregiver considered from their solicitude, the care facility considered from its habitability and the societal, institutional and scholarly context considered from the perspective of the good life, justice and decency. The crux is enabling all these different entries with all their different aspects to be taken into account. In Corona times this turns out to be more crucial than ever. (shrink)

Forrester’s proposed seventh style of reasoning – thinking in cases – functions as an analogous, dyadic relationship that, whilst indebted philosophically to the logical reasoning and semiotics of Charles Peirce, is prone to creating feedback loops between induction and deduction, precluding novel abductive hypotheses from advancing medical knowledge. Reasoning with a Peircean triadic model opens up the contexts and methods of meaning-making and reasoning through medical cases, and the potent influence of their genre conventions, to intellectual critical scrutiny. Vitally, it (...) offers a third mode – abduction – that this article argues needs to be reintroduced into Forrester’s model of reasoning with cases. This article demonstrates this by applying a Peircean triadic model of reasoning to Forrester’s own model, tracing a shared genealogy but one in which the abductive element was lost. The article goes on to illustrate the explanatory and predictive potential of Peircean abductive reasoning and the necessary re-theorising of the case this entails. This argument is supported through an analysis of early case reports of what would become HIV/Aids, drawn from the Case Records of Massachusetts General Hospital series in the New England Journal of Medicine. (shrink)