Out of Hours Between ‘thisness’ and quiddity: the place of the GP

The role of the GP is to apply their knowledge before you, as opposed to the quiddity, but ADDRESS FOR CORRESPONDENCE of medicine, science, the arts, to an individual they are poor categories. By poor categories Gervase Vernon patient in front of them. Two philosophical I mean they do not take you very far in John Tasker House, 56 New Street, Dunmow, concepts from the 13th century can help describing the particular person in front of Essex, CM6 1BH, UK. us here. ‘Thisness,’ ‘haecceity’ is the you and therefore in deciding whether that E-mail: [email protected] characteristics of the being that make it that particular treatment will suit him. We need particular being. The thisness of my dog lies a richer picture of the individual human in the way she wags her tail, prefers ball being. I have written earlier of the numerous grasp the thisness of the person in front of games even to food, twitches her nose; all and conflicting meta-narratives with which us we need both intellectual and emotional the things that make her just herself and post-modern man may seek simultaneously empathy. Intellectual empathy means not another dog. All things have thisness, to understand the world.3 It is certainly understanding their situation from their point of view. Emotional empathy means not just people and dogs. A rock will have an worth becoming aware of these by listening feeling the emotions they feel. In the jargon individual essence which makes it just this carefully to the patient: by eliciting their of psychoanalysis this is called counter- rock and not another one. The 13th century thoughts, beliefs, and expectations as we philosopher Duns Scotus1 popularised the transference. In everyday practice it simply tell our trainees. However the privileged notion of haecceity, adapting it from Aristotle, means that I become aware that I am feeling way to access the thisness of a patient and he has had many admirers down the anxious or angry or depressed and realising is by dialogue; together we can struggle centuries, including the German philosopher that this is a clue to what the patient is to work out if the proposed treatment is Martin Heidegger (who in 1915 wrote his feeling. Love is not love that is empathy a suitable treatment for this patient. Our habilitation thesis on the philosophy of Duns alone, it must lead to action, but action now thisness does not lie in the mind alone Scotus.) But it was the Victorian poet and attuned to the world of our patient rather but in our social role and in our body. Can Jesuit, Gerard Manley Hopkins, who coined than our own. ‘thisness’ as an English word meaning this person open this pill-bottle; can he To summarise the role of the GP is haecceity. He memorably uses the concept read or remember instructions, what are to apply his knowledge, which relates to in his poem As Kingfishers Catch Fire: his pharmacogenetics? This dialogue is humankind in general, its quiddity, to the clearly an iterative process; when we talk to individual before him in all his glorious ‘ ... Each mortal thing does one thing and the patient we move between quiddity and thisness and eccentricity. This is a very the same: thisness, the general and the particular, until general description of which I have only ... myself it speaks and spells, we agree on a best course of action. sketched some consequences here. Crying What I do is me: for that I came ...’2 Interestingly, in designing treatments, However it means that we have a job that modern Western medicine starts from is unique and irreplaceable. The more our Quiddity is in some ways the opposite. quiddity whereas traditional therapeutic scientific knowledge increases the more this This is those characteristics a dog shares systems start from thisness; they consider role will be needed. At a time when some with other dogs that make it a dog, a table what is individual about the patient and GPs feel disorientated, this role is something with other tables that make it a table. Now base their treatment choice on this. For clearly needed which we are good at and science studies precisely this, the things example, according to Michel Foucault, the can be proud of. Of course GPs do many we share in common so that a treatment medieval Western physician would design other things; running practices, rationing that works for one man may work for all. his treatment starting from the health the health service and so on. But we should As GPs we take a treatment that works beliefs of his client.4 not be seduced into making these more in general and see if it is appropriate in a The motto of the Royal College of General important than what I see as our prime and particular person. Evidence-based medicine Practitioners is Cum scientia caritas. irreplaceable role; interpreting quiddity to acknowledges this when it says that you Scientia, in this context means knowledge, thisness. should consider whether the patient in front knowledge about the general properties of of you is like the patients in the trial; in things, their quiddity. Caritas simply means Gervase Vernon, terms of age, sex, and place of care (that is love. Love implies not only grasping the GP Principal, John Tasker House, Dunmow. hospital or primary care). These categories thisness of the person in front of us, but DOI: 10.3399/bjgp13X669284 do belong to the thisness of the patient choosing to act in a way that respects this. To

REFERENCES 1. Bates T. Duns Scoutus and the problem of universals. London: Continuum, 2010. “The thisness of my dog lies in the way she wags her 2. Hopkins G. Poems and prose of Gerard Manley tail, prefers ball games even to food, twitches her Hopkins. London: Penguin Books, 1953. 3. Vernon G. What is man? Br J Gen Pract 2003; nose; all the things which make her just herself and 53(491): 504–505. not another dog.” 4. Foucault M. Naissance de la Clinique. Paris: Presses Universitaire de France, 1963.

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