St. Mary’s Hospital

Montreal Quebec

St. Mary's Research Seminar Series

February 19th 2013

Richard Hovey, PhD Division of Oral Health and Society

McGill University

Researching patient experience: an

interpretation of an interpretation

Language and narrative constitute the fabric of everyday

life because we live our lives though narratives and

stories.

Research / Scholarship

Conversation

Interviews

Data collection

Interpretation

Rigor and Transferability

Transformational Learning

Philosophical hermeneutics

Philosophy is NOT, as one often hears,

the professional art of splitting hairs, the

search for artificial precise

definition’s—one who attempts to

philosophize must first of all have an

attentive ear for the language in which

the thinking experiences of many

generations has been sedimented, long

before we begin to attempt our own

thinking. (Gadamer,1989, p.181)

Experience, Research and Writing

“Experience is initially always the

experience of negation: something

is not what we supposed it to

be”(Gadamer 1989, p. 354).

“Clean and reasonable

scholarship about messy,

unreasonable experiences [is] an

exercise in alienation” (Tamas, 2009, p.16)

“Language and thinking about

experience are bound together.”

(Gadamer, 1989, p. 417)

“Experiences of exceptional joy or of

grief share intricacies that evade easy

linguistic expression but are not

beyond words. Profound experiences

only assumes significance once

brought into language spoken or

thought (Davey, 2006, p.49).”

Researching human experience

interpretation of interpretation

6

Hermeneutics, is an activity

carried out in the name of its founding

spirit, Hermes: Messenger of gods,

guardian of thresholds, and carrier of

cryptic codes.

Different meanings

Tricksters and messengers

All / most cultures

Philosophical Hermeneutic…

…inquiry is the tradition, theory and practice of interpretation

it is a reflective, dialogic inquiry, concerned with understanding the lifeworld and the various forms in which understanding is manifested.

Gadamer’s dialogical philosophical

hermeneutics

… unite the experience of

one subject with that of the

others.

The researcher is working

toward understanding the

experience of the individual

within the context of a

community of experiences.

The meaning of living with chronic illness

“Richard, in the five years that I had osteoporosis,

experienced fractures, many-many trips to

doctors, hospitals and at last here at the Grace

Osteoporosis Centre, you are the first person who

has asked me how it feels to have osteoporosis.”

Hermeneutic research…

“… understanding is not

something that takes place at

the end of humanistic

research about an object, it

stands at the beginning and

governs the whole

process of questioning,

step by step”.

(Gadamer, 2001, p. 50)

Annie…

My three-year-old looked at

me one day, about four

months after my daughter

died.

He said, mommy, did the

doctors hurt Annie?

You think about what was

going on in his mind.

And I said, Well, it’s more

like she was falling and

nobody tried to catch her.

Hermeneutics…

…allows us, with the help of

others, to make sense of the

particulars of these contexts and

arrive at deeper understandings

and the meaning of health /

illness, medical-patient education

/ practice within a certain context.

Humanizing medical error

Yes, I’ll tell you about it [a patient

experience], but I have to tell you

that whenever I discuss this…

...the way my son explained it to me

was that it is very much like putting

your hand into a pocket full of razor

blades.

It is very painful and people don’t

necessarily see the little small cuts.

But I feel it’s very important that I

speak out about my experience. My

mother died as a result of medical

error, and actually a series of

medical errors.

Articulating a new experience

Experience itself seeks and finds

words to express it. We seek the

right word—i.e. the word that

really belongs to the thing (or

experience) so that the thing

comes into language. (Gadamer, 1989, p. 417)

Trauma and Metaphor

“Yes, you know

undoubtedly when you are

first diagnosed it is

traumatic. Have you ever

seen the movie Snow

White and the Seven

Dwarves? Remember

when the Queen diverted

into the witch, she looked

exactly how it feels.”

Philosophical Hermeneutics…

… offers the opportunity

to conduct thoughtful,

effective, skillful and

humane practice in

contexts where

prescription and assumed

practices do not

adequately satisfy the

complexity of such

practices.

Conversation…

“One of my first experiences, we always wore

these little Topees (sun hats) in India for the sun.

And when you go through the Red Sea on your last

trip home from India, it is chucked over into the

water. I was just devastated because I had never

ever been allowed anywhere without it. My Mother

chucked it overboard as that is what you did on

your last return trip from India to England.

The topi continued

Of course my topi was my friend so that was

adaptation for you as a child. And of course I did not

have my parents for a year when I was with my

grandparents. I think people have very restricted

stable lives in one place and not much change and

they do not have to deal with change. But you look

at my life and it is constant change.

I guess I have just had to adapt to it and I don’t

know how you teach that, because some people

find change very threatening.”

Loss

“Loss is a cavernous, empty place,

filled with pain and longing for

something that can’t be restored. It

defines you in particular ways that

nothing else does. You begin to

know the journey, dreaded and

unannounced, sometimes too well,

the sickening sense of being

abandoned, the dread when you

remember after you have briefly

forgotten, the sense of something

missing that never really leaves, and

the sadness, and the waste of

someone’s life unlived.”

References

Davey, N. (2006). Unquiet understanding: Gadamer’s philosophical hermeneutics. Al- bany, NY: State University of New York Press.

Dreyfus, H. L. (1991). Being-in-the-world: A commentary on Heidegger’s being and time. Cambridge, MA: Division I. MIT Press.

Frank, A. W. (2009). Tricksters and truth tellers: Narrating illness in an age of authenticity and

appropriation. Literature and Medicine, 28(2), 185-199.

Gadamer, H. G. (2001). Gadamer in Conversation: Reflections and commentary. (R. E. Palmer,

Ed. & Trans. New Haven: Yale University Press.

Gadamer, HG (1992). HGG- on Education, poetry and history: applied hermeneutics. State Univ

of New York Pr.

Gadamer, H. G. (1989). Truth and method (2nd rev. ed.). (J. Weinsheimer & D. G. Mar- shal,

Trans.). New York: Continuum. (Origi- nal work published 1975).

Gadamer, H. G. (1996). The enigma of health: The art of healing in a scientific Age. (J. Gaiger &

N. Walker, Trans.). Palo Alto, CA: Stanford University Press.

Hovey, R., & Craig, R. (2011). Understanding the relational aspects of learning with, from, and about the other. Nursing Philosophy, 12(4), 262-270.

21

References

Hovey, R., & Massfeller, H. (2012- In press). Exploring the relational aspects of patient and

doctor communication. Journal of Medicine and the Person.

Hovey, R., Cuthbertson, K., Birnie K., Thomas, B. C., Robinson, J., Massfeller, H.,

Ruether, J. D., & Scott, C. (2012). The Influence of Distress on Knowledge Transfer for

Men Newly Diagnosed with Prostate Cancer. Journal of Cancer Education. (DOI)

10.1007/s13187-012-0343-2.

Hovey, R., & Craig, R. (2012). Learning to live with osteoporosis: a metaphoric narrative.

Journal of Applied Hermeneutics. Article 3.

Hovey, R., Dvorak, M., Hatlie, M., Burton, T., Padilla, J., Worsham, S., & Morck, A. (2011) Patient safety: A consumer's perspective. Qualitative Health Research, 21(5), 662-672.

Kearney, R. (2011). What is diacritical her-meneutics? Journal of Applied Hermeneutics. Article 1.

Ricoeur, P. (1998). Hermeneutics and the human sciences: Essays on language, actions and interpretation (J.B. Thompson, Trans.). Cambridge: Cambridge University Press

Tamas, S. (2009). Writing and righting trauma: Troubling the autoethnographic voice. Forum Qualitative Sozialforschung/Forum: Qualitative Social Research, 10(1) Article 22.

22