title: Caring about the clinician who seems uncaring: the 'as if' approach.
abstract: This paper suggests how a patient may be able to give and receive the caring he/she wants with respect to a clinician whose (in)action he/she perceives to be uncaring. The approach suggested draws on the philosophy and psychology of framing and adopting Hans Vaihinger's 'as if' theory. I draw on my own experience as a patient to apply this approach that requires imagining and acting as if an apparently uncaring clinician is caring. This fiction need not be objectively true but nor is it necessarily false because the as if theory assumes that the only world anyone can know is one of appearances. At least when the lack of caring appears objectively minor and uncertain to the person feeling it, the caring fiction can be morally important, both for its own sake and for its utility to the patient, the clinician and the maintenance of their relationship. Lastly I discuss the strengths and limitations of the as if approach for clinical practice.
authors.affiliation: General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand.
authors.forename: Stephen
authors.initials: S
authors.lastname: Buetow
mesh_terms: D004645:Empathy; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D018802:Patient-Centered Care / Q000941:ethics / Q000379:methods*; D010817:Physician-Patient Relations
keywords: patient-centred care; person-centred medicine