The Challenge of Medical Dichotomies and the Congruent Physician–Patient Relationship in Medicine

Abstract

As Scott Fitzgerald remarked [1] “The test of a first-rate intelligence is the ability to hold two opposed ideas in mind at the same time and still retain the ability to function.” And we would add not just function but function more effectively. It is an important ability because from the subatomic foundations of physical existence to hypercomplex patterns of human behavior and social organization, life in this world is rife with dichotomies. There always seems to be two of everything, and the two are often mutually exclusive: light/dark, knowledge/ignorance, life/death, etc. Although dichotomies are endemic to every facet of our existence, we have never gotten comfortable with them. They are perturbations in the integrated flow of life, and discordant elements disrupting our sense of harmony and unity. We feel compelled to get past them, to resolve them. The easiest way of dealing with them is to ignore them or deny their existence. Second to this is collapsing them by choosing one element over the other. The physicist can choose whether he wishes to consider the wave-like properties of light or its particulate nature. He cannot simultaneously study both. He can choose to know the position of a particle or its momentum. He cannot simultaneously know both. Moderate dichotomies may be amenable to some level of integration. Do we want a liberal or a conservative government? We cannot have both, but we can have a conservative minority government modulated by the impact of liberal coalition partners.