Being objective about subjectivity can be a challenge

June 10, 2014

Some healthcare professionals have to make “professional discretion” decisions based on the patient’s subjective opinion. Pharmacists need to be objective about subjective pain that patients express.

Steve AriensSo many elements of our daily lives are individually subjective experiences, events that are nearly invisible to our consciousness. I’m talking about states of being such as hunger, fatigue, and thirst, and sensory inputs from our organs of sight and sound, to name a few.

According to Wikipedia, “subjectivity” is the condition of being a subject: i.e., the quality of possessing perspectives, experiences, feelings, beliefs, desires, and/or power.

Subjectivity is used as an explanation for what influences and informs our judgments about truth or reality. It is the collection of perceptions, experiences, expectations, personal or cultural understanding, and beliefs specific to a particular person.

It is often used in contrast to the term “objectivity,” which is described as a view of truth or reality that is free of any individual’s influence.

Relying on subjectivity

As pharmacists, we depend on objective measurements (lab tests, blood pressure test, etc.) to make a judgment call - a recommendation, normally referred to as “professional discretion.”

Some healthcare professionals have to make determinations of “professional discretion” on the basis of the patient’s subjective opinion.

Just imagine an optometrist determining the correct parameters for your prescription eyeglasses without asking you, “Is the first or second view better?”

Imagine an audiologist determining the proper setting for a patient’s hearing aid without asking, “Can you hear something now?”

 

The legislated life

Some bureaucrats such as former New York Mayor Bloomberg have tried to help improve our health by putting limits on what we can buy or eat. Consider limiting soda drinks to 16 oz. or less, taking salt shakers out of restaurants, taking soda/candy machines out of schools and other public places, and other really nonsensical regulations.

As we move toward a single-payer national health insurance, it is not beyond the realm of possibility that some well-meaning bureaucrat will decide that, in order to lower our national health bill, each of us has to reach our “ideal weight” - or at least that bureaucrat’s definition of our “ideal weight.”

Suppose that to reach that goal, it is dictated that anyone above his or her ideal weight will be mandated to participate in a portion-controlled food program, such as Nutrisystem or Jenny Craig. Limits might also be placed on your beverage choices, so that you can consume only a stipulated amount of no-calorie or low-calorie drinks daily.

How can they know?

I know you’re saying that they can’t do that. I remember the favorite saying of the professor in my logic class: “Never say never and never say always, because someone will always prove you wrong.”

So now you are thinking, how does someone else know how hungry I am,  how thirsty I am, or what I am supposed to do? If I exert myself doing some yard work or exercise, I will burn more calories, I will get hungry, I will sweat, and I will need more liquids to compensate for that.

You think to yourself, how can these bureaucrats know how hungry or thirsty I am on any given day or at any point during the day?

No one knows or can determine how hungry or thirsty I am. Only I know that. That is a subjective decision. Only I can make that call/decision!

 

Too much medication? Really?

Now back to the pharmacy. The next time you have a patient on the phone or at the register who has chronic pain and the thought goes through your head that “This person can’t be in that much pain” or “He can’t need that much medication,” is that your professional discretion talking, based on facts, or is it a decision based on your personal biases?

Really, how are you able to come to that conclusion about something so subjective?

Steve Ariens is a pharmacist, pharmacy advocate, blogger, and National Public Relations Director for The Pharmacy Alliance (www.thepharmacyalliance.com). E-mail him at steve@steveariens.com.