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What is that’s going on here? A multidimensional time concept is foundational to framing for decision making in situations of uncertainty

Abstract

STEM disciplines are the dominant culture in K-12 education. With its study of organs and diseases that afflict patients’ bodies, Western evidence-based medicine is seen and understood in the modern cultural paradigm as a science and as the practice in which a subject, the doctor, acts on an object; the patient’s body—a dominant culture in the patient’s journey. However, with the continually evolving high-technological and medical knowledge, life-saving therapeutic options are life-changing. They can range from changes in the diet, requiring structural and cultural changes in family life, to changes related to the experiences of learning to live tethered to a machine that is partly inside and partly outside one’s body or with somebody else’s heart. In this article, we show how competing needs to personalize care for the patient as a person forcefully emerge in response to evidence-based medicine’s global cultural dominance. We highlight two fundamental issues emerging in decision-making processes: (1) Framing evidence-based knowledge, uncertainties of the course of the disease and options, and (2) working with different, equally important, and often at odds conceptions of time in the care for the Other. Through the longitudinal analysis of moment-to-moment interactions in high-tech medicine encounters of a patient, his family, and the team caring for them, we show how framing and different conceptions of time emerge as issues, are profoundly interconnected, and are addressed by participants to care for a patient confronting existential decisions.

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