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The arithmetic of gestalt

  • Stephanie D. VandenBerg (a1)

Extract

It has been said that we are the sum of all we have met. As a learner in the emergency department, I have a lot of meeting to do. Take Sandy, a 35-year-old single mother.

Her triage note reads that she came to the hospital after losing her breath bathing her 3-year-old daughter.

If you had read it.

If you had asked her, she would have told you that she’s been sweating through her clothing during the day, causing her colleagues in the university administrative office to stare awkwardly. She says no to your list of Pulmonary Embolism Rule-Out Criteria (PERC) criteria queries, uses a copper intrauterine device (IUD) as birth control (it was the cheapest option), and is healthy, as far as she knows.

If you had asked her.

If you had listened, she would have described a difficult social situation that had left her the sole provider for her young daughter. She walks the local drag once or twice a month, selling sex to whomever will buy as her current job does not pay enough to make rent every 30 days.

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References

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1. Wittenborn, D. Fierce people. New York: Bloomsbury; 2002.
2. Koffka, K. Principles of gestalt psychology. New York: Harcourt-Brace; 1935.
3. Klein, J. Five pitfalls in decisions about diagnosing and prescribing. BMJ 2005; 330:781–3, doi:10.1136/bmj.330.7494.781.
4. Cook, C. Is clinical gestalt good enough?. J Man Manip Ther 2009;17:6-7, doi:10.1179/106698109790818223.
5. Miles, RW. Fallacious reasoning and complexity as root causes of clinical inertia.. J Am Med Dir Assoc 2007;8:349–54, doi:10.1016/j.jamda.2007.05.003.
6. Bachmann, LM, Muhleisen, A, Bock, A, et al. Vignette studies of medical choice and judgement to study caregivers’ medical decision behaviour: systematic review.. BMC Med Res Methodol 2008;8:50, doi:10.1186/1471-2288-8-50.

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The arithmetic of gestalt

  • Stephanie D. VandenBerg (a1)

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