Soft to know?

Gordon D. Hardacre

In response to Dr J.L. Reynolds’ excellent article “Hard to know. What is hard knowledge?” (Can Fam Physician 2007;53:385 [Eng], 389 [Fr]), I am given to believe that it is not just end-point medical knowledge itself that is dichotomously labeled (and overtly so) as “hard” or “soft.” It is also the process employed resulting in discovery of a given quantum of enlightenment that draws the inference of “hard” (nowadays the complimentary term) versus “soft” (a term of disparagement). Dr Reynolds thoughtfully refers to facts (today called hard but by the passage of time not infrequently discovered to be changeable, erroneous, or impermanent— therefore in reality soft) versus the “touchy-feely stuff,” currently denigrated as soft material but which, being rooted in “human beingness,” is often shown to be nature’s hardest, most lasting knowledge.

The rigidities of the scientific method being what they are, it is the exemplariness of the randomized placebo-controlled crossover trial, and, of course, only when encompassing a statistically-blessed large n, that merits the badge of “fact” or “hard.” Biological observations derived from merely human circumstances (such as occur daily over a practitioner’s lifetime) could not possibly, by today’s orthodoxy, merit such acclaim. You mean … What? … Such observations are not deemed worthy of being called evidence?

And therein lies, as Reynolds writes, the sadness—a profound sadness. But therein also lies, as his words imply, the very reason that we teach (read “demonstrate”) our trainees the behaviours (read “processes”) of inquisitiveness, imagination, and compassion, together with their inherent mores and values. Our careful recording of, and our learning from, such types of observation also constitute a science, in my opinion. Indeed, parts of this new science are beginning to adopt names, such as “narrative medicine.” A bright future can, in all possibility, hold as goals for the family physician an expansion of the accepted meaning of evidence and especially a rehabilitation of the meaning of “soft” (as in “knowledge”). Who better than we, given the kinds of persons we strive to be and to train, and given the situations we encounter daily, to reflect so?