Something in Nothing: Negative Space in the Clinician-Patient Relationship

Stephen A. Buetow

doi:10.1370/afm.914

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Comments on space
H. John Blossom

Published on: 26 January 2009
Problems with the words negative space
Marjan Kljakovic

Published on: 15 January 2009

Published on: (26 January 2009)
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Comments on space
H. John Blossom, Fresno
I enjoyed Stephen Buetow's article on Negative Space in the January issue of Annals of Family Medicine. In my Family Medicine article, "What the Shadow Knows" I describe some of the important points that Buetow makes. I think that one important conclusion to draw from his and my observations is that many teaching modalities are not constructed to allow observation of the ecology of the doctor patient interaction, includ...
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I enjoyed Stephen Buetow's article on Negative Space in the January issue of Annals of Family Medicine. In my Family Medicine article, "What the Shadow Knows" I describe some of the important points that Buetow makes. I think that one important conclusion to draw from his and my observations is that many teaching modalities are not constructed to allow observation of the ecology of the doctor patient interaction, including the aspects of negative (and positive) space that he so accurately describes.
I have often been surprised at what in-the-room observation sessions produce in regard to physician behavior as contrasted to traditional presentation/review of info/quick visit to see the patient sessions produce. One resident got well into his training before it was discovered that he stood throughout all visits with patients (as a sign of respect). Another put on surgical gloves before touching his patients! Neither of these unusual behaviors, clearly impacting space, would have been known without observation (either in room or video).
Dr. Buetow also discusses longitudinal space. Here I would like to share my experience with "letting" patients determine when they would like to return for their next visit. While the physician will have ideas about the medical timing of visits that need to be part of the discussion of return appointments, patients frequently have their own ideas. As a busy family physician, I was surprised (years ago) to learn that my patients were happy with more time between visits than I had assumed.
Thanks to Dr. Buetow for a most interesting approach to patient physician relationships.
John Blossom MD
1) Blossom HJ, “What the Shadow Knows.” Family Medicine, November-December, 2003, 35(10):742-4.
Competing interests: None declared
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Competing Interests: None declared.
Published on: (15 January 2009)
Page navigation anchor for Problems with the words negative space
Problems with the words negative space
Marjan Kljakovic, Canberra, Australia
Buetow is right to point out that more theoretical work is needed for us to understand and explain the nature of the GP consultation. Unfortunately Buetow’s concepts of negative physical space, negative communicative space, and negative longitudinal space are confusing rather than enabling. The problem is that Buetow does not address how the words 'negative' and 'space', and the phrase 'negative space' actually work in e...
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Buetow is right to point out that more theoretical work is needed for us to understand and explain the nature of the GP consultation. Unfortunately Buetow’s concepts of negative physical space, negative communicative space, and negative longitudinal space are confusing rather than enabling. The problem is that Buetow does not address how the words 'negative' and 'space', and the phrase 'negative space' actually work in explaining general practice consultations.
In my understanding, the word 'negative' has reference to a range of issues from a different direction in a number line, to the opposite of a positive entity, to a kind of moral connotation. The word 'space' also refers to a range of issues from a geographical location, a social milieu, or a dimension used in physics. The phrase 'negative space' is a phrase (I guess) borrowed from physics where they talk about other worlds in quantum mechanics. I am sure that the phrase is quite foreign to general practice consultations.
Perhaps Buetow is trying to revive interest in the conceptual work done on the consultation in the 1980s where researchers would observe consultations looking for pauses in sentences, silence, and the social distance between the patient and the GP. Pauses, silences, and social distance can each be measured (e.g. as in conversational linguistic analysis of consultations). Buetow's concepts cannot be measured and therefore we cannot see their impact on outcomes from consultations. Furthermore, clinicians are right not to notice “the importance of how what is not present gives depth, perspectives, and clues to the real meaning of social action in clinical encounters”. Buetow's theory does not explain how “what is not present” can have a causal role and therefore observable on patients’ outcomes from the consultation.
I applaud Buteow in reviving thought in a previously languishing area of general practice.
Competing interests: None declared
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Competing Interests: None declared.