Panoramic Vision and Simultaneous Perspectives for Decision-Making in General Medicine and Epidemiology

The perception of conflicts and the challenges that social reality is facing is not only a magnificent way of gaining an understanding of our environment, but it is also an excellent way of anticipating the challenges we must face and anticipating the consequences. Only in this way can we evaluate the basic epidemiological conditions, risks and capacities of individuals or groups, in order to define correct strategies in the medium and long term. We normally view data and their interpretation (clinical symptoms and signs; epidemiological data such as the distribution, frequency, magnitude, and determinants of existing diseases in defined human populations) from only one perspective, our own. But there is a “panoramic view” that allows the individual to get a better understanding of what he is looking at. From a single perspective there are always parts of an object that are hidden or obscure: the vision of a forest or the mind of a person need panoramic views to get to know them better and avoid distortions and illusions inherent in a single perspective. In addition, the “panoramic vision” is useful for human relations. Is there something that requires a better understanding of human contexts than the way we communicate and interact? Thus, it is appreciated that things are not what they appear to be from a single point of view, and that what appears to an indisputable actor in a given scenario for an observer is different for another.

The individual, the group, the family, the “sick” community, seen from a panoramic point of view, can appear as an admirable, intricate, beautiful unit of process. What we normally perceive as conflict, contradiction, dissociation, risk, problem, etc., can then be perceived as inevitable, necessary and even adequate. That is, if said person, group, family, community can be fully understood, everything finds its proper place and can be perceived. All conflicts and ruptures turn out to have a meaning and explanation. Even the concepts of disease and health can merge and blur their contours, when we consider the symptom as a pressure towards health, or we consider neurosis or dysfunction as the healthiest possible solution for the moment to the problems of the individual or the family and their context. The panoramic vision contextualizes clinical and epidemiological work: it is like the process of opening doors and windows for the professional and for the patient/community, and seeing how light illuminates environments and relationships, clarifying the understanding of a situation or problem [1,2]. In this way, general medicine and epidemiology could be illustrated with the jazz metaphor [3-5]. Jazz seeks volume of sound, volume of phrase. Classical music was based on planes (not volumes) arranged in layers, built one on top of the other; horizontal and vertical planes, which created an architecture of noble proportions: palaces with terraces, colonnades, monumental stairways, receding into deep perspective. In jazz all these elements are brought to the fore [6].

Another example is what happens in cubist paintings: It is a characteristic of both cubism as well as general medicine and epidemiology, to convert a part into a whole, to produce an absolute reality from a fragmented reality. Cubists artists, such as general practitioners and epidemiologists focus on translating a complex individual/community reality, and on expressing the factors of the environment that are above the outer appearance [5, 7, 8]. But, not only the cubists, but certain classical artists also enlighten us on the concept of panoramic vision: didn’t Dürer and Leonardo da Vinci make a deliberate simultaneous use of various perspectives and points of view when it suited their purposes? El Greco gives the example of an artist’s perspective, leaping violently back and forth, fixing on the same canvas details of a city, seen not only from various exterior points, but also from various streets, alleyways and squares; and the complexity of their vision also includes various allegories: the Tagus River, the Virgin and San Ildefonso, and the situation of the Hospital de Tavera, appearing on a cloud, in explicit reference to the administrator of the building, a friend of the painter and probably author of the commission for the work [9].

The analysis of what is the process by which diagnoses or epidemiological assessments are made, was initially aimed at describing the reasoning of the expert physician, and later has been influenced by statistical models [10, 11]. But, every disease is a story that involves the person’s body, community context, and it occurs at a time and in a place, with unique characteristics in the patient, the doctor and other relevant actors in each case. With all these subjective and objective data, clinical and epidemiological decisions are made. The information will be true if it is useful in its context; whether it makes sense or significance in our patient and community. This panoramic contextualization of simultaneous perspectives makes the subjective data become objective in this situation. Clinical-epidemiological reasoning includes assigning certain weights to information from various sources. Facts not only have true value, but have importance, significance, or relevance. Trivial information fails to be significant even if it is a true value of an objective measure. Therefore, in the clinical and epidemiological method we need to increase not the mathematical objectivity, but the relevance of the data, and the path is the panoramic view.

None.

No Conflict of interest.

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