The intersubjective and the intrasubjective in the patient physician dyad: implications for medical humanities education.

At the heart of medicine is the patient, and the fundamental relationship in medicine is the patient-physician dyad. Smith's argument for the intersubjective creation of knowledge, which is itself indebted to Bakhtin's notion of the utterance and of the necessity of "the other" in the development of meaning, enables an exploration of the creation of meaning during the patient-physician encounter. The analysis is enriched by Haraway's concepts of partial perspectives and of dispersion, which expose the many roles and voices in which the physician and patient may interact. This approach emphasises the use of the medical humanities as a tool to teach medical students about the ambiguities of clinical practice, in which there is often no "right answer" except what is appropriate for the individual patient.