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Defining attention

care health soundness attention well-being oversight healthcare

In the previous section we established a "problem-oriented" view of healthcare by defining a patient as one who suffers a health problem, which in turn we defined as the actual or potential loss of soundness. We are now ready to investigate what it means to care for a health problem. In reviewing the list of definitions for care introduced earlier (Tables 1 & 2), the definition that seems to be called for by a health problem is noun definition 5a.

care 5a: close attention; painstaking application


Attention * is the ability to concentrate (to center or focus) mentally upon a particular object, in this situation a given health problem of a particular patient. This noun is derived from the verb to attend, which literally means to stretch toward from the ancient root [ten-] * to stretch. From the same root, we get the English words tense, tension, tenable, tenure, distend, extend and intend. Metaphorically, attention is similar to sentience (reaching mentally across a distance between subject and object) except that with attention the connection between subject and object connotes increased selectivity and perhaps greater intensity.

In cognitive psychology, research on attention has been focused on visual and auditory perception, and on the central aspects of cognition such as memory formation, pattern recognition and problem solving. In both cases, however, it appears that the aspects of selectivity and intensity are important. In terms of selectivity, attention seems to act as a kind of gate, allowing in some things while excluding most others. In terms of intensity, attention seems to be a kind of (limited) resource that must be allocated among competing tasks or sensory inputs. The word intensity, it should be noted, comes from the same root as that of attention. The phrase "close attention" is therefore nearly redundant, but closeness here may simply imply greater than usual intensity.

The word selectivity * comes from two different roots, [s(w)e-] *, a reflexive pronoun referring back to the subject of the sentence, itself (also self, secret), and [leg-] *, to gather, to choose (also collect, elect). Selectivity is a crucial aspect of attention. In paying attention, the subject is choosing for itself what features of the objective world it will make subjective.* There is a balance, therefore, between objectivity and subjectivity. It is the objective world that is observed or attended to, but the selectivity of attention introduces subjectivity. In fact, the word observe comes from the Indo-European root [ser-] *, to keep, to protect (also preserve). The act of observing thus "keeps" selected stimuli while unobserved stimuli are lost.

To tend, to attend to

Close attention is one definition of care. By the same token, one definition of the verbs to attend and to tend is to care for. Both verbs may be either transitive or intransitive, but to attend to as in giving attention to is an intransitive verb, as is care, requiring an indirect object. [He attended to one problem at a time.] On the other hand, tend is more typically transitive, taking a direct object. [He tended the garden.] Thus to tend implies a more direct connection between subject and object than to attend or to care, although tend can be intransitive as well. [Please tend to the task at hand.]

As an aside, we may note that the verb to tend has a whole other set of meanings related to care in an off-hand way. To tend can mean to lean toward, be inclined toward, to intend or to have a tendency. [I don't care much for apple; I tend toward peach myself.] The common denominator here is the aspect of selectivity: to prefer or to choose. The antonym of the first set of meanings is to neglect, the negation of to select. It should be acknowledged, however, that the verb to tend has a slightly different flavor from the noun attention and may be more closely related to definition 5b of care:

care 5b: up keep; maintenance

To give attention to (to attend to) a problem implies the selectivity and intensity of this very moment, while to tend an object (a person or a garden, for example) connotes a more long-term relationship, as in up keep or ongoing maintenance. We will study this aspect of care in more detail later (Defining oversight). For now, however, we simply note that the root [ten-] of the word maintenance * is the same as that of attention, but more in the sense of to hold, to keep (sustain), than to stretch.


After close attention, the second synonym for care in definition 5a, is painstaking application. Application * itself has a variety of definitions including the act of applying, putting to special use, a specific use, being usable or relevant, close attention, diligence. The verb to apply * literally means to fold toward from [plek-] *, to fold (also comply, to fold together and complex). This verb is often ditransitive, taking both a direct and an indirect object. [The artist next applied glue to the paper.] The metaphor is of the direct object (glue) being "folded toward" the indirect object (paper). In the case of healthcare, the direct object is some kind of knowledge that is applied (folded toward) a particular health problem.

We saw above that attention typically involves selectivity and intensity. By analogy, we might say that application involves specificity and diligence. It is not just any direct object that is applied to the indirect object. It is not knowledge in general that is usually applied to a health problem, for example, but rather knowledge specific to that particular problem. Thus, there is a sense of being fitting or especially useful. One picture that comes to mind is "folding" point A to point A', point B to point B' and so on. Paradoxically, a synonym of specific * is the word explicit *, which literally means to unfold.

Painstaking * is defined as requiring great pains; careful and diligent. Thus painstaking application perhaps requires diligence beyond that implied by application itself. Although diligence is marked by persevering, painstaking effort, this word stems from the root [leg-] *, to choose. The original meaning of diligence is loving, from to choose apart, to single out.

Defining provider

We are now ready to begin naming the "sentient subject" in the healthcare relationship. Since one definition of care is close attention (to attend to), as described above, we might call the person giving care the attendant. [The attendant cares for the health of the patient.] Closely related is the word attending * or attending physician. [The attending cares for the health of the patient.] For our purposes, however, attendant is probably too general and attending much too narrow.

A more inclusive word would be clinician, which happens to have an interesting etymology in its own right. In our investigation of inclination (Defining care), we looked at the root [klei] *, to lean. From the same root comes the Greek word for bed or couch (as in reclining) and from this the word clinic. From the Greek, then, the clinical setting is one in which the patient is lying on a bed or couch, and a clinician is one who cares for the patient directly in the clinical setting. Much of healthcare, however, takes place outside the clinical setting, and perhaps clinician is still too narrow.

Another approach might be to use an encompassing word like professional and limit its scope with the adjective healthcare. [The healthcare professional cares for the health of the patient.] But professional * may still be a bit too narrow for our purposes, implying as it does that healthcare is an occupation or career. It often is, certainly, but it need not be. In a similar vein, we might use another two-word phrase, healthcare provider. Not only is this phrase commonly used in present day parlance, it turns out to carry important semantic implications.

A provider, of course, is one who provides. The -er * suffix simply creates a noun (more specifically, a subject: one that performs the action specified) from the verb to provide. This verb consists of two morphemes: pro-, meaning forward, and the prehistoric root [wied-] *, to see, the source of view and vision, for example. To provide, therefore, not only means to furnish or supply, as in the present day definition, but it also connotes exercising foresight by making preparations.

And what is it that the healthcare provider provides? What the patient is usually seeking from the provider is health, but health is a condition to be restored, not a commodity to be dispensed or acquired. A provider can provide care for health, not health per se. It is also tempting to think of the provider and the patient as being distinct individuals, but it is helpful and more accurate to view them as distinct roles.


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