The Instrument Is the Least of It

The patient arrived with a folder three inches thick. Imaging, splints, two surgical consultations, a decade of diagnoses that contradicted one another politely, the way experts do. She set it on the counter and said: nobody has looked at me yet. They looked at the pictures.

Twenty-five years in, I believe her. The mirror and the explorer matter less than I thought when I bought my first set. What examines the patient is attention — the instrument merely goes where attention has already been.

The exam does not begin when I pick up the mirror. It begins when the patient begins to speak.

Iain McGilchrist argues that the kind of attention we bring to a thing changes what we find there.¹ Narrow, grasping attention finds parts: a joint, a disc, a wear facet. Broad, receiving attention finds a person whose jaw has learned, over years, to brace against something. Both are needed. Only one can be delegated to the imaging center.

Suzuki said that in the beginner’s mind there are many possibilities; in the expert’s, few. The folder on my counter was the work of experts — each certain, each brief. What the beginner’s mind would have noticed is what she said in the first ninety seconds, before anyone reached for a probe: it started the year everything else started.

So the treatment plan, more often than my younger self would believe, is via negativa. Remove the third splint. Remove the clenching reminder app that has made her think about her jaw four hundred times a day. Remove the certainty. What remains — a joint doing its best under a nervous system doing too much — usually knows the way back.