Room for a view: Atlas nodded

What joint in your body is most important in allowing you to relate effectively to patients? From time to time I pose this question to medical students and residents. It's an unfair question; indeed, it's something of a riddle, as it requires a read-my-mind approach to the correct answer. But riddles can be a good way to regain the attention of fatigued or simply bored house staff. Rounds are long; attention is short. Some house staff attempt to answer; others meet my gaze with blank stares and smiles as they stall for time, waiting to see if any more information is forthcoming. A few nod to signify that they have understood the question, and I nod vigorously at this clue that they might be willing to hazard a guess — thus giving a hint about the correct answer: the atlanto-occipital joint. Although, in its title, it bears the name of one of the two bones of this joint, Grant's Atlas of Anatomy contains no clear depiction of the entire atlanto-occipital joint. Figure 5-37 shows the superior articulating facets of the atlas, the “convex-up” surfaces on which the base of the skull, and the metaphysical world, rest. Figure 7-32 reveals the opposing “convex-down” surfaces of the occipital condyles in situ, delicately resting on the atlas. The articulating surfaces of the occiput are rockered, much like a hobby horse, and they work in exactly the same way. This design allows the head to effortlessly nod back and forth through a somewhat limited arc, without requiring movement of the rest of the cervical spine. It's not hard to nod. Indeed, given the propensity of medical students and residents to nod off when they are tired, relaxation alone is clearly enough to effect this simple motion. Phenomenologically, a nod consists of much more than a small movement of the head at the atlanto-occipital joint; it is a statement of affirmation signalling understanding, comprehension, willingness and, even more important, a desire to hear more. Nodding says, “I hear you and understand you and affirm the legitimacy of your problems as you perceive them, and, please, do continue to tell me all about them.” Thus the simple act of nodding allows the patient to become better known to the doctor, a necessary part of the therapeutic relationship. And it contributes to the establishment of trust, for we are inclined to trust those who understand us. Do we not feel safest with those who have demonstrated a willingness, ability and desire to hear and understand? The temporo-mandibular joint is, of course, a reasonable second guess, but excessive reliance on this joint by a clinician can easily result in patients hearing more than they understand, knowing more than they wish, and, worst of all, being given little opportunity to be understood. Indeed, excessive reliance on this joint results in the patient nodding in affirmation as his or her understanding of the physician is increased. The regular use of the atlanto-occipital joint does not suffer from these shortcomings; indeed, I would argue that it is difficult to overuse it in caring for patients. Do you find yourself nodding in affirmation?

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.