Your Consciousness Knows Things Your Labs Don't
Part one of a two part series.
I was listening to a podcast last week when author Michael Pollan said something that inspired me mid-commute, even as I tried not to engage with my rage at the injustice of reckless drivers endangering us all. Pollan was talking about his new book on human consciousness, delving into what the zeitgeist believes consciousness is, and why it matters now more than ever. He described human consciousness as “a very precious realm, the realm of our privacy and our freedom to think.”
In that moment he was justifying having written a book about lofty philosophical and neuroscientific ideas, even as we are just scraping by with horrific politics, governance, and societal decline. Do we really have the luxury of reading a book about consciousness in a time of titanic clashes— democracy versus fascism, centibillionaires versus the working class, climate collapse versus unthinkable climate change denial?
Absolutely.
I’m going to riff on the idea of consciousness as it pertains to our physical, mental, and holistic notions of health, in addition to gaming out a better way to be a patient and a doctor in a room together. This is part one.
And if you like where this essay goes, I will also follow Michael Pollan’s answer about how our consciousness is being polluted by our politics in 2025-26, and how that absolutely impacts our collective health and wellbeing. This would be part two.
As a family doctor I have the privilege and peril of being a jack of all trades, a synthesis seeker, a crackpot philosopher when I feel up to it.
Let’s go.
The gap
Have you ever walked into a doctor’s appointment as a conscious being, maybe suffering, or at least aware that something is wrong in ways you may not have words for or that cannot be measured/scanned/poked and prodded… yet the visit proceeds as if only the measurable parts of you matter?
I want to ask a narrower version of Pollan’s question: What would medicine look like if we actually took consciousness seriously? What follows is my attempt at an answer. Not like PhD-level philosophy, but like something we could use in an exam room, as part of a therapeutic relationship, as a re-humanization paradigm.
A vignette:
A woman walks into her doctor’s office with fatigue, diffuse pain, and a sadness she can’t name. Her labs are normal. Her scans look good. She is told she is fine. Drink plenty of water.
But she does not feel fine.
She is conscious after all, aware of her pain, her dread, her felt sense that something is wrong. And that intuitive awareness is the one thing modern medicine is least equipped to address. We have extraordinary tools for measuring what happens in the body, a catalogue of pills for every problem, but a limited clinical framework for engaging with what it feels like to be in that body. We often outsource that, or try our best within the 20 minutes we have for an impossibly long meeting agenda.
And yet every symptom a patient reports, every fear they carry into the exam room, all of it is mediated by consciousness. It is the medium through which all suffering is experienced and all healing is potentially felt, and we are fools not to discuss this explicitly more often.
Please allow me to try.
What consciousness actually is (the short version)
Consciousness is what it’s like to be you, right now. The philosopher David Chalmers called explaining this the “hard problem.” We are not talking about how the brain processes information, but why any of it feels like anything at all. You know, like why we are not automatons and zombies.
Three dimensions matter clinically:
Phenomenal consciousness is the raw feel of experience: the sharp burn of a paper cut, the heaviness in our chest at bad news.
Access consciousness is what we can put into words for our doctor: the pain is a six out of ten, it started three days ago, it’s worse after eating.
Interoceptive consciousness is perhaps the most important for medicine. It is our awareness of our body’s internal states, our heartbeat, our breath, our gut, the felt sense of our physiological being. Interoceptive consciouness carries information that lab tests can approach but never fully capture. And many people themselves have lost an intuitive, embodied understanding of it entirely.
What generates these dimensions of consciousness?
The most clinically useful theory of consciousness generation right now is something called predictive processing. The idea is that the brain doesn’t passively receive reality. It actively constructs a best guess. This in part explains why two patients with identical pathology can have radically different experiences, why the placebo effect genuinely works, and why some chronic pain persists long after tissue has healed. Sometimes the brain’s prediction simply hasn’t been updated.
Biochemistry supports what the theory suggests. There is no symptom that is purely physical and no symptom that is purely mental. Over 90% of the neurotransmitter serotonin is produced not in our brains but in our guts. Chronic stress cortisol structurally remodels the brain. Inflammatory cytokines cross the blood-brain barrier and alter consciousness itself. The patient is not a mind riding in a body. The patient is a bodymind, one conscious biochemical being.
Now let me disclaim something important. None of this replaces good reductionist medicine. When someone has bacterial pneumonia, the actionable answer is antibiotics, not embodied awareness. The Western biomedical model’s power lies in its ability to isolate treatable mechanisms: the fractured bone, the occluded artery. But that lens is a method, not the whole truth. Every intervention we make ultimately serves a conscious being whose experience of illness and recovery is the true measure of whether we’ve helped.
The honest problem
If you’re a fellow physician reading this, you may be thinking: This is lovely, but I have twenty freaking minutes with each person.
I know. I freaking know.
The compressed visits, the documentation burden, the panel sizes, the clinical decision-making volume make consciousness-informed medicine nearly impossible to consistently practice. We are lucky to make it to the bathroom to urinate without feeling several kinds of pressure at once.
And if you’re a patient, you will never have a physician who speaks to you about consciousness per se, though hopefully you’ve experienced the related corollaries of empathy and compassion. You will certainly have twenty minutes with someone who is already thirty minutes behind schedule. And unless you are feeling vulnerable, or have a good doctor-patient relationship with a trusted doctor, you might not even want someone attending to your intimate, conscious experience.
And yet most of us do want that human connection, that humanization, that holistic analysis and resonance with a helpful soul. I do as both a patient and a physician.
So here’s what we might do on our own first.
When we are patients
There are some concrete, easy-ish things we can start doing today that tune us into our consciousness.
Rebuild our ability to listen. Try a five-minute body scan: eyes closed, attention moving from head to feet, not diagnosing, just noticing what’s tight, heavy, or numb. Most of us have learned to override the body’s signals, treating them as interruptions rather than information. This is a practice of paying attention again. Meditation emphasizes this sort of awareness, acknowledging but not following unpleasant sensations.
Keep a real journal when struggling. Not just symptoms, but context: mood, sleep, stress, any grief or conflict, what we ate, whether we moved. No single office visit can reveal the patterns that emerge over weeks.
Trust the signal when labs are normal. If our tests look fine but we feel terrible, we shouldn’t accept that as proof nothing is wrong. It may mean our conscious experience is detecting something our current tools haven’t captured yet. Advocate calmly, persistently, and without apology. And yet the paradox here is that sometimes a normal work up, an MRI that looks good, can be therapeutic in and of itself. More on that later.
Name the emotional dimension. Even silently: I’m afraid this won’t get better. I’m angry no one believes me. I’m grieving the life I had before this started. Naming isn’t wallowing. It’s the moment unconscious suffering becomes conscious and therefore workable.
The deeper tools
Now, are you ready for the rabbit hole?
I don’t think the crux of this whole framework is just paying attention to our bodies. It’s developing the capacity to watch ourselves paying attention. Researchers call this metacognition. Contemplative traditions have been teaching it for centuries.
Most of us experience this fleetingly: the moment we notice we’re anxious rather than just being anxious. The moment we catch ourselves catastrophizing and think, there I go again. That small gap between experience and the awareness of experience is, neurobiologically, one of the most powerful therapeutic instruments a human being possesses. The square of the square in mathematics.
Here’s how we might deploy it deliberately.
With physical symptoms: Most people encounter a sensation and immediately leap to a story about it. This headache means something terrible. This chronic fatigue means I’ll never feel normal again. Meta-awareness lets us insert a step between sensation and narrative. The sensation is data. But the story is prediction. And as predictive processing tells us, the story our brains construct about a symptom can amplify or even generate suffering far beyond what the original signal warrants. Have you ever noticed that just by turning the conscious spotlight on a symptom, a twitch, an ache, a worry, we magnify the experience as if through a magnifying glass? There is brief utility in that, but there is also risk.
A moderating practice is both simple and difficult: What am I actually feeling right now, and what am I adding to it with my mind?
With mental health: A person who is depressed and identified with their depressive thinking might become trapped inside the content of consciousness. Thoughts like I’m worthless, nothing will ever change, it’s hopeless feel like hard facts. A person who can observe that same thinking with a step back, who can notice that their mind is generating hopeless thoughts and that it tends to do this when they’re exhausted and isolated, has not eliminated the depression. But they have fundamentally changed their relationship to it. The thoughts are still present, but they have been reclassified from truth to weather. This is a predictor of recovery across anxiety, depression, PTSD, and addiction actually, and a good counselor can evoke and harness this sort of reckoning.
With chronic illness: Patients with fibromyalgia, long Covid, autoimmune conditions, menopausal syndromes, and chronic fatigue often endure the additional injury of not being believed. Meta-awareness can give them a kind of internal authority that doesn’t depend on external validation. When we have carefully and consistently observed our own body, when we know that our fatigue deepens predictably after certain exposures and that our pain has a rhythm our labs can’t see, we carry an evidentiary record that no dismissive encounter can erase. We are not guessing or making stuff up. We are reporting from direct, disciplined observation of our own consciousness.
*The common thread: meta-awareness does not change what is happening. It changes our relationship to what is happening. And that shift, from being captured by experience to being present with it, turns out to be one of the most consequential chess moves a human being can make in life. It is the difference between being lived by your illness and living with it, even above it. Mindfulness meditation is one way to learn some of these techniques.
For the doctors in the house
No new philosophy degree required. No billing codes.
Swap one closed question (Are you depressed?) for one open one (What’s been weighing on you?) and watch how often the answer reframes the entire clinical picture. Changes the therapeutic nature of the encounter itself.
When labs are normal but the patient isn’t feeling it, say so honestly: Your tests look reassuring, and I also hear that you don’t feel right. Both can be true. Let’s keep looking, and keep the door open in this conversation.
We all know there is an art and a science to doing this job well. Just like schools with underfunded budgets, the first thing cut is usually art.
And protect your own consciousness. One breath before you open the door. A self scan of body signals and cold hands. One moment of genuine eye contact before the keyboard. A precious shred of small talk before the complex problems. These aren’t luxuries. A burned-out, dissociated physician is operating with the same diminished integrative capacity we’d recognize as pathology in our patients.
Where this may all be going
Artificial intelligence is being rolled out like a steamroller. It is more aptly described as alien intelligence, yet it fundamentally seems to work on predictive cogwheels like human consciousness may be deploying.
As artificial intelligence increasingly handles the pattern recognition, differential diagnosis, and algorithmic decision-making that have traditionally defined clinical expertise, scrutinizing this parallel intelligence becomes urgent. Existential.
AI can read an imaging study faster than any radiologist. It can predict hospital readmissions more accurately than any risk calculator. What it cannot do, and what it may never be able to do, is authentically meet another consciousness with presence. It cannot recognize the irreducible particularity of a patient’s suffering, or hold the space in which a person becomes more than their diagnoses. It has not suffered, triumphed, had a first kiss or a broken heart.
As medicine’s technical functions become automated, the physician’s core competency will shift toward exactly what machines cannot replicate. We need to use AI not to become even more dehumanized technicians, but to free up attention for what has always mattered most: the human capacity to bear witness to another’s consciousness with compassion and humility and professional expertise.
In this future, understanding consciousness won’t be a philosophical luxury.
It just might be the defining clinical skill.
The End
Michael Pollan wrote his new book because he believes consciousness is worth defending. I plan to read it (which translated means that I plan to listen to the audiobook on my pithy-thought-generating, expletive-laden-battle of a morning commute).
In the exam room, I argue it's worth practicing with consciousness. Two people sit across from each other, each carrying an inner life and light that no chart can hold, and for a few minutes they have the chance to actually meet. Perchance to dream. That meeting, small and unglamorous and perpetually rushed as it is, remains the most powerful clinical tool either of them will ever have access to. More powerful than sitting at home, DIY, alone in front of a screen, typing fretful thoughts into a search field or chatbot prompt.
We must do that searching… but we must not forget our luminous and human consciousness, nor the vital connections to other people, ourselves, and the deep well of collective possibility and understanding contained within.
Another golden substack from Dr. Mc. You describe a holistic view of medicine which is so often needed in western culture. Thank you for sharing the deep thinking you do. The world and your patients are privileged for you to be able to share your perspective, instead of keeping it locked inside your mind. You have touched upon how a large chunk of our lived experiences are rooted in the stories we embody, and the importance in paying attention as observers of our 3D experience. Dare I say I feel a bit more enlightened after reading this substack?! "Namaste"
Thank you, thank you, thank you! Many of us with autoimmune diseases pay close attention to our body's messaging. When medical professionals discount our observations, we're forced to doctor ourselves. It's not always safe but neither is the constant medical gaslighting. In a perfect world, doctors would work synergistically with patient observations. Not many of the western medicine doctors I've seen are willing to do so past the first departure from textbook expectations, however.