Archive for July, 2007

I read a great post on the SlowDownNow.org blog. In it Christopher Richards describes his experience of being looked after by a doctor who took his time, then his experience of trying to find a new doctor after this first one had retired.

I’m pretty sure we’re losing something really important with our current round of NHS reform. And its something related to speed. Sure you need fast, effective treatment when you are acutely unwell, but the surgeon or physician who is tending you still needs to take his or her time and not rush things or the job just won’t get done properly. However, the big demand in health care these days is chronic disease and here we really have been looking for quick fixes at the expense of taking our time to listen, to understand and to enable patients to adapt, to grow and to enlarge their lives in the presence of their diseases.

An American sociology professor, Arthur Frank, wrote “The Wounded Storyteller” (ISBN 0-226-25993-5) to describe his study of how patients talk about their illnesses. He identified three major “genre” of narrative – the “restitution” one – which is the quick fix approach to health care (“A bit of me’s broken. If you could just fix it or replace then I’ll be on my way”). This is appropriate in much urgent and acute medicine but is really of no use in chronic illness or in enabling patients to become genuinely healthy. He proposes that doctors should help their patients to create new narratives – “quest narratives” based on the principles of Joseph Campbell’s work on the structure of myths and legends (otherwise known as Hero stories).

That very process entails a shift from the quick, the immediate, the partial to the slow, the lasting and the whole.

I wrote here about countering Getting Things Done with Dolce Far Niente, and here about finding the spaces where you can relax, and here about becoming aware of the gaps in our experience.

What ways do you slow down?

Does slowing down improve your quality of life? Give you time to reflect, re-charge, and to grow?

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“It is a truth universally acknowledged, that a single man in possession of a good fortune must be in want of a wife.”

Hands up if you recognise that opening line……

David Lassman, the director of the Jane Austen Festival in Bath decided to copy out opening chapters of Jane Austen novels, changing only character names and send them to publishers as his own work to see what would happen. He sent Northanger Abbey, Persuasion and, yes, even Pride and Prejudice (that’s the opening line up there….!) to a number of big publishers and agents.

Two interesting things happened. Firstly, they all got rejected – the publishers didn’t want to publis them. Secondly, nobody seemed to spot the plagiarism – well, apparent from one person at Jonathon Cape. But here’s the bit that really struck me – Penguin said this about his Pride and Prejudice look-a-like

It seems like a really original and interesting read

When challenged about this later they said

A spokeswoman for Penguin pointed out that its letter had said only that it “seemed” original and interesting. “It would not have been read,” she insisted.

What??! They said it “seemed” interesting but they didn’t read it? Oh dear, is publishing totally random? Is it just luck? I suppose it would have been worse if some publisher had offered him a contract and published it without realising the book was actually a Jane Austen novel, but that probably was never going to happen. The saddest part of this tale is the way the rejections either suggested the book was not good enough to be published (poor Jane Austen!), or gave false hope. Wouldn’t it be better for a manuscript to either be sent back with a note saying the company did not want to look at it, or for it to be taken seriously and a clear, honest communication about it to be given to the author?

Why does this interest me? Well, one of the key themes of this blog is a call for individuals to matter more than institutions and systems. The more impersonal and systems based our society becomes the more we are all poorer.

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The Guardian today has an article about a research paper published back in May in the British Journal of Psychiatry. There are more and more attempts to control the future in our society. Predictive statistical models are increasingly being used by everyone from supermarkets (to “target” their marketing to you on the basis of what they think you might like to buy), to social work (to give special help to young mothers who they think might give birth to children who will become criminals), to the criminal justice system (to try and predict re-offender probability), to (my main area of interest) health care (where the experience of groups is used to determine what interventions an individual should or should not recieve – so called “Evidence Based Medicine”).

The paper discussed in today’s Guardian shows that the margin for error between the group studies and individual outcomes is so great that –

When applied to individuals the margins of error are so high as to render any results meaningless.

Almost every day I have a discussion with patients about risks and choices. I always emphasise that the statistical predictions are based on groups and averages and that there is absolutely no way of knowing to what extent they are relevant to this individual.

We are all different. Nobody, but nobody, can tell an individual what their future holds and to pretend they can on the basis of statistical modelling which isn’t up to the job is potentially very harmful.

This heroes not zombies site is about encouraging people to become aware, to think, and to develop their uniqueness. We need to celebrate individuality and difference more and we need to understand that people matter more than statistics – especially in social work, justice systems and health!

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Tonight I went to see the firework display over La Cite, Carcassonne.

Here’s the closing sequence captured on my K800i mobile phone

The display is known as L’Embrasement

Some of the photos I took are here

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You’ve heard of GTD haven’t you? It’s everywhere on the web (3,260,000 hits if you google it!) It stands for “Getting Things Done” and was invented by David Allen. Put simply, its a system to try and help you beat procrastination and clutter by focussing on actually doing what needs done instead of just thinking about it and hoping that one day you might get round to it. The basic idea is a good one – that things that need done but which you haven’t done yet clog up your brain like clutter clogs up your house. However, as with all “systems”, (especially ones which get trademarked), it all gets a bit too complicated for its own good. Zen habits is a personal organisation blog which I like and here you’ll find a simplified version of GTD.

I confess. I love notebooks and pens and diaries and calendars so this whole thing catches my attention. I’ve even read the book! More than that, I’ve changed my home filing system to the simple one he suggests and I try pretty regularly to action or file the pile of mail that heaps up on my kitchen windowsill – clearing that windowsill is a strangely life-enhancing experience!

But I’ve been on holiday for the last week and as I’ve had a busy week of NOT Getting Things Done (NGTD), an Italian phrase popped into my head for some reason –

Dolce Far Niente

First time I saw this I wrote it in the front of my then current Moleskine. In English it would mean “Doing sweet nothing”. I can remember when I was a busy GP rushing from surgery to housecalls and cutting through Holyrood Park. I would often see someone sitting on one of the park benches. Just sitting. And I’d think “How wonderful! To be able to just sit! No bag. No phone! Just sitting!” That’s one version of “Dolce Far Niente” (DFN). You can make up your own. What’s your favourite way to enjoy doing sweet nothing?

While thinking about this post I came across this painting by John William Godward

It’s entitled “Dolce Fa Niente”

Dolce Far Niente

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clouds over water, originally uploaded by bobsee.

I find water so fascinating. In all its forms.
Clouds are lovely. They manage to look solid and soft and substantial and impermanent all at once.
Here’s a photo I took looking down on the clouds as I flew over the French coast.
What’s really amazing here is how you can see the shadows of the clouds on the surface of the sea.
Water reflected on water
Water moving over the face of the water.
Shadows of heaven on earth

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raindrops on leaves, originally uploaded by bobsee.

I can’t stop myself photographing water! I love to see drops of water like this on a leaf or a petal. The perfect shapes, the way water sits in droplets on leaves reflecting the light of the world. You can see whole worlds in there. You can see LIFE in there.
It’s beautiful

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