Archive for March, 2010

I had a conversation with someone this week where we discussed how you can’t know someone in isolation. If you put a person into an empty room and observe them through a video link for example, you’re not going to discover a lot about who they are. We need others to reveal that.  We are fundamentally social, relational creatures. I stumbled across a comment recently which went something like this “isolation is the dark room I go to to develop my negatives”.

I’ve known that truth about how we reveal ourselves in our interactions with others for a long time. I’ve also long been aware of how we can see ourselves in others too, both in the positive sense of empathy, feeling resonant with another, and in the revealing sense of how the behaviours of others can teach us something about ourselves (ever met someone who consistently presses certain of your buttons? How would you know what buttons even exist without those people?).

I think this is an aspect of being human which we often neglect. A lot of attention to the “self” is focused inwardly, but our “selves” are not contained within us. Another phrase I heard this week was something about how limited it was  “to consider the self  from the one skull perspective”. A striking way of getting us to realise that the self is inter-relational, not isolated within the human body.

I just read this by Virginia Woolf, writing about watching people looking at a portrait of Montaigne.

There is always a crowd before that picture, gazing into its depths, seeing their own faces reflected in it, seeing more the longer they look, never being able to say quite what it is they see.

She goes on to write….

As we face each other in omnibuses and underground railways we are looking into the mirror…And the novelists of the future will realise more and more the importance of these reflections, for of course there is not one reflection but an almost infinite number; those are the depths they will explore, those the phantoms they will pursue.

Now there’s a creative writing project to explore!

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autumn island

I would love to live
Like a river flows
Carried by the surprise
Of its own unfolding

John O’Donohue

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What’s most important in providing good health care?

My answer – people.

Every doctor I know has personal stories of experiencing a dehumanisation of patients in health care. From the well known “liver problem in bed 3” way of referring to someone, to stories like the ones Dan Siegel tells in his “Mindsight” book of being clearly and specifically instructed not to ask about patients’ lives and feelings, but, instead to concentrate on “diseases”.

Here’s two conversations I’ve had with junior doctors in the last few months. One told me that she had been instructed by her clinical teacher “Don’t believe patients. They lie all the time. You can only trust the results” By “results”, they meant the results of investigations – blood tests, X-Rays etc. The second told me she’d been taught “If a patient takes an evidence based drug and says that it didn’t help, they’re either lying or they didn’t take the drug.”

Frankly, both these conversations shocked me. It seems like dehumanisation has been take to a new level. What kind of doctor has these attitudes and beliefs? Are these caring doctors? What, or who, do they care about? Are they scientific doctors? Is it scientific to dismiss patients’  narratives and patients’ subjective experiences? It’s not. Dr Robert Smith, in his book, “Patient-centered Interviewing. An Evidence Based Approach” describes clearly and eloquently why it’s not. Without considering all the “data” available, he says, then the assessment will be invalid. He makes the point that the “data” includes the patient’s reported subjective symptoms.

These attitudes were very evident in the recent Science and Technology Committee’s attack on homeopathy. They made it very clear that they considered irrelevant the fact that repeated research has shown 70% of patients who received homeopathic treatment on the NHS stated that it helped them.

There’s another consequence of the failure to make people the most important priority in health care – that’s they way the health carers are treated. There’s wholesale destruction of professionalism underway with nurses’ and doctors’ work being broken down into hundreds of individual tasks which can be measured and monitored. Procedures become more important than people, and the nurses and doctors feel undervalued.

It’s sad. And it’s not good.

Do we need to create a campaign to redress the balance? To insist that people are more important than statistics? To teach doctors to believe what their patients tell them and to show that there are no “evidence based drugs” which work in every person who takes them? To create the conditions for more care and more respect?

I think we do. What do you think?

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