Archive for February, 2011

Blue sky

You know that thing that happens where a noise stops and it’s only when it stops that you realise just what a noise it was? Well, I had a similar experience yesterday and today. When I went out for a walk yesterday this is what I saw –

stirling castle

No, I don’t mean Stirling Castle, I see that every day. I mean the blue sky! Look at it! Not a cloud in sight! Then as I walked to the railway station this morning it was so light I couldn’t believe it. I began to wonder if I’d slept in, or if the clocks had changed and I’d missed it. It feels like we’ve gone from weeks and weeks of winter darkness, just suddenly into Spring sunshine….

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Another great post from Seth Godin

Great innovations, powerful interactions and real art are often produced by someone in a state of wonder. Looking around with stars in your eyes and amazement at the tools that are available to you can inspire generosity and creativity and connection. Anger, on the other hand, merely makes us smaller.


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Once you learn that most of the activity of the brain goes on without either conscious awareness, or with conscious awareness only kicking after the initial response, you begin to doubt that all our choices are conscious ones…..or rational ones. In fact, the brain stem and the limbic system are the key centres for our survival responses, our drives, our avoidances, and our emotional processing. How often do we behave in ways which really can’t be understood from the premise of consciously choosing once presented with the facts? Is that how human beings function? Would that even be the best way for human beings to function? (consciously and rationally, whilst discarding other ways of perceiving, processing our experience and responding). What do you think once you learn that there is an enormous neural network around the hollow organs of the body, the heart, and the gut especially, which we might well use to figure things out….where we might process and produce what we call “gut reactions”, or “heart felt” beliefs?

I’ve stumbled on two very different texts in this area in the last couple of days. Isn’t that weird, actually? It’s that old “coincidence” thing again…..never quite got to a point of really figuring out how those “coincidences” come about, or what they mean.

A few days ago, I read about a report for the WWF called “common cause“. The report, written by Tom Crompton. Essentially it argues that if we look at the research evidence, it would seem that human beings don’t make decisions using rational thought very much. Here’s a paragraph from the Summary –

There is mounting evidence from a range of studies in cognitive science that the dominant ‘Enlightenment model’ of human decision-making is extremely incomplete. According to this model we imagine ourselves, when faced with a decision, to be capable of dispassionately assessing the facts, foreseeing probable outcomes of different responses, and then selecting and pursuing an optimal course of action. As a result, many approaches to campaigning on bigger-than-self problems still adhere to the conviction that ‘if only people really knew’ the true nature or full scale of the problems which we confront, then they would be galvanised into demanding more proportionate action in response. But this understanding of how people reach decisions is very incomplete. There is mounting evidence that facts play only a partial role in shaping people’s judgment. Emotion is often far more important [see Section 1.3]. It is increasingly apparent that our collective decisions are based importantly upon a set of factors that often lie beyond conscious awareness, and which are informed in important part by emotion – in particular, dominant cultural values, which are tied to emotion. It seems that individuals are often predisposed to reject information when accepting it would challenge their identity and values.

That’s got me thinking about the importance of understanding our values (and/or our “virtues”) again.

Then, this morning, I read a post about some interesting TED videos, and the first one was this, by Dan Airley. He makes the case that we suffer from “cognitive illusions” just as much, if not more than, we suffer from “optical illusions”. (It’s about how we make decisions. It’s VERY entertaining, and thought provoking, and it’s just 17 minutes long. Take the time to watch it)


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Have you read the book, “The Butterfly and the The Diving Bell”? Or seen the movie? If so, you’ll have an idea of what “locked in syndrome” is. It’s where someone is completely paralysed and unable to communicate apart from maybe being able to blink an eye. Can you imagine? Can you imagine what that must feel like? Well, read this study of people who have this condition and prepare to be amazed. 91 people took part in this study.

Over half the respondents acknowledged severe restrictions on their ability to reintegrate back into the community and lead a normal life. Only one in five were able to partake in everyday activities they considered important. Nevertheless, most (72%) said they were happy.

Said they were happy! Isn’t that amazing? And here’s what amazes me, perhaps even more.

But a shorter period in the syndrome — under a year — feeling anxious, and not recovering speech were also associated with unhappiness. A greater focus on rehabilitation and more aggressive treatment of anxiety could therefore make a big difference, say the authors, who emphasise that it can take these patients a year or more to adapt to this huge change in their circumstances.

In other words, they adapted. Doesn’t this speak volumes about the human capacity to adapt? And doesn’t it make you wonder just what happiness is?


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I was going to title this post “And not or”, but then I realised that very title was falling into the trap which “or” always poses – it divides. The General Semanticists talk about “two value thinking”. Others say this tendency to categorise into two categories is “digital” thinking, in the sense of “on” or “off”, “1” or “0”. Of course we are often faced with such simple choices in life – “go left” or “go right”, “stay home” or “go out” and so on. The drawback of “or” comes when one of the choices is rated as “right” and the other as “wrong”. When that happens, the digital choice is reduced to only one option – the RIGHT one, or as Mrs Thatcher famously said, “There is no alternative”. We see this in health care in the dangerous distortion of “evidence based medicine” to create a digital rating system – treatments “which work” and those “which don’t”, which is then extrapolated to those treatments which should be made available and those which should be withdrawn. In so many instances this is a delusion. Most drugs don’t do what they’re “proven” to do for most of the people who take them.

So, what’s the alternative?


This insight has emerged from the internet, but applies to everything which could be considered using networks as a conceptual framework. On the net, you don’t have to think, will I publish my work on “Flickr” of “Blipfoto“? Will I “tweet” or post on “facebook“? Will I blog, or will I “stumble“, or will I “posterise“? You can do them all, link them all, and communicate much more widely than I could if I had to choose only one, and discard the other options.

But “and” has another great power. Instead of considering a reduced set of information, say, for example, from using “the scientific method”, we can also consider the perspectives brought from subjective experience, from cultural mores, from both individual and group perspectives and so on.

Think of Deleuze’s three ways of thinking – science – thinking about function; philosophy – thinking about concepts; art – thinking about percepts and affects.

Think of Wilber’s “Integral Theory” with it’s elegant four quadrants.

Think of the benefits of truly multidisciplinary working where all the disciplines bring relevant insights.

I much prefer “and” to “or”, and I rarely believe Mrs Thatcher’s “There is no Alternative”. Alternatives are always there. We just need to open our eyes to see them.

Here are two songs about “and” and “or” – I love them BOTH.

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It seems strange to me that so much of “health care” is focused on diseases and their management. A disease is always only a part of a patient’s life and experience. Whilst it’s important to deal with disease when it’s present, surely that’s never enough. Health is experienced by a person, a whole person, and care is expressed in relationships. Without a focus on health and care, what kind of “health care” do we get?

At times it seemed to her they were so focused on disease that patients and suffering were incidental to their work

Cutting For Stone. Abraham Verghese

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Having just written a post about the importance of caring in health care, last night, I opened a novel to start reading it, and here’s what I read first….

….for the secret of the care of the patient is in caring for the patient. Francis W Peabody, October 21, 1925

Couldn’t say it better myself. Funny it pops up so close to that post. I love the amazing surprises of life.

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je t'aime


Show your love

Don’t just say it. Show it.

And why not do it every day this month…..it is the month of love

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We shouldn’t reduce health care to a mechanical set of “measurable” processes. Health care is about the human beings – human beings who are suffering, and human beings who are trying to relieve suffering. This paragraph at the end of an article which looks at the difference between psycho-analytic approaches and cognitive behavioural ones captures the idea beautifully

The respected therapist and writer Irvin Yalom, among others, argues that depression and associated forms of sadness stem from an inability to make good contact with others. Relationships are fundamental to happiness. And so a science that has the courage to include the doctor’s relationship with the patient within the treatment itself, and to work with it, is a science already modelling the solution it prescribes. What psychoanalysis loses in scientific stature, it gains in humanity.


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This caught my eye

Showing clinical empathy to patients can improve their satisfaction of care, motivate them to stick to their treatment plans and lower malpractice complaints, found a study published in CMAJ (Canadian Medical Association Journal).

What did I think when I read this?

You don’t say!

I mean, seriously, empathy’s a good thing?? But then, I looked again, and there was a little extra word in there which disturbed me…..and several days later, it’s disturbing me still. Can you guess which word is bothering me?


What, oh what, is “clinical empathy”? Maybe I’m a bit odd this way, but you know what? I care about every single patient I see. I just do. I want to help them. I feel for them. Nobody taught me this. I became a doctor because of it. It wasn’t something to include in my curriculum. Surely that’s not odd. It’s certainly not uncommon amongst the doctors I know and work with.

Here’s my question. Why would anyone want to be a doctor if they didn’t care?

OK, you’ll probably come up with a ton of reasons, but if you could choose, next time you need to see a doctor, wouldn’t you rather choose one who connected with you, who understood you (or at least tried to understand you), over one who didn’t?

It’s not my experience I’m unusual. But in my experience, it’s not something which seems to be particularly valued in health care. “Outcomes” are rarely anything to do with caring, empathy, or relationship. I really hope that’s changing. Let’s not modify “empathy” by calling it “clinical empathy”, let’s value and encourage the practice of giving a damn.

(The Scottish government is rolling out through the whole of the NHS in Scotland a measure called “CQI-2”, a measure of the “Consultation Quality”, to capture patient’s experiences of compassion, caring “enablement”. That’s an important step. It’ll be an even more important step if we connect it to funding decisions. )

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