Archive for October, 2011

I love to write. Why is that? Well, Nicole Krauss, writing about Roberto Bolano in the Guardian last week beautifully describes one of the main reasons….

Writing is always an expansion: a writer, given only one life, is compelled to manufacture other lives, other stories, other realms. The one life is not enough; it is necessary, for whatever reason – an overabundance of language or imagination, curiosity, desire, a distaste for finalities – to multiply the possibilities.


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I heard on the news last night that 70 people had been killed by a bomb in Somalia. What do you think about that? What do you think about those 70 people? What did the terrorist think about those 70 people? Did he, or she, know any of them? Could the bomber name any of them?

Reduction of individuals to a mass, by terrorists, by journalists, by governments, businesses, scientists, blinds everyone to the absolute uniqueness of every person.

It’s not possible to see the uniqueness of an individual when we absorb them into a mass.

But there’s another way to lose the uniqueness of individuals. Go in too close. In Medicine we focus on a part of a person – their blood pressure reading, their cholesterol level, their “lesion” – but when we do that we lose sight of the individual, the person whose body we are peering into, and in so doing their uniqueness is lost in their becoming a “case of hypertension”, or “a cancer patient”.

Zoom out to the mass, and we lose the individuals and everything which makes them unique, makes them uniquely human. Zoom in to the lesions or the biological parameters, and we lose the individuals and everything that makes them unique (even looking at an individual’s DNA doesn’t reveal anything like their full uniqueness)

There’s only one level at which we can see a person’s uniqueness – the level of the person – one to one, me to you, you to me. That’s what I’ll be doing again today. Sitting listening to individual, unique stories of men, women and children. I think that’s what being a doctor is about – fully focusing on the uniqueness of each and every person I see for the time I spend with them. The knowledge of the mass might enter the exchange, the knowledge of the parts might enter the exchange, but the consultation has to begin and end with a clear focus on this whole, unique person.

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living in the present

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In the US, they’ve set up a research institute, The Patient Centered Outcomes Research Institute, with a funding of $600 million a year!

It’s good to see a resourced emphasis on patients. The current dominant model in decision making in health care policy often seems to put the average, or the group, over that of the person. The evidence based medicine model originally recommended taking the statistical results from group experiments, then working out with individual patients what is best for them. I’ve heard a doctor say she was taught that if a patient takes an evidence based drug and says she is no better, then either she hasn’t taken the drug, or she is lying. That strikes me as bonkers. One way to get a more relevant decision for individual patients is to use “patient centred outcomes”.

The new US research institute will focus on the following four questions –

1. “Given my personal characteristics, conditions and preferences, what should I expect will happen to me?”

2. “What are my options and what are the benefits and harms of those options?”

3. “What can I do to improve the outcomes that are most important to me?”

4. “How can the health care system improve my chances of achieving the outcomes I prefer?”

Shouldn’t these ALWAYS be the questions a doctor and a patient should consider together? I think so.

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october fruition

In October, I love to see all the berries splashing their colour amongst the green and golden leaves of autumn. It’s the month of harvest thanksgiving in many countries and cultures too.

So, what can you think of this year so far, which has come to fruition? For me it’s my BE THE FLOW project – the website, the beautiful, colour, photographic book of Be the Flow, the little black and white paperback, and the Kindle version too. You can find them all at www.betheflow.net

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I’m a great fan of Seth Godin’s work. His latest book is “We are all Weird“. Seth’s great at picking an eye-catching and provocative phrase (remember the purple cow?). So, he makes it clear what he means by “weird” –

In this manifesto, I’m not talking about weird by birth, I’m talking about people who are making an affirmative choice to be weird. Most people who make that choice are paradoxically looking to be accepted. Not by everyone, of course, but by their tribe, by the people they admire and hope to be respected by.

The key element of being weird is this: you insist on making a choice.

We all need to belong. Seth focused on that in his book on “tribes”. We like to associate with like minded people, with people who share our values and beliefs. In short, with people who share our choices. But we also need to know that we are all unique, that we are individuals. Remember the battle cry from “Braveheart”? FREEDOM.

Well, we all need freedom. The freedom to choose for ourselves, not being the least of the freedoms we need.

In “We are all Weird”, Seth shows how over the last century or two the concept of the “mass” has come to the fore. Mass marketing, mass consumption, globalisation of brands which seek to treat everyone as the same. Politicians like that. It gives them control. Marketers like that. It’s gives them the control. Goodness, those who seek to tell us all what’s best for us in health care irrespective of our individual needs, like that. It gives them control.

But the world is changing. It’s easier than ever now to express yourself. It’s easier than ever to be your own person, to make your own choices, and to find the others in the world who share those choices, to find your tribe. And this is completely changing the game. Power is shifting away from those who want to control the “mass” and into the hands of those who celebrate their uniqueness.

We’re seeing that in Medicine with the frustration of health care professionals and patients at being corralled into protocols and guidelines based on “evidence” which is statistical analysis of group experiments extrapolated out to be applied to the “mass”.

Read this book.

I recommend it. Read it and share it with your tribe. Be part of the change in the world. Be a hero, not a zombie.

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