Archive for March, 2012

Seth Godin is sharing his thoughts about education and they are very stimulating thoughts! His ebook (which is free) is entitled “Stop Stealing Dreams“.

The basic thesis is that our education system is designed to produce compliant producers and consumers. Compliant producers/workers tend to end up in hourly paid jobs and with the globalisation of large corporations, there’s been a race to the bottom. If you work for an hourly rate, you are disposable. In fact, increasingly it’s likely your employer will seek to replace you with someone who will work for less – either in your country, or in another one.

There’s not much of a future for any of us down that road, so what we need instead are unique, autonomous, creative individuals – artists (he says) and scientists (of the ideal type – the ones who are truly constantly skeptical, not the ones who think they are the new guardians of THE TRUTH!)

Schools need to change to meet the changing times. In particular we need to move from FEAR – which is used to induce compliance – to PASSION – to encourage self-starters, innovators and life-long committed learners.

Part of that process is to encourage our children to dream (hey, we need to encourage our ADULTS to dream too!) – to dream BIG, but to dream REALISTIC. In other words, not to accept the status quo, but not to opt out by dreaming the dreams sold by those in control – dreams of celebrity for example.  No, the kind of dreams we need to encourage are the dreams which motivate people to engage with working towards making them happen.

Here’s a quote or two –

 19. The dreams we need are self-reliant dreams. We need dreams based not on what is but on what might be. We need students who can learn how to learn, who can discover how to push themselves and are generous enough and honest enough to engage with the outside world to make those dreams happen. I think we’re doing a great job of destroying dreams at the very same time the dreams we do hold onto aren’t nearly bold enough

11. School’s industrial, scaled-up, measurable structure means that fear must be used to keep the masses in line. There’s no other way to get hundreds or thousands of kids to comply, to process that many bodies, en masse, without simultaneous coordination. And the flip side of this fear and conformity must be that passion will be destroyed. There’s no room for someone who wants to go faster, or someone who wants to do something else, or someone who cares about a particular issue. Move on. Write it in your notes; there will be a test later. A multiple choice test. Do we need more fear? Less passion?

29. There really are only two tools available to the educator. The easy one is fear. Fear is easy to awake, easy to maintain, but ultimately toxic. The other tool is passion. A kid in love with dinosaurs or baseball or earth science is going to learn it on her own. She’s going to push hard for ever more information, and better still, master the thinking behind it. Passion can overcome fear – the fear of losing, of failing, of being ridiculed.

Seth highlights a problem I see in health care, even though he is focused on education in this ebook. He describes Taylorism and Scientific Management –

“measure often. Figure out which inputs are likely to create testable outputs. If an output isn’t easily testable, ignore it.” It would be a mistake to say that scientific education doesn’t work. It creates what we test.

That really is the trouble with health care – see my recent post about finding the person in the patient,  and the earlier one about people not processes.

Here’s his definition of an artist by the way –

“An artist is someone who brings new thinking and generosity to his work, who does human work that changes another for the better.”

He uses the same definition in his We are All Weird.

And, just to finish with here, he highlights the issue of getting people to give a damn –

“Can we teach people to care? Can we teach kids to care enough about their dreams that they’ll care enough to develop the judgement, skill, and attitude to make them come true?”

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“seeing the person in the patient” caught my eye as I read this letter in last week’s BMJ –

The key to the successful management of comorbidities (and all illness) is to “see the person in the patient.” That is not easy for doctors who see patients only briefly and tend to use that time to focus on their patients’ illnesses. At 68 years of age and with a fine collection of comorbidities of my own, I speak from experience. The key to success in treating comorbidities is to discover what motivates patients, what their ambitions and aspirations are, what they would like to be able to do, and then to agree with patients an individual care plan that accommodates all of their conditions, is practicable from their point of view, and which will—as far as possible—enable the fulfilment of those aspirations. Kamerow is right that dealing with such patients is logically a primary care issue but, in the UK at least, that is not simple. In my GP practice, I rarely see the same GP twice in succession, so continuity of care has something of a hollow ring to it. Perhaps there is a case for a GP with a special interest in comorbidities, or are there so many of us with comorbidities that no GPs would be left to treat acute illnesses?

The letter is written by Peter Lapsley, who is described as the BMJ’s “patient editor” (not sure what that is, but I really agree with his comments). He was writing in response to a piece by Kamerow about the difficulties in dealing with patients who have more than one thing wrong with them – “comorbidities”. The problem is that the reductionist approach to illness compartmentalises people into bits, trying to find and define the wonky bits (my term!) and fix them. This approach uses guidelines and algorithms created from reviews of research into treatments for individual diseases – pretty much always conducted on patients with just one thing wrong with them.

Actually, as Peter Lapsley points out, the problem is resolved by focusing on the person instead of the individual diseases.

The trouble is that takes time, a holistic, patient-centred approach, and a real effort to understand what’s important to the patient and responding to their aspirations and values. It absolutely is not a one-size-fits-all approach to health care. It’s time to stop trying to squeeze everyone into protocols and rediscover the value of both continuity of care and the importance of focusing on the human, or the “person”. This is especially true when dealing with people who have long term conditions.

(I’ll declare an interest here – where I work we deliver 100% continuity of care, and we completely focus on the individual and help them find a way to better health according to their aspirations and values)

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As we walked through the Birks o’Aberfeldy yesterday we came across this amazing performance by a leaf dancing in the wind.

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In the main foyer of the National Portrait Gallery in Edinburgh, as well as the spectacular friezes, there are these stunning lamps.
I was especially taken by the design of the chains supporting the lamps – look at the lovely three circles within a greater circle, creating an inner Celtic triskele….


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looking up at the roof while standing in Waverley Station, Edinburgh yesterday….


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More of us are living more years than our ancestors did. That’s often presented as a problem. How will we afford all the pensions? How will we afford to pay for the extra care these millions of additional frail people will need? How will we afford to pay for the extra years of drugs they’ll be prescribed?

And what about respect for the elderly? Do we see this increase in the numbers of older people as providing us with unique resources of knowledge, wisdom, care, love, support?

How refreshing to read the words of Herman Hesse on this subject –

Aging is far from being only a process of reducing, wilting and fading. Old age, like every other stage of life has its own merits, its own magic, its own wisdom, its own sorrow.
Whoever becomes old consciously, can observe that in spite of diminishing powers and potencies, every ear brings an increase and an enhancement in the infinite web of relations and connections.

Oh, I so understand that last point in particular. With my now five grandchildren my web of relations and connections has been enhanced amazingly. And over the last few years, with teaching in different countries, and writing this blog, I’ve made many, many new friends and connections, meeting such different people who so often shift my perspectives and make my world a bigger, yet smaller place!

Here’s more from Hesse on the benefits of aging –

…increased independence from the judgement of others, less vulnerability to compulsion and more undisturbed reverence before the eternal

You should have been with me this morning when one of my very sprightly, beautifully dressed, 86 year old patients told me as I asked her if she was ok to climb the staircase with me to my consulting room, “that’s a beautiful, straight bannister on this staircase. Maybe I’ll slide down it on my way out!” ……made my day!

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Seasons of the Soul

The Seasons of the Soul: The Poetic Guidance and Spiritual Wisdom of Herman Hesse [ISBN 978-1583943137] – one of the most pleasurable, delightful, stimulating and enjoyable books I’ve ever read. It’s years, no decades, since I read Herman Hesse’s books, but this beautiful collection of poems, with enlightening and inspiring introductions by the translator, Ludwig Max Fischer has reignited my passion for his writing.

Here’s what Ludwig Max Fischer says about Hesse’s work

His gentle voice, full of truth, reminds us of the greater dimensions, the larger forces acting in our lives, beyond the immediate dramas of fear and desire. The soul, love, inspiration, the mysteries of nature, the unknowable divine, time and the stages of life are the major agents in Hesse’s world and are as relevant today as when he distilled them from his life experience.

and in Hesse’s own words –

My only goal in life is to be able to love this world, to se it and myself and all beings with the eyes of love and admiration and reverence….


It is a mysterious and yet simple secret known to the sages of all ages: the most minute act of selfless devotion, every act of compassion given in love makes us richer, whereas every effort towards possession and power weakens our strength and makes us poorer.

There’s a lot more like that in this book, and many inspiring poems too. I’ll give you one extract which strikes me as very relevant this Spring day. This is from his poem, Bursting With Blossoms –

Ideas too break open like buds of blossoms
at least a hundred every day
Let them unfold and roam as they wish!
Don’t ask for rewards!
There must be time for play and innocence in life
and room for boundless blossom.

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