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Archive for July, 2012

Ever since I was a little boy I’ve loved to look up at the sky on a clear night and lose myself in the wonder of the fact that the light from every single star has taken years and years to reach the Earth. How incredible that the tiny spots of light landing on the backs of my eyes left those stars millions of years ago!

Its astonishing to think that as you look up at the night sky you are looking at the past, the distant past. And how astonishing to realise now that our latest astronomical instruments let us see back billions of years, almost to the Big Bang itself. But not quite.

I recently came across the phrase “Cosmic Horizon”. The Cosmic Horizon is the furthest visible point in the Universe. In every direction as we scan the skies, we can detect signals from far away stars right up to a point of darkness which is so far away, so far distant in the past, that we can’t see anything any longer. This is the horizon. It’s like the horizon we see where the sky meets the earth or the sea, but much, much further away.

In the book, “The View from The Centre of The Universe”, Joel Primak and Nancy Abrams, building on this idea that the Cosmic Horizon is a limit in the timescale we can know, propose that we, the human race, need to develop our “Responsibility Horizon”.

This is a fascinating idea. Think about it. How far does you current “Responsibility Horizon” extend? One generation, maybe two? When you make decisions, do you consider the impact of those decisions on the lives of your children, or your grandchildren? You might. If you have children or grandchildren you might be concerned about the kind of world we are creating now for them to inhabit in the years ahead. But let’s stretch that beyond two generations. How far ahead do you want your Resonsibility Horizon to reach? And if it’s three or four, or more, generations, how will that influence the choices you make today?

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NHS CIC

What We Do

At the NHS Centre for Integrative Care in Glasgow Homeopathic Hospital this is what we do…..
The NHS Centre for Integrative Care provides a range of services for patients with Long Term Conditions. At the first consultation patients receive an integrative, holistic assessment which has three goals. 1. A comprehensive, biopsychosocial understanding of the person and their illness; 2. An orientation of care towards supporting vitality and resilience achieved through individual empowerment and skills required to maximise self-healing and self-management; 3. The creation of an individualised therapeutic plan. Therapeutic plans can involve a number of elements delivered one-to-one or in groups, in ambulatory outpatient, day case, or inpatient environments, as appropriate.
Care is delivered by multidisciplinary teams of generalist medical doctors, nurses and Associated Healthcare Professionals.
Interventions include patient education programmes, relaxation, meditation and cognitive behavioural classes, Tai Chi, Yoga, massage, Art Therapy, Counselling, Acupuncture and Homeopathy. All interventions are drug-free and intended to improve well-being and reduce the long term need for medication and surgery.
The Centre is particularly able to help patients with “Medically Unexplained Symptoms”, multiple co-morbidities and those who have exhausted other possible solutions to their problems.

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Evolution

From the Big Bang, to the first stars; from the stars to galaxies and superclusters; from stars to planets, to Earth; from Hydrogen and Helium to all the elements of the Periodic Table; from single cell life forms to plants, to animals, to human beings……….there are a couple of themes which run through the whole story.

Differentiation and diversity. It’s a story of increasing difference, of more and more unique and different elements.

Integration. Integration is the building of mutually beneficial relationships between differentiated parts.

Complexity. As different elements, or parts, build more and more mutually beneficial links, greater complexity emerges.

And here we are now. Human beings. With the most complex systems known in the Universe – our bodies, our brains, our consciousness.

Wow! It’s really pretty breath-taking.

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Dee Mangin, Iona Heath and Marc Jamoulle have published this week, in the BMJ, one of the best editorials I’ve ever read. It gives me hope.

They comment on a report from the US Institute of Medicine on people with chronic illnesses living well and right at the outset say it doesn’t go nearly far enough. They claim we need a shift in emphasis from “reducing mortality” to “living well”.

In recent years the single disease model has become an end in itself as disease management frameworks and targets for single conditions have become embedded in evidence based guidance and care pathways. Focus has shifted from patients and their experience of diseases to measuring parameters of the diseases themselves. Although evidence based models of single diseases in isolation work well for patients with one disease, they can lead to “siloing” of care for people with multiple conditions, and this can result in chaotic care. One study found that applying individual disease guidelines to a patient with five chronic conditions would result in the prescription of 19 doses of 12 different drugs, taken at five time points during the day, and carrying the risk of 10 attendant interactions or adverse events. Care that is “measurably better” may be meaningfully worse and a nightmare for the patient.

The prioritising a disease model approach over a person centred one leads to polypharmacy and steadily increasing numbers of patients being harmed, or even dying, from the very drugs prescribed to help them. As the authors point out, a lot of the problem comes from excessive and inappropriate use of guidelines –

The use of guidelines as standards enshrines polypharmacy and therapeutic positivism

and

Recommendations in guidelines are often based on the average response in study populations that are usually selected to be free of comorbidity and polypharmacy. Applying such evidence to the treatment of those with comorbidity who are taking a variety of drugs reduces benefit to an unknown extent and increases the potential for harm. The evidence base for the effect of treatments in the context of comorbidity is poor and does not account for variability in the genesis, expression, and progression of illness; the interaction of illnesses; the physiological damage caused by the stress from life events; and the impact of biopsychosocial interventions

One of the most important and stand out sentences in this editorial is

Chronic illness is characterised by its variability

Well, human beings, actually are characterised by their variability. Everyone is unique. No two people share the same story, the same life events, the same experiences. No two people make sense of their lives the same way or respond to their illnesses the same way. It’s time we redesigned our health care to take that simple fact on board.

There is a pressing need to reverse the current trend towards management of individual diseases in silos so that care of patients with chronic comorbid illness is much more closely driven by their particular symptoms, needs, and treatment effects and their own priorities for care. An improvement in health status must be seen not as an end in itself but as the means to fulfilment and possibility in the life of the patient. Furthermore, healthcare systems need to start to value and provide adequate support for the kind of iterative generalist care that focuses more on the person than on the disease entity and the necessary variation this entails. This would place equal value on the art of “not doing”—making complex decisions not to give treatments, not to order tests, and to stop current treatments when in the best interests of the patient.

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I was struck yesterday by a report from the London School of Hygiene and Tropical Medicine which found that almost 12,000 people “die needlessly” in NHS hospitals each year due to basic errors by medical staff.

There was one point in the report which really leapt out for me –

They [medical staff] were not assessing patients holistically early enough in their admission so they didn’t miss any underlying condition. And they were not checking side-effects….before prescribing drugs.

Learning from the events where things don’t work out as well as we’d hoped is a key way for all human beings to develop and improve. Whilst it’s terrible to read about people dying from basic errors in the health care system, there’s a real light of hope in the identification of the kinds of problems to be addressed.

If we could treat people holistically, seeing them as whole people, not as episodes of disease, then we’d have a better understanding of their problems and be better placed to address them. If we paused before prescribing, and consciously considered the potential side-effects and interactions (the harms) rather than prescribing by protocol drug X for condition Y, then maybe we’d reduce over all prescribing as well as prescribing errors.

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I’ve lived in my present home for just over a decade. I look out through the big old arched windows of this 1800s textile mill across the Carse of Stirling to Ben Ledi. I must have looked out on over 3000 different days.
I have never seen the same view twice.
See how it looked last night.

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I’ve never seen it look like this before.

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photo

I know it’s easy to think, oh no, another rainy day! But look at the beauty captured in a raindrop.

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