Archive for January, 2014


So, here’s a study which makes you go…..duh!? Is anybody surprised?? The conclusion is this –

When physicians spend too much time looking at the computer screen in the exam room, nonverbal cues may get overlooked and affect doctors’ ability to pay attention and communicate with patients

Using video cameras to follow eye gaze the researchers found that physicians using electronic health records were likely to spend a third of their time in the consultation looking at the computer screen (I’m surprised it was only a third!) and, more surprisingly, that the patient too gazed at the screen, even if they couldn’t see, or read, the details on the screen.

When doctors spend that much time looking at the computer, it can be difficult for patients to get their attention,” said Enid Montague, first author of the study. “It’s likely that the ability to listen, problem-solve and think creatively is not optimal when physicians’ eyes are glued to the screen.”

Can’t disagree with that….it’d be surprising if a doctor could pick up the non-verbal clues when they are looking at a screen.

What do the researchers recommend?

Nope, not putting a bag over the screen the way people used to put a bag over bird cages to get noisy parrots to go to sleep. Instead they say their findings could contribute towards

more effective training guidelines and better-designed technology. Future systems, for example, could include more interactive screen sharing between physicians and patients

Pssst! Researchers! I’m over here! How about getting Humphrey Bogart to teach doctors? If the norm was “here’s looking at you, kid”…..well, what do you think??

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colorsplash rainbow nelson mandela



Fear drains the colour from our world, hope paints it back.

Fear is used in such a controlling way in our world…..it’s the major tool used to produce conformity, uniformity, compliance, and obedience. Yet no life can be lived without hope.

Every day that’s my job….to help dispel fear, and instill hope.

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Peter Block, headlines his website with this quote from Thomas Merton –

Do not depend on the hope of results … In the end, it is the reality of personal relationship that saves everything.

(I wonder if we should have that painted onto the walls of every consulting room?!)

He was recently interviewed by Tami Simon in the Sounds true Insights at the Edge programme. She initially asks him about idealism, which he defends –

Well, when you defend idealism, you defend imagination. You defend possibility. You defend the world of ideas. The argument against idealism is the wish to be “practical”—the wish for an evidence-based world, the wish for proof. Idealism affirms the place of mystery, not knowing, and caring about things that are [immeasurable]. So I always see the argument against idealism as the argument against democracy, the argument against love, the argument against justice and equity, and all the things that our culture has abandoned in the name of privatization and economic well-being.

I was often “accused” of being an idealist as a teenager, and it was always a charge I was happy to accept. I still do. I completely agree with him about the place of mystery, and about caring about things which are immeasurable.

He then goes on to discuss how being “results minded” values doing what is already being done, and repeating it. I remember Sir Harry Burns, the Chief Medical Officer of Scotland saying how he worried that “evidence based medicine” was being used to stop innovation and development, how if all we do is keep doing what we have already “proven”, then we will hold back improvement and creativity.

It’s just [I know] that the conversation about results-orientation doesn’t produce results. When people say they’re “results-minded,” I know that they just want to recreate the past. Underneath it all, they’re kind of bored. So that language of a tough-guy adolescent—zero defects; failure is not an option; total results-oriented; if you can’t measure it, it doesn’t exist; evidence-based medicine; evidence-based education. All that language doesn’t take us anywhere.

I’m sure some people will find that view controversial, but it sure “sounds true” to me.

Finally, I really liked his suggested question for us to ask ourselves….

What would it take to create a future distinct from the past?

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Swan cruising

Goldie Hawn said in an interview the other day

There’s so much left. You know if you lose wonder, you’ve lost everything, so I can’t tell you what I’m going to be wondrous about tomorrow, but I live now, and what I’m living right now is the world of wellness, helping as much as I can, being the voice and the creator of more applications and more ways to access happiness.

Yes! Wonder, or the “emerveillement du quotidien” gives daily life a constant quality. And “living right now” is the only way to really live.

Goldie was talking at the World Economic Forum about her MindUp project – a programme her Foundation has created based on mindfulness practices and positive psychology. I like her emphasis on neurobiology and her focus on children and schools.

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In the A – Z of Becoming, the fourth verb, D, is for Dream.

Sleeping baby on hoarding

I took this photo some years ago in the Ginza district of Tokyo. I think it captures two ideas about dreaming.

The first is that when we think of dreaming, partly what we think of is what we do when we are asleep. What did you dream last night? Can you remember? Nobody understands what night time dreaming is about, but for many years psychoanalysts and others have found that dreams can be a rich source of insights into the unconscious mind. If you want to explore what lies within your own dreams, you’re going to have to start improving your ability to remember them. The best way I know of doing that is to keep a notepad beside your bed with a pencil or pen beside it and when you wake up, immediately write down what you can remember from the dreams you’ve been having that night. I’m sure you’ll have had the experience of waking up in the midst of some vivid or powerful dream, only to find all trace of it disappears when you have your first thought about the day you’ve woken up into. I think there is also some mileage in setting your intention. Before you go to sleep, your last thought can be “let me dream tonight, and let me remember tonight’s dreams when I wake tomorrow”. Many people say setting such an intention, coupled with having the notebook ready for when you wake, gives you an increased chance of capturing those dreams. As with so many other thoughts and behaviours, the more you do it, the more easily you’ll do it, so even if the first few mornings you find you still can’t remember anything, persist. Once it becomes established, it becomes more useful.

The second is the kind of dreaming we do when awake, and I don’t particularly mean free-floating day dreaming, I mean consciously dreaming. The fact this construction company in Tokyo chose to print an image of a sleeping baby, cleverly hints at that other kind of dreaming….the kind which is part of the creative process. Dreams which become plans, blueprints, goals, projects…..dreams which become paintings, poems, stories and songs. Dreams of where we want to go, what we want to see and do.

Allow yourself this week to become aware of both these kinds of dreams. Maybe you can note some of them down in your notebook….in your dream journal? Maybe you’d like to have two dream journals, one for the dreams of sleep, and one for you conscious dreams, or maybe, and I prefer this option, the one journal for ALL your dreams……after all, you might find that the one kind of dream becomes entangled in the other kind, and something quite surprising might emerge.

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Integrative Medicine is an approach to health care which emphasises the need for greater levels of integration.

But what is integration?

Simply, integration is the creation of mutually beneficial bonds between well differentiated parts.

The two aspects of that definition are the bonds – better integration means more connections of a mutually beneficial nature, and better differentiation of the parts.

Within our own bodies, which are incredible complex networks of highly differentiated cells, we see a healthy state when each of the individual organs (each of which are networks of millions and millions of different cells), are functioning well……the heart functioning and flourishing as the best heart it can be, the liver functioning and flourishing as the best liver it can be, and so on….and where each of the organs are contributing to the health of the other organs.

Within an organisation, which are also incredible complex networks of distinctly unique human beings, we see a healthy state when each of the individuals is flourishing….developing and exhibiting their greatest potential…….and relating to all the others in the organisation in mutually beneficial ways.

In short, be your unique self, and relate to others in ways which are good for you AND the other.


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It’s Burns Night tonight, but I’d like to share the opening verse of a poem by another old Scottish poet, Thomas Campbell. From his, ‘The Pleasures of Hope’…..

At summer eve, when Heav’n’s ethereal bow
Spans with bright arch the glittering hills below,
Why to yon mountain turns the musing eye,
Whose sunbright summit mingles with the sky?
Why do those cliffs of shadowy tint appear
More sweet than all the landscape smiling near?—
‘Tis Distance lends enchantment to the view,
And robes the mountain in its azure hue.

first thing this morning


Although this turns around the French idea of the “view from on high“, in some ways, it’s the same idea. How often does it seem that it’s the distant mountains which catch our eye when we look at a landscape? I know that’s what catches my eye first. Every single day I look out of one of the windows of my flat and look for Ben Ledi. Unless there is mist, or the clouds have come down in front of it, it’s Ben Ledi I see first.

I like this idea of Campbell’s that the ‘distance lends enchantment to the view’, and I think our everyday often lacks enchantment, so maybe here’s an easy way to increase it…..look to hills, folks!

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These are not my photos, but here are two amazing revelations of diversity.

The first is a magnification of grains of sand…..yes, sand, the kind of sand you find on the beach. Did you have any idea that grains of sand were so diverse?



Then, you might have come across these amazing photos of snowflakes…..here is just one of them.



So, folks, if even grains of sand and snowflakes are so diverse, can you imagine how diverse more complex forms are….like lifeforms? Like human beings?

This is one of THE main purposes of the universe – to produce ever more uniqueness, ever more diversity

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ferns unfurling

“There is nothing noble in being superior to your fellow man; true nobility is being superior to your former self.” – Ernest Hemingway

My favourite movie portrayal of Hemingway is in Woody Allen’s Midnight in Paris

One of the key themes of Marc Halévy’s work is the idea that the purpose of Life, indeed the purpose of the Universe, is “l’accomplissement” – the notion that everything that exists, every organism which exists, every person who exists, is trying to accomplish its, or their, full potential.

There is a direction to evolution, and its the same direction we see in every single life. The continuous striving to flourish, to be the best, the most, the greatest they can be. From a crystal, to a plant, to a bird, to every unique human being…..”true nobility is being superior to your former self”

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paris park

Sometimes I think there are two kinds of people (that’s nonsense of course because there are as many “kinds” as there are people!). The two kinds I’d like to consider here are those who value stories, and those who value data.

I am still astonished when I remember the conversation I had with a young junior doctor who told me they were being taught “Don’t listen to the patient, they lie all the time. Only the results tell the truth” That is a data teacher talking, and, frankly, I think it’s scary to think such an attitude exists in doctors, especially doctors who are teaching young doctors. (by the way, do you remember a character called “Data“?)

What I love is the story. Every person I meet tells me a new story. It’s in the narrative that I can make sense of their suffering. It’s in the narrative that I can see the connections between the mind, the body and the spirit.

We all use narrative, not only to understand each other, but to make sense of our own lives.

When I first started to explore the use of narrative in medicine, I think the very first article I read was by Rita Charon. Here’s a passage from her book, Narrative Medicine.

What I am trying to convey is the kind of listening that will not only register facts and information but will, between the lines of listening, recognize what the teller is revealing about the self. Conventional medical care has not considered this kind of listening to be its responsibility. Except for some psychiatrists and psychoanalysts, health care professionals cannot give the time or get the training needed to listen for stories. Without knowing what is salient to an illness and what is not, many doctors and nurses fear that such listening will trap them for hours hearing information that is unrelated to disease. Listening to it, they think, will only distract them from the task at hand— to deal with the insomnia or to treat the abdominal pain. Unfortunately, sickness does not travel in straight lines, and we who care for sick people have to be equipped for circuitous journeys if we want to be of help. Although many health care professionals worry that they do not have the time to listen for stories, many of us who have incorporated listening into practice find that time invested early is recouped quickly. Indeed, the first few visits with a patient may take more time than in conventional practice, but time is saved shortly down the road by having developed a more robust clinical alliance from the start. The serious consequences of not being able to do this kind of narratively sophisticated listening is that patients’ symptoms get dismissed, their non-medical concerns get ignored, and treatable disease gets missed. More compellingly, only this kind of narrative listening will hear the connections among body, mind, and self, and disease recognition and treatment cannot proceed, we are beginning to believe, without simultaneous attention to all three.

I think that’s so right. The shame and weakness of the UK NHS is how it is constructed around routine encounters between doctors and patients which last less than ten minutes. What on earth can you understand about a patient in ten minutes? How do you make a diagnosis? No wonder doctors send patients off for X Rays, scans of this, scans of that, and blood tests so much nowadays. But what worries me most about our current model of care, is how prioritising data, results in just what Rita Charon says “patients’ symptoms get dismissed, their non-medical concerns get ignored, and treatable disease gets missed.”

Jennifer Percy, writing in The Atlantic, says

The language of science was unsatisfying to me. “The most incomprehensible thing about the universe is that it’s comprehensible,” Einstein said. But I don’t think human relationships are ever fully comprehensible. They can clarify for small, beautiful moments, but then they change. Unlike a scientific experiment with rigorous, controlled parameters, our lives are boundless and shifting. And there’s never an end to the story. We need more than science—we need storytelling to capture that kind of complexity, that kind of incomprehensibility.

It’s not just human relationships which are never fully comprehensible, it’s human beings. Can we really apply “rigorous, controlled parameters”, to lives which are “boundless and shifting”?

We do need storytelling to capture the complexity. And we do need to understand that these stories never end.

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