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Archive for the ‘from the reading room’ Category

How we figure out what other people think

Posted in from the reading room, neuroscience, psychology on March 18, 2008| 2 Comments »

How we figure out what other people think or how they are likely to act is a complex phenomenon, but here’s one interesting aspect of it. There’s a technique being used quite a lot these days to try and understand how our brains work. It’s called fMRI – which stands for functional Magnetic Resonance Imaging. This is a scanning technique which allows us to see which parts of the brain kick into action when we are thinking or doing certain things. A Harvard team have used this technique while getting volunteers to answer questions about how strangers might think on the basis of having been given short descriptions of the strangers before hand. The interesting thing is that there was a clear difference in which part of the brain was used to answer the questions depending on whether or not the volunteer thought the stranger was similar to themselves or not. When the volunteer thought the stranger was similar to themselves they used the same part of the brain to answer questions about what the stranger might think, that we all use for thinking about ourselves (the areas we use for introspection, the ventromedial prefrontal cortex (vMPFC)).

In summary, we are more likely to refer to our own experience and ideas of ourselves when trying to guess how another person will think or act, only if we consider that person to be like us. If we don’t think they are like us, we have to use other cues – and those other cues, most psychologists think, come from observations and society’s rules, not from personal reflection.

This isn’t a huge breakthrough in understanding but I’m sure it does say something about why we are able to be more empathic with some people than we are with others, and probably also why communities are wary of strangers. It’s the basis of that old “you’re not from round here are you?” question which indicates the stranger is thought to be, well, strange!

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Your whole self working in unison

Posted in from the reading room, life, personal growth on March 16, 2008| 5 Comments »

Now and again I read a book that significantly changes things for me. Sometimes, it’s because the author describes new concepts I had never previously encountered. Sometimes, it’s because the author makes something I wasn’t sure about suddenly very clear. And, yet other times, it’s because the author’s words or ideas take my understanding of something to another level.

Books like The Joy of Philosophy, Linked, and Why Do People Get Ill are all good examples.

Recently, I stumbled across the work of William Glasser. His idea of Reality Therapy and Choice Theory immediately appealed to me so I bought one of his books. Choice Theory: A New Psychology of Personal Freedom. I’ve just finished reading it and I’m going to share a few things with you in a number of posts.

One of his key ideas is captured with the term “total behaviour”. What he means is that all behaviour is “total behaviour”.  All behaviour is made up of four elements –

  1. Acting
  2. Thinking
  3. Feeling
  4. Physiology

We can control our acts, and our thoughts, but we can’t directly control our feelings or our physiology. However, what we do and what we think affects our feelings and our bodies – for example, if you step into a dark empty house you might start to think about ghosts or people hiding in the darkness. Such a thought will make you feel scared and set your heart racing and quicken your breath. If you’re thought on entering the dark empty house is just “where’s the light switch” you won’t be feeling the fear and your heart and lungs won’t be speeding up. OK, that’s a very simplistic example, but I’m sure you get the idea. Everything in interconnected. The flows are two way. Just as a thought can influence your body or your feelings, so can a bodily change influence your feelings and your thoughts (and so your actions).

This holistic concept of whole being changes in different situations reminded me of the work of the General Semanticists of the mid 20th century.  They too talked about these links between the body and the mind. They used a different term from “total behaviour” – they used “organismic changes or responses”. But it was a similar idea. In much more recent times we’ve begun to see emerging areas of scientific study termed “psychoneuroimmunology” and “psychoneuroendocrinology” which are helping us to understand the mechanisms of these two way influences between body and mind.

I think it’s a great concept to keep in mind – that these four aspects of behaviour are always present and connect the many diverse parts of ourselves so that our whole self always works in unison. When you’re feeling bad, or your body is playing up, this understanding will help you to realise all is not lost. You can work on your thoughts and you can choose different actions and your feelings and your body will respond.

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Heroes Not Zombies – the book of the blog

Posted in creativity, from the reading room, photography, writing, tagged , on March 11, 2008| 9 Comments »

I’ve just taken delivery of my first attempt to use blurb.com to produce a book. It’s fabulous. It was so easy to do and the quality of the hardback book I’ve received is way beyond my expectations. And for any fellow bloggers, it’s a real treat to be able to page through a hard copy of your blog. I really do recommend it.

I am SO thrilled with the result. Click here to go and see for yourself.

What I wanted to do was produce a hardback copy of my first year of blogging. The blurb service has a program to download called “booksmart” and you use this to create your books. Included in the program is a great tool called “blogslurp” which downloads a complete copy of your blog into a template on your hard drive. You can then edit every single page, choosing different page layouts, upgrading low resolution photos for higher resolution copies from your photo library, and deleting or adding any text you choose. You then hit “upload” and that’s it. If you want you can preview the book as a pdf but I didn’t bother. I chose the largest format hardback book they do.

I am delighted with the quality of the printed copy and it got to Scotland in less than 10 days from the time I hit the upload button.

Here are some photos of the book to give you an idea what it looks like.
Heroes not Zombies The Book
Heroes not Zombies The Book
Heroes not Zombies The Book
Heroes not Zombies The Book
Heroes not Zombies The Book

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How Doctors Think

Posted in books, from the consulting room, from the reading room, health on February 19, 2008| 3 Comments »

“How Doctors Think” by Jerome Groopman (ISBN 978-0-618-61003-7) should be on the recommended reading list of every medical student and doctor. Dr Groopman is a physician who specialises in Haematology. This book is the best presentation on the cognitive processes involved in medical decision making I’ve ever read. Actually it’s main focus is on how doctors make a diagnosis and on their cognitive errors which result in them missing or mistaking the correct diagnosis. It’s clear and it’s comprehensive. It’s the kind of book that stimulates me to think about a number of aspects of medical practice and I’ll probably do individual posts about a number of them.

My summary understanding of this book would be that doctors make diagnoses by recognising patterns – that certainly seems consistent with what I think about my own practice. The key to this is the doctor-patient relationship. It’s the patient’s narrative that holds the key and the effect the patient has on the doctor colours how he or she hears that narrative.

My one criticism of this book would be that the whole focus is on the discovery of the “lesion” which is the source of the symptoms. Trouble is, as Kroenke and others have shown us, the vast majority of symptoms presented to doctors don’t come from “lesions”. I’d have liked to read Dr Groopman’s take on that huge issue.

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Creativity the Medici Effect way

Posted in books, creativity, from the reading room on February 13, 2008| 6 Comments »

The Medici Effect by Frans Johansson (ISBN 978-1-4221-0282-4) says on the front “If you can’t read it and come up with at least a minor Mona Lisa or two, you’re not trying”. Pretty enticing, huh? Well, so far, it hasn’t done that for me. Am I not trying? Well, actually, as Johansson shows, just reading about something isn’t enough. You have to turn your reading into actions.

The front cover quote is kind of misleading – this is an inspiring book but it certainly isn’t a “how to do it” kind of book.

The Medici Effect is an exploration of a single, simple concept – the intersection. The author’s claim is that innovation and creativity flourishes in the intersections. What intersections? Where different disciplines come together in the same team or project; where cultures meet; where languages meet. This concept reminds me strongly of the network science ideas which I read about in the fabulously inspiring “Linked“.

I think it’s very true. Some of my most creative times come around my visits to France and Japan. I spend most of my holiday leave in France and I love to go to the bookshops and the newsagents. The French publish utterly different magazines and books from the kind I find anywhere else in the world, and there is something about their perspective which I find so different from the one I find in the UK. In fact, for me, there’s something about reading French which is stimulating and exciting. I also visit Japan a couple of times a year and there the culture, the architecture, the contrasts of the spiritually ancient and the gaudy new sitting side by side, the design ethos focussed on transience and the constant dynamism of change, I find totally inspiring. When I go to Japan, I teach, with the aid of an interpreter which slows down my presentation style and gives me much more time to reflect. I come up with a new way to communicate something every time I go there.

The Medici Effect is what happens when you bring together diverse influences, and Johansson makes the claim that creativity and innovation is, in the final analysis, something that happens randomly. He gives the example of Edgar Allen Poe, who used to randomly choose three words from the dictionary and try to tie them together to make a new story.

As well as the valuing of difference and diversity which challenges and shifts our perspectives and stimulates our creative flow, Frans Johansson recommends abundance. He gives the example of Joyce Carol Oates, who published 45 novels, 39 collections of stories, 8 poetry collections, 5 dramas and 9 essay collections in four decades.

I especially liked his point that to be an innovative person you can’t just come up with ideas, you have to come up with ideas which are valuable and which are taken up by society or by other people. That seems so true to me. The truly creative people produce. They don’t just think. They do.

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The use of music to understand scientific experiments

Posted in from the reading room, science on February 12, 2008| 2 Comments »

Sometimes scientific experiments and findings can be really beautiful. When this happens we see a real cross-over from science to art. I recently came across a rather technical study from the field of quantum mechanics. Researchers have used a laser to study the wave patterns of movement of nuclei inside hydrogen molecules. As well as producing amazing colourful images which clearly show exactly the phenomena revealed in the experiment, the scientists produced an acoustic version relating the frequencies at the subatomic level to frequencies which we can hear, so letting us understand what’s going on using the musical analogy of notes and chords. The whole experiment is reported here. Do scroll down to reference 2 which gives a clickable link to a short movie file where you can see and hear what happens.

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An Eater’s Manifesto

Posted in from the reading room, health, tagged on February 10, 2008| 5 Comments »

Michael Pollan has written a Change This Manifesto about his new book “In Defence of Food”. I love the opening line –

Eat food. Not too much. Mostly plants. That, more or less, is the short answer to the supposedly incredibly complicated and confusing question of what we humans should eat in order to be maximally healthy.

In a three part book, he attacks the dominance of “experts” who promote a reductionist idea of nutrition based on components which are not foods; the Western diet with its imbalances and overload of processed foods; and sums up with 12 commandments to escape from the effects of the Western diet.

Essentially, he is arguing for us to eat whole foods, not industriously produced so-called foods which are manufactured from components; to enjoy our eating as a social experience; and for us to eat more fruit and veg, and less meat. The conclusions then are not ground-breaking but I like the simplicity of the message and the call to treat food as food, not as some utility, and to enjoy the sharing of meals.

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The enigma of health

Posted in books, from the reading room, health, philosophy on February 5, 2008| 8 Comments »

Maybe, like me, you have a collection of “significant” books. By that, I mean books which had a big impact on the way you think, or the way you understand life. I’ve written about some of those books here already, but here’s another one which I read a few years ago. Hans-Georg Gadamer‘s “The Enigma of Health: The Art of Healing in a Scientific Age” is a collection of essays by this professor of hermeneutics (I know, I had to look it up in a dictionary too, but, trust me, this man had a brilliant mind!)

Gadamer died in 2002, and while I was visiting Tokyo, a copy of the Japan Times slid under my hotel room door early one morning, included an obituary about him. I’d never heard of him, but it’s amazing what you’ll read in the wee small hours in a foreign country when your body and your head are still half a day away in your home town! I was completely fascinated with what I read and his thinking about health really captured my imagination so I went online and ordered up “The Enigma of Health” from Amazon. By the time I got back home it was waiting for me. Let me share a few quotes with you. I wrote them down in my Moleskine (as I do!)

Although health is naturally the goal of the doctor’s activity, it is not actually ‘made’ by the doctor.

I make this point with every new patient I see. It’s the big unspoken truth about medical practice. Doctors’ treatments might reduce or remove a pathology, might even redress an inner imbalance, but they don’t cure – only the body does that. He says more about here –

Yet the goal of the art of medicine is to heal the patient and it is clear that healing does not lie within the jurisdiction of the doctor but rather of nature. Doctors know that they are only in a position to provide ancillary help to nature.

Franklin put it another way when he said “God heals and the doctor takes the fees”

I often ask medical students to tell me the answer to this – if a patient with a urinary tract infection gives a urine sample which grows bacteria which the lab shows are sensitive to a particular antibiotic and the patient is prescribed that antibiotic, what will the antibiotic do? The ones who don’t think carefully say the antibiotic will cure the infection. It won’t. It’ll kill the bugs. That’s it. The inflamed bladder wall, which might even be bleeding from the effects of the infection will be restored completely by the body’s repair processes. The healing is natural. The antibiotic only removes the offending bug to let the healing system do its job. This might seem like nit-picking, but it isn’t. It involves a profound change in thinking. Doctors aren’t gods. At best they assist healing and all healing is a natural process.

…the doctor’s power of persuasion as well as the trust and the co-operation of the patient constitute essential therapeutic factors which belong to a wholly different dimension than that of the physico-chemical influences of medications upon the organism or of ‘medical intervention’.

There are some who think that health and illness can be understood in purely physical terms and that treatments can be understood to work, or not work, on the basis of their physico-chemical effects. That’s a limited way of thinking. Healing involves more than that, and may not even involve any physico-chemical intervention at all. Those who think medicine can be reduced to a science (as opposed to a science and an art) rely on measurements of phenomena. Gadamer is brilliant about this –

….modern science has come to regard the results of such measuring procedures as the real facts which it must seek to order and collect. But the data provided in this way only reflect conventionally established criteria brought to the phenomena from without. They are always our own criteria which we impose on the thing we wish to measure.

I believe it was Max Planck who said “facts are what can be measured”. Well, reality cannot be reduced to facts. The tendency to reduce understanding to physical measurements is accompanied by a concept of health as some kind of product – an end point or state which can be known and measured. Gadamer argues instead –

…physicians do not simply create a product when they succeed in healing someone. Rather, health depends on many different factors and the final goal is not so much regaining health itself as enabling patients once again to enjoy the role they had previously fulfilled in their everyday lives.

This clear statement suggests to us that health is an experience and it’s an experience which in its detail will be different for every person depending on the characteristics and environments of their lives. Later in his essays Gadamer considers how far from being a measurable product, health is really what is experienced when illness is not present or goes away. This is the “enigma” of health – that we only know it by its absence. Consider the fingers of your right hand. Right now you’re not really aware of them. Trap them in a car door and then you instantly become aware of them. You get the idea?

This post could go on forever! I’ll stop, but suffice it to say this is a deeply thoughtful consideration of our concepts of health, illness and healing.

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The importance of the person in medicine

Posted in education, from the consulting room, from the reading room, health on February 4, 2008| 8 Comments »

Sometimes these days, with the dominant biomedical model of health and illness it can seem like people don’t actually matter. The individual stories of patients are dismissed as anecdotes and treatments are divided into one of two categories “proven” or “unproven” on the basis of statistical analyses of clinical trials (experiments on pre-selected groups of volunteers). The implication is that what works in health care is the intervention, be that a drug or a surgical procedure. Who the patient is, and who the doctor is, seems to be of secondary, or, sadly frequently, of no importance at all.

Yet, if you are ever unwell, I bet it matters to you who you consult and how they behave. I think we all want to consult a doctor who, frankly, gives a damn! I know I do. How many of us would seek a health care system based on dispensing machines which dole out drugs after you input your symptoms?

Amazingly, this idea of the importance of the person in medicine is having to be fought for. So, it was with great interest that I read a review of a book in the BMJ this week. The book is “When Doctors become Patients” by Robert Klitzman (ISBN 978 0 19 532767 0). The author is a psychiatrist who became depressed and was so shaken by his experience of becoming a patient that he set about interviewing other doctors who had become patients too.

Time and again Klitzman found that becoming a patient transformed the doctors’ views (and of practice) of medicine.

Non-specific complaints, side effects such as weight gain and fatigue, fear, humiliation, and spirituality acquired new significance. Struggling to adhere to burdensome schedules, they became less draconian about poor adherence to treatment. In presenting medical information, they became aware of the importance of framing the information sensitively.

I guess this is not a surprise. You’d expect experience to change your views. However, you’ll probably find it more than a little shocking that the doctors needed the illness experience to figure this stuff out. We’re clearly missing something in medical education.

The phrase that really hit me between the eyes though was this –

In choosing their own doctor, most interviewees preferred bedside manner over technical skill.

It’s what I’ve always felt personally. I’ve always felt that what’s really important is that you find a person who cares, listens and puts your interests at the heart of the consultation. I take the technical skill bit as kind of a given. ALL doctors should have the technical skills they need to do the job and the processes of continuing education, annual appraisal and the coming revalidation procedures of the General Medical Council are all designed to ensure that. But what about the human bit? What about the importance of the person? We need to make this case more clearly. Too often, the technical skills are attended to, and then we stop.

Finally, the BMJ reviewer concludes –

Klitzman, like Gawande and Groopman, is part of a contemporary group of reflective doctors who, through their writings, contribute to the less palpable but nevertheless crucial moral, social, and experiential dimensions of medicine.

We need more of this. Maybe we are building a body of knowledge and opinion but we’re sadly lacking in the areas of research into the “experiential dimensions of medicine” and in providing medical education which considers this as of equal importance to the knowledge of drugs, trials and the technical skills required to do surgical procedures.

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How we learn – teaching and training

Posted in creativity, education, from the reading room on February 2, 2008| 4 Comments »

Pick the Brain has a great post about teaching and learning. It’s called The Movie Director’s Guide to Effective Teaching. In it, Victor Stachura, the author refers to William Glasser’s theories. Well, this is new to me. I’ve never heard of William Glasser. If you have, what do you think about his ideas and his suggestions? There’s a William Glasser Institute and my little browsing there so far has interested me. I want to find out more. Victor Stachura highlights something he read about learning and teaching from studying William Glasser –

“We Learn . . .
10% of what we read
20% of what we hear
30% of what we see
50% of what we see and hear
70% of what we discuss
80% of what we experience
95% of what we teach others.”

I don’t know about you, but that seems intuitively correct to me. I might take issue with the actual figures used and I also think it doesn’t allow for the processing preferences highlighted from the work of things like the NLP approach which helps us to understand that we are different and some process auditory information better than others, some visual information, and yet others kinesthetic information. However, with that in brackets, the overall thrust of this seems right.

If you are involved in teaching this is an important observation and if you want to learn, it’s equally important. It certainly highlights the importance of what is known as active learning. Sitting attempting to learn passively by just listening or just watching something isn’t easy. But when you have something to read, something to see and to hear, and then you discuss it, you will learn so much more. The challenge beyond that I think is to experience and to teach. I don’t know if you can experience much in a classroom, can you? Don’t you need to get out and actually live what you’re learning? I certainly think that’s true of medical training. Can’t see how you become a good doctor without actually doing it! That last step of teaching so works for me! I find that almost every time I teach, not only in the preparation stage, but also in the delivery, I learn something new myself.

I ran a training day based around characters in Lord of the Rings last week and not only did it convince me that I’ve learned more about my subject than ever, but the feedback from the students was about the best I’ve ever had. The day involved film clips from the Lord of the Rings movies and various small and plenary discussion groups. It was active and interactive all day long.

If you teach, how much do you use movie clips? I use them a lot. I find that not only do they combine the auditory and visual stimulation we need, but they are great for getting discussion going and, fundamentally, they provide the group with an experience – usually something involving both thought and emotion.

To return to the blog post which has seeded this one – the main focus of the piece refers to the “primacy-recency” phenomenon – the finding that we remember the first and last things in a sequence better than the things in the middle. Victor Stachura recommends we deal with this in teaching not just by putting important information at the beginning and the end, but by breaking up the lecture every 15 minutes with some audience exercise, or discussion, to keep attention from waning. He points out that good movie directors know this and change the pace of the movie frequently to achieve a similar effect.

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