Feeds:
Posts
Comments

Archive for the ‘from the reading room’ Category

Becoming a hero…..slowly

Posted in from the consulting room, from the reading room, health, life on July 19, 2007| 6 Comments »

I read a great post on the SlowDownNow.org blog. In it Christopher Richards describes his experience of being looked after by a doctor who took his time, then his experience of trying to find a new doctor after this first one had retired.

I’m pretty sure we’re losing something really important with our current round of NHS reform. And its something related to speed. Sure you need fast, effective treatment when you are acutely unwell, but the surgeon or physician who is tending you still needs to take his or her time and not rush things or the job just won’t get done properly. However, the big demand in health care these days is chronic disease and here we really have been looking for quick fixes at the expense of taking our time to listen, to understand and to enable patients to adapt, to grow and to enlarge their lives in the presence of their diseases.

An American sociology professor, Arthur Frank, wrote “The Wounded Storyteller” (ISBN 0-226-25993-5) to describe his study of how patients talk about their illnesses. He identified three major “genre” of narrative – the “restitution” one – which is the quick fix approach to health care (“A bit of me’s broken. If you could just fix it or replace then I’ll be on my way”). This is appropriate in much urgent and acute medicine but is really of no use in chronic illness or in enabling patients to become genuinely healthy. He proposes that doctors should help their patients to create new narratives – “quest narratives” based on the principles of Joseph Campbell’s work on the structure of myths and legends (otherwise known as Hero stories).

That very process entails a shift from the quick, the immediate, the partial to the slow, the lasting and the whole.

I wrote here about countering Getting Things Done with Dolce Far Niente, and here about finding the spaces where you can relax, and here about becoming aware of the gaps in our experience.

What ways do you slow down?

Does slowing down improve your quality of life? Give you time to reflect, re-charge, and to grow?

Read Full Post »

Getting published

Posted in books, from the reading room on July 19, 2007| 1 Comment »

“It is a truth universally acknowledged, that a single man in possession of a good fortune must be in want of a wife.”

Hands up if you recognise that opening line……

David Lassman, the director of the Jane Austen Festival in Bath decided to copy out opening chapters of Jane Austen novels, changing only character names and send them to publishers as his own work to see what would happen. He sent Northanger Abbey, Persuasion and, yes, even Pride and Prejudice (that’s the opening line up there….!) to a number of big publishers and agents.

Two interesting things happened. Firstly, they all got rejected – the publishers didn’t want to publis them. Secondly, nobody seemed to spot the plagiarism – well, apparent from one person at Jonathon Cape. But here’s the bit that really struck me – Penguin said this about his Pride and Prejudice look-a-like

It seems like a really original and interesting read

When challenged about this later they said

A spokeswoman for Penguin pointed out that its letter had said only that it “seemed” original and interesting. “It would not have been read,” she insisted.

What??! They said it “seemed” interesting but they didn’t read it? Oh dear, is publishing totally random? Is it just luck? I suppose it would have been worse if some publisher had offered him a contract and published it without realising the book was actually a Jane Austen novel, but that probably was never going to happen. The saddest part of this tale is the way the rejections either suggested the book was not good enough to be published (poor Jane Austen!), or gave false hope. Wouldn’t it be better for a manuscript to either be sent back with a note saying the company did not want to look at it, or for it to be taken seriously and a clear, honest communication about it to be given to the author?

Why does this interest me? Well, one of the key themes of this blog is a call for individuals to matter more than institutions and systems. The more impersonal and systems based our society becomes the more we are all poorer.

Read Full Post »

Why your uniqueness matters

Posted in from the reading room, health, life, science on July 19, 2007| 4 Comments »

The Guardian today has an article about a research paper published back in May in the British Journal of Psychiatry. There are more and more attempts to control the future in our society. Predictive statistical models are increasingly being used by everyone from supermarkets (to “target” their marketing to you on the basis of what they think you might like to buy), to social work (to give special help to young mothers who they think might give birth to children who will become criminals), to the criminal justice system (to try and predict re-offender probability), to (my main area of interest) health care (where the experience of groups is used to determine what interventions an individual should or should not recieve – so called “Evidence Based Medicine”).

The paper discussed in today’s Guardian shows that the margin for error between the group studies and individual outcomes is so great that –

When applied to individuals the margins of error are so high as to render any results meaningless.

Almost every day I have a discussion with patients about risks and choices. I always emphasise that the statistical predictions are based on groups and averages and that there is absolutely no way of knowing to what extent they are relevant to this individual.

We are all different. Nobody, but nobody, can tell an individual what their future holds and to pretend they can on the basis of statistical modelling which isn’t up to the job is potentially very harmful.

This heroes not zombies site is about encouraging people to become aware, to think, and to develop their uniqueness. We need to celebrate individuality and difference more and we need to understand that people matter more than statistics – especially in social work, justice systems and health!

Read Full Post »

Horizons and the size of a life

Posted in from the consulting room, from the reading room, health, life, photography on June 28, 2007| 2 Comments »

I’ve just started reading Sebastian Faulks’ Human Traces. On page 21 this sentence struck me

Do we already possess all we need to stop feeling the world as the sound of footsteps and the ache of our backs and to look up – to the woods and the hills and the oceans that stretch out in their immensity, just waiting to be seen?

I’m in the habit of drawing simple little diagrams to explain things to patients. I draw one which is just a circle. I say “This circle represents your life”. Then I draw a much, much smaller circle inside the first one and I say “When we have chronic pain, or sadness, or breathlessness, or stiffness, or whatever, our life becomes much smaller. Maybe we can’t go out so much. Maybe we can’t face other people. Maybe everything loses its joy. It’s necessary to do this to survive sometimes. We all need to feel safe before we can grow. If the treatment I’m going to give you works it’ll reduce your symptoms and stimlate your body’s natural healing processes and so let you begin to look up and start to see that you can move outside of this constricted, safe zone, and as you do, your world will start to get bigger and more enjoyable again. Then we’ll know you are getting well.”

We don’t grow with our heads down. We grow when we look “to the woods and the hills and the oceans that stretch out in their immensity”

These are the hills I see from my bedroom window

Read Full Post »

The Witch of Portobello

Posted in books, from the reading room, life on June 25, 2007| 4 Comments »

The Witch of Portobello by Paulo Coelho. ISBN 978-0-00-725184-1

If you enjoy the work of Paulo Coelho, and I am someone who does, then you will enjoy his latest book. He has created a very distinct style for himself. As a reader you know what to expect and you’re not disappointed. Mind you, having worked as a General Practitioner in Portobello, Edinburgh until I took up my current post, I was disappointed that the book wasn’t set there! There’s plenty to enjoy and lots to think about in this novel. Let me focus on the idea of the witch because that is fundamental to the whole work. On page 13 he describes four archetypes of women –

  • Virgin
  • Martyr
  • Saint
  • Witch

What really got me thinking here was his description of the path to enlightenment characteristic of each of these archetypes –

  • Virgin – Independence
  • Martyr – Suffering
  • Saint – Unconditional Love
  • Witch – Pleasure

Do you recognise these archetypes? I don’t think they are exclusive to women. As with all archetypes of the psyche I think each of us resonate with them to greater and lesser extents. It’s unusual to find someone who can be fully described by a single archetype. So which of these do you resonate with? And how can you play to your strengths then?

Like all Paulo Coelho’s books, this is a story of self-discovery and how to find your own way in life.

Read Full Post »

To boldly go where thinking hasn’t thought before……

Posted in from the reading room, health, philosophy on June 17, 2007| Leave a Comment »

Interesting article on ScienceDaily today about a physicist postulating the existence of non-particles. It’s one of those mind-bending thoughts that physicists are so good at – maybe not everything is made of particles? Maybe there’s something else? “Non-particles”?

The line that really caught my attention was this –

a theorist who restricts their imagination to merely the likely possibilities probably isn’t trying hard enough.

I totally agree. This is true in life as well as physics. If you only think about the kinds of things you’ve already thought about you’re either stuck in a loop or you’re restricting your view.

The area of clinical practice in which I work is Homeopathic Medicine – as a doctor in the National Health Service, in Scotland’s only NHS Homeopathic Hospital. Some people ridicule homeopathy because they say there is “no plausible mechanism” to explain how it can work. But two thirds of the patients we see at the Homeopathic Hospital have already failed to have their pain, wheeze, depression, whatever, relieved by the best “Evidence based” treatments, but get relief after treatment with homeopathic medicines. It might be hard to accept that a treatment we can’t explain can have a useful place within the Health Service but the daily reality is that it does. So, I say to other doctors or “scientists” who dismiss this form of treatment, learn from the physicists…..

Try harder, imagine the unlikely as well as the likely.

Read Full Post »

What would you like to win?

Posted in books, from the reading room, health, life, philosophy on June 14, 2007| 3 Comments »

Here’s a quote from The Conqueror by Jan Kjaerstad

Supposing one were a conqueror – what would one win? The world? A little peace of mind? A name? Immortality? Oneself? Power? Women? There were times in Jonas Wergeland’s life when he felt there was only one thing worth striving for: health. To be fit and well.

What do you think? Do you agree with Jonas? What do YOU think is worth striving for?

Read Full Post »

The Conqueror by Jan Kjaerstad

Posted in books, from the reading room, narrative on June 13, 2007| 5 Comments »

ISBN 1-905147-16-3. The Conqueror is the second in a trilogy by Norwegian author Jan Kjaerstad. The first volume, The Seducer, certainly seduced me. I read it when the English translation was published in 2003. That first volume hooked me before I even opened the book. On the back cover the blurb begins

So how do the pieces of a life fit together? Or, to put it another way: do they fit together at all?

Well, this is an idea which really intrigues me. I often think we have so many roles, so many aspects, so many threads running in our lives that it’s quite a challenge to see how it all fits together. Every time I sit with a new patient I’m doing the same thing – collecting the pieces of their lives, the fragments of their stories and trying to piece it all together, to make sense of it. The novel tells the story of one Jonas Wergeland, a famous Norwegian TV producer who arrives home to find his wife dead on the lounge floor. Shot. He is arrested and charged with her murder. The whole of the 600 pages of that first volume is made up of dozens of stories that try to explain how Jonas ended up at this juncture. By the end of the book we don’t know if he has been found guilty. The quality of the writing and the way he built up an understanding of Jonas by the telling of multiple stories of his life completely enthralled me. It’s taken four years to get volume two, The Conqueror, translated into English.

In The Conqueror we are made aware that Jonas has indeed been found guilty and Jan Kjaerstad uses the same technique to try to explain how a great TV producer, revered by a whole nation, could end up killing his wife. Here are a couple of lines from The Conqueror that will explain why this book so captures me as a reader

Maybe our existence is best understood as a story.

I don’t know any other way to understand either my existence or that of another. We construct ourselves and we communicate our private subjective unique experience of living through telling stories.

 For so it is: even though life is lived forward, it is always understood backward. You turn around and behold – in awe or fear – a pattern that you are not aware of having made.

Isn’t that so true? This man writes beautifully. I find his novels totally addictive. And how long will it be until the third and last part of this trilogy comes out in English? I suspect it’ll be around 2011! Well, you know what? I’ll content myself with a re-read or two of The Seducer AND The Conqueror while I wait!

There are many lines in The Conqueror that I’ve noted down and want to say something about. I’ll take them individually in separate posts (first of all over the next few days, then, probably, as I re-read these books, over the next few months). If you love stories, layers and layers of stories that develop an understanding of a person’s life, and you love good writing, I’d recommend you buy these novels and treat yourself.

This blog is titled “Heroes Not Zombies” because I have this belief that most of us sleepwalk through most of our lives, on automatic pilot, and that life can be better for any of us if we wake up, become more aware, more reflective and more creative. In short, the best kind of life is the one where we are the heroes of our own unique stories. Here’s Jan Kjaerstad again

Because most heroic tales can awaken forces which until then have lain fettered inside a person.

The BIG work of the main character of these novels, Jonas the TV producer, is his documentary series on Great Norwegians. As each episode is described, another Norwegian hero’s life and significance is manifested to the whole, hooked nation. Norwegians are described in the novels as a nation of spectators and the spectacle of this series on national heroes is what makes Jonas’ reputation. Every episode captured my imagination so much that I swung between wishing the series had been real so I could actually buy the DVD and watch it, and feeling I had seen and heard every detail in the author’s wonderful descriptions anyway.

This is a book which will make you think. It’ll make you think about stories and how we use them to understand ourselves and others. It’ll make you think this

But no occurrence, no day in a person’s life is so trivial that it might not be crucial. Important things happen all the time………all days are in a way, holy days.

Read Full Post »

Walking is good for you (but how can you be convinced?)

Posted in from the reading room, health on June 3, 2007| 3 Comments »

A BMJ-published study from the Scottish Physical Activity Research Collaboration has focussed not on the fact that walking 30 minutes every day will significantly reduce your chances of suffering from several diseases (potentially halving heart disease risk for example) but on how to motivate people to act on this advice.

What would it take for YOU to change your habits and walk for 30 minutes every day?  The answer is interesting –

Our findings are consistent with (but certainly not proof of) an assumption that different types of people may respond to different approaches, tailored to their psychological characteristics or life circumstances. In other words, one size may not fit all and various approaches should be offered: some people may respond best to personal advice from their doctor, others may prefer the private feedback from a device such as a pedometer, others (perhaps those in a more advantaged socioeconomic position) may benefit from interventions delivered through the internet, others may benefit from the social support of a walking group, and others may increase their walking in response to prompts about reducing their car use on environmental grounds.

In other words, what works for one person doesn’t work for another and if we want to help people we need to both actually communicate with them to find out a bit more about them, and then tailor our advice to best suit the individual.

This kind of study gives me hope. For too long Medicine has focussed on disease and then tried to treat every patient with the same disease in the same way, but we are beginning to see the glimmers of the New Medicine which focusses on the individual and tailors the treatments according to the individual’s uniqueness.

This is a move from Zombie Medicine (unthinking, treat everyone the same) to Hero Medicine (thinking, holistic and individualised)

Read Full Post »

“Novel” treatments?

Posted in education, from the reading room, health, science on June 3, 2007| 2 Comments »

A three year study of treatment for “acute promyelocytic leukemia” adding arsenic into the mix has shown that doing this can increase the survival rates significantly.
What really struck me in this story though was this comment by the Reuters journalist –

Arsenic has been used as a traditional therapy in China for more than 2,000 years, but its use in the United States is still rather novel.

Why is that? What is it about the tendency to certainty in Western thinking? I suppose we have a long history of believing we are right and that our ways are best. We live in a chaotic world where chance events change people’s lives forever every single day. When it comes down to the individual all the so-called certainty of our statistics-focussed view of the world is of little use. When I meet a patient with disease X, I have no way of telling whether or not they will CERTAINLY respond to the same treatment as other patients with the same disease, nor of knowing EXACTLY what will lie ahead for them. But as human beings we can’t cope with total chaos, and complete uncertainty. We need to have some idea of what’s happening in our lives and some idea of how things MAY turn out with particular choices we make. That’s just how we are. We need to juggle our knowledge of uncertainty and unpredictability of the particular with our knowledge of probability gained from the general. The problems arise once we turn those probabilities into certainties.
There was an interesting line of dialogue in CSI the other night – one character, a forensic scientist, said “I am confused”, and her boss replied “Good. That’s the best place for a scientist to be”. He was SO right. Well, not that scientists should always be confused but a scientist who stops doubting, stops looking and stops thinking.
Wouldn’t it be a good thing for us to look outside of our little boxes and see what phenomena are actually already well-observed (just by other people in other places – people who think differently from “us”)

I’m a homeopathic doctor and homeopathic arsenic was the very first remedy I had success with. Whether or not you believe in homeopathy, one thing a study of the subject brings is a greatly increased knowledge of substances used medicinally in different cultures over the centuries. It’s well known to homeopathic doctors that arsenic has traditionally been used to increase stamina and staying power (in fact, it was used to do just that in racing horses until it was made illegal!)  It’s also well known to us that arsenic is a commonly indicated homeopathic palliative treatment in cancer.

I wish we could replace the arrogant know-it-all and I-know-best in scientists and doctors with an attitude of lifelong curiosity and wonder.

What do you think? How would you change the education of scientists and doctors to increase open-mindedness, creative thinking and foster a spirit of humble, endless curiosity?

Read Full Post »

« Newer Posts - Older Posts »