Feeds:
Posts
Comments

Archive for the ‘health’ Category

What a consultation with your doctor should be like

Posted in from the consulting room, from the reading room, health on September 7, 2007| 2 Comments »

In Kieran Sweeney’s “Complexity in Primary Care” he quotes from Toon’s “What is Good General Practice?” paper –

The consultation is the patient’s forum for coming to understand her illness, not merely a rational understanding, but an understanding which involves the emotions and which contributes to the growth of the individual.

Oh, how, very, very true.

Print that out. Take it with you next time you have to consult a doctor. That’s what the consultation should be about – it’s YOUR forum, for YOU to gain an understanding of what’s happening in a way that will “contribute to the growth of the individual”.

There’s your standard. Measure your doctor visits against it!

Read Full Post »

Complexity, evidence and intuition

Posted in from the consulting room, from the reading room, health, science on September 7, 2007| 6 Comments »

I’ve just read Kieran Sweeney’s “Complexity in Primary Care” (ISBN – 1-85775-724-6) and found it both stimulating and agreeable. I am SO glad that books like this are being published. I’ve read both of his previous books – “Complexity in Healthcare” and “The Human Effect in Medicine”. He’s one of those authors who is bringing the fairly new ideas of complexity science to the attention of clinicians, I think with the intention of trying to redress the balance a bit. Medicine has become very reductionist and limited in its approach and whilst this has paid off in dealing with acute diseases it hasn’t helped in dealing with chronic disease OR in the wider desire to maintain health. In addition to this, the modern thinking he scopes out in these books really has a chance of helping us to reclaim a much more human-centred practice of medicine.

Here’s a couple of quotes from the book which really struck me –

The requirements of medical research are limited by insisting that an answer should be numeric, otherwise it is not a real answer.

That reminded me of what I just posted the other day there about the value of patients words over numbers. It also reminded me of this – I once heard a dentist describe his experience of replacing a retired colleague in a specialist facial pain clinic. He didn’t know that his predecessor had devised a scoring system for pain and had trained all his patients to report a figure as a way of telling him how much pain they were experiencing. Apparently, this man would become quite frustrated with patients who tried to talk about themselves and would even say “Stop. Not another word! I want the next thing to come out of your mouth to be a number. Nothing else! On a scale of 0 to 20 how has your pain been?” The dentist who was telling me this story was quite baffled when he took over the clinic and saw one patient after another come in for follow-up consultations and just say “17” or “12” or “9”, then refuse to say another word. They were too frightened! He didn’t find their answers very useful.

It seems that a lot of what I’m reading just now is challenging me to think about non-rational thought, intuition, gut-feelings, whatever you call that way of understanding the world. In particular I’m reading Solomon’s “Joy of Philosophy” and loving it – he argues this point. See what Sweeney has to say about it –

At the theoretical level chaos and complexity can help us to synthesise evidence and intuition. They dignify the notion of intuition, and re-establish the importance of experience and wisdom, seeing them as emergent properties of the thousands of iterative, recursive interactions in consultations.

Oh, I like that! He’s showing that from basic principles of complexity science we can understand intuition is a way of knowing which arises through our interactions with each other. Thank goodness someone is making a call for us to develop a form of medicine which is greater than the sterile world of “Evidence Based Medicine” with its mind-numbing protocols and guidelines.

Read Full Post »

The Secret

Posted in from the reading room, from the viewing room, health, life, personal growth on September 6, 2007| 13 Comments »

Do you know about The Secret? This was originally produced as a TV series by an Australian TV producer called Rhonda Byrne. It wasn’t shown by the TV channel which commissioned it and was turned into a DVD, book and now a whole movement it seems. Wikipedia has a pretty thorough article on the background story plus a presentation of the views of people for and against The Secret. According to their article, the book which inspired Rhonda Byrne was the 1910 The Science of Getting Rich by William Wattles. They also say the principles espoused are pretty much the same as those of the New Thought movement.

What is The Secret?

Well, it’s the “Law of Attraction” – which is the belief that if you ask for something, then the Universe will deliver it. Of course this will strike a chord if you ever read “Ask and you will receive” in the New Testament of the Bible, or if you came across the New Age “Cosmic Ordering” idea. These ideas have been around a long, long time but “The Secret” has packaged it up in a DaVinci Code kind of way to sell it to a new market.

I watched the film recently and found I had an enormous mix of responses. You can find a whole range of views and opinions about this film on the net – everything from the view that “The Secret” is the answer to life, the universe and everything to the view that’s it’s psychobabble nonsense. Actually, I think it’s neither of these things.

When I watched the film, which is basically a talking heads documentary, I enjoyed the graphics, but didn’t enjoy the rather trite little “drama” scenes used to illustrate the points, and the speakers, for me, ranged from inspiring to PU-U-U- LLEEEEZE – Let me OUT of here!!! (I’ll leave you to make your own judgement on exactly who fell into which category!)

It is EASY to be critical of this film – you could easily say it is simply positive thinking embellished to the point of magical thinking. However, there are useful and inspiring messages in it –

  • Starting your day with thoughts of gratitude orientates you towards an awareness of the positive in your life.
  • Having a positive mental attitude is likely to help you to greater happiness.
  • What you focus is on is what you experience most in life.

But where it goes wrong for me is pushing it into the magical realm of a belief system that we entirely create our own reality and that our thoughts will be responded to by the universe which will give us exactly what we think. This lends itself to a blame-the-victim mentality where suffering is seen to be a result of the person’s own thinking – they brought cancer, or violence, or abuse, or whatever, down on themselves. This is distasteful and naive. It also lends itself to the no-effort-required view that you don’t have to strive for anything you can just lust after it hard enough and the universe will deliver it!

And yet, and yet……….

Here’s the most interesting thing for me about it so far. It’s not the positive thinking bit. I reckon that idea is difficult to challenge. There’s ample evidence from psychologists and philosophers that taking a deliberate focus on the positive can be beneficial not just in terms of mental health, but in terms of physical health, and recovery from serious disease. It’s also quite evident in life terms – from personal to business success.

Now it is quite clear to me that just thinking you can be whatever you want to be will bring that about is nonsense – as a 53 year old, 5 foot 5 inch man I will never get to play for the Harlem Globetrotters and I won’t run in the British 400 metre Relay Team at any Olympic games! You can NOT just “be whatever you want to be” – there ARE limits!

No, the interesting bit to explore is the idea that you create your own reality. I think this cosmic ordering kind of idea has got it the wrong way round. It doesn’t seem credible to me that there is some mysterious magical force in the universe which delivers your every wish if only you visualise it clearly enough and apply a type of faith to believing that whatever you visualise will come to pass. I do believe, however, that if you focus clearly on something, you raise your awareness to daily phenomena, events and circumstances which are relevant to that focus. I also think if you apply a highly motivated creativity to your focus then you are way more likely to actually achieve your goals. But I think this direction of flow is the opposite to that espoused in The Secret.

Stuff happens. Good stuff and bad stuff. We live in a chaotic universe. The development of scientific understandings of chaos and complexity shows us that chaos has both features of cause-and-effect and of randomness. Some things happen as a consquence of the actions of ourselves or those of others. But some things happen that are literally random. Nothing to do with anyone’s thought processes. How we cope with that stuff, how we adapt to that stuff……..that’s what radically alters our experience.

So our reality is created both by our experiences and by our reactions to our experiences. It’s not created by an intelligent or magical universe and it’s not created just by our thinking.

I’m glad I watched The Secret. Yes, its tacky focus on materialistic consumerism feels small-minded and is uncomfortable. But, it’s also thought-provoking and inspiring.

Read Full Post »

The richness of stories

Posted in from the consulting room, from the reading room, health, narrative on September 5, 2007| 4 Comments »

When patients consult me I begin the first consultation (after having made my introductions) with some variation along the lines of “Your doctor has sent me a referral letter which gives me some of the background information about your illness but it’s best you tell me your story yourself”. This allows the patient to set the agenda and to tell me whatever they want to tell me in their own preferred order. When they come back to see me for a follow-up appointment I tend to begin with a question like “How’s things?” – deliberately vague and open, again to let the patient tell their story their own way.

I try to write down their exact first words. How they are doing is often captured richly in those opening sentences. For example, something along the lines of “Doing well. Got back to work and really enjoying it now” or “Managed to have our first family holiday in years”, tells me that there has been a significant shift. The details follow but the essence and magnitude of the change is often right there in the first few words.

We use an “outcome scale” with our patients in Glasgow Homeopathic Hospital. “0” means no change; “1” means some improvement, but not enough to be of value in daily living; “2” means improvement of value in daily living; “3” is significant change which has brought a significant improvement in daily living; and “4” is hallelujah, I’m cured!

Whilst it’s satisfying to see that two-thirds of our patients score a 2 or more, these bare numbers really lack the richness of the actual words the patients use. What is more important really is to capture the “story” of the change. The story needn’t be a long one; the first few minutes are usually time enough the hear it because the essence of the story is conveyed literally in the first three of four sentences the patient utters.

Interesting that this issue was on my mind today as I was musing about to capture these changes more systematically, when I came across a post on Lifehack about stories. (This post, by the way is Part 6 in a series about Chip Heath and Dan Heath’s book Made to Stick: Why Some Ideas Survive and Others Die)

This phrase really struck me –

Stories, then, allow us to impart not just our conclusion, but the actual experiences by which we came to that conclusion.

That’s it! I thought. That’s it in a nutshell. Figures are so uninteresting because they present a conclusion. They are thin information. How much richer is the information conveyed in a story!

I can tell you that in all my years of practice I’ve never heard the exact same story twice. It’s by telling their stories, with their own preferred vocabulary, in their own preferred way, that patients convey the experiences of their illnesses to me. And healing is in no small measure a matter of enabling somebody to tell a different story, to start a new chapter with new vocabulary and to develop new themes – positive themes, health themes as opposed to illness ones. It’s such a treat!

Surely we must resist the current trend to do medicine by numbers where individual stories don’t matter, where individual people don’t matter!

Here’s to the richness of stories!

Read Full Post »

How do you know how engaged your are?

Posted in from the consulting room, health, life on September 3, 2007| 5 Comments »

Wesley Fryer’s excellent Moving at the speed of creativity blog has an interesting post today on “Measuring Engagement“. Engagement is, I think, a key quality of a healthy life. But what does it mean exactly?

I think of it as being in active exchange with your environment – both consciously and unconsciously; physically, emotionally and spiritually. There are three elements to this –

  1. the environment
    We are embedded in multiple environments. By that I mean you can’t see who you are in isolation. Nobody exists out of all context. Our environments are multiple – the physical environment of air, light, heat, noise and so on; the relationship environment of our place in our own personal networks of people (family, friends, colleagues, society etc); the semantic environment of meaning – the sense we make of the signals and symbols around us; and so on…multiple life contexts.
  2. being in exchange
    Within our environments we are continually receiving and responding to signals – detecting changes and adapting to them.
  3. active
    By active I especially mean conscious – the greater our awareness, the greater our ability to choose between possible responses to the changes in our environments. In addition, by active, I mean creatively active, because when well we don’t just respond to changes in our environments, we initiate changes too.

Wesley Fryer’s area of interest is education. I’m primarily a physician but a significant part of my job is education so that perspective interests me too. I share his interest in web technologies and it’s a Facebook development that seems to have stimulated this particular post. Facebook has measured applications on the basis of numbers of users but is now changing that to measure “engagement” instead – by this they really mean they are measuring a number of ways users interact with an application. Jeremiah Owyang argues that this is not really “engagement” but just “interaction”. Whatever you think about the Facebook model, Wesley goes on to consider how teachers measure engagement in the classroom (as opposed to just participation).

So, all this got me thinking. If I believe that engagement is a key quality in health, how do I know how well that is functioning in a particular patient’s life? Let me explain a little further…….

When someone has chronic suffering, be it pain, breathlessness, depression, whatever, their lives can become much smaller. They can retreat from work, from social interaction, and even from the basics of life – not noticing the world around them, collapsing further and further into a deep, black, hole. As they start to become well again they begin to notice more and respond to more around them, become more active socially and their lives gradually expand. This expansion is one of greater engagement (in illness, the contraction of life is a loss of engagement).

So, here’s my query – how do you know you are more or less engaged in life? Are you aware, when your world is either shrinking or expanding, of what it is that’s changing? What does “engagement” mean to you?

Read Full Post »

Noise kills

Posted in from the consulting room, from the dark room, health, photography on August 23, 2007| Leave a Comment »

I made up a wee mindmap of virtues for myself which I pasted into the front page of my moleskine. I survey it every morning so I can have one of the virtues, or areas of virtues, in my mind as I go through the day. This morning I settled on the “Calm” area – slow, silence and tranquillity are my three virtues there, so imagine my surprise when I see this article in the Guardian as I travel through to Glasgow on the train.

Coronary heart disease caused 101,000 deaths in the UK in 2006, and the study suggests that 3,030 of these are caused by chronic noise exposure, including to daytime traffic.

This is quite astonishing. I know that noise can be really irritating but I hadn’t thought through the idea that chronic noise levels induce chronic inflammatory (“stress”) responses in the body that might actually lead to death from heart disease!

So, tranquillity and silence turn out to be even more important than I had realised.

dscn0843.jpg

Read Full Post »

Health-related images from the Wellcome Library

Posted in education, from the dark room, health, photography, science on August 17, 2007| Leave a Comment »

The Wellcome Library specialises in the history of medicine. It’s based in London but has recently put online a collection of images which you are able to use freely under the Creative Commons License. The Head of Wellcome Images says,

Wellcome Images is an invaluable tool for teachers and researchers of medical history, health, clinical and biomedical sciences. Through visuals users are able to develop a more profound understanding of human and animal biology, and can use them in their research and teaching. What is unusual for a picture library of this nature, is that the online service is completely free.

The collection is grouped into six sets (each starting with the letter “W”!) –

  • Wellcome
  • War
  • Wonderful
  • Witchcraft
  • Wellness
  • World

Some of the images are startlingly beautiful. Go have a browse. This is an especially useful resource if you teach biological or health sciences.

Read Full Post »

Drug-based preventitive treatments

Posted in from the consulting room, from the reading room, health on August 14, 2007| 2 Comments »

The BMJ published a study today which has been reported across at ScienceDaily. This is an incredibly thoughtful article which questions the prescribing of lipid-lowering drugs (statins) to the elderly. Whilst there is good evidence that lowering lipid levels in younger patients reduces their risk of suffering from cardiovascular diseases, there is not good evidence that the same benefits can be achieved with the elderly. However, doctors are being encouraged to treat the elderly with the same assumptions as they make when treating younger patients. Worryingly, one of the studies conducted in the over-70s who take statins shows that while there did seem to be a reduction in death from cardiovascular diseases, the overall mortality remained the same. In other words they died from something else. In this particular study there was an increase in deaths from cancer. The authors of this paper ask a question which I’m astonished has not been asked before.

Is it possible, they ask, that by introducing preventive treatments in the elderly aimed at reducing the risk of a particular cause of death, we are simply changing the cause of death without the patient’s informed consent?

Too often drugs are presented to the public and the medical profession in terms of “saving lives”. Drugs don’t save lives. However, they do alter the experience of dying, and, of course, therefore, the experience of living. But when coerced into taking medication to “prevent” future diseases, patients are not being told exactly what not dying from this particular disease might mean for them. What are they more likely to die from if they don’t die from heart disease for example? This is not a question that should only be asked when treating the elderly. It’s time we had some decent research on how medication changes the experience of living and dying, not just research which only focusses on single diseases. Only then can doctors and their patients make truly informed decisions.

However, the issue of treating the elderly as if you can expect they will receive the same benefit from a treatment as a younger person is also something we need to think about. It doesn’t make sense. People are different and “evidence” from drug trials conducted on younger people may well not be at all useful “evidence” when making a prescribing decision for an elderly person. To be useful, evidence has to be relevant to the individual patient who is being persuaded to take medication.

Read Full Post »

“I’m happy basically. But before my stroke, I wasn’t really” Edwyn Collins

Posted in creativity, from the music room, from the reading room, health, life, video on August 11, 2007| 2 Comments »

Last weekend’s Sunday Herald carried an article about Edwyn Collins. The headline spread over two pages was “I’m happy basically….but before my stroke, I wasn’t really”. Well, as you might imagine, that caught my attention.

Edwyn Collins is a singer. You maybe remember his 1994 hit “A girl like you”

Just over couple of years ago, aged 44, he suffered a stroke. A serious stroke, paralysing his right side and taking away his speech. But here’s a man who doesn’t give up. Through determined rehab with incredible loving support from his wife he’s not only singing again but is about to release a new album. Although right handed he’s also taught himself how to draw again using his left hand! It’s an amazing interview.

I have a stroke to deal with. But I’m feeling positive. And feeling relaxed, and generally focussed on things. I’m relaxed and dreaming all the time. So my life is happy at the moment. I feel connected. I feel alive again.

His wife adds

I think you’re a better tempered person. You cope. And you have patience. And you’re not self-pitying at all. You’re not even depressed………We’ve got so much to feel…….

and Edwyn finishes her sentence

…..to feel grateful for.

Well, what do you think? Health and the absence of disease are not the same. It’s wrong of us to write people off who have a chronic illness or disability. You can experience “health” in both the absence and the presence of disease.

This is a story of someone who believes their life got better through the experience of recovery from illness (same kind of story Lance Armstrong tells in his autobiography, It’s Not About the Bike). Notice the elements of Edwyn’s story. All of these were involved, sorry, are involved in his recovery –

  • hope
  • loving relationships
  • determination
  • patience
  • an absence of self-pity
  • a capacity to cope
  • creativity
  • music
  • drawing
  • slowing down
  • reflection
  • dreaming
  • gratitude

Worth thinking about?

Finally, when I searched for him on youtube I first found A Girl Like You but then I found this – I’m sorry I can’t show that video clip here, the person who posted it to youtube has disabled embedding but please follow that link and listen to the lyrics. “Make Me Feel Again” was recorded in 1993. Don’t you think that’s amazing?

Read Full Post »

Happiness

Posted in from the reading room, health on August 3, 2007| 9 Comments »

I read a really fabulous article by Jean Kazez on Philosophy Now. It’s a review of three books about Happiness. I was SO impressed with her discussion that I popped over to Amazon and bought all three (while I was there I put her own book into the basket too). I’m almost finished the first one now “The Happiness Hypothesis” by Jonathan Haidt and I am thoroughly enjoying it. I’ll post more about later but for now let me say he writes very well, and with a nice sense of humour. He considers what Buddhist and Greek thinkers have said about happiness and sets them against modern, scientific insights from neurology, evolutionary biology and psychology. He’s keen on positive psychology and that’s another point of agreement for me. I can’t remember right now how I stumbled upon positive psychology but when I was teaching in Japan a few years back one of the doctors there asked me if I’d heard of “Solution Focussed Approach”. I hadn’t, but when I read the textbooks they immediately made sense. See, one of my bugbears about health care is that it isn’t focussed on health at all – it’s focussed on disease, so to read about a therapeutic approach which explicitly focussed on how an individual might become well again was very appealing. It wasn’t long after that when I came across the writings of Martin Seligman. I was VERY impressed. So, reading Jonathon Haidt’s summary of Martin Seligman’s “Happiness Formula”, and his linking of the old idea of virtues to the new ideas of positive psychology sent me off again to the Authentic Happiness site where there are loads of interesting questionnaires which will help you understand what your own greatest strengths are. Go check it out if you haven’t done so already. I really recommend it!

Read Full Post »

« Newer Posts - Older Posts »