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Archive for the ‘philosophy’ Category

I came across a Royal College of General Practitioners document recently – “Fit for the Future” – It is a vision of General Practice in the UK for 2030. There is a lot in it that I’d support but one of the statements is this –

An overhaul of the GP-patient record into a personalised ‘data dashboard’, accessible by healthcare professionals across the NHS, and that will draw on data from the patient’s genomic profile and wearable monitoring devices.
Now, maybe you read this and it excites you, but it made me stop and think “Hang on a minute! A ‘data dashboard’?”
I remember a line from the English philosopher, Mary Midgely, in her book, ‘Wisdom, Information and Wonder’.
One cannot claim to know somebody merely because one has collected a pile of printed information about them.
She wrote that back in 1989, and it’s clear that, since then, we have, to some extent, replaced the piles of printed information with hard drives full of data. But the point remains the same – you won’t know somebody just by looking at data.
One of my roles when I worked at the ‘NHS Centre for Integrative Care’ in Glasgow was to train young doctors in holistic practice. They’d be allowed to spend as long a consultation as they wanted with a patient then they would come to “present the case” to me. In other words, they’d consult their notes (often several A4 pages of notes) and tell me what they’d learned about the patient. At times what they actually communicated to me were detailed descriptions of the patient’s symptoms. Sometimes so many symptoms in such detail that the amount of information was quite overwhelming. By the time they’d finished I would find myself saying “Well, you’ve told me a lot but I don’t know who this person is'” I had no picture of the patient, their life, how illness came into it, how they’d coped, or the effects the illness had had on them, their family and their friends. A holistic case history is not a “pile of printed information”.
Data, or information, as Midgley pointed out, makes “much better sense when [it has] a context”. The context is revealed by the story. I don’t see how you fully understand a person without hearing their story.
Yet, one junior doctor told me she was being taught elsewhere “Never believe patients. They lie all the time. You can only believe the data” (meaning the results of investigations). That appalled me. What kind of Medicine can we practise if we think “patients lie all the time”? What kind of Medicine can we practise if we distrust their personal, unique stories, but trust only in “data”?
Now, I’m not saying that data isn’t useful. It can be. It would be daft to ignore that. But putting data up front and centre to the point where it replaces the relationship and the story? That’s my fear. That someone will think, “all we need is good algorithms and they will deliver all the right answers once we feed the data in.”
I’m sceptical. It doesn’t seem rational to me. It doesn’t seem realistic to me. And it risks shoving aside human values and the crucial importance of relationships.
Then, just yesterday the UK Health Secretary, Matt Hancock, put forward an aspiration for every newborn child in the UK to have their genome sequenced. ¬†Interestingly, a poll of doctors revealed – “>2000 responses. Only around 10% of doctors would find genetic data more useful than postcode in planning the care for a newborn baby.”
I think we have to claim the ground for the importance of the unique human story. If, as doctors, we fail to consider the environments and circumstances of an individual life, we will fail our patients.
Data without contexts has some use, but it is not a full understanding of, or even a “knowledge of”, a patient.

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I took this photo over five years ago but it’s still one of my favourites. One of those photos I return to and spend some time with. It does more than please me. It brings back memories of that day. It activates connections I have deep inside. It inspires me.

What do I notice?

Well, the largest part of the image is taken up with rock, and just look at that rock! It flows and it folds as if it is pliable. But, take it from me, that rock feels as hard as ….. well, rock! It must take aeons to shape it like this. What shapes it? I’m not a geologist but it seems pretty obvious to me that the major creative force here is water. See the river rapids just beyond it? That lively, foamy, energy-charged flow of water? That’s the main sculptor here. Moment by moment, day by day, year by year, era by era, it persists, crashing against the rock, flowing over it, caressing it, smoothing it, shaping it.

There’s something else in that interaction of rock and water which is not so obvious from this image…..the water and the rock change each other. The content of the water is changed by the elements washed out of the rock. The direction, the speed and the force of the water is changed by their encounter.

The look directly in front of the rock at the log…..this log which is the remains of a tree which fell who knows how long ago and who knows where? It looks like it has been carried downstream to here. Is this where its journey ends? It too has been shaped by the river. It brings its own structure, its own patterns, but it now reflects the flow of the water and the markings on the rock it lies next to.

Each of these, the river, the rock, the tree, are interacting with each other, exchanging atoms and molecules, intermingling their energies, influencing and shaping each other.

In front of the tree is more water, this time less energetic, less white and foamy. This time pooling more peacefully, almost resting between the tree and some smaller rocks. And look at that rock in the front of the photo….a striped rock, a history of millennia running right through its middle, reminding us just how ancient this world is.

When I look at that striped rock I see a hint of a baby elephant. Now there’s one creature which has never been known to stroll through the forests of Scotland! But that’s how we function, we humans, isn’t it? We are continually being influenced by and interacting with everything we see, everything we hear, smell, taste and touch, and by all those invisible flows of microbes, molecules, and energies that continuously shape us, just as we shape them.

That’s what this image leads to, for me ……. a sense of the Life Force, the Creative Force of the Universe …… active, dynamic, flowing, shaping, influencing and interacting.

That delights me.

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What do you see here?

Autumn leaves? Some turned partially red, some now brown and dusky, others as white as bones…..

People talk about leaves falling at this time of year, but do they fall, or are they pushed? Or do they jump? I’m not a botanist and I don’t know the answer to that question but I do wonder about it….especially when I look at this wonderful “Boston Ivy”, or “Faux vigne”, which covers the huge wall along one side of the garden.

Isn’t it glorious when it’s at the peak of the transition?

Well, I’ve seen hundreds of photos of red, yellow, golden and brown leaves over the years but I never get tired of them. Like sunsets and rosy dawns they are magnets for me. They draw me outside to have a better look. But look what happens next with this particular plant…..

These are the stalks which connected each leaf to the rest of the plant. A few days on, and these stalks will be lying on the ground in heaps. How does that happen? How do the leaves leave the stalks, and then, the stalks leave the vine? I don’t know. It amazes me. I’ve lived here for five years now this month, and every year this unfolding sequence of leaves changing colour, leaves falling to reveal all the stalks, then stalks falling to reveal ……..

…purple berries on bright red stalks……well, I just love it.

If you go back to the first photo in this post you’ll see a couple of purple berries lying there in amongst the leaves…and, remember, each of those berries contains the seed/s of new plants, so in that one image I see something like the alchemical image of the snake which swallows it’s own tail (the Ouroborus)

Nature, seen, this way, isn’t linear…..the past, the present and the future all there in the one moment, the one image…I feel the rhythms, see the cycles, experience the connectedness of everything.

As T S Eliot wrote, in The Four Quartets –

 

Time past and time future
What might have been and what has been
Point to one end, which is always present.

 

(read the poem here)

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What does your perfect day look like?

“Perfect” – there’s the problem right there……just what is “perfect”? Hard to say, really, but I’m pretty sure it always means something better. Better than what? Better than what is?

There’s something unreal about perfectionism, isn’t there? Something unachievable. It’s always just out of reach (or sometimes it seems way out of reach!)

I like blue skies.

I like beautiful rosy pink dawns and tobacco or scarlet sunsets.

This photo is of none of those things – no blue, no pink, no sepia hues, no deep crimson reds. It’s grey. Grey and dark greens shading into black and that one bright, bright white circle in the sky…..the Sun, struggling to make itself known, veiled in mist and cloud.

But it’s beautiful, don’t you think?

When I stepped outside I could hear the mist. Well, what I mean by that is I could hear what the world sounds like around here when there is a thick morning mist hiding the vineyards and the neighbouring villages. Like snow, the mist is a muffler. It produces a particular kind of silence. I can’t quite put my finger on it and define just how the misty silence differs from the silence of a bright sunny Sunday morning here in the Charente. The Sunday morning silences are recognisable too. If I didn’t know what day of the week it was, I reckon I’d be able to tell from the particular quality of the silence around here on a Sunday morning. But this silence, this autumnal misty silence, is different from that. Maybe it’s because the mist disguises the sounds, whereas on Sunday mornings, there just aren’t the sounds to be disguised?

So I look up and I see where the Sun is. I can’t see the Sun. It’s not distinct, but I absolutely know where it is….strongly filtered through the watery veil lying thickly on the ground. And I think “How beautiful” “What a moment!” To stand here, looking in every direction and seeing only a shallow foreground of grass, trees and bushes, but knowing, from memory, what lies beyond them. To stand here, in silence, listening. To stand here, in silence, knowing that the Sun up there is probably going to make most of this water evaporate and reveal itself in all its fiery glory again, maybe in an hour or so, maybe a little longer.

Unexpectedly, I think “How perfect”.

I don’t know what makes a day a perfect day, but maybe it’s any day when I become fully aware, fully present in this moment and this place.

Maybe a perfect day isn’t an unachievable, unreachable, figment of the imagination, but a day with a moment, or several moments, where I feel it’s just so good to be alive, where I find myself saying “thank you”.

“Thank you, I feel blessed to be alive”.

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I came across a discussion about identity recently, and as identity politics and populism seems to be to the fore in many countries these days, it got me thinking – who am I, really?

A few years ago I was in Marseille and these incredible sculptures were installed around the “Vieux Port”. They really grabbed my attention. Here’s just one of them (see the photo at the start of this post) showing what I immediately perceived as a person. He’s not all there, of course, but we fill in the gaps to make him whole, don’t we? Well, it struck me that that’s what we do all the time.

At least once a week in my consulting room a patient on their first visit, after telling me their story over the course of an hour, would say “I’ve never told anyone what I’ve just told you. Never.” And they’d often add “I feel you know me so well”. It was good feedback, and it reassured me I was on the right track and had established a good therapeutic relationship. But I often thought, “Actually, I only met you an hour ago, and I think it takes a lifetime to get to know someone. I think we can spend most of our lives with a partner but we never really completely know them. I’m still getting to know myself, for heaven’s sake,¬†and I suspect I’ll be doing that for the rest of my life”. Sometimes, I’d say that out loud, but other times, I’d just think it. I think it still.

Here’s me at Primary school –

And here’s me about sixty years later –

Is this the same person?

From my perspective it certainly is! I have the experience of a continuity of Self. I know these are both photos of me, but, boy, have I changed!?

So, who am I, really?

Am I this body?

It’s pretty obvious, even from just those two photos, that this body has changed a lot over the decades. Our bodies are made up of over 30 trillion cells (a number too big for us to imagine, and that’s just an estimate because nobody has been able to count them). Almost all of these cells live much shorter lives than I have done. Some cells live only a few days, other weeks or months, and only a minority last a full lifetime. So, it’s pretty certain that only a minority of the cells in this body I have now are the same ones I had in that earlier photo.

Interesting choice of verb there…..”had” – do I have a body? If so, who is this “I” who has this body? I’m tempted to say, no, I don’t “have” this body, I “am” this body. But there’s the trap, huh? Because if the body is always changing, am “I” always changing too? Where does my sense of continuity of being come from? And I am more than my body aren’t I?

What more am I?

Scientists have discovered and put forward at least three other elements of identity by studying genetics, the “the human microbiome” and epigenetics.

For a while the “Selfish gene” idea gained a lot of traction. “The Human Genome Project” was completed in 2013 and there were great claims for it at the time – a bright new future of “personalised medicine” based on your gene sequences was heralded. Some claimed it would lead to the elimination of a host of diseases. Richard Dawkins, whose book entitled “The Selfish Gene”, popularised the idea that our essence, our core, the “real” “I” wasn’t the body, it wasn’t the mind, it was the double helix spirals of gene sequences….our DNA.

Things haven’t turned out the way the great gene believers imagined however. It seems we can’t be reduced to the level of chains of little molecules. We are more than that. What more?

Well, next up was an exploration of the cells which are part of us but aren’t us – all the bacteria, viruses and other micro-organisms which live on and in our bodies but don’t have the same DNA as we do. It turns out there are at least as many of them as there are “our own” cells. “The Human Microbiome Project” was launched four years after the end of “The Human Genome Project” and by 2016 a lot had been discovered, but it’s still not enough to pin down who we are.

Have these projects helped me to answer the question “Who am I, really?” Not really, but it does make me deeply aware of the fact that I’m not so much an object as some scientific models have suggested. I’m certainly not a fixed entity. Instead, it seems I’m a constant, lively, energetic flow of cells.

It makes me think I’m more like a river than a stone! I’m certainly not like a machine.

But wait, it gets more complicated yet – following on from the discovery of the “genetic codes” researchers discovered that not all the genes are active all the time. In fact they switch on or off all the time. They’re more like music than they are computer code. What presses the keys to play the tunes? What determines which genes are expressed, and when? It seems a whole host of “environmental factors” are involved. You aren’t determined by your genes. They only represent some kind of potential. Whether they become active or not depends on the life your live – the environment you live in and the events and experiences of your life.

We don’t know what all the factors are, or how they work….. “The Human Epigenetic Project” anyone? Well, what do you know? There IS “The Human Epigenome Project“! A consortium exploring at least one of the links between genes and the environment.

So, if my body isn’t all there is to me, if my genes aren’t all there is to me, if my microbiome isn’t all there is to me, then what else is there?

My thoughts? My feelings? My memories, dreams and imaginings? The stories of my life?

Tick “all of the above”. (There are volumes of books which have been, and are still to be, written on each of these)

But there’s a vivid red thread running through all these observations – connections.

Who I am, really, will never be answered by considering myself in isolation. It seems I am a flow. Constantly changing, constantly receiving materials, cells, energies and information from the world in which I exist, constantly sending out materials, cells, energies and information, and constantly changing myself and the world in the process.

My story is not just my story. It’s our story. You and me. Every relationship, every encounter, every exchange, shapes, changes and moulds me, and, you, and the planet we live on.

That excites me.

It’s a new story. It’s the story of evolution, of emergence, of connections, contexts and change.

The answer to “Who am I, really?” won’t be found by looking at smaller and smaller parts. It’ll be found in experiences, in performances, in events, in relationships and interactions. It’ll be found in the unique stories that only I, and only you, can tell. It’ll be found in what we share and how we relate.

Identity is fluid, relative and dynamic.

Maybe we should think of it more as what we share, than what divides us.

 

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Maps…..representing the world by making maps is one of the most characteristic skills we humans possess.

We don’t just draw maps on paper, but we make them inside our heads. Dan Seigel, who wrote “Mindsight” says we create three particular maps in the most forward part of our brains – the prefrontal cortex. He says we make a “me map”, a “you map” and a “we map”. He means we have an image, a pattern, or some other form of representation in our minds by which we recognise ourselves, the people we meet, and the relationships we have with them. These maps do more than allow us to recognise ourselves and others, they enable us to navigate our way around them. They help us predict, plan and choose which actions to take.

I don’t know about you but I LOVE maps. There’s something magical about them. I love to see maps over the ages which reveal how we have come to make sense of the world. So, when I was in Tordesillas, Spain, earlier this year I was delighted to find a whole host of astonishing maps in the Museo del Tratado de Tordesillas.

Look at this one, pictured above, it’s part of the Quesques Abraham map, otherwise known as the Catalan Atlas, from 1375.¬†These first couple of sections depicts the world around the Mediterranean. You’ll probably recognise the British Isles, the Iberian Peninsula, the land we now call Italy, the North of Africa and so on. It’s pretty fascinating but it’s typical of the kind of geographical maps with which we are familiar. I think the Catalan Atlas gets even more interesting in the next set of panels –

This is the world to the East of the Med. The physical structures are way less recognisable, and that’s largely due to the fact that the world to East of the Med wasn’t known very well in those days. In fact, this section of the map is drawn from stories. It’s drawn from the stories of Marco Polo and other explorer/adventurers who travelled in the East and then wrote their travel journals, and from stories told in religious texts and passed down in various oral traditions.

I don’t think I’ve seen a map created that way before.

A map made from stories!

But then, I thought, isn’t that exactly what we do when we create these “inner maps”? The “me map”, the “you map” and the “we map” that Dan talks about?

So, I wonder……what stories do I draw on to create my “me map”? What stories do I draw on to create the various “you maps” and “we maps”? The stories of our encounters? The stories of other peoples’ encounters? Wow! What an idea!

I think I’m off to explore that further…..I wonder what those maps look like, and what stories created them?

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One of the things I love about living here in Cognac is the availability of different, fresh, locally produced food. I popped into one of the market-style shops here this week and discovered it was “Fete du Pommes” week – a celebration of apples. Because, of course it’s autumn now here and apples are available in abundance. I know I can go into one of the big name supermarkets and select a plastic bag of shiny “perfect” same-size, same-shape apples of a big name variety (“Pink Lady” anyone?) which have been shipped here all the way from the Southern Hemisphere but look what I can get when I go local instead?

I selected four different varieties, none of which I’ve heard of before, and placed them in the cardboard box from the stack at the entrance. Even within each of the many varieties available I could choose big apples, small apples, round apples, wonky apples! What a delight!

Diversity is a core feature of Nature.

There are no two of us the same. The Universe celebrates diversity by bringing to life millions and millions of unique plants, creatures and forms.

Nature abhors mono-cultures. They die out, taking the richness of the soil with them.

I delight in the diversity of human beings. During my four decades of work as a clinical doctor I looked forward to the start of each week when the next patient in the door would tell me an utterly unique story, one I’d never heard in my life before.

I wonder if it’s possible to respect uniqueness and diversity if Clinical Practice is determined by guidelines and protocols for patients who are even more diverse than the locally grown apples in the market.

There’s a beauty in diversity, as you can see from my photo, but it’s a fundamental tenet of reality too….

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