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Relationships – here’s the key to understanding living organisms.

We don’t understand a human being by measuring his or her parts and adding up the results. We understand a human being by studying how the parts relate, and how the person relates to the rest of Nature.

Fritjof Capra puts it this way –

Systems thinking emerged from a series of interdisciplinary dialogues among biologists, psychologists, and ecologists, in the 1920s and ’30s. In all these fields, scientists realized that a living system – organism, ecosystem, or social system – is an integrated whole whose properties cannot be reduced to those of smaller parts. The “systemic” properties are properties of the whole, which none of its parts have. So, systems thinking involves a shift of perspective from the parts to the whole. The early systems thinkers coined the phrase, “The whole is more than the sum of its parts.” What exactly does this mean? In what sense is the whole more than the sum of its parts? The answer is: relationships. All the essential properties of a living system depend on the relationships among the system’s components. Systems thinking means thinking in terms of relationships. Understanding life requires a shift of focus from objects to relationships.

I find this completely thrilling and it explains so clearly why we can’t use reductionism to fully comprehend living beings.

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Facing the Med

There’s a lot of talk around just now about “patient centred care”. It’s one of those concepts that nobody argues against. In fact, pretty much everyone claims to be doing it. If that’s true, then it must mean different things to different people. Or it must have so many aspects, that different people resonate with the concept because they understand and value one of those aspects.

There’s a vast and growing literature on “patient centred care” but I’d like to make a contribution to the debate. I’m writing here from the perspective of a generalist, holistic, integrative doctor. I work at the “NHS Centre for Integrative Care” which, we claim, is a patient centred service within the NHS.

Some health care services are disease centred. There are Diabetic Clinics, Asthma Clinics, Hypertension Clinics and so on. These are specialist services where only people with particular diseases are seen, and where progress is measured primarily by measuring changes in the disease activity.

Some services are therapy centred. When you attend one of those services, only particular therapies will be used, no matter what your diagnosis, or who you are. The two biggies are surgery and drugs. Most services are designed to support the delivery of one of those two therapies. “CAM” (“complementary and alternative medicine”) clinics are often therapy centred too. Acupuncture Clinics, Osteopathic Clinics, Homeopathic Clinics etc. When you go to one of those you will see someone who has specialised in that particular therapy, and they will try to help you using that therapy.

Integrative Care is a patient centred therapy. It delivers individualised, multidisciplinary care using a range of different therapies, based on a holistic, personalised understanding of the individual patient. It is generalist, in that it is not limited to patients with specific diseases, and it is integrated in that it is not limited to the use of one particular therapy.

Now, I’m sure, there are many who will explain why their disease-centred, or therapy-centred service is also patient-centred, but I hope it’s helpful to clarify why an “integrative care” service cannot be defined by either the therapies used, or the disease diagnoses of the patients attending.

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The other day I came across, in David Wade’s beautiful “Crystal and Dragon” book, a little drawing of the paths each planet takes (relative to Earth) and, apart from making me want to dig out an old “spirograph”, I thought it was simple but wonderful.

planets

 

There are patterns everywhere, and we human beings seem to be particularly good at spotting them.

There is diversity and uniqueness everywhere. In the cosmos, in the solar system, on our planet, Earth, in every living organism.

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floating petals

I came across this statement the other day

You can’t direct a living organism, you can only disturb it.

I think this is such an important truth, yet we lose sight of it all the time in health care.

Our current reductionist, mechanistic model of living organisms has resulted in our unsustainable version of health care, based on the premise that diseases are entities which can be defined, isolated, attacked and removed, using “evidence based” interventions which are certain to produce the outcomes demonstrated in clinical trials.

Life, of course, isn’t like that. The intended “outcomes” are difficult to achieve, impossible to predict in individuals, and turn out not to be the end of the story when life carries on.

Why is that?

One reason, it strikes me, is because you can’t “direct a living organism”. You can’t control a living organism. People aren’t like cars. Living beings contain many, many parts (cells which work together to create tissues, organs and networks), but those parts relate to each other in non-linear ways.

Simply, that means that doing X to Y will not predictably produce Z.

The failure to remember that leads to polypharmacy where each “evidence based” drug is prescribed to direct a part of the living organism – the heart, the brain, the lungs, the stomach etc – but when that part changes under the influence of the drug, it’s relationship to the other parts changes – unpredictably (and the drug, which is not specific to the part it is trying to direct, produces changes in many other parts at the same time)

If we remember that we can only “disturb” a living organism, not “direct” it, then we are called to be more humble, less certain (and so more aware, more reflective at every stage), and more holistic.  We are called to constantly return to the focus on the person, on this unique individual we are caring for, and to assess, with them, how life is changing as a result of this “disturbance”.

We can’t control individuals. But we can disturb them, and then ask with them, how is life now? What direction is life taking?

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water green from reflected leaves

I love stories. I love the stories I hear every day in my consulting room. New stories. Amazing stories. Unique stories.
Years ago, when I started this blog, I called it “Heroes not zombies“. My hope is that what people read here will inspire them or stimulate them to wake up, reflect, and create a brand new story. In the story of YOU, you are the hero.

James Hollis in his “Creating a Life” says this about stories –

Each of us lives out a story, a dynamic narrative whose only consistency is that we somehow show up in each of the scenes…….The gods set things in motion, but the choices are ours. The sum of those choices, and their consequences which may ripple through generations to come, is the story of our life.

What story are you living? And what story will you choose?

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Deeply orange

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Blossoming

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No matter how often I see this, it fills me with wonder. How great to be able to slide back the consulting room glass door, step outside, and capture this abundance of buds and early blossoms. These simple pleasures make it great to be alive.

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Reducing risks

If you suffered from a heart attack or a stroke you’d probably be interested in trying to reduce your chances of a second one. So here is something which apparently achieves the following results –

35 per cent reduction in risk for cardiovascular death
14 per cent reduction in risk for new heart attacks
28 per cent reduction in risk for congestive heart failure
19 per cent reduction in risk for stroke

Pretty impressive huh?
So what is this wonderful treatment?

“A heart-healthy diet rich in fruits, vegetables and fish” , according to a big study conducted by researchers at McMaster University.

In the report about the study was a little passing comment – “At times, patients don’t think they need to follow a healthy diet since their medications have already lowered their blood pressure and cholesterol — that is wrong,” said Mahshid Dehghan, the study’s lead author and nutritionist at McMaster University’s Population Health Research Institute”
That is actually such an important point. How many people are suckered into the belief that as long as they take drugs they can forget about trying to live a healthier life?

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I’ve always taken great pleasure in making a diagnosis. But for me, I go back to the roots of the word. A diagnosis is an understanding. It thrills and delights me to be able to understand people. I think that’s the beginning of the journey to health, because as I concentrate on trying to understand someone, they usually increase their understanding of their condition and even of themselves. That’s powerful and I think, as we are all meaning seeking creatures, it’s a key goal of most consultations – to make sense of our lives (through the creation of our stories) But I reject the reduction of diagnosis to labelling or categorising. For me, that’s just not good enough. I want to know more than the name of a disease. I want to know a person.

Iona Heath writes eloquently about diagnosis in this week’s BMJ

Beyond the technical expertise of those in the craft specialties, the key skill of all doctors is diagnosis. However, diagnosis itself poses profound problems of scope and usefulness. Every experienced clinician is fully aware that no two people ever experience the same diagnosed disease in exactly the same way, and yet the taxonomies of diagnosis and the international classifications that underpin them ignore this underlying truth. The diagnoses tabulated in this way are theoretical abstractions, but we are inclined to give them a level of credence and reality that tends to exceed that granted to the patients so labelled. In this way, our diagnoses begin to condone structural violence and to excuse social injustice

Good diagnosis is an individualising process, not a generalising one.

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Ever since I was a little boy I’ve loved to look up at the sky on a clear night and lose myself in the wonder of the fact that the light from every single star has taken years and years to reach the Earth. How incredible that the tiny spots of light landing on the backs of my eyes left those stars millions of years ago!

Its astonishing to think that as you look up at the night sky you are looking at the past, the distant past. And how astonishing to realise now that our latest astronomical instruments let us see back billions of years, almost to the Big Bang itself. But not quite.

I recently came across the phrase “Cosmic Horizon”. The Cosmic Horizon is the furthest visible point in the Universe. In every direction as we scan the skies, we can detect signals from far away stars right up to a point of darkness which is so far away, so far distant in the past, that we can’t see anything any longer. This is the horizon. It’s like the horizon we see where the sky meets the earth or the sea, but much, much further away.

In the book, “The View from The Centre of The Universe”, Joel Primak and Nancy Abrams, building on this idea that the Cosmic Horizon is a limit in the timescale we can know, propose that we, the human race, need to develop our “Responsibility Horizon”.

This is a fascinating idea. Think about it. How far does you current “Responsibility Horizon” extend? One generation, maybe two? When you make decisions, do you consider the impact of those decisions on the lives of your children, or your grandchildren? You might. If you have children or grandchildren you might be concerned about the kind of world we are creating now for them to inhabit in the years ahead. But let’s stretch that beyond two generations. How far ahead do you want your Resonsibility Horizon to reach? And if it’s three or four, or more, generations, how will that influence the choices you make today?

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