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Patterns

March 23, 2013 by bobleckridge

We are a pattern-spotting, and pattern-creating species. This is a brilliant quality to possess. It allows us to make sense of very complex systems, to engage with Life and phenomena holistically and to see (or create) the meaning behind our daily perceptions and experiences.

eye of the tree

Margaret Wheatley, in her Leadership and the New Science, says

Wholeness is revealed only as shapes, not facts. Systems reveal themselves as patterns, not as isolated incidents or data points.

Further, she says,

It is the nature of life to organise into patterns

morse moss

 

What patterns do you see today?

What patterns touch you, capture your attention, or help you make sense of things?

Every consultation I do, I sit with a patient and we have a conversation. It’s best if I do most of the listening, and stimulate the odd reflection when I begin to discern patterns. At the simplest of levels I was taught diagnosis at Medical School. I still think we make the best diagnoses by quickly spotting the patterns – the connections and inter-connections between the elements of a story, the symptoms expressed, the signs and changes manifested, and recognising the pattern which holds this all together.

At the deepest level there are a multiple of patterns in every person’s life, each interacting and interweaving to create ever more beautiful and amazing spiralling narratives. This is how we get to know each other. This is how we get to know ourselves.

Let’s make some new patterns together……how about it?

 

zen garden

Posted in creativity, from the consulting room, from the dark room, from the living room, health, life, perception | 2 Comments »

Battles and wars

March 19, 2013 by bobleckridge

What’s with all the war language these days? The War on Terror. The War on Drugs. The War against Cancer. Winning the battles against bacteria and viruses. And all the disease-focused charities – “beating cancer”, a recent one in Scotland “let’s take this outside, cancer”, “help win the war against heart disease”, “beat obesity” and on and on and on……

What are these wars exactly? And what would winning them look like? A world which eliminated these “enemies”? When it comes to bacteria, have a read at the chapter in Howard Bloom’s “Global Brain” about bacteria – is there any other life form on the planet which has been able to adapt to, and colonise such an incredible diversity of environments? Some live in us. Some live in the mouths of volcanoes which are erupting miles under the oceans! They demonstrate fabulous adaptive powers…..we see that in how they “learn” to resist toxic drugs which we throw into the environment and they can spread that knowledge around the globe with fantastic speed. Anyway, we don’t want a world without bacteria. We’d die. Did you know that apparently there is ten times as much bacterial DNA in YOU than there is your own DNA? Pretty mind boggling.

I enjoyed Howard Bloom’s “Global Brain” but he did emphasise the competitive element of Life too much for me.

But wait, I hear you say, surely competition is the ESSENCE of Life! At least, isn’t that what we learned from Darwin and from his followers? “Nature red in tooth and claw” and all that?

I think that’s partly where we’ve gone wrong. Yes competition is a strong part of Life. To deny that would be to deny reality. But that is not the same as doing battle or waging war. Think about sports like athletics, cycling or ice skating for example. The winner of those competitions is the person who performs the best. Usually the person who does the best and wins the medals is achieving their “personal best” too. They win by being the best they can be. They don’t win by waging war on the other competitors. Competition, in other words, can bring out the absolute best in people by being focused on the self – by trying to achieve one’s personal best. Yes, I know other sports are not like that. There are sports where you have to harm your competitors to win – boxing being the obvious example. But most sports, it seems to me are not like boxing. Maybe we should award “personal best medals” at competitions as well as “best competition performance medals”?

But the other big thing that is missing in this focus on war and battle is co-operation and collaboration. No, I’ll go further, it neglects the importance of the inextricable links between us, about our co-evolution, our co-dependence. Read books like, The Bond, Connected, Linked and you might start to see things differently. What matters in the evolution of complex adaptive systems is the connections, the relationships between the parts.

We won’t win these so called wars. What we should be doing is trying our best to be the best us we can be. We should be encouraging diversity, flexibility, autonomy, the building of mutually enhancing bonds between us and between ourselves and other aspects of Nature. Only down that road will we adapt, grow and thrive…….

Posted in from the consulting room, health | 4 Comments »

connected to….the rhythms

March 13, 2013 by bobleckridge

sometimes the easiest way to connect to Nature’s rhythms is just to look out of the window……

DSC_0622

Posted in from the dark room, from the living room, photography | Leave a Comment »

Principles of living systems

March 6, 2013 by bobleckridge

Margaret Wheatley works in the area of leadership and organisational change from the perspective of what we can learn from living reality. She has the complex adaptive systems concept at the core of her work. I recently stumbled across her writings, particularly her four “principles of living systems”. Here they are –

  1. Participation is not a choice
  2. Life always reacts to directives, it never obeys them
  3. We do not see “reality”. We each create our own interpretation of what is real
  4. To create better health in a living system, connect it more to itself

The first principle relates to the reality that everyone, every thing, every aspect of our world, our universe, exists inextricably embedded in the contexts of its existence. A living organism is an “open system”, with information and energy constantly flowing into and out of it. A living system is dynamic and perpetually changing and “co-evolving” with the other elements of the ecosystem in which it lives. You can’t change a part of a person without producing changes in the rest of that person, and you can’t change a person without setting off a cascade of unpredictable changes in the world in which that person lives (and vice versa – you can’t change something in someone’s world without setting off changes in that person). Participation is not a choice, it’s an inevitability.

The second principle is the core of adaptation. Every individual is unique and cannot be controlled like a robot or a machine. You can force people to behave a certain way for a period of time, but ultimately all the organisations and political systems based on force collapse. You can’t force the sun to shine, the wind to blow, the rain to fall, or Life to obey your commands.

The third principle is something we often forget. Iain McGilchrist, in The Master and His Emissary, highlights how the left cerebral hemisphere is particularly well developed to “re-create” reality. It creates “re-presentations” of the raw information and energy which flows into the person. These representations allow us to make sense of the world and to literally to grasp things better. It’s a fantastic development and is probably at the core of our industrial and technological development as a species. We also know now that the part of the brain just behind the forehead, the mid-prefrontal cortex, has many, many functions, but amongst them is a map-making facility. It’s crucially involved in creating, what Dan Siegel calls, “a me map, a you map and a we map”. We never know any of this reality directly. Rather we constantly create our perceptions and our understandings, influencing those creations with our memories, our hopes, our beliefs, our values and our desires.

The final principle is Margaret Wheatley’s way of talking about integration. When a system is well integrated there are healthy, mutually beneficial relationships between all the connected parts. That produces coherence and harmony. It’s the basis of health.

When I first created this blog, I wrote a permanent page on “ACE” – “Adaptation, Creativity and Engagement“. It was really interesting for me, therefore, to discover this quote from Margaret Wheatley (which I believe, essentially highlights the same characteristics)

Over many years of work all over the world, I’ve learned that if we organize in the same way that the rest of life does, we develop the skills we need: we become resilient, adaptive, aware, and creative. We enjoy working together. And life’s processes work everywhere, no matter the culture, group, or person, because these are basic dynamics shared by all living beings

 

Posted in books, from the living room, from the reading room, health, life, perception, philosophy, science | 4 Comments »

Cloud Atlas

March 5, 2013 by bobleckridge

Why did I leave this book lying unopened on my bookshelf for about four years? I don’t know. However, while recuperating last week, I read it, and, boy am I glad I did. What a superb piece of writing it is. Maybe you’ve been out to see the movie by now (I haven’t), but Cloud Atlas, by David Mitchell, is a story cycle. It is six interlinked stories, with each story ending on a cliff-hanger before going on to the next story, right up to story number six, then we pick up all the threads, revisiting first story five, then four, then three and so on. The range of genre and styles is astonishing, with everything from a sixteenth century travel journal to science fiction set in the twenty third century. I loved it all. Each story links to the others in a multiple of ways and the very last couple of pages sum up what it’s all about.

Here is what it is all about (don’t worry, no plot spoilers revealed here)

What precipitates outcomes? Vicious acts and virtuous acts. What precipitates acts? Belief.

The character, Adam Ewing, goes on to write….

Belief is both prize & battlefield, within the mind & in the mind’s mirror, the world.

What a great phrase! ….the mind’s mirror, the world.

If we believe humanity is a ladder of tribes, a colosseum of confrontation, exploitation and bestiality, such a humanity is surely brought into being……If we believe that humanity may transcend tooth and claw, if we believe divers races & creeds can share this world as peaceably as the orphans share their candlenut tree, if we believe leaders must be just, violence muzzled, power accountable and the riches of the Earth and its Oceans shared equitably, such a world will come to pass. I am not deceived. It is the hardest of worlds to make real.

With that, Adam decides to dedicate himself to the cause of the abolition of slavery, mindful of how he is likely to be vilified, and attacked for doing so, and how is father-in-law will say

only as you gasp your dying breath shall you understand, your life amounted to no more than one drop in a limitless ocean.

And Adam will reply

Yet what is any ocean but a multitude of drops?

What do you believe? What kind of world are you creating?

Posted in books, from the reading room | 3 Comments »

Spring…a reappearance

March 4, 2013 by bobleckridge

Oh there are some nasty viruses around! Got whacked by one, but I’m back now.

Here are some of the colours around just now….

purple tulips

yellow tulips

white orchid

snowdrop hill

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What can you expect from your doctor before they hand you a prescription?

February 16, 2013 by bobleckridge

The GMC has recently revised its guidance on prescribing. Here’s the relevant paragraphs related to what a doctor is expected to do before they issue a prescription –

3. For a relationship between doctor and patient to be effective, it should be a partnership based on openness, trust and good communication.  Each person has a role to play in making decisions about treatment or care.
4. No single approach to discussions about treatment or care will suit every patient, or apply in all circumstances. Individual patients may want more or less information or involvement in making decisions depending on their circumstances or wishes. And some patients may need additional support to understand information and express their views and preferences
5. If patients have capacity to make decisions for themselves, a basic model applies:
a. The doctor and patient make an assessment of the patient’s condition, taking into account the patient’s medical history, views, experience and knowledge.
b. The doctor uses specialist knowledge and experience and clinical judgement, and the patient’s views and understanding of their condition, to identify which investigations or treatments are likely to result in overall benefit for the patient. The doctor explains the options to the patient, setting out the potential benefits, risks, burdens and side effects of each option, including the option to have no treatment. The doctor may recommend a particular option which they believe to be best for the patient, but they must not put pressure on the patient to accept their advice.
c. The patient weighs up the potential benefits, risks and burdens of the various options as well as any non-clinical issues that are relevant to them. The patient decides whether to accept any of the options and, if so, which one. They also have the right to accept or refuse an option for a reason that may seem irrational to the doctor, or for no reason at all.
d. If the patient asks for a treatment that the doctor considers would not be of overall benefit to them, the doctor should discuss the issues with the patient and explore the reasons for their request. If, after discussion, the doctor still considers that the treatment would not be of overall benefit to the patient, they do not have to provide the treatment. But they should explain their reasons to the patient, and explain any other options that are available, including the option to seek a second opinion.
What interests me most about this is that the GMC is absolutely clear that health care is a partnership. We often seem to deliver health care as if the expert knows everything and the patient knows nothing. But, in fact, the GMC expects that doctors will act more as expert advisors to enable patients to make their own choices, and that whilst the doctor does not need to defer to the patient’s choice, neither does the patient have to defer to this particular doctor’s choice.

Posted in from the consulting room, health | 1 Comment »

Complicated or complex….what’s the difference?

February 13, 2013 by bobleckridge

There is a big difference between what is complicated and what is complex.
A machine can be very complicated. As cars have become ever more sophisticated they have become more complicated. It’s not easy to see what’s wrong when your car breaks down, unless you have learned how it works.
Machines are made up of different parts, and there may be hundreds or thousands of parts in a machine but we can still learn exactly how it works and how to fix it by learning bit by bit just how each part works and how it affects any other part.
People on the other hand are complex. We also are made up of many many parts, billions and billions of cells, each of which is an agent acting on many other cells, and each of which, in turn is acted upon by many other cells. In fact, through the multiplicity of interactive connections which exist, it becomes impossible to deal with any single part in isolation, or, indeed, to be able to accurately predict the over all effects of any single change. It’s parts don’t necessarily function the same way in isolation as they do when under the influence of their multiple connections.
This structure makes the organism a complex one, not a complicated one.
Here is the key difference –
A complicated structure can be understood by understanding its individual parts.
A complex one can only be understood as a whole.

Posted in from the consulting room, health, science | Leave a Comment »

The scientific method

February 9, 2013 by bobleckridge

This week I sat next to a student on the train. She was revising her notes on “clinical research”. I was struck by her list of keypoints under the heading “the scientific method”

  • Observation
  • Description
  • Explanation
  • Prediction
  • Control

I have a life long interest in science, but for me, science is just one form of enquiry. I’m actually an insatiably curious person. I love learning. I’m constantly reading. I read on the train, I read in cafes, at home, at work, everywhere. Having a kindle reader on my iphone and my ipad has made it even easier to weave reading into my day. I have thousands of books in my own library. I have google searches set up, rss feeds delivered to my MrReader app, Flipboard and Zite apps on my ipad…..I’m a reader!

But I’m also a photographer and a writer, as you can see if you browse through this blog. And I’m a thinker. I love to learn, to reflect, to understand. I love that every work day I get to spend time with people and try to understand them.

I observe, I describe and I explain.

But predict? I’m not so keen on that one. I find life so complex and every human being so unique, that I find it impossible to predict the future. In broad brush terms, or in generalisations, or statistical probabilities I can have a bash, but I know that for this person, right here, right now, I can’t predict how things will go.

And control?

Control?

No thank you. Way too much compliance and control going on in our society for my liking and it doesn’t seem to be improving much. I’m a lot more keen on values than I am on control.

Is science about control? I thought it was about discovery and wonder. I thought it was about learning with every new insight that we have more to learn.

I was very impressed the first time I read Deleuze and Guattari who described three ways of thinking –

Art – which is thinking about percepts and affects

Philosophy – thinking about concepts

Science – thinking about function

I like that. Science for me is about discovering patterns, and getting some insights into how something works. That’s what I loved about my undergraduate medical degree – discovering the anatomy, physiology, biology of how the body works. It’s been years and years of daily medical practice, of reading, of reflecting and of thinking, which has brought me to my present place of understanding how a person works. And I sure haven’t got all THAT figured out!

There’s something that jars with me about science directed towards control. But maybe that’s because I don’t like to be controlled!

 

Posted in education, from the living room, from the reading room, science | 10 Comments »

Health is an experience. Can we agree about that?

February 7, 2013 by bobleckridge

Health is not a THING.

Health is not an entity or a product.

Health is more than the sum of the set of “normal” measurements.

Health is a lived experience.

As an experience, health is a characteristic described by the experiencing person, by the subject. Without a person to experience health, there is no health.

So, why do we deliver health care by treating diseases and people as objects, or by processing people to reach pre-determined targets, which might have precious little to do with the experience of health?

The shocking report on Stafford Hospital, suggesting between 400 and 1200 patients might have died due to the way they were treated in the hospital concludes that

“There was a lack of care, compassion, humanity and leadership,” he said. “The most basic standards of care were not observed and fundamental rights to dignity were not respected.”

Chris Ham of the Kings fund says

The priority must be to shift from a culture in which the behaviour of staff is driven by compliance with targets to one in which there is a real commitment to patient-centred care in every hospital and surgery

But so far the government’s response seems to be to drive towards greater compliance with tougher regulation and inspections.

The problem isn’t one of control, it’s one of “care, compassion and humanity”. How did the Health Service come to this?

Increasingly we treat health care delivery in the same way we treat a business or a factory, by measuring, standardising, and enforcing compliance. None of that seems to be improving the experience of health care because none of that is based on the fact that health is a lived experience, not a product.

Every single human being is unique.

Every life is unpredictable.

A truly patient-centred care will consider the uniqueness of the individual at all stages in the health care journey, and will require imagination – the imagination needed to enable health care workers and managers to imagine what it would be like to experience what the patients are experiencing.It will also take a lot of non-judgemental listening. Without really hearing a person’s story, we fail to know their uniqueness, fail to comprehend or consider their beliefs, values or wishes.

The Stafford story is not the end of the story. It’s probably the tip of an iceberg. Maybe now is a wake up call for all of health care. Maybe now is the time to reconsider the commodified, reductionist, materialistic basis of the current model which pushes more and more drugs into more and more people every single year, and processes more and more people through hospital beds ever more quickly.

After all, if health is an experience, we should design health care around making personal experiences better.

Check out the manifesto for slow medicine.

Posted in from the consulting room, health | Leave a Comment »

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