Heroes Not Zombies

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.