Three points: firstly doctors clearly have attractors - Deliberately making
myself wonder whether many people disliked this man is an old habit (or
attractor). My usual response on finding my dislike emerging out of the
shadow world of my side of the consultation is to think 'if I dislike
them, maybe this person suffers lots of dislike from many sides, so what
must that be like for them?' And to get out of the dead-end of dislike
does take significant conscious internal energy - it feels as though I'm
lifting myself out of a 'dislike' trough, over the hill, and landing in a
more useful what-must-it-be-like-to-always-be-disliked valley. And
sometimes I fail to make it and stay stuck in covert antagonism. So yes, we
definitely do have attractors. Or things that act like them.... but which
might also be called habits or training or education.
Which brings me to my second question which is epistemological - what is
the nature of the insights that complexity brings to primary care? Are they
'true' in some deep, or objective, or refutable way? Or are they just a
handy suite of interlocking metaphors - similar to the psychoanalytic ones
that Balint introduced to general practice - that provide a more coherent
set of explanations to doctors or patients? A better fitting shroud
through which, indirectly, to continue our grasping apprehension of the
consultation? I can think of ways that one could test the utility of
complexity stories ( do they lead to consultations with better outcomes? Do
doctors or patients 'like' them?) but I find it hard to think of how they
might be tested or refuted in any deeper way. Any thoughts from the
research group?
Finally who or what is doing the culling on the fitness landscape? what
mechanism takes the variety within the consultation and decides, and by
what criteria, which strategy is going to be
successful/propagated/repeated? The only candidate that I can see is our
own internal judgement - that seemed to work, that did n't - which
presumably is one reason why we get paid a lot of money but which has
little explanatory power. Maybe we should devise ways for patients to
decide, devices by which they can 'cull' or at least more explicitly
respond to our responses and statements about them. Or maybe this is a
point at which complexity theory gives out, part of the boundary marking
the end of its utility?
Paul
Paul Hodgkin
Primary Care Futures
21 Briar Rd, Sheffield S7 1SA
tel: 079 46463698
email: [log in to unmask]
-----Original Message-----
From: Ceri Brown [SMTP:[log in to unmask]]
Sent: 07 December 2001 23:15
To: [log in to unmask]
Subject: Re: tipping points, reply to AM Cunningham
In a message dated 07/12/2001 19:55:05 GMT Standard Time,
[log in to unmask] writes:
> I'm a novice/munchkin with regards to complexity theory.
>
Liebe Munchkin, (Benign Witch of the North West writes:)
>
> I have a few questions:
>
> Firstly, as doctors/health professionals- can we only give energy to help
> people out of the holes rather than change the landscape.
> I suppose in the model it doesn't matter whether you push or pull the
> patient. All that's required is a transfer of energy from you (acting as
a
> conduit for the 'energy' of the medical world) to the patient. If you
> prefer another physics analogy, transferring some of your available
> potential energy to add to the patient's kinetic energy in the hope that
>
> Also it seems a very doctor-centred model- Yes it is iatrocentric, I
>
could the patient find other sources of energy.
The general point is that 'energy' can be transferred from anywhere that
the
person thinks appropriate. Doctors are but one source. Social Services may
be
another, friends, groups etc etc. Get out of that 'potential well' by any
means possible, but some means are more efficient, or more socially
acceptable, than others
Are we at the bottom of the hole/well?- or travelling about on the
landscape
too?
The patient is travelling in her/his own landscape. We are travelling in
ours. Maybe the landscapes intersect at the point of consultation. NOW
THERE'S A NEW THOUGHT!!!!!!. I don't think we're at the bottom of the
patient's well, because we're not on the same fitness landscape. I can be
at
the 'peak of my profession' for the purposes of this argument, therefore
demonstrably not in the well. However I am aware of the patient's location
by
her/his description of the surroundings - feelings, symptomatology etc. We
just have to using similar conceptual frameworks to describe / understand
the
landscapes that others are on. Why did the conversation which started with
'crap' end up with a discussion of parents? ("They **** you up, your mum
and
dad..... Larkin) Presumably this is where the collaborative inquiry starts
to
fit in
>
> I'd rather conceive of myself as someone- if I couldn't level the
> landscape out altogether- who tried to help the patient develop better
> skills at negotiating the landscape so that he doesn't feel a constant
> dread of ending up in a hole, even though I could help him climb out
> (rather than push him).
>
> You can only do what you can do. Tipping the landscape isn't easy, but
look
> what's happening in Afghanisatan in relation to women. No-one's
> pushing/pulling them individually out of their Taliban induced wells, the
> whole landscape is being tipped to free them,or prevent them getting in
the
> wells in the first place. A medical analogy could be the introduction of
a
> health service or public health measures (back to the Victorian sewers
> point), where the action/energy of many individuals tipped the landscape.
> Another option is that the peaky landscape was rendered flatter.
>
A
> s for the dread of ending up in a 'crap' hole, I guess that's what
education
>
T
> here is obviously a lot more to be teased out of this. Maybe I should
have
> gone to the doctor-patient group after all! See you next time then?
>
Don't forget to polish the shoes!
BWOTNW
aka
Ceri Brown
Critical Care Programme
Project Development and Research
0161 720 2342 (Secretary)
07659 120 038 (pager)
07876 230 561 (mobile)
Thanks to my variable clinical commitments, calls to my mobile won't be
answered promptly. Please leave a message, or page me.
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