When we met last week the doctor-patient group discussed things that they
could do within the consultation to explore aspects of complexity. A number
of possibilities were raised -increasing feedback loops, how you might use
complexity to discuss complex outcomes e.g. cardiac risk factors - but in
the end we settled on two themes:

A. Is it useful to think about hte patient's 'shadow' world - all those
informal thoughts, feelings, beliefs, gossip, experience that determine
when and why patients bring particular problems?How do you quickly and
tactfully access this material? What questions are the most effective? And
if you are successful, is this useful to doctor or patient?
Initial questions that might be worth exploring in consultations were:
*'When you set out to come here today what did you think I could do for
you?'
*why has this happened to you now?
*how would your best friend describe your health?
*what would your best friend tell you to do about your health?

These questions could be seen as simply re-framing a health belief model
into complexity. Part of the inquiry could focus on whether this is so and
what the added value of complexity theories and the 'shadow world'.

B. Exploring contradiction and paradox
There is often paradox and contradiction in consultation - from patient or
doctor or both. How can we train ourselves to notice this better? how can
we use contradiction in consultations? what happens when the paradox is
highlighted - is this therapeutic? dangerous? useful? What is a paradox and
how is it different from a contra-diction?
Example of paradox quoted was 'what bad things would happen if you got
better?' - here the underlying assumption that everyone wants to get better
is being contra-dicted by the patients behaviour.
Possible ways to access this that were suggested:
*keeping a log of all paradoxes occurring in a surgery
*noticing how you noticed them, what called your attention to them
*why you did or did not articulate them
*and what happens when you do.
Happy inquiring
 Paul

Paul Hodgkin
Primary Care Futures
21 Briar Rd, Sheffield S7 1SA
tel: 079 46463698
email: [log in to unmask]