My opinion is that the VIRUS of simple rules is a poor substitute for
examining the richness of human interaction particularly in primary care.

I think that translating the ideas of complexity from the natural into the
Social sciences give us slightly greater hegemony over the technical
rationalists to examine the QUALITIES of who we are in relation to each
other. General Practice has been part of this conversation for a while
already (thank you Balint) [Iona I still haven't found the balint reference
to the Doctor and Patient as Experts]

This invites the question about qualities of reflection we
are able or willing to achieve when we EXAMINE these relationships.
My experiences of self reflection is that it is hard and painful.

My Mum had a 'simple rule' that it was important to be nice to people
I couldn't really disagree although at the time I wanted to. It often
Boiled down to whether she thought I was being nice to others (particularly
her and I am still learning) (-grin-). The simple rule itself is useless
without some reflection about it.

Simple Rules are systems based ways of thinking
That invites away of talking and thinking
That 'conveniently' avoids having to face
The issue of Power  Stacey (2001) complex responsive processes

So does complexity illuminate the data - NOT SURE IT DOES.
I think the value rests in its reflection on process issues rather than
content issues.

I think it invites the question about how we choose to look
at the data and the significance of the meaning the data has for
us and who we (including  David :-) might become as a consequence of our
reflection.

How has our collective reflection on David's narrative affected us.
No simple rules could have predicted the level of energy that
Has arisen from his input. Or did this level of energy happen by chance?

Me thinks not. Could this list serve be a narrative reflection of the
'Complexity/ richness' of the interactions amongst its participants?
More tautology  - but I guess that's complexity for you.

Alasdair
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On 6/12/01 10:20 pm, "Dr. Paul Hodgkin" <[log in to unmask]>
wrote:

> I think this debate is great - but would be even better if informed by some
> data from our interactions with patients -  after all one point of a
> co-operative inquiry is to connect up these intellectual debates with the
> real world - and vice versa.
> My only experiment so far with the tentative questions posted by the
> doctor-patient group has  been with a 50+ year old man, off sick for >1year
> following stress at work and chronic asthma. 'Why do you think you're ill
> now?' elicited 'Because I feel like total crap' - at one level deeply
> unimpressive. At another maybe a statement of some actual shadow world of
> somatic-crapness?? Either way my own internal shadow world was at this
> point illuminated by the sharpening focus of how much I disliked this man,
> which in turn made me think that this was probably a recurring reaction
> from many people to him (after all I'm normal aren't I !!) - and thence to
> proceed down a conversation about his own childhood with its very
> domineering father and a mother who ignored him.
> Interesting - but the question for me is does complexity illuminate this
> data? And if so how? and in any more valid ways than GPs have always
> discussed? Or is it just another useful metaphor in the internal
> armamentarium of therapeutic musings?
> Paul
> Paul Hodgkin
> Primary Care Futures
> 21 Briar Rd, Sheffield S7 1SA
> tel: 079 46463698
> email: [log in to unmask]
>
>
>
>
> -----Original Message-----
> From:   Blackman, Tim [SMTP:[log in to unmask]]
> Sent:   06 December 2001 15:23
> To:     [log in to unmask]
> Subject:        Re: tipping points
>
> This is my first contribution to this fascinating list (quiet member I
> think
> is the term). I am a mere social scientist/academic manager, not a
> clinician. But the answer seems to be to think of the individual as an
> attractor. If the fitness landscape is re-tuned by say an improvement in
> material conditions, new attractors emerge (healthy individuals). Thus, the
> epidemiological transition can be thought of as a phase transition from one
> landscape to another. The attractors for individuals are quite different in
> the two landscapes.
>
> Tim Blackman
>
> -----Original Message-----
> From: William House [mailto:[log in to unmask]]
> Sent: 06 December 2001 10:31
> To: [log in to unmask]
> Subject: Re: tipping points
>
>
> What an interesting angle! Of course, diseases are ideas - the
> manifestation
> of disease theory. Outside patients they are only concepts. As with other
> ideas/concepts they can blind us to the world not encompassed by it. Using
> the cholera analogy, we could easily be so mesmerized by the disease
> cholera, that we do not see that it is actually a public health problem.
> That seems obvious to us now, but surely the same is currently happening
> with the present day scourges of the developed world - such as ischaemic
> heart disease, asthma, depression, type 2 diabetes and cancer - all largely
> diseases of our society taking root in the favourable soil of an individ
> ual.
> Disease theory blinds us to it - or is it the daunting social engineering
> required to tackle it? The Victorians were not daunted! How can complexity
> theory help? I sense it might but I am still too much of a beginner to
> understand how. William House
>
> -----Original Message-----
> From: Ceri Brown [mailto:[log in to unmask]]
> Sent: 03 December 2001 21:03
> To: [log in to unmask]
> Subject: tipping points
>
>
> I wasn't there but it seems to me there was a tipping point on the 29th!
>
> The Tipping Point is also the title of a pop management book by Malcom
> Gladwell (Little Brown & Co.). His analysis of large scale behavioural
> change is based on using the similie of ideas being like diseases. The
> whole
> work is based around the disease (idea), the host (individuals) and the
> environment in which both disease and host find themselves.
>
> In contrast to public health medicine, Gladwell's book is dedicated to
> spreading the "disease," with consequent benefits to society or corporate
> balance sheets. He has a few more categories than the three mentioned
> above,
> but it's basically treating the success of "Sesame Street" as a cholera
> outbreak.
>
> A few nice ideas in it though.
>
>
>
> Ceri Brown
>
>
> << File: ATT00002.html >>
>

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