Two questions for Paul:
1 Did you like the man more at the end of the consultation than you did
at the beginning?
2 Since when has "objective refutable truth" been more true than poetic
(metaphorical) truth?
Iona
xxx
PS Years ago, one of my partners said that life was a pool of shit and that
his job, as a GP, was to direct people to the shallow end - somehow Ceri's
magnificent description of two dimensional phase space seemed to be saying
much the same thing.
-----Original Message-----
From: Dr. Paul Hodgkin <[log in to unmask]>
To: [log in to unmask]
<[log in to unmask]>
Date: 8 December 2001 17:45
Subject: tipping points and shadow worlds
>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.
>
> << File: ATT00009.html >>
