Thinking of the consultation as a CAS is a user friendly way of thinking
about how to live with complexity- but what Dan says is correct in my
opinion.

Tim
-----Original Message-----
From: Complexity and chaos theories applied to primary medical and
social care [mailto:[log in to unmask]] On Behalf Of
Dan Munday
Sent: 24 April 2002 07:25
To: [log in to unmask]
Subject: Re: Fw: Fw: Consulting as a CAS?


What is a consultation? Is the whole interaction of CAS doctor - CAS
patient over a period of time (7.5 minutes if you're lucky) "the
consultation" or does the consultation emerge from the wider interaction
of these CAS-s? If the whole thing is the consultation ie all that is
interacting in that period within the two, now nested CAS-s (with their
fuzzy boundaries), then it is, I would suggest, a CAS itself. If the
consultation is the bit of the interaction that is identified by the
CAS-s and any observer as "the consultation" then it is one factor
emerging from the CAS formed during that period, largely, though not
wholly within the four walls of the consulting room. Other levels of
emergence might be anger, frustration, resolution, enhanced doctor
patient relationship etc.

Dan

On 23 April 2002 08:17, Trevor Griffiths
[SMTP:[log in to unmask]] wrote:
> I find myself agreeing with Harjinder and Rakesh, that the
> consultation
is
> not 'a thing' that is a complex system. The consultation is a
conversation
> between two complex systems, both of which have their own time frames,
sense
> of environment and existential reality, some of which co-incide with
> the other's.  I find it curious that many people talking about the
consultation
> itself as a CAS start looking at measurables such as waiting times,
computer
> data, written notes etc. rather than the impact of WAITING on the
attitude
> (fractal or fractious?) of one 'system' coming in late into the
consulting
> room of another's! Certainly, that conversation between two CAS's
> takes place nested within a wider CAS, but that wider CAS is not just
> a
physical
> environment or a time-limited scale - it is the whole practice as a
> functioning unit of the NHS - another collection of 'whole people' who

> function more-or-less adaptively. The computer and its (reliable?)
> data
are
> part of that nesting system - adjuncts to the information content of
> the conversation but not to be confused with the conversation. If you
> take
this
> view, then as a consequence it would be OK to use time frames to
> analyse whether the two CASs in conversation are functioning
> adaptively relative
to
> each other, or whether the doctor is functioning more as a
> 'complicated non-adaptive slave' to a wider system that has made
> him/her adapt to governmment guidelines more than to the patient!
>
> ----- Original Message -----
> From: Rakesh Yahoo <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Saturday, April 20, 2002 5:09 PM
> Subject: Fw: Fw: Consulting as a CAS?
>
>
> > ----- Original Message -----
> > From: Rakesh Biswas <[log in to unmask]>
> > To: Complexity and chaos theories applied to primary medical and
> > social
> care
> > <[log in to unmask]>
> > Sent: Wednesday, April 17, 2002 10:08 PM
> > Subject: Fw: Fw: Consulting as a CAS?
> >
> >
> > >
> > > ----- Original Message -----
> > > From: Harjinder Singh <[log in to unmask]>
> > > To: Rakesh Biswas <[log in to unmask]>
> > > Sent: Wednesday, April 17, 2002 2:17 PM
> > > Subject: Re: Fw: Consulting as a CAS?
> > >
> > >
> > > > Dear Rakesh,
> > > > I am tempted to give an answer to the question on consultation
being a
> > > > CAS.
> > > > I write to you because I do not have time to look into details
> > > > and
my
> > > > answer should be
> > > > taken as a naive response. With greater confidence, I should
> > > > have written to the seeker of Truth directly.
> > > >
> > > > Firstly, consultation is not a system, it is a process. A system

> > > > is something that undergoes processes. If my language is right,
> > > > the consultee (the one who seeks
> consultation),
> > > > say C1,
> > > > consults the consultant, say, C2.
> > > >  Both ends of the process C1 and C2 are complex systems, because
the
> > > > degrees
> > > > of freedom in each case are practically infinite.
> > > > But it is possible that we are talking about a precise problem
> > > > with
a
> > > > limited
> > > > number of degrees of freedom, for instance I (C1) have $100 and
> > > > I
have
> a
> > > > choice to
> > > > go to a theatre or to indulge in a five star dinner. If I
> > > > consult
the
> > > > radio (C2) to
> > > > find a solution with only one parameter, the traffic (whether it

> > > > is easier to drive to the theatre or to the gathering of the
> > > > stinking rich), it is not
a
> > > > complex system anymore.
> > > > However, if I look for a friend (hopefully of the right sex - or
the
> > > > left) who should be able
> > > > to advise me on what to choose, now that is a complex system and

> > > > my guess is, even an adaptive one.
> > > >
> > > > >
> > > > ...........laltu
> > > >
> > > >
> > >
> > >
> > >
> > >
> >
> >
> > _________________________________________________________
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> >
> >
>