Dear All,
Good achievement getting it published. Will take time for the Lancet to realise the opportunity it has missed. I too have been working on the patient narrative, primarily recording using filmed/video. Such narratives provide a key real-time insight that fits well with complexity and transformational change (least it's not just a systems derived toolbox). In some areas it is gaining recognition. Like The Lancet however in my experience the rest seem to be oblivious to the real usefulness of the patient narrative to help bring about change and improvement - particularly in the context of relationships and respect. Again it will take time for this to gain better recognition. Congratulations again to Carmel and yourself re publication...and thank you for your tenacity and persistence.
Shaun and Marian Naidoo
Naidoo and Associates
[log in to unmask]
-----Original Message-----
From: Complexity and chaos theories applied to primary medical and social care [mailto:[log in to unmask]] On Behalf Of Anne Cunningham
Sent: 18 December 2008 19:38
To: [log in to unmask]
Subject: Re: published paper in relation to "Narrative Evidence Based Medicine"
Dear All
For some reason I have missed out on some of the list messages so didn't get the attached paper. I
will look out for it elsewhere however. I have been thinking about the place of patient narratives
in medical education recently too. Here was my latest blog about this:
http://wishfulthinkinginmedicaleducation.blogspot.com/2008/12/patient-narratives-in-medical-education.html
I'm really glad to see that others are thinking about this too.
Anne Marie
Dr Anne Marie Cunningham
Clinical Lecturer
Department of Primary Care and Public Health
Centre for Health Sciences Research
Cardiff University
3rd Floor, Neuadd Meirionnydd
Heath Park
Cardiff
CF14 4XN
Tel: 02920 68 71 70
Fax: 02920 68 7219
>>> Adrian French <[log in to unmask]> 18/12/2008 17:19 >>>
'I wonder when we shall get a case reports journal which
would include patient's perspectives as well and not just
talk on the disease.'
Something like this?
http://www.healthtalkonline.org/
Adrian
On Wed, 17 Dec 2008 19:43:57 +0530
Rakesh Biswas <[log in to unmask]> wrote:
> Dear Achim, Carmel, Steve and Sandy,
>
> Thanks for this interesting discussion. I agree with
>Sandy's comment on IMGs
> based on my experience of teaching students in India,
>Nepal and
> Malaysia (many of who end up as IMGs when they land up
>with you). However I
> am sure they are quick to adapt to the newer thought
>processes as well (if
> they have adequate relevance to their future assessments
>I guess).
>
> I would like to share another quote from Osler (also
>contextualized in
> another paper in the same issue of the Journal with
>Carmel and Achim as co
> authors):
>
>
> *"Carry a small note-book, and never ask a new patient
>a question without
> note-book and pencil in hand...Begin early to make a
>three-fold category -
> clear cases, doubtful cases and mistakes. And learn to
>play the game fair,
> no self-deception, no shrinking from the truth; mercy
>and consideration for
> the other man, but none for yourself, upon whom you have
>to keep an
> incessant watch. It is only by getting your cases
>grouped in this way that
> you can make any real progress in your post-collegiate
>education; only in
> this way you gain wisdom with experience."*(Osler 1904,
>1928)**
>
> Another definition of Knowledge and wisdom comes from
>Information theory:
>
> *Knowledge* is information that can be easily recalled
>( Imagine a very
> knowledgeable person who expounds volumes on a
>particular topic that may be
> vaguely related to the query you have posed but hardly
>goes anywhere near
> answering it). Even google is quite knowledgeable that
>way and can even
> often answer our queries after giving us a lot of
>information options to
> choose from.
>
> *Wisdom* is in being able to apply knowledge in a manner
>that answers our
> queries with minimum noise or redundancy in the
>information conveyed. This
> off course just remains a human trait for now, I am not
>sure how long
> though.
>
> I am very interested in clinical problem solving
>exercises (which you
> mentioned about your student) that would apply a patient
>centered stance
> rather than the disease based stance that we are
>compelled to publish as
> case reports.
>
> I wonder when we shall get a case reports journal which
>would include
> patient's perspectives as well and not just talk on the
>disease. This
> may have come out in isolated snippets as the patient's
>journey in BMJ but
> its time we had a complete journal devoted to it.
>
> Or better still an open access online data base that
>keeps getting regularly
> updated...Or why not conate/collate already accumulated
>patient health
> professional experiences available on the net to help
>solve our clinical
> problems in a patient centered manner on a regular
>basis? ( this is
> probably the bottom line in the other paper with Carmel
>and Achim in the
>
same issue of the journal)
>
> rakesh
>
> http://peoplesgroup.academia.edu/RakeshBiswas
>
>
> On 12/17/08, Alexander Reid <[log in to unmask]> wrote:
>>
>>
>> Dear Achim,
>>
>> I too add my congratulations to you both: it is a long
>>time since I met
>> Carmel and I did not know she was in Canada (greetings)
>>
>> I do not quite understand Stephen's comment that other
>>disciplines "do not
>> even appear to approach the concept of what knowledge
>>is" Philosophy has
>> been examining it for thousands of years.
>>
>> *Knowledge*: the psychological result of perception and
>>learning and
>> reasoning
>>
>> *Wisdom*: ability to apply knowledge or experience or
>>understanding common
>> sense and insight
>>
>> An interesting word not in the dictionary is "Conation"
>>which more or less,
>> means 'grasping emerging meaning'
>>
>> The introduction of 'cynefin' is interesting, and the
>>concept of knowledge
>> as a 'flow' are also interesting and I think relates to
>>'conation'
>>
>> Most of our colleagues will not be interested in the
>>philosophy, but some
>> will be interested in the practical application to
>>medicine. I have moved
>> through Newcastle students- encouraged to think; UNSW
>>students 2000
>> interested only in facts; UNSW 2008, more inclined to
>>think; International
>> medical graduates the majority of whom come to us full
>>of facts, but many
>> have no idea how to apply them. If the patient fits
>>into a disease box
>> they are happy, if not, many are lost.
>>
>> I recently watched a good registrar work his way through
>>about 5 patients
>> who were largely 'insoluble' in medical terms. By using
>>a McWhinney/
>> Stewart model he explored their *illness* and managed
>>them well- this was
>> a nice example of wisdom in a young person. (Happily a
>>student of the UNSW
>> Rural Clinical school Wagga!). None of us knew at the
>>beginning of the
>> consultations what was hidden, and what was to be
>>revealed in the process of
>> fluid acquisition of knowledge described in the paper.
>>
>> I have been watching Bill Leake, Facepainting on the
>>ABC. He is painting
>> pictures of people now dead using a variety of sources
>>of information.
>> Neither he, and certainly not we, have any idea where he
>>is going: it
>> appears chaotic for a start, but grows as he proceeds
>>and ends up as a
>> complete picture. We undergo a process of 'conation'.
>> This is analogous to
>> the picture we build in many consultations, certainly
>>the ones I observed
>> recently.
>>
>> Medical education has tended to concentrate too much on
>>facts and diseases
>> (important though they are). They are easier to assess.
>>We have not spent
>> enough time on trying to encourage wisdom by using
>>experience, and
>> encouraging common sense and insight- none of these
>>appear in the books!
>>
>> Osler still has a lot to tell us
>>
>> He who studies medicine without books sails an uncharted
>>sea, but he who
>> studies medicine without patients does not go to sea at
>>all. *
>> **William
>>Osler*<http://www.brainyquote.com/quotes/quotes/w/williamosl393617.html>
>>
>> In seeking absolute truth we aim at the unattainable and
>>must be content
>> with broken portions. *
>> **William
>>Osler*<http://www.brainyquote.com/quotes/quotes/w/williamosl386283.html>
>>
>> It is much more important to know what sort of a patient
>>has a disease than
>> what sort of a disease a patient has. *
>> **William
>>Osler*<http://www.brainyquote.com/quotes/quotes/w/williamosl391388.html>
>>
>> The good physician treats the disease; the great
>>physician treats the
>> patient who has the disease. *
>> **William
>>Osler*<http://www.brainyquote.com/quotes/quotes/w/williamosl386616.html>
>>
>> Regards, Sandy
>>
>> Professor Sandy Reid AM
>> Rural Clinical School
>> Faculty of Medicine
>> University of New South Wales
>> PO BOX 5695
>> Wagga Wagga NSW 2650
>> email: [log in to unmask]
>> phone
: 02 6933 5111
>> fax: 02 6933 5100
>>
>>
>> *Steve Wilkinson <[log in to unmask]>*
>>
>> 16/12/2008 03:58 PM
>> To
>> JP Sturmberg <[log in to unmask]> cc
>> "Carmel Martin" <[log in to unmask]>, "'Rakesh
>>Biswas'" <
>> [log in to unmask]>, "Liz Farmer"
>><[log in to unmask]>, "'Di
>> O'Halloran'" <[log in to unmask]>, "Dimity Pond" <
>> [log in to unmask]>, "Claire Jackson"
>><[log in to unmask]>,
>> "Leon Piterman" <[log in to unmask]>,
>>"'Kaye Atkinson, Dr'" <
>> [log in to unmask]>, "Michael Fasher"
>><[log in to unmask]>,
>> "Per Fugelli" <[log in to unmask]>, "Andrew
>>and Norma Innes" <
>> [log in to unmask]>, "David, Dr. Annette\(DHP:TFI\)" <
>> [log in to unmask]>, "Annette\(DHP:TFI\) David"
>><[log in to unmask]>,
>> "Cathy Regan" <[log in to unmask]>, "Daniel
>>\(Tai Pong \) Lam"
>> <[log in to unmask]>, "Dave Snowden"
>><[log in to unmask]>, "David A
>> Katerndahl" <[log in to unmask]>, "David Wright" <
>> [log in to unmask]>, "Hsu-ming Teo"
>><[log in to unmask]>,
>> "Janet ANDERSON" <[log in to unmask]>,
>>"Janet ANDERSON"
>> <[log in to unmask]>, Jens-Martin Trder <
>> [log in to unmask]>, "John De
>>Simone" <
>> [log in to unmask]>, "Lyn Clearihan"
>><[log in to unmask]>, "Mark
>> Moes" <[log in to unmask]>, "Michael Kidd"
>><[log in to unmask]>,
>> "Neil Spike" <[log in to unmask]>, Pl
>>Gulbrandsen <
>> [log in to unmask]>, Pl Gulbrandsen
>><[log in to unmask]>,
>> "Cilliers Paul" <[log in to unmask]>, "Peter Maguire" <
>> [log in to unmask]>, "Richard Lauwrence " <
>> [log in to unmask]>, "Sandy Reid"
>><[log in to unmask]>, "Sam
>> Heard" <[log in to unmask]>, "Shmuel Reis"
>><[log in to unmask]>,
>> "Shake Seigel" <[log in to unmask]>, "Sholom
>>Glouberman" <
>> [log in to unmask]>, "Stephen Lew "
>><[log in to unmask]>, "Stephen
>> Wilkinson" <[log in to unmask]>, "Stewart
>>Mennin" <
>> [log in to unmask]>, "Tim Holt" <[log in to unmask]>,
>>"Viv Read" <
>> [log in to unmask]>, "Vlad Matic"
>><[log in to unmask]>, "Wes Fabb"
>> <[log in to unmask]>, "William Miller"
>><[log in to unmask]>, "Zorayda
>> Leopando" <[log in to unmask]>, "Kaye Atkinson"
>><
>> [log in to unmask]> Subject
>> Re: published paper in relation to "Narrative Evidence
>>Based Medicine"
>>
>>
>>
>>
>> Dear Joachim
>>
>> Congratulations to Carmel and yourself re publication
>>... and your tenacity
>> / persistence.
>>
>> Fascinating to see this paper coming from a
>>philosophical approach within
>> medicine.
>>
>> Imagine the legal profession dealing with this! Their
>>approach to evidence
>> appears to me to be rigid and archaic.
>>
>> Or other disciplines / professions dealing with it!
>>
>> Medicine appears far more sophisticated and forgiving,
>>whilst being
>> embryonic and possibly overbending with tolerance.
>> Attempting to see the
>> world the way another person sees is still a blinkered
>>way of seeing the
>> world ... but it potentially helps within medicine ...
>>and can be superior
>> to seeing it only the way the self does ... we can
>>discuss self later,
>> should you wish ... or attempting to construct a common
>>world view suitable
>> to all ... the concept of an objective reality.
>>
>> Medicine tries to understand an individual's perspective
>>and also expand
>> the view of the practitioner. Law tries to impose .. or
>>to tease out
>> understanding to restrict views all involved ... to make
>>imposing judgments.
>> Other disciplines ... except psychology ... and I'm not
>>talking about
>> philosophy as a discipline / profession so much as an
>>inherently human way
>> of being / thinking .... do not even appear to approach
>>the concept of what
>> knowledge is.
>>
>>
Medicine still has problems within the area loosly
>>considered to be part of
>> psychiatry eg concepts such as body dysmorphism, sexual
>>abuse, dissociative
>> disorders, PTSD, refugees ... trauma in general ... dare
>>I mention false
>> memories ... delerium / dementia / depression ... as
>>well as recall / memory
>> / knowledge in everday life, which you are addressing.
>>
>> Keep in contact re phase II!
>>
>> Happy Holidays.
>>
>> Regards
>>
>> Stephen
>>
>>
>>
>>
>>
>> On 16/12/2008, at 11:47 AM, JP Sturmberg wrote:
>>
>> Dear All,
>> As you may recall I circulated the paper "Narrative
>>Evidence Based
>> Medicine" earlier in the year. In response I wrote a
>>paper to the Lancet
>> that they promptly rejected with the following comment -
>> "thank you we are
>> interested in your trial and are happy to publish your
>>phase II results".
>> It got recently published in Evaluation in Clinical
>>Practice and is
>> attached.
>> All the best for the festive season
>> Joachim
>>
>> Joachim P Sturmberg
>> A/Prof of General Practice
>> PO Box 3010
>> Wamberal, NSW 2260
>> Australia
>>
>> Tel -61-2-4384 2255
>> Mobile - 61-407-003240
>> P Please consider the environment before printing this
>>message
>>
>>
>>
>>
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