I wonder if the paper attached might be of interest? It is a
metasynthesis of accounts of expertise in maternity care, and we
finished up with the concepts of wisdom, enacted vocation, and skilled
practice. We make a plea in the paper for systems of maternity care to
acknowledge and accomodate these elements, to maximise safe motherhood
and optimal care.
The discussion on connation is fascinating, and it may be something we
pick up on as we take our work on expertise forward - thanks!
All the best
Soo
Professor Soo Downe
Director
WISH Reseach Group
and ReaCH (Research in Childbirth and Health) unit
Faculty of Health
University of Central Lancashire
Preston PR1 2HE
Lancashire
England
UNITED KINGDOM
+44 (0) 1772 893815
tel: 01772 893815
>>> Carmel Martin <[log in to unmask]> 12/21/08 12:50 pm
>>>
Reminds me of the old saying
you can take a horse to water but you can't make him drink
Connation is a very interesting concept, which seems to be located
within an individual: yet it appears to strongly relate to emergence,
adaptation and self organization in social systems as a group
phenomenon.It bears exploration further in the issue of change in
complex health systems with early adoption and resistance phenomena.
Carmel
Carmel M Martin, MBBS, MSc, PhD, MRCGP, FRACGP, FAFPHM
Tel: +1 613 562 4262 ext 2032; Cell +1 613 878 7372
Fax: +1 613 482 4609
Email: [log in to unmask]
Date: Sun, 21 Dec 2008 22:31:03 +1100
From: [log in to unmask]
Subject: Re: published paper in relation to "Narrative Evidence Based
Medicine"
To: [log in to unmask]
Dear Sandy,
Thank you, and thanks for broadening the discussion. For those
not familiar with the term, here is the Wikipedia explanation –
albeit a little
thin.
Let me add two quote from William J Mayo
Truth is a constant variable.
and
The ills of today must not cloud the horizon of tomorrow.
Cheers
Conation
From Wikipedia, the free encyclopedia
Conation
is a term of relatively recent origin that is synonymous with
motivation/will/drive, the preferred terms in psychological discourse.
From the
Latin verb "conari" which means to attempt or to strive.
The
power or act that directs or impels to effort of any kind, whether
muscular or
psychical.
[edit] Conative
Style in popular psychology
Conative
Style is the personal "how" tasks are processed; many intelligent
people have had issues with work or their chosen careers due to
personality
conflict that happens when bosses process one way and employees
another.[citation needed] People are
motivated, simply, by different instinctive conative styles.[citation
needed] Neither are
wrong and can actually be complementary and highly effective together-
if the
leader can recognize and appreciate the differences instead of
labeling
employees as "non-conformists" or "rebels".[citation needed] Many
people
have become insecure and dis-heartened from beration and
misunderstanding and
therefore lost their sense of "self-efficacy'.[citation needed] This is
the
ability to effectively process tasks. So, invariably an intelligent,
productive
individual can be lost to productive and meaningful work life without
the
understanding of a learned and progressive upper management.[citation
needed]
Wiktionary,
the free dictionary.
conatus
[edit] External links
Huitt, W. (1999). Conation
as an important factor of mind. Educational Psychology
Interactive.
Valdosta, GA: Valdosta State University. Retrieved [2008-06-15.
Remarks on "conative style" at Oprah
Winfrey's website [1]
Kolbe Corp. offers services in learning
and interpreting your Conative Index.
The Center for Conative Abilities
seeks to educate people in understanding and using their conative
skills.
This
psychology-related
a
rticle is a stub. You can help Wikipedia by expanding
it.
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
From: Alexander Reid [mailto:[log in to unmask]]
Sent: Wednesday, 17 December 2008 1:49 PM
To: Steve Wilkinson
Cc: Annette(DHP:TFI) David; Andrew and Norma Innes; Carmel Martin;
Cathy
Regan; Claire Jackson; Zorayda Leopando; Dave Snowden; David, Dr.
Annette(DHP:TFI); David Wright; Dimity Pond; 'Di O'Halloran'; Liz
Farmer;
Cilliers Paul; Hsu-ming Teo; Janet ANDERSON; Janet ANDERSON; JP
Sturmberg; John
De Simone; David A Katerndahl; 'Kaye Atkinson, Dr'; Leon Piterman;
Stephen Lew
; Lyn Clearihan; Michael Fasher; Michael Kidd; Mark Moes; Kaye
Atkinson; Neil
Spike; Pål Gulbrandsen; Pål Gulbrandsen; Per Fugelli; Peter Maguire;
'Rakesh
Biswas'; Shmuel Reis; Richard Lauwrence ; Sam Heard; Shake Seigel;
Sholom
Glouberman; Stewart Mennin; Sandy Reid; Stephen Wilkinson; Tim Holt;
Daniel
(Tai Pong ) Lam; Jens-Martin Träder; Viv Read; Vlad Matic; Wes Fabb;
William
Miller
Subject: Re: published paper in relation to "Narrative Evidence
Based Medicine"
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
In seeking absolute truth we aim at the unattainable and must be
content with
broken portions.
William
Osler
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
The good physician treats the disease; the great physician treats the
patient
who has the disease.
William
Osler
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 Träder
<[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]>, Pål Gulbrandsen
<[log in to unmask]>, Pål 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
medicin
e
... 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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