Dear Doctor, I have a list . . .

It seems reasonable to suggest that my trips to see the GP as a child:

"What's the problem Mrs Jones?"

"It's Peter, he's not eating!"

"Well, does he seem ill? ... Is he lying down all the time?"

"No, he's running around all day"

"Well he sounds OK but let's check" ... ... ...

"Say arr!"

 (That's to me - not you reader!)

"Argh!"

"Mmm.. ok, ok. ... What does he eat?"

"Tomato soup, chips, chicken, beans on toast, raw carrot, boiled egg."

"Oh! And jam butties!"

"Well he's of slim build, no doubt underweight, but he's fine. Keep the jam butties rolling, and I suspect he'll keep running around."

- were in the days pre-one-problem-per-visit to the surgery. Even now I wonder is this an urban (rural) myth. But then it rears itself with a comment by family, or overheard. The 1960s and 1970s were a different time, a different age. We always saw the same doctor. Continuity mattered then. Thankfully, I was not a regular 'visitor', or the more derogatory term frequent flyer.

individual

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INTERPERSONAL : SCIENCES

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL

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group

Ever since starting in the NHS as a nursing assistant, you became aware of the anxiety provoked by many patients when it is their turn to see the doctor. Being asked to bring the patient and any relative(s) through. It often entailed a walk.

I remember one instance their being 12 professionals. Learners can soon increase numbers and restrictions were imposed. Voices were raised. Patients did see the doctor separately. Back in 1980s, I became a CMHN (CPN) in 1985, I used to encourage patient's to prepare, to make notes of points - questions they wanted to ask. I framed it as their time, their opportunity. A learning opportunity too. Of course, humour always needs to be used carefully, but on occasion we would joke about walking into the meeting with a list.*

In case of long-term mental illness families are also greatly involved. Sometimes a case review would take place in the patient's home. If it's care in the community, delivered by the community team then surely the administration can be organised in support?

At times, I would offer to assist and the team were always responsive. This role of advocacy has changed, transformed over the decades, but it is still there. As a nurse you listen for the voice: but have to be ready to 'pick this up' on another's behalf. Ready

*Lists: Long a tool for safety and situational awareness.

'What Kingdom' by Fine Gråbøl

client - person - individual - self - patient

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humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL

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group

What Kingdom

'Gråbøl was lucky. Eventually she started seeing a new psychiatrist, who looked at that record "and was like, "Wow, you receive So much more medicine than all the other people who live there. Why is that?'" She didn't know. Gradually, though, she was able to come off the drugs; and two doctors decided that she didn't, in fact, have borderline personality and bipolar disorders, removing the diagnoses that had shaped her sense of her self. In time, she left the unit and rebuilt her life. She's no longer on medication today, but the ghosts of her past diagnoses haunt her. She wonders whether the conditions are merely in hibernation and she'll wake up one day and enter another depressive episode. She doesn't wish she'd never been diagnosed, but does feel that her doctors underestimated the effect those labels would have on her development. At 17, she points out - the age she was diagnosed as bipolar - most teenagers don't yet know who they are. "You want to find a box or language to define yourself, so that you can close yourself in. And one way of getting that sense is getting into the psychiatric system." Since returning to "normal" life, she has also struggled with survivor's guilt: the feeling that while she made it out of the system, others did not.

'Above all, she wishes that the emphasis would shift away from the suffering individual and onto their broader context. We need to become better, as a society, at making room for people who aren't fully functional citizens. Gråbøl's narrator phrases it as a question: "Could we not imagine treatments that are instead externally directed involving the outside world gearing itself towards a wider and more comprehensive emotional spectrum?" Gråbøl's answer, though, is the same as my own: "I don't know."'

the system citizens?

My source:
Leaf Arbuthnot, Interview. We need to make room for the mentally ill. Review, The Daily Telegraph, 21 September 2024, pp.8-9.

Image:
https://images3.penguinrandomhouse.com/cover/9781953861849

Paths, lines, corners, edges and axes . . .

'If a farmer has made a path, he is able to saunter easily up and down it. That is what the path was made for. But the work of making the path was not a process of sauntering easily, but one of marking the ground, digging, fetching loads of gravel, rolling, and draining. He dug and rolled where there was yet no path, so that he might in the end have a path on which he could saunter without any more digging or rolling. Similarly a person who has a theory can, among other things, expound to himself, or the world, the whole theory, or any part of it; he can, so to speak, saunter in prose from any part to any other part of it. But the work of building the theory was a job of making paths where as yet there were none.' 

Gilbert Ryle, The Concept of Mind (1949; Penguin, 1999), p. 272.

path

https://hodges-model.blogspot.com/search?q=path

line (line of sight)

https://hodges-model.blogspot.com/search?q=line

corners

https://hodges-model.blogspot.com/search?q=corners

edges

https://hodges-model.blogspot.com/search?q=edges

axes: STRUCTURE

domains: CONTENT

Frayn, Michael (2006). The human touch: our part in the creation of a universe. Notes. London: Faber & Faber. p.425.

Previously: 'Frayn on maths'

I will keep this book a bit longer - chapter 'Home Address' (the self) a good read.

Hear* are the Global Evidence Results: Health 10 :: Education 1

individual

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EDUCATION 1 MENTAL HEALTH X?	HEALTH 10
	DEFENCE 10

Key recommendations

Our main recommendation is for countries to collaborate on evidence synthesis. The most promising avenue for evidence synthesis is Living Evidence Reviews (LERs), which are systematic reviews that are continuously updated. We propose that ‘meta’ LERs are conducted across all areas of social policy to answer the questions that really matter to policymakers.

“Globally, it may be helpful for countries to join forces in producing systematic reviews and identifying evidence gaps. One proposal, currently being shaped by David Halpern and Deelan Maru, proposes that a handful of likeminded governments join forces to produce better systematic reviews and avoid duplication (Halpern and Maru, 2024)… Like the Cochrane Collaboration and the Campbell Collaboration, such an approach can help expand our knowledge of what works, and put a spotlight on the areas where more evidence is needed.”

A Blueprint for Better International Collaboration on Evidence

https://www.bi.team/publications/international-collaboration-evidence/

My source:
Harford, T. Intellect. Used in evidence. FTWeekend, Magazine 2-3 November 2024, p.9-10.

*We really need to listen and respond to this!

ERCIM News No. 139 Special Theme: "Software Security"

Dear ERCIM News reader,

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What are the characteristics of living a life?

What about Nationhood?

Citizenship?

[Spiritual ( Sciences, Sociology, Intra- Interpersonal, Political )]

person(hood) individual

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SOCIOLOGY : POLITICAL

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group

speak see hear	speak hear see
speak hear see

Source: Various since 2021 - image 'X'.

Women's rights in Afghanistan: An ongoing battle
https://www.europarl.europa.eu/thinktank/en/document/EPRS_BRI(2023)747084

Afghanistan: No future without women’s participation

https://news.un.org/en/story/2024/09/1154721

Patriot

individual

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group

	Patriot by Alexei Navalny

Source: Various

NOT 'Nanny State': Protection & assurance of the quality of nutrition

The Government needs a plan to fix our broken food system and turn the tide on the public health emergency

24 October 2024

The House of Lords Food, Diet and Obesity Committee demands that the Government should develop a comprehensive, integrated long-term new strategy to fix our food system, underpinned by a new legislative framework. This is the key conclusion of the Committee’s report, ‘Recipe for health: a plan to fix our broken food system’.

Chair's comments

Baroness Walmsley, Chair of the Food, Diet and Obesity Committee, said:

“Food should be a pleasure and contribute to our health and wellbeing, but it is making too many people ill. Something must be going wrong if almost two in five children are leaving primary school with overweight or obesity and so many people are finding it hard to feed healthy food to their families. That is why we took a root and branch look at the food system and analysed what had gone wrong over the past few decades.

“Over the last 30 years successive governments have failed to reduce obesity rates, despite hundreds of policy initiatives. This failure is largely due to policies that focused on personal choice and responsibility out of misguided fears of the ‘nanny state’. Both the Government and the food industry must take responsibility for what has gone wrong and take urgent steps to put it right.

“We hope, given the recent comments from the Prime Minister, Lord Darzi and the Secretary of State for Health, that there is now an appetite to shift towards prevention of ill health. We urge the Government to look favourably on our plan to fix our broken food system and accept that not only is it cost-effective, but that it would lead to a lot less human misery.”

[My emphasis] 

About time! Real action please.

DO NOT DILUTE TO TASTE!

individual

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SOCIOLOGY : POLITICAL

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group

Personal responsibility Educational determinants Health literacy My choices Role model Internal - Extrinsic motivation The life chances I am afforded impact my 'health career'.	Environmental/Physical determinants  Ultra Processed Foods Smoking Food & Nutrition Impacts of Obesity Child development Nutritional value of foods
Social determinants public (mental) health information Family economics Social values Sustainable Living	Political determinants 'Nanny State' (political rhetoric) Lobbying - (Food) Industry Business ethics Food poverty Advertising regulation Cost to Government, NHS, Society Security

Spiritual determinants: Values of society, governments, citizens, business . . .

Previously:

Jones P, Wirnitzer K. Hodges’ model: the Sustainable Development Goals and public health – universal health coverage demands a universal framework. BMJ Nutrition, Prevention & Health 2022;5: https://nutrition.bmj.com/content/5/2/358

'nutrition' on W2tQ

https://x.com/search?q=%40h2cm%20%27nanny%20state%27&src=typed_query&f=live

Gambling?

RCN: Are you an internationally educated RCN Member?

Please tell us about your experience so we can campaign for change on issues you care about the most!

We are keen to hear from *all* members, including HCAs and students, so please share this with your networks.

https://surveys.rcn.org.uk/s/IEQ1BS/

This survey closes at 11:59pm on 3 November 2024.

Thank you

Case formulation - Theory and Practice

 Still sorting papers, I've discovered copies of slides from the COPE course University of Manchester on Case Formulation by John McGovern.

An original purpose for Hodges' model is to help bridge the theory-practice gap.

The slides include -

• content: ingredients - preliminary formulation
• a means of understanding an individual's problems and distress in line with cognitive behavioural theory
• hypothesis to explain acquisition, and maintenance of problem
• not piecemeal

ROLE OF CASE FORMULATIONS

Bridge between theory and practice

a flexible tool for guidance

an explanatory framework to share with the patient

How types of formulation can be related to situations (Hodges' model is situated) - inference chain.

Comprehensive formulation - reflects the template that supports data gathering

inc. core beliefs - conditional beliefs

Questions for Preliminary Formulation

Main Ingredients - includes social support/relationships/employment/finances

(so this touches on determinants)

Choosing Treatment Targets

group exercise and summary