ii Thoughts re. Ecosia's AI Chat 'answer'

Reading the response, this is a black box. I've no idea as to the sources that were called upon. There are no references. A 'human' reading makes me wonder if the 'answer' is what I want to hear?

The reply gives me quadraphonic joy (if read out-loud). Not only are the domains recognised, but the LLM/agent ai takes the intrapersonal / interpersonal in its stride (from the blog?). Subjects related to each of the domains are given in brackets. 

There is of course a bias (several) in the prompt, as the care domains were never intended to be comparable. It is positive that each domain is seen as having its own specific scope and function. Over twenty years notes were started on a paper on Hodges' model and its role/function in helping to define 'scope of practice'. Significantly, in the UK the rise of associate positions across disciplines has provoked much debate, vitriol (on X and union and lobbying) and soul searching in certain professional groups. Given the increasing importance of the global health and social care workforce this trend is reflected globally. A situation set to be extended with uncertainties and tensions exacerbated by artificial intelligence in practice.

Before 'explaining' the asymmetries (in points 1-4) it seems the domains are complementary (for all their differences), and provide a holistic underpinning for the model as a whole (my reading).

1. Scope and Focus 

Interesting, how the science and sociology domains are described as broad. Perhaps I am underestimating the depth/density of sociology, after all folk theory is found there? Unfortunately, we can also add a myriad of conspiracy theories? Sociology can also lay claim to quite a few constructions of its own. Including aesthetics as a bridge to architecture and design(?).

On 'X', Hodges' model has been described negatively as inviting / fostering generalism. So, this is a bad thing? Is it not strange then that your Advanced Nurse Practitioner, Consultant doctors (all specialities) and students cross-curricula can all use Hodges' model? The fact that my own responses were never engaged has helped train my thought. Here the relevance of the model to students and continued professional development is made through generalizable knowledge.

The response to the political domain is supportive, acknowledging resource allocation and the distinction between individual and collective (see for example):

S. Bettiol, P. Jones, H. A. Onyedikachi, and W. G. Kernohan, (2026) Bridging Gaps in Oral Health Frameworks: Mapping With Hodges' Health Career - Care Domains - Model, Journal of Public Health Dentistry. 1–14, https://doi.org/10.1111/jphd.70034.  

I've seen tweets today regards IQ reductions in younger people. This is one reason for support of the top-left mental domain being designated as 'Intrapersonal – Interpersonal'. Our interpersonal skills and awareness are surely dependent upon our achieving a given level of inner mental life? Encouraging to see how subjectivity and objectivity is assigned too. Although, I think I'm in an echo chamber!

2. Epistemological Differences

In arguing for a model of health and social care that goes beyond:

• medical model;
• bio-medical model;
• bio-psycho-social model.

Reading 1-2 from the perspective of the Intrapersonal – Interpersonal domain you see how limiting this is, if an individual in a mental health/illness/mental capacity context can only point to sciences and sociological domains. Indeed, they may be relying guardians and advocates as they are unable to does this and raise the political matter of their rights. Without the POLITICAL domain (or as a result of it - neglect, structural racism) there is no law enshrining independent advocacy...

3. Practical Application in Care

To care is to act. Think about triage and emergency response.

Now in the 21st century 'care' must include self-care, health and social care, and (delayed or not you decide?) planetary care.

This necessitates a change of mindset at an individual and collective level. Consider the literacies that (again) young people must master to be effective, productive and happy citizens tomorrow?

So the following is a gift (in my eyes): 

"This means the intrapersonal-interpersonal domain is not just another 'content area' but a lens through which all other domains are experienced and integrated."

4. Hierarchy of Integration

'While the domains are conceptually equal in Hodges’ model' ..

This is interesting in itself.

[There does seem a emphasis upon the Intrapersonal – Interpersonal domain in this answer?]

This is quite a step, as the idea of a nexus and integration are picked up; and pointing to what are the determinants of health:

'For example:

• A scientific understanding of depression (e.g., serotonin levels) must be interpreted through the intrapersonal experience of the individual.
• A sociological analysis of healthcare disparities must be understood through the political structures that enable or inhibit change.
• A political decision about resource allocation must be filtered through intrapersonal values and priorities.'

I'm pleased I did this, as long as I'm not being trapped in an epistemological cocoon: otherwise known as a circle. Apart from a few occasions, I have not used AI/LLMs, perhaps it is time to explore more? I'd like to preserve my naivety, especially were maths is concerned. I'm not sure of what baggage I may pick up and lack the knowledge to interpret?

Previous post:  https://hodges-model.blogspot.com/2026/06/h2cm-domains-symmetry.html

AI Chat: Are the domains of Hodges' model comparable?

In drafting a future post: 'The Sciences: points, lines, angles and perspectives on domains', I thought I would ask Ecosia's AI Chat a related question, here is the (quick) prompt and reply:

PROMPT: 
In Hodges' model there are four care, or knowledge domains. The four domains are the sciences, sociology, political, and intrapersonal – interpersonal domain. In terms of potential content are these domains comparable, or is there an essential asymmetry?

(I have saved the prompt for future reference and refinement.)

RESPONSE:

 

In Hodges’ model, the four care (or knowledge) domains are:

1. Sciences (biological, physiological)
2. Sociology (social, cultural, environmental)
3. Political (legal, policy, organizational)
4. Intrapersonal – Interpersonal (psychological, emotional, relational)

These domains are not strictly comparable in terms of content, scope, or function. Instead, they represent complementary perspectives that together form a holistic framework for understanding human health, well-being, and care. Here’s why there is an essential asymmetry between them:

1. Scope and Focus

• Sciences and Sociology are broad, well-established academic disciplines with extensive theoretical and empirical foundations. They provide generalizable knowledge about biological processes and social systems.
• Political is more narrowly focused on power structures, governance, and resource allocation. While critical for systemic change, it is less about individual experience and more about collective frameworks.
• Intrapersonal – Interpersonal is deeply personal and subjective, focusing on individual psychology, emotions, and relationships. It is less about universal laws and more about unique, context-dependent experiences.

This makes the intrapersonal-interpersonal domain inherently asymmetrical compared to the others, as it deals with subjectivity and variability rather than objective or structural phenomena.

2. Epistemological Differences

• Sciences, Sociology, and Political domains rely on external observation, measurement, and analysis. They are rooted in positivist or structuralist traditions, where knowledge is often generalized.
• Intrapersonal – Interpersonal is rooted in interpretivist and phenomenological traditions, where knowledge is co-created through subjective experience and dialogue. It resists universal generalization.

This creates a fundamental asymmetry in how knowledge is produced and validated across the domains.

3. Practical Application in Care

• The Sciences, Sociology, and Political domains provide frameworks for action (e.g., medical treatments, social policies, legal rights). They are instrumental in shaping systems and interventions.
• The Intrapersonal – Interpersonal domain is transformative—it shapes how individuals perceive, interpret, and respond to care. It is the domain where meaning is made and agency is exercised.

This means the intrapersonal-interpersonal domain is not just another “content area” but a lens through which all other domains are experienced and integrated.

4. Hierarchy of Integration

While the domains are conceptually equal in Hodges’ model, in practice, the intrapersonal-interpersonal domain often acts as the nexus where the other domains intersect. For example:

• A scientific understanding of depression (e.g., serotonin levels) must be interpreted through the intrapersonal experience of the individual.
• A sociological analysis of healthcare disparities must be understood through the political structures that enable or inhibit change.
• A political decision about resource allocation must be filtered through intrapersonal values and priorities.

This integrative role makes the intrapersonal-interpersonal domain asymmetrical in function, even if not in formal status.

Conclusion: Essential Asymmetry

The four domains are not comparable in content or function. Instead:

• The Sciences, Sociology, and Political domains provide structural and systemic knowledge.
• The Intrapersonal – Interpersonal domain provides subjective and relational knowledge, which is essential for meaning-making and agency.

The asymmetry arises from the epistemological and practical differences between objective/systemic knowledge and subjective/experiential knowledge. Hodges’ model emphasizes that all domains are necessary, but they operate in fundamentally different ways.

'Curiosity': child safety and safeguarding c/o BBC News

'Teacher who killed his adopted son given whole life prison sentence

14:30 18 June

That concludes our live coverage of the sentencing hearing.

To recap what happened at Preston Crown Court earlier: A teacher who sexually abused and murdered the 13-month-old baby boy he adopted with his partner has been told he will spend the rest of his life in prison.

Preston Davey died in July 2023 at the hands of Jamie Varley, 37, who subjected the child to physical, sexual and emotional abuse during the final four months of his life.

Varley, from Blackpool, told police Preston had accidentally drowned in a bath, but a post-mortem examination discovered the child had suffered 40 injuries.'

Continued ...

◇

individual

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INTERPERSONAL : SCIENCES             

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

SOCIOLOGY : POLITICAL   

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group

curiosity
	PROFESSIONAL CURIOSITY

Source (Various): BBC Live News https://www.bbc.co.uk/news/live/c4gyrewq8xkt

 Previously: 'curiosity' : 'risk'

Evidence sent to Cumbria Police about 61 baby deaths at church-run home c/o ITV News

'Some babies born with disabilities were denied medical help because they were judged unadoptable, as ITV News Social Affairs Correspondent Sarah Corker reports

---

Evidence has been submitted to Cumbria Police in connection with allegations of historical abuse at a church-run mother and baby institution where more than 60 newborn babies died, following an ITV News investigation.

A new report by Dr Michael Lambert, an historian of the welfare state at Lancaster University, has outlined a high infant death rate at St Monica’s home in Kendal.

The report concluded that the deaths were due to a combination of failings, including inadequate facilities, malpractice and poor care from those delivering babies and a lack of oversight from the church and state.

Analysis of public health records, alongside birth and death certificates, indicated that children with disabilities born at the mother and baby home were deemed "un-adoptable" and denied modern medical care, according to the new research.'

◇

individual

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INTERPERSONAL : SCIENCES             

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

SOCIOLOGY : POLITICAL   

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group

emotional neglect and abuse  grief, trauma and guilt  shame	physical neglect and abuse  high infant death rate inadequate facilities malpractice
mother and baby   social / societal punishment  public health	institutions  criminal investigation  records

Source: ITV: NW News and https://www.itv.com/news/2026-06-09/evidence-sent-to-cumbria-police-about-61-baby-deaths-at-church-run-home

vi Book: 'Complexity in Health Care - A Paradigm Shift for Clinical Practice'

The rest of the book is practice-based which is a strength. Chapter 18 has three clinical illustrations, were reflection and self-reflection is brought to fore. Especially so, as it pointed out that the 'clinical situation/encounter' introduces its own 'vagaries', or noise which can impact the 'quality of the bond between clinician and patient'. Rapport is the key. 

I was still missing 'complexity' and its dynamics, but I'm sure of the following:

If this was discussed - could be represented then the book would be theory-laden and I and other would-be readers would not be able to understand.

I still think Hodges' model can help, and in chapter 19 picked out 'manifold' (p.113), as if doing so, manifests something more esoteric. There is something here, the author noting the need to shift from individual to group perspectives. So, yes I think we can do more than embrace 'complexity' (p.114).

On page 116 there is discussion of the sometimes sudden path to recovery, 'probably common but often not comprehended'. Please pardon the naivety, but I scribbled 'hidden in complexity, what would (say) the three(?) equations be?'. For a book published in 2023 'artificial intelligence' is not indexed. This might be one area that AI could assist, given the progress in formal mathematics (but see below p.183!)? Algorithm is mentioned throughout the book. Further reading here, informed me that engaging with a reading group on 'Philosophical Counselling' is worthwhile. It is!

Part IX had me wondering if the debate about typical and complex cases, there is a slight of perspective going on? You can end up with paradoxes in terms of an individual's needs, criteria, risk, 'need for admission'. Which I must think about! Chapter 20 has three further reading texts on abductive reasoning. There's an appeal(?) on page 129 for an appropriate treatment model, well that is my take. Collaborative care and stepped care models are suggested. But with acknowledgement that:

'In truth, all models currently available may involve a defect in continuity within or between systems'. p.129.

I beg to differ. A role of Hodges' model is to help frame aspects of care through time, to facilitate and assure continuity.

Part X tackles the required precision in assessment, hence recourse to mathematics and statistics. The next two chapters may be useful for early career researchers and yet looking over our shoulders what is ai offering here? In Case 1 I was impressed by the suggestion of a health record that is over 70 years old. Not impossible of course, but I thought of the Lloyd George envelopes, their hospital equivalents, other paper sources and inevitable scanning this would entail here in the UK? Of interest to research is the creation and validation of complexity profiling inventories (tools) not just that, but their self-assessment form of delivery. And, yes in summary chapter 24:

'We are still left with the challenge of rating the patients' severely compromised health situations where "health" includes social, emotional, and financial well-being.' p.143.

'How do you factor this interpersonal situation into your complexity equation?' p.144.

Yes, how indeed? 

The realities of research of dealt with - funding for the development of tools a problem universally. The references here concern biopsychosocial complexity. Chapter 25 describes abstraction, and hiding detail, which is of great interest here. DSM-5 criteria for major depressive disorder are listed (DSM-6 may be released in 2029?). 

In chapter 25 the authors are once stymied by 'how to include (integrate? PJ) four dimensions, three time periods,and assorted assessment items in a single assessment.' 

As noted the four domains are here again (p.151): medical, psychological, social and care delivery and on page 153, introducing chapter 26, limitations of complexity assessment tools. Parity as in 'parity of esteem' is not indexed and I don't recall having read this, but this is well represented in later deliberations on variables #2. You will find psychosis, but not in depth or severity.

 In 'Creation of a New Model for Clinical Practice' (Chapter 31) identity is stressed, as a prompt to encompass those variables that contribute to preserving the person - what is humanistic. Allied with manifold, identity is a 'coi' for me, concept of interest - for this same reason. On page 172: the authors observe they 'are left with the question of whether there are acceptably accurate clinical models that are simpler and more straightforward than ours? We believe the answer is no!'. I believe there is a way, and a model to help 'keep the life in clinical work' - not take it out. There is a sense that Chapter 32 seeks what I was looking for above: as they explore random variable and 'sample spaces' descriptively - over a page.

Ah! 'Artificial intelligence' is found in text p.183. I'm surprised an editor, proofreader aloud the following sentence to go unchallenged?

'But, as will be discussed, these computer techniques have their limitations based on their lack of flexibility.' 

I was genuinely surprised to read this. Plus, again on ai on page 185: 'Making inferences is not reliably their domain.' I think I would look more at the human-ai interface. And the status of ai within psychiatry as opposed to medicine, but that is also another (parity - divide) debate. Things really are complex now on so many fronts: ethics especially.

Perhaps I am looking for the cookbook formula as introduced for chapter 35 clinical judgement. The further reading is combined with critical thinking. More detail on the empirical-collaborative method is welcome. When I read 'illustrated' I take this literally. Again I can disagree twice on page 220. I know Hodges' model is not validated, but it can - with practice(?) - do this light (simple) or heavy (complex) lifting. 

The warning about dogma needs to be repeated regularly. It is rather like the need for nurses to revisit their profession, role and work as relates to the law. Is Hodges' model an over-valued idea? Am I guilty of thinking I'm an expert? A problem with that view is that any assumed expertise is stretched across the whole model. So if anything there is a shallowness, but this means that I see my particular scope of practice, as other colleagues / professions see theirs. Here in the UK of late, this seems to have become rather blurred. 

In closing with this and achieving a "real-life" understanding of a case, with synthesis - path analysis diagram, the author's underline the value of their book which I have enjoyed and informed my preparation for WCCS26 (more to follow there). The authors can perhaps be reassured that all practitioners have a means to achieve their paradigm shift as described here - with added value and values.

There is a missed word: "of the situation ['with'?] him" on page 114. And revision needed re. text beginning with 'his boyish Paul McCartney "mop-top" ... on page 214. Spelling error on 216 'retu(r)ning'. 

Thanks again to Daniela and colleagues at SpringerNature for the review copy.

Steven A. Frankel, Steven D. Thurber, James A. Bourgeois (2023) Complexity in Health Care: A Paradigm Shift for Clinical Practice. Cham. Switzerland: Springer. ISBN: 978303114948.

"Keep politics out of sport!"

individual

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INTERPERSONAL : SCIENCES             

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

SOCIOLOGY : POLITICAL   

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group

Lewis	Russell
Norris

Previously: 'sport'

See also: https://www.formula1.com/ 

Hodges' model: An antidote to "Cognitive Surrender"*

'The pope's counterpoint that humanity flourishes "not despite limitations but often through them" is one that many people are becoming more aware of in the case of "cognitive surrender": the realisation that making things easier through AI can diminish rather than enhance our abilities. It is in a similar vein that the FT commits to always keeping human judgement at the centre of our journalism.'

* - and burnout?

The FT View, The ethical dilemmas of artificial intelligence. FTWeekend, 6-7 June 2026, p.12.
https://www.ft.com/content/d2c90246-11d7-4169-ac35-988de7fdb2af?syn-25a6b1a6=1

See also: https://www.futureofbeinghuman.com/p/magnifica-humanitas-and-being-human

Previously: 'ai' : 'language'

NHS Corridor Care – Urgent and Emergency Care Daily Situation Reports

If politicians & policymakers regularly 'walked'
 all the corridors of Hodges' model -
 they would see the false economy 
of their combined incremental works.

Incremental? Yes, in first being a 'temporary measure', then having a deleterious impact as the duration per patient and number of patients on corridors increased.

Now to the situation when the standard of care is unsafe, sub-standard, and denigrates the NHS as a social institution.

The fact of insufficient beds and its effect on care (pathways) and patient (and family) experiences severely affects staff morale, as they recognise subtle abuse, a precursor to structural and attitudinal changes that foster, encourage and establish institutionalised harm.

Staff also realise that they risk being de-skilled, 're-educated' -
becoming less compassionate ... (a 'lesser Nurse') as corridor care 
and its consequences are normalised.

Ignoring demographic trends and without an alternative concerted 
preventive/health education and health promoting plan, this is the result 
of the health and social care funding and policy
of successive governments, enacted by NHS management.

NHS England: Corridor Care – Urgent and Emergency Care Daily Situation Reports
https://www.england.nhs.uk/statistics/statistical-work-areas/corridor-care-urgent-and-emergency-care-daily-situation-reports/

v Book: 'Complexity in Health Care - A Paradigm Shift for Clinical Practice'

Chapter 11 held promise in the title 'Formalising the Clinical Field'.

If anyone is interested, formalisation is what I would like to focus upon - using Hodges' model - over the next several years (taking nothing for granted). If truth be told, I'd be stressed as if (true) formalisation was discovered here, I may find this is beyond me, but this is the course I have chosen.

There was nothing new, the 'clinical illustrations' continued. The reading is worthwhile, in trying to define complexity, or what constitutes a 'complex case', hence 'Each new entry expands the complexity and gravity of the case, moving it beyond "plain vanilla" of a single medical or socially based condition'. I was reminded here of the user personas used in developing online communities. And in health the way personalised detail gets lost as personal details - emotional content gets lost (necessarily) as data is aggregated. The chapter revists the definition of clinical complexity.

'So, how does this information fit with our tentative understanding of clinical complexity as "the potential for progress toward health recovery in the context of a particular set of diagnoses and available treatments" (Kathol et al. 2018)? The phrase "particular set of diagnoses" could be replaced by "clinical challenges?" After all, where do you fit cultural considerations or family disjunctions here? Neither are diagnoses per se. Both have typically been relegated to the periphery of diagnostic considerations. Instead, they are elements in a loose matrix of clinical influencers.' p.76. [My emphasis].

Well, Hodges' model provides an ideal place for cultural considerations and family disjunctions. But replacing 'particular set of diagnoses' with 'clinical challenges' will be met with a challenge itself. This serves my purpose in advocating for Hodges' model, if challenges across the model's four care/knowledge domains can be seen as 'clinical'.

Identity morphism

Part VI on Subjectivity and Intersubjectivity is an important lesson to look; then look again - beyond the (basic!) subjective-objective dichotomy. You want patients - clients to recover quickly. The clinical illustrations are helpfully carried forward, as per the longevity their being 'complex' portends. The fact that in a clinical conference, social aspects are barely mentioned is one rationale for use of Hodges' model in practice. What has not been discussed? For 'Seth' a case formulation is raised, (I sketched a 'simple'  triangle) and the limited conceptual scope acknowledged above (p.80). Reading, I did wonder what a new edition might look like given developments in the USA? Would it make a difference? There a question about to categorise one client. And I scribbled 'identity' in the summary for the subjectivity between client and clinician.

I've always liked archaic terms^ and here cussedness springs to mind as the authors seem compelled to return to the issue of a definition for complexity. You could say - they can't put it to bed! 'Lifestyle' is not indexed. But it is clear that the adopted lifestyle of many clients also compounds, contributes to the clinically complex presentation. Case, condition, set of sign/symptoms, state of affairs, situation - all may be simple or complex. On page 87 regards Mark: 'The management challenge of this situation is evident. The situation itself is not medically complex. However, managing it is.'

When I read the aforementioned formalisation (chapter 11), I thought logic might follow, a specific illustration? Abduction is a teaser introducing chapter 14. It is chapter 15 that inference including abduction is usefully discussed:

'Abduction goes further than obtaining general and specific logical conclusions. Abduction seeks explanations beyond logic. The clinician listens to the utterances of a patient and integrates word meanings and word referents with other gathered data. The clinician abductively decodes information and concocts potential explanations for the words of the patient that fit with aggregated clinical findings. This rational processing results in what the clinician considers the best explanation for the information at hand. However, other explanations remain as viable until and unless eliminated by subsequent data. The clinician using abductive reasoning always maintains an openness to changing explanations and an intention to expunge unsatisfactory conclusions as accumulating data dictate [1].' p.96.

The author's empirical-collaborative (E-C) approach spans the book. They might find that Hodges' model as a conceptual framework can seamlessly fit with E-C. A reference on Bayesian Statistics. Lee PM (2013), plus further reading is listed.

There is a spelling mistake p.73; 'contacted a disease'?

One more post to follow ... may add here also.

Thanks again to Daniela and colleagues at SpringerNature for the review copy. 

Steven A. Frankel, Steven D. Thurber, James A. Bourgeois (2023) Complexity in Health Care: A Paradigm Shift for Clinical Practice. Cham. Switzerland: Springer. ISBN: 978303114948. 

Image:

https://krossovochkin.com/posts/2020_04_26_category_theory/ 

 

^Which is ok, I'm a grandad now. 

Typologies in nursing - Macduff (2007)

This paper was brought to my attention by the author Colin Macduff (now retired) who was Principal Investigator in a project [2018-2020] RIPEN. This included a series of workshops to which I was able to contribute. I knew this would be useful and must find the paper (in 14,1) also mentioned.

"What are typologies?

In relation to this initial question. Patton (2002) offers a useful definition and  distinction: 'Typologies are classification systems made up of categories that divide some aspect of the world into parts along a continuum. They differ from taxonomies, which completely classify a phenomenon through mutually exclusive and exhaustive categories, like the biological system for classifying species. Typologies, in contrast, are built on ideal types or illustrative  endpoints rather than a complete and discrete set of categories'." p.41.

'Most commonly, typology constructors such as Roberts-Davis et al  (1998) and Nolan et al (1995) present them as ways of clarifying thinking  rather than as rigid structures that are universally applicable. The difficulty  here is that within nursing discourse a number of other devices such as conceptual frameworks and models are also commonly used to this end.' p.42.

individual

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INTERPERSONAL : SCIENCES             

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

SOCIOLOGY : POLITICAL   

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group

Box 1: Typology of family care (Nolan et al 1995) Anticipatory care Preventive care   Supervisory care   Instrumental care   Protective care   Preservative care   (Re)constructive care   Reciprocal care p.44.

If you can obtain a copy^, do check out Box 2 and Figure 1, plus the discussion and conclusion.

Macduff, C. (2007). Typologies in nursing: A review of the literature. Nurse Researcher, 14(2), Article 2.  https://doi.org/10.7748/nr2007.01.14.2.40.c6020 (^Paywall)