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.

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. 

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

After a first mention on page 23, it is chapter 6 that discusses "awe" - the chapter's title. I wrote (in light pencil!) 'It keeps you going'. This is deeper than job satisfaction, but in healthcare is a contributing factor. And different again to (clinical) intution (with many mentions), which recurs, despite (or due to) its subjective nature.

Within its 3.5 pages you will find 'interpersonal awe', Piaget's 'accomodation', the neuroscience of awe, and humility. From a physiological and experiences with short-sightedness and vision, I have applied the concept of accommodation over the years. All this, quite rightly, places emphasis upon the therapeutic relationship. Even since the book's publication in 2023, this relationship has grown in importance.

'The sense of awe is an emotional reaction to events characterized as "vast" or to experienced stimuli outside the domain of the usual and prototypical. A sense of "awe" is often described by scientists who peer through telescopes (immensity) or who observe the uniqueness and expansiveness of the microscopic world. A similar emotional reaction can ocur with respect to the overwhelming experience of the clinician processing the complexity of intertwined variables experienced with a patient. When interpersonal awe occurs, it potentially opens the mind of the clinician to enhanced information gathering, cognitive processing, and empathic understanding.' p.49.

I often feel obliged to apologise that the spiritual does not have a concrete home in Hodges' model. Personally, it is INTRA- and interpersonal. Our religious beliefs, and committments were they apply. Unfortunately, the spiritual is often expressed politically: 'shock and awe'(?). Socially, the spiritual is manifest in the world's religions, our cultures and upbringing, recognition of others - in our communities, the media, ability to 'see' beauty, experience empathy, rapport and shared emotions. On twitter I've often written -

(SPIRITUAL [Intra- Interpersonal; Sciences; Political; Sociology] )

So, Hodges' model is embedded within - should be viewed as surrounded by the spiritual. 

Chapter 7, 'Clinical Decision-Making' utilises the thought of Daniel Kahneman. I like the use of ratiocinations here. I do try to bear in mind the 'traps' afforded by Hodges' model. To be clear, it is not the only clinical cognitive tool I have used. For some reason, against ratiocinations I scribbled 'running the axes, or the corridors of care'. Formal training brought to mind training to assure the marking of student's work (if still needed!), and mentoring student nurses. Case-based learning features here, and in the conclusion: CBL 'will be the central element of this book and will involve actual patients with pronounced biopsychosocial complexities.' p.56. How I wish there was an extra reference (a #16) here: clinical decision-making is fundamentally political; both reflectively and reflexively.

Part V then begins (p.59) on further technical considerations with chapter 8 Introduction to Clinical Complexity. A shift is flagged from a linear, logical-based approach to mix of logic and clinical content. At two pages I did hope for more: biological complexity and resolution left me hungry for more. There is however a key learning point on p.62, re. resolution; that of suffering. Connected to this and a well made point is priorities and what is clinically important and any contrast for the clinical team and the patient.

In a BASIC program from the 1980s on the 'Nursing Process' (essentially p.11 in the book, and somewhere on W2tQ?) I'd included a woman, medical ward with chest pain, who was agitated and couldn't explain herself that well. It wasn't delerium, but we eventually found out she was alone at home and worried about a cat. Attention and listening are not in the index, but should be in all clinical texts. An essential ingredient in the aforementioned reflective/reflexive aspect of interpersonal exchange. In the summary for C8 it was good to read of constellations. Our forebears joined the stars to provide meaning and explanation for what was life, being and experience for them, who had passed, and who was to follow. Without that political domain, the meaning is incomplete, may be repeatedly mistaken. How impoverished [we are / are we] as a result?

 Chapter 9 starts to present the clinical model, with clinical illustrations - case examples. The focus here is underrepresented factors. There is always an issue about granularity in how much data/information is needed for a comprehensive assessment/evaluation. A paragraph considers The problem of simplication. A question is raised:

'How can a clinician think of all the contributing factors on the spur of the moment, the point at which many if not most clinical decisions are made? Our guess is that your response, as a reader, may be to wipe your brow and decide to return to "treatment as usual." reverting to comfortable algorithms.' p.67.

This 'treatment as usual' is surely institutional in origin? Back to the 'political' again. Well I can think of a way to frame, apprehend all the contributing factors and on the spur of the moment. Healthcare is inherently situated. Healthcare professionals need to proceed with care, especially with constant reference to statistics and algorithms. Hodges' model can provide an anchorage, a safe harbour even if the visit is fleeting. These harbour fees, or dues, service charges are negligible.

 In Chapter 10 brings the complexcity of the clinical "field", once more through a case illustration, a woman with chronic schizophrenia, complexity based on clinical diagnosis. The process of diagnosis (and a medical matter) is largely a matter of data reduction, a means to simplify, and provide an avenue to aggregate and group. There is a history lesson in the development of hospitals, even as in the UK bed numbers have seen whole scale reductions. Interestingly (for further study), of course, diagnosis is also a way to abstract away details. The problem is that although this makes the unknown a known, it is binding when it comes to complexity. It ties down a flux, a dynamic that doesn't just want to be free it is constantly changing and may also achieve a more ordered state. The authors try to get to grips with this, they highlight housing, employment, comorbidity and how these may prevent recovery. All this as they seek to define complexity in clinical terms. No easy task: itself part of the problem.

In the summary for chapter 10 it was encouraging to see the cultural aspects for the person and group emphasised, plus how identical demographic factors can still result in disimilar prognoses, hence the importance to 'see' the person and their respective 'self-management'. 

More to follow ...

^Jones P. (2014) Using a conceptual framework to explore the dimensions of recovery and their relationship to service user choice and self-determination. International Journal of Person Centered Medicine. Vol 3, No 4, (2013) pp.305-311. 

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.

Slingshot AI? Meet the Earthshot (Prize ...!)

Slingshot AI

Ash
"the first AI designed for therapy" 

'In January 2024, we set out to build a 
foundation model for psychology. 

The mental health crisis sweeping across 
our communities isn’t going anywhere, 
and what we’re doing clearly isn’t enough. 
Therapists have one of the hardest jobs in the world,
and there just aren't enough people 
or resources to help everyone in need.
And we all know in our hearts that everyone 
could use some help with their mental health. ...'

'We need a foundation model for psychology.'

 

🔷 

 

Plus a bit more ...? 

 

INDIVIDUAL

|

    INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

The four primary therapeutic approaches used by Ash are: Cognitive Behavioral Therapy (CBT): Focuses on identifying and modifying dysfunctional thoughts, emotions, and behaviors. Dialectical Behavior Therapy (DBT): Teaches skills for emotion regulation, distress tolerance, and interpersonal effectiveness. Acceptance and Commitment Therapy (ACT): Focuses on accepting difficult emotions while committing to actions that align with personal values. Psychodynamic Therapy: Explores unconscious patterns and early life experiences to understand current behaviors. [ Google AI Overview* ]

?

?

?

Our 'Intelligence' is embodied.
The whole of Hodges' model is / can be 
embodied - embedded within the SPIRITUAL.

My source: Electronic therapy - Machines of loving grace, The Economist, November 15th-21st, 2025. Vol. 457: #9474. pp.72-73.

 *"slingshot ai - what are the four therapeutic approaches used by ash?"

 

Previously: 'health' : 'ai' : 'parity of esteem' : 'foundation' : 'language' : 'embodied'

'Drama classes help GPs handle difficult patients' c/o BBC

'Hull Truck Theatre has just won the Innovation prize at the Stage Awards for their new training scheme for GPs. Associate Director Tom Saunders and GP Dr Eman Shamsaee discuss why drama classes are helping doctors treat patients.' 

BBC Radio 4 'Front Row' https://www.bbc.co.uk/sounds/play/m002q2jz (15 mins ...)

◇

Holly Phillips, East Yorkshire and Lincolnshire and Ian Youngs, Culture Reporter

Published - 21 January 2026

'A theatre company is using drama training to help doctors deal with challenging patients.

Hull Truck Theatre's classes feature actors performing difficult GP consultations, with GPs giving feedback before taking over the consultation themselves.

The theatre recently won the Innovation Award at the Stage Awards for the programme.

Dr Eman Shamsaee, who has taken part in the training scheme, described it as a "really creative way of doing GP training".'

BBC News:  Drama classes help GPs handle difficult patients

INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

The training programme has completed its pilot stage and is now in the delivery phase

A reminder of co-working to deliver STORM training with a Clinical Psychologist colleague. 

See also: 'communication' : 'primary care' : 'GP' : 'drama'

studium and punctum c/o Rose (2012)

'Care' as a Photograph - duality . . .

Visual Methodologies

"It is as if the Photograph always carries its referent with itself, both affected by the same amorous or funereal immobility, at the very heart of the moving world; they are glued together, limb by limb, like the condemned man and the corpse in certain tortures." [Barthes 1982: 5-6] p.121.

 "The referent is there in photographic images in ways it is not in other sorts of visual imagery, Barthes argues. And a result, he suggests that photographs can be interpreted in two ways. First, there is a level of the studium, which is a culturally informed reading of the image, one that interprets the signs of the photographs. But he says that some photographs produce a different response, which is a second kind of reading, by containing what he called a punctum. A punctum is unintentional and ungeneralisable; it is a sensitive point in an image which pricks, bruises, disturbs a particular viewer out of their usual viewing habits. And he went so far as to suggest that 'while the studium is ultimately always coded, the punctum is not [Barthes 1982: 51]. That is, there are points in some photographs that escape signifiers and shock the viewer with their 'intractable reality' [Barthes 1982: 119]. And while shock is something that most adverts aim to achieve, it is the case that recent advertising is relying more and more, not only on the transfer of meaning between signs, but on the evocation of a feeling or a mood attached to a brand that is difficult to analyse using semiological terminology." p.122.

On twitter* @h2cm over the years I've noted a certain stance, an aversion even, to generalist approaches in nursing (as suggested apparently by Hodges' model). The simplicity of Hodges' model in its template (basic) form belies how the model can address both generalist and specialist practice and theory. Bluntly: choose your domain; slice, dice and drill as you wish. 

Rose's reference to Barthes, in-particular studium and punctum stands out. We can equate the former with the situation as found, the clues provided in the referral details, the initial cues, data and information gleaned upon assessment. What might be expected, so to speak, including assumptions. 

But the punctum, may be described - interpreted in person-centred (yet professionally balanced) terms. Especially in assessment, planning, intervention and evaluation. The punctum signifies salience: what is important to this person. If the academic emphasis is upon ‘reflection in action’, ‘reflection on action’, ‘single loop learning’ and ‘double loop learning’ (Schön, 1987), can the punctum represent empathy, rapport, the sustenance of dignity and respect, an individual's sense-making? 

Our photograph, taken through Hodges' model is comprised of four frames. The photograph is  compound, and with several exposures it can be animated.^ When played, it reveals a hint, a fraction, an interval in an individual's (potential) health career. A light upon the several-fold determinants of health and their influence and impact upon life chances experienced and exercised to date - and to follow (climate change). 
 

Rose, G. (2012). Visual Methodologies: An Introduction to Researching with Visual Materials (3rd ed.). London: Sage. PB. [Now in 5th edition.] Image - Amazon.

Schön , D. (1987). Educating the reflective practitioner. San Francisco, CA: Jossy Bass. 

*Yes, I know.

^The Producer - Director depends on your Spiritual stance.

Rose (2012) now with student nurses [on placement from Chester University].

"How much empathy should doctors have?" c/o BBC Radio 4 'All In The Mind'

In ongoing reading and writing, I'm developing examples of care situations and contexts that extend across the domains of Hodges' model, candidates include:

1. Eating Disorder
2. Sense-Making in light of information disorder
3. Public Understanding of Science
4. Empathy and Rapport in healthcare disciplines

#4 has loomed large for quite a while. The contrast between being humanistic and mechanistic: warmth, engaged, attending, person-centred  and subjective; set apart from being objective, logical, cold, precise, mechanical, efficient, and accurate. These terms and more also indicate the scope (vertical and horizontal) of Hodges' model. In my nurse training, I remember that first intramuscular injection, and how my mentor - supervisor explained how, as a prescribed treatment - remember the patient needs it. The 'political' dimensions of this - informed consent, capacity, personal - professional ethics, mental health, and mental health act, add obvious complexity and critique to this example. 

 

In #4 I've the more general medical example of the surgeon and empathy. Then, this past week 'All In the Mind' devoted an informative feature on the topic (available for 12 months):

"A good bedside manner is a wanted quality in healthcare professionals. But as is performing procedures that can be painful or uncomfortable. As medical students train to become doctors, they can experience changes in their levels of empathy; the ability to resonate with how others feel. Learning long lists of diagnoses and pathologies, the human body starts to resemble more of a machine. But how detrimental is this? Claudia Hammond asks Jeremy Howick, director of the Stoneygate Centre for empathic healthcare at the University of Leicester, who is training healthcare professionals to express more patient empathy to improve health outcomes and reduce burnout. Lasana Harris, professor of social neuroscience at UCL, describes how too much empathy might be a cause of burnout, and medics should toggle empathy on and off depending on context. Medical students from the University of Bristol express how they feel empathy should come into their future roles. "

'Welcome to the QUAD' includes many previous posts on empathy, rapport.

Below, I have mapped key concepts and programme content to Hodges' model:

INDIVIDUAL
|
INTERPERSONAL    :     SCIENCES              
HUMANISTIC --------------------------------------  MECHANISTIC
SOCIOLOGY :   POLITICAL
|
GROUP

Empathy (regulation) and Rapport Therapeutic alliance Risk of burnout Emotional curiosity	Research - BioMedical Model [machine] First injection - 'invasive' procedure . . . Doing Surgery - cutting a person Body posture - Sitting down with person - patient
Social Neuroscience Language, presence Pre-op contact with nurses Restore 'humanity' Reassure	Lived experience - Staying in hospital a night. 'Being a patient?' Accountability - Responsibility Time and Resources to do the job. [PJ]

STEM Women: Dame Clare Marx [RIP]

Pablo Picasso. Science and Charity. Barcelona, [March-April of] 1897. Oil on canvas 197 x 249.5 cm.
Museu Picasso, Barcelona. Donation Pablo Picasso, 1970. MPB 110.046. Museu Picasso, Barcelona.
Fotografía, Miquel Coll © Sucesión Pablo Picasso, VEGAP, Madrid 2020

 INDIVIDUAL
|

 INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

Clare  intelligence ...	physical contact, touch ... good surgical hands ...
Marx ... ability to talk to patients	Dame

Dame Clare Marx "First woman to be elected president of the Royal College of Surgeons who sought to root out sexism and expand surgical training ... A charismatic colleague taught her the three qualities of a successful surgeon: intelligence, good surgical hands and an ability to talk to patients."

"Marx said Picasso's Science and Charity emphasises
'the importance of physical contact' between doctor and patient."

Register, Obituaries, The Times, November 30, 2022, p.53.

See also: 'Arts'

c/o [hifa] WHO Webinar: Compassion - mapped to Hodges' model

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

sympathy, empathy, compassion mental states, feelings, emotions communication (verbal - non-verbal) experience, sorrow, suffering personal ethics, learning reflection, self-compassion psychometric instruments mentor, role model listening, non-judgemental student idealism  meditation, contemplation (drug concordance) Poor psycho-	Research Teaching methods and methodologies measure compassion Technical competence diagnostic accuracy studies - literature (drug compliance) QUANTITY health & compassion as a 'science'
social support  QUALITY culture peer support - sharing reflexive, desire to help rapport, PRACTICE based research Research on empathy > compassion role models teamwork	better outcomes, public demand (for more compassionate) health workers - high workload mission statements Health Institutions Regulatory organizations Medical councils harassment - poor team functioning compassionate leadership

See also and c/o HIFA:
c/o [hifa] WHO Webinar: Compassion – the heart of quality people-centred health services

No Body... No Mind...

Hodges' model: an open conceptual space for the naive beginner and expert alike...

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

NO BODY...!?	NO MIND...!?

"I also find it helpful to be both expert and naive. Following Shunryu Suzuki’s saying, “in the beginner’s mind there are many possibilities; in the expert’s mind there are few,” I find it helpful to approach each client with an attitude of “we don’t really know anything about this, let’s explore it together.” On the other hand, clients expect (and have a right to expect) some level of expertise and the fact as clinicians is we do have a body of knowledge which is valuable. By being both “expert and naive,” simultaneously teacher and student, we can model a kind of being-with-a-problem, which is most paradoxical but most essential: I (and you) are both healthy and ill, distressed and just fine." p.23.

Rosenbaum, R., & Shahar, Golan. (2012). Thoughts on Mrs. T: No Body, No Mind. Journal of Psychotherapy Integration, 22(1), 19-26.

Information? Let me introduce you to Empathy! (New Scientist #3073)

This week's New Scientist asks the question: "What is Information?". Its neighbouring article is on empathy. I've bought a copy to add to my small library on 'information' (and its analogue?).

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

"I feel your pain."  pp.32-35.	New Scientist: What Is Information? pp.28-31.

Battersby, S. (2016) The unseen agent. New Scientist, 230: 3073, 14 May, pp.28-31.

Young, E. (2016) I feel your pain. New Scientist, 230: 3073, 14 May, pp.32-35.

Book: Skills for Communicating with Patients

Skills for Communicating with Patients

Part 1 of my studies at Lancaster has been a busy two years. Picking up this book which I used in a research paper, the delivery note was a surprise. The book arrived c/o Radcliffe Health in April 2014. Since then Radcliffe is no more, but the title is available through CRC Press.

An established text given a 3rd edition it is accessible, thorough and well organised. The content presents the Calgary - Cambridge Guides as described on the back cover (PB).

Initiating the session. Gathering information. 
Providing structure to the interview. Building the relationship. Explanation and planning. Closing the session.

(As a non-medic) what I like about this CPD certified book is the clear path through the chapters that explain the Calgary - Cambridge Guides. Other models, frameworks and approaches are described. The Calgary - Cambridge Guides is process-centric as is evident in 'gathering information', but the complexity that arises in achieving competence is included and fully referenced (pp. 263-293) throughout the book. Framing questions in open and closed form is covered, with example dialogue between patient and doctor on many practical points. Person-centredness, uncertainty, motivational interviewing, mental health - psychosis, risk (suicide) are also explained. While person-centredness is not the main focus, 'patient' ... is very well served in the index. There is much here about shared understandings and planning and how to make suggestions and raise options rather directives (concordance, p.193). Although it might be viewed as 'cold', I liked the emphasis on information and inclusion of health literacy.

In a very brief break from my proposal I've brushed off two draft papers I've mentioned before on W2tQ at some point. They relate Hodges' model respectively to:

• threshold concepts 5,000 words 
• case formulation 4,000 words

In a way the Calgary - Cambridge Guides is a means to a formulation, but a formulation that is consultation (appointment, session) specific. Perhaps in future we will see developments that are more integrative and consider continuity as a vital part of this critical activity. This is the challenge in communication getting the scalability of communication and communication skills right. Clearly beyond the scope of this book but how much of that communication gets passed-along (communicated!)?

This is however a very complete, readable and informative read. Without expanding the book further: but more on technology-mediated communication (beyond computers in the consultation) must be essential in a 4th edition? I am biased but in dusting off the above papers, more on the challenges within mental health, especially self-harm, body-image, mental capacity, and forensic might highlight troublesome (threshold) concepts. Understandably, the disease-illness model is highlighted (p.65). Living well through self-care, living with chronicity, strengths and recovery perspectives may also deserve mention? Working towards a 'meeting of experts' (p.184) helpfully begins to address such developments. With my project in mind I also looked for 'evaluation'. If "research" had its own place in the index - what would the content be?

It proved helpful having a break from the draft papers I wished I'd picked this text up sooner and that I can look at my research proposal similarly refreshed...

Silverman, J., Kurtz, S., & Draper, J. (2013). Skills for Communicating with Patients, 3rd Edition, CRC Press.

Below I have mapped some of the elements of the Calgary - Cambridge Guides to Hodges' model (disrupting the original).

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

1. Initiating the session: Preparation Exploration of the patient's problems patients's perspective background information - context Aiding accurate recall and understanding Identifying the reasons for the consultation	Providing STRUCTURE: 2. Gathering information: biomedical perspective 3. Physical examination: Providing the correct type and amount of information
Building the RELATIONSHIP: Approp. non-verbal behaviour Developing rapport Involving the patient Achieving a shared understanding: incorporating the patient's illness framework 4. Explanation and planning:	Making organisation overt Planning: shared decision making 5. Closing the session: Ensuring appropriate point of closure Forward planning

Image source:
CRC Press

Workforce: What binds us all together?

individual
|
INTERPERSONAL : SCIENCES
humanistic --------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
|
group

Empathy  Rapport Ben Obi-Wan Kenobi:  "The Force is what  gives a Jedi his power.  It's an energy field  created by  all living things. ... Dignity   Respect Emotional Intelligence Open wonder PURPOSE	... It surrounds us and penetrates us.  It binds the galaxy together." http://www.imdb.com/title/tt0076759/quotes PROCESS
Shared values PRACTICE Communication Mutuality Partnership Collaboration Caring	Obi Wan: "I FEEL A GREAT DISTURBANCE IN THE WORKFORCE" Illustration credit HSJ cover Malcolm Willett http://www.willett-ink.co.uk POLICY

Memories from 1977-1978

In order to listen... 4 holistic care...

As we 'listen' to patients, carers and others in need of care - verbally and non-verbally - we need for safety's sake to be aware of our starting point and where we are heading. Even if only roughly, amid raw emotions, pain, confusion, fear and hope - that next step must be a safe one.

Is there a logic to the steps being taken? There may not be. Sometimes it is listening and being there. There may not be a clear destination, but how will we know when we have arrived at that point in-between? If the way becomes unclear, what signs do we read that might point to the need for an extra hand on the tiller?

Do we have the tools to remain oriented? Is there a compass-4-care? A re-source to map the journey we are both being taken upon?

If listening is but a part of holistic care, is there a tool we can utilise to integrate these many and yet unique journeys?


Source - title:
Alicea-Planas, J. (2015). Listening to the Narratives of Our Patients as Part of Holistic Nursing Care. Journal of Holistic Nursing, Volume XX, Number X, XXXX. doi:10.1177/0898010115591396

Bits of information a-cross the centuries - Bad Tidings & The Love Letter

As noted previously on W2tQ the significance of information practically and as a concept is very obvious in health and social care. Not just the debate about assuring privacy and confidentiality of clinical records and professional disclosure, but the meaning of information to an individual. This is assuming that the person concerned has the mental capacity to recognise what a particular circumstance, event, item of news means; and not just this morning, but tomorrow...

A diagnosis, lab result, a date for this procedure or that operation all can be a major source of anxiety and stress.

This week's visit to Amsterdam also included a visit to the Stedelijk Museum, where I saw Jobstijding (Bad Tidings), 1932 / Carel Willink (1900-1983). On Saturday I marvelled at Vermeer's The Love Letter and many other great works at the Rijksmuseum. ...

Through art and these works in particular we can contrast the social impact of information, of news - its meaning past and present with our ongoing preoccupation with binary representation and the information age.

Snail mail may be less common and yet the impact of decisions, news, life events ... remains.

individual
INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

group

Vermeer - The Love Letter	1 0 0 1
Carel Willink - Jobstijding (Bad Tidings)	0 1 1 0

Image sources:
The Love Letter, Vermeer
http://www.sai.msu.su/wm/paint/auth/vermeer/vermeer.love-letter.jpg

Jobstijding (Bad Tidings), 1932, Carel Willink (1900-1983) Stedelijk Museum, Amsterdam, The Netherlands

http://www.pinterest.com/pin/567383253025365412/

Interviews: In the political melee don't forget the green corner...!

individual
INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

group

Therapeutic alliance

"Sir Robin cited research conducted by two psychologists on interviews during the 1987 general election campaign. Dr Peter Bull and Kate Mayer found that Kinnock and Thatcher avoided more than half the questions put to them. They concluded the party leaders used 31 different forms of evasion, among them ignoring the question, acknowledging the question without answering, questioning the question, attacking the question, attacking the interviewer, declining to answer, giving an incomplete answer, repeating a previous answer and claiming already to have answered the question." FT Weekend. p.1

Source:
Katz, Ian, (2014) The death of the political interview. FT Weekend, Life & Arts, September 6-7th. p.1.

Book: The Empathy Exams & Michel Serres Institute

individual
INTERPERSONAL : SCIENCES
humanistic ------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL

group

The Empathy Exams Interpersonal Skills	The Natural Sciences
Local, Society & Socio-	-Economics Law

As recent posts reveal I'm overwhelmed with reading at present. Material that is essential for the TEL course and reading more tangential and yet potentially enjoyable titles. It will be a busy summer as all this is brought together(!?). Especially as I've a literature search in mind as a module submission - progress permitting.

The publication of Jamison's book this (N) spring sits well after the findings last year about the benefits of reading fiction in increasing empathy.

Since 2008-2009 I've lost touch with the work of Michel Serres:

Jones, Peter, Exploring Serres’ Atlas, Hodges’ Knowledge Domains and the Fusion of Informatics and Cultural Horizons (Aug 15, 2007). SOCIAL INFORMATION TECHNOLOGY CONNECTING SOCIETY AND CULTURAL ISSUES. Available at SSRN: http://ssrn.com/abstract=1842504 or http://dx.doi.org/10.2139/ssrn.1842504

I only scratched the surface of Serres' oeuvre in the above paper and when time permits will revisit this work having just learnt of the Institute:

The resource-systems approach

"Reframing the conceptual and operational field of natural resources requires deep interdisciplinarity across fields encompassing legal and socio-economic studies, and life-sciences. And, it goes without saying, philosophy. The priorities at present are the aid to decision-making and a participative, pro-active civil society acting to (1) manage human activities while meeting the specific territorial potential and resource capacities and (2) ensure a fair re-allocation of such resources according to vital human needs and coherent public goods policies. Who are the members, what are the missions and the activities of the (...)."

Book cover image: c/o Author.

My source: The Empathy Exams
FT Weekend, June 7-8, 2014.

'Intellectual brutalisation' and the saving grace and power of poetry

BBC Radio 4 Today: An eminent cardiologist has organised and funded a poetry competition for his medical students to stop them becoming, in his words, intellectually brutalised.
Gabrielle Gascoigne, pictured, is a previous winner.
The BBC’s Jane Dreaper discovers more.

[no longer available] Listen to ‘Poetry competition for 'intellectually brutalised' medics’ on Audioboo

PBS: For these medical students, poetry nurtures the soul

Here's (source: http://www.bbc.co.uk/programmes/b03s6mdp/live ) the full version of Mastectomy - For His Wife, by Gabrielle Ruth Gascoigne:

It will be an honour
to bathe the scars.
Don’t think my tears imply
an ounce of sorrow -
only joy
could fill my eyes.

It will be a pleasure
to hold you close.
Know this – your precious flesh
calls the bluff on gold
and silver -
makes me a king.

It will be a delight
to talk with you
into the night we thought
stolen, clean away -
until day
renews our hope.

It would be too heartless
if all this love,
these sinner’s prayers and more
should fall to nothing
more than rain
on empty streets.

INTERPERSONAL : SCIENCES
humanistic ------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL

individual

subjectivity insight, rapport, empathy emotional control, detachment, engagement risk of burnout	objectivity anatomy, physiology          physicality, processes, mechanistic intellectual brutalisation
humanistic communication, relationships (medic) poetry	funding, crowded curricula hidden curriculum

group - population

Nursing (Health) Art or Science...?

Is nursing an art or science?
It is simply and complexly both ...

"Warp. Weft. Woof! are terms from weaving: the threads or yarns that run lengthwise on the loom are called the warp; the crosswise threads or yarns are called the woof or weft. The web is the name given the completed woven fabric, and it also has wide figurative use: What a tangled web* of circumstance you've woven.
All these are Standard."
(http://warpweftwoof.com/)

*Also known as the care plan!

Original image source:
http://www.wovenwire.co.uk/plainweave.htm

Additional links:
http://www.africancrafts.com/