Euclidean or Projective Care?

How many dimensions does a written - narrative record have?

Sketching out some ideas, I asked the question on Google and as usual an AI Overview response followed - snippet:

AI Overview

A physical written record has two primary spatial dimensions (length and breadth/width) as a flat document, or three dimensions (including thickness or depth/height) when considering its physical form or binding. [1, 2]

In archival and Records Continuum theory, a written record exists dynamically across four conceptual dimensions: [1, 2].

I put the question to the Records Management list with the above snippet and received several useful suggestions and sources. Perhaps I can share that at a future point? 

Acutely aware of not pursuing maths and category theory for its own sake, the query was driven by an attempt to look at Hodges' model in mathematical terms. Starting, rather obviously with the models structure and axes. When the model is assembled, as per many posts, the vertical axis:

INDIVIDUAL
|
GROUP

- shouts out the issue of parity and the distinction between mind and body. It does this at the individual and collective level. If we were to draw a silo, a cylinder springs to mind, and there are specific reasons for silos adopting this shape. Descartes gives us the perfect excuse, in the ongoing legacy. 

     Mathematical Visions

The question above came up from Joan L. Richards book 'Mathematical Visions' (c/o Lancaster Univ. library). Euclidean and the emergence of projective geometry is described. There is an interplay between 2D and 3D representation, that made me think about the health record and its dimensions. Not in a dataset sense (multi-dimensional), more generally and concretely(?). A patient's record on paper has physical dimensions (A4), there is a flow. An EHR has its virtual dimensions (discuss!). Abstractly the content is a time machine. At some point in a health encounter it is a literal 'history', the level of detail in accord with the context. The record might present the problem, premorbid situation, diagnosis, current state, observations and prognosis and much more.

I can revisit this, Richards provides a series of figures. We progress from two distinct circles (my silos) through to examples with a discussion of continuity and projection that sees the circles touching, then intersecting. This is a radical axis.

Richards, Joan L. (1988), Mathematical Visions: The Pursuit of Geometry in Victorian England, Boston: Academic Press, ISBN0-12-587445

Book cover: Amazon.

Disciplines in Disarray - Scope of Practice, Disciplinary boundaries

To be in a state of disarray, is to be disarmed, without access to resources, or at least having an impaired ability to organise strategically for reasons of defence, disputation or argument. Constructive debate will be hard to achieve and so the confusion continues.

Prior to 2013 ideas for a paper with a would-be co-author began. Early that year there were 5000 words. There's probably mention of (another!) project on these pages – somewhere/when? The focus was using Hodges' model to explore 'scope of practice' in nursing. As the conceptual gift that keeps giving, Hodges' model can encompass all health disciplines, curricula, and professions, informal caring and social care too.

This post is prompt-ed (human ‘intelligence’ needs a nudge too) by ‘discussion’ on what was twitter, and currently on ‘X’. So in turn I can reflect on how relevant this paper would be today.

I still have that draft of over 5000 words. It is now woefully out-of-date. Out-of-date? Well the available job postings across the health and care sectors, have always changed. If you scan the paper copies of  Nursing Times, Nursing Standard, Nursing Mirror (anyone?) and the BMJ, The Lancet, Health Service Journal over three-four decades the evidence is clear. Then try the e-media, (and with it AI!)?

Now, for several years the impacts of  policy and change in advanced nursing practice, plus associate roles, that have also been applied in medical training and education are coming home to roost. Depending on your corner, and position in the debate there's a position called 'Noctor' (Vaughan and Kar, 2026).

I find it regrettable that consultants and 'senior' nurses have taken corners, as policy results in grossly negative examples with potentially safety consequences. There has always been a 'distance' to be bridged between health disciplines. In the past any sense of competition was usually, and so constructively patient-centred - grounded in the delivery and quality of care. The contest was tempered through mutual respect and dignity, and recognition of respective roles, knowledge, abilities and contribution to what is (and remains?) the multidisciplinary team?

Now with technology and AI in the mix, maintaining goodwill, common-sense and keeping the patient, public and future generations in sight will need a degree of diplomacy as yet not called-upon.

This made me think of the unions in the 1970s and more recent examples of work-to-rule. 

As health professionals argue between themselves, what is the cost of distraction?

Yes, that paper using Hodges' model on 'scope of practice (and theory!)' would be timely now.
In fact, it is urgently needed.

Vaughan L, Kar P. Vexatious complaints are being weaponised to discourage debate BMJ 2026; 394 :e100697 doi:10.1136/bmj-2026-100697 

Previously: 'scope' : 'publications'

Munker illusion: Finding a palette for holistic, person-centred care

Hodges' model - Integrated Care?

It is as obvious as black and white.

Health, social care & education
are bound to be siloed.

Get over it!

What do you want: a rich picture?

Color Assimilation Grid Illusion

"Only the grid is colorful, the rest of the video is in grayscale, but the lower resolution of our color perception makes the color assimilate/blend into the grayscale cells within the human visual system."

https://www.patreon.com/posts/color-grid-28734535
 

"I've found that the grid works best."  Øyvind Kolås

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

#carearchitecture #careresolution #integratedcare

See for original post:
https://www.patreon.com/posts/color-grid-28734535

My source: Massimo

AI Governance & (Old) Chestnuts - When Healthcare is a Silo

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

intelligence SMART bias safety explainability *(effect)?	artificielle [ ;-) ] V s E i R t T u I a C t A i L o    n    s Healthcare and Energy (Sectors) bias, safety, explainability unintended consequences ZERO emissions
"There are areas where we need to do the research before we know  what are the right kinds of  approaches to take". Sundai Pichai *(effect)?	REGULATION Governance Blanket vetting or Sector-by-Sector rules? anti-competitive privacy infringement Advertising* (cause) *(effect)? Google AI principles

Source:
Bradshaw, T. (2019) Google chief urges regulators not to rush into AI crackdown, FT Weekend, 21-22 September, p. 15.

Dear McKinsey and Company, Re. "The era of exponential improvement in healthcare?"

Re. Your article:

The era of exponential improvement in healthcare?

(By Shubham Singhal and Stephanie Carlto)

Technology-driven innovation holds the potential to improve our understanding of patients, enable the delivery of more convenient, individualized care—and create $345 billion to $420 billion in value by 2025.

Healthcare advances have delivered great benefits to society, bringing material improvements in average life spans and quality of life.¹ Yet these improvements have come at a cost—an ever-expanding portion of the US GDP is being consumed by healthcare expenses.² Could technology, enabling delivery of healthcare advances while improving affordability, be part of the solution? We have reviewed the evidence, done the math, and identified technology-enabled use cases that could create between $350 billion and $410 billion in annual value by 2025 (out of the $5.34 trillion in healthcare spending projected for that year³ ).

Read more ...

<>

But how would we recognise the era of exponential improvement in healthcare?

SELF - individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - POPULATION

The exponential benefits realised 'elsewhere' in global, local and glocal health and healthcare systems finally sees the achievement of parity of esteem with mental health not only fully funded, but designated as the key that must be turned 4 happiness. Despite the diametrical opposition of this domain to the political domain, there is a breakthrough in policy makers and the body politic prioritising "The Long Now"

"Predictions of an exponential increase in people living with dementia in the coming 30 years require evidence-based strategies for advancing dementia care and maximizing independent living. However, the evidence required to inform priorities for enabling improvements in dementia care is rarely presented in a way that stimulates and sustains political interests."  Martin, O’Connor, & Jackson (2018).

Community-based healthcare becomes  the norm and the educational, preventive and sustainable ethos for health and healthcare systems is adopted globally. Look at the readiness and response-to potential epidemic crises, plus  interventions in population health.  Exponential benefits are accrued. Evidence - look at the number of  (new) hospital beds. The community IS the market.

Exponential growth in global healthcare funding, health information for all, access to universal health care.  Social Determinants of Health not just a vision: but enacted and ongoing #SDoH-X. Evidence - climate change slowing, air quality improving - the 21st Century truly begins ...

Martin, A., O’Connor, S., & Jackson, C. (2018). A scoping review of gaps and priorities in dementia care in Europe. Dementia. https://doi.org/10.1177/1471301218816250

My source:
email - McKinsey Insights

Finding space in Hay-on-Wye: Complexity & healthcare - book

This time last week I was in Hay-on-Wye the book town on the border of England and Wales. February is still pretty cold, a good excuse to really browse.

complexity and healthcare - book cover

Amongst some great finds were three books on complexity in primary care and medicine.

I am sure that the way complexity can be woven within Hodges' model are manifold. On page 4 of Sweeney & Griffiths: 

'Using the idea of multidimensional phase space can help us understand categories of disease without clear boundaries. Instead of thinking of a person's illness as a walled off and separate pigeon hole, it can be useful to think of it as a point within a multidimensional illness space'

Kieran Sweeney, Frances Griffiths (eds). (2002) Complexity and healthcare: an introduction. Radcliffe Medical Press Ltd.

Health Care - drawing lines

Multidisciplinary care

Original image source:
http://www.jointline-group.co.uk/councils.php

Weber: Universities, disciplinarity - academic publishing

As I read through the latest book I have received for review, I came across this interesting quote from Samuel Weber:

The university, itself divided into more or less isolated, self-contained departments, was that embodiment of that kind of limited universality that characterised the cognitive model of professionalism. It instituted areas of training and research which, once established, could increasingly ignore the founding limits and limitations of individual disciplines. Indeed, the very notion of academic "seriousness" came increasingly to exclude reflection upon the relation of one "field" to another, and concomitantly, reflection upon the historical process by which individual disciplines established their boundaries. Or the historical dimension was regarded as extrinsic to the actual practice of research and scholarship: history itself became one discipline among others. (1987, 32)

Weber, Samuel. 1987. Institution and Interpretation. Minneapolis: University of Minnesota Press. Revised and reprinted as Samuel Weber, 2001. Institution and Interpretation (Expanded Edition). Stanford, Calif.: Stanford University Press.
Cited in Hall, Gary 2008. Digitize This Book!: The Politics of New Media, or Why We Need Open Access Now. University of Minnesota Press. Chapter 2, Judgement and Responsibility in the Wikipedia Era, p. 74.
(My review of Hall's book to follow).