If the person you are talking to doesn't appear to be listening, be patient. It may simply be that he has a small piece of fluff in his ear.
-- Pooh's Little Instruction Book, inspired by A. A. Milne
..... or it may simply be that they're caught up in feeding the machine on their desk or the gadget in their paws. When there are so many signals competing for our attention, multi-tasking could appear to be the solution. However, the findings of studies into multi-tasking are pretty negative.
Multitasking: “mythical activity in which people believe they can perform two or more tasks simultaneously as effectively as one.” (Edward Hallowell)
In the therapeutic relationship listening is a fundamental consultation skill for the therapist. What about the client though? As you consider this listening, you will really begin to hear more complete messages coming back. How consistent is it with the message you are sending? You should feel reassured that there is an understanding. What you do to improve this understanding will depend on the situation, but there is certainly some wisdom in Pooh's advice.
Thursday, 17 November 2011
Wednesday, 14 September 2011
The Modern Expert Generalist
"The modern expert is someone who knows how to access knowledge efficiently and judiciously and who can form conceptual links between seemingly unrelated areas."
This quote comes from a series of articles about Complexity science in the BMJ back in 2001. It would support the idea of the generalist. Rather than using the brain as a store of information, it can be liberated to consider multiple dimensions and to understand at a deeper level. Did Einstein really decline to memorise his phone number?
A generalist is able to consider a wider spectrum of information, mulling this in the mind with great care and allowing solutions to emerge with the client.
As you consider whether to use pharmaceuticals, acupuncture, homeopathy, CBT, NLP, mindfulness, you will realise that they may all offer something to a certain extent and there will be other approaches you hadn't considered. Gaining a greater understanding is a powerful healer; a Health Consultant can draw on knowledge of a range of therapeutic avenues offering great flexibility; many concepts will simultaneously be operating within the process. The individual practitioner will recognise their own strengths and be able to refer to appropriate specialists.
You really can now trust yourself to actualise your better future right now; you can see the importance of being the best person that you can be.
This quote comes from a series of articles about Complexity science in the BMJ back in 2001. It would support the idea of the generalist. Rather than using the brain as a store of information, it can be liberated to consider multiple dimensions and to understand at a deeper level. Did Einstein really decline to memorise his phone number?
A generalist is able to consider a wider spectrum of information, mulling this in the mind with great care and allowing solutions to emerge with the client.
As you consider whether to use pharmaceuticals, acupuncture, homeopathy, CBT, NLP, mindfulness, you will realise that they may all offer something to a certain extent and there will be other approaches you hadn't considered. Gaining a greater understanding is a powerful healer; a Health Consultant can draw on knowledge of a range of therapeutic avenues offering great flexibility; many concepts will simultaneously be operating within the process. The individual practitioner will recognise their own strengths and be able to refer to appropriate specialists.
You really can now trust yourself to actualise your better future right now; you can see the importance of being the best person that you can be.
Wednesday, 3 August 2011
Positive Regard
This blog entry brings together previous posts to clarify some of the points raised. Let's start with the statement that a Health Consultant does not treat illness. This means that the client is left free to give as much or as little information as they wish. There will be solutions that are tailored to the person rather than their illness. This is no radical idea:
“The good physician treats the disease; the great physician treats the patient who has the disease”
"Don't tell me what type of disease the patient has, tell me what type of patient has the disease"
Dr William Osler (1849 – 1919)
However, such a focus can more easily be held when the confounding concerns of medico-legal responsibilities are diminished; this has a liberating effect on the therapeutic relationship and opens new avenues.
If the client chooses to give only a little information then the health consultant should listen carefully, be willing to do the best they can and suggest a strategy for enabling health. You will not be burdened with having to go through the whole story all over again. If we touch on issues that you find difficult, the Health Consultant will make it very easy for you to shift the process and the positive regard towards the client would not in any way change.
Please excuse me as I end this short entry by wishing you a very fulfilling summertime.
“The good physician treats the disease; the great physician treats the patient who has the disease”
"Don't tell me what type of disease the patient has, tell me what type of patient has the disease"
Dr William Osler (1849 – 1919)
However, such a focus can more easily be held when the confounding concerns of medico-legal responsibilities are diminished; this has a liberating effect on the therapeutic relationship and opens new avenues.
If the client chooses to give only a little information then the health consultant should listen carefully, be willing to do the best they can and suggest a strategy for enabling health. You will not be burdened with having to go through the whole story all over again. If we touch on issues that you find difficult, the Health Consultant will make it very easy for you to shift the process and the positive regard towards the client would not in any way change.
Please excuse me as I end this short entry by wishing you a very fulfilling summertime.
Friday, 22 July 2011
Rocking Gently
From The Guardian 19th July 2011:
"Healthier behaviour plans are nudge in the wrong direction, say peers: House of Lords committee criticises attempts to curb junk food and alcohol consumption through voluntary agreements"
This article relates to a House of Lords science and technology committee report which questioned ministers use of what is known as the nudge theory.
Nudge theory is described in the book by Thaler and Sunstein entitled "Nudge: Improving decisions about health, wealth and happiness". Nudge theory advocates influencing behaviour by altering the context or environment in which people choose.
Here are a couple of quotes from the book:
"Nudges count as such and qualify as libertarian paternalism only if any costs are low"
"By properly deploying both incentives and nudges, we can improve our ability to improve peoples lives"
Nudge theory is relevant to social policy; it is not a tool to be used at the individual level. For instance, to pry into peoples personal habits is not a nudge, it's a poke in the ribs and a health consultant should not do it.
Infact, often people find themselves tossed precariously on stormy waters; a little nudge from government in such a situation is not going to have much influence. In such a situation, the Health Consultant would wish to support and assist you until you feel yourself rocking gently on those waves.
Stevie Smith - Not Waving But Drowning
Nobody heard him, the dead man,
But still he lay moaning:
I was much further out than you thought
And not waving but drowning.
Poor chap, he always loved larking
And now he's dead
It must have been too cold for him his heart gave way,
They said.
Oh, no no no, it was too cold always
(Still the dead one lay moaning)
I was much too far out all my life
And not waving but drowning.
"Healthier behaviour plans are nudge in the wrong direction, say peers: House of Lords committee criticises attempts to curb junk food and alcohol consumption through voluntary agreements"
This article relates to a House of Lords science and technology committee report which questioned ministers use of what is known as the nudge theory.
Nudge theory is described in the book by Thaler and Sunstein entitled "Nudge: Improving decisions about health, wealth and happiness". Nudge theory advocates influencing behaviour by altering the context or environment in which people choose.
Here are a couple of quotes from the book:
"Nudges count as such and qualify as libertarian paternalism only if any costs are low"
"By properly deploying both incentives and nudges, we can improve our ability to improve peoples lives"
Nudge theory is relevant to social policy; it is not a tool to be used at the individual level. For instance, to pry into peoples personal habits is not a nudge, it's a poke in the ribs and a health consultant should not do it.
Infact, often people find themselves tossed precariously on stormy waters; a little nudge from government in such a situation is not going to have much influence. In such a situation, the Health Consultant would wish to support and assist you until you feel yourself rocking gently on those waves.
Stevie Smith - Not Waving But Drowning
Nobody heard him, the dead man,
But still he lay moaning:
I was much further out than you thought
And not waving but drowning.
Poor chap, he always loved larking
And now he's dead
It must have been too cold for him his heart gave way,
They said.
Oh, no no no, it was too cold always
(Still the dead one lay moaning)
I was much too far out all my life
And not waving but drowning.
Friday, 15 July 2011
Making Headway
Ending the stalemate over CFS/ME
Fiona Godlee
BMJ 2011;342:doi:10.1136/bmj.d3956 (Published 22 June 2011)
The very term CFS/ME indicates the separation and disagreement that exists over this condition. It seems a sensible approach not to argue over terminology, whether it's CFS or ME, and use the term CFS/ME. Diagnostic classifications, causation and treatments are all still hotly disputed. What would the Health Consultants position be?
The Health Consultant does not treat illness. Really?
Enhancing health is quite distinct from treating illness. Illness and its multitude consequences will inevitably drain health and vitality and it is the role of the Health Consultant to help restore this. If you were looking for somebody to execute a cure to your illness you would need to look elsewhere.
The Health Consultant helps the person; a constructive approach to enabling health would be possible without the client even mentioning any diagnostic labels. Such labels result in certain judgements being made; not always a bad thing if information is properly deliberated to avoid it being misjudged.
When working with the Health Consultant it should be apparent to you that you are engaged in a confidential dialogue, that is open-minded, impartial and focused on positive outcomes.
Fiona Godlee
BMJ 2011;342:doi:10.1136/bmj.d3956 (Published 22 June 2011)
The very term CFS/ME indicates the separation and disagreement that exists over this condition. It seems a sensible approach not to argue over terminology, whether it's CFS or ME, and use the term CFS/ME. Diagnostic classifications, causation and treatments are all still hotly disputed. What would the Health Consultants position be?
The Health Consultant does not treat illness. Really?
Enhancing health is quite distinct from treating illness. Illness and its multitude consequences will inevitably drain health and vitality and it is the role of the Health Consultant to help restore this. If you were looking for somebody to execute a cure to your illness you would need to look elsewhere.
The Health Consultant helps the person; a constructive approach to enabling health would be possible without the client even mentioning any diagnostic labels. Such labels result in certain judgements being made; not always a bad thing if information is properly deliberated to avoid it being misjudged.
When working with the Health Consultant it should be apparent to you that you are engaged in a confidential dialogue, that is open-minded, impartial and focused on positive outcomes.
Tuesday, 5 July 2011
Acupuncture
Acupuncture for ‘frequent attenders’ with medically unexplained symptoms: a randomised controlled trial (CACTUS study) Paterson et al. The British Journal of General Practice June 2011
The introduction to this paper states:
"People who have persistent physical symptoms that cannot be explained by current medical knowledge (‘medically unexplained physical symptoms’ [MUPS]) make up 11–19% of UK GP consultations and up to 50% of new referrals to outpatient clinics."
A large proportion of patients in the NHS are being lumped into the box labelled "MUPS". The result of this is expressed well in the same paper:
"In addition to their physical symptoms, such patients, and their doctors, are distressed and frustrated by the lack of explanation, credibility, and acceptable treatment options."
The CACTUS study concluded:
"The addition of 12 sessions of five-element acupuncture to usual care resulted in improved health status and wellbeing that was sustained for 12 months."
"The factor for which least evidence was found was the sharing of acceptable and empowering explanations"
It should be noted that this study used practitioners fully trained in traditional 5-element acupuncture rather than the minimally trained western medical practitioners within the NHS who adhere to conventional western neurophysiological principles. The findings show very clear benefits to the patients. It is suggested that further work is needed regarding explanations that patients find "acceptable and empowering". It would be interesting to see the difference it makes if the gap between western medical explanations and alternative theories is bridged to allow greater health enablement; this is what the Health Consultant aims to do.
The introduction to this paper states:
"People who have persistent physical symptoms that cannot be explained by current medical knowledge (‘medically unexplained physical symptoms’ [MUPS]) make up 11–19% of UK GP consultations and up to 50% of new referrals to outpatient clinics."
A large proportion of patients in the NHS are being lumped into the box labelled "MUPS". The result of this is expressed well in the same paper:
"In addition to their physical symptoms, such patients, and their doctors, are distressed and frustrated by the lack of explanation, credibility, and acceptable treatment options."
The CACTUS study concluded:
"The addition of 12 sessions of five-element acupuncture to usual care resulted in improved health status and wellbeing that was sustained for 12 months."
"The factor for which least evidence was found was the sharing of acceptable and empowering explanations"
It should be noted that this study used practitioners fully trained in traditional 5-element acupuncture rather than the minimally trained western medical practitioners within the NHS who adhere to conventional western neurophysiological principles. The findings show very clear benefits to the patients. It is suggested that further work is needed regarding explanations that patients find "acceptable and empowering". It would be interesting to see the difference it makes if the gap between western medical explanations and alternative theories is bridged to allow greater health enablement; this is what the Health Consultant aims to do.
Wednesday, 22 June 2011
Screening
The Independent reports today:
"Separate guidance on safe drinking levels for over-65s should be issued by the Government as current recommended limits are based on younger adults and are too high for the elderly, the Royal College of Psychiatrists said in a report."
The Health Consultant is content with the provision of information to aid people to make informed choice. NHS choices website also contains useful information. The report goes on:
"Recommendations include screening by GPs for substance misuse amongst the over-65s, as part of a routine health check and a public health campaign on alcohol and drug misuse targeted at older people."
If an individual would prefer not to be "screened" in such a way, when challenged regarding their lifestyle, there is often a detrimental effect upon the therapeutic relationship. The Health Consultant sees a role for somebody to help you manage relationships with your medical team to avoid such problems. As a client of the Health Consultant you would not be required to answer such direct questions.
"Separate guidance on safe drinking levels for over-65s should be issued by the Government as current recommended limits are based on younger adults and are too high for the elderly, the Royal College of Psychiatrists said in a report."
The Health Consultant is content with the provision of information to aid people to make informed choice. NHS choices website also contains useful information. The report goes on:
"Recommendations include screening by GPs for substance misuse amongst the over-65s, as part of a routine health check and a public health campaign on alcohol and drug misuse targeted at older people."
If an individual would prefer not to be "screened" in such a way, when challenged regarding their lifestyle, there is often a detrimental effect upon the therapeutic relationship. The Health Consultant sees a role for somebody to help you manage relationships with your medical team to avoid such problems. As a client of the Health Consultant you would not be required to answer such direct questions.
Wednesday, 15 June 2011
Would that the world was a perfect place
A Royal College of General Practitioners (RCGP) report in March 2011 makes the following comments:
"Things often go badly wrong for patients when they are in transition between different parts of the health service. In such a case the doctor, acting as the patient’s agent, will go out of his or her way to fill the gaps. Patients themselves and their relatives may have to put in enormous effort and persistence to overcome deficiencies in care at the interface, and these can be exceptionally distressing."
"With all the extra activities GPs are encouraged to take on in addition to direct patient care, their working day has become more intense. Surgeries that run for more than three or four hours without a break are now commonplace."
"In many practices it requires enterprise, determination and social skill to get to see your chosen doctor."
Although the RCGP are likely to emphasise the hard work of GPs, this view is shared by most. The report didn't adequately highlight the misunderstandings that can occur due to pressures on time. Issues that are crucially important to the patient are unspoken and the opportunity to correct matters is missed. Clearly it is not ideal that "enterprise, determination and social skill" can alter the way a person is treated; would that the world was a perfect place.
"Things often go badly wrong for patients when they are in transition between different parts of the health service. In such a case the doctor, acting as the patient’s agent, will go out of his or her way to fill the gaps. Patients themselves and their relatives may have to put in enormous effort and persistence to overcome deficiencies in care at the interface, and these can be exceptionally distressing."
"With all the extra activities GPs are encouraged to take on in addition to direct patient care, their working day has become more intense. Surgeries that run for more than three or four hours without a break are now commonplace."
"In many practices it requires enterprise, determination and social skill to get to see your chosen doctor."
Although the RCGP are likely to emphasise the hard work of GPs, this view is shared by most. The report didn't adequately highlight the misunderstandings that can occur due to pressures on time. Issues that are crucially important to the patient are unspoken and the opportunity to correct matters is missed. Clearly it is not ideal that "enterprise, determination and social skill" can alter the way a person is treated; would that the world was a perfect place.
Friday, 10 June 2011
Enablement
The BBC reports this week:
The Dementia Action Alliance - which includes the RCGP, Department of Health, Alzheimer's Society and Age UK - want all prescriptions for antipsychotics to be reviewed by the end of March 2012.
Jeremy Hughes, Chief Executive of the Alzheimer's Society, said it was unacceptable that people with dementia were having their health and quality of life put at risk because of antipsychotics:
"It is essential we bring an end to this chemical cosh and empower people with dementia and carers with the information they need to ensure they are not prescribed these drugs inappropriately. This call to action can do just that."
"It's not just about reducing antipsychotics but also about improving quality care. This means developing alternative treatments and finding better ways to manage pain and other medical conditions."
Most agree that the aim of this campaign is worthy. I wonder how and whether it will be achieved. I consider the use of the term "chemical cosh" could encourage an aggressive indignation from those affected; this risks undermining the trusting relationship with their medical team. There is clearly battle analogy being used with patients pitted against Doctors. This is not likely to lead to empowerment, but I also question whether empowerment is desirable or whether enablement is not more helpful. People would often benefit from assistance in managing relationships with their medical team and avoiding misunderstandings; this needs to be done with care and who is best placed to do this?
The Dementia Action Alliance - which includes the RCGP, Department of Health, Alzheimer's Society and Age UK - want all prescriptions for antipsychotics to be reviewed by the end of March 2012.
Jeremy Hughes, Chief Executive of the Alzheimer's Society, said it was unacceptable that people with dementia were having their health and quality of life put at risk because of antipsychotics:
"It is essential we bring an end to this chemical cosh and empower people with dementia and carers with the information they need to ensure they are not prescribed these drugs inappropriately. This call to action can do just that."
"It's not just about reducing antipsychotics but also about improving quality care. This means developing alternative treatments and finding better ways to manage pain and other medical conditions."
Most agree that the aim of this campaign is worthy. I wonder how and whether it will be achieved. I consider the use of the term "chemical cosh" could encourage an aggressive indignation from those affected; this risks undermining the trusting relationship with their medical team. There is clearly battle analogy being used with patients pitted against Doctors. This is not likely to lead to empowerment, but I also question whether empowerment is desirable or whether enablement is not more helpful. People would often benefit from assistance in managing relationships with their medical team and avoiding misunderstandings; this needs to be done with care and who is best placed to do this?
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