Managing Complexity In Musculoskeletal Conditions: Reflections From A Physiotherapist

In this blog (and linked article), physiotherapist Matt Low explains how he uses patient narratives, mind-maps and the vector model of causation to help his patients. The result is a person-centered approach that emphasises causal complexity, individual context and the idea that at least some of the causes of pain can be counteracted and thus controlled by the patient. Matt is a collaborator of CauseHealth and this is his second article describing his unique approach to chronic pain.

Perspectives on Physiotherapy

I was fortunate enough to have been invited by Physio First to contribute to their journal ‘In Touch’ and I chose to write about managing complexity with the different types of ‘evidence’ that we deal with in a healthcare setting.

This is an area of interest for me and I still grapple with many areas of clinical practice.  These include balancing the normative and narrative examination, evaluating and weighting the evidence appropriately for the person seeking care in front of me and also reconciling and communicating the reasoning process within a person centred framework.  Clearly, this is work in progress and I hope this reflective piece demonstrates a movement in this direction.

I hope this paper is informative and useful in that it shares some of my deliberations, thoughts and perspectives in clinical care.

Many thanks to Physio First http://www.physiofirst.org.uk/ for giving me the opportunity to share this.

Managing complexity…

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Living with complexity and big data. Causal dispositionalim enters pharmacovigilance

Ralph Edwards on dispositionalism in pharmacovigilance

We have seen a lot of interest in the CauseHealth approach and issues during these last years, especially among clinicians who see a need for a more person centered healthcare. Can this be useful also outside the clinic? Yes, according to senior medical advisor at the WHO Uppsala Monitoring Center for Drug Safety, Ralph Edwards. In a recent perspectives article in the UMC report, he argues that dispositionalism can be useful for dealing with complexity, individual variation and the patient’s unique context. Continue reading “Living with complexity and big data. Causal dispositionalim enters pharmacovigilance”

DATA AND THEORY: NEW CAUSEHEALTH PAPER ABOUT THE PROBLEM OF WEIGHING COMPLEX EVIDENCE IN MEDICINE.

by Elena Rocca

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In the early 19th century, the Hungarian physician Ignaz Semmelweis noticed from his clinical experience that antiseptic routines in healthcare reduced infections at childbirth. After carrying out some studies on the matter, he proposed that the practice of disinfecting hands in the obstetrician ward of the Vienna General Hospital, where he worked at the time, would have reduced the incidence of puerperal fever. However, for that time this seemed as an implausible suggestion.  The germ theory of disease was still unheard of (Pasteur developed such theory only some decades later), and therefore there was no accepted understanding of how disease could be transmitted from one organism to the other. Semmelweis suggestion was therefore rejected by the medical community. Continue reading “DATA AND THEORY: NEW CAUSEHEALTH PAPER ABOUT THE PROBLEM OF WEIGHING COMPLEX EVIDENCE IN MEDICINE.”

CauseHealth goes to Evidence Live

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Evidence Live is an annual conference, jointly hosted by the Centre for Evidence-Based Medicine, University of Oxford and The BMJ. This year, CauseHealth was represented in two of the sessions, by Elena Rocca and Rani Lill Anjum. Continue reading “CauseHealth goes to Evidence Live”

Evidence based medicine. What evidence, whose medicine, and on what basis?

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Rani Lill Anjum

The evidence-based medicine movement was intended as a methodological revolution. Its proponents suggested the best way to establish the effectiveness of treatment and new criteria to choose between available treatments without bias. Philosophically, however, these changes were not so innocent, at least not ontologically speaking. In bringing itself closer to science, medicine has become less suitable for dealing with complex illnesses, individual variations and, as I will argue, with causation in general. Continue reading “Evidence based medicine. What evidence, whose medicine, and on what basis?”

Capturing the Colour: Classification and its Consequences

Author Eivind Hasvik
(#5 in the Whole Person reflections series)

Gazing through my window, I’m enriched by a muted but beautiful December twilight-palette. The remains of autumn covered by a thin layer of snow. It’s said that every culture has its own sense of the different hues. I’m reading a beautiful passage in White by Kenya Hara about the traditional Japanese way of naming colours. Contrary to the modern way of categorizing a given spectrum of light, such as greens, magentas or yellows, it’s said that red, blue, white and black were the only basic colour adjectives in 8th century Japan. The tradition was not to classify, but to describe and texturize, capturing the seasons and surroundings. This narrative heritage is beautifully documented in the book The traditional colours of Japan.

I’m imagining a metaphorical link from all this to the difficulties of describing experience—sensations, emotions, pain or pleasure. Continue reading “Capturing the Colour: Classification and its Consequences”

Glasses and Blind Spots: Through the Eyes of a Tester

Author Wenche Schrøder Bjorbækmo
(#4 in the Whole Person reflections series)

The test’s glasses and blind spots – seen through the confession and experience of a tester. Continue reading “Glasses and Blind Spots: Through the Eyes of a Tester”

Does your regular GP know you – as a person? And if so, does it matter?

Written by Bente Prytz Mjølstad
(#3 of the Whole Person reflections series)

Have you ever thought about whether your regular GP knows more about you than your blood pressure or cholesterol levels? If so, might such knowledge be of any medical relevance?

Most of us visit our regular GP once or twice a year for more or less trivial complaints, and you are probably most interested in the GPs medical skills, and not so concerned about whether the doctor knows you as person or not. However, if you got seriously ill or had a chronic illness, would it still not matter? Continue reading “Does your regular GP know you – as a person? And if so, does it matter?”

CauseHealth workshop N=1 is now a section in JECP special issue.

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The Journal of Evaluation in Clinical Practice has dedicated a section of its latest special issue to collect seven contributions which were previously presented in the CauseHealth workshop N=1. A further contribution from the same workshop was published by the same journal last year. Continue reading “CauseHealth workshop N=1 is now a section in JECP special issue.”

What if…

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Author Anna Luise Kirkengen
(#2 of the Whole Person reflections series)

What if one would weave a text by means of threads coloured by the recent topics of the on-going CauseHealth project. One thread would be causality, and how it is understood and applied in current biomedicine. Another would be ontology in the sense of how a human being and the human body is conceptualised in medicine and how this concept underpins the Western health care systems. A third thread would be methodology, and how the predominant methods for knowledge production, group based, randomised trials often including thousands of patients, might be radically challenged by the concept of N=1. A fourth thread would be stories in the sense of biographies before a person fell ill, and stories in the sense of testimonies of being ill – and how these have been systematically avoided as possible source of contamination in medical knowledge production. A fifth thread would then be knowledge condensates as these have grown both in number and normativity in the shape of clinical guidelines in all medical specialties during the latest years. Together, these threads can form quite different pictures, dependent on the frame applied. Continue reading “What if…”