Communication, explanation and understanding

Judges in the US are attending a programme of classes to educate them in the science and medicine that underlies the detection, diagnosis, treatment and prognosis of disease. The programme is intended to help in the ajudication of medical malpractice cases.

In addition to acquiring a scientific knowledge base, judges said they learned that understanding physician-patient communication is key to interpreting complex medical cases.

Ohio trial Judge Lee Sinclair said he was particularly enlightened by a mock exercise in which a newly diagnosed cancer patient evaluated treatment options with several doctors, including a surgeon and an oncologist.

When the judges got together to discuss the conversation, “what you realized was everyone in the room heard things in a different way,” Sinclair said. “Often what you hear in medical malpractice cases is the physician saying he explained it to the patient and the patient saying it never happened.”

The insights are especially valuable in helping judges eliminate potentially frivolous lawsuits or find alternate ways to resolve legal disputes without going to trial, said Marvin J. Garvis, a Maryland federal judge.

I found this exercise interesting for a number of reasons. How many times have we heard someone say, "But I told you that", or "You never told me about that". Sometimes, we have been told information but the stress or shock of the circumstances under which we were told means that we don't remember. Sometimes, we retain fragments of the information, rather than its context.

Fish v. Drugs for Children And Criminals

When most of us think about Eating Our Way To Happiness we tend to think delicious doesn't exist on the same spectrum as nutritious. There are several T.V. advertising campaigns promising happiness in association with foodstuffs at present. Pop Quiz. Do you think that these foodstuffs are vegetables or confectionery? Nutrient-dense or nutrient-poor? How much truth is there in this advertising?

Does it matter? Well, according to research conducted in prisons, the nutritional profile of what we eat may matter a great deal. Physiologist Bernard Gesch had lead this research in UK prisons and is quoted as claiming that:

Research suggests that we may have seriously under-estimated the importance of nutrition for our social behaviour. Since the 1950s there has been a ten-fold increase in offences. How else can we explain that but by diet? It is not down to genetics. The main change over that period has been in nutrients.

Gesch's trials with supplements in a prison population indicated that inmates responded with a drop by more than a third in their level of antisocial behaviour (as measured by assaults and similar transgressions) relative to their previous records. For some, this raises questions about the link between diet and behaviour, and the link between violence and free will. Gesch was interviewed on the topic for the New York Times [behind a paywall] and argues:

They're Not The Priority But What Would You Do For The Carers?

There's another new medical blog, Diagnosis NFI. Magwitch is the author, and an Emergency Care Practitioner. The blog hasn't been up for long but has already provoked some interesting questions about policies that affect the lives of carers.

Magwitch tells us about a call out to an elderly woman who seems to be the Sad and Lonely of the title.

In the end it all seemed to boil down to depression. She was a proud and independent lady but now, due to arthritis and cancer, was confined to her own home. Most of her friends has passed away and, apart from the odd neighbour who popped in from time to time, she had no one to talk to during the day. She had a son, who now lived with her and was her main carer, but he went out to work and she was left to her own devices for 8 to 10 hours at a time. She felt she was becoming a burden on him and the more she thought about it the worse she got.

Now, she was very obviously the priority, and for various reasons, she was admitted to hospital for further assessment. However, it became apparent that the son had problems related to his role as a carer. His mother resented the times when he was not with her and had begun to phone him if he was 10 minutes late home from work. She was taking over his days-off.

What Is The Cost Of Doing Nothing?

Malcolm Gladwell has an extraordinary piece entitled Million Dollar Murray: Why problems like homelessness may be easier to solve than to manage. In a lengthy and fascinating read he effectively challenges some of my previous thinking about homelessness as a wicked problem causing honest paralysis over difficult issues. Wicked problems arose in the area of public policy and are described as "a set of problems that cannot be resolved with traditional analytical approaches". It is the nature of wicked problems that unanswered questions and chronic issues can take years to work out or never be satisfactorily resolved.

Two police officers in L.A. made an informal calculation as to the costs of managing "chronically homeless inebriates" like Murray Barr whom they had cared for over many years.

...Johns and O'Bryan realized that if you totted up all his hospital bills for the ten years that he had been on the streets—as well as substance-abuse-treatment costs, doctors' fees, and other expenses—Murray Barr probably ran up a medical bill as large as anyone in the state of Nevada.

"It cost us one million dollars not to do something about Murray," O'Bryan said.

Gladwell discusses the research into homelessness by Dennis Culhane.

What he discovered profoundly changed the way homelessness is understood. Homelessness doesn't have a normal distribution, it turned out. It has a power-law distribution. "We found that eighty per cent of the homeless were in and out really quickly," he said. "In Philadelphia, the most common length of time that someone is homeless is one day. And the second most common length is two days. And they never come back...

...The next ten per cent were what Culhane calls episodic users. They would come for three weeks at a time, and return periodically, particularly in the winter. They were quite young, and they were often heavy drug users. It was the last ten per cent—the group at the farthest edge of the curve—that interested Culhane the most. They were the chronically homeless, who lived in the shelters, sometimes for years at a time. They were older. Many were mentally ill or physically disabled, and when we think about homelessness as a social problem—the people sleeping on the sidewalk, aggressively panhandling, lying drunk in doorways, huddled on subway grates and under bridges—it's this group that we have in mind.

Culhane discovered that about despite the size of the homeless population in New York, there are 'only' 2500 who are chronically homeless. Culhane's most startling finding was that New York spent sixty-two million dollars p.a. to shelter just those 2500 hard-core homeless. Studies in both Boston and San Diego reported extraordinary levels of medical and social care spending on similar high-need populations that confirmed the calculations made by Johns and O'Bryan in L.A..

Happiness: Experience Rich and Theory Poor?

In The Tipping Point, Malcolm Gladwell promotes the idea that small actions can spark “social epidemics”, that are good for our well-being. I’ve been thinking about this in relation to happiness and other small social movements like the ones supported by UnLtd. We can get so caught up in the mechanics of delivering a project that is neither a full-time job nor an income source that we can overlook the need for the idea to be promoted to wider, less-involved groups (other than over dinner-tables). Apart from this blog and a few other efforts like the Fun Federation I’ve been concentrating on finding suitable groups and venues for delivering the Happystance workshops.

It has taken months for me to set up tomorrow’s taster workshop at a meeting of the people who are involved in local carers’ groups. It’s a good opportunity to give an interested audience an experience of Happystance but I know that I’ve been neglecting the wider promotion of what I’m working on. There is a quiet crisis of unhappiness in Britain. And it is so paralysing that even when there is an opportunity to discuss it (like my recent letter to my local newspapers), it excites no response. Either happiness is perceived as an issue that is too trivial to engage with or there is a failure of imagination when asked to imagine that things could be different.