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At Least Four Perspectives in Medicine

Discussion in 'Action Alerts and Advocacy' started by alex3619, Nov 30, 2013.

  1. alex3619

    alex3619 Senior Member

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    One of our biggest problems in advocacy is a failure to engage with the medical community on their terms. Many of us in advocacy are coming from a scientific perspective. Some are from a political perspective, in which I include regulation and laws. However there are two more. The third is a managerial perspective, and the fourth is the irrational mindset found in psycho-psychiatry, and especially psychogenic psychiatry. This last is most clearly exemplified in biopsychosocial thinking.

    I have a science and logic background. Its not really a science and philosophical background as I didn't study much historical philosophy. In the last 5 years or so I have tried to mentally engage with the political process in medicine in order to advocate better.

    In the last two years I have had to include evidence based medicine in my thinking.

    What makes these other views so different?

    Scientific thinking is about proposing, testing and disseminating hypotheses. Its about evidence and reason. Its about rejecting hypotheses that do not fit the facts. In advocacy many of us are aware of much of the scientific research. We easily see that most of the claims and actions about ME in the world are not consistent with the facts. So we rightly reject them. However we typically fail to communicate that. In the last few years more and more of us have published articles, letters, papers etc. that deal with this issue from a scientific mindset. This is a good sign for advocacy. The person in advocacy I consider leading that charge is Tom Kindlon, whose work I greatly admire.

    Political advocacy is really a blend of two things, so it might be argued there are even more views, but I want to try to keep it simple for now. The first is law/regulation, and includes concepts like governance, transparency and accountability. The second is political processes like consensus and voting. The governments or regulatory agencies define the regulations and legislature that we have to deal with, so to a large extent laws and regulations are politically determined, which is why I am lumping them together for now. Recently we have engaged in more Freedom Of Information requests, advocacy with elected officials, and even legal challenges. These are all good signs even if we have not succeeded.

    For a long time there has been a push to make medicine more scientific. Since around the late 1970s there has been a push to regulate medicine. I used to consider this process a political one, based on science, but now I think it is not primarily political and only vaguely influenced by science. I call this the managerial viewpoint. It is more influenced by economics.

    The managerial viewpoint is dominated by accounting and economics. I regard the first major architect of this approach as Maggie Thatcher. She really did change how the world worked, but I am coming to regard that as more a bad thing than a good thing. Society has limited resources, politicians have to work within that, but politics is becoming increasingly dominated by managerial views, and so is medicine. The managerial mindset is about how to regulate the use of resources in medicine to achieve the most public good at the least cost, and to constrain costs within some limits.

    Evidence Based Medicine exemplifies the managerial view in medicine. Agencies practicing this include NICE and the IOM. We cannot effectively engage with such agencies without understanding the basis of how they work, and it makes it harder that the evidence-based approach is constantly evolving and unregulated.

    I am going to leave biopsychosocial and psychogenic medicine alone for now, but please feel free to discuss it too.

    I created this thread so that issues on perspectives, and how to engage with audiences who operate in those perspectives, can be discussed. We need to reach audiences that are resistant to views from other perspectives, so we have to engage them within their own conceptual framework, or engage in actions that alter their conceptual framework.
     
    ahimsa, leela, lastgasp and 6 others like this.
  2. helen1

    helen1 Senior Member

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    Thanks for clarifying this for us, Wayne. I knew there was something about 'evidence-based' that bothered me, but couldn't quite figure it out.
     
    aimossy likes this.
  3. aimossy

    aimossy Senior Member

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    Evidence based although good in lots of ways seems to have become an excuse to cut costs/increase time consuming paper filled systems and reduced the ability to implement common sense and in the end harmed health professionals and patients at least within the economical management that in my country now governs over health professionals and patients. I may have stuffed up and not got my point across there but i tried with my fog and all.:):bang-head:
    Edit: this system/style has in turn made it very difficult to 'make things happen' in the context of getting health professionals/patients needs met.
     
    Ren, beaker, merylg and 3 others like this.
  4. justinreilly

    justinreilly Stop the IoM & P2P! Adopt CCC!

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    I watched a YouTube lecture by Harvey Fineberg president of Institute of Medicine. He talked about knowing your audience and meeting them where they are, not where you are/come from. This is kind of common sense, but it bears repeating and is also much easier said than done, so I think we need to keep striving to do this.

    It would be great if more patients worked in advocacy, most especially now with the IoM disaster looming. So if you are reading this and don't normally go over to the advocacy section, please do check out the IoM sub forum! We need your help, including those who have no experience or don't understand advocacy, since you might have a perspective that jibes with out audience and you can really help that way.

    We also need to engage civilians (non-patients) more to help us, like Jen Brea is doing with her film, especially specialists like (pro bono or paid) PR firms and lobbyists, or just anyone you are friends with who can help out. This is difficult to do, but will yield huge results much greater than could otherwise be gained.

    Back to my first point, In his talk, Dr. Fineberg spoke about a woman who said to an American author "your work is even better in French." He responded "Yes, it loses something in the original." Fineberg said that Public Health loses something in the original, in that public health people want to try to persuade people to change their habits based on statistics, epidemiology, and other things that regular folks find boring. He cited CDC's Zombie Apocalypse preparedness graphic novel as a great example of meeting people where they are; talking about what you want to get across in a language that is interesting, credible or engaging to our audiences.

    Learning how to do this is also difficult, but necessary.
     
    Ren, aimossy, merylg and 1 other person like this.
  5. aimossy

    aimossy Senior Member

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    just a thought.....sometimes I think we have been unable to prick the conscience of the medical community and wonder why and how could this be changed. changing our approach to the med community in order to prick that conscience?
    just a random thought.
    Alexs' analysis was very good I felt.:)
    anything that helps explain theory and practice connections are important in my view.
     
    Ren likes this.
  6. Ren

    Ren Primum Non Nocere

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    Potemkin Village
  7. Tom Kindlon

    Tom Kindlon Senior Member

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    Thanks Alex. :)

    I've been pleased to see all the others who have become involved. Ellen Goudsmit was one person who did quite a lot of this sort of work in the past but she has stepped back to an extent. Charles Shepherd can also write good letters but he has a lot of responsibilities so can only write occasionally. So the new blood is most welcome.
     
    Ecoclimber likes this.
  8. alex3619

    alex3619 Senior Member

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    @Tom Kindlon, your Harms paper made a real difference. :) Credit where credit is due. :thumbsup: Further we now have patients seeing that things can be done, though they may be difficult to do. So the paper was inspirational, not just of scientific value.
     
    Tom Kindlon and aimossy like this.

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