This the final instalment of a series that began with Being Black, and went through I Can’t Breathe, I Can’t Breathe II, I Can’t Breathe III, To the Last Breath, and Algorithms are from Mars. There was a delay as the series has spun off a lot of other ideas that will hopefully bear fruit in time. In mid-series, George Floyd got justice but this is clearly just a beginning. The tens of thousands yearly killed by medicines given by their doctors need recognition and justice also – people like Stephen O’Neill, and Sam Morgan.
Algorithms and procedures risk being authoritarian rather than democratic. They call on us to follow rules. When these work as in cars or computers they can be good for each of us, even conveying a degree of freedom, but the extension of this If X then Y thinking into every nook and cranny of our lives leaves us in systems that inevitably end up managed by someone other than us – managed essentially by bureaucrats.
At one point, Rulers stood in contrast to democracies. The democracies that replaced them became representative democracies rather than the androcracies for which Athens was famous. Thanks to science, these representative democracies have now been captured by technocrats and related special interests. We are told we have no option but to do as we are told because our leaders are following the science when in fact science opens up doubts rather than provides rules we should blindly follow.
Ultimately robots and 3-D printers and A.I. could take care of everything that is If X then Y-able leaving us free to explore the universe, be artistic, pursue scientific questions that will overturn the answers we are told to follow today, focus on things that are not programmable or perhaps engage in the question of ruling ourselves through something more like citizens’ assemblies where each of us has a vote.
Medicine stands as one domain where a great deal, all the important things, are not If X then Y-able or should not be handled as though they were. At its heart lies an element of magic – bringing good out of the use of a poison or a mutilation. Mention the word poison now and liberals – progressives hiss. They buy into a sacramental vision of the drugs we use. Sacraments are something that can only do good and cannot harm (although the Catholic Church had a recent oops moment and removed gluten from the Eucharist).
The idea of bringing good out of the use of a poison or mutilation does not compute for health insurers or managers of health services.
A consumer ‘right’ to access poisons doesn’t compute either.
The magic is not about correcting some blood levels of something – it lies in bringing a person out of the mix, enabling someone to live the life they want to live.
This cannot be done without a relationship. No one can help someone live the life they want to live if they don’t engage with that person and find out what it is they want. They may not be bothered about living an extra few months compared with having enough mental clarity to ensure a child, or grandchild, or friend gets the input now that only they can give.
Relationships stand beyond procedure. They offer a matrix in which the rules can be made to work for a person rather than having the person bent to fit the rules. They create trust without which no procedure can ultimately work – a trust that for millennia has been known to give a brother supported by a brother the strength of a walled city.
Is it economic to spend time getting to know people? It is. It’s the difference between having a doctor handle 100 what are often called heartsink patients or having 100 free research assistants. People with problems or conditions or a problem from some drug have skin in the game and this gives them a motivation worth at least as much as expertise.
Anne Marie who discovered the role of SSRIs in causing alcoholism is a great example of this as are the many people with enduring sexual dysfunctions like PSSD, PFS, PRSD or PGAD who have done so much testing of treatment options and so much pushing against doors to get these conditions recognitions and who should get recognition by whoever wins a Nobel Prize for work in this area when an answer comes as it surely will.
At some point in the not too distant future it looks like robots will let us produce pretty well all If X then Y-able goods for free. There will at least be no labour costs. Money will lose a lot of its relevance.
The focus will turn to the production of the most valuable asset we have – other persons. While we can be nudged and surveilled and often controlled far more than we might like to think, ultimately each of us retains a spark of something that is not If X then Y-able. Whether you call it the divine or just the human, it is a spark of something that is not one dimensional.
If there is to be money, and perhaps even power, in this new world, it makes the most sense that it should lie with those who produce people. Whether literally those who labor to produce people. Or those who work on transforming infants into people initially at home but later in schools and then ensuring the survival of the person when faced by illness – this doesn’t mean ensuring they live as long as possible it means ensuring they have a chance to bring something out of the situation they are in and that they remain seen and heard as persons in the midst of it.
This applies in spades to the elderly. These are the people with the most experience and often wisdom who should be enabled to live as full a life as possible and contribute as much as possible rather than be warehoused. When they complain about being tired, this should not be put down to old age, if they have for instance recently been put on some medicine for osteoporosis or hypertension.
Perhaps not exclusively, but largely, in this new world women would hold the power and the money. As things stand, the whistleblowers to everything from corporate misdeeds to drug wrecks are more likely to be women. When it comes to drug wrecks, it’s not women standing up for their own rights but women as the daughters of parents, mothers of children, and occasionally the partners of men or possibly more often other women.
Too used to being overlooked, they often don’t stand up for themselves. But, perhaps because they are more used to being gaslighted than men, and having to distinguish gaslighting from the genuine thing, they aren’t as easy to palm off when others in their care are affected.
One hundred and fifty years ago, in Venus in Furs, Leopold von Sacher Masoch made the case that for relations between the sexes to be on a sound footing there needed to be equality of education, income and power. Power has been the most elusive element in the mix. But in algorithmythising so much and putting so much weight on algorithms, men may have painted themselves into a corner. The most worthwhile thing to do – making people – will become almost the only thing to do and they are way behind when it comes to being able to do this.
Making people requires affection or perhaps love or care. The correct word should connote something tough and muscular. It involves standing up with someone else for what looks like its happening when Dalek-like the algorithms are saying Does Not Compute, Does Not Compute.
There is more in heaven and earth, more in the world of people, than was ever dreamt of by your algorithms Horatio.
This is not just a matter of Mercy. In the final analysis this applies to Justice also which relies on collective judgement calls by groups of women and men who are given a chance to weigh the testimony of others in front of them.
I shop therefore I am needs to become Decernimus ergo Summus – it is in making judgement calls together that we are.
This is the message of Shipwreck of the Singular.
Copyright © Data Based Medicine Americas Ltd.
There was a wonderful comment from Mary Hennessey on the current RxISK post – https://rxisk.org/farewell-marchino/ – which conjured up the idea of doctor-splaining – something that women perhaps have better antennae for than men but haven’t been putting into practice in their own case – for their children and parents yes but not for themselves
Snippett from my comment on previous post written by the Ivy Surgery in Derby
EXTENSIVE SUPPORT AND HELP FOR MENTAL HEALTH ISSUES BEING LARGELY IGNORED
Mental health has always made up a good proportion of the daily workload of a GP. Sometimes this work can be one of the most rewarding to sort out, but also the most challenging. However during the pandemic, as mentioned in our previous updates, we have seen huge numbers of people whose mental health has been affected during these very difficult times that we are all experiencing at the moment.
On some days, mental health cases and also cases where mental health is a contributory factor, are taking up to 10-15% or more of the total cases. We are also dealing with cases of significant self-harm, where assessment can take anything from 30 minutes up to an hour for that single patient and where subsequent referrals to secondary care or crisis teams can take a good part of the day to arrange.
Whilst dealing with serious cases like this is part of bread and butter general practice and we must stress that we do not have a problem at all with helping people when they are at their most vulnerable, we are also finding that many people, especially those with milder illness, are also actively avoiding contact with many of the other services that are available to help them during this crisis.
Even some who are just needing a bit of advice or reassurance from a mental health professional are actively ignoring the links we have provided to those mental health professionals and choosing to contact us first, again only for us to tell them to get in touch with the correct services directly. This can lead to frustration for both patients and staff alike, and delay access to services.
There have also been services newly set up in the pandemic to support patients’ mental health and wellbeing but which are being ignored by patients, whose preference it is to contact the GP first before doing anything else.
As a practice, we have tried to help our patients by collecting all available mental health resources so that they can be easily accessed by anyone, from children, right through to old age. Many of these services are an appropriate first port of call for patients in this situation and we actively encourage you to explore them in order that you may start to get the help that you need.
Always bear in mind, and this is true not just for mental health services but for most other NHS services in general, if you contact or present yourself to the wrong service, or you have presented yourself to the right service, but subsequent assessment shows that your case needs escalating, you will always be directed to the right service. So for instance, please don’t worry if you have self-referred to counselling, thinking your case might not be appropriate – the service will assess and advise you and can indeed refer you on if needed.
MEDICAL ADVICE BEING IGNORED
Again choosing a solicitor as an example, would you ring your solicitor asking for advice on a complex legal matter, and once they had given that advice, then proceed to berate them saying you completely disagreed with it or just completely ignore it? Or, indeed would you approach any other highly qualified professional, asking them for their opinion on something well within their specialist field and then promptly disagree with them?
Outside of the crucial principle of consent, and just as a side note, it would be interesting to know why medicine seems to be treated differently by everyone, because on the one hand, it is so important that a specialist with their specialist knowledge must be involved, but on the other hand, the opinion of the patient is as equal to or exceeds the importance of that specialist knowledge.
We have many instances where patients have readily contacted us for our specialist professional advice on a health matter, but who will then promptly choose to dismiss or ignore the advice because they are unhappy with the answer or with what we have said.
We always try to involve our patients in any decisions regarding their care, however there are some interactions where there must be a definitive response or outcome, such as you do need 999 if you can’t move your arm and have slurred speech from the stroke you have just developed, and you do not refuse to go in because you don’t want to trouble anyone else and you personally don’t think that the crushing chest pain you have could possibly be a heart attack.
Undue delay resulting from ignoring or dismissing medical advice can give rise to increased risk of complications and harm to patients.
We always make our decisions on the basis of clinical need and urgency and based on what you have told us, either on the telephone, or within an eConsult and not because we want to be awkward, obstructive or dismissive. Remember it is always in our interests to deal with your problem as effectively as possible so that you can get healthy and well and don’t need to keep coming back to us!
All these years waiting for ‘H’ ..
Snoopy in Furs
‘Instead of a Fairy Tale, we need an anti-Fairy Tale, a Wizard of Oz story, where an average girl persuades average people that they have a heart and a backbone and a brain and that the guy behind the screen manipulating everything is himself a prisoner in need of rescuing.’
louis appleby @ProfLAppleby
Superb & beautifully subversive. Went beyond police drama to make wider point about truth, integrity, loyalty & accountability. Corruption disguised as incompetence. #LineofDutyFinale
Got it in one …
“I didn’t float up the Lagan in a bubble” – Ted Hastings…
‘Mother of God!’ ..
I am a Nomad…
louis appleby @ProfLAppleby
is as good as they say. Real lives merged with fiction, decent people in hard times, cramped worlds & stunning landscapes. An outstanding film about loss, about grief.
Nomadland -..available at Disney + Star …
Giving ‘Rotten Tomatoes’ film reviewer a run…
“Mother of God” – Ted Hastings…