evidence and story

[nari]

On another bb there is a discussion underway re evidence vs story, looking at how we can present evidence in a lively, informative way to patients (and other health professionals) that holds their interest. Patients in particular can get lost with data per se, facts aren't all that mind-grabbing to most people, whereas they can avidly listen to a story/narrative.

How can we combine in our education in a mix of data and narrative so their attention is caught and their retention is more than temporary?

What language do we use - humour, metaphor, simple everyday words to describe, for instance, sensitisation or neuromatrices?
How much art can we put into science in conversation?

Just some ideas; the patients I am thinking of are those who say:
"Just get rid of the pain, luv, and fix me up"....

Nari

[bernard]

Nari,
This is the Thread you cited on RehabEdge (Thanks Barrett)

Stories versus Evidence

[bernard]

Originally Posted by Nari

Just some ideas; the patients I am thinking of are those who say:
"Just get rid of the pain, luv, and fix me up"....

They are not the easiest ones.
They get pain and are convinced that pain is an external condition that may be cured by our intervention. They were told that we are going to make something for them.

Often, too, they are very Cartesian about pain knowledge and reject the brain modulation/creation of this output. "The pains is coming from my back!"

So, i begin with a very Cartesian metaphor: A car and a driver (we are car drivers and it is a car civilization! )

I start my story like that:
"Imagine a car driven by a blind driver! Imagine that car entering a town at the insane speed of 200 km/h, conducted by this blind driver, what will happen?"

Every time, the response is: "a car crash"
Thus,
I follow my metaphor with this slight changes: "Imagine, now, that our body is a car and the driver is sitted in your brain! What will happen if you close the eyes and drive it at such speed?"

Normally, many of them understand that they are responsible (fully/partly) of their car crashes...

It seems to me a good start for an education.

[nari]

Bernard, that sounds a good story blended with evidence!


Nari

[Luke Rickards]

Does anyone else think that Butler's 'Explain Pain' is an excellent example of blending story and evidence for the masses?

Luke

[nari]

I think it is good, but rather sophisticated for what I call "a Bega farmer" (unfairly) with respect to terminology. Some of his constructs and concepts would be rather hard for some patients to understand. I know some nurses had a few problems with it...

Nari

PS For all you foreigners - Bega is a small rural town near the far south coast of Eastern Australia.

[Luke Rickards]

I sometimes forget things are a little different here in the eastern suburbs of Sydney. I do think that some parts of it are great though.

Luke

[bernard]

Originally Posted by Luke

Does anyone else think that Butler's 'Explain Pain' is an excellent example of blending story and evidence for the masses?

Yes, it is a good example. As Nari already said it, it is a bit complex to use in common practice since it's the full collection of pain problems and pain mechanisms. It is not easy to make a digest in a time of a session.
I found that it was more successful to plunge the patient in their film?! Often there are just spectators of their pain and distress. They forgot (but did they knew) how to move and to change.

My second concern is there is no French version. But why not? I'm trying to convince some French PTs at the moment.

[Diane]

I'm reading Eric J. Cassell's The Nature of Suffering (and the Goals of Medicine 2nd.Ed.), and the dilemma is entirely parallel. Plus there is a great exposition of the way medicine dances with culture, how it changes its theory of itself in response.

Very good book, very readable. Bernard, were you aware that it was in France that the disease theory evolved, the first 4 decades of the 1800s? I didn't know that in a specific way. (I know Pasteur was French.. his name hasn't come up yet though.)

[bernard]

Originally Posted by Ian

Bernard I couldn't post this in reply to diane on the somaboard

Ian -its the thread on shacklock when she talks about the cassells book


Diane --glad you like Cassells book --i think it is excellent ......
It is one of my course books and one of the tutors - a GP is doing is
doctorte on teaching this book to Dr's .........
One other book that i have just finished is David Morris --illness and
culture in the postmodern age . This makes you think and most of my book is
underlined .
Interestingly, Morris argues that pain is an archetypal postmodern epidemic.
Morris looks at a biocultural model as a way of explaining the many issues
we struggle with.
I think we struggle as we don't look at ways in which society has shifted
and the ways we complain and suffer are very different to our not too
distant past ........The way these books are written makes you really
question the labels .
i am increasingly convinced that the more complex issues we deal with are
better handled by acknowledging the role that other areas may contribute to
our understanding of people(thats why the humanities interest me!) ......For
me stories are important although no weight is given to the subjectivity of
the individual life .....It is as if science and the biomedical model wishes
to group people together to find truths independent of the obvious fact that
each persons illness behaviour (which is what we 'treat') is unique to them
.......
For me Cassels book asks the tricky obvous questions of how or why we do
what we do .....there's a great story in the book if you have come to it
about a man who has pneumonia but it is any one of a number of facts hidden
that may contribute to this mans suffering (bereavement/social isoloation /
lack of food due to inability to get out due to a debiliating painful oa
knee etc ......Patten recognition was made by a professor of art who could
'see' the disease on the slide as he is used to seeing order and symmetry
....etc etc ..so many ways of seeing and understanding and i am afraid that
ion channels are not the only answer or for that matter represenational
neuroscience!

Hmmm Ian, just ask or eamil me if problems persist.

[Diane]

Hi Ian,
Yes, I love both of Morris' books, read them a few years ago.

About labels, and medicine, have you checked out Lynn Payer's book called (I think) Medicine and Culture? She describes the completely different treatment cultures in France, Germany, Britain and the US.. countries where you would expect a bit more consistancy given that they are European based, have scientific tradition, nd have learned from one another for centuries. One's disease can even change names as you cross a border. In particular, how "female" conditions are treated,e.g., breast tumors, vary widely from one country to another. You'd think there's be some sort of universal human scientific standard, but no, instead treatment is largely dependent on cultural mores. Doctors are as much a part of their culture (subjective) as anyone else.

It's an older book, ('97 I think); it would be interesting to see if the subject matter still holds true today. Given the glacial pace of change in most clinical treatment, and how culturally based it is, probably it still would. (Not that actual glaciers aren't speeding up these days..)

[nari]

On the glacial metaphor - almost every glacier (except one, in Argentina) is receding rapidly and the result is more water released - perhaps that will indicate a more rapid change in cultural outlook.

Discrepancies in diagnoses and management are world-wide, for sure.

Ian, if I can butt in here...one of the legendary follies of medicine is 'fitting' people into identifiable groups so a recipe can be followed. Which is why chronic pain persons fall by the wayside..they don't fit. Physiotherapy isn't much different, but things are changing; albeit slowly. Professions 'hoard' techniques like bower birds, it looks good to have a 'toolbox' full of options.

Nari

[Diane]

I think I recall Barrett saying something a long time ago that tools are far less important than a deep understanding of the materials and its properties that one is working with. It blended over into another metaphor about using fewer leeches.

[nari]

He did mention the leeches - though he did not specify the variety of leeches.

There was a thread on toolboxes once, with disparity between those who wanted the phrase as common usage and those who did not agree.
It does sound technical in nature, rather like a car mechanic. The toolbox I used was forever getting upended all over the floor, rearranged and rusty stuff discarded forever. A couple of PTs referred to me as a minimalist supremo - and they were not being complimentary. Not useful for students, I guess.

Nari

[Diane]

"Not useful for students, I guess"
I think it would depend greatly on the student, if they wanted to learn minimalism or wanted to learn thick volumes/manuals of applications.

[bernard]

Originally Posted by Nari

Bernard, that sounds a good story blended with evidence!

Well but I introduce some more tips about pain/flags...

"You're searching a street in a foreign town! Your attention is normally focused by this quest but suddendly the car stops! You didn't see the sidewalk on the right of the road, too bad!"

It means that often pain doesn't come suddendly but we weren't aware of the circumstances of its happening. It explains, too, why sometimes we have pain and some minutes later, we don't.
It explains also that the driver is one more time responsible of the car crash.