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Greetings,
I just signed up for the group and thought
I should take an opportunity introduce myself. I am a general internist and
an associate professor of medicine at the University of Washington. I came
across Life Itself in the process of searching for a better foundation
for a medical model than mechanistic biology seemed to
offer. In the early 90's I wrote a piece called "Biologies Einstein?"
about Life Itself and RR which he seemed to like and which I believe
he may have shared with Judith. Perspectives in Biology and Medicine
turned it down, though I've been thinking of late of revising and resubmitting
it somewhere. I published 2 pieces on Rosen's work in Advances (a journal of
Mind-Body health) in the mid-late 90's. One discussed the similarities
between the relational model of an organism and Gregory Bateson's concept
of mental processes. The other tried (not very successfully) to explain
the differences between semantic and syntactic information. I became a
clinician-administrator in our medical center 4 years ago, which has cut into
my scholarly pursuits, but am working on reclaiming more time for academic
work.
Off an on for the last 14 years I've been
thinking about ways that the ideas in Life Itself and Anticipatory Systems
could be used to solve (or at least illuminate) problems in healthcare, so I
found past posts from Judith and others regarding a Rosennean Modelling Project
of interest.
One outcome of this ruminating was the thought
of designing a clinical instrument that would illustrate anticipatory
systems in medicine. The best I've been able to come up with so far is the
idea that disagreements between patients and physicians (or between the
patient's model/representation and the physician's model/representation)
regarding what they think is going on or is going to happen to the patient could
have some characteristics of an anticipatory system. My thought is along
the lines that recognizing and acting on disagreement could influence
future events, such as decreasing the likelihood of a diagnosis being missed or
increasing the chances of patient following a treatment plan. (I recognize this
isn't a perfect description of an anticipatory system and hope that more
accurate depictions of a practical anticipatory system could be designed.) In
any case I was eventually able to design and test an "agreement instrument" with
such a purpose in mind. A paper describing these findings (which doesn't
contain any references to anticipatory systems) has just been published in the
Journal of General Internal Medicine. For those interested it is at
As a next step in this project I'm preparing a
small grant proposal to test this instrument in a primary care and and ER
setting to see if agreement predicts patients intention to adhere to treatment
recommendations, resolution of symptoms, and/or patient
satisfaction. If this works, I would envision trying to teach
clinicians to better recognize disagreements with their patients and trying to
show that better recognition of such situations could improve certain future
outcomes. Another of my goals is to translate some of the ideas from Life
Itself into a relational model of medicine, but having spend a couple years off
an on working on such a project, I'm painfully aware of the challenges of
translating RR's concepts for the uninitiated.
Thanks to T. Gwinn and to Judith for developing and
maintaining this discussion. I look forward to trading ideas with all of
you. Best wishes,
Tom
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