Re: greetings and request

David, I've attached a Word version of this paper if you have questions that aren't addressed in my comments below. Again, be aware that the study described was designed to evaluate an agreement instrument and doesn't refer to anticipatory systems directly.

As I mentioned in the prior post, I've been trying to come up with a practical application for Rosen's ideas in patient care. In Anticipatory Systems I recalled reading that the likelihood of a system failing increased with a greater discrepancy between the system's behaviors and its models of what was actually occurring or about to occur. My thought was that both a patient and a physician are formulating models (of sorts) or representations of what they think is causing problems for the patient and of what is likely to happen to the patient. My hypothesis would be that disagreements between the patient's and the physicians representation of what was wrong with the patient are a marker for either a missed diagnosis, an incorrect prognosis, communication problems, or unrealistic expectations.

If patient-physician disagreement is sometimes a marker for a missed diagnosis, an incorrect prognosis (or some other problem with the patient's care), and physicians could learn, through training or feedback, to recognize and act on these disagreements, they might be able to improve certain future patient outcomes. While I don't think this is necessarily the best possible example of an anticipatory system (in the sense of a system in which its behavior in the present is influenced in part by the system's models of the future) it seems to me to have some of the characteristics of one and a way to provide an example of how the present could be entailed by something other than recursive, mechanistic processes. (A related set of examples that I see in reviewing events in our medical center is that adverse events are not infrequently preceded by disagreements between physicians and nursing staff, families, and/or patients.Whether such disagreements occur more often before an adverse event than in other circumstances would potentially be an interesting study.) What do others think of this as an example of a sort of an intentionally designed anticipatory system? Any suggestions for a better design of an anticipatory system in the realm of patient care would be most welcome.

I'm glad to be part of a motley crew. Best wishes,

Tom

----- Original Message -----

From: David Macy

To: ***

Sent: Sunday, October 16, 2005 9:23 AM

Subject: greetings and request

Hey Tom,

Welcome to the list, where "list" means motley crew! This seems to me an eclectic crowd so you may be too approachable to fit in here.

I'm afraid that I don't have a subscription to Blackwell Synergy, so I didn't read your article. Nevertheless, I find the outline of your proposal for an "agreement instrument" intriguing. Could you perhaps repeat yourself somewhat so that those of us here who can't read you're paper at Blackwell Synergy could get a better idea of what you intend by an agreement instrument and it's use?

In any case, again, welcome to the list.

David