Analogy

I enjoy analogies.

I find they help me remember.

They are part of a theory I have, when writing or teaching, that, they help ideas stick.

Perhaps not, it is just a theory.

My most recent analogy related to person-centred care.

Yes, I know I should move-on, find something else to worry about, yet, it remains such a central component of everything I do and believe that it is hard to me to shift gear or change focus.

The basis of this is humanism.

To the best of my knowledge, we have not, as yet, discovered another system of belief that supports in an equivalent way outside of the supernatural.

Avoy.

Which I am told is not a Yiddish word, but one which somehow established itself in my subconscious and pops-out every so often. (To me it means ‘oy vey’ and ‘there you go’).

Back to the analogy.

I will use it tomorrow.

I am giving my annual ‘old people’ lecture to medical students in Sheffield.

It was a damp squib last year (if I did it at all, I am not sure, might have been the year before) as I did a Zoom recording.

I hate recording myself on Zoom.

There a technique or a system to employ to bring-out spontaneity in the process; suffice it to say, I haven’t found it and it leaves me feeling wooden. Woollen. Woollen and wooden.

Not a scintillating educational combination.

Tomorrow is face-to-face.

It could be that my daughter will be sitting-in as it is after he school day and the lecture is in Sheffield, so, if I pick her up she can see me in action. Which, to me, is something as none of my family have ever seen me lecture.

‘The analogy, my good fellow, tell us about the analogy!’ You ask. (I read A Room with a View last week & watched the movie last night) (lots of good fellows in Edwardian England).

So, yes, the analogy.

Well, it relates to the concept of care that we provide to patients.

There are different ways of caring.

You can care on the basis of what you think is right, good and proper for the patient (Cousin Charlotte) (Oh, I am EM Forstering this!) – this is doing to.

This is paternalism.

‘You have a cancer, we will open you up, cut it out, a few stitches and all will be well.’

Versus.

Doing with,

That is, finding-out what is important to the person/patient, establishing what they want and working-out how you can use your clinical skills to achieve a goal that is doable by you and desirable by the patient.

There is a whole movement which espouses this approach, it started in Scotland (Ah, the Scots. Sláinte.) and has spread globally – What Matters To You.

All the evidence (and there is much) suggests if you as a doctor, nurse or therapist do something to a patient that they don’t want, i.e. doing to, the outcomes are much worse than doing with the patient.

Logical but surprisingly uncommon in 21st century Western Medicine.

The analogy.

Well,

The first form I used was based upon my daughter’s request for an iPhone.

It went something like this:

My daughter asks for an orange iPhone.

I buy her a black iPhone.

It is as good as the orange iPhone.

It is black.

My daughter thanks me for the black iPhone.

It’s not the orange one.

This was meant to illustrate beyond the realms of pettiness that, if someone wants something, even if you get a thing that is quite similar, if it isn’t what the person wants, if you miss the mark by even a tiny amount, the effect is diminished; you have done to, rather than done with.

The medical equivalent might be the patient agreeing to have their bowel cancer removed.

They wake the next day and the cancer is gone.

They have a stoma.

No one mentioned a stoma.

Yes, they care cured, the cancer is gone, yet, now a stoma.

Maybe it is not right to compare cancer treatment to iPhone purchasing, apologies if I have offended.

For the lecture, after discussing the above with my daughter, I changed the narrative;

I asked for an orange iPhone for my birthday.

My family bought me a black iPhone.

It is as good as the orange iPhone.

It is black.

I thank my family for the black iPhone.

It’s not the orange one.

Subtle change of context;

Easier to use yourself in these things.

I am not sure how this will go down tomorrow.

I wasn’t sure what other cultural reference to use with the students.

I am getting older, by the minute, by the moment, and they, are eternally stuck at 20.

Weird to consider.

I am not sure how teachers do it.

Facing their mortality on a daily basis.

For me, most of my patients are old and getting older with me.

It makes me think of a spacewalk where the tether has snapped; I am drifting off and the spaceship is moving away. It is me or the ship that is moving? Both of us? All is change. You can’t put your hand in the same river twice.

I need to move-on.

Or perhaps stand still.