For the Love of our Health @drphilhammond @JARWillis @microphilosophy

In my last post – about the BHA 2015 Conference – I noted that listening to Dr Phil Hammond had put me in mind of Dr James Willis.

Although the former is now more famous than the latter – stand-up entertainer, TV-panelist, etc – they represent two generations of medical doctors warning against the damage being done by successive top-down re-organisations of the National Health Service. Dr Phil’s latest book “Staying Alive – is about exactly that and how personal love and individual evidence-based care can save us, and it. Dr James’ wrote two successful books in the same vein, Friends in Low Places and The Paradox of Progress, both still recommended because clearly the situation hasn’t really changed.

One of James’ targets is the “evidence-based” concept itself – something of a mantra for a certain kind of top-down managerialism, but it’s the classic evidence as bean-counting in situations where not everything that counts can be counted. Their common message is that a large part of the value of health care experienced empirically and personally is down to qualities like love and compassion and …. personal care of the individuals involved – the art of caring. Hard to account for objectively in top-down management target-setting and the like, but clearly most meaningful at the inter-personal work-face encounters – the “low places” of James’ work. As Dick Taverne notes evidence must not be ignored, it must always be taken into account when making decisions, but it is totally wrong to assume such evidence is always of the objectively scientific kind, or to ignore the kind that isn’t. What counts as evidence in ethical and political decision-making?

Anyway, that’s a recurring theme in this blog too, so it was interesting to re-connect with Dr James Willis. As well as his original “Friends in Low Places” web-pages as a vehicle for his books and numerous other articles and references – his The Monster and the Whirlpool (Scylla and Charybdis) keynote to the Royal College of GP’s is a personal favourite – he is now active on both Twitter ( @JARWillis ) and his own “Generally Speaking” blog. But I had forgotten what first created the contact between us.

I note here that Robert Pirsig has been a source of inspiration for me to investigate philosophical grounding of the kind of knowledge that really should count as evidence, the very point of my Psybertron blog. It was of course James’ own reading of Zen and the Art of Motorcycle Maintenance (ZMM) that first brought him to my attention. Both being people with scientific underpinnings to our professional lives, medicine in James’ case, technology and engineering in mine, we both shrank back at the Zen, hippy lifestyle aspect of Pirsig – too “woo” in the modern rationalist vernacular – and were reluctant late readers of Pirsig. However as James puts it:

“Pirsig convinces, utterly, that in motorcycle maintenance, of all superbly-chosen examples, the art is more fundamental than the science. It’s having the right attitudes that matters. So, we must ask ourselves, how much more must this apply to medicine! How could we ever have been so blind as to think otherwise!”

Perhaps in my case it was perhaps less a case of being blind, as not having any language to get a grip on the issue of art being more fundamental than science, but the effect has been the same. Coincidentally talking with Julian Baggini the evening before hearing Dr Phil Hammond, Pirsig may still fail to “utterly convince” philosophers that he has the metaphysical solution, but it’s clear he has provided many of us with a useful insight.

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