Local Knowledge
The summer my oldest son was two, one day he was being difficult and not finishing his lunch. I stood over him and insisted he eat because I had errands to run.
He was a skinny little thing and prone to being sickly, so I worried that Child Protective Services would be called on me if I didn't make sure he ate enough. And, really, a parent telling their kid things like "You will eat what is on your plate" or "You will clear your plate" is not at all unusual.
Thirty minutes later, while out running those errands, my child stood with one foot in his baby seat and one foot on the truck seat throwing up on me and into my jacket that was still laying on the seat. I actively encouraged him to keep vomiting on the jacket so it wouldn't get elsewhere in the truck.
This incident was the birth of me having a strict policy of not forcing him to eat. Thereafter, I set a high bar on doing all I could to make sure it was possible for him to choose to eat well by keeping healthy foods he liked readily available, but I left it up to him to decide what he ate, when and how much.
This was a really excellent policy. It's the reason he has a healthy relationship to food in spite of having TWO incurable conditions, either one of which can land a child in a residential therapy program to teach them to eat.
This is a policy that honors local knowledge over supposed expertise. It is a policy rooted in the idea that "Well, maybe my child doesn't feel well and is just too young to be able to effectively articulate why he doesn't wish to eat."
It is a policy based on the idea that even at the age of two, my child has a wealth of knowledge informing his decisions and overriding that process without a really compelling reason is a bad idea. No, me being an adult and thus "smarter" and more experienced than him is not a really compelling reason, even though it's very common for adults to think they know what is "best" for their children in a way that dismisses the child's own knowledge of their own life.
The world has a lot of expertise it lacked not that long ago and there is a general trend that expertise or similar has come to be valued above local knowledge and local conditions in a way that causes problems.
In medicine, it wasn't that many years ago that a doctor was typically one of the smartest, wisest and best educated people in town and also had a lot of local knowledge about the people around him such that simply listening to your doctor was a fairly reliable means to get a better answer than you could provide.
This is no longer the case. There are a great many more educated people these days and life has changed such that doctors are much less likely to know all that much about the lives of their patients.
We underestimate the value of that lost knowledge where a doctor took his little black bag, went to your house and saw with his own eyes some of the potential sources of health problems in your life. Because he went there in person and saw how you lived to some extent with his own two eyes, he didn't need you to mention X while he was taking your medical history to realize that X was likely the real source of your health issue and solving that would be pertinent to getting you well.
Part of the value of this paradigm was that he didn't need to do a lot of explaining of his logic. He could politely gloss over a lot of things that would be a social faux pas to talk about and just write up medical instructions that solved the problem seemingly incidentally without necessarily saying anything about what he believed the real issue to be.
Unfortunately, this means that the value of this aspect of medical practice was largely undocumented. It's loss has gone largely unrecognized as a significant contributor to current issues in health care.
The Star Trek tricorder strikes me as a concept that "We will keep our little black bag and house calls and other current social factors that make current medical paradigms work well but technology will enhance our ability to diagnose." The reality is that in place of a tricorder, we now have people go to the hospital because MRIs and other diagnostic tools require special equipment that takes up one or more rooms all by itself.
Our diagsnostic technology has yet to achieve tricorder status. It falls far short of pointing a device at someone and magically knowing exactly what is wrong with them.
Worse, the development of diagnostic tech has been actively hostile to the practices that previously and largely invisibly helped make doctors "wise men" who reliably gave good advice.
Doctors have become technicians and for many conditions, their patients may know more than they do about the specific condition in question. You increasingly hear horror stories concerning how hard it is for patients to get their pain taken seriously, to get the right referral so they can get a useful diagnosis, etc.
Getting diagnosed with atypical cystic fibrosis was wonderfully life enhancing for me but since my diagnosis, I gradually moved away from getting medical treatment for it. This was not something I really wanted.
People online act like I am some radical defying doctors. The reality is that as I began to get better, my CF specialist began scheduling me fewer appointments and told me "Well, you don't really need me. I have patients that need me."
No, he was not curious as to how I was getting better when that's not supposed to be possible. He just didn't want to waste his valuable time on a patient that "didn't really need him" in his estimation.
I know that what I do works. I am less confident that I know how to effectively share that knowledge with others so they can replicate my success. That's trickier than I imagined it would be.
But I keep trying because I'm not seeing other solutions really emerge such that I feel what I know is not relevant.
It's relevant. I just face challenges in figuring out how to not only put the information into a useful format but getting it adopted.
Modern medicine is broken because it treats patients like specimens in a petri dish and that's not what it used to do. It's broken because expertise and diagnostic tools have displaced local knowledge, local culture and wisdom and historic best practices.
My approach seeks to interject modern expertise into a system of local knowledge, local culture, etc instead of ignoring those local conditions on the ground. It seeks to do so in a way that raises the bar on health and quality of life, something modern medicine is failing at for far too many people as we medicalize everything in a manner that is openly hostile to the lives of far too many people.
People like me are just supposed to accept being subjected to large quantities of drugs and surgeries while still dying young. No one has any real sympathy for the fact that this produces a very poor quality of life.
I have chosen quality of life over a metric of "just not dying" as the only thing that matters. It is gradually making me healthier and steadily extending my life while making it a life worth living, something mountains of drugs and surgeries cannot offer me.
As is often the case, I feel this post is wholly inadequate for expressing what I wish to express. And, yet, you have to start somewhere. So here it is.
He was a skinny little thing and prone to being sickly, so I worried that Child Protective Services would be called on me if I didn't make sure he ate enough. And, really, a parent telling their kid things like "You will eat what is on your plate" or "You will clear your plate" is not at all unusual.
Thirty minutes later, while out running those errands, my child stood with one foot in his baby seat and one foot on the truck seat throwing up on me and into my jacket that was still laying on the seat. I actively encouraged him to keep vomiting on the jacket so it wouldn't get elsewhere in the truck.
This incident was the birth of me having a strict policy of not forcing him to eat. Thereafter, I set a high bar on doing all I could to make sure it was possible for him to choose to eat well by keeping healthy foods he liked readily available, but I left it up to him to decide what he ate, when and how much.
This was a really excellent policy. It's the reason he has a healthy relationship to food in spite of having TWO incurable conditions, either one of which can land a child in a residential therapy program to teach them to eat.
This is a policy that honors local knowledge over supposed expertise. It is a policy rooted in the idea that "Well, maybe my child doesn't feel well and is just too young to be able to effectively articulate why he doesn't wish to eat."
It is a policy based on the idea that even at the age of two, my child has a wealth of knowledge informing his decisions and overriding that process without a really compelling reason is a bad idea. No, me being an adult and thus "smarter" and more experienced than him is not a really compelling reason, even though it's very common for adults to think they know what is "best" for their children in a way that dismisses the child's own knowledge of their own life.
The world has a lot of expertise it lacked not that long ago and there is a general trend that expertise or similar has come to be valued above local knowledge and local conditions in a way that causes problems.
In medicine, it wasn't that many years ago that a doctor was typically one of the smartest, wisest and best educated people in town and also had a lot of local knowledge about the people around him such that simply listening to your doctor was a fairly reliable means to get a better answer than you could provide.
This is no longer the case. There are a great many more educated people these days and life has changed such that doctors are much less likely to know all that much about the lives of their patients.
We underestimate the value of that lost knowledge where a doctor took his little black bag, went to your house and saw with his own eyes some of the potential sources of health problems in your life. Because he went there in person and saw how you lived to some extent with his own two eyes, he didn't need you to mention X while he was taking your medical history to realize that X was likely the real source of your health issue and solving that would be pertinent to getting you well.
Part of the value of this paradigm was that he didn't need to do a lot of explaining of his logic. He could politely gloss over a lot of things that would be a social faux pas to talk about and just write up medical instructions that solved the problem seemingly incidentally without necessarily saying anything about what he believed the real issue to be.
Unfortunately, this means that the value of this aspect of medical practice was largely undocumented. It's loss has gone largely unrecognized as a significant contributor to current issues in health care.
The Star Trek tricorder strikes me as a concept that "We will keep our little black bag and house calls and other current social factors that make current medical paradigms work well but technology will enhance our ability to diagnose." The reality is that in place of a tricorder, we now have people go to the hospital because MRIs and other diagnostic tools require special equipment that takes up one or more rooms all by itself.
Our diagsnostic technology has yet to achieve tricorder status. It falls far short of pointing a device at someone and magically knowing exactly what is wrong with them.
Worse, the development of diagnostic tech has been actively hostile to the practices that previously and largely invisibly helped make doctors "wise men" who reliably gave good advice.
Doctors have become technicians and for many conditions, their patients may know more than they do about the specific condition in question. You increasingly hear horror stories concerning how hard it is for patients to get their pain taken seriously, to get the right referral so they can get a useful diagnosis, etc.
Getting diagnosed with atypical cystic fibrosis was wonderfully life enhancing for me but since my diagnosis, I gradually moved away from getting medical treatment for it. This was not something I really wanted.
People online act like I am some radical defying doctors. The reality is that as I began to get better, my CF specialist began scheduling me fewer appointments and told me "Well, you don't really need me. I have patients that need me."
No, he was not curious as to how I was getting better when that's not supposed to be possible. He just didn't want to waste his valuable time on a patient that "didn't really need him" in his estimation.
I know that what I do works. I am less confident that I know how to effectively share that knowledge with others so they can replicate my success. That's trickier than I imagined it would be.
But I keep trying because I'm not seeing other solutions really emerge such that I feel what I know is not relevant.
It's relevant. I just face challenges in figuring out how to not only put the information into a useful format but getting it adopted.
Modern medicine is broken because it treats patients like specimens in a petri dish and that's not what it used to do. It's broken because expertise and diagnostic tools have displaced local knowledge, local culture and wisdom and historic best practices.
My approach seeks to interject modern expertise into a system of local knowledge, local culture, etc instead of ignoring those local conditions on the ground. It seeks to do so in a way that raises the bar on health and quality of life, something modern medicine is failing at for far too many people as we medicalize everything in a manner that is openly hostile to the lives of far too many people.
People like me are just supposed to accept being subjected to large quantities of drugs and surgeries while still dying young. No one has any real sympathy for the fact that this produces a very poor quality of life.
I have chosen quality of life over a metric of "just not dying" as the only thing that matters. It is gradually making me healthier and steadily extending my life while making it a life worth living, something mountains of drugs and surgeries cannot offer me.
As is often the case, I feel this post is wholly inadequate for expressing what I wish to express. And, yet, you have to start somewhere. So here it is.
