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  • Writer's pictureKit Wisdom

Explorative, complex, relational experiences: how are they valued in healthcare?

Updated: Aug 30, 2020

By valuing the easier-to-measure over the potentially immeasurable, are we missing the shared human narratives that are essential for the now and for our future?


A decade ago, whilst working as a physiotherapist, I burnt out.

Six years into a lifetime career of caring for people and their painful physical problems and all I felt was the weight of their worlds on my shoulders. I felt desperate to help them yet alone in how, because my physiotherapy degree had not imparted skills for coping with the totality of the human condition. (Looking back, perhaps neither had my #lifedegree)


Throughout my undergraduate degree and subsequent professional development, we were always taught how to 'fix' people, not truly understand them. We were continually taught how to examine and treat people like machines, not embrace them for being complicated, broken, fallible humans. We were distinctly taught to look for problems and find certainty in solutions, not hold space for complexity, and expect uncertainty.

I was dumbfounded no one was talking about how incongruent these worlds were. What we were taught in our physiotherapy bubble was not matching up with what the world was really about. I couldn't 'fix' people like I was taught. In my confusion, I just assumed that I was wrong. I must have missed something. I must not be good enough. I must have been the reason things weren't working. Everyone else seemed to be managing - and managing really well.


In order to cope with my feelings of confusion and inadequacy, I tried to hold it all. I held the stories that I heard; I held the fear that was unexplored; I held the pain that couldn't be explained; I held the feelings that had no box in which to categorize them; I held the labeling of patients as 'faulty' whilst craving to give permission for wholeness.


I held it all and hid it all, thinking it wasn't important to the physiotherapy world - nor valued. I believed it made me weak and vulnerable, even less of a practitioner. I convinced myself to focus on the evidence, the anatomy, the exercises, the special tests, the linear pathways of management, and push the stories down, away from the surface, somewhere less visible - and in doing this, it slowly burnt a hole in my heart.

 

Humbled and inspired. In awe.


These words continue to illuminate what I witness whilst working with people who bravely step into a curious exploration of themselves; their story of self. Often, these adventures transpire when they really just want an answer. They need an answer. Any answer. Advice, recommendations, exercises - anything that might stop their current experience with pain, with suffering, with the weight of not knowing. Anything that might take this problem off of them, away from them, that might help alleviate the heaviness of it all. Anything, rather than having to generate courage and energy to explore the uncertain, complex, real stuff. The hard stuff. The stuff that is so much easier avoided.


Ever since I nervously stepped more wholly into a different way of relating to the humans I work with, I have learned more than ever before. I have learned more deeply, more humanly, more heart-breakingly. I have learned through listening to each person's story that my job has nothing to do with fixing, and all to do with witnessing; I have learned through humble inquiry, that the way each person uses certain words, about how they feel in certain moments, about how they relate - to people, to ideas, to their pain - keeps me out of knowing and holds me in curiosity. I have learned through openly interconnecting their mind, body, and heart within my questions - that how these all relate, shapes how they see their world, make sense of it, and choose choices.


I continue to learn, that despite being in the field of behaviour change, I cannot actually change anyone's beliefs nor behaviours - not even with some sneaky 'motivational interviewing' techniques - because that, to me, is still leading the patient somewhere I think they need to go. It assumes that I still hold their answers, that I 'know' for them.

We do not have their answers. We do not know for them.


Don't get me wrong, all my physical-body-knowledge and staying up to date with the monstrosity that is the scientific evidence-based world, keeps me accountable and honest and weighs heavily into the information presented as part of patient care, yet it is a lens that does not include how we relate.

That is, how we know each other, how we understand each other's needs; what really matters to us, what scares the shit out of us, how we really feel about the things out of our control, who is central in our lives, what systems oppress us, how our past continues to haunt us, how our values and culture shape us, which moments expand our hearts infinitely, what we grieve and cannot bear to go without.

Relational experiences are hard - they can be raw, uncomfortable, even nauseating - they can make our palms sweat, our throats constrict, our hearts hammer so fast despite sitting so still. They can feel hot - too hot, sticky, and prickly all at once.


They take courage.

They take us out of our healthcare knowing, they take us off our pedestals, out of our professionally-shaped expert egos - they bring us crashing down to earth as a fellow human, a comrade. This in itself can feel hugely conflicting - it's like we itch to fix, to stay separate, to stay 'in control' of the situation - but we need to ask ourselves, are we really?

Relational experiences are explorative and complex. They do not necessarily have a definite start point nor endpoint; there is no one 'solution'. That, in itself, is the essence of relating. These experiences cannot be squished into subjective boxes; they need to be shared through a narrative that creates space for an authentic tempo; they need to walk to their own beat. They feature humble inquiry and deep listening. A place where curiosity allows us to see the strength, the spirit, the beauty in each other's stories. They need space to emerge. They require us to let go of pathology, of certainty, of expectations, of how we view time and success.


Nora Bateson, of The International Bateson Institute, calls this interrelational information Warm Data. Warm Data is the messy stuff, the muli-contextual, non-measurable relational information - it is the movement within a complex living system. It is the information that is alive. Warm Data is not about the practitioner or the patient or the evidence-based information presiding over the 'problem' - it is the relationship, the movement, the connections, the conversations between them. Warm Data is the kind of information that fosters our belief that a deeply human response to complexity is conceivable.

To me, in the healthcare world, Warm Data has the potential to become (if you allow it) an agent of change for practitioners traversing between the 'old' and 'new' healthcare paradigms. It is the glue to fostering meaningful, quality, collaborative care - whilst vulnerably stepping into the uncertainty of "I don't know". Isn't this what we are hoping to evolve amongst a healthcare landscape that is increasingly failing both its patients and practitioners?


And yet, we do not seem to place much value on Warm Data.


It exists as a distant-second-cousin (what was their name again?) to cold data. Cold data exists everywhere throughout our frame of choice, the biopsychosocial model. Within it, we are taught to critically think our way through the evidence for load management, pain-science, biomechanical requirements, optimal exercise programs, nervous system responses, psychologically-informed practices. The list goes on. All the things we need to 'know', to have a grip on, to be able to put into practice to help 'solve' our patient's problems. We use systematic controlled trials to measure, validate, fail, learn. And yet, despite all this constantly evolving, hugely important, and hard-worked-for evidence, it doesn't seem to be impacting our worldwide prevalence of persistent pain, loneliness, disconnection, and, mental health issues.


It makes me wonder, is our emphasis on the 'measurable' cold data taking too much of our attention, creating too much of our worry, draining too much of our energy, fostering too much of a power dynamic; and in doing so, taking our humanness away from how we could relate to the people in our care?

Nora Bateson recently wrote about Warm Data and its capacity for emotional, intellectual, and cultural healing. She suggests, "the things we are looking for look nothing like the things we think we are looking for. The next system walks and talks very differently than the last system. In the next system, it is all about the relationships. At every moment, in every instance, the relationships matter. Relationships build relationships. People need people."


It makes me wonder how we really feel about where these experiences fit within our clinical life?

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