Tuesday, April 24, 2012

Treatment continuum I

Rather than write write write to describe how I view the treatment spectrum, I have made a bunch of pictures illustrating how I have come to view the archeology of it over time.

1. We start with a simple diagram of a human organism:
Every human organism starts out as a single cell, which becomes a two-layered blob, ectoderm on top and endoderm on the bottom. Ectoderm builds the nervous system.

Ectoderm gives off some cells which leak down under it, between the two layers, called mesoderm.

2. Mesoderm builds the structural parts of the body.

3. When we put them together we get this:

The peripheral nervous system is where the two overlap.
So, very simple, very schematically, this is what we treat.
The patient is alive, conscious, his or her brain straining to understand what it must do to cooperate.
We provide said brain with some good pain education, before we "do" anything else.

4. Here is a simple diagram to represent all interventions anyone makes for anyone. It's expandable.

5. When laid over top of the human organism we end up with something like this:

The larger circle in front represents that which can be scientifically studied, and evidence obtained.

"Operator model interventions", on the left, target the "body". These are generally "practitioner knows best" types of interventions. The patient may be informed but the treatment plan is well-worn and not particularly subject to debate.

On the right, we see "Interactor model interventions" which include the patient him or herself,  the patient's conscious awareness, seek to obtain permission and cooperation, active participation. The patient is taught that they retain full locus of control, and how to use it. They are encouraged to provide feedback and think of possible alterations to the plan themselves. Together the practitioner and the patient map out a path together, over time.

For more about these two ways of thinking about treating patients, see this google document on the topic. 
The line of demarcation between the two isn't usually as clear as it appears in the picture.

More to come.

Operator/Interactor models (google doc)

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