In this paper we argue that knowledge in health care is a multidimensional dynamic construct, in contrast to the prevailing idea of knowledge being an objective state. Polanyi demonstrated that knowledge is personal, that knowledge is discovered, and that knowledge has explicit and tacit dimensions. Complex adaptive systems science views knowledge simultaneously as a thing and a flow, constructed as well as in constant flux. The Cynefin framework is one model to help our understanding of knowledge as a personal construct (...) achieved through sense making. Specific knowledge aspects temporarily reside in either one of four domains – the known, knowable, complex or chaotic, but new knowledge can only be created by challenging the known by moving it in and looping it through the other domains. Medical knowledge is simultaneously explicit and implicit with certain aspects already well known and easily transferable, and others that are not yet fully known and must still be learned. At the same time certain knowledge aspects are predominantly concerned with content, whereas others deal with context. Though in clinical care we may operate predominately in one knowledge domain, we also will operate some of the time in the others. Medical knowledge is inherently uncertain, and we require a context-driven flexible approach to knowledge discovery and application, in clinical practice as well as in health service planning. (shrink)

"Every man has his particular way of being in good health" - Emanuel Kant. Emanuel Kant's description of health stands in stark contrast to accepted definitions of health. For example, the WHO defines ‘health’ as ‘a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity’. However, as people get on with day-to-day living, no one can achieve the goal of ‘complete physical, mental and social well-being’. It is odd to define ‘health’ as (...) a negative state that puts it beyond the reach of everyone. This paper explores the idea of health being a personal state, health being the product of every man's particular way of making sense of his particular circumstances. (shrink)

We are never illness or disease, but, rather, always their sum in the world of day-to-day experience. Disease and illness are not closed systems, but mutually constitutive and continuously interacting worlds. In the patient’s case it is always experience as well. Pain, sickness and death help make that particular experienced identity unavoidable, and at some level ultimately inaccessible to medicine’s changing understanding of disease and tools for managing it. Health—rather than cost containment, specific conditions, or technologies—should be the central focus (...) for health care and health-care reform. A compelling reason to focus on health comes from the observation that the prevalence of disease over the .. (shrink)

When natural time sequences were replaced by clocks, time became a measurable commodity and the ‘speedy use of time’ a virtue. In medical practice shorter consultations allow more patients to be seen, whereas longer consultations result in a better understanding of the patient and her problems. Crossing the line of time-efficiency and time-effectiveness compromises the balance between short-term turnover and long-term outcomes. The consultation has all the hallmarks of a complex adaptive system whose characteristics are not determined by the characteristics (...) of the components, but by the patterns of interaction among the components. Systems are dynamic and change over time; the dynamic nature is not incidental, but necessary as complex systems operate at conditions far from equilibrium. The central notion when we talk of time and complexity is that of ‘memory’. Memory is carrying something from the past over into the future. Memory is filtered/interpreted, separating noise from information. Memory therefore is not an instantaneous thing, it takes time to develop; it is slow. The dynamics between the participating agents in the consultation will create shared memories that live on to shape future interactions. Shared memories are stronger and contain more relevant knowledge if they are based on frequent interactions and ongoing doctor–patient relationships, leading to a better understanding of the whole person – a process that takes time. Sufficient time, that is, ‘a certain slowness’, is an essential element of the healing relationship in the consultation. It creates a sufficiently stable, but adaptive, environment that can withstand changing demands. Hence a more complete understanding of the consultation and its time demands will not only lead to more effective treatment, it will also humanize a situation which has become to a large extent purely instrumental. This process of humanization is important not only for the patient, but also for the doctor. (shrink)

This article presents and discusses different kinds of data documents, including data sets, data studies, data papers and data journals. It provides descriptive and bibliometric data on different kinds of data documents and discusses the theoretical and philosophical problems by classifying documents according to the DIKW model (data documents, information documents, knowl­edge documents and wisdom documents). Data documents are, on the one hand, an established category today, even with its own data citation index (DCI). On the other hand, data documents (...) have blurred boundaries in relation to other kinds of documents and seem sometimes to be understood from the problematic philosophical assumption that a datum can be understood as “a single, fixed truth, valid for everyone, everywhere, at all times”. (shrink)

Gegenstand dieser Arbeit ist der anthropologische Personenbegriff Heinrichs von Gent (vor 1240-1293). Die zentrale These lautet, Heinrich entwickele zwar keine geschlossene Theorie der menschlichen Person, verbinde aber ganz verschiedene philosophische Kontroversen seiner Zeit inhaltlich durch eine bestimmte Perspektive auf den Menschen in seinem Verhältnis zu Gott auf der einen Seite und der Natur auf der anderen Seite miteinander. Vor diesem Hintergrund widmet sich der Autor Heinrichs Beitrag zu den Fragen nach dem Prinzip der Individuation, der Ewigkeit der Welt sowie dem (...) Verhältnis von Verstand und Wille. Im Zentrum der Darstellung steht hierbei jeweils, wie Heinrich zu seiner Positionierung unter Rückgriff auf verschiedene Autoritäten ein Konzept entwickelt, hinter dem eine scharfe Grenzziehung zwischen den Bereichen Gott, Mensch und Natur steht. Die Bestimmung dessen, wie der Mensch einerseits aus reinen Naturkategorien herausgehoben wird, wie zugleich aber vermieden werden muss, den Menschen selbst zu Gott werden zu lassen oder Gott in denselben Strukturen wie die von ihm geschaffene Natur zu verstehen, verknüpft Heinrich von Gent immer wieder mit dem Begriff Person. Sich als Person gegenüber Naturkausalitäten frei verhalten zu können, begründet für Heinrich die Würde einer Person. Die philosophiehistorisch angelegte Studie zeigt durch die direkte Auslegung der Quellentexte auf, wie Heinrich von Gent eine solche Position entwickelt: Einerseits durch Rückgriff auf verschiedene Traditionen und andererseits in Auseinandersetzung mit anderen Denkern seiner Zeit, allen voran Thomas von Aquin. (shrink)

Drawing upon case study research investigating the Irish Health Service Executive’s (HSE) response to a fake news attack on their human papillomavirus (HPV) vaccination campaign, we argue that responses to fake news should be analyzed from a legitimacy perspective. A model for emotional legitimacy management is proposed in which the HSE and a third-party collaborate to (a) connect with the emotional aspects of the issue; (b) leverage emotions to build vicarious legitimacy; (c) transfer the third-party’s legitimacy to the HSE; and (...) (d) emotionally activate the public. This study contributes to fake news and legitimacy management by moving beyond fact-checking and debunking strategies. We suggest a framework centered on legitimacy in which emotions are used to counteract fake news. Finally, we emphasize the importance of third-party vicarious legitimacy building and the transfer of this legitimacy to the organization. (shrink)

U. Hoyer's argument for the linearity is discussed and a modification of the argument is proposed.

Aus psychoanalytischer Sicht wird die therapeutische Haltung in der Beziehungsarbeit mit psychotisch erlebenden Menschen beschrieben. Eine solche psychodynamische Haltung ist nicht nur in der Praxis des Psychoanalytikers hilfreich, sondern bewährt sich auch in der Akutstation einer psychiatrischen Klinik, in der sozialen Rehabilitation oder bei der Psychopharmakologie. Im ersten Teil wird die Arbeit in und an der therapeutischen Beziehung als Ausgangspunkt gewählt und die für die Autoren maßgebliche Haltung anhand der beiden Begriffe Engagement und Respekt dargestellt. Anhand einer klinischen Vignette wird (...) im zweiten Teil darauf hingewiesen, dass eine Therapie – nicht nur, aber auch mit psychotisch erlebenden Menschen – eine Gratwanderung zwischen beiden Dimensionen sein kann. Im dritten Teil schließlich werden die ersten beiden Teile von der Mitautorin, die psychose- und psychiatrieerfahren ist, kommentiert. (shrink)

Die psychoanalytische Debatte um unrepräsentierte psychische Zustände und die Grenzen der Behandelbarkeit schwerer seelischer Leiden ist theoretisch ebenso wie klinisch für die Psychoanalyse der Gegenwart zentral. Theoretisch gehaltvoll ist sie, weil das Verhältnis von verbalsprachlichen und infralinguistischen »Einschreibungen« sowie zwischen intrapsychischer und interpersonaler Erfahrung neu zu klären ist und einige enorm heterogen verwendete psychoanalytische Kernbegriffe zur Repräsentation neu zu sichten und voneinander abzugrenzen sind. Klinisch entscheidet sich an diesen Fragen, welche Leiden der psychoanalytischen Therapie zugänglich sind. Die vorliegende Arbeit will (...) einen sowohl theoretisch wie klinisch relevanten Beitrag zur Diskussion leisten. Sie geht aus von Sigmund Freuds Konzepten zu den unbewussten Vorstellungen, aus deren Perspektive die weiterführenden Gedanken neu gelesen und überprüft werden. Dabei stehen die Modelle von Green, Levine, Botella & Botella und Kristeva im Mittelpunkt. Sie kommt zu dem Ergebnis, dass es vorschnell ist, infralinguistische oder semiotische Erfahrungsschichten als »nicht repräsentiert« einzustufen. Vielmehr sollen die verschiedenen Darstellungsformen seelischer Zustände gewürdigt und aufeinander bezogen werden, die schließlich sprachlicher Repräsentation und so der Behandlung geöffnet werden. Ein ausführlicher Fallbericht und Hinweise auf die Behandlungsdynamik der Anorexia nervosa erläutern beispielhaft, wie das in der Kur gelingen kann. (shrink)

It is now—at least loosely—acknowledged that most health and clinical outcomes are influenced by different interacting causes. Surprisingly, medical research studies are nearly universally designed to study—usually in a binary way—the effect of a single cause. Recent experiences during the coronavirus disease 2019 pandemic brought to the forefront that most of our challenges in medicine and healthcare deal with systemic, that is, interdependent and interconnected problems. Understanding these problems defy simplistic dichotomous research methodologies. These insights demand a shift in our (...) thinking from ‘cause and effect’ to ‘causes and effects’ since this transcends the classical way of Cartesian reductionist thinking. We require a shift to a ‘causes and effects’ frame so we can choose the research methodology that reflects the relationships between variables of interest—one-to-one, one-to-many, many-to-one or many-to-many. One-to-one (or cause and effect) relationships are amenable to the traditional randomized control trial design, while all others require systemic designs to understand ‘causes and effects’. Researchers urgently need to re-evaluate their science models and embrace research designs that allow an exploration of the clinically obvious multiple ‘causes and effects’ on health and disease. Clinical examples highlight the application of various systemic research methodologies and demonstrate how ‘causes and effects’ explain the heterogeneity of clinical outcomes. This shift in scientific thinking will allow us to find the necessary personalized or precise clinical interventions that address the underlying reasons for the variability of clinical outcomes and will contribute to greater health equity. (shrink)

Im Wintersemester 1967/68 bin ich nach Göttingen gegangen, um dort ein Studium der Germanistik, Klassischen Philologie und Philosophie zu beginnen. Schon im zweiten Semester habe ich die Philosophie anstelle der Germanistik als Hauptfach genommen. Die Philosophie in Göttingen wurde damals von Günther Patzig und Erhard Scheibe vertreten, der eine die Kapazität der klassischen griechischen Philosophie in Deutschland, der andere – mit einem massiven Hintergrund in der Mathematik und Physik – in der Wissenschaftstheorie und Logik zu Hause.

Background Metaphors are central to the human understanding of complex issues; through the immediate associations they evoke and frame problems and suggest solutions. Our suggestion of Music in the Park as a metaphor for health systems reform brings to the forefront the environmentally diverse but bounded spaces of health services that offer a variety of attractors within their confines, while pushing into the background organizational and economic concerns.Reflections Parks, like health services, are embedded in their local landscape, serving their communities, (...) but most importantly parks are public spaces, publically funded, ideally offering universal access and equity and to be shared by all who want to go there.Music, like health, is tangible, technical and scientific, yet ultimately experiential and based on meaning. While it encompasses a wide range of styles and approaches, music making requires as its most important skill active listening which brings with it to be ‘in the moment’, to take personal risks and to draw energy and inspiration from the participants. Hence ‘audiences’ are equally active participants because music only has meaning if it internally resonates with the listener and only can exist in what is a co-constructed experience.Conclusions Music in the Park is a metaphor for primary health care systems based on shared values of experts and unique local communities. Health professionals are players in this arena, who develop and practise the full range of their skills in response to individual and community needs and preferences. Their leadership works through inspiration and empowerment, making patients ‘co-producers’ of their own health and ‘co-shapers’ of their health services. (shrink)

Bd. 1. Kunst als Lehre vom "Begriff" und von der "Neuen Unmittelbarkeit".

Les lettres reproduites ici furent échangées au début de 1935 entre Ludwig et son frère Paul, le pianiste qui avait perdu un bras à la guerre, et dédicataire des concerti pour la main gauche de Ravel et Prokofiev entre autres... La relation entre les deux frères était toute de spontanéité, dénuée de contrainte et de formalisme. Nous verrons en quoi...

Die Dinge als Dinge sind in den letzten Jahrzehnten immer mehr ins Zentrum des Forschungsinteresses gerückt. In diesem Buch geht es darum, ob es so etwas wie eine Rhetorik der Dinge gibt, ob man eine Theorie des Stilllebens zu den Dingen im Bild formulieren kann und was all das zusammen mit der Frage nach dem Ding-Design mit Rhetorik zu tun hat.