Diagnosing the Root Cause of our Political Dis-Ease and Formulating a Treatment Plan

Two weeks ago, I was honoured to be asked to give the keynote address to an incoming class of medical students, and during my preparations I realized that there was so much I wanted to say which could not have been said in ten minutes.  Although the main points I wanted to get across were that most of our medical diseases were lifestyle related and hence preventable, and that as a profession we need to change course, I realized that a similar case can be made for the political establishment not only here in St. Kitts-Nevis, but also regionally and internationally.

In this blog article, I will attempt to show you that much of the dis-eases which have developed in the political arena can be prevented, and all it takes is a recognition of the root cause and a sincere attempt to change our maladaptive mindsets and lifestyles that have resulted in these dise-eases in the first place.  As you may gather, I am going to take a clinical approach and surgically dissect out the main issues, highlight the symptoms and signs of this political malady, and then formulate a treatment plan in terms of primary, secondary and tertiary prevention.

I will attempt to show that much of the dis-eases arise from our present way of thinking, and that these maladies are unintended consequences of the decisions made by sincerely misguided leaders who are elected by sincerely misguided citizens.  The conclusions to be drawn are  palatable and the solutions are readily implementable if we all accept that as individuals and as a collective we are only doing the best we can given our level of awareness and understanding.  NO ONE IS TO BE BLAMED AND THERE IS NO CONSPIRACY THEORY.  What we are experiencing today are the growing pains that we must bear as we mature and grow as we traverse this adolescent phase of our development.  Above all, this article also serves to sow the seeds of hope by attempting in some small way to increase our level of awareness and understanding of the core issues, and by helping to provide solutions for the way forward.

If I can identify from the onset the core issue, I would have to say that the root cause of all our political maladies arise from, on the one hand, the tensions that exist between the rights and responsibilities of individuals and the collective (i.e the state), and on the other hand, the codification of maladaptive misguided strategies in the informal and formal rules of society, to deal with these tensions.  For example, when we prioritize the rights of the individuals above their responsibility to the collective, we end up with the capitalistic experiment that has bedevilled most of the Western world with its unintended consequences of poverty, inequality and the distributive injustices. When we prioritize the responsibilities of the individuals to the state above their own individual rights, we end up with the communist experiment with the unintended consequences of inefficiencies in the system and the denial of basic freedoms and human rights.

Having identified the shortcomings in both of these suboptimal and more-left-to-be-desired systems, we can now make progress moving forward.  What we need now is an instrument or tool or calculus that inputs the rights and responsibilities of the individual and the collective, and outputs a solution that is adaptive for that particular time and place.  This would be a living and breathing instrument that grows, develops, matures and evolves, and above all should serve as one of our greatest accomplishments we, as a human race, have ever constructed.

What I am talking about already exists in principle but is perverted and twisted in practice by the powers that be.  What I am talking about is true democracy.  A democratic state is one in which the opinions, views and aspirations of each individual are taken into consideration in determining the way forward in terms of the visions presented and ultimately the policies codified in the laws of the country.  The instrument or tool or calculus that I am referring to is what we call general elections and the processes that support them that make them trustworthy, robust and fair for one and all.  This is how it should work.  Two or more party leaders put forward their visions on as many issues as is relevant to that period of time, and the party that puts forward the most convincing plan based on track record and merit, and not just rhetoric, would get the most votes; hence the collective decision (experiment) would reflect the majority of the individuals and one would have succeeded in bringing about the greatest good for the greatest number of people.  If this experiment succeeds in accomplishing its goals, then our leaders and we as individuals share in the fruits of our labour, and if this experiment fails, then our leaders and we as individuals share in the losses.  This would ensure that we always reap what we sow, and we would match the collective rights of the citizenry with their collective responsibilities in choosing the leaders who best reflect our collective aspirations.

Unfortunately, our political system, as it stands today, is out of balance and totally dysfunctional in achieving its intended goals.  What is missing in this balancing act are 1) the checks and balances in the system that would help to keep our leaders and their advisers honest, and 2) the lack of trust of civil society and the business community for our leaders and vice versa.  Unfortunately again, and I make no apologies in stating this, the system, as it stands right now, gives too much power to our leaders to gerrymander the mindset of the citizenry, using what resources they have at their disposal, to serve their self interest and by extension that of their party and ultimately those of their election financiers, and not the electorate for whom they have in fact been chosen to lead and above all to serve.

So how can our politicians regain the trust they claim they rightly deserve when they have been ceded power to act in our best interest?  To regain that trust they need to implement the checks and balances that would help keep them honest, put the necessary infrastructure in place to enable a fair electoral system which has the blessing of all involved, and above all a constitution which serves as a social contract or covenant which cedes power back to the people. Unfortunately our present constitution gives the incumbent powers that be too much and unfair powers to manoeuvre under the radar through the loopholes of the system and to gerrymander the rules that are self-serving and puts party aspirations over those of its own citizens.

We need to build into the system the tenets of transparency, accountability and good governance as these sow the seeds of trust by our electorate for our politicians, and allow us to create an environment of partnerships that enables us to work together in the hard times and that also enables us to celebrate together in the good times.  This would allow the best ideas by individuals among the collective to rise like the cream of the crop, rather than the ideas which appear to be at the top of the garbage heap only getting the light of day.

The unintended consequence of our system today as perpetuated by our sincerely misguided leaders and our sincerely misguided citizenry is that of political tribalism.  So this political tribalism IS the root cause of our political dis-ease, and when we examine the situation closely we realize the signs of victimization, dependency, lack of productivity, poverty, crime, disunity of civil society, and above all regression in the development of the hearts, minds, souls and spirits of the individuals in our beloved land of ours; this despite the claims made by the powers that be who would like us to think that we are as a nation better off today despite these social maladies.

Having made the diagnosis of the root cause of our political dis-ease, we need now to formulate a treatment plan.  There have been many political injuries, impairments and disabilities which need to be rehabilitated, and I propose that a way forward would be in setting up a National Truth and Reconciliation Commission that would bridge the political divide and would help bring the root issues to light and guide this therapeutic process with as much sensitivity and maturity as possible.  It is only by us engaging as a nation in this form of socio-cultural-political psychotherapy, that many of the repressed feelings can be brought to the surface so that we can therapeutically give vent to these seeds of maladaptive thinking and behaviour.  This would then allow us to grow up and develop through our immature political adolescence as we become fully mature, responsive and above all responsible citizens.

The above deals with what we call tertiary prevention as it serves to heal wounds, and prevent the escalation of maladaptive mindsets and behaviours that enables and sustains this political divisiveness.  However, we also need to talk about secondary prevention, as these political injuries are complications of a deeper issue which deals with our ability or lack there of, to trust our leaders, and our leaders to trust us.  So we need to screen and do regular check-ups on the political establishment and civil society and the business communities, and to pick up the early signs and symptoms of this political tribalism and effectively deal with them before the complications arise and they get out of hand.  Hence, no one can doubt the absolute necessity for the urgent passage and implementation of Integrity in Public Life and Freedom of Information Legislature, supported by periodic Electoral and Constitutional Review and Reform to deal with emerging and transitioning political issues, which as a matter of fact, in all honesty, are urgent public health issues in and of themselves.

And finally, we need to talk about primary prevention and here we are dealing with the mindset of our people, what our principles are, how high should our standards be, and what should or nor be compromised along the way.  We should start to change our mindset and be true to our motto by putting our “Country above Self,” and not party above country as this is what we do when we claim directly or indirectly that we are party supporters for life and absolve our leaders of any responsibility.   When we aid and abet and put our party interests above that of our country, then party affiliation becomes idolatry and we end up giving lip service to our Christian covenant and principles that have guided us, and I have to say have protected us thus far.  So it is a maladaptive mindset and its ensuing maladaptive behaviour that has gotten us into this situation; but I am hopeful, that by changing our mindset and our behaviour by creating a new responsible political dynamic that is more responsive to the needs of the people and the country and not our wants, we would be able to effect the much needed transformation that our ancestors had strived to create, and for which our children dearly yearn and without a doubt duly deserve. And this should rightly begin with the politicians as they are called to LEAD BY EXAMPLE as it is they who have it in their power to catalyze this reawakening and guide us through this period of growth and development.

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Keynote Address given at the White Coat Ceremony at UMHS on May 12, 2012

A pleasant good morning to everyone.

It is a pleasure and an honour to be invited here today and to be asked to give the Keynote address. It was only 20 years ago that I started my medical training at the Mona Campus at the University of the West Indies in Jamaica. And seeing you all here today, I can well imagine what is going through your mind, as believe it or not, I was once a medical student just like you. Although I was naive, insecure, and unsure of my skills and the challenges that lay ahead, I had many mentors along the way who reassured me that although the journey would be a difficult one, I would eventually succeed and that my dream of becoming a doctor, would one day become a reality. They were fond of telling me that, “medicine is easy”, (which I did not believe at the time, but now I do), and that “the only difference between them and I was time.”

What I hope to do in the next ten minutes or so is to share with you some of the insights gained, and words of wisdom given, that have shaped me, and that have allowed me to stand before you today.

First of all, we must understand that medicine is a privileged and sacred profession, in that we deal with patients at their most vulnerable, as many will be suffering from chronic illnesses and some even with terminal diseases. From the onset, we must realize that our calling is not just to save lives, as inevitably we all have to die, but our calling must be to prevent and even decrease the suffering in our patients’ lives. Although we may accurately define life as “a sexually transmitted disease with terminal prognosis”, I want to reassure you that this is not a problem with life or suffering itself, but our perception of our role in it.

Secondly, we must appreciate that our medical training is modelled on the scientific method. When we formulate a diagnosis, we are actually putting forward a hypothesis that may explain a patient’s complaint. If we are to serve our patients well, we have to first have an excellent grasp of the basic sciences so we can appreciate where the abnormal structure in the anatomy or the abnormal function in the physiology of the patient lie. Having become well grounded in the basic sciences, we then proceed to the bedside or clinic where we interact with the patients and develop our clinical skills in applying what we have learnt from the basic sciences to our patients’ health needs. This skill involves us interacting with the patients by interviewing them and dissecting their symptoms (which we call history taking) and examining them using our senses of sight, hearing and touch, sometimes smell, and rarely taste, looking for clues which may be consistent with or help rule out a given list of hypotheses (which we call differential diagnoses). If at this point we have not made a diagnosis, we then augment our senses by using the tools of modern medicine such as microscopes, cameras, Xrays, chromatography and spectroscopy, to pinpoint the structural or functional lesion that is the source of our patient’s complaint.

I fervently hope that at this point you can fully appreciate that a good grounding in the fundamentals plus developing critical thinking skills in pattern recognition is the key to becoming a successful practitioner. Please remember this truism that medicine is an apprenticeship, where our unwritten motto is, “See one, do one, and then teach one,” and that we progress and “we see further by standing on the shoulders of Giants”. We should thus heed the advice of one of those giants, Sir William Osler, who teaches us; “He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.”

To be a successful doctor, we should develop in ourselves the five Cs. First of all, we should be compassionate, this goes without saying. Secondly, we should be competent, and this competence is developed from understanding the fundamentals in the basic sciences and developing our clinical skills to the best of our abilities. Thirdly, we should be confident in our skills, as this is important in nurturing the relationship between our patients and ourselves, and also of us in ourselves, as confidence in our knowledge and skills, is the antidote for anxiety and indecisiveness in our professional and personal lives. Fourthly, we have to be of sound character, as believe it or not, we are role models for our patients. In order to earn the trust of our patients, we need to “practice what we preach.” It was a wakeup call for me, that when I told my third patient that she needed to lose weight as part of her treatment plan, she turned around and asked me what I was doing to lose weight myself, as at the time, I was also obese with a BMI of 31kg/m2. Like all great leaders, and being leaders in our fields, we also have to apply the tenets of accountability, transparency, and good governance in our professional and personal lives, and to appreciate that respect and trust form our patients, is something that is not granted, but earned.

And the last C, which I feel is the most important quality, is that we need to become efficient catalysts of change by fostering healthy behavioural change in the lives of our patients. As you know, a catalyst is a substance that speeds up a reaction without being consumed in the process. So as efficient catalysts, we should bring the right knowledge, the right treatment plan, the right specialist, to the right patient at the right time, to speed up the rate at which our patient recovers from sickness to health, or help our patients who are healthy remain healthy. Thus our goal in our professional and personal lives, as we grow and develop and evolve, should be to become more compassionate, more competent, more confident, of sound character and also more efficient as we catalyse the recovery of our patients, and better yet, empower our patients to maximize their wellbeing.

It would be remiss of me at this point not to throw some light on a major shortcoming of our medical profession, and it is my fervent hope that your generation would be the ones to help us in remedying this suboptimal situation. Believe it or not, we have spent much time and energy and research in discovering skills, medications and technologies to save lives. However, we must wake up to the realization that as medicine is practiced today, which is based on the sickness model, medical research is taking us where we cannot afford to go, as our health care model as it stands today, is without a doubt unsustainable. It has been said that “an ounce of prevention is worth a pound of cure.” Better yet, we say to you, that putting more time, energy, and research into prevention IS the cure for the unsustainable sickness model within which we find ourselves immersed today. During your training, you will discover that most of today’s diseases are lifestyle related and hence preventable, and I hope one day that in addition to the patient’s bill of rights, we can by consensus formulate a social contract or a covenant with each other and our patients called a patient’s bill of responsibilities. As Arun Ghandi, grandson of Mohandas Ghandi has said, we commit one of our greatest human blunders when we divorce human responsibilities from human rights. Gone should be those days when we amass great wealth and fortune by profiting from human suffering, and by capitalizing on the physical, cognitive and emotional frailties of our patients. I yearn for the day when we as a profession are not perceived as human mechanics, eagerly waiting for our patients to break down, but are seen as sincere health coaches eagerly reaching out to our patients to guide them and encourage them to partake in wholesome healthy living. In so doing, we would become partners with our patients in helping them become more empowered and more responsible, and helping them decrease suffering in their lives and those around them. We need to be our patients’ advocates and help convince our policy leaders that that their number one priority should be in helping shape the rules of society where the healthier choices, become as a matter of fact, the easier or cheaper choices.

And finally, we would like to share with you the secret to our being here today, what motivates us and inspires us in the difficult times and what keeps us grounded in the good times. As you can guess, this apprenticeship is not only a professional journey, but also a spiritual one. And when we say spiritual, we mean one in which we endeavour to develop in ourselves a sense of connection to all that there is in time and space. To be one with each other and with the whole universe, we endeavour everyday to cultivate in ourselves to the best of our awareness, a sense of infinite gratitude for all things past, a sense of infinite responsibility for all things future, and ultimately a sense of infinite service for all things present. (Some of you here would recognize at once that this is basically the heart of Buddhist philosophy.)

So thanks again for lending me your ears. Good luck on your journey as you not only fill your mind with information, knowledge and wisdom as it pertains to the practice of medicine, but also as you fill you heart, soul and spirit, with faith, hope and love for your profession and above all for your patients you are ultimately called to serve.

Thank you.

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From Sense to Sensibility – Our Human Nature and Our Human Potential Redefined

Who am I, from where did I come, what is my purpose here on earth, and what will happen to me when I die? These are the questions that have preoccupied man’s search for meaning since the dawn of civilisation. I will attempt to show that we can deepen our understanding of the mystery of our existence, if, and only if, we can rediscover our true human nature, and we can reimagine our true human potential.

Our empathic human nature rediscovered

Over the past year, I have discovered a new worldview that I hope will help us usher in a new age of understanding of what it means to be a human being. It is a worldview that is refreshing and uplifting and one that is based on a new appraisal of human nature and the human potential. This view distills the wisdom of all of the worlds religions, and the wisdom of all the philosophical traditions and physical sciences, and synthesizes a more accurate worldview that is grounded on the latest developments in our search for a better understanding of the workings of the mind and consciousness.

Four persons have played a critical role in sowing the seed that have germinated into this newfound realisation. To give you a sense of where I am heading, I will introduce you to three RSAnimate videos and one TED talk that have impacted on my psyche immensely in ways before then unimmaginable.


Bestselling author, political adviser and social and ethical prophet Jeremy Rifkin investigates the evolution of empathy and the profound ways that it has shaped our development and our society.

 

 

 

The entire RSA talk can be found here: http://www.youtube.com/watch?v=1-7BjeHepbA


This animate was adapted from a talk given at the RSA by Sir Ken Robinson, world-renowned education and creativity expert and recipient of the RSA’s Benjamin Franklin award.

 

 

 

The entire RSA talk can be found here: http://www.youtube.com/watch?v=mCbdS4hSa0s


Matthew Taylor explores the meaning of 21st century enlightenment, how the idea might help us meet the challenges we face today, and the role that can be played by organisations such as the RSA.

 

 

 

The entire RSA talk can be found here: http://www.youtube.com/watch?v=x5ZjSEqWQQU


Tapping into the findings of his latest book, NYTimes columnist David Brooks unpacks new insights into human nature from the cognitive sciences — insights with massive implications for economics and politics as well as our own self-knowledge. In a talk full of humor, he shows how you can’t hope to understand humans as separate individuals making choices based on their conscious awareness.


Please take your time and view these videos, first the animate, then the enitre talks, then the animates again.

Having done so, you will be able to appreciate a new world view emerging.

Happy watching.

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