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I saw this painted stone today on my way back home
Hi dear Flickr friends!!
I am writing to you from the Internet shop because my PC is not working :-(
This means I will not be on Flickr for some days and can also not comment.
When I am back I will try to catch up all your beautiful pics!
Have a good time ...so long!
Claudia
Abstract
Alchemy was the synthesis or transmutation of all elements in perfect balance to obtain the philosopher’s stone, the key to health. Just as alchemists sought this, so health practitioners always seek the best possible practice for optimal health outcomes for our patients. Best practice requires full knowledge—a little information can be dangerous. We need to serve our apprenticeship before we master our profession. Our profession is about improving health care. While the journey may start at medical school, the learning never ceases. It is not only about practising medicine, it is about the development of the practitioner. Professional practice requires systematic thinking combined with capacity to deal morally and creatively in areas of complexity and uncertainty appropriate to a specific context. It requires exemplary communication skills to interact with patients to facilitate collaborative decision making resulting in best practice. The synthesis of scientific and contextual evidence is a concept which applies to all disciplines where theoretical knowledge needs to be transferred to action to inform best practice. Decisions need to be made which take into account a complex array of factors, such as social and legal issues and resource constraints. Therefore, journey towards best practice involves transmutation of these three elements: scientific knowledge, the context in which it is applied and phronesis, the practical wisdom of the practitioner. All science has its limitations and we can never know all possible contextual information. Hence, like the philosopher’s stone, best practice is a goal to which we aspire but never quite attain.
Evidence-based practice, lifelong learning, postgraduate education
Issue Section: Editorial
Introduction
Alchemy was the synthesis or transmutation of all elements in perfect balance to obtain the philosopher’s stone. It was about the creation of a ‘panacea’, the elixir of life, a remedy to cure all diseases, the key to health. Just as alchemists sought this, so health practitioners always seek the best possible practice for optimal health outcomes for our patients.
Best practice requires full knowledge—a little information can be dangerous. We need to serve our apprenticeship before we master our profession. Our profession is about improving health care. While the journey may start at medical school, the learning never ceases. It is not only about practising medicinebut also about the development of the practitioner.
Professional practice requires systematic thinking combined with capacity to deal morally and creatively in areas of complexity and uncertainty appropriate to a specific context. It requires exemplary communication skills to interact with patients to facilitate collaborative decision making resulting in best practice. The synthesis of scientific and contextual evidence is a concept applies to all disciplines where theoretical knowledge needs to be transferred to action to inform best practice. Decisions need to be made which take into account complex array of factors, such as social and legal issues and resource constraints. Therefore, journey towards best practice involves transmutation of these three elements: scientific knowledge, the context in which it is applied and phronesis, the practical wisdom of the practitioner.
Clinical practice can be considered to be the sum of scholarship and professionalism. Scholarship is about empirical knowledge, research evidence, science and logic. We need to know how to assess the quality of evidence, judge the relevance and value of new knowledge to our own practice and determine whether this new knowledge is practice confirming or practice changing. Thus, the basis of our practice is scientific scholarship but we also need to learn the art. Professionalism is about the understanding and application of contextual knowledge and professional expertise, it is about artistry and judgement. We need both clinical reasoning and ethical decision making.
Alchemy was about integration across domains. The basic elements of water, fire, air and earth and core processes of decomposition, sublimation, distillation, amalgamation, fermentation and purification needed to be precisely combined and balanced to attain the philosopher’s stone. Similarly, clinical practice involves the domains of both scholarship and professionalism. For best practice, we must consider the prevalence of a condition, its diagnosis and treatment and its likely prognosis. However, in our management of patients, we must also consider the interplay of many other factors—the law, human rights and dignity, issues of equity for all patients, the potential benefits and harms of intervening or not intervening, the role of the professional and the emotional responses of all involved (Fig. 1).
FIGURE 1
Domains of alchemy and domains of clinical practice
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Domains of alchemy and domains of clinical practice
Alchemy involves finding perfect combination of planetary metals (such as silver, copper and mercury) and mundane elements (such as potassium and sulphur) to transmute matter into the elixir of life. The alchemist studied and practised for many years striving to reach this goal. In the same way, to determine best practice, we need to know the scientific evidence. Randomized controlled trials can demonstrate whether intervention is effective. This knowledge may be strengthened if we combine trials in systematic reviews and meta-analyse. We need to know how well a test will pick or miss a diagnosis. Case-controlled studies help us identify factors, which contribute to a particular disease. Qualitative research brings narrative to our numbers, adds the why and how to our results (Fig. 2).
FIGURE 2
Types of matter and types of evidence
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Types of matter and types of evidence
However, in practice, evidence needs to be assessed from perspective of a particular patient. Many things contribute to what decisions are actually made. These include both the patient and the practitioner’s values, numerous attributes of the patient (such as their age and their co-morbidities), their family and the community in which they live, their culture and local policy. Limited resources may mean that the ideal test or treatment is not affordable. For example, evidence indicates that heart failure should be diagnosed on basis of an echocardiogram, but if patient does not have access to this test, then the clinician may rely on symptoms and signs. Best management might include use of beta blockers, but if the patient has asthma, which this drug exacerbates, alternative treatments must be chosen. A child with bacterial pneumonia requires antibiotics, but relatives of elderly demented and chronically ill person with this condition may decline such treatment for their family member.
Best practice is the transmutation or synthesis of knowledge. However, all science has its limitations. What has been found to be true for particular population may not be generalizable to another. Furthermore, we can never know all possible contextual information. For example, we may not be able to predict that a person will have allergic reaction to drug we give them. Hence, like the philosopher’s stone, best practice is a goal to which we aspire but never quite attain.
Scientific knowledge is incomplete. It is always undergoing change and being added to. We need skills to access and critically appraise new knowledge as research progresses. Likewise, the context changes with every patient, and patient’s needs and values change over time. Professional expertise also requires self-reflection and evaluation of the outcomes of our decisions. All this evidence goes back into the mix and contributes to future decision making (Fig. 3). This is the process of lifelong learning—how the apprentice achieves mastery.
FIGURE 3
Synthesis of knowledge into best practice
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Synthesis of knowledge into best practice
The principle of the synthesis of scientific and contextual knowledge, funnelled through the wisdom of the practitioner, applies to health care in the realms of clinical and forensic practice, research, education and dissemination of information.
Clinical practice
Cecil Lewis, the founding Dean of my Medical School, emphasized that most health care takes place in the community not in the hospital and that doctors should treat patients holistically—body, mind and spirit. He believed it important for doctors to be well-rounded people and their education should include both science and humanity. He introduced a 3-month elective in the final year for students to spend 3 months doing whatever they passionate about, something to feed their soul, be it music, art, science or medicine. Combining theoretical knowledge with real life situations begins with clinical practice.
Alchemists were early doctors, in search of potions to promote healing. This is an intent that doctors still seek, applying scientific knowledge within a particular context to assist our patients to heal. My first general practice experience job was as a locum in Blaengwynfi, a mining village in South Wales. I shared the on-call roster with Dr Julian Tudor-Hart, a GP from the neighbouring village Glyncorrwg. I found him to be a truly inspirational GP. Julian was working with his patients to make their lives healthier through systematically checking their blood pressures and helping them to change their lifestyles—getting them to look at their diet, their smoking and exercise or lack of it. These Welsh villages very impoverished and the GPs who worked there did twice as much work for half pay of those working in more affluent areas. Julian taught me that the people most likely to need health care were the least likely to receive it. It was only many years later that I learned that Julian is an icon of general practice in the UK and that his ‘inverse care law’ is famous.1
I worked as a doctor in Jamaica for 2 years, where the health need was great. There I experienced first-hand how best practice has to be tempered by the circumstances and what is available. I ran a health centre just out of Kingston where there had been no doctor for a number of years and ∼20 000 people in the catchment area. However, there was a great team of auxiliary staff whom I trained to deliver health talks to the large group of people who would sit in shade of the mango trees waiting to see the doctor. The staff would also write labels, count pills and put into bottles the drugs I used to wheedle from the Ministry depot in downtown Kingston. After every 20 patients, I would stop consulting and dispense my own prescriptions. Patients were instructed to bring back pill bottles for recycling. I used to estimate patients’ haemoglobin levels by the strength of copper sulphate solution in which a drop of their blood would float. While a public laboratory was available at the downtown hospital, generally this was not an accessible option due to resource constraints (most patients could not afford the bus fare) and the potential associated harms (gun wars in ghettos made travelling there dangerous).
Forensic practice
Transmutation of scientific and contextual knowledge also applies to forensic practice. This involves examining all available evidence about the circumstances, applying what we know from scientific literature and then assessing whether the evidence may confirm or refute that alleged events occurred or were committed by person accused. Both the presence and the absence of evidence need to be considered. Sometimes evidence points to guilt. The accused may then plead guilty or be found guilty at trial. Sometimes evidence points to innocence. The charges may then be dropped or the accused found not guilty. Other times, it provides an estimate of probability or improbability. Crimes do not have to be proved; only that person is guilty beyond reasonable doubt.
The roles of the clinical and forensic practitioner are different, and you cannot serve Hippocrates and Hammurabi at the same time. The clinician serves Hippocrates, the Healer. This role is to relieve suffering, provide treatment and prevent further illness or injury and the duty of care is to the patient. The forensic physician serves Hammurabi, the lawgiver. Here, the role is one of evidence gathering with the basic tenet of impartiality. The role is to provide expert opinion and the duty of care is to the Court. While both roles require the synthesis of scientific and contextual evidence, clinicians called upon as expert witnesses need to make this distinction between their therapeutic and forensic responsibilities. Before a hearing, there is a complainant not a victim and a defendant not an offender. Both clinical and forensic practitioners should treat complainants with compassion and respect, and this treatment should also be afforded to the accused.
Research
The alchemist was researcher, constantly experimenting to find philosopher’s stone. He was looking for the perfect balance not only of ingredients but also of processes. Primary care research needs to study not only the prevalence, diagnosis, management and prognosis of disease but also issues such as how to communicate our knowledge to our patients. Clinical decisions may require the complex weighing up of the potential benefits and harms of each course of action. There are numerous ways to communicate this—as relative or as absolute risk, odds, numbers needed to treat or natural frequencies, positively or negatively framed, as numbers or in pictures.2 Our methods of communication will influence how well our patients understand the possible consequences of a management decision and may also actively encourage or discourage them from making particular choices. Using only relative risk may be manipulative. For example, if we tell a patient that one drug has double the chance of a particular side-effect compared to another, the impact of this information is likely to be very different if the risk changes from 1 in 20 to 1 in 10, than if the risk increases from 1 in 20 000 to 1 in 10 000. There is no single optimal method of communicating information on potential benefits and harms, but research can assist us to find the best way to impart knowledge to ensure truly collaborative decision making.
Education
Because knowledge is always changing, clinicians need to embark on a journey of lifelong learning and those with knowledge need to pass it on to others. A network of schools of alchemy existed for over millennia, starting in ancient Egypt and Mesopotamia, spreading to India, Persia and the Far East, on through classical Greek and Roman civilizations to the medieval Islamic world and then medieval Europe. The science and art of alchemy were passed down to students by master alchemists.
Postgraduate education needs to follow the same model of combining scholarship and professionalism. In all clinical disciplines, practitioners need the tools to access and critically appraise new knowledge as research progresses to assess the quality of evidence and its relevance to their own practice. This knowledge can then applied in context of individual patients. Professional expertise also requires self-reflection and the assessment of outcomes of decisions. Postgraduate students need to be able to look at research knowledge from populations and ask:
Should this confirm or change my practice?
Are these findings realistic—is this test or intervention available, will it be used and will it be worthwhile?
Is it relevant to this particular patient?
How does it apply to patients with other conditions and preferences?
What are relative gains and risks for my patient?
They can explore their own and other colleagues’ clinical reasoning and decision making in specific scenarios. This enables them to reflect on the weight they give different components, such as exploring and explaining relative benefits and harms of intervening or not intervening and issues relating to the law, equity and human rights and dignity.
Publication
Finally, our ever-growing body of knowledge needs to circulated. The philosophy of alchemy persisted for >2000 years. The findings of alchemists were recorded in texts and scrolls and disseminated in their schools and libraries. The best way to disseminate primary health care knowledge is via our peer-reviewed indexed medical journals. Primarily, this is the publication of original research. However, while scientific evidence can help inform best practice, sometimes there is no evidence available or applicable for a specific patient with his or her own set of conditions, beliefs, expectations and social circumstances. Evidence needs to be placed in context. General practice is art as well as a science. Quality of care lies also with nature of clinical relationship, with communication and truly informed decision-making. We also need to publish editorials, viewpoints, commentaries and reflections that explore areas of uncertainty, ethics, aspects of care for which there is no one right answer.
Conclusions
In the journey from apprentice to master, we gain knowledge and practical wisdom along way. As clinicians, researchers and teachers, we are all on a journey of lifelong learning, constantly adding and re-evaluating knowledge to practice the best that we can.
From a cycle: Northern Tadmor
"Собака философ"
близ пляжа "Отрада", Одесса, Украина
декабрь 2015
из цикла: Северный Тадмор
Dysart Castle is a castle ruins and property just outside Thomastown in County Kilkenny, Ireland. It is best known as the childhood home of George Berkeley, the Irish philosopher for whom Berkeley, California and the Trinity College Dublin Berkeley Library is named. The property is currently privately owned and the castle in urgent need of restoration.
Located south of Thomastown, the site has held a medieval church, the castle, and other buildings. The castle and church property are situated low along the sharp curve of the River Nore. The church was originally adjoined to the castle but the properties were eventually separated by 21 ft. Dysart Castle was small and considered "rudely built," divided by a stone arch, with an access path in the second storey leading into the church. Dysart's lands and structures were granted to the Priory of Kells by founder Geoffrey fitz Robert in 1193. The charter suggests that it was known as Dysart of St. Mo-Colm-óg, or Colman, meaning St. Colman was the patron of the place. The church and castle and surrounding property belonged to the Priory of Kells, until suppression in 1540. Accounts conflict over whether Berkeley was born at Dysart Castle in 1684; he was, however, raised on the grounds of Dysart, his family home which stood beside Dysart Castle.
In the 2000s, with a summary report released in 2009, archaeologist Ben Murtaugh conducted an excavation of the area with the support of fund from the Royal Irish Academy. Ruins of three stone buildings remain above ground on the property and are situated next to close to each other; four periods of activity were identified with the site. The first period related to the Early Medieval monastic site and church, associated with St. Colman. This included a primary stone church and graveyard, a round house, two cross slabs and Romanesque architectural fragments. In the second period, the site was an out farm or grange of the Augustinian Priory of Kells (c. 1200–1540). This included an extension to the church, the construction of a tower house and the later phases of the graveyard. The third period involved the post-medieval redevelopment of the site, following the abandonment of the graveyard for burials and the church for worship. The church appeared to have been converted into an outhouse or barn. Furthermore, a long dwelling house was constructed to the south of the tower house. In this third period, the place was the childhood home of philosopher George Berkeley (1685–1753).
Due to degradation of structures, Dysart is now considered a romantic ruin. In April 2003, The Irish Times published an urgent appeal for assistance for restoration of Dysart Castle and cited the risk of "imminent collapse" following the emergence of new cracks in the walls of the castle; previously conservation work had been conducted with the aid of Kilkenny County Council acting for the Department of the Environment and private efforts.
Busts of Greek philosophers from Socrates to Epicurus as seen in the British Museum, London.
This is part of a series I took today as I tried to play around with my lenses and understand how depth of field works...
Bruce Lee (born Lee Jun-fan; 27 November 1940 – 20 July 1973) was a Chinese American, Hong Kong actor, martial arts instructor, philosopher, film director, film producer, screenwriter, and founder of the Jeet Kune Do martial arts movement. He is widely considered by many commentators, critics, media and other martial artists to be the most influential martial artist, and a cultural icon.
Lee was born in San Francisco to parents of Hong Kong heritage but was raised in Hong Kong until his late teens. Lee emigrated to the United States at the age of 18 to claim his U.S. citizenship and receive his higher education. It was during this time that he began teaching martial arts, which soon led to film and television roles.
His Hong Kong and Hollywood-produced films elevated the traditional Hong Kong martial arts film to a new level of popularity and acclaim, and sparked a major surge of interest in Chinese martial arts in the West in the 1970s. The direction and tone of his films changed and influenced martial arts and martial arts films in Hong Kong and the rest of the world, as well.[10] He is noted for his roles in five feature-length films: Lo Wei's The Big Boss (1971) and Fist of Fury (1972); Way of the Dragon (1972), directed and written by Lee; Warner Brothers' Enter the Dragon (1973), directed by Robert Clouse; and The Game of Death (1978), directed by Robert Clouse.
Lee became an iconic figure known throughout the world, particularly among the Chinese, as he portrayed Chinese nationalism in his films. He initially trained in Wing Chun, but he later rejected well-defined martial art styles, favouring instead to use techniques from various sources in the spirit of his personal martial arts philosophy, which he dubbed Jeet Kune Do (The Way of the Intercepting Fist).
Brandon Bruce Lee (February 1, 1965 – March 31, 1993) was an American actor and martial artist. He was the son of martial arts film star Bruce Lee. After a promising start in action movies and the signing of a multi-film contract with 20th Century Fox, Lee was accidentally shot and killed in North Carolina at the age of 28 while filming The Crow.
source: wiki
They are buried in Lake View Cemetery, Seattle, Washington
...... I fix you up real good - just look at the model on my desk
AI creation on Nightcafe with my trained Selfie Lora
PROMPT:
My Neurologist advised me to quit this nonsense before all the neurons leaked out of my brain Surrealism. Medium shot. A neurologist intensely advising a patient. Warm studio lighting. Whimsical, melting clockwork mechanisms embedded in the doctor's skull, a la Salvador Dali. Soft, dreamlike blur around the edges. Earthy tones with flashes of vibrant, pop-art colors. Masterpiece. Best quality. Detailed. Eerie, mysterious atmosphere. Thick, heavy textures. Unsettling, fantastical elements. Oil painting style. Juxtaposed, distorted proportions. 8k resolution. Cryptid Taxidermistcreation in Bogomils Univers by the surreal painters Otto Rapp and Paulo Cunha, with an assist by H.R. Giger and Hieronymus Bosch, while Beksinski just watches the procedure.
Have you ever met a “Philosopher in Residence” from a major health sciences centre? Probably not because this is the only one anywhere. Meet Sholom who holds that title at Toronto’s Baycrest Health Sciences, “a global leader in geriatric residential living, healthcare, research, innovation and education, with a special focus on brain health and aging.” (www.baycrest.org/about/our-story/)
I met him on the first day of a course I am taking through my lifelong learning program. He and I were the first ones in the classroom which gave me an opportunity to get acquainted and which included chatting about retirement. I explained that my Human Family photography project has been an important part of my retirement and he expressed interest. Of course I invited him to participate as a subject and we agreed to do a couple of photos outside the building at the end of class.
Sholom’s course is titled “A Patient’s History of Medicine” which reflects his strong interest in patient advocacy and in active patient involvement in medical treatment. The course outline follows the structure of his most recent book (not yet in print) by the same title. He is a fascinating person and a great teacher. As with all great teachers, he combines an organized presentation of stimulating material with a group discussion about the topic being covered.
A philosopher by training (he has a PhD from Cornell), he also has a strong background in planning. His current position is a somewhat serendipitous result of a funding collapse. Sholom was working as a planner for a new hospital wing in Montreal when, upon completion of the plan, the government funding dried up. The hospital CEO was so impressed by Sholom’s value that he insisted in keeping him on staff, but what would his new role be? Sholom suggested “How about Philosopher in Residence?” And so it came to pass that he carries that title, even though he and his wife have relocated to Toronto. His job covers a wide variety of activities within and outside the institution where he is responsible for teaching patient centered care to staff along with teaching duties at the University of Toronto.
Sholom describes himself as “semi-retired” but he must have a unique definition of “semi-retired” because to hear of his current activities leaves one breathless. His current book is his fourth one published, he does research on health policy, he is the founder of Patients Canada, a patient advocacy organization and he commutes regularly to England – not to mention the adult education course he is teaching at The Life Institute. He told me that he will be in Montreal later this week to deliver a lecture at McGill University. Does that sound like semi-retirement to you? You can read Sholom’s bio here: www.sholomglouberman.net/ and here: research.baycrest.org/sglouberman . You can access his blog on medical history here: healthandeverythingblog.wordpress.com/.
I can tell that this is going to be a fascinating course covering the history of medicine from prehistoric times to the present through the lens of the patient’s role in treatment. Despite his juggling of numerous activities, Sholom presents as a calm and thoughtful man and was sure to connect with me after class for the photo shoot outside the building on campus. He expressed interest in my background and noted that his wife is a therapist herself. I don’t know where he has found time for it, but he told me that he likes to paint which must serve as a form of relaxation as well as creative expression. I took photos in two nearby locations – one in front of the large boulders on campus (appropriate since today’s class was about prehistoric times) and another against the wall of the campus bookstore.
As I walked him toward the subway I asked if he had a message to share with the project and he said (with a smile) “Take charge.” His message probably had a more general meaning but it would also seem to apply to his views on our role as patients in our own health care.
Thank you Sholom for participating in my photography project. This is my 475th submission to The Human Family Group on Flickr.
Welche Philosophen sind oben zu sehen? | Which philosophers are shown above?
Um das Rätsel zu knacken: Kommentare oder Tags lesen. | In order to crack the riddle: Read the comments or tags.
Today, 25 November, is the feast of St. Catherine of Alexandria, who is the patroness of philosophers and preachers.
St. Catherine is believed to have been born in Alexandria of a noble family. Converted to Christianity through a vision, she denounced Maxentius for persecuting Christians. Fifty philosophers whom she is said to have converted by her eloquence were then burned to death by Maxentius.
Maxentius offered Catherine a royal marriage if she would deny the Faith. Her refusal landed her in prison. While in prison, and while Maxentius was away, Catherine converted Maxentius' wife and two hundred of his soldiers. He had them all put to death.
Finally, Catherine was likewise condemned to death. She was put on a spiked wheel, and when the wheel broke, she was beheaded.
She is depicted here, flanked by angels, in a splendid window by Edward Burne-Jones in Christ Church Cathedral, Oxford.
We have passed this pub on many an many an occasion and often wondered about its name. This time I took a photo and 'googled' it on our return home. It has a very interesting history.
For those who wish to know - here you go...........CHEERS!
www.tipplingphilosopher.com/history/
Think you might like this one Cynthia:-))
Past this building many a time and always wanted to photograph it.
It's on private ground but I was granted permission to take these shots under the conditions I wouldn't be selling them. Hence the watermark......I've had images stolen in the past and used. But it's something I've never let worry me too much, if I was trying to make money out of this I would be a little more careful on the quality of the images I post and would put the watermark in a much harder place to clone out.
Any way back to the tower.......it belongs to the Earl of Shaftesbury family. It was thought the 3rd Earl was a philosopher and spent many a time thinking here.
I know I could ponder quite happily here watching the gorgeous sunrises.
( When we get them that is! )
"We understand that God, the Creator of all things, is superior to the things that are to be changed. If, therefore, on some points we teach the same things as the poets and philosophers whom you honour, and on other points are fuller and more divine in our teaching, and if we alone afford proof of what we assert, why are we unjustly hated more than all others? For while we say that all things have been produced and arranged into a world by God, we shall seem to utter the doctrine of Plato; and while we say that there will be a burning up of all, we shall seem to utter the doctrine of the Stoics: and while we affirm that the souls of the wicked, being endowed with sensation even after death, are punished, and that those of the good being delivered from punishment spend a blessed existence, we shall seem to say the same things as the poets and philosophers; and while we maintain that men ought not to worship the works of their hands, we say the very things which have been said by the comic poet Menander, and other similar writers, for they have declared that the workman is greater than the work."
- First Apology of St Justin Martyr, chapter XX
Today, 1 June, is the feast of St Justin Martyr, the philosopher martyred c.167 in Rome.
This mosaic is in a bath house in Ostia Antica.