My work is all about improving health and health care through knowledge. It spans medical publishing to community health, taking in technology and innovation, and is influenced by growing up in a working-class community. I share insights from all of the above through public speaking.

The Paralysis of Neatness

It's been a while.  

I'm in Cyprus, Potamitissa to be exact. It's a much-needed break. As well as getting time off, I'm also catching up with a little reading (and remembering that I like blogging off-the-cuff). I've just caught up with the Medium-published "It's All About Relationships" (part of "The R Word"). The idea is to explore the importance of relationships in social welfare, an idea they distil down to "relational social policy". 

The idea is that it's supposed to be a conversation. The author puts out an argument; readers weave in their thoughts. It's a nice idea. It might even be working (I've not check Medium to see the response; I read the posts through my RSS Reader). But, for me, it's a perfect example of why dialogue is hard. Why?  

Because the author makes her points too well.  


I see this a lot. People are obsessed with "the evidence". They want to review it, distil it, serve it up, and then say they want a dialogue. I'm not doubting that they do - or that the people behind "The R Word" are anything but genuine - but there's something about the presenting of "evidence" that tends to shut out discussion. For me, the posts are too well argued, too neat. They don't introduce enough of the ambiguity and uncertainty in the research. Their neatness is part of why dialogue is hard, if not impossible.  

I witness versions of this a lot. Doctors are especially prone to it (likely including myself). They're up there, on stage, usually in a tie, clicking through PowerPoint slides, and weaving a narrative that'll conclude as a proposition. I've heard some doctors say their community health strategy, for instance, is "evidence based", a contention that makes me laugh out loud because so little has worked to date so what evidence are they speaking of? I want to ask this question, demand to see the original data, the interpretations, and how they've drawn from it. But it's hard. There's never time. People are given just enough time to present something neat, pose some next steps, and then be gone. 

It's not good enough. 


We have to get better at introducing uncertainty. We have to stop being neat. And we have to find new ways to share with doubt - and find the humility to say, "We think this means X but it could also mean Y. We're using the following to assume it's X and taking the next steps on that basis, but will continue to be mindful of Y". 

And Z. And G. And K.  

I'm sure the folks behind the R word have more humility than the "evidence based" doctors I've had to endure. But there's something about the medium (sic), the neatness of the posts, and the well-packaged questions at the end of each post that leave me unable to engage.  

A Neologism

That caveat withstanding, I can't help feeling there is something akin to whataboutism in all this - the way in which people don't respond to criticism directly but find something else to focus on, to divert the discussion away from the thing being criticised (presumably because they don't have a good counter-argument). It needs a name. Evidencebasism, perhaps? That doesn't feel strong enough. Someone with more imagination than me needs to dream up something memorable. 

I don't know. You don't know. No one knows. But let's try something. 

I said something like this a few weeks ago to a major US health care payer. They're interested in my work and want to know what do next. It was a good natured call and we all laughed at the (seeming) absurdity of my response. But once we got past our learned behaviour - in which we seek certainty, models, plans, investment guides, and promised ROIs - they realised that we were in unchartered territory. And that it was ok to say we don't know. And that we might make some effort to work stuff out together.  

One of the key hurdles for innovation in socially complex challenges is "evidencebasism". Overcome that and we can start being genuinely creative.  

Let's leave the neatness behind.  


Pritpal S Tamber 

I’m the Co-Founder & CEO of Bridging Health & Community (BH&C) and the Founder of the Creating Health Collaborative. Before all this, I was the Physician Editor of TEDMED, Medical Director of Map of Medicine, Editorial Director for Medicine at BioMed Central, the company that pioneered open access publishing, and an editor at the BMJ. I have an MBChB (a UK equivalent to an MD) from the University of Birmingham, UK. This is my personal blog. If you're interested in BH&C or the Collaborative, check out the BH&C website, including the updates, which you can receive by email. My speaking agent in the US is Executive Speakers Bureau; elsewhere I'm represented by Maria Franzoni Ltd and London Speaker Bureau.

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