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It's all in the Mindlines

Posted by Helen McCarthy at 9:52am on Tuesday, 16th November 2004

This article in the BMJ from a few weeks ago (please don't ask me why I'm reading the BMJ) suggests that primary care clinicians (ie GPs and practice nurses) rarely explicitly or directly access and use evidence from research to inform their practice, relying instead on so-called 'mindlines' - collectively reinforced, internalised, tacit guidelines derived from interactions with colleagues, patients, pharmaceutical reps, opinion-formers and so forth and morphing over time. Word is, if you want to influence medical practice, don't write a book - tap into the mindlines.

This will sound all too familiar to many a Demos researcher who has done time in the company of civil servants, teachers, policemen, voluntary sector managers or any of the other groups of professionals with which Demos works. It also reinforces the characteristically Demos-esque view that pamphlets are only half of the story and that the real route to organisational culture change is through the formal and informal networks, relationships and interdependencies that provide the conditions for knowledge creation and learning in any professional environment. It's also a great excuse for never reading any books of course...

Comments

1
Wow, even medical experts, whom we trust our lives to, are human beings, and as socially malleable as the rest of us. Now that's scary. The cognitive psychologist Gerd Gigerinzer (probably the wrong spelling) has conducted various studies on the 'innumeracy' of medical practitioners in Europe and the US, and come to the same conclusions - doctors are more likely to make choices based on peer consensus than objective evidence. Lawyers, he believes, are even worse.
Posted by Jon Minton  at 5:04pm on Tuesday, 16th November 2004
2
Interesting piece, thanks Helen. I suppose its not surprising that medical practice is shaped as much if not more through social discourse as it is by some realm of supposedly 'pure' fact. Yet we still insist on separating scientific debate from its social context and the subsequent real world impact it has on all of us. As Bruno Latour would argue, we need to find a way of thinking about science that spans fact, power and discourse rather than keeping them all in separate boxes.
Posted by David David  at 5:30pm on Tuesday, 16th November 2004
3
I think Helen?s entry is so fascinating my brain wants to expload. It questions why people want to work in think tanks, what policy is for, how ideas bring about change, where the divide is between a political party/civil service/think tank and where the legitimacy for the work of think tanks lies. If you?re really a person changing politics, you should probably really be a person constructing a community and in many ways, this isn?t just in the broadsheets and it?s certainly not just in Westminster. Well, unless of course you still believe in unleashing policy from the top. We?ve said that we?re a ?think and do? tank for a while now to express our dual functions of creating ideas and working with organisations to put them into practice. It sounds good but maybe in the rhetoric we can at times lose sight of the importance of ********how*********** you work with an organisation (tap into the mindlines) to bring about change, rather than just replicating conventional think-tank working styles, but with organisations. It?s here that the fertile ground lies. The irony of course is that it?s hard to explain that you?re a community of interest, or an agent in developing communities of interest, without sounding massively pretentious.
Posted by Charlie Tims  at 11:37am on Wednesday, 17th November 2004
4
One word: 'Groupthink'. Potentially, the 'collective mind' of a group is much more 'clouded' than that of any of the individuals who form it. 'Anti-synergy' is a real problem when lots of smart minds get together. Earlier today I attended a seminar where someone lamented the lack of ability to affect positive changes in various institutions (The prison sector was the example he gave, as he had personal experience in the sector). He said he'd spoken to many senior figures within a beaurocracy who make and follow decisions they believe are fatally flawed and likely to fail, because if they make other decisions they're not following the conventional wisdom within the group, and lose their place within it. I guess it's better to be a dilligent, hardworking member of a sinking ship than the weird guy who shouts 'ICEBERG RIGHT AHEAD!' when everyone else sees clear waters.
Posted by Jon Minton  at 2:53pm on Thursday, 18th November 2004
5
The increasing focus on anthrological and ethnographic approaches per se in the social sciences is key to this shift that Helen is describing in Demos's work, and yes Clifford Geertz's notion of thick description is a really powerful way of getting inside the culture of the group you're studying. Its certainly become the new paradigm within the academy and as such the 'old fashioned' quantitative number crunching approach has been dismissed into the dustbin of history within the social sciences as naive. we are told we are moving from an atomistic approach to a holistic approach that gauges knowledge within its situated context. however, there is a problem with this: often ethnographers fail to query the quantitative assumptions that they make in their own research. also if you want to know certain things you still need stats. too much context can become as useless as too little. endless self-reflexivity about your position within the research will ultimately lead to the dead end of auto ethnography where nobody can really 'know' anything except what they know about themselves.
Posted by David David  at 3:13pm on Thursday, 18th November 2004
6
just in reponse to Helen's point. I'm not suggesting binning the conventional model of think tankery, just that if you're really conducting public interest consultancy/working with organisations/doing policy into practice/think and do/etc the research approach that you take can't be the same as writing a pamphlet. Although crucial, in many ways a physical output is less important than the slection of understandings that you create in the process (something that can never be fullfilled by the "cups of tea with key stakeholders/bash out a pamphlet" formula). I think that youre right in that this suggests a blurring in the lines between research processes/evidence and outputs, but ethenography with key stakeholders seems only one better than cups of tea with them. I'm thinking more along the lines of overnight stays in hotels, workshops, scenario sessions combined with open-source documents and wikis etc. facilitating group discussions. Basically like a kind of post-modern rally. You give people the tools and they do the work for themselves; a bit like continuous professional development. Maybe that's fancifull.
Posted by Charlie Tims  at 4:17pm on Thursday, 18th November 2004
7
Just to come wading into this one with a pair of big, fat, reactionary boots, let's not get so wrapped up in a knowledge managing consultifying orgy of institutional self-flagellation that we underestimate the power of books and public ideas. Can't you do both? Mustn't you do both?
Posted by Paul Paul  at 2:19pm on Monday, 22nd November 2004

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