Only Anecdotal

5pm came none too soon today, phones ringing, and the strangest and most difficult situations making me wonder what on earth had happened over the weekend.

And then, we all remembered the full moon.

Oh, I have used the full moon as a catch-all explanation before, along with other convenient superstitions. But in truth, it is just another way of expressing that I often feel a need for making sense out of nonsensical situations, and often want some control when in fact I have very little–or absolutely none.

I include the idea of “evidence-based practices” in this conversation tonight, not in the medical sense, but because I often consider the meaning of this concept in my own work, as I try to justify it. Sure, I do keep data for my day job, despite what I talk about here, and am surprised more at the sheer quantity of people served than in any trends I see in those particular numbers. Maybe the numbers I pull are not the right ones. But then, what should I be measuring?

So, I think through the various stories I hear–my evidence, only anecdotal, as I have said–and try to look for patterns. Why so many people from one particular town? I assume a common referral source, but then realize that they are coming from everywhere, from doctor’s offices to hospitals to the neighbor from two towns over. Why so many with the same disability? or the same age? and why all at once?

I try to think of marketing efforts, or people in the community who have talked to me recently, or anything that makes sense of it all.. and rarely can I figure out any sort of reasons. Maybe it’s in the water. Or maybe there really are a lot of people who are turning eighty years old at the same time in a particular town, a town that lacks resources for transportation, perhaps, and a town where reassessed properties have caused taxes to rise dramatically on houses that these octogenarians paid off years ago…

But we have not measured these sorts of things–not effectively–and we certainly have not added transportation resources or other services that may give any sort of opportunity to test what sort of difference they might make.

And this leads me back to thoughts about the full moon, and that natural event that somehow may predict things. The moon, the stars, the transit of Venus… Do they predict anything?

In many ways, I like to deal with uncertainty, to figure out how to cope in spite of it–because in the end, life itself is uncertain. Beyond that, also, sometimes all the causal relationships we try to create may in the end make no difference if the people involved do not believe in them. And they believe in them, because they feel the difference from a qualitative perspective, not because we assign a quantitative value to that difference.

I want to figure out evidence-based practices for people’s lives–but I am not sure that any of us is ever so great at determining what will work best in a situation that is not our own. We can insist that someone will do better in a situation, but in fact, we may be better at predicting the emergency department visits spiking at the full moon.

Perhaps the thing we should measure is whether people, given enough resources, really do figure out their own best practices for themselves, and in what manner they want to use our expert advice.

But for now, it is easy to be superstitious when we have so few other choices. And maybe, just maybe, good things will happen, if I just keep my fingers crossed.

Oh, and get ready: there is another full moon later this August! Only in a blue moon…