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looked properly, explained her thinking and answered our questions She could have helped create autonomy in all four of us but instead she treated us as an irritation, therefore causing us to be much sadder, more anxious and more annoyed than we need have been The second reminder happened the next day, at the conference A presenter was giving a paper summarising the results of her PhD research on shared decision-making between doctors and patients with end-stage renal failure124 She had discovered that the doctors she had researched were exclusively concerned with what she called molecular management with clinical concerns about co-morbidity, survival rates, scheduling dialysis according to clinical priorities, and so forth whereas the patients were concerned about their quality of life being able to go shopping and to spend time with their families, even if this meant going against some of the clinical priorities.

The right product encompasses in the rapidly evolving markets a very advanced services and systems concept. GSM offers the most comprehensive range of services: telephony, short message, data and a very comprehensive range of supplementary services. Above this a superior set of toolkits for service creation was de ned. GSM is the only system allowing a global roaming to all continents. GSM offers an unmatched voice quality due to the basic high quality radio transmission and a range of voice codecs, even with an adaptive system solution offering the optimum combination of capacity and quality in each cell. GSM systems offer a very high capacity by employing a very high frequency ef ciency by using an advanced TDMA technology with adaptive power control, strong channel coding and equalisation, slow frequency hopping and discontinuous transmission, microcells under the umbrella of macrocells. GSM is very robust due to the mobile assisted handover. GSM is optimised for hand-helds. Digital technology allows the use of very largescale integration. The technology is less complex than some competitors. A sleep mode allows battery saving. Slow frequency hopping ensures a high quality for slowly moving hand-helds. GSM s superior security and anti-fraud measures protect the users privacy and the operator s revenue. GSM is an open standard, that is not dominated by the IPR of a single manufacturer. GSM provides the only complete system standard de ning services, system architecture and selected interfaces: SIM/ME, terminal/base station, two intra-network interfaces and an inter-network interface enabling international roaming. GSM terminals, infrastructure and test systems have the highest market volume and the widest number of manufacturers leading to the widest choice and lowest cost.

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Paradigm X concerns were making Paradigm Y possibilities invisible Everyone (apart from the medical establishment, apparently) knows why this is happening: despite everyone else in the world being able to see it as plain as day, doctors do not understand that work for health is work to liberate a broad range of human potentials and so they miss the chance to make health care more humane They don t miss the chance because they are bad or uncaring people, they miss it because the system that taught them and the system they work in is so overwhelmingly locked into Paradigm X that it blinds them to basic human considerations and it blinds them to the fact that they need to make a commitment: (a) to working for a speci ed purpose; and (b) to their own version of what it is to be ethical.

Another way of putting this is to say that the doctors rational elds are not properly seen by them They believe they are practising solely evidence-based medicine, but this is impossible in fact they are stumbling in ethical blindness, unable to see beyond the wall that surrounds their clinical pathways and ow-charts, often almost totally unaware of patients quite different rational elds Doctors suffer from both a lack of insight and a lack of outsight.

This simple intervention allows the therapy to continue while making subtle inroads into the dysfunctional communication style It is far more effective to introduce small, positive changes in the context of therapy than to attempt to teach an abridged version of Communication 101 Beyond the obvious intent of allowing each partner time to speak and be listened to, the purpose of effective communication is to encourage partners to reach out to each other at a far deeper level than in the past Keeping communication at a superficial level is what they have become accustomed to Using new communication skills involves risk: sharing insecurities and vulnerabilities, listening to the emotion beneath the words, and sharing profoundly in the joys and struggles that are part of life.

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