Summary:
This article describes and formally defines the Benhur effect derived from a 1950s movie in terms of achieving perfect healthcare outcomes through various means.
In many ways it follows as a logically contradictory and paradoxical solution to a much more famous effect from another movie in the 1950s called the Rashomon effect where the problem statement posed is that truth can be viewed and distorted through multiple lenses (for example clinical vs statistical significance for any data hinting at causality in healthcare) and there shall always be a lingering discontent on the residual uncertainty to any complex cultural decision making with multiple stakeholders.
The Rashomon problem is that it can be so much more of a resource drain as the truth would invariably be subject to over-testing and overtreatment (from other industry contexts just think of it as over utilisation and deployment of resources) to satisfy multiple perspectives of multiple stakeholders.
Benhur effect on the other hand is not a problem statement but a description of a perfect solution, albeit a tad magical rather than simply logical and all it shows is the perfect endpoint of all conflict resolution as an energized state visible on the countenance of the person experiencing it as a perfect example of attaining the whole gestalt in a sudden coming together of all the parts forming something more than what would be expected on adding up the parts (https://en.m.wikipedia.org/w/
whole health, peace, Nirvana, Vishwaroop darshan etc. The article below using a generous helping of quotes from other authors, discusses the theory of Benhur effect with illustrations on how humans have attempted to attain it moving from a Rashomon crisis to a Benhur state, since ages using different technology tools that evolved over time and how contemporary health care settings invoke it using user driven healthcare tools toward concerted team based learning where the outcomes are much more than the sum of it's parts.
UDHC keywords glossary:https://
Introduction:
We have been using this term, Benhur effect, in our local networks loosely over a decade and thought it was time we formalized it in this preprint.
The movie "Ben-Hur" released in 1959, employed a unique film technique in that the actor portraying Christ never showed his face, despite several scenes in which he interacted with Ben-Hur, including when he gave water to him after he had cried out to God for help, and when Ben-Hur likewise came to Jesus' aid when He needed water as He carried his cross. This technique, noted in the LA Times, subtly placed Jesus in the heart of the story. The technique evoked an aura of majesty that surrounds Christ every time he appears, as Gabriel Miller notes in his essay on "Ben-Hur."
Perhaps the most memorable moment in the entire film is when the Roman decurion, or cavalry officer — who had just denied Ben-Hur water — looks into Jesus' face. As the Hollywood Reporter notes, again, Christ's face is invisible. The audience only sees the face of the Roman melting as he realizes the sanctity of Jesus; the officer turns away, mute.
Unquote
In the context of healthcare or for that matter any service delivery industry, the unseen face of Jesus, perceived indirectly through those who are able to perceive it directly becomes a demonstration of attaining the whole (gestalt) in a sudden coming together of all the parts (https://en.m.wikipedia.org/w/
"Gestalt” as a concept was introduced by German philosopher Christian Von Ehrenfels in 1890. The term “gestalt” is abstracted from “ungestalt” (German word for ‘deformity’), which is why there is still no exact translation for “gestalt”. According to Webster’s dictionary, gestalt means “something that is made of many parts and yet is somehow more than or different from the combination of its parts”. It is commonly defined as a ‘form, or ‘shape’, a ‘unified whole’ or ‘configuration’."
Unquote:
Rashomon effect on the other hand poses the problem statement that truth can be viewed and distorted through multiple lenses (for example clinical vs statistical significance for any data hinting at causality in healthcare) and there shall always be a lingering discontent on the residual uncertainty to any complex cultural decision making with multiple stakeholders.
The Rashomon problem is that it can be so much more of a resource drain as the truth would invariably be subject to over-testing and overtreatment (from other industry contexts just think of it as over utilisation and deployment of resources) to satisfy multiple perspectives of multiple stakeholders.
"That others have perspectives that are opposed to ours but are not ‘wrong’ can be a painful thing to acknowledge. As the priest in Rashomon states: ‘This time, I may finally lose my faith in the human soul. It’s worse than bandits, the plague, famine, fire or wars.’
Unquote
Solution to the above problem statement:
Globally humans have been reconfiguring the sole individual (individual soul or self) amidst multiple disparate events (complexity) pivoting around a singular similarity that exists across multiple sole individuals (universal self or generalize-able self) who also hold on to that single similarity inspite of all their other disparate complex events. It's the current logical imperative to optimizing clinical complexity in the background of usual normative reductionism.
For most humans, the first step in this direction begins with sense making of their first clinical encounter. https://www.
And the second step is to document that encounter as a case report, maybe even as informally as a text message with a query seeking resolution from a friend or a group.
Case reports driven learning in healthcare is perhaps as age old as the usage of written communication in early human civilization and officially, the US National Library of Medicine in Washington, DC has on display one of the earliest written case reports — from 1500 BC from Egypt — an oncology case. https://www.swihm.com/
"The CARE guidelines have anticipated a long future for case reports and provide guidance for the writing of high quality case reports that benefit healthcare stakeholders around the world. “The growth of case reports in an era in which clinical trials and systematic reviews dominate the tables of content of medical journals indicates that case reports have value, particularly with the increasing importance of individualized care."
Gagnier JJ, Kienle G, Altman DG, et al. The CARE Guidelines: Consensus-based clinical case reporting guideline development. Global Adv Health Med. 2013;2(5):38-43. doi:10.7453/gahmj.2013.008.
Individualized care has seen exponential growth in the era of internet where multiple internet users who are also stakeholders in the individual patient's care, such as health professionals, administrators, patients and their relatives interact in a process of medical cognition, which is directed to improving that particular individual patient's health outcomes. Medical cognition was first described by Dr Vimla Patel in 1999, and cognition in medicine pivoting around a case based gestalt was described by Dr
Helmut Kiene around the same time.
In recent times the entire process of medical cognition that regularly happens globally in real time as a team based learning between local patients, relatives, advocates and global physicians, scientists and technologists was termed user driven healthcare with it's slogan 'global learning toward local caring!'
https://pubmed.ncbi.nlm.nih.
One of the important concerns in user driven healthcare workflows globally is protecting patient privacy and confidentiality and a real world practiced strategy, recently over few decades that has it's origins with the first printed case report at 1,500 BC is to deidentify the patient data and remove personal identifying information or personal health identifiers as per established global guidelines such as HIPAA. https://www.ncbi.nlm.
Hence humans have been creating deidentified case reports since ages with the sole purpose of matching each deidentified solo case report with an assortment of similar deidentified solo case reports such that one can join certain common dots or attributes in each solo case and create a bigger whole that often becomes an ontology (aka something that binds and joins and is itself a bound fabric, think of the two needles in the process of knitting a sweater)! More here: https://
The deidentified case report which is also a deidentified EHR (electronic health record) is akin to a horcrux from which a part of the individual soul of the person being presented has been removed to allow it to amalgamate and integrate with an ontology of matching attributes that could make up a clinical problem. It's a digital twin that has come from an individual with a potential to form not just digital twins but multiple more horcruxes in triplets, quadruplets, quintuplets and so on! More about the horcrux EHR digital twin case report here: https://userdrivenhealthcare.blogspot.com/2024/08/the-horcrux-ehr-electronic-health.html?m=1
Benhur effect postulates that even without being able to identify the person, multiple stakeholders, in the problem solving team based learning exercise, centred around the patient's problem, would still be reasonably effected by the patient's data at multi dimensional levels which would help them to answer the patient's multidimensional requirements.
The actual manifestation of the Benhur effect (as felt in the movie and elucidated above) can happen to all stakeholders in the patient centred team based learning group and is described in a quote below:
"The needs of both the patient and the clinician for connection and meaning in their lives are possibly met through a transpersonal dimension of medical care that may be recognized in occasional moments during medical encounters.
These moments are often marked by a
physiologic reaction, such as gooseflesh or a chill; by an immediacy of awareness of the patient’s situation (as if experiencing it from inside the patient’s world); by a sense of being part of a larger whole; and by a lingering feeling of joy, peacefulness or awe. Such moments seem to be therapeutic for the patient and the clinician alike."
Unquote:
Matthews, D. A., Suchman, A. L. & Branch, W. T., (1993) Making
‘connexions’: enhancing the therapeutic potential of patient-clinician
relationships. Annals of Internal Medicine, 118, 973–977.
https://commons.m.wikimedia.org/wiki/File:Ben_hur_1959_poster.jpg#mw-jump-to-license
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