{"id":40136,"date":"2017-09-15T16:10:08","date_gmt":"2017-09-15T15:10:08","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=40136"},"modified":"2017-09-25T14:53:35","modified_gmt":"2017-09-25T13:53:35","slug":"jeffrey-aronson-when-i-use-a-word-performance","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2017\/09\/15\/jeffrey-aronson-when-i-use-a-word-performance\/","title":{"rendered":"Jeffrey Aronson: When I use a word . . . Performance"},"content":{"rendered":"<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/jeffrey_aronson.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-32935\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/jeffrey_aronson-223x300.jpg\" alt=\"jeffrey_aronson\" width=\"112\" height=\"151\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/jeffrey_aronson-223x300.jpg 223w, https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/jeffrey_aronson.jpg 446w\" sizes=\"auto, (max-width: 112px) 100vw, 112px\" \/><\/a>As I discussed <a href=\"https:\/\/blogs.bmj.com\/bmj\/2017\/09\/08\/jeffrey-aronson-when-i-use-a-word-art-and-science-medical-skills-and-knowledge\/\">last week<\/a>, skills and knowledge constitute the art and science of medicine. To these the General Medical Council, in the first domain in its <a href=\"http:\/\/www.gmc-uk.org\/guidance\/good_medical_practice\/knowledge_skills_performance.asp\">document<\/a> <em>Working with Doctors; Working for Patients<\/em>, adds \u201cperformance\u201d. This suggests a modern reworking of an ancient construct, the trivium (implying eloquence) and the quadrivium (implying knowledge).<\/p>\n<p>The word \u201cart\u201d has <a href=\"https:\/\/blogs.bmj.com\/bmj\/2017\/08\/25\/jeffrey-aronson-when-i-use-a-word-art\/\">diverse meanings<\/a>. Among them, the plural form \u201carts\u201d was very early on (the first example in the <em>Oxford English Dictionary<\/em> dates from 1300) used to describe the seven subjects formed by combining the ancient trivium and quadrivium (Box). These subjects, outlined by Plato in <em>The Republic<\/em>, gave an excellent educational grounding for the study of philosophy and practical subjects, such as medicine and architecture. Later, the terms \u201cfree arts\u201d and \u201cliberal arts\u201d were used instead, conveying, in the words of the <em>OED<\/em>, \u201cthe idea that these were the subjects of study considered worthy of a free man\u201d. Today, universities confer the degrees of Bachelor or Master of Arts on graduates in any subject, including sciences.<\/p>\n<p>I have in mind a modern trivium and quadrivium, to some extent reorganising the ancient ones. The modern quadrivium combines general literacy (reading and writing); numeracy (mathematics);\u00a0<a href=\"http:\/\/www.voice21.org\/\">oracy<\/a>, the ability to speak and communicate clearly; and computeracy. The modern trivium combines skills, knowledge, and performance in any specialised field of study and practice (Box). I have previously discussed <a href=\"https:\/\/blogs.bmj.com\/bmj\/2017\/09\/08\/jeffrey-aronson-when-i-use-a-word-art-and-science-medical-skills-and-knowledge\/\">skills and knowledge<\/a>.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-40142 aligncentre aligncenter\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/09\/aronson_performance_replace.png\" alt=\"\" width=\"717\" height=\"291\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/09\/aronson_performance_replace.png 594w, https:\/\/blogs.bmj.com\/bmj\/files\/2017\/09\/aronson_performance_replace-300x122.png 300w\" sizes=\"auto, (max-width: 717px) 100vw, 717px\" \/><\/p>\n<p style=\"text-align: center\"><strong>Box<\/strong> Quadrivium and trivium, classical and modern<\/p>\n<p>The word \u201cperform\u201d comes from the IndoEuropean root <a href=\"http:\/\/www.bmj.com\/content\/342\/bmj.d34\">MERBH<\/a>, to shine. MERBH gives the name Morpho to a genus of nymphalid butterflies with shiny blue wings. And because anything that shines can easily be seen, MERBH also came to mean to appear or take shape. The Greek word \u03bc\u03bf\u03c1\u03d5\u03ae, form, gives us allomorph, amorphous, morphology, and metamorphosis. Morpheus, the Greek god of sleep, who gives us our name for morphine, conjured shapes in men\u2019s minds while they slept. Anamorphosis is a distorted projection or drawing, most famously seen in the skull at the foot of Hans Holbein\u2019s portrait <em>The Ambassadors<\/em> (picture). James Murray, the first editor of the <em>OED<\/em>, referred to this picture in an article in the <em>Mill Hill Magazine<\/em> in 1876, describing the skull as \u201canamorphosed\u201d; when he included the verb \u201canamorphose\u201d as a back formation in the first fascicle of the <em>OED<\/em> (1884), the only example he could find was in his own article, which he therefore cited.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-40139\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/09\/aronson_performance2.png\" alt=\"\" width=\"621\" height=\"612\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/09\/aronson_performance2.png 506w, https:\/\/blogs.bmj.com\/bmj\/files\/2017\/09\/aronson_performance2-300x296.png 300w\" sizes=\"auto, (max-width: 621px) 100vw, 621px\" \/><em><br \/>\nDouble Portrait of Jean de Dinteville, the Bailly of Troyes and Georges de Selve, Bishop of Lavaur<\/em>, better known as <em>The Ambassadors<\/em> (1533), by Hans Holbein the Younger. For a detailed discussion of the objects in the painting see <a href=\"https:\/\/archive.org\/details\/gri_33125001712401\">Hervey MFS<\/a>. <em>Holbein&#8217;s &#8220;Ambassadors&#8221;: The Picture and the Men. An Historical Study<\/em>. London: G Bell &amp; Sons, 1900, and <a href=\"http:\/\/www.kristenlippincott.com\/assets\/Uploads\/1999-Holbeins-Ambassadors.pdf\">Dekker E, Lippincott K<\/a>. <em>The scientific instruments in Holbein&#8217;s <\/em>Ambassadors<em>: a re-examination<\/em>. J Warburg Courtauld Inst 1999; 62: 93-125.<\/p>\n<p>The goddess Aphrodite was supposedly named from aphros, the foam of the sea, whence she was born, as Botticelli (<em>The Birth of Venus<\/em>, 1485) and Titian (<em>Venus Anadyomene<\/em>, 1525), among others, depicted. But \u201cAphro\u201d also looks like Morpho metathesised, and Morpho is what the Spartans called the shapely Aphrodite.<\/p>\n<p>Metathesis morphed the Greek \u201cmorph\u201d into the Latin \u201cforma\u201d, appearance or beauty, and its diminutive, \u201cformula\u201d, shape. Formosus meant full of shape and therefore beautiful; \u201cInsula Formosa\u201d was the original Portuguese name for Taiwan. Forma also gives us form and format, conform, deform, inform, platform, proforma, reform, transform, uniform, the vermiform appendix, and of course perform. In Latin, formare meant to give shape to something and the postclassical addition of the prefix per-, with the connotation of thoroughness or completion, gave performare, to give a definitive shape to, and therefore to carry out an action.<\/p>\n<p>The GMC doesn\u2019t explicitly define \u201cperformance\u201d, a potentially ambiguous term, since it can be good or bad. However, paragraphs 7\u201313 in Domain 1, \u201cDevelop and maintain your professional performance\u201d, state that \u201cYou must be competent in all aspects of your work, including management, research and teaching, \u2026 keep your professional knowledge and skills up to date, \u2026 regularly take part in activities that maintain and develop your competence and performance, \u2026 be willing to find and take part in structured support opportunities offered by your employer or contracting body, \u2026 be familiar with guidelines and developments that affect your work, \u2026 keep up to date with, and follow, the law, our guidance and other regulations relevant to your work, \u2026 [and] take steps to monitor and improve the quality of your work.&#8221;<\/p>\n<p>Presumably, all of these things constitute \u201cperformance\u201d, the things one is expected to do and at which one is expected to be competent. The <em>OED<\/em> defines competence as \u201cSufficiency of qualification; capacity to deal adequately with a subject\u201d.<\/p>\n<p><em><strong>Jeffrey Aronson<\/strong>\u00a0is a clinical pharmacologist, working in the Centre for Evidence Based Medicine in Oxford&#8217;s Nuffield Department of Primary Care Health Sciences. He is also president emeritus of the British Pharmacological Society.<\/em><\/p>\n<p><strong>Competing interests:<\/strong>\u00a0None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>As I discussed last week, skills and knowledge constitute the art and science of medicine. To these the General Medical Council, in the first domain in its document Working with [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2017\/09\/15\/jeffrey-aronson-when-i-use-a-word-performance\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":38359,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5762],"tags":[],"class_list":["post-40136","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-jeff-aronsons-words"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Jeffrey Aronson: When I use a word . . . 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