The KHIT Blog: Health care for the homeless

Saturday, March 9, 2019

Health care for the homeless

More on that logo art in a moment. Love it.

First, as part of my customary early morning online news review workflow, I ran across this at The Atlantic:

Medieval Diseases Are Infecting California’s Homeless
Typhus, tuberculosis, and other illnesses are spreading quickly through camps and shelters.

…“Our homeless crisis is increasingly becoming a public-health crisis,” California Governor Gavin Newsom said in his State of the State speech in February, citing outbreaks of hepatitis A in San Diego County, syphilis in Sonoma County, and typhus in Los Angeles County.

“Typhus,” he said. “A medieval disease. In California. In 2019.”

The diseases have flared as the nation’s homeless population has grown in the past two years: About 553,000 people were homeless at the end of 2018, and nearly one-quarter of homeless people live in California.

The diseases spread quickly and widely among people living outside or in shelters, helped along by sidewalks contaminated with human feces, crowded living conditions, weakened immune systems, and limited access to health care.

“The hygiene situation is just horrendous” for people living on the streets, says Glenn Lopez, a physician with St. John’s Well Child & Family Center, who treats homeless patients in Los Angeles County. “It becomes just like a Third World environment, where their human feces contaminate the areas where they are eating and sleeping.”

Those infectious diseases are not limited to homeless populations, Lopez warns: “Even someone who believes they are protected from these infections [is] not.”…

Shit. Literally and metaphorically.

I have never been homeless (came close once, in 1967, in the wake of an extended period of illness). I can't imagine.

More recently, before my younger (now late) daughter was dx'd with Stage IV pancreatic cancer, I was a weekly volunteer with the San Francisco "Muttville.org" senior dog rescue center. The nation's most highly overeducated dog rescue shelter laundromat attendant. My parents never let us have pets. I've been a stray magnet ever since. "Senior dog rescue?" I'm there.

The seven or so blocks between the 16th and Mission BART station and Muttville burst at the sidewalk / curbside seams with the shopping carts, blue tarps, tents, and raggedy deitrus of the homeless.

Nasty. Sad. Pungent odors in the air. Watch where you step.

I try to imagine. And I am so grateful for our relative good fortune. As I write, Cheryl and I are doing the final paperwork to close on our 3rd (and likely final) home purchase, in Baltimore, to be close to our son, who happily lives there with his (Baltimore native and state environmental engineer) Eileen in Pigtown.

He has now lost both of his elder sisters to cancer and is the last kid standing. We have to be nearby.

In light of our lovely over-the-ingoing-budget-cap price tag on this place we settled upon, I feel a coming-out-of-retirement stint looming in my future (Cheryl has certainly earned her slack). With my new aortic valve firmly pounding away, I'm loaded for Bear. (There's always Busking, LOL.)

So, just out of curiosity I started putzing around on SimplyHired.com. Talk about a target-rich environment in Baltimore-DC area: "writer," "analyst," "policy analyst," "ethicist," "ASQ," "quality engineer,"... tons.

"Lean health care?" Yes!

Which led me to "Health Care for the Homeless" of Baltimore (and Maryland more broadly). They're soliciting for a (Lean) "Performance Improvement Specialist."

We need to talk. These folks are doing important work.

to wit, apropos of the above Atlantic article, see their page "Homelessness makes you sick."

Indeed.

Their national affiliation:

nhchc.org

UPDATE

Wow. Just wow.

Below, is this cool, or what?

Again, The Atlantic:

"People living on the streets or in homeless shelters are vulnerable to such ['medieval' disease] outbreaks because their weakened immune systems are worsened by stress, malnutrition, and sleep deprivation. Many also have mental illness and substance-abuse disorders, which can make it harder for them to stay healthy or get health care."

ERRATUM

In 2012 while covering one of my many conferences I met and immediately befriended techie internal med physician Jan "Doc" Gurley, a well-known authority on the medical plights of the homeless. She'd long been with the San Francisco Department of Public Health.

A couple of years ago, she just seemed to fall off the planet. No one among my Health 2.0 crowd knows what has become of her. The last time we spoke she told me of her new effort to address the medical plights of parolees (who overwhelmingly become homeless--if not reincarcerated--in short order). I told her I'd love to help with that. She told me she was taking CCTV classes at Berkeley to learn how to do video documentary episodes.

Then, "poof." Vanished.

Disconcerting. Anybody?

ON DECK

Amazon's "AI" has certainly "got my number."

I expect this book will cohere nicely with my prior post "Can medicine be cured?"

"Polypharmacy?" "Overdo$ed America?"
_____________

More to come...

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Brave New Health

Commonwell Health Alliance

Another important read (pdf)

I love this kind of stuff. It sustains and humbles me. "As politicians, advertisers, salesmen, and propagandists for various political, economic, moral, religious, psychic, environmental, dietary, and artistic doctrinaire positions know only too well, fallible human minds are easily tricked, by clever verbiage... Common language—or at least, the English language—has an almost universal tendency to disguise epistemological statements by putting them into a grammatical form which suggests to the unwary an ontological statement. A major source of error in current probability theory arises from an unthinking failure to perceive this."

Quotes

"An economist is a person who sees something that works in practice and tries to figure out whether it will work in theory."

- J.D. Kleinke, medical economist
___

"The only person who enjoys change is a baby with a wet diaper."

"Every misspent dollar in our health care system is part of somebody's paycheck.

- Brent James, M.D., M.Stat

“We could do healthcare, at markedly higher quality, for everyone in this country, without rationing or denying anybody the care that they need, without having the government dictate how doctors practice or whether hospitals could expand, at half the cost we do it now.”

- Health Care Futurist Joe Flower

Most of the sciences, unlike parts of medical science, are not concerned with the impossible. There is not complementary and alternative physics, or chemistry, or biochemistry, or engineering. These disciplines compare their ideas against reality, and, if the ideas are found wanting, abandoned."

- Mark A. Crislip, MD

"Q: How much alcohol is too much?
A: More than your doctor drinks."

- a physician I once heard speak during a CME presentation

“Just because science doesn’t know everything, doesn’t mean you get to fill in the gaps with whatever fairy tale most appeals to you.”

- Dara O’Briain

'[I]t is one small step from using the computer for "helping" doctors to monitoring them, judging them, dictating to them what to do, and withdrawing payment for computer non-compliance. The use of computer data is a multi-edged sword. It can be used for the "good," facilitating diagnosis and treatment and making it more accurate and up-to-date, and for “evil,” invading privacy, inviting security breechs, and making decisions based on the opinions of remote authorities rather than those present at the patient-doctor encounter.'

- Richard Reece, MD

“[T]here ARE statistics which are non-political. Just because The Washington Post/Fox News reports the temperature is 75 degrees doesn’t mean it’s really snowing and sunscreen is a liberal/conservative plot. Even if you earn a living being ideological.”

- Michael L. Millenson

"It is a generally a fairly convincing argument that people shouldn’t have to be subsidized to undertake a change which is in their best interest.

The reconciliation seems to be that EHR is not supposed to make a doctor’s practice more efficient and higher quality. It is supposed to make the system of care more efficient and higher quality, which is not the same thing. Those of you who took calc recall that maximizing the total of variables is not achieved by maximizing any one variable and this is a perfect example of that.

Those of you have served in combat certainly noticed that too — if everyone works as a team the unit takes fewer casualties. If you try to save your own hide, you might, but at the expense of more casualties overall."

- Al Lewis

"There are two ideas to keep in mind about Bayesian reasoning and how we tend to mess it up. The first is that base rates matter, even in the presence of evidence about the case at hand. This is often not intuitively obvious. The second is that intuitive impressions of the diagnosticity of evidence are often exaggerated."

- Daniel Kahneman, "Thinking, Fast and Slow"

"Physicians apply advanced scientific knowledge, but they must do so without the favorable conditions that experimental scientists create for themselves. Multitasking is forced on physicians, often in chaotic environments and under severe time and resource constraints."

- Lawrence and Lincoln Weed, "Medicine in Denial"

"It’s time to stop the whining about Obama care and acknowledge we already have universal health care. We just pay for it in the stupidest way possible that ensures problems are that much more disastrous and complicated when they’re finally treated."

- Mark Hoofnagle, MD, PhD

"Every act of conscious learning requires the willingness to suffer an injury to one's self-esteem. That is why young children, before they are aware of their own self-importance, learn so easily."

- Thomas Szasz, MD
___

"Of course, one reason that process metrics* are so popular is that processes are much easier to define and measure than outcomes."

- The Skeptical Scalpel
___

"There is an “illusion of validity” for any random data point, a seductive sense that is colored by what we hope will be true. Mountains of pharmaceutical claims are often made from mere molehills of data."

- Danielle Ofri, MD
___

"Joy empowers people. It is a source of energy that enables people to hope and plan and change their lives for the better. Spend some time around someone who is relentlessly negative and how do you feel–drained, right? More and more research shows that joy is not something that just happens to you, like a bolt of lightening out of the blue. Joy is, instead, a habit to cultivate. Negative thinking and despair are the crabgrass of our souls–weeds that take root and spread, sometimes to all areas of life. Joy, in contrast, is a soul’s rose–hardy when cared for, able to put down roots over time and withstand disease and extremes. Like a rose, however, your joy can become blighted from neglect or harsh conditions. We all need to tend to our joy–to prune away the badness, and to know that, even though it may look like a prickly bare root, if you invest time in a joyous outlook, gorgeous things will bloom, even in the harshest conditions."

- Dr. Jan Gurley
___

"'Solutions' exist only in mathematics."

- Karen Martin
___

"The issue of how to regulate clinical software is, in the long run, indistinguishable from the issue of how to regulate medicine. The only difference is that medicine is practiced in the open, without secrecy, subject to peer review, and under a merit-based state license."

- Adrian Gropper, MD
___

"Economist, rope, tree: some assembly required."

- Source unknown

DISCLAIMER:

I write this blog wholly on my own time and my own dime. The views proffered are expressly my own as a concerned and active citizen/taxpayer (in addition to being the result of my substantive experience in the various IT fields), and in no way reflect any policy views of my former employer, notwithstanding that some of the thinking has indeed obviously been spurred by the implications of the work with which I have been doing for them.

FAIR USE POLICY
I cite a ton of news and web sources spanning the breadth of relevant technical and policy domains, sometimes at substantial length. I believe I remain well within the bounds of "Fair Use," as [1] I am not doing any of this for profit, [2] I always provide attribution and links -- which, [3] far from negatively impacting any copyright holders' commercial interests, might actually increase traffic to and interest in their offerings.

Nonetheless, should I post anything of yours regarding which you have any objection, just let me know and I will remove it forthwith.

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Saturday, March 9, 2019

Health care for the homeless

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