The KHIT Blog: KHIT Reporting from Body-More Murdaland

Tuesday, June 4, 2019

KHIT Reporting from Body-More Murdaland

A.K.A. Baltimore, Maryland.

A "graffiti" screen shot from HBOs' 89 hour masterpiece "The Wire."

Back during my second tenure with the Nevada-Utah HealthInsight Medicare QIO (the 2005-2008 "DOQ-IT" initiative), I was sent to the eClinicalWorks Boston area HQ for a week of hands-on training on their eCW ambulatory EHR. One night while surfing the TV channels in my hotel room I ran across "The Wire." I'd not even been aware of it.

I was stunned, mesmerized, instantly hooked. I eventually bought the DVD box sets for all five seasons, and have watched each episode therein at least a dozen times. I can cite verbatim large swaths of the screenplay.

Yeah, I know. Get a life...

From The Wiki:

Set and produced in Baltimore, Maryland, The Wire introduces a different institution of the city and its relationship to law enforcement in each season, while retaining characters and advancing storylines from previous seasons. The five subjects are, in chronological order: the illegal drug trade, the seaport system, the city government and bureaucracy, education and schools, and the print news medium. The large cast consists mainly of actors who are little known for their other roles, as well as numerous real-life Baltimore and Maryland figures in guest and recurring roles. Simon has said that despite its framing as a crime drama, the show is "really about the American city, and about how we live together. It's about how institutions have an effect on individuals. Whether one is a cop, a longshoreman, a drug dealer, a politician, a judge or a lawyer, all are ultimately compromised and must contend with whatever institution to which they are committed."

Now Cheryl and I live here, in the venerable bucolic, Colonial "shire" that is the "Homeland District" not far from Johns Hopkins University. Mere blocks away, on the east side of the north/south York Road, police helicopters routinely circulate amid recurrent news reports of "shots fired." A recent NY Times article featured a graphic depicting a cluster of notably violent areas. Midway down was a cluster of central American countries--El Salvador, Guatemala, Honduras, Nicaragua--with the city of Baltimore right in the mix.

Whatever. I will be buying one of these t-shirts. Saw a huge mural poster on the wall of a church a couple of blocks from our house.

Repeatedly, when I tell locals that I just moved here, I get "condolences." "What? Why? Did you kill someone and have to escape California?"

Our son Matt lives here, in Pigtown with our delightful future daughter-in-law. She's a Baltimore native and an environmental engineer with the state of Maryland. They love it here. After Matt lost a second sister to cancer last year, he's our last kid standing. Moving close by was a no brainer. Our CusterFluck of a transcontinental journey is beginning to fade into a dull irritating memory. Baltimore it is. Gotta find ways to serve productively.

Baltimore is getting a lot of stuff right. Note my permanent links column hard link on the right above the fold--"Healthcare for the Homeless."

BTW, see also my April 22nd post "An #Earthday reflection from Baltimore."

I also need one of these for my yard. They're all over Homeland.

JUNE 15TH UPDATE ERRATUM

An outraged neighbor just posted about this bit of "witty" vandalism on Nextdoor.com.

I wouldn't be surprised if the perp was Biff from Delta House at Loyola University Maryland just down the street.
_____________

More to come...

No comments:

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.

The KHIT Blog

Search the KHIT Blog

Tuesday, June 4, 2019

KHIT Reporting from Body-More Murdaland

No comments:

Post a Comment