The KHIT Blog: Honoring our nurses

Sunday, November 22, 2020

Honoring our nurses

From 1993 to 2013, I served three intermittent tenures with the Nevada / Utah Medicare QIO, HealthInsight (hospitalization outcomes analyst, Novell network administrator, Health IT workflow advisor). Most of my colleagues, including senior management, were nurses. I could not have more respect for their abilities and dedication. The medical system could not function at all without them. That has never been more clear, and as we head into our dark winter of renewed Covid-19 incidence and prevalence acceleration, it will become acutely more evident. We now have numerous reports of acute care staffing shortages (nurses predominantly among them).

UPDATE

Janet Campbell-Vincent, former ICU nurse

I have been an ICU nurse for 17 years. I never thought I'd leave. Now I'm not sure I'll ever go back.

I've been on the front lines of Covid-19 since it broke out eight months ago. More than 250,000 people have now died in the United States. Case numbers are rising in all 50 states and Washington, D.C.And health care workers like me are burning out.

Meanwhile, President Donald Trump spends his weekends golfing, and Majority Leader Mitch McConnell sent the Senate home for Thanksgiving vacation a day early, even though the Centers for Disease Control and Prevention just advised against holiday travel.

I wish medical workers could take vacation days, too. I ran out of those months ago, when I contracted Covid-19 treating patients in the ICU. I'm exhausted. I'm angry. I'm sick of watching patients die. I'm tired of comforting families feeling guilty over the birthday party that cost their loved one's life.

I finally hit my breaking point and recently quit doing direct patient care in a hospital setting. Without sufficient personal protective equipment and staffed hospital beds, a national plan for testing and sufficient relief for those hardest hit by the virus, including hospitals, I didn't have the strength to continue...

GLORIA AND EMILIO ESTEFAN

Prime movers of this initiative.

Notwithstanding that I'm Irish, I have always dug the hell out of Latinx music. The Estefans are totally awesome.

Below, my friends' band in Las Vegas. Eclectic top-shelf salsa / funk / jazz. I'd love to see Emilio and Gloria sit in with them.

ON DECK

Read a review in Science. Had to get it.

In 2019, the Global Health Security (GHS) Index ranked the United States as the most prepared country in the world for a pandemic. Just over a year later, the United States has not only failed to control coronavirus disease 2019 (COVID-19), many consider the nation's response to the pandemic to be one of the worst in the world. Was the GHS Index biased? Or did the country's preparedness change drastically during this period?

Answering these questions requires understanding the pandemic as a complex system— one that reveals our greatest strengths and most debilitating weaknesses. In his provocative new book, Apollo's Arrow, Nicholas Christakis uses such an approach, drawing on his experience as both a hospice physician and a leading network scientist to integrate societal, technological, and biological data into a single cohesive narrative of the unfolding pandemic. Not surprisingly, the book is far-ranging, covering relevant aspects of epidemiology, human behavior, social networks, technology, immunology, and applied mathematics...

...There is no shortage of books that argue that pandemics are complex or ones that discuss the public health issues raised in Apollo's Arrow, and it is unlikely that there will be a shortage of future works that dissect domestic and international responses to the COVID-19 pandemic. What sets Christakis's work apart is that it was written in real time by an expert who astutely shows how pandemics are as much about our societies, values, and leaders as they are about pathogens.

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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
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"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
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"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
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"'Solutions' exist only in mathematics."

- Karen Martin
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"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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Sunday, November 22, 2020

Honoring our nurses

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