The KHIT Blog: The Empathy Diaries

Sunday, April 18, 2021

The Empathy Diaries

What a life! #TheEmpathyDiaries

72, 'eh? Ma'am, can I see some ID?

I forget now how this book came my way (IIRC it may have been an Amazon recommendation), but I am immeasurably grateful it did. I've been on a reading tear across the past two weeks (while watching every day of the ominously portentious Derek Chauvin murder trial live).

I related to Dr. Turkle's memoir on so many levels. Right outa the chute, I had an "Amen" moment.

Yeah. Fundamental to the SOAP process: Look, Listen, Palpate. "Information" has to effectively abet those, not replace them.

See also my "Clinical workflow, clinical cognition, and The Distracted Mind."

Recall that this blog commenced as an iconoclastic (often heretical) tech diary of my work in Health IT prior to my retirement. Early on, I took no prisoners. See my "Clinic Monkey" spoof site.

Beyond Sherry's astute academic and tech observations, I was quite moved at the outset by her candid, often painful personal "memoir" revelations regarding family difficulties. I am two years her senior, born in western Long Island not far from the NYC Queens borough. All of my family hails from that area (e.g., Floral Park, Elmont). Her descriptions of her young life resonated with me vividly—"empathic" reactions in spades.

I too experienced ongoing parental turmoil. My Dad came home from WWII minus the leg he left behind on Sicily (night landing glider crash). His teen dream of becoming a golf pro dashed, he would subsequently be the chronically angriest man I ever knew, a hair-trigger combative. I mostly just feared him and tried to avoid his wrath. My Ma was profoundly clinically bipolar, hobbled by recurrent "nervous breakdowns" landing my sister and I at Grandma's in Elmont and her in "sanitariums," where the go-to treatment of the era was electroshock (lithium, where art thou?). All it did was make her angry as well. I sometimes have joked (unfairly) that it was "a miracle I'm not a serial axe-murderer" given the enervating acrimony under our roof.

By the time I was 18, I'd had quite enough, thank you very much. In lieu of college, I went on the road in a bar band. Got my first college degree 21 years later at age 39 and hung up the axe. I now joke that I'm just "an ailing, old washed-up guitar player."

I also used to joke that I traded the guitar for the keyboard—the IBM 101 PC keyboard. It paid better.

Sherry is on a bunch of videos on YouTube. e.g.,

Wonderful. Buy and read her memoir. A great life story, and a person with compelling, timely analytic observations on technology and humanistic ethics.

My favorite quote from Sherry's book.

Goes to my concerns with respect to the overlapping exigencies we face: The Covid-19 pandemic, economic turmoil, academic disruption, healthcare system stresses, climate change, pollution, menacing threats to democracy, and social/racial justice challenges.

We're gonna have to materially Up Our Game, IMO. and, time is not on our side.

“I’ve explored the human effects of science and technology since I arrived at MIT from Harvard in 1976 with a doctorate in sociology and psychology. My subject is the “inner history” of technology, how it changes our relationships, including our relationship with ourselves. Over the years at MIT, I have been able to see how easy it is for a fascination with technology to take well-intentioned people away from empathy and its simple human truths. So technologists become invested in the promise of electronic medical records and forget how important it is for physicians to make eye contact with patients during their meetings. Engineers become fixed on the idea of efficiency, and soon it seems like a good thing to prefer texting to face-to-face talk, because on screens we can discuss personal matters with less emotional vulnerability. Talking to and through machines makes face-to-face exchanges with people seem oddly stressful. And less necessary. These days, our technology treats us as though we were objects and we get in the habit of objectifying one another as bits of data, profiles viewed. But only shared vulnerability and human empathy allow us to truly understand one another.”

NetFlix miniseries documentary, anyone?

_________

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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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Sunday, April 18, 2021

The Empathy Diaries

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