What 2 Why (eBook)

MBA Eugene Keller MD (Autor)

eBook Download: EPUB

2022 | 1. Auflage
292 Seiten
Bookbaby (Verlag)
978-1-6678-6415-0 (ISBN)

Infos

The current medical landscape is heavily impacted by technology, both information and diagnostics. Although tremendously important it has negatively impacted the relationship between patients and caregivers. The corporatization of health care has also hastened the end of the personalization of care. The book attempts to strike a balance between the relentless march of current medical trends, mirrored in many other fields and suggests the focus on personal attachment, ownership and accountability at a very human level.

---

The book is organized around five W,s. 1. What: What are we about organizationally? What is our overarching culture as expressed in goals, leadership, and approach to quality and safety?2. Why: As individuals why are we here? What is our commitment, ownership, accountability, and decision-making? The decision vortex is a balance between the information algorithm, emotional intelligence and intuition. 3. What: What do we know about our organization? How we get data and how we interpret it. 4. Why: The data is only a number, why does it occur and what analysis is necessary to make it useful. 5. What: Once we have an understanding of the Why, what can we do about it?

Textauszug

II.
INTRODUCTION

It was pretty dark in the cave and the air was filled with smoke and ash. The flickering minimal light shed by the dwindling fire did not reach the bodies clustered in its far reaches. An occasional movement or murmur was lost to the sound of moaning that pierced the smoke-filled blackness. Closer to the white coals at the fire pit base lay a single figure, clad in an oily hide covering only his genitals, holding his arm up in a pleading gesture. Blackened fingernails protruded from a scabbed and filthy hand. He pointed to his abdomen and looked at the men squatting around him with frantic eyes. Their voices raised as the figure cried out and drew his knees to his chest.

Moments later, a shadow pierced the dim light coming from the mouth of the cave. Indistinct but wearing a headdress topped with skins and antlers, the figure moved toward the group clustered around the prone body by the fire. Guttural sounds of greeting followed him as he moved forward. He kneeled carefully on the stone floor. Minimal words were spoken, and the figure adorned with animal skins threw stained and worn animal bones on the cave floor from a leather sack he pulled from around his neck. He studied the pattern of bones, making repeated animal-like barking sounds as he did so, beseeching the spirits. He then suddenly shifted his gaze to the prone figure near the fire. The clustered men halted their movement and watched as the heavily adorned newcomer reached out his hand and gently touched the suffering man. The medicine man prodded the lying man’s abdomen with troubled eyes and was rewarded with writhing and moaning.

The first history of men who joined together in the struggle against disease was recorded by Cro-Magnon artists about twenty thousand years ago. Evidence discovered in caves in Dordogne, France, was the first record of a doctor as there had been no written or pictorial language. In Ariege France, a particular cave contained actual grease paint pictures of the first prehistoric representation of a medicine man. The use of grease in the paint has helped preserve the colors from the moist air and water over the millenniums (1).

It should be noted from the suffering man on the floor of the cave that the ritual reading of bones was the primary diagnostic approach. Yet, in this instance, the medicine man redefined his role by reaching out and touching the patient. He confirmed a bond with that physical contact and tactilely added to his understanding of the patient’s underlying condition. Even though twenty thousand years ago there was no help for the “patient” that would soon die from a ruptured appendix, he took halting first steps on a path that would morph into modern medicine.

These early healing practitioners were predominantly translators of spirits, religion, and magic while touching those suffering from disease and trauma. It was not until Hippocrates that medicine started to rise out of the veil of mysticism and belief. Although considered the father of medicine, it was not for his abilities as a doctor to cure but his interest in facts that propelled us forward. He attempted to define the difference between the sick and the well, and “he scrutinized sick men and recorded honesty the signs and symptoms of disease honestly theorizing” [(2) p. 65].

It is perhaps him that we have to thank for the journey of embracing knowledge and facts to advance the safety and quality of the patients we serve. Yet, it should be noted that we are still on this trek. Unfortunately, we are still struggling despite generations of medical professionals, scientists, academics, and even the advent of the computer and its ramifications.

Multiple advances in medical technology and laboratory medicine have raised the bar in inpatient care, but untoward events and medical mishaps occur daily. There are numerous factors for this situation, gleefully reported in various modern lay communications, that yearly cause hundreds of thousands of medical errors and associated deaths. These factors must be put in a statistical perspective. Nevertheless, a single medical error or substandard care for any patient is an anathema to what we hold most dear to us. As physicians, our personal goal has always been to care for our patients every single day. We have humbly recognized the ownership of that duty and the accountability it represents.

This book represents efforts to understand the state of modern medicine, discuss how we got here, and not criticize our colleagues or those who have come before us. I know the fantastic resources in our world and hope to present some clues on how best to utilize what is available and envision our future and how to “get there.” Some of the “stories” are taken from personal experience; some are compilations, and some are gleaned from the experiences of others, either from direct communication or from the literature.

As you engage with this material, you will find many themes that play through the specific discussions on the subsequent pages. They reflect firmly held opinions, and perhaps even selected references have been cited. Danial Kahneman would suggest that we, like most everyone, have our biases (3). He and Amos Tversky virtually invented the field of behavioral economics. Still, their material is exceptionally pertinent to how we make decisions in medicine, not just in the large-scale system and data issues, but at the bedside, taking care of a single patient. Their understanding of heuristics in multiple papers led to Kahneman winning the Nobel Prize after Tversky’s death. In evaluating decisions, the theme of bias is one of the elements woven into the discussions in later pages. I will openly discuss my own biases and some of the reasons for writing this book.

Perhaps the first bias that does not even have a chapter or section devoted to it is that we can never overlook that medicine has been and always should be about basic humanity. It is ultimately people taking care of people. The essential tableau of the medicine man in the cave was his reaching out to touch the sick man, not his crying out to the spirits, not his belief in the bones, but in the confluence of his life with that of his patient. As a physician, the outstretched hand of the medicine man, the human touch, so much symbolized one of the critical elements in caring for patients.

The physician or APP (advanced care provider) of today has multiple arrows in their quiver for both the diagnosis and treatment of the patient. The introduction of the electronic health record (EHR) and the fundamental belief in its Artificial Intelligence (more accurately automated intelligence or assisted intelligence) has distracted, at least in part, the doctor’s focus from the bedside. The average provider spends significantly more time ordering and evaluating information from various sources, such as lab, radiology, MRI, and cardiac catheterizations, than with the patient. Add to this the time spent in the laborious documentation now demanded by the EHR; it is no wonder that patients don’t know who their provider is. This too will be a theme in the following pages.

As with society in general, medicine is changing extremely rapidly. Writing this during the Covid-19 pandemic highlights some of the external forces that merge with the internal influences that offer opportunities for change and demand a rapid adaption that few of us are used to. A few years ago, the diligent care provider would read the medical journals delivered to his door. Getting something written and then published was a rigorous process that took months or even years. The Internet has obliterated this lengthy process, and we now see articles and scientific data presented almost daily that record information and discoveries from just yesterday. Although an excellent source for keeping providers up-to-date, there is so much information that selectivity trumps literacy in wide-ranging areas. A practitioner felt pretty good if he kept up with two or three publications directed in his specialty. Now the information stream is so vast that, to stay current, the priorities of the modern provider demand a narrower scope. This favors specialists who can focus on new information in limited and more biased fields.

This trend in specialization has participated in significant advances in medical therapeutics and outcomes but has somewhat complicated the continuity of patient care in our health care system. Factor in the popularity of hospitalists, and the average number of individual physicians seeing a patient during a single stay in today’s hospital is three and one half. The concept of physicians wholly committed to taking care of only hospitalized patients is not new. Training programs for physicians now focus on preparing doctors to focus on patients meeting the criteria for hospitalization. Hospitalists are on-site, many twenty-four hours a day, seven days a week. For the most part, nurses calling doctors in their offices to react to rapid changes in sick patients or the response to results of a myriad of testing has been replaced with this onsite shift coverage of dedicated, well-trained in-house practitioners. However, owing to the diversity of treating individuals and the pull of the provider by the EHR (Electronic Health Record), many patients, when asked who their doctor is, cannot identify them.

Procuring follow-up care for patients discharged from the hospital continues to be a significant problem. Seeing their own primary care physician after an inpatient stay is far from a slam dunk. Because of its issues, continuity of care, both in the...

Produkt-Details

• Erscheint lt. Verlag: 21.11.2022
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie
• ISBN-10: 1-6678-6415-7 / 1667864157
• ISBN-13: 978-1-6678-6415-0 / 9781667864150