Tag: blogs I like

Diamonds in the Rough ‘n Tumble Webternets: What Med-people of Conscience Are Blogging (Part 4/4)

Posted by – August 19, 2014

Part 4 of 4 of the series When Life and Death is “A Matter of Policy”

For part 2, I wrote an overview of some of the bad things that have occurred when people in medical settings follow policy strictly even when it leads to horrible consequences, or in the case of Eric Garner, they don’t follow anything (aside from what the cops said) with horrible results.  In part 3, I covered the psychology of obeying.
For the last part, I look at what some med-people of conscience have said about obeying bad top-down mandates, the VA kerfuffle, and related issues as our medical ecosystems undergo tectonic shifts in the U.S. with very mixed, highly debatable, results.

I’ve always been drawn to posts blogged by nurses, doctors, RTs, et al…

Cartoon description: Just like the iconic photograph of five helmeted WW2 veterans working together to plant an American flag in a muddy clearing on Iwo Jima, but in this iteration, the five famous GIs struggle to foist forward a tower of VA paperwork instead.

“VA Red Tape” by John Darkow, Columbia Daily Tribune.

and for understanding the complexities of the overlapping universes (univerii? the multiverse?) of health care models and their rules and regulations, the medical bloggers out there are invaluable.

Dr. Marc-David Munk, blogging from his unique vantage point as “Chief Medical Officer” of an ACO in Central Massachusetts, explains the paradox behind the epic fails seen at the VA and other “big healthcare” institutions: the more top-down mandates, rigid accountability rules, and abstract “performance metrics” are imposed, the more you accelerate crapification¹, enable unaccountability and cooking the books, remove front-line staff’s decision-making powers, and lessen patient-focused medicine.
Dr. Munk deftly unpacks the weirdity:

It’s a common story to anyone who has been around big healthcare: senior management attempts to respond to a business problem by implementing a series of high level mandates that remove front-line management’s ability to think and make operational decisions.

…A cascade of things happens with high-level mandates: Senior management becomes obsessive about setting and measuring metrics. The degrees of freedom for people to make patient-focussed care decisions diminishes and every manager along the way starts to feel squeezed on all sides. Some find work-arounds such as the secret set of “waiting lists” kept off the books at the VA and the false reports generated by some.

See the entire blog post: The VA, Laws on Healthcare and the Dangerous Business of Replacing Front-Line Thinking with Corporate Mandates

Dr. Roy Poses, blogging fearlessly at Health Care Renewal, takes on the issue of top-down mandates from corporate managers with uncommon boldness, questioning the ability of the MBA managerial class to understand medical care long-haul at all, even pondering the role corporate psychopaths helming our big health care conglomerates might be playing in the present state of affairs. I applaud you, Dr. Poses! Your candor and insight (and pure gutsiness) is desperately needed. PLEASE keep bloggering on – KBO!

Dr. Michael Hein (linked to by Dr. Munk) sheds light on the 90% of the iceberg underneath the VA scandal we’re not seeing or addressing: the crisis of woefully scarce primary care.  Most civilians wait much longer than 14 days for an initial primary care appointment; 30 days if you’re lucky, up to 6-9 months depending on which part of the country you’re in.
Dr. Hein also linked to the always insightful OB/GYN Dr. Jen Gunter reining in “metrics madness” at the VA and elsewhere with her lasso of truth.

I hope to blog more about the issue of the supply of health care in the future.  The Affordable Care Act and Medicaid expansion (see my post explaining the Medicaid expansionboost access to insurance (and ostensibly health care) without a corresponding effort to expand the supply of doctors, nurses, hospitals, and so forth.  Though I disagree with libertarian sources like Reason Magazine on most issues excepting civil liberties and bad, counterintuitive regulations being bad, I gotta give ’em a big tip of the hat for addressing the supply of health care and the many unnecessary choke-points in the supply pipeline head-on: Video: How to Grow the Supply of Health Care RIGHT NOW!

Paul Levy, a former hospital CEO whose bloggings at Not Running A Hospital led me to Dr. Munk’s blog to begin with, is running down part of the health care supply problem: monopoly. Embedded in the Bay State, Not Running A Hospital is giving much needed scrutiny to the recent deal with Partners HealthCare and the Attorney General Martha Coakley, the behemoth corporation that owns Massachusetts General Hospital and Brigham and Women’s Hospital, both affiliated with Harvard, allowing them to eat South Shore Hospital and related doctors’ practices and ultimately become more scary and behemoth-y, the prices even gougier.  “…it cannot be in the public interest to permit a dominant provider to become still more dominant” Levy points out in his letter to the trial court set to rule on Coakley’s “anti-trust settlement”—read his full letter here.
He deserves not only an award for activism but an award for blog journalism, as he has pulled together an excellent collection of factual information about Partners HealthCare and the ongoing anti-trust dispute in a way spin-doctored news media don’t, and examined things, like Gov. Patrick’s unserious “wait and see” lip-service, that the news media won’t.

And this brings us full circle back to the concepts I began this series with: rules, regulations and policies decided in boardrooms, courtrooms and back-rooms have an enormous affect on all our lives, especially when you’re a “patient.”

Like Lambert Strether at (terrific blog critical of big finance) naked capitalism wrote, the way the corporations code their systems—the computer code, the 1s and 0s—increasingly is becoming the law. Notably in cases of big banks’ mortgage databases that perpetrated mass-scale fraud, the courts just assessed penalties per offense, “cost of doin’ bidness” for banks, and the big databases roll on, slapped on the wrist but essentially made legal after the fact.

Step one: Code the system. Step two: Rewrite the law to match the code, and grant immunity. It is, after all, better to ask for forgiveness than permission.

Code is law.

See the whole post here: “Code is law.” Literally. | naked capitalism

It’s symptomatic of a weak state and broken legislative branch(es). More and more, we need to lobby the corporations, the guys who control “the code” and the related bureaucracies—my focus is medical bureaucracy —just as much or more than the public officials who ostensibly run things in a democracy.
We’ll need good bloggers, good advocates, good blog-journalists and blog-activists. The aforementioned blogs are great examples of what that can look like.  I hope to be a part of it.

Nick

 

Part 1: the introduction/weird ventilator rule

Part 2: Paramedics, the VA and obedience gone wrong

Part 3: The Milgram experiment, the tendency to obey and medical contexts

 

Footnote:
1. crapification – coined by Yves Smith (nom de blag of Susan Webber, head of naked capitalism) to describe the ever crappier quality of consumer goods and services as everything inexplicably succumbs to “the race to the bottom”… “…long-overdue and largely futile backlash against the crapification of almost everything“…

Insightful Blogging in the Wake of the Gov’t Shutdown

Posted by – October 22, 2013

October 2013 Roundup: Acts of Bloggery in the Shutdown’s Wake

My picks for the blogosphere’s most valuable insights into the shutdown insanity:

Moral lens:

The 8 immoral ways the government shutdown is hurting the needy On Faith – the shutdown inflicted pain on people already struggling and making due on government aid amidst the post-2008 “economic realignment,” cutting or threatening to cut already weakened social programs, though this has been badly underreported. 

The Day After | Talking Philosophy – The Philosophers’ Magazine Blog –  applies the measures of philosophy to the shutdown crisis, who has the moral responsibility and perceived “moral blame?” It’s a strenuous task to be sure, but valuable.

Unexpected impacts:

Government shutdown hits comics | The Comics Beat – the government shutdown’s impacts seemed to leak into every nook and cranny of American life.  Even comic books were impacted, new books delayed, stuck at the docks waiting to be cleared through customs.

Student projects interrupted by US shutdown | Nature – because of the shutdown, Siddharth Hegde’s extremophile PhD experiment at NASA Ames, after carefully nurturing and growing his extremophiles, might have died off for want of feeding since the Lab was locked up and 98% of NASA personnel were ruled non-essential and furloughed. It’s not known whether the extremophile experiment survived the extremophiles in Congress (I put the question to Hegde) but if the cell samples died he won’t be able to re-do the experiment, as his visa is only for three months.

Cartoon:

“Shutdown” by POLITICO’s Matt Wuerker

“Shutdown” by POLITICO’s Matt Wuerker

Political assessments:

In Washington and in Lansing, tea party zealots are costing us a fortune as they waste our hard-earned tax dollars | Eclectablog – “This is what happens when you elect people who hate the government to run the government.”  Eclectablog’s Chris Savage chronicles the heavy economic price paid for the shutdown shenanigans that were advertised as helping ease the deficit but did the opposite.

Lessons Learned? | Official Artur Davis – in this interesting assessment by (deeply strange black ex-Democratic Congressman—7th district—from Alabama) Artur Davis, who—after losing the black vote in Alabama—has re-made himself as an advisor to Republicans on winning the black vote, he says “The haziness of wishful thinking, overshadowed by a deeper failure to appreciate that shutdown itself validates the obstructionist label, the impression of being too inflexible to govern, that so threatens the party nationally and is even starting to creep into red states like Georgia and Louisiana.”   and “…conservatism has been painfully slow to distance itself from the radicalism that has surged in the party…”

Historical perspective:

The Philosopher’s Stone: A REPLY TO ANTHONY TSONTAKIS – philosophy professor Robert Paul Wolff reflects on the right-wing’s fierce opposition to the Affordable Care Act… are there core philosophical differences?  Wolff doubts there are deep ideological underpinnings to the opposition, noting that “the central features of the ACA entered public discourse in America as a set of conservative Republican proposals put forward by the right-wing Heritage Foundation…”

History Unfolding: How Much of a Victory? – after the shutdown ended, historian David Kaiser tried to put the House Tea Party guys in historical context, difficult given the unprecedented events involved.   “I have tentatively decided, after much thought, that perhaps the best historical analogy for the Tea Party are the Radical Republicans of the post-civil war era.   I must apologize for the analogy insofar as I admire the goals of those Republicans, namely, the full enfranchisement of freed slaves, while I feel the Tea Party is trying to undo all the good that the US government has accomplished over the last century.”

And this is just a slice of the ongoing discussion.  Will keep ya’ll posted.

Nick

Nick And The Not So Happy Hospitalist

Posted by – August 5, 2009

I’ve inadvertently stirred up some shit controversy at one of the major medical blogs, Happy Hospitalist (a hospitalist is a relatively new term for a doctor specializing in the care of hospitalized patients).

Don’t get me wrong, this story is not black and white; there’s plenty of value in much of what “Happy” writes, I’ve gained a lot from his posts explaining the medical payment system and have learned about how government is skewing the incentives toward procedures and the many other failures of government health policy. So, I’ve found it informative,

THATS 15 UNCOMPENSATED MINUTES!

"THAT'S 15 UNCOMPENSATED MINUTES!"

and the frequent discussions useful, and stimulating me to think more and write more. But “Happy”‘s writings often seem the opposite of happy; he routinely complains about doctor’s pay, about being overtaxed by the government (when taxes on the rich are the lowest since the 1920s), about how he has to spend 15 minutes of uncompensated time with this patient and that patient. And how any uncompensated time is SLAVERY. After a paid evaluation is over, if the patient waylays him for 15 minutes asking questions, that’s SLAVERY! He rants about how people, heaven forbid, “feel entitled” to his time! I pretty much ignored that, until he juxtaposed all this with the ostentatious display of wealth in his hospital’s parking lot, revealing that doctors at his hospital ain’t struggling in the least. Then I blew up at him, and earned myself a new post from him focusing on what I’d said.

I may have been too strident in my initial response; I’m sorry for that. And you know what they say about fighting on the internet…. But my point was, you can’t expect me to buy into the “poor uncompensated doctor” shtick, nor can you expect the American people to support loan forgiveness or payment reform, right after showing “Drive Your Lexus To Work Day.” For most laymen, a lot full of Lexuses = doctors at that hospital are doing JUST FINE with the current system, and don’t need us increasing the fee schedule or other government help. Pleading poverty after that is going to go over like a lead balloon. If docs are really united in trying to convince the public to support their agenda, ostentatious six-Lexus-in-a-row displays should probably be avoided.

Not that some doctors shouldn’t complain; primary care physicians are grossly underpaid by our notoriously bad reimbursement system, to the extent it’s reached crisis levels. But primary care docs are mostly objecting to how they only have 10 minutes with patients, how the system harms patient care, how it hurts doctors and their patients; I don’t see many family doctors bitching about being “uncompensated” as they’re sauntering to their BMW and filing their nails. But “Happy”‘s no family practice doctor, and plenty of his posts give off that vibe.

Reading “Happy” complain is more akin to seeing the insurance companies claim poverty. I was accused of jealousy and hating the rich, but that was not my point. My point was that when (relative to most people) you’re swimming in a vault of gold, don’t whine about how unfortunate and enslaved you are! It’s too much, and sticks in my craw. And though there’s a lot I respect about the man (including how he’s built such a popular blog through sheer persistence to post 2-3 times a day) I couldn’t help but speak up on this one.

Nick

Lots Of New Links On The Blog’s Sidebar

Posted by – April 23, 2009

Last night I spent lots of time filling up the blog’s sidebar with content.

Added:

Facebook badge with photo

Text explaining the blog

Media Coverage of Nick

    Links to web, newspaper, radio and TV stories about what I’ve done

Sites I Read

    A list of my favorite blogs and news sources, but, unlike many blogrolls, I’ve limited it to sites I actually read routinely.

Check out the new sidebar, and please comment below and tell me your thoughts.

All my best,

Nick