Thoughts and Readings To Consider - 9/14/18

Thoughts, Books and Articles worth a Review…

 As Simple As A Cup Of Coffee – Several weeks ago, I arrived at Boston Logan for a very early morning flight to someplace.  As I got to the airport, I realized that I had left my credit cards and cash at home due to the very early morning hours of my departure.  So, there I was credit- and cash-less heading out of town on a couple-of-days trip.  But, always the prepared traveler – I have traditionally carried a stash of $100 dollar bills in my briefcase for just such emergencies – which have only occurred twice in 40+ years of continuous travel.  Here’s where the interesting part comes in…  I went to the Starbuck’s, ordered a cup of Vente to get myself going to mentally regroup and offered up one of my $100 dollar bills.  The attendant looked at me and said, “Are you kidding?” and refused to take my money but – she also refused to give me the coffee.  I responded, “No, I’m not kidding.  It’s called money.” – obviously in a bit of snarky retort.  At this point, the Millennial gentleman standing next in line reached over with a $5 dollar bill and said to me and her, “Don’t worry, it’s on me!”  And, I responded, “Are you kidding?” with a laugh, of course.  He said, “No, really!”  I offered to walk away. He insisted. I relented and walked away thinking – yes, the next generation is prepared to assume authority!  I continued to shake my head – in a positive way – as I walked toward my gate thinking it was, in fact, time for my generation (“The Boomers”) to give way to the next generations – all because I got a cup of coffee when I really needed it.  Long story short, after about five minutes, the young man showed up at the gate and was headed to the same city.  I walked up to him, thanked him and gave him my card and offered that if there was anything I could ever do to help him in any way – he should reach out.  I would try to do whatever I could do to help him.  I’m waiting for the call…

Forever In Favor Of Biden – Many do not know this but I served as Joe Biden’s health policy advisor for his Presidential campaign in 1988.  I had high hopes for a corner office in The White House when with a one-two punch the campaign was knocked out rather quickly over the course of a couple of weeks.  First, Biden gave the exact same speech that Neil Kinnock had given in Parliament to a group in Iowa including references to his father – not a good thing to do.  Plagiarism is not a good thing on the campaign trail.  Second, he developed excruciating headaches and was diagnosed with a brain aneurysm which ended the campaign.  So, I’ve been a Biden fan for a very long time!!  But, his eulogy for John McCain, III was not only touching but memorable for what he brought to the forefront for at least a couple of moments – the need for civility in our public discourse.  He articulated so very well the passion that both he and McCain brought to their respective roles in the U.S. Senate which was based on trying to reach an understanding between two different assessments of the same situation.  We sorely need someone like Joe – for as much as I believe him to be the type of person we need as a leader in our nation, the nation probably needs someone other than Joe.  It’s time for the next generation to step forward.  My generation should guide them and support them.  The torch needs to be passed…

Media To Consider - 8/17/18

Books and Articles Worth a Review…

 OyVey – If you haven’t heard the Terri Gross interview on NPR’s Fresh Air from July 19, 2018 – it’s worth the time of listening.  Terri is one of the best interviewers on either television or radio – from my perspective and, she’s extremely fair, always trying to get to the real information.  Check it out!  The interview will make your hair stand on end. 

 The Ongoing Aging Issues – One of the challenges many of us face is the slow moving implications of aging.  Unlike the younger years when we were seemingly invincible, quick and agile – there are times as we age when we begin to feel a bit vulnerable, slower than normal and even a bit clumsy.  While others may not see it, the decline is self-evident.  But, it’s not as bad as it seems AND, we can do something about it.  Forgetfulness is one of the big issues.  Check out the information on WebMD if this is one of your bugaboos.

 Curiosity and Medicine – Atul Gwande, MD recently gave the UCLA commencement address for the School of Medicine graduate in June, 2018.  The address was titled: “Curiosity and What Equality Really Means”.  It is an excellent reflection on the “why?” that many of us learned in medical school and too often let fall by the wayside.  It’s an excellent reminder that as health care professionals, one of the most important elements we bring to the bedside in caring for people is our curiosity.  At least for the moment, no technology, learning machine or protocol will replace that capability.  Consider it…

 

Media To Consider - 7/16/18

Books and Articles worth a Review…

A Quick Read – But, Looming Problem – Sometimes when we are in the thick of the problem right in front of us, we forget about the bigger problem that is on the horizon.  It happens too often.  Then, the bigger problem falls on our doorstep and we are fully unprepared to deal with the crisis. Such is the state of antimicrobial resistance (AMR) which causes an estimated 700,000 deaths annually.  Read the article in the May 18, 2018 issues of Lancet for an overview of the problem titled, “Global Governance and Antimicrobial Resistance”.

And, Another Looming Problem – According to the Centers for Disease Control and Prevention (CDC), 36 252 Americans died because of gun violence in 2015—11.3 deaths per 100 000 people—an average of about 100 gun deaths every day.  By comparison in 2016, the approximate number of firearm-related deaths were about 39,000.  Compare that to motor vehicle-related deaths at 40,000 and drug overdose-related deaths at 64,000.  Yet, while there is substantial ongoing research in both the motor-vehicle area to improve the safety of our cars and in drug overdose to make treatment more effective (although not enough resources, I might add) – there are almost NONE allocated to gun research.  As a clinician, I’m very data driven.  But, the CDC nor any of the other branches of government – which fund research on all matter of other problems – discontinued gun-related research after the Dickey amendment took effect in 1996 which states that “…none of the funds made available for injury prevention and control at the [CDC] may be used to advocate or promote gun control…”.  And, the Trump Administration has continued to provide only funds for monitoring the situation.  In another Lancet issue on June 23, 2018 the article, “Gun violence research in the USA: the CDC's impasse” touches on a big issue.  Consider it. Think about it.  Act on your thoughts…

Media To Consider 5/11/18

Books and Articles worth a Review… 

What Are You Reading? – I came across a statistic in the last week that was shocking at best.  The statement that drew my attention is that One third (1/3) of high school graduates and 42% of college graduates never read another book after completing their degree!  I actually couldn’t believe it.  So, I did some further research and the results come from a study done in 2003 by the Jenkins Group, Inc. – an independent publishing company.  So, what’s wrong with that?  In a period where transformational change is all around us – where are people getting their new information?  So, I did some research.  Here’s what I found:

  • According to the National Library Board, 68% of Americans get their news and information via print or digital sources; 41% via social media sources; and, 19% via books and e-books. 
  • The Pew Research Center basically did a similar study in 2016 with the same results.
  • A Reuters Institute study discovered that only 16% of the U.S. population paid for digital news last year with only half of those paying for a recurring subscription. In other words, only about 52 million Americans are getting their news this way. The remaining 274 million Americans are simply using Facebook, free news services and websites they like to supply them with “news”.
  • The Millennials and GenZ are more likely to pay for news subscriptions than any other generation although it’s still relatively low.
  • So, where do people get their news? Historically, it’s been via television, but that source is on the decline as well.  The upsurge in take home news for the clear majority of Americans is via social media.

Now – do these statistics cause you heartburn or, is it just me?  The era of Walter Cronkite or Huntley and Brinkley sourced, reliable and consistent information is over!  Anyone can throw “news” out on the web.  Folks – the combination of these data points is of major concern or am I becoming my father?

Media To Consider - 3/30/18

Books and Articles worth a Review…

Preparing For The Virtualist – As my regular readers will know, I’ve been an advocate for some time that we need to be considering how best to appropriately train clinicians to become “virtualist” care providers.  I do not believe that you simply take good clinicians, place them in front of a computer and say, “Have at it!”.  If we do not prepare these clinicians to understand the nuance of voice inflection, to detect the potential meaning of facial reactions, to understand the basics of large data analytics, to have a core understanding of the field of informatics – and, a host of other “to” items, the Health Care Virtualist will not be adequately prepared to provide high quality care in a virtual environment.  And, while I’m on the topic – this is NOT just a medical or physician’s domain.  I believe that if we are to be successful in adopting, adapting and effectively using tele-technologies – it will require a team model.  In essence, I’m making the argument that “virtualist” training should become a core element of training for all clinicians just like physiology, or microbiology, or pharmacology are consider part of the core curriculum.  There is the JAMA Virtualist article by Michael Nochomovitz, MD that advocates the need for considering a “Virtualist” specialty.  While that may actually evolve over time, I think the real discussion needs to be centered on cross-disciplinary approach toward “virtualist care” training for all clinicians.  Virtualist care will be the norm in the not-too-distant future – just like a stethoscope hanging around your neck.  

The Siren Call From The CDC – For those who missed it, Ken Thorpe and team had an article in Health Affairs last week on the lack of attention to a major, growing problem – antibiotic resistance.  There is not much known about the contribution of antibiotic resistance to rising health care costs.  So, the researchers reviewed the data from the Medical Expenditure Panel Survey to derive an estimate.  Their assessment was that antibiotic resistance adds about $1,400 or, about $2.2 billion annually across the entire nation. So, you can see that if we extrapolate the data on an international basis, the cost is very substantial.  More importantly, it’s growing at a very rapid rate. Something needs to be done and, it starts with educating physicians on the use of antibiotics and in how pharmaceutical companies manage antibiotic manufacturing – especially in foreign countries.  Dr. Thorpe’s team called for new infection prevention programs, antibiotics, and vaccines to prevent and treat antibiotic-resistant infections as an international priority. This is one of those looming problems that is on the horizon and my fear is that when the problem finally hits us on a massive scale – the health care community is going to look at one another in bewilderment.

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