The Occasional Perspective - 2/22/23

Opinions and Reflections 

What’s Love Got To Do With It? –  The American Heart Association’s website on the “heart” carries a substantial amount of information on heart healthy activities, heart-related medical symptoms and the like. In addition, they also recently included a subset of info on what happens when we have the “love” feeling take over our souls. Given that we just passed Valentine’s Day, I thought it might be a useful bit of information for all of us who are working to maintain an emotionally sensitive, aligned and robust attachment to the ones we love. Check it out! 

Much Ado About Something – If there’s a consistent “information technology” theme over the last several weeks, it’s that ChatGPT has inextricably changed the environment across the waterfront from healthcare, to finance, to politics, to education to whatever industry you care to discuss!! One of the louder voices on the potential downside of augmented intelligence (AI) over the last couple of weeks came to us from the former CEO of Google, Eric Schmidt. He spoke at a session sponsored by the Carnegie Endowment for International Peace on augmented intelligence (AI). The online discussion covered the waterfront. But, the example he shared that captured my attention was a podcast between Joe Rogan, the ultraconservative podcaster and Steve Jobs, the former CEO of Apple – which never happened!! Schmidt points out in the podcast that while AI can potentially be a very valuable tool for “good”, it also has the potential for creating “bad” or “erroneous” information that – if not scrutinized – will be digested by a gullible public. Schmidt pointed that: "There are people who will use this for terrible outcomes. We don't have a solution in society for this." In essence, he argues that while the AI toolsets offer some very clear advantages to us in our work, the tools have not yet caught up to the nuance of being human and the policies for managing the tools are way, way behind! Having spent over an hour on the phone with a computer system this past weekend to simply change an airline ticket AND being unable to get a “human” on the line, I think Schmidt is correct. Or, as some may argue, “Houston, I think we have a problem…” By the way, in a separate piece, I learned that ChatGPT passed the US Medical Licensing Exam without the benefit of any assistance from a clinician. Hmmm – robotic doctors on the horizon? – I wonder? Check It Out!!

The Occasional Perspective - 1/3/23

Opinions and Reflections 

Misinformation Breeding Misdirection Causing Misunderstanding in the Metaverse– In a recent issue of The Fickenscher Files, I regaled my readers on the difference between “leadership” and “power”. My premise was – AND, is – that much of what we see in the USA today is all about obtaining “power” rather than providing “leadership”. This is especially prominent in the political sector although the phenomenon is seemingly present throughout all industries to varying degrees. If you’re into power, you’re clearly into making sure that everyone around you is totally supportive of you in every way regardless of the outcome. Alternatively, if you’re into leadership, you know that there is a segment of the populace or followers that likely have some degree of opposition – or, at least questioning – of your ideas, proposed directions or, even philosophy despite the fact that you may be making progress in solving problems.

I think that most of you would agree that there seems to be a plethora of misinformation, outright lies, and conspiracy theories that are continuously perpetrated on the public across many different fronts. One small example is the nearly half a billion dollars that evidently been spent by the Russian government to dissuade the American public and others from supporting the Ukrainian opposition. It’s just one example. We could no doubt find examples on other issues both large and small for social and economic reasons. To understand misunderstandings, it seems to me that we need to first understand the misinformation that breeds misdirection within the greater community of this new, evolving world now referred to as the “metaverse”. This triad seems to be creating intractable obstacles that prevent the initiation and support of needed changes in society across the board.

Ironically, the trend of media misinformation seems to be coming from both sides of the equation although more prominent among autocratic advocates or autocrats. But, the autocrats are not the only ones! Misinformation or distortions are propagated by racists, by misogynists, by people with a subversive agenda, by science deniers, by those seeking change at any cost; and, by people who simply hate or are fearful of any type of change on all sides of any aisle. They are exacerbated by governments like China, Russia, the Saudi autocracy, political action committees (PACs), the dark money managers and others with an overt agenda for controlling the direction of decisions, resource allocation, political responses and the like. The same could no doubt be said for some corporations or industrial sectors (e.g., the oil industry related to climate change). In recent years, the use of misinformation has accelerated through the use of internet trolls or, websites built specifically to draw people in and feed them spurious information. It also has infected more traditional interactive sites like LinkedIn, Facebook, Instagram, Twitter, YouTube, etc. In other words, you have the opportunity to pick your favorite source of information which can take you down a rabbit hole if you only rely on that one source…

The second issue relates to misdirection! And, misdirection is interesting. One of the lessons I’ve recently learned from a high school friend who happens to be a very good performance magician is that the reason for his success is the effective use of misdirection to captivate, direct, arrest, and control the attention of the audience. He’s a master at sleight-of-hand magic. In fact, now that he’s clued me in – I’m more observant of his performance manipulation. Magicians actually use the term misdirection to describe their approach toward understanding the basic laws of human interest. It’s exemplified by the coin magically appearing from the ear of a child or even an adult. Misdirection is rampant across social media and even among network media. Where is Walter Cronkite when we need him?

And, finally – the end result of mis-information coupled with misdirection is misunderstanding! The unsuspecting are pulled down a garden path into an abyss where the cycle of further misinformation and misdirection deepens the well of misunderstanding. This is what is happening in America on too many fronts. Whether it is the spewing of totally erroneous information on immunizations that prevent the spread of COVID-19 amidst the worst pandemic in over a couple of centuries or, the divisive or, the creation of rationales for bringing the world to the precipice of global instability through the unilateral invasion of a sovereign nation – this triad of misinformation breeding misdirection to cause misunderstanding in the metaverse is spreading the disease of social instability!!

It’s not clear to me how to stop it but it will require leadership[1] – a capability that I find woefully missing – especially in our current political culture. As a centrist I can find fault on both sides of the aisle but what is coming out of the political right is quite disturbing. Where are the Bob Doles, David Durenburgers, Everett Dirksens and the like when we need them? The cauldron seems only to be fed by further mis-information and mis-direction especially by the immediate past President of our country. It’s time for leadership to emerge (aka Rep. Liz Cheney and Adam Kinzinger) to help us all move through the evolving morass.

As we all know, leadership is built on principles. Without clarity on one’s personal set of principles, it’s very difficult to surf the tsunami of misleading tropes and information on all sides of the equation. I mention all of this because our nation has far larger problems than need our attention. So, what are they?

  • We’ve got massive income disparity exemplified by the fact that in 2021, Jeff Bezos earned a stunning $8.56M (yes, that’s a “M”) per hour versus the two parent family with service jobs and two kids barely making ends meet. Now, granted – he also lost about $65 billion in stock value which comes to about half a billion per month. But, still his per hour rate seems a bit high.
  • There are also obvious issues facing our nation’s health care system that will NEVER be solved without bi-partisan collaboration. I could go on a rant for several pages on the issues facing health care in our nation that need to be fixed. But, you all know the issue as well as I.
  • Higher education is also challenged! The completion of education after high school is no longer a ticket to success in any nation. I’m not sure that “free” college is the answer but clearly we need to provide a way for “every eligible member of society” to better themselves through college education with low interest support. It’s a smart strategy in a global economy. Education is the spark of competitive capability for any nation.
  • The technology sector is in dire need of better policy on any number of fronts. Telecom – which has become an essential part of everyone’s life is frequently not available in rural areas and can be out-of-reach for many urban dwellers as well.
  • The investment world needs some retooling according to many advocates although in which direction is up for debate.

The list goes on and on…and yet, we dither about with mis-information breeding misdirection causing misunderstanding in the new metaverse. As we consider the focus of our nation in the coming year, we “the people” need to step up with ardent support of advocates for the spread of accurate information, for setting a direction the works to bring together the concerned voices seeking understanding that will sustain the future of our nation, the global community, the environment and – ultimately – the world. We need to demand a focus on solving problems to create a sustainable future. Now is the time.

We desperately need leadership!! Solving the problems I’ve outlined is only the beginning of a long list and the tough decisions we need to make. It will require individuals step forward as leaders with a clear set of articulated principles that we can all assess. Society and the global community need it. We don’t need mis-information and misdirection. Thanks for letting me ventilate…


[1] See more on this topic in my last Fickenscher Files – sent out on August 23, 2022 – Volume 10, Issue 10.

Responding in Kind - 12/7/22

Responses and comments from my readers…I do receive periodic information from the many readers of the blog. While I have often responded individually, I decided that I should share more transparently. Hopefully, this contributes to an ongoing dialogue… 

Thanksgiving Diet Information – I received a note from a very trusted, nutritional expert colleague about “Healthline” which was the source I used for information on appropriate dieting in the days before and during Thanksgiving. While my colleague indicated that “the info you shared about Med Diet is ok…”, they also noted that Healthline is “not a very reliable source of information for diet and nutrition and especially about food safety.” I wanted to pass along the information. And – thanks to my colleague for sharing…

The Occasional Perspective - 12/7/22

Opinions and Reflections

Shining Light On Dark Money – One of the elements I’ve cherished over the years from the 1960s onward when I became more cognizant of “issues” and “policy” in the US was the relatively open nature of information availability. Due to the transparency, the tragedy of the Vietnam War, the Watergate affair, the secret funding of regimes in Latin America, the impact of the withdrawal of US troops from various conflicts and the like have all been considered within the context of an open society questioning what the heck was going on…and, why? Now we learn that DonorsTrust – a 501(c)(3), tax-exempt charity received two separate anonymous gifts totaling more than $425 million dollars. The information was uncovered by POLITICO. In fact, the group brought in more than $1 billion in 2021. The problem with these funds is that it creates an ongoing opaque financing of the political ecosystem. It is groups like DonorsTrust that are becoming the conduits for funds from high net worth individuals as well as corporations. In effect, “the people” are bypassed through these not-for-profit groups. While the Supreme Court OK’d this in a decision several years ago, it is the type of decision that fosters the continued erosion of the board public interests. Rather, the perspective of the wealthy are the first fed at the political table. Some of my readers may disagree. But, this is affecting decisions by our political leaders across the board – including the health care sphere. 

On The Antitrust Cusp: Considerations Related to Hospital Consolidation – I recently came across a new item noting that the U.S. Senate Subcommittee on Competition Policy, Antitrust, and Consumer Rights held hearings in May, 2021 on the issue of increasing hospital monopoly power across the nation. The U.S. Senate hearing was a bipartisan affairs led by Sen. Lee (R-UT) and Sen. Klobuchar (D-MN). In addition to focusing on the problems, they also discussed potential solutions. I anticipate that this topic will be an ongoing discussion with major ramifications for care delivery as the U.S. health care system continues to evolve and change.

The Occasional Perspective - 11/151/22

Opinions and Reflections 

The Immediate Looming Crisis – The recruitment demand for physicians and advanced practice providers is increasing at an exponential rate according to a recent report from the Association for Advancing Physician and Provider Recruitment. Why? In large measure to replace departing (i.e., retiring) physicians. The placement of such physicians has increased 16% for the period 2018 to 2021. From an overall perspective, the number of clinical searches reached 47% for physicians and 32% for APPs. The shortage is especially acute in the primary care (i.e. frontline) areas of health care with the specialties of family medicine, internal medicine, and hospital medicine represented as the highest need areas. Furthermore, for many health care organizations – the recruitment of clinicians is their #1 problem!! So, why is the turnover occurring? The reasons among the health care systems with 300 to 1000 provides included:

                                                                                           MDs                      APPs

  • Leaving for a similar position                                   74.6%                   91.7%
  • Retirement                                                                67.3%                   12.5%
  • Geography                                                                50.9%                   43.8%
  • Burnout                                                                      34.6%                   33.3%
  • Compensation                                                            30.9%                   68.8%

As a “rural health advocate” it’s also clear that the rural communities are the hardest hit by the problems of clinician shortage. Furthermore, the “thinning” of specialty availability is exacerbating the “burnout” issue. It’s been estimated that 1:5 physicians will retire or leave practice over the next five years or, 20%! And, it could be higher. Some studies show that the number of physicians who will reach retirement age is more than 35% of the workforce over the next five years. That’s huge. In fact, I predict that over the next five – yes FIVE – years, we are going to see a massive shortage of primary care providers due to the retirement and burnout of primary care providers of the Boomer Generation. The overall shortage by some studies is predicted to be over 120,000 physicians not even considering the APPs (for which I do not have any good numbers at this point) But, it’s not just clinicians leaving – it’s also a lack of entry by the next generation of clinical providers into the primary care fold. Finally, one more stake in the heart of primary care is that they are among the lowest compensated of the providers and yet, primary care is one of the most important areas for offering sustained quality with the best outcomes over the longer haul at the lowest overall cost. Hmmm. It’s time for a “rethink.” I personally believe that a move toward “value-based care delivery models” is a major component of the “rethink.”  

But, There’s A Bigger Looming Crisis Needing Our Advocacy Now, while I believe that the shortage of clinicians (physicians and advanced practice providers) is a big issue (SEE above commentary) that requires our attention – I think we also need to be cognizant of the (dare I say) much bigger crisis of climate change. From National Geographic this horrific crisis has been exacerbated by the opening question of “climate injustice”. What’s that? It’s where the least responsible nations for climate change are experiencing the worst burdens at the present time. The results of the recent United Nations Climate Conference or, COP27 held in Egypt point in this direction by offering fair warning from a large contingent of frustrated developing countries on “who” is going to pay for the “loss and damages” due to global emissions. The question is raised because the least developed nations are contributing the leastest of the least amount toward emissions responsible for global climate change. For example, the United States is responsible for 20+% of all historical global emissions of gases (e.g. methane, carbon dioxide) that cause climate change. What’s a world to do? Evidence that “not enough” might be the answer came in the form of plans for resolving the problem. About five years ago the global community of 190+ nations agreed that each country should put together a plan within five years on their intent for helping to solve the problem. The reports from the COP27 meeting revealed that only 25+ reports have been received AND NONE OF THEM were from the leading contributors to the problem = the United States, Europe, China, Russia, etc. It makes the shortage of clinician providers seem like a minor problem…

Healthcare Consultants

    ...Inspiring creative change to benefit the human condition