Deep Dive: A humanist physicist; patient autonomy vs misinformation; self-injury; A RECIPE; healthcare violence and busness; Gaza; other items
This is an occasional wrap-up Of recent articles, quotations, or other items that may be worth your attention
The Life Scientific: Sir Michael Berry on phenomena in physics’ borderlands - This is a wonderful interview with physicist, Sir Michael Berry. He reflects wisdom, curiosity, and appreciation of the human experience. And, don’t be turned away by the physics. You’ll be fine.
Balancing a Patient’s Autonomy Against Misinformation - One could argue that the worst recent pandemic is the pandemic of magical thinking plaguing modern society. We’d made great progress since the Dark Ages. We seem stuck on the precipice of magical thinking’s allure and danger, ready to topple over. In this essay from the ethics gurus at The Hastings Center, the author considers the care of a woman with COVID who is quickly worsening after self-medicating with vitamins. She refuses intubation. What to do? She will die if she isn’t intubated. Yes, we do respect people’s wishes. But, there has to be evidence that such a person is thinking clearly or we (health care providers) are acting unethically. The case notes are filled with wisdom. The essay is completely on target. The problem is that those who spread misinformation and their followers aren’t reading this material and seeing these cases. Even when they are, they make no course corrections in their beliefs. If you haven’t actually seen these cases, you have no idea how hard they are on care providers who are leaving in droves.
Accounting for diversity in the treatment of suicide and self-injury: A systematic review of the past 50 years of randomized controlled trials. - In this recent review of fifty years of randomized controlled trials exploring suicide and self-injurious behaviors, we still aren’t doing a good job of doing quality and inclusive sampling. If we intend to figure out how to help the greatest numbers of people and discern what groups are most affected, we have to broaden the net and understand who is in the net. Who is hurting the worst? Then, we can more accurately figure out how to help the most people and specific demographics.
Mindfulness-Oriented Recovery Enhancement for Veterans and Military Personnel on Long-Term Opioid Therapy for Chronic Pain: A Randomized Clinical Trial - Short version? Mindfulness-Oriented Recovery Enhancement was superior to psychotherapy in modulating opioid reduction for chronic pain among veterans and military personnel. From the American Journal of Psychiatry.
Bacon, Egg, and Cheese Okonomiyaki - I think I’ll have to try this recipe from Saveur. Slide to the side BLT?
Healthcare Violence: Doctors and Nurses Are Bearing the Brunt of Business Pressures - I hope you’ll take a look at this insightful piece on healthcare violence. There are several important insights: the framing of healthcare as a customer service where you get quality care (is that the same as health?) in exchange for what?; the responsibility of healthcare machinery, particularly insurance companies, that delay essential and lifesaving therapies (all while they make record profits off their insureds); and, frayed/afraid patients who feel like pawns in a shell-game ultimately giving rise to fight or flight behaviors. What Dr. Lewis does not address is the extent of insulation enjoyed by governmental, insurance and corporate health structures. They are sealed off - quite literally in some cases - from the risks faced by those actually providing bedside and outpatient care. We can do little to nothing about the fight/flight experience of desperate patients and families. But we can eliminate insulatory protections afforded to those who make therapeutic decisions about the lives of patients and families. Those who have no skin in the game have zero business making health care decisions involving the people who do.
If I were in charge, every single person working in health care or health care processes - insurance executives, health system executives, IS, nurses, doctors, environmental services, pharmaceutical executives, everyone - would switch roles for at least one week each year with someone working on a role opposite their usual job. Health care and insurance executives would work in patient-facing roles. Nurses would work in IS or EVS or the pharmacy. The point is this: if we can’t get people to appreciate others roles in a natural, empathic, and human way, perhaps we need to make structural, systemic changes might accomplish the same thing. It might also deepen the richness of moral engagement with the mission of healing. Right now, we are all insulated from one another by siloed job descriptions. Healthcare will not change until this changes. It’s not possible. We have to talk the same language before change can happen.
California system gave $100,000 bonuses to nurses for retention. Did it work? - (Becker’s Hospital Review) In this innovative approach, a California hospital asked, what if we addressed retention by bonuses? A short but helpful read.
The Magic of the Blackboard - from Nautilus.us (referred by the BigThink newsletter), this article explores the enduring charm and utility of the Blackboard. The blackboard, you ask incredulously? Yes. The Blackboard. In the same way a child finds a large box more interesting than a toy at Christmas, a Blackboard can also be a far better tool for thought than the best and coolest digital device. Read it. You’ll understand.
How do caring, compassionate people consider and respond to the violence in Gaza? There’s no better place to start than Tara Brach’s blog post, What is Love Asking from Us: Reflections on Gaza, the West Bank and Israel. She’ll be the first to tell you she’s not a historian or a politician. She is a leader in compassionate, mindful teaching and behavior. I grew up in strong Christian traditions that saw Israelites as God’s people. I find myself fairly appalled at that idea in my older days. All people are God’s people. As Brach points out, the human tendency of othering is dangerous and sets the stage for these kinds of atrocities. I hope you’ll read her short post and then speak up appropriately. All people are God’s people.
Oncologists Sound the Alarm About Rise of White Bagging - Consider what the past ten years have been like for that average American (whatever that is). Executives earn 399 times more than the average worker in 2021 (since 1978, executive earnings grew 1,460%). Thrown into that mix is growth in executive compensation even during a pandemic.