Mark's Musings - August 19

Below is an aggregation of the stories I posted on LinkedIn since my last edition. I curate them through the prism of an "intersection of chronic pain and appropriate treatment" and so they come attached with my opinion.

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How Do You Measure Quality in Health Care? (133 views)

This is a very thoughtful article on the various definitions of "quality" in healthcare. The end result is there are manifold ways to encourage and measure quality based on outcomes or adherence to process or "feelings" (by either the patient or provider). In the age of wanting efficiency, measuring quality is definitely not ubiquitous. In fact, recognizing the lack of quality is probably easier. But, regardless of the method, measurement should lead to improvement - data without action is just a random assortment of 0s and 1s on a computer. Do any of these stories resonate with you? Do you have a methodology that isn't mentioned?

"For example, even if my facilities are spotless and my clinical staff is expert at avoiding preventable infections, does that mean they’re good at explaining diagnoses to their patients? Do they know how to communicate effectively and sympathetically when delivering bad news? Do they return patient calls at night? In today’s health care climate, physicians are often required to see a specific number of patients each day. But how effective are our measurements if a physician misses that quota because she devoted extra time to a single patient who really needed the extra attention and care?"

"We found that physicians at these sites (high-quality care with a lower overall cost) were thinking more deeply about what each individual patient needs to navigate in the periods between primary care office visits... Does their illness affect their executive functioning? Are they following through on laboratory tests? Are they taking their medicines as prescribed? Are all of the doctors and specialists a patient sees aware of important aspects of their care plan, such as the existence of an advance directive?"

Great questions. Sometimes difficult to answer.

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Anhedonia (253 views)

Have you ever heard of the term "anhedonia"? It is "the inability to feel pleasure" and is "a common symptom of depression as well as other mental health disorders." Does that describe you? Does it describe someone you know? This is a warning sign - please don't let it go unheeded. There have been seasons in my life (sometimes mere minutes, sometimes for a few days) where uncertainty or frustration or setbacks caused me to lose my joy. However, something happened - a personal message, a revelation, a change in fortunes, an acceptance of reality - that jolted me out of that joyless existence and back to "normal." You have probably dealt with that yourself. Those are a normal part of life. When you can't escape that feeling - or, better said, lack of feeling - is when you need to seek assistance that can provide perspective.

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California AG alleges North Bay doctor killed 4 patients with opioids (280 views)

They are still just allegations. And the "defense" that it was actually suicide is a twist. But it will be interesting to watch what happens here. Although apparently there were questions about nine patients, the second-degree murder charge for four deaths and felony elderly abuse for a fifth is the primary focus. The AG claims the pain management physician "would often prescribe 180 to 300 pills in each prescription despite urgent warnings from pharmacies and insurance companies and even after some patients died of drug overdoses." Why were those warnings ignored? Why didn't somebody do something more than a warning before somebody died?

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The Science of How Tea Benefits Your Brain (228 views)

I will have 1-2 Coke Zeros per week as a "dessert." Instead, I either drink water or iced tea throughout the day. Since I grew up in the South it was usually sweet tea, but about 15 years ago I switched to unsweetened tea (and no artificial sweeteners). The physiological benefits of tea (cold or hot) are outlined in this article. What you drink can have an impact on so many things and either be a help or hindrance. To co-opt a famous commercial ... So what's in your glass? As I have become more aware of the risks v. benefits I have had several conversations with family and friends that drank a lot of soda (either regular or "diet" that includes a lot of ingredients only chemists can pronounce) and had varying success in convincing them to switch to water. Now I have an even stronger argument for including tea into the mix.

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Perspective (478 views)

I heard a helpful analogy by my friend Barry Bloom during his WCI session with Dr. Teresa Bartlett about Evidence Based Causation (they were an awesome team). It's all about perspective, and even though everybody has access to the same information they can often draw different conclusions. The most memorable line to him from the 1996 movie Jerry Maguire was "Show me the money" because those words (or at least intentions) have been used in so many personal and business circumstances. Because that was his takeaway he (subconsciously) assumed everybody else did too. However, asking others he found they remembered "You complete me" or "You had me at hello." Same movie, same script, different outcomes. Medicine based solely on opinions (instead of science) can yield similar disconnects. So ... "Show Me The Evidence." The rationale of "because I said so" is used in parenting and medicine. It is not very effective in either scenario.

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In addition, I published two blogposts:

• "Mark's Musings - August 12" on August 16
• "Marijuana’s Complexities" on August 16 by WorkCompWire

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"It's Never the Wrong Time to do the Right Thing" - Martin Luther King, Jr.

#PreventTheMess + #CleanUpTheMess = The Answer.