“Letting Go”

Atul Gawande at The New Yorker:

People have concerns besides simply prolonging their lives. Surveys of patients with terminal illness find that their top priorities include, in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others. Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars. The hard question we face, then, is not how we can afford this system’s expense. It is how we can build a health-care system that will actually help dying patients achieve what’s most important to them at the end of their lives.

The usual brilliance from Dr. Gawande. This one, though, is emotionally powerful. It’s amazing, really, how unwilling American medicine is to talk about end-of-life care. The comforting story, as he presents, is how fruitful and positive hospice can be.

Trying things

I think we should all just go ahead and acknowledge that no matter how the macro-economic healthcare resources are distributed or the system through which they are delivered will ever reach an ideal state.


That said, we shouldn’t ever stop trying to reach it–even with different definitions of what exactly that ideal state may be. The flux of it all is the engine of its progress.

To that end, what’s being proposed for England’s National Health Service may provide an interesting example to learn, or run, from.

Read about it at The New York Times. From the article:

Practical details of the plan are still sketchy. But its aim is clear: to shift control of England’s $160 billion annual health budget from a centralized bureaucracy to doctors at the local level. Under the plan, $100 billion to $125 billion a year would be meted out to general practitioners, who would use the money to buy services from hospitals and other health care providers.

The plan would also shrink the bureaucratic apparatus, in keeping with the government’s goal to effect $30 billion in “efficiency savings” in the health budget by 2014 and to reduce administrative costs by 45 percent. Tens of thousands of jobs would be lost because layers of bureaucracy would be abolished.


Fake bus stop prevents patients from leaving

The Telegraph:

The bus stop, in front of the Benrath Senior Centre in the western city of Düsseldorf, is an exact replica of a standard stop, with one small difference: buses never stop there.

The idea emerged after the centre was forced to rely on police to retrieve patients who wanted to return to their homes and families but had forgotten that in many cases neither existed any longer.

“It sounds funny,” said Old Lions Chairman Franz-Josef Goebel, “but it helps. Our members are 84 years-old on average. Their short-term memory hardly works at all, but the long-term memory is still active. They know the green and yellow bus sign and remember that waiting there means they will go home.” The result is that errant patients now wait for their trip home at the bus stop, before quickly forgetting why they were there in the first place.

Via kottke

Creativity matters.

An article by Po Bronson and Ashley Merrymen at Newsweek about creativity has been making the internet rounds.

All around us are matters of national and international importance that are crying out for creative solutions, from saving the Gulf of Mexico to bringing peace to Afghanistan to delivering health care. Such solutions emerge from a healthy marketplace of ideas, sustained by a populace constantly contributing original ideas and receptive to the ideas of others.

The problem, notes the article, is that creativity scores (determined by researchers) are falling in the U.S. Have a read; a notable pull:

When faculty of a major Chinese university asked Plucker to identify trends in American education, he described our focus on standardized curriculum, rote memorization, and nationalized testing. “After my answer was translated, they just started laughing out loud,” Plucker says. “They said, ‘You’re racing toward our old model. But we’re racing toward your model, as fast as we can.’”


I was ready to comment on this article about the potential nurse strike in Minnesota. I’ve been following the labor dispute loosely; what has surprised me is the predominantly anti-union sentiment taken by newspaper article commenters (Minnesota tends to the liberal side of the spectrum).

This afternoon hospitals and the union agreed to a to-be-voted-upon proposal. Good news for patients. In a quick analysis, it looks like the nurses conceded more than the hospitals. The union had claimed that mandatory nursing ratios were their central concern. None were agreed to.

What is considerably striking is the level of emotion portrayed in this Star Tribune article. Words like “ecstatic,” “happy,” and “tears of joy.”

There has been plenty of internet commentary (e.g.) about unions outliving their useful lives (maybe, maybe not). So what I’m wondering here is what members of the Minnesota Nurses Association think about their union? More importantly, the alluded-to joy in the Star Tribune article reflects a painful, stressful, and tumultuous time for Minnesota nurses–considering the imminent deal, is being a part of a union worth that emotion to them? Count me as an interested observer.