Memorial Day – A Celebration of Life.


As we celebrate Memorial Day lets us all take a deep breath and look at those around us. Celebrate with remembrance. I would like to suggest that we continue to remember those who are struggling as much as we celebrate the fallen. The fallen are a reminder of how terrible we can be to each other and a caution to us all. Let us not lose focus, we celebrate because some were taken before their time.

Let us celebrate life and work to preserve our essential freedoms without the need for the loss of life. Let us celebrate nature and the circle of life. Happy Memorial Day to all.

DO YOU LIKE COOKING?


I can still remember my first time cooking a full meal. It was summer-time and we wanted soup. Soup was what we had for dinner every Friday. For months I had observed. It was mine time to repeat what I had observed. I followed the recipe as I had seen. I made what I thought was great soup. We enjoyed to the last drop. Since then I have enjoyed cooking. I enjoy cooking and would love my girls to have the same joy from cooking. Cooking is an excellent way of learning science and may help us eat better. By better I mean great tasting food with lower caloric density.

Making breakfast for my girls this morning was a wonderful expression of my love for them and my indirect way of passing unto them great eating habits. I suggest we all cook more. We all should eat more home cooking. Eat more home cooking for better health and family unity. I made what the girls requested, one fried egg with two strips of Turkey Bacon and blueberries. What is on your breakfast menu this morning?

WAKE THE FUCK UP AMERICA!


As a parent I want the best for my children. I want them to achieve more than I have. I want them to be fully equipped to take on the challenges ahead. The only lasting thing I can give them is an opportunity to get an education. The education they get will determine their ability to make a living and be productive citizens. Their education will help them avoid the pervasive scams in our society. The education I fight for them to attain will improve their ability to survive. I will continue to fight for their right to be given a competitive education. As such, I am proud to support the goals of common core. It seems I am among the minority of persons who believe that common core is a good thing for the American K-12 system.

The continued attempts to disparage the goals set reflects a fundamental misunderstanding of what education means. It is a reflection of how urgent the need for better education is. The problem is that most Americans know enough to complaint but not enough to assist in the fix. We are a very poorly educated society in spite of the graduated masses. We are a society that prefers quick answers rather than long processes. The truth is that getting the correct answer is less important that understanding how you arrive at it. Every time I see a story decrying the ills of common core I see another example of a parent or teacher who lacks the fundamental understanding of what education means. Our education is lacking and we cannot compete, but we want to go back to the old ways. The old ways have not worked. The old ways have created people who oppose change not because the change is bad, but because they are so poorly educated they do not understand the change.

 
Someone suggested to me a novel solution. The parents who do not want their children learning in the common core “way” should be allowed to go to their own schools and the rest of us learn a common core based education. That sounds great to me, but the truth is that the educated will continue to suffer at the hands of the stupid. Do not be stupid and destroy your kids ability to compete. If you want to disadvantage your child let me thank you now. Thanks for removing my childs competition.

Can we please wake the fuck up America.

WE ARE WITHOUT SANCTUARY.


I am happy to be living in a country that affords me the opportunity to succeed. As a parent I am happy that my children will have more opportunities open to them than I did. My job is to guide them into success. As I look around America I am worried for my children in spite of all the opportunity that exists. The recent string of killings of men and women of color has helped to refocus my attention on the details. I, like many people of color in this great country have been lolled into a false sense of achievement. Worst is that we have allowed the wider society to accept the fallacy that racial justice as arrived. We have failed in teaching our children the important details.

As a parent of girls of color I have focused on making sure they are confident and well-educated, that is not enough. Over the last few months I have had to re-evaluate everything I have come to believe about equity in America. The history of people of color in this country is one of brutality and subjugation. There has not been enough change in our situation. In the last several month several studies have shown the depth and pervasiveness of our disenfranchisement. Our girls are 6 times more likely to be harshly punished in school compared to white girls. Americans of African heritage with master degrees are paid the same as whites with bachelors degrees and even doctors of African heritage are paid about 10 % less than similarly educated white doctors. Why is this so? I have come a conclusion, that question is not relevant. It is not relevant because those in power do not care to fix the problem. I have given up on the idea of equity in my country. The continued inequity makes me angry and concerns me for the future of my girls. I am angry but I will not be deceived into violence. Protesting does no good. Voting does almost as little.

So, in my quest to find a better answer I have looked around and think I have found the only viable route in the Jewish experience of World War 2. No one is allowed to forget the Jewish Holocaust and so too no one should be allowed to forget American Slavery and Jim Crow. The end of the Jewish Holocaust is celebrated but the brutality of it is what is referenced most often. This is what we all are reminded of daily. As people of color we need to teach our children about the brutality of the American enslavement of out ancestors and the continued brutality of Jim Crow America and the current discrimination. We need to have them understand that the current celebration of Martin Luther King Jr is fake and serves only to assuage the guilty. It is not a sign of contrition, it is hollow and designed to distract from the ever-present and pervasive discrimination against people of color. Our children need to know about the Martin Luther King Jr struggle before they can appreciated his success. They need to know and see the pictures of America brutality to their ancestors. They need to know the name Emmet Louis TIll along with Martin Luther King Jr. The goal is not anger, it is empowerment. Our children need to understand that things have changed and that we have many opportunities, but they also need to understand that they need to succeed in spite of the many race based road blocks. They need to succeed to honor their ancestors.

Violence is not the answer, it is only a way to continue to enslave us in the prison complex which is designed to strip us of the rights our ancestor died to attain. Our children need to understand the context of their lives in this land of opportunity. We need them to take the opportunities and make progress while making sure no one forgets the brutal treatment of our ancestors. We should honor our ancestors for their willingness to stand up for their rights and we should build on their success by taking the opportunities available and making the most of them. We know that we will not be treated fairly nor paid equitably because this is the current state of America. There is no real hope of progress beyond the eventual death of the merchants of death. As parents of children of color we need to prepare them to survive and thrive until that day of Martin Luther King Jr’s dream arrives. Don’t get violent, get angry and achieve.

NO VITAMINS PLEASE.


The encouragement to take a daily multivitamin continues to be strong. However, the accumulation of data suggests strongly that daily supplementation is not necessary. The reasons for fortification of specific foods with specific nutrients starting in the early twentieth century was deliberate and with good reason. The indications for Folic acid, VItamin D, Iron and Iodine were clear and scientifically proven interventions using prevention as treatment for neural tube defects, Ricketts, iron deficiency and goiter. For these diseases the scientific connection was clear and proven. Forward to today and vitamin and micronutrient fortification is touted as a panacea and treatment for all that ails. The evidence for the addition of most supplements is weak at best. Frankly, it is without merit and almost totally baseless.

The extrapolation that since we need small quantities larger quantities will be better is short-sighted and potentially dangerous. The evidence does not support that view. The industrial production and addition of vitamins to every conceivable food item is primarily a marketing tool. It is a waste of money for consumers. If we look at nature we can see a better paradigm to extrapolate from. The concentration of vitamins and micronutrients are small and very large quantities of whole foods would need to be consumed to approach the quantities in many of the marketed items. If there is not a proven deficiency there is no need to add to our foods. The proven need is for small quantities that is more than adequately supplied by a balanced diet. The evidence for benefit beyond that is none existent.

Although, the evidence for potential harm is small we must ask the question. Will super sizing the quantities we ingest be harmful in the long run? Like with the craze for copious quantities of bottled water we have been marketed a hook and we have bitten and are drowning in a sea of misrepresentation. Improve your diet. Make fruits and vegetables the base of all meals and stop wasting your money on bottles of urine coloring.

COMPETENCE ABOVE ALL


The first principle of health care is to “first do no harm”. In the complex system that we live we seem to have forgotten to whom we are responsible. The duty of care and the equitable distribution of such has taken a back seat.  The comfort of the staff is vital but their competence is far more important to our patients. Many seem to believe that our staff members being “nice” is the key to care. ThIs misguided notion is taking us into the weeds and missing the real problem in many institutions. Our real problem is competence and consistency. If the goal of our system is to provide consistent and dependable care we must first stand up for equity. The equity I mean is equity of care standard.

The care delivered varies wildly and the reason for such disparity is as varied. Fortunately many institutions have noticed the problem but their solutions seem worse than the problem. The government has stepped in because we have not consistent applied the care we know to be best. The government has used the same consumerist benchmark of satisfaction that is used in retail sales as a proxy for care delivered. This approach is sub-optimal at best. It is not likely to be the best measure. However, our opposition to these measures will not improve patient care. What we need to recognize is that patient satisfaction can be a good proxy if we work in a system where competence is priority number one.

Patient satisfaction is a complex fickle beast. We cannot practice from the point of providing a ‘satisfying’ experience. Our care should be directed at proving the best outcome to all. The only way to provide such care is if our systems are focused on designing best in class care systems and staffing such systems with competent staff. In recent years our systems has fallen into the sad and despairing state were we have lost focus on care and the competence of our staff. The misguided first basis focus on the social behaviour of the staff is driving the best out of the system and putting out patients at the mercy of the less competent, but ” nice”.  If our purpose is best in class care and superior outcomes there is only one matrix that matters. We must provide our patients with the best trained staff. Our efforts must be evidence bases and physician driven.

EXAMINE YOUR LIFESTYLE.


The new year is here and I still cannot believe it. 2014 came and went at a seemly quicker pace. The truth is that the speed of time as not changed. What has changed is how we experience it. We continue to allowed procrastination to decrease how much we achieve. We over think and neglect to take the actions that would allow us to attain more of our goals. As we second guess our decisions the universe continues forward at the same pace we found it. We are achieving less and the feeling that time is going by faster is just a reflection of our lack of focus on the important things.

For the new year we all should stop thinking and start doing. I am a parent and want to leave a better planet for my children. What are you planing to leave to your children? The discussion about climate change is just one of those issues where we could improve the world for our children. The facts are not in dispute, the climate of earth is changing. I do not dispute that human activity is the cause. If you dispute that I hope we can at least agree that the climate is changing.

With that in mind I would ask you, how do you think climate change will affect your children or grand children? I would suggest that the most likely direct effect will be on the quality and quantity of food and water available. The current estimate of people around the world going hungry is about one billion annually. Concurrent with that is the fact that some of the most productive agricultural areas are in regions whose water supply is dependent on seasonal rain and snow falls. It is already evident from current objective measurable data that these regions are close to breaking point in their water balance. The drought in California, which is the current bread basket of the United States is worrying. The gravity of the danger is not being addressed. But if the level of the water in Lake Mead Nevada is any example we should all be much more concerned.

Our water usage patterns are unsustainable and more forthrightly has led us to a very dangerous place. Agriculture is the primary user of water both for plant and animal production. Animal production is an especially egregious drain on our every decreasing available water sources. The continuing willful deafness of many of our leaders to the coming and already present crisis is criminal. The low intelligence of many of the people on mass media discussing the topic is genocidal in their effect. As we continue to neglect the obvious the problem worsens and the solutions become evermore burdensome. The unfortunate consequence is that the poor all around the world are already experiencing the trauma of food and water insecurity. Even the wealthier among us are being affected. The difference is that most of us can afford the increasing cost of our basic supplies. The larger question needs to be asked, what will happen when the squeeze truly gets to the richer among us?

I am of the scientific persuasion and believe that all the evidence points to mans central impact in leading to climate change. However, I will acquiesce to those who have not attain that clarity. I need only you agree that no matter the cause climate change is occurring and that we need to act to protect our global society.

I would suggest that we start by examining our consumption patterns. Change your lifestyle and change the world. We are all apart of the change that we need.

AMERICAN SWEAT SHOP.


There is a curse that inhabits the American work place. We have become slaves to profitability and not to best outcomes. The primacy of profits has led us to misunderstand the nature of work and the importance of worker satisfaction. Making ever-increasing profits is the goal but how we get there makes a difference. Some employers have lost their focus. Sustained profitability is about worker satisfaction. In many fields lip service is paid to the worker, while they are trapped under inhumane work conditions. Fortunately work conditions in the developed world are better than they were. However, we still have a way to go before we can claim victory over poor working conditions. The severity of the impact of poor conditions is dependent on your industry. In health care the impact can be life threatening.

Our culture for too long as valued hard work over smart work. We seem to believe that the worker that workers longer hours is more noble and deserving of praise. This misplaced praise has led to continued poor choices and has led to the misery and burn out of the American middle class. The depth of the problem continues to go unnoticed and unacknowledged. Poor outcomes continue to be placed at the feet of poor training and individuals are blamed. I too have a tendency to blame the individual. The truth is that sometimes the individual is to be blamed, but we too often neglect to evaluated the conditions under which mistakes are made. The systems under which most of us work are archaic, inefficient and are undermining our ability to be the best we can be.

I will be attacked for my stand but the truth needs be told. I love my work because it gives me the opportunity to help my fellow humans at a time when they are most in need. From my limited experience that help is best delivered when I am well rested. Some may consider me weak for insisting that adequate rest is required for best productivity and patient safety. I, however, would rather follow the evidence that suggests that efficiency and safety are best attained with a well rested and optimally trained work force. The conditions of many operating rooms where staff can work full daytime shift and take overnight call then work a full day shift is putting our patients at risk.

The unfortunate problem is that when a staff member makes a mistake that harms a patient she alone is blamed. The idea that she needs to take personal responsibility for her mistake is commendable , but essentially is a cop-out. Her bosses are just as culpable, because they have put in place a system that does not allow her to work at her best. The continued scapegoating of individuals is a sickness in our system that needs to be driven into the grave. Our success is dependent on the balance and efficiency of the systems we construct. Spending money on technology is commendable and necessary but alone will not improve patient outcomes.

Better pay is a great place to start, but is a poor quality band-aid when one works under mentally oppressive conditions. Improving the system starts by focusing on the best assets of the system. Our human capital is our best asset and must be treated as such. We are not robots, we are better. We may not be able to work as long hours and we get bored easily; but until robots can think intuitively and problem solve on the fly we will continue to be the best part of the workflow equation. Functioning at maximum efficiency must be out foremost goal. For humans to be focused and efficient we must have adequate rest and distraction. If we would focus on those areas many of our problems would be resolved without the need for expensive investments in equipment.

Let us invest in our best and most productive assets, our people.

THE NEW YEAR IS COMING.


This is the time for resolutions. It is almost the new year. Have you met your goals this year? If you have not, there is nothing to be worried about. There is still time. If you have run out of time you are not alone. Most of us are too busy living life to focus on our resolutions. I would suggest that we all use this time to look back over our year and be thankful for all that we have accomplished. We all have come a long way and are on the brink of a new year. Let us be happy.

The new year will bring new challenges that will give us more opportunities to grow. Let us take hold of our challenges and continue to succeed in spite of the opposition. All our challenges should be viewed as a means to success. It is only by confronting and overcoming that we can advance. Wipe clean the slate, start anew and conquer. The only person standing in our path is ourselves. Set that goal, make a plan, hold yourself accountable and make it so.

Have a wonderful and successful 2015.

WHERE IS THE CHECKLIST?


I have loved health care for as long as I can remember. I cannot imagine doing anything but providing care . What I have learned in the trenches is that the love of providing care is not enough. Over time i have realized that a fundamental problem with health care is not in the expensive of it but in the nature of the people in it. We want to provide care, but we bring into the system our biases. Those biases allow for less attention to be paid to some patients because of their language or skin color. We may say that we provide the same care to all patients, but as a black physician I see otherwise. My experience of the system at institutions where I am not known by members of staff is vastly different. The consequence of this uneven care is a system where those that can afford care and are the correction completion receive care that is more compassionate and timely.

How do we overcome the inherent bias in the system? The answer is not more training nor necessarily more diversity. The answer will be in the wide-spread use of evidence based payment structures. Our medical systems are complicated and expensive but are systems in name only. We have a complex string of components. All the parts are mostly well-trained and competent. However the results we obtain are not commensurate with the level of training nor the level of expense. The incongruity of expense and quality of results continues because those attempting to improve the system have not acknowledged or do not recognize the biases of the system. The gap in quality of outcome is most obvious in communities of color. The often given excuses are truly just that. Recognizing that there is a problem is the first step to a solution.

Paying for quality work is the only avenue to improved results. The question as to how we get better care for all patients is simple and complicated, but we have a great example in the aviation sector. My brother is an airline pilot and his training is extremity rigorous, but he starts his day with a checklist. He does not feel that his autonomy is being challenged, but that he is making sure that he does not kill himself. We in health care do not have any real skin in the game. Until the decision makers have some skin in the game we will not embrace what is necessary to make our constellation of components into a functioning system. Let us start delivering quality care by implementing checklists. Checklists are reminders of the quality in our options. The checklist is not for you it is for your parents and friends. That checklist is not for you, it is for that provider that is on her sixth surgery of the day. It is a nudge because she is tired. A checklist is for every one of us. It helps us by removing silly mistakes from our systems. For me the checklist is my hope that I will be treated like a patient deserving of care on the off-chance that I am a patient in a strange place where all that can be seen is the color of my skin.