The Winkler Nurses Case on #RNchat

When I started #RNchat last year (@RNchat on Twitter), my hope was to assemble a simple and supple forum for nurses and the public to discuss important issues from the perspective of a diverse group of people.

Here’s a re-post of the transcript for Friday, February 12, 2010’s RNchat, with my commentary on the Winkler County, Texas Nurses case:

Below is a SlideShare of #RNchat for Friday February 12, 2010, organized in chronological order (from beginning of chat to sometime just after). The chat was moderated by Ellen Richter (@EllenRichter on Twitter).

The #WinklerRNs case was the topic of conversation. In Winkler County, Texas, nurses who went through the torment of being charged for leaking private medical information. One of the nurses went to trial and was acquitted within one hour. Now the nurses are responding

This is an important case, one which – among many other things – highlights the need for swift and bold and sturdy nursing organizations. This case isn’t just about defending nurses: it’s ultimately about the safety of patients, the ethical fiber of nurses and doctors and administrators and government officials. Had Anne Mitchel been found guilty, the ramifications could well have been ominous for the integrity of our entire health care landscape.

Friday’s RNchat, discussed topical features of this case: the best practices for whistle-blowing and how to get more organizations behind nurses and the public. Feel free to share the presentation below.

Let’s hope that nurses don’t become scapegoated victims. Do nurses make technical mistakes? Sure they do – we all do. But it’s critical that nurses never feel afraid of expressing their sincere perceptions, their intuition nor their ethical belief system. People can die under those circumstances.

Nurses are the last Jedi Nights of our faltering Republic. A cheesy metaphor? Yes. But it’s true. Anne Mitchell and the other nurses involved in this case are Jedi Knights who fought through a derangement of how ethics and law and responsibility should work.

Anne Mitchell has gone through a Kafka-like hell. Let’s hope she receives comfort and equity and sanity.

NOTE: We also are preparing for a special even in conjunction with the Robert Wood Johnson Foundation. Details upcoming soon!

As always, thank you to those who joined today. If you’re new to #RNchat, just follow @RNchat on Twitter and we’ll provide updates and links on how to make the best use of this nursing chat. You can also send inquires to info [at] RNchat [dot] org.

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An Interview of @EndreJofoldi of HealthMash

The Web abounds with health care information (good, bad, ugly). In fact, for all practical purposes we have an infinite abundance of content on the web. And this abundance has produced a scarcity of meaning, relevance and reliability. So any attempts to provide searchers of content are welcome efforts.

THE WORLD WIDE HEALTH WEB

HealthMash is one of the newer search engines for health care content and media by a team from Hungary and the US. HealthMash returns an array of finds and displays them within categories. Here in the US, most of the Web products that receive the most attention come out of Silicon Valley. What goes unnoticed is just how much remarkable work gets done around the world. Hungary, for example, has traditionally had one of the highest per capita rates of mathematicians. So it’s encouraging to see these products being developed internationally. And in the arena of health care and social software, Dr. Bertalan Mesko ( @Berci on Twitter) is doing amazing things with ScienceRoll.

HealthMash enables users to search generally, or ask the engine to return results garnered from Twitter or for Video for Images or Drugs and other contextualizing formats. Here’s how HealthMash presents Cystic Fibrosis within its Clinical Trials results (click to enlarge):

HealthMash Search Result for Cystic Fibrosis

Contextualizing information is an important process, especially since we now have so many sources of potential information. I won’t review the reliability of the results here, but I recommend test driving the interface. Another service that attempts to bring context and curation to health care search results is iTriageHealth.

For now, I’ll let Endre Jofoldi of HealthMash (@EndreJofoldi on Twitter) explain more about the product he and his team are working on. My hope is that these interviews engender entrepreneurial interest in the what I’m starting to call the Health Web. By the way: If you’re a developer and seek funding, I recommend following Robert Scoble’s  Twitter List of Venture Capitalists. Yes, Twitter has its uses. :)

THE INTERVIEW

You seem to be passionate about the Web and building custom search engines. Tell us about yourself – where are you from, what you do and what got you interested in health care and web technologies and communities.

The HealthMash “virtual team” in the US and Hungary consists of experts in medical informatics, computational linguists and software developers. Our individual team members have worked on many health related projects at the National Institutes of Health and the National Library of Medicine, thus we have first hand familiarity with the challenges of the health arena. Although most of our team are relatively young and healthy, a couple of the “old timers” have had enough health problems themselves and in their families, to have special empathy for all patients. So as you can see, we are naturally interested in web technologies and health communities.

HealthMash, which bills itself as a Revolutionary Health Knowledge Base and Semantic Search Engine, piqued my interest. What inspired you to build this type of search  engine? What does HealthMash do that other health search engines don’t? What technologies are under the hood?  What are your plans for HealthMash?

There are thousands of good health sites on the Web, like Medlineplus.gov and the MayoClinic,com, however they are limited in their scope and coverage. There are also tens of thousands of sites that offer questionable or harmful health advice. At the same time, we also know that even the best health practitioners can’t keep up with all the new developments in biomedical research and apply all that knowledge to the individual needs of patients. Our inspiration was our own health concerns and the inevitable health problems of our families and friends and fellow human beings, to envision a web site that offers the most comprehensive and most reliable health information to enable informed personal health decisions:

  • Thus, our goal with HealthMash has been to interpret the meaning of health related queries and, using our proprietary semantic search algorithms and bring together all kinds of potentially relevant information for the user (trusted health information, News, clinical trials, the research literature etc.)
  • Another important goal has been to support user exploration and discovery. HealthMash facilitates serendipity and discovery via our automatically generated  Health Knowledge Base which contains millions of relevant associations between health concerns, treatments, drugs and alternative medicine approaches, to name a few.
  • It is the sum of all of the content and technological innovations “under the hood”, and our passion for promoting healthy living, that distinguishes us from the competition.

Do you see it primarily as a stand alone search engine or are you considering developing social features into the service?

First I would like to turn this question into a bit different direction. HealthMash can be utilized by other search services. Our Explore and Discover section is also available through an API for third parties to embed it into their medical databases and search systems. To answer your question, developing social features into HealthMash has been planned from day one, but not implemented yet. As a matter of fact, our Hungarian health sites already have some social features in them (http://varoszoba.hu means “Waiting Room” and http://dokim.hu means “My Doc” ).

What other projects are you currently working on? If you had the necessary resources to build your dream health care technology/application, what would it look like and what problems would it seek to solve?

HealthMash keeps us pretty busy, given that it is in beta stage. And of course we also have to make a living, so we are working on “bread and butter” custom search and federated search engine projects for paying customers both in Europe and in the USA. If we had the necessary resources – and frankly we are hoping that a major player or venture capital firm will provide those resources to us sooner or later – our “dream” health care application would be to add sufficient intelligence to HealthMash to be able to answer any health related question and do it in all languages and all countries of the world.

Thank you, Endre. Keep us up-to-date. And good luck to your team. For more, you can always follow  Endre on Twitter.

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Zen and the Art of the Tweet

I’ve been thinking a lot about the nature of our collective mindfulness lately. Every month, millions of more people are increasing their connectivity to the Web. Facebook’s gravity keeps swelling. Twitter continues to flap upwards in users. Mobile devices and operating systems continue to evolve and proliferate. It seems every week a new feature or service or gadget makes a debut.

The Web is not only expanding like a universe but it’s also infiltrating every nook of our daily lives. And it’s expanding and infiltrating at an accelerating pace. What effect is all this happening on our capacity to attentively engage with life? What disciplines and skills and understanding do we need to acquire as the Web continues its unstoppable inflation?

PRESENT MOMENT, WONDERFUL MOMENT

Thousands of years ago certain cultures around the world discovered and cultivated the art of breathing mindfully. In some cases, entire religious traditions grew out of these practices.

Our brains and sense-organs are powerful attention-devices. Our minds are always teaming with thoughts, feelings, hunches and visions. Even asleep, our brains actively stream profuse experiences like dreams. It’s how we survive.

But our very powers of attention and awareness and cognition can distract us from the present-moment happenings of our lives. We’re always breathing, but rarely notice unless we pay attention. And this presents us with a fundamental observation about life: if we’re constantly processing the relentless influx of internal and external sensory data but never focusing our full attention on what happens, how alive are we? For to have a meaningful life, we must feel alive – otherwise we’re just automatons obligated to the patterns made by others and the larger external world.

Being aware of the present moment is the easiest and hardest thing to do. Try it: sit for 5 minutes and pay attention to nothing but your breath. How many times did your mind wander from that simplest of tasks? If you can’t pay attention to your life right now, when do you expect to do it? After you die? In some other world?

TWITTER MIND, MONKEY MIND

Some Buddhists have a phrase for how our minds endlessly flit from one thought to the next:  Monkey Mind. One aim of meditation is to “tame” the Monkey Mind. Not so much to control it, as to pay attention to it – and, in the process of paying attention to a fast-moving mind, paradoxically slow it down to a point where the present moment reveals itself most fully.

Of all social networking sites, perhaps Twitter best exemplifies the electronic version of Monkey Mind. The tiny bursts and pulses of text and hyperlinks stream through the world like flashes of thought across a busy mind. Twitter’s a powerful way to connect with others and receive news and important or trivial nuggets of information. And yet, if you’re not paying attention, it’s easy to get sucked into Twitter Mind – an energetic state of dopamine excitation, where the sense of time is lost.

As more of us use these tools, how do we maintain our sense of mindfulness? How do we tame Twitter Mind? Few of us practice any sort of traditional meditation to discipline our Monkey Mind. Now we have social media. The Social Web is like an extension of the neocortex. It may sound crazy to think that our brains have a new layer, but it’s not a bad way to think about the kind of world the Web is making.

We will need to understand more about the effects of the Web on our brains, on our attention and our ability to feel fully alive between the sliver of light between birth and death that was entrusted to us.

THE NEVER-ENDING STREAM

When was the last time you felt the beating of your heart? The breath in and out of your chest? The sound of rain falling on leaf-mush?

Do you know why you’re on Twitter? How long you’re on Twitter?

The Art of the Tweet – if there is one – is this: using the medium to learn something about our world and sharing your unique view of it with us mindfully. Life without mindfulness is a life lost. Twitter may increase your awareness of the world around you but only your mind supplies your life with meaning. How are you  maintaining your mind?

Tweets are like raindrops falling into a stream. So are the moments of your life. Are you paying  attention, or something more expensive?

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Power Dynamics & Virtual Health: Protecting Professional Boundaries in an Unbounded Web

Virtual Health – however that’s defined – has become a hot topic lately, especially in light of the rapidly evolving two-way real-time Web. Power dynamics – the interplays between patient and provider – must be protected in order to safeguard patient rights and protect their dignity, privacy and well-being. There’s more to virtualized practice than may be apparent on the surface.

Here are some thoughts, including an explanation of what I am (half-humorously) calling the “intimacy-boundary membrane”. [Link to video]

Power Dynamics & Virtual Health: Protecting Professional Boundaries in an Unbounded Web from Phil Baumann on Vimeo.

Patients are increasingly demanding online ways of interacting with their providers. As social media evolve, improve and proliferate, the ePatient movement will continue to expand and the healthcare industry will have to develop ways to meet the demand.

This movement, however, will have to ensure that it does not overlook the important behaviors all health care providers must express. It will also have to mature so that we aren’t left with a virtual health care landscape that is little more than a circus of amateurs. Experience matters more than content.

But social media is also rapidly shortening the spaces of intimacy and boundaries between people. This means that as health care professionals interactively enter the Web, the tension between intimacy and boundaries will increase.

We could say that there exists a safety zone between intimacy and professional boundary. These zones have traditionally been worked out for in-person clinical relationships. Online, however, we have a long way until we establish a collective understanding of how these technologies affect our virtual health care experience.

Since the space is shrinking to a thin wall, I’ve decided to call this problem the intimacy-boundary membrane. How do we go about protecting that membrane? Is this metaphor useful? You tell me.

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Time Value of Health

Traditional Polish pączki
Image via Wikipedia

Let’s introduce a simple term to an old problem in health care. As health problems increase, and their costs rise, we need to start thinking about ways to make it easier for the public to improve the lifestyle choices they make.

What you do today influences what happens tomorrow. Eat a deep fried donut today, have a heart attack later in life. Your health has a time value. Let me explain.

DO YOU KNOW THE TIME VALUE OF YOUR MONEY?

The concept is simple and it borrows from finance the concept of the time value of money:

A dollar today is worth more than a dollar tomorrow.

This is important because the opportunity cost of taking a dollar tomorrow is the investment that you could make with that dollar today. In terms of health, exercising today is an investment of effort that pays of in the future. Another way to look at it is the future value of a donut:

The future value of eating a donut today is a heart attack years later.

THE TIME VALUE OF YOUR HEALTH

It’s a simple concept. One of the reasons Americans are so unhealthy these days is because we don’t consider the consequences of our lifestyle choices in ecnomic costs. Invesment always involves effort, sacrifice and consideration of options. Long-term investors almost always enjoy prosperity over the course of their lives. The essence of (good) capitalism is discipline and self-restraint. So my definition of the Time Value of Health is this:

The time value of health is the interest you accrue from delaying the cost of an acute or chronic disease later in life.

If you don’t think that the time value of money is a matter of health, just look at the primary cause of our current economic health. Do you think that if all of the people involved in the biggest ponzi scheme in history exercised discipline, that we’d all be in better financial health?

Weight-management is harder for some people than others. So is daily exercise. Our culture isn’t helping: as we move more online, it’s easier to forego healthier choices that enhance our cardiovascular systems.

HOW CAN I USE THE TIME VALUE OF HEALTH IN MY LIFE?

The Time Value of Health doesn’t require complex calculations. It doesn’t need a number. It just requires a little imagination. Don’t make too much of this concept I’m offering you.The next time you’re tempted to go nuts on foods that you don’t need, ask yourself a simple question: is it worth the pleasure of eating this eclair to endure a stroke in 20 years?

Consumers If your a consumer, consider incorporating the idea into your lifestyle. Don’t be a nazi about it. Maybe just use it to save the goodies as a treat once in a while, or for your weekend. Create zones of healthy living. We all need indulgences (there’s health in feeling good about a nice dish). Investing some effort and discipline how you live earns a healthy return over time. What’s more, often the returns pay sooner: being fit and active produces a sharper, happier mind.

Providers If you’re a healthcare professional, consider ways of introducing the Time Value of Health into your practice. You probably don’t have much time anymore to give long speeches with tons of advice (too bad). A simple meme can often travel far. What’s to lose?

Readers Does this intuition pump help? Is it frivilous or does it offer a meaningful practical way to help improve the lives of good people who have a hard time with making healthy choices? The next time you grab those wings, or all that sugar in your coffee, could you imagine yourself on the floor panting in agony for breath in front of your children or granchildren?

What is the time value of your whole life?

(Sorry for tempting you with those donuts above. It’s OK, one won’t hurt you, will it?)

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Are You Serious?

The Thinker, Artist's rendering of the sculptu...Image via Wikipedia

The healthcare industry is full of serious people. They should be serious, shouldn’t they? After all, health care is serious business. Life is at stake and life is sacred. But if you had to choose between two different kinds of providers, which one would you prefer: the serious one or the responsible one? The two kinds aren’t necessarily the same. Being serious is an emotion. Responsibility is a state of awareness. That difference could seriously influence the quality of your treatment.

THE COST OF BEING SERIOUS

Most of the people in health care are good, competent and emotionally secure human beings. Unfortunately, there are also a lot of angry people in the same industry. I know that I don’t want an angry surgeon or ticked off nurse giving me a medication. Do you? Could anger stem from being serious? I believe that it could.

Our culture teaches us to be serious. There’s nothing wrong with being serious per se. But it’s worth a peek at what grows beneath the word. The root word of serious is seryows, which sounds a bit like sorrows. Ours is a serious world. It’s also sorrowful. Perhaps there’s a connection. If language influences our perceptions and behaviors, then we need to re-think what we teach our children. Otherwise, they will grow up to confuse seriousness with responsibility. They will be depressed. Look around you if you think I’m exaggerating.

THE BENEFITS OF BEING RESPONSIBLE

Fortunately, our culture teaches us to be responsible too. Resonsible is rooted in respuns, or response. Responsibility by definition requires action, a reply. Being responsible, however, is not the same as being serious and yet our culture often equates and confuses the two words. That’s an error that might be costing us lives.

I understand the need for bearing a sacred sense of emotion when providing care to patients. I’m not arguing against the sacred. I am arguing for stripping away the assumptions we make which prevent us from being our most responsible. Experienced professionals have smashed medical equipment against walls because they were serious about saving their patients’ lives. That’s pretty serious. It’s not responsible, especially when the equipment is life-saving.

Many health care facilities still tolerate this madness. Why? I think it’s because some of the people who run those organizations are serious about healthcare and they’re afraid that by condemning the serious behavior they are violating the sacredness of life. Health care is an ancient business. It’s an historical confluence of religion, warfare, science, art, culture and just about everything else that makes a civilization. So it’s not much of a wonder why the healthcare industry is so serious about being serious. The industry can do better. It’s your health, so it’s your responsibility too.

If you want to find out for yourself, offer to volunteer at your local hospital. See if there’s anything you can do to lighten things up.

LESS SERIOUS. MORE RESPONSIBILITY.

I think it’s time we publicly recognize the difference between being serious and being responsible. The two aren’t necessarily mutually exclusive; but the semantic relationship might just be too close for us to dismiss.

I know I want to be responsible. If that means I have to be less serious, so be it. Nursing might be a lot more fun. It should be. After all, life is a stake and life should be fun. Fun is a responsiblity of the living. Seriousness is for the dead. It’s our responsibility to save our sorrows for the dead. That’s how we rescue them.

If being serious leads to anger and anger leads to error, then we need to be less serious and more responsible. Life is at stake and life is sacred. Seriously.

If you have ideas on how to improve our health care responsibilities, please comment here. If you like what your reading, subscribe to my feed and we can continue the discussion.

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Four Steps to a Healthy Layoff

If you had to layoff your employees, how would you do it? We can blame big companies for being ruthless and uncaring. But for the people doing the actual layoffs, it can be a terrible experience. A layoff doesn’t have to be an evil, does it? Layoffs happen every day and people survive, don’t they? In fact, don’t layoffs give people the opportunity to find  better ways to invest their time? Is there such a thing as a healthy layoff?

Layoffs are often botched by thoughtlessness or by fear of saying the wrong things. Some businesses do better in this department than others. For whatever reason, though, many businesses don’t really understand how to layoff. Layoffs aren’t supposed to happen. But they do. Almost everyday we hear about them. So why not outline a Layoff Action Plan that could help, not hurt, people?

Where the danger grows, so does the saving grace.

Friedrich Holderlin

A layoff can be an opportunity for a company to redeem itself from the tactical and strategic blunders it made that may have led to the layoff. For the people who actually do the layoff, a creative Layoff Action Plan can be the difference between another drink and the happiness derived from helping others overcome adversity.

HOW WOULD YOU SLICE THE KNIFE?

So, how would you do it? How could you make the most of it and turn bad news into a reason to hope?

Would you stealthily order your lawyers to structure the layoff so you don’t have to call it a layoff? After all, that would save the PR fees which qualm your fears of how the word layoff will make you look to the general public. Whatever would Wall Street do with your stock if they discover your secret? Heaven forbid!

Or would you consider these completely different approches?

1. INTRODUCE YOUR EMPLOYEES TO YOUR COMPETITORS

Introduce your employees to your competition and say:

Here are one hundred remarkable employees. We know they’re remarkable because we hired them. We’re having a tough time right now and we don’t quite know what to do with them. Maybe you or your connections do. Please do what you can because we want our industry to thrive and these people are our industry’s future.

2. INTRODUCE YOUR EMPLOYEES TO THE WORLD

Introduce your employees to your vendors, your suppliers, your alumni, you neighbors, your minister, your rabbi, your monk, and your therapist {the risks of depression and suicide increase after layoffs}. Introduce them to your friends or relatives who own businesses thirsty for the remarkable talent that you’re pouring away.

If nothing else, your employees will feel appreciated. They could be energized to find a beautiful land beyond your crumbling empire.

3. INVITE THEM TO YOUR LINKEDIN PROFILE

Invite them to your LinkedIn profile and write them recommendations that will last in their profile for the rest of their careers? Would fewer calls for reference checks lighten your newly weighted workload?

Use the Answers and other features to promote your former employees in creative ways. You should do this selflessly, of course, but could you think of any beneficial side-effects from this approach?

4. PROCLAIM YOUR LAYOFF ACTION PLAN

Instead of playing legal word-games, call a spade a spade and proudly proclaim your layoff to the world. Let the whole world know that you’re liberating enormous talent for hire into the community. Issue a press release on your own terms that outlines that you’re doing #1, #2 and #3. Let the world know how much you sincerely care about the social consequences of your economic misfortune.

Now is the time to invoke the genius of your PR folk. Get them to market your employees to the community. This is a radical departure from the status quo; this isn’t your boiler plate PR. It would be unique and remarkable PR for PR. Imagine how your employees and the community would feel about you now.

What would happen to your company’s wealth if you simply explained what happened and how you intend for your company to thrive in a time of adversity?

Do you think that your customers and the public would LOVE that story? Do you think that Wall Street would entrust your long-term leadership with more of their investing dollars because NOW you look like you know what you’re doing? After all, it’s clear now that you’re not afraid of acclaiming your status as a remarkable leader in your industry. You’re in it for the long-run now, not the short-term speculative nonsense that’s puling our Republic into mindless consumerism.

This post is a Capitalist Manifesto.

WOULD YOU LAYOFF YOUR TALENT USING THIS APPROACH?

So, what do you think? Do think these steps are worth a try? How much psychological and economic depression could our contry avoid if we did things in steps 1 through 4? Since it’s my goal to improve the health care of every child, woman and man in the world, this would advance my cause.

Perhaps some would say: This is too much work! To that I’d say: No wonder you have to layoff your employees! If a business can’t do the hard work needed to get through its Dips, then it should responsibly close up shop and leave it to competitors who know how to work hard and creatively.

Is it possible that so many companies botch layoffs because it’s culturally expected that layoffs are a bad thing, a terminal curse? What would happen to our world if we shook up the bowl, thought and did things in ways we never did before? Sometime we are more programmed for certain responses than we realize.

We are more than the product of our assumptions.

The world’s changing, whether you’re in denial about it or not. Why not make your next layoff remarkable?

If you have ideas to add to this list, feel free to add. Who knows, a brokenhearted CEO might stumble upon this blog. Maybe she’ll change the world and found a novel way to network talent for the 21st Century.

CLOSING WORDS

If you’re in a cog job, find out why. Go bookmark Seth Godin’s blog (he’s not just for Marketing types; in fact I think he’d appreciate it more if cog-jobbers read him as if he were our Poet Laureate). Also, download A Brief Guide to World Domination, print it out and read it.  It will expose that lie you were told years ago.

For those of you who have been laid off, or who might one day end up at the end of the layoff riffle, here’s a little secret I’d like you to keep:

You must change your life.

Rainer Maria Rilke


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