#beth is almost ehre

[twdmusicboxmystery]

Interview From Norman About the Spinoff

@wdway:

I'm trying to get the ET interview of Norman from last night at AMC Up Front event. He talked about the spinoff a lots of things he's already said but he did say this was kind of a reset. He also said it was romantic and use words to describe it like poetic and beautiful. Norman, also Jeffrey and Lauren about their spinoff.

@galadrieljones:

Just watched the interview w Norman. I love how he keeps calling it romantic. I think he means sort of like aesthetically romantic but he says it twice.

He also posted a shot of the Eiffel Tower today on Insta, maybe he’s back in France now?

@twdmusicboxmystery:

Yeah, I noticed that, too.

@wdway:

He starts out with talking about remember the last scene Daryl gets on the bike and rides off and everything goes terrible. I know this is probably silly and maybe just me but I felt like it was a decoy. You guys know that I am hung up on the missing year and I just felt like it was a "don't look over there at that missing year look at what you last see and let me tell you what it is."

I'm just hung up with something that was said by someone high up a few months ago that we would see a surprising twist at the beginning of the spin-off and I don't think us seeing him being kidnapped is the surprise twist because they keep telling us about it.

His talk of romantic and poetic a course everyone's going to assume that it's going to be romance between him and (sorry cannot think of her name the French actress) which if anything to me that the absolute sign that it will not be between him and her. Why would you give that away.

I love absolutely love when he says it's a reset.

@galadrieljones:

I feel like he says in the interview that the series ends with him “taking off on his bike to look for someone.” Does he say that? I thought that’s what I heard but I didn’t understand like, did we already know that? I will recheck as soon as I can.

I also love the word reset because it implies a dc al coda.

I think you’re probably onto something with the missing year. It’s an arbitrary amount of time, and it’s weird that he comes back but then he is leaving AGAIN and this time to go find his happy ending, and per his goodbyes to Carol, there seems to be this implication that he might not be back for a long long time. He tells Judith if he finds Rick while he’s gone, he’ll bring him back, right? Implying he’s not looking for Rick. So why is this trip so singular? And where was he before this. Why does he keep leaving.

I had forgotten the mention of the twist. I think it’s interesting how Norman focuses on the aesthetics of the show in his interview to avoid talking about the content or the story, even as we do have a hint from gimple that foreshadowing for the spin-off lies in the WB coda.

I wanted to mention too that amc posted that same throwback with Daryl and Leah on Twitter. Most of the comments are about how they hated the arc because it went nowhere and felt unfinished.

Just reminded me of what ppl once said about Grady. I know we believe that these arcs feel u finished for a reason. But a lot of ppl do just think tptb likes to drop things for no reason.

I fully believe that if and when they pick back up those unfinished arcs all these same haters will be back in the audience in two seconds.

So it really doesn’t matter what ppl say. It’s like Lori’s actress said, if the writing is good, anything can work, and it will.

@wdway:

In answer to your questions Norman does say he's taking off to look for someone. I believe that is another decoy because most people think he's going to go look for Rick even though he tells Judith that if he finds everything about Rick/ Michonne he'll bring them back which means that isn't his main mission.

Maggie said that they should look (not sure of the wording) for other communities but the scene ends with that so are we to believe that Daryl is leaving everyone plus the kids again after just returning from the "frontier." Judith is totally OK with him leaving after we saw her in s10&11 not telling about why her mother has not returned because she was afraid that Daryl would leave her. Now she ties his leaving with Daryl finding happiness.

I'm just having a hard time with so few people not questioning Daryl gap year. That we're told repeatedly that Daryl will be kidnapped and wake up in France not knowing where he is and what happened a verrry strong recall to the title of the episode after Coda, What's Happening What's Going On.

Gimple gave us that strange coda at the end of TWB and tied it to Daryl's spin-off and yet tptb doesn't spend much time in reminding us of that fact.

@galadrieljones:

Interesting. Okay I actually took it as a weird (probably planned) slip-up. Anyone actually watching this closely will notice he said that and will also know he’s not actually going out and looking for Rick. Immediately I was confused because I don’t think anyone has ever said before that in the spin-off Daryl is going to look for someone.

To me this would support the theory that while he’s gone during the “lost year,” he discovers something and then he radios back to Judith about it. He talks to her about it and warns her he’s coming home but he’s going to have to leave again because he has to go and try and find THIS PERSON, that he couldn’t live with himself if he didn’t follow up at least, and that it could be the thing that finally brings him peace. Judith would be sad but would ofc understand. She would have some time to come to terms with the fact that he’s going to leave again.

Maggie’s attitude is weird after the time jump, too. That weird line about like, discovering the outside world or whatever. Maybe Daryl lied to her about where he’s going, because it’s already happened once that somebody told Maggie Beth was alive and then she wasn’t alive. Daryl would never do that to her again. He would lie, and he would tell Judith that she can tell Maggie the truth if she wants to, like he would never ask her to lie, but not until he’s already gone. Because he knows Maggie would insist on coming, and he wants to go alone, and he also has no idea if what he heard or saw will even lead to anything.

I was thinking like maybe he’s lying to everyone. Like Connie thinks he’s just out navigating the wild frontier but in reality he just went back to Atlanta, and he ended up at Grady, and he found something.

Daryl would totally be the man to keep all that a secret, or to only tell Judith. Maybe he’d tell Carol but Carol can keep a secret. And Carol would understand if Daryl wants to go alone.

I also agree that the use of the word romantic is a decoy to make ppl think he’s going to have a love story with Isabelle. But if you’re paying attn then you know this is unlikely, not only because we know that tptb knows how much another random new love interest would irritate the fan base, but because we have seen “leaked” photos of her that imply she is a nun.

Ofc casual viewers and people who only care about ship wars and what not will get pissed at this and rage share the information just to complain, and this is free PR and exactly what tptb wants.

Because there’s a HUGE fan base that just wants Daryl to be happy. They’re not ride or die Carylers or whatever. They will tune in just to see if there’s a chance Daryl could finally bs happy.

I am suddenly remembering that Morgan will be heading back to Atlanta in the final season of Fear. I would not be surprised if they’re driving the entire narrative back in that direction, ie: going back to the beginning to unlock new information and blaze a new trail forward.

@twdmusicboxmystery:

I hope so! Love all the discussion today!

[technicaldr]

EHR and Challenges of the Modern Medical Note

There was a time when documentation was an almost inconsequential process. After seeing a patient, the doctor would scratch a note, close the folder, and file it on a shelf until the next visit.

  Things are different and the medical note has evolved. As it’s evolved, electronic health records (EHR) have brought efficiencies to the medical note while introducing new challenges. And like the cognitive biases that impact patient care, the problems inherent in documentation need attention.

  Thinking about these challenges becomes important in documenting care and training the next generation of health professionals. Here are a few that I think about

Auto Documentation

One of the powers of the EHR is that it allows users to auto-populate the medical record with chunks of pre-fabricated text known as smart phrases. But these personally created building blocks of the medical note create the potential for one-clip-fits-all documentation. As I’ve said in the past, the smart phrase is not new technology.

  I work to keep smart phrases out of my history of present illness and impression where individualized narratives show what’s unique about a case. Free text keeps me real.

Replicability

While smart phrases represent the dropping of self-created language, we have the ability to clip and paste information from other parts of the chart. This may include bits and pieces from notes penned by another medical professional.

  While we all lift bits of language from places like CT and biopsy reports, issues arise when the origination of our language is that of another health professional. Epic now allows visualization of a phrase’s origin when not created by the author.

  I’m careful about what I copy. I’m twice as careful with what I paste as a representation of my own thinking.

Size and absence of constraint

While smart phrases are limited only by our imagination, a digital note with no constraints predisposes to note bloat, one of the looming threats to modern medicine. Pre-digital notes were constrained by writer’s cramp.

  I’ve laboured through notes where every single lab drawn on a complicated patient is dumped into the note. Pages and pages of marginally abnormal CBC and metabolic panels create a scenario where it’s difficult, if not impossible, to discern what data is relevant to the decisions made.

  I try to consider the needs of the end user of the note. Of course, this is challenging when our opinion of what constitutes a ‘good note’ varies from that of the note read.

Ambiguity of purpose

This is the most remarkable phenomenon of the modern medical note. Medical notes have traditionally had pet purposes. Medical students learn early on that ‘the right way to write a note’ varies not only by speciality but by the whim of the individual physician responsible for the note. Physicians with firm views regarding what constitutes the purpose of a note may even morph their perspective depending upon the nature of an individual case.

So if you ask 3 physicians the purpose of a medical note and you’ll get 5 answers ranging from billing and quality documentation to legal coverage and professional communication. Over time the medical note has morphed into all of these things at once.

  The problem with an ambiguity of purpose is how to manage the expectations of the end user. A physician who feels compelled to paste three months worth of blood results into the data portion of a note will be at odds with someone like myself who believes that a note serves to offer nothing other than concise support for what I’m thinking and planning.

  As notes become more visible to more folks we can expect ambiguity of purpose to become more pronounced. Digital notes and their capacity for customization amplify this divergence of purpose.

Scaling visibility of the EHR

Once restricted to the shelves of offices in big buildings, medical documentation has traditionally been siloed. This was fine because notes existed for the doctors who occupied those individual offices.  The medical note is now enjoying new freedom in its electronic shape. More notes are more visible to more professionals. This is evident within consolidated health systems where networks of offices connect to big hospitals.

  Beyond professionals, patients are watching and, in some cases, editing their own notes. OpenNotes is a related program based in Boston’s Beth Israel hospital. Regular patient review and revision represent a revolutionary move in medical documentation.

This scaling visibility of the modern note brings greater scrutiny for what we do or don’t do.

  This idea of the medical note and its evolution gets little attention yet it represents the core medium of all documentation by medical professionals. It deserves more thorough attention and study.

Technical Dr. Inc.'s insight:

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