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orbemnews · 4 years ago

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Psychiatry Confronts Its Racist Past, and Tries to Make Amends Dr. Benjamin Rush, the 18th-century doctor who is often called the “father” of American psychiatry, held the racist belief that Black skin was the result of a mild form of leprosy. He called the condition “negritude.” His onetime apprentice, Dr. Samuel Cartwright, spread the falsehood throughout the antebellum South that enslaved people who experienced an unyielding desire to be free were in the grip of a mental illness he called “drapetomania,” or “the disease causing Negroes to run away.” In the late 20th century, psychiatry’s rank and file became a receptive audience for drug makers who were willing to tap into racist fears about urban crime and social unrest. (“Assaultive and belligerent?” read an ad that featured a Black man with a raised fist that appeared in the “Archives of General Psychiatry” in 1974. “Cooperation often begins with Haldol.”) Now the American Psychiatric Association, which featured Rush’s image on its logo until 2015, is confronting that painful history and trying to make amends. In January, the 176-year-old group issued its first-ever apology for its racist past. Acknowledging “appalling past actions” on the part of the profession, its governing board committed the association to “identifying, understanding, and rectifying our past injustices,” and pledged to institute “anti-racist practices” aimed at ending the inequities of the past in care, research, education and leadership. This weekend, the A.P.A. is devoting its annual meeting to the theme of equity. Over the course of the three-day virtual gathering of as many as 10,000 participants, the group will present the results of its yearlong effort to educate its 37,000 mostly white members about the psychologically toxic effects of racism, both in their profession and in the lives of their patients. Dr. Jeffrey Geller, the A.P.A.’s outgoing president, made that effort the signature project of his one-year term of office. “This is really historic,” he said in a recent interview. “We’ve laid a foundation for what should be long-term efforts and long-term change.” Dr. Cheryl Wills, a psychiatrist who chaired a task force exploring structural racism in psychiatry, said the group’s work could prove life-changing for a new generation of Black psychiatrists who will enter the profession with a much greater chance of knowing that they are valued and seen. She recalled the isolation she experienced in her own early years in medicine, and the difficulty she has had in finding other Black psychiatrists to whom she can refer patients. “It’s an opportunity of a lifetime,” she said. “In psychiatry, just like any other profession, it needs to start at the top,” she said of her hope for change. “Looking at our own backyard before we can look elsewhere.” For critics, however, the A.P.A.’s apology and task force amount to a long-overdue, but still insufficient, attempt at playing catch-up. They point out that the American Medical Association issued an apology in 2008 for its more than 100-year history of having “actively reinforced or passively accepted racial inequalities and the exclusion of African-American physicians.” “They’re taking these tiny, superficial, palatable steps,” said Dr. Danielle Hairston, a task force member who is also president of the A.P.A.’s Black caucus and the psychiatry residency training director at Howard University College of Medicine. “People will be OK with saying that we need more mentors; people will be OK with saying that we’re going to do these town halls,” she continued. “That’s an initial step, but as far as real work, the A.P.A has a long way to go.” The question for the organization — with its layers of bureaucracy, widely varied constituencies and heavy institutional tradition — is how to get there. Critics operating both inside and outside the A.P.A. say that it still must overcome high hurdles to truly address its issues around racial equity — including its diagnostic biases, the enduring lack of Black psychiatrists and a payment structure that tends to exclude people who can’t afford to pay out of pocket for services. “All these procedural structures that are in place are helping to perpetuate the system and keep the system functioning the way it was designed to function,” said Dr. Ruth Shim, the director of cultural psychiatry and professor of clinical psychiatry at the University of California, Davis, who left the A.P.A. in frustration last summer. They all add up, she said, to “an existential crisis in psychiatry.” A racist history White psychiatrists have pathologized Black behavior for hundreds of years, wrapping up racist beliefs in the mantle of scientific certainty and even big data. The A.P.A. was first called the Association of Medical Superintendents of American Institutions for the Insane, according to Dr. Geller, who last summer published an account of psychiatry’s history of structural racism. The group came into being in the wake of the 1840 federal census, which included a new demographic category, “insane and idiotic.” The results were interpreted by pro-slavery politicians and sympathetic social scientists to find a considerably higher rate of mental illness among Black people in the Northern states than among those in the South. In the decades following Reconstruction, prominent psychiatrists used words like “primitive” and “savage” to make the cruelly racist claim that Black Americans were unfit for the challenges of life as independent, fully enfranchised citizens. T.O. Powell, superintendent of the infamous State Lunatic Asylum in Milledgeville, Ga., and president of the American Medico-Psychological Association (the precursor to the A.P.A.), went so far as to outrageously state in 1897 that before the Civil War, “there were comparatively speaking, few Negro lunatics. Following their sudden emancipation their number of insane began to multiply.” Psychiatry continued to pathologize — and sometimes demonize — African-Americans, with the result that, by the 1970s, the diagnosis of psychosis was handed out so often that the profession was essentially “turning schizophrenia into a Black man’s disorder of aggression and agitation,” said Dr. Hairston, a contributor to the 2019 book, “Racism and Psychiatry.” Since then, numerous studies have shown that an almost all-white profession’s lack of attunement to Black expressions of emotion — and its frequent conflation of distress with anger — have led to an under-diagnosis of major depression, particularly in Black men, and an overreliance upon the use of antipsychotic medications. Black patients are less likely than white patients to receive appropriate medication for their depression, according to a 2008 report published in “Psychiatric Services.” Fixing the problem To change course, and serve Black patients better, organized psychiatry is going to need to make a higher priority of training doctors to really listen, said Dr. Dionne Hart, a Minneapolis psychiatrist and addiction medicine specialist and an adjunct assistant professor of psychiatry at the Mayo Clinic College of Medicine and Science. “We checked a lot of boxes publicly,” she said in an interview. “Now we have to do the work. We have to show we’re committed to undoing the harm and working with all of our colleagues from all over the country to recognize trauma and acknowledge trauma where it exists and get people appropriate treatment.” Psychiatrists lean liberal, and many say that people with mental illness are a marginalized and underserved group. In 1973, the A.P.A. made history by removing “homosexuality” as a psychiatric diagnosis from the second edition of its Diagnostic and Statistical Manual of Mental Disorders. But the kind of soul searching that occurred around that decision has taken much longer with race. Psychiatry today remains a strikingly white field where only 10.4 percent of practitioners come from historically underrepresented minority groups, who now make up nearly 33 percent of the U.S. population, according to a 2020 study published in “Academic Psychiatry.” That study found that in 2013, Black Americans were only 4.4 percent of practicing psychiatrists. The discipline’s history of pathologizing Black people — to “regard Black communities as seething cauldrons of psychopathology,” as three reform-minded authors put it in 1970 in the American Journal of Psychiatry — has deterred some Black medical students from entering the profession. “Some people in my family, even now won’t say that I’m a psychiatrist,” Dr. Hairston noted. “A family member told me on my match day that she was disappointed that I had matched to psychiatry and not another specialty — it seemed like I was letting the family down.” The difficulty in finding a Black psychiatrist can put a damper on the willingness of Black patients to seek treatment. And psychiatric help is also strikingly inaccessible for patients without money. Psychiatry is an outlier among other medical specialties for the extent to which its practitioners choose not to participate in public or private health insurance programs. In 2019, a study by the Medicaid and CHIP Payment and Access Commission found that psychiatrists were the least likely medical providers to accept any type of health insurance: Just 62 percent were accepting new patients with either commercial plans or Medicare, while an even more anemic 36 percent were accepting new patients using Medicaid. In contrast, across all providers, 90 percent reported accepting new patients with private insurance, 85 percent said they accepted those with Medicare and 71 percent were willing to see Medicaid patients. Many psychiatrists say they do not participate in health insurance because the reimbursement rates are too low. A 2019 study showed that, nationwide, reimbursement rates for primary care physicians were almost 24 percent higher than for mental health practitioners — including psychiatrists. In 11 states, that gap widened to more than 50 percent. The A.P.A.’s advocacy in this particular area of equity has focused on pushing for full insurer compliance with the Mental Health Parity and Addiction Equity Act, a 2008 law that requires health insurance plans that provide mental health care coverage to do so at a level comparable to what they provide for physical health care. While the profession hopes for higher reimbursement rates, the gap that affects patients, in the short term, is inequitable access to treatment. “The thing that’s always bothered me the most in the practice of psychiatry is, you can talk about your commitment to things like equity, but if you have a system where a lot of people can’t get access, so many patients are cut off from access to quality care,” said Dr. Damon Tweedy, an associate professor of psychiatry and behavioral sciences at Duke University and the author of “Black Man in a White Coat: A Doctor’s Reflections on Race and Medicine.” “What are our values?” said Dr. Tweedy, who sees patients at the Durham Veterans Affairs Health Care System. “We might say one thing, but our actions suggest another.” Source link Orbem News #Amends #confronts #Psychiatry #racist

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angeliquemd · 7 years ago

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The Post-Graduate Internship Experience

What is a post-graduate intern (PGI) you ask? In some countries such as ours, after doing 4 years of undergraduate college studies, then another 4 years of med school proper, and then finally FINALLY graduating, we are expected to do a year of hospital work before we can take our licensure exam. These are essentially physicians in training - already having a medical degree but cannot practice without the supervision of a senior, and cannot take the board exams just yet. At this time, we once again do rotations in different specialties/subspecialties for further exposure, and well, I guess we need as much exposure as we can get for us to really learn the art of saving lives. I had my internship at Chinese General Hospital and Medical Center, and it isn't by far something I regret. When I was still in school doing my clinicals, we had guest PGI's from different hospitals give talk to us on how life as an intern is. Mostly, their goal was to get us to apply in their hospital after graduation :P Chinese Gen was always dubbed as a "toxic" hospital - having 1 intern per building at duty hours (which I didn't believe at first but later on found out to be true). I still decided to push through and go in this hospital because 1) it is near the university area, and 2) although I am proud to be a Thomasian healthcare provider, I thought it would be great to learn about the culture of other hospitals - non school-based hospitals with a variety of doctors coming from different institutions. I'd also probably add to my reasons the stipend they offer all interns, as well as the free meals (yep, breakfast, lunch, dinner, as well as our midnight snacks are free). It's the perfect set-up for busy bodies especially those who live alone in dorms/condos and do not have the time to fix meals. My first rotation was Internal Medicine, and you can read about my write up here Let me do my impressions to the specialties I’ve been in, otherwise this post would be a novel haha. Surgery: What is this “rest” you speak of? It was in Surgery where I experienced the most tiring day of my life (from non-stop OR’s in the morning and ward calls at night, then after the 30 hour shift we have to stay for dance practice. YES! It was Christmas season that time and Chinese Gen is big on Christmas parties so yeah). We had to stay for 40 hours straight then were expected to be present by 6:30am the next day, no excuses. Oooh I also did a 5-day straight duty here so I can avail a 5-day straight off. That was during the Christmas/New Years’ season. I took the straight Christmas duty so I can be free on New Years’ Eve. That time it was me basically bringing my whole house to the hospital. Haha. During the non-holiday months, the OR schedules still looked like ward censuses where we reach 20++ OR’s per day, so by no means should one think that surgery is a sitting down rotation. We also had our Anesthesiology, ENT/Ophtha, as well as Psychiatry mini rotations during surgery, all of them were a-okay. OB-GYN: Where do all these babies come from? They said OB-GYN was benign - I don’t know why I fell for that. I must have examined a hundred of cervixes (LOL) during OPD as well as Charity sessions, and the cesarean sections I have scrubbed in to was close to that number. I experienced a duty wherein I was in the OR from 3pm to 11pm at night. Good thing my residents were super cool and chill. They’re the perfect balance between a cool mom *yay Mean Girls reference* and a prudent friend. Community: Pedia patient 1: Cough and colds. Pedia patient 2: Cough and colds. Pedia patient 10: surprise!..oh wait, it’s still cough and colds. All interns do community work, and it depends on your hospital what kind of community you'll be at. Thankfully, the community we got assigned to was just a few minutes away from hospital base. The outreach center caters to both adult and pediatric patients, where we mostly do check-ups. For me, this was a great breather. We were already 3/4 done with internship by this time so I guess everyone from my team was already so burnt out that anything which involved outside rotations was welcome. Community was light. We get off early and don’t need to come in till 8am. We do however come back to base every 3 days to do ER work from 4pm to 6am, then we’re off to go to be at the center by 8am. Our co-interns are super nice to those who did ER work the night before, thank heavens. They do most of the work and let those who did ER duties sleep. Community was a good time to meet new people as well since our center catered to interns from different hospitals so yeah. Everyone was chill and awesome :) Pediatrics: Where your patient is the child AND the parent. My last rotation. To be quite frank, I didn’t expect I’d have fun in Pedia. I was the only one in my team to have a partner dutymate, so all my work was reduced by half ;) We had so much cases that reviewing for the board exam was me basically thinking of the patients I handled! From Kawasaki disease to dextrocardiacs to tracheoesophageal fistulas -- we sure had a great variety. My favorite though was exposure to the neonates. It was here that I learned the skill of extracting blood from day old babies :)) The downside of pedia thought is that parents can be sooo overprotective at times that it hinders you from doing your job. I mean, I understand why parents can act a bit extra at times but also please understand that what we do is for your child as well. Okay? :) Overall, my stay in ChiGen is an 8/10. Aside from the stipend and free food, I forgot to mention that interns are also involved in conventions c/o the hospital. We get the lectures as well as the freebies!!! We take home so much stuff in the end, I swear. I ended up giving away the physician's sample meds to those who needed them more than I did. Also, in the hospital, we were treated as doctors and the staff was very kind and courteous to us. It was always a "kilig" moment when we get called "Doc" in this early phase of our career. I would recommend it to clinical clerks still wondering where to do their internship. That's it for my post, sorry if it got a bit lengthy! :P

#med school #internship #MD #post graduate internship #med life #chinese general hospital

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myweightlosstodaycom · 5 years ago

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Plate with a keto diet food. Fried egg, bacon, avocado, arugula and strawberries. Keto breakfast.

Review

“It’s hard not to like a program that promotes a healthy diet and promises faster results in less time.” ―Web MD Expert Review

“Give the Supercharged South Beach diet a try and be amazed at how you feel and look.” ―Dieting Smarter

About the Author

Arthur Agatston, M.D., is a preventive cardiologist and associate professor of medicine at the University of Miami Miller School of Medicine. In 1995, Dr. Agatston developed the South Beach Diet to help his cardiac and diabetes patients improve their blood chemistries and lose weight. Since then, his book The South Beach Diet and its companion titles have sold more than 22 million copies. Dr. Agatston has published more than 100 scientific articles and abstracts in medical journals, and recently he received the prestigious Alpha Omega Award from New York University Medical Center for outstanding achievement in the medical profession. He lives in Miami Beach with his wife, Sari.

Joseph Signorile, Ph.D., is a professor of exercise physiology and assistant director of the Laboratory of Clinical and Applied Physiology at the University of Miami. He is widely published and lectures frequently on the subjects of exercise training, muscle physiology, and metabolism.

Chapter One

Changing the Way America Lives

The South Beach Diet was always intended to be more than just a diet. In fact, it was originally developed to help my cardiac and diabetes patients lose weight in order to prevent heart attacks and strokes. As a cardiologist, I have always felt that the South Beach Diet is less about dieting and more about living a long, healthy, and active life. I wrote the original book in 2003 because I wanted to help change the way America eats. Now I have a new goal: I want to change the way America lives, not only by helping people eat healthfully and lose weight, if necessary, but also by helping them become more fit. We must begin to overcome the poor eating habits and sedentary lifestyle that are making us fatter and sicker with each passing year.

Over the past several decades, we have witnessed an unexpected epidemic of obesity in this country. One-third of American adults over age 20 are obese, and two-thirds of us are overweight. The number of seriously overweight children has tripled. Moreover, statistics show that 51 percent of Americans don’t engage in any kind of regular physical activity. The results have been catastrophic.

This epidemic of obesity is causing an array of health problems that is much broader than we doctors ever imagined. Beyond the cosmetic concerns that pervade our culture, the list of real problems arising from our toxic lifestyle is getting ever longer. A partial list includes—and you may want to sit down for this—heart attack, stroke, prediabetes, diabetes, many types of cancer, Alzheimer’s disease, macular degeneration, arthritis, osteoporosis, psoriasis, acne, depression, and attention deficit disorders. And this is just a sampling.

It also appears that if we do not reverse the health course that we are on, the cost in human and economic terms will reach crisis proportions. Our poor diet and sedentary lifestyle are already exacting a steep toll in terms of mortality and money. They’re responsible for an estimated 300,000 premature deaths every year and $90 billion in health-care costs, but I believe the real costs are much higher. And as the baby boom generation gets older, these health costs will likely continue to soar.

Sadly, this is not only an American problem. Just as our sedentary, fastfood lifestyle is being exported around the world, so are the attendant health problems. The good news is that now that we better understand what’s happening to us, we can start to create solutions.

A Sedentary Nation

In order to develop strategies to halt and reverse the epidemic of obesity, we must be aware of the trends that have gradually but inexorably brought us to the crisis situation we are in today. I have found in my practice that by putting patients’ current problems into a context they can understand, they can more easily become cooperative partners in moving toward solutions. Perhaps because I was a history major (not all doctors are bio majors), I also find that tracing today’s health problems back to their original roots is fascinating.

The truth is that while our bad diet and unhealthy lifestyle have been many decades in the making, the toxic changes in the way we live have really accelerated in recent years. Our DNA is designed to live, eat, and exercise the way our hunter-gatherer ancestors did, and it hasn’t changed substantially since that time. But we no longer live in the wild. We don’t have famine in this country to keep us thin. We no longer burn calories hunting and gathering our food.

On top of that, a completely sedentary lifestyle has gradually crept in, invention by incredible invention. Due to the march of technology, we sit in front of computers both at work and at home. Machines and gadgets lift, move, and carry things for us. We communicate by e-mail, and many of us don’t even walk down the hall to chat with colleagues as often as we used to! While studies document how much less physical exertion we’re doing, we really don’t need research studies to appreciate the trend. All we have to do is look around.

The preponderance of labor-saving devices, from tractors and forklifts to remote controls and the personal computer, has had a major impact on the number of calories we expend daily at home and at work. These devices have also had devastating effects on our muscles, bones, tendons, and ligaments. Sitting bent over at a computer for most of the day is simply not good for our health. In Chapter 5, “Boomeritis: The New Epidemic!” I talk about these evolving physical problems and their solutions. And in Part II of the book, I present the South Beach Supercharged Fitness Program. Not only will this 20-minute-a-day program help you burn more calories even when you’re not working out, it will also strengthen the key core muscles in your abdomen, back, pelvis, and hips. It’s your core muscles that help you avoid the back pain and other muscle problems that so often result from our sedentary lives.

Missing Our Nutrients

Our unhealthy lifestyle is made even worse by our poor diet. Since we began growing fields of grain about 10,000 years ago and developed the ability to cultivate fruits and vegetables, the nutritional content of our foods has seriously deteriorated. This is because we tend to breed plants for hardiness, taste, and aesthetics, not nutrients. Today, the fruits and vegetables we find in most supermarkets are larger, sweeter, and better-looking than those our ancestors gathered. The problem is that they also have less fiber and fewer vitamins, minerals, and other nutrients than is optimal for our general health—not to mention our waistlines. Luckily, more and more Americans are embracing organic foods, heirloom fruits and vegetables, and sustainable farming methods, all trends that are bringing food back to its more natural and nutritious state. In Chapter 7, “Supercharged Foods for Better Health,“ I recommend some foods with powerful nutritional benefits that can help you stay healthy and avoid the host of chronic and degenerative diseases currently affecting so many of us.

A Nation Overprocessed

Beyond our desire to cultivate and produce food almost exclusively to please our tastebuds, other social and technological trends have affected our food supply for the worse. A few generations ago, our great grandparents walked to local markets on a daily basis to buy whatever produce they didn’t grow themselves as well as fresh bread and other food for their families’ next meals. They could only travel to local markets and take home what they were able to carry. With the advent of the automobile and the home refrigerator, however, it became possible to travel farther to shop, and people could take home enough food to feed their families for a week or two. But for that to be possible, foods had to have longer shelf lives. This led to supermarkets and to food processing, which, unfortunately, removed important nutrients while adding substances like sodium and trans fats to prevent spoilage. In a sense, we began digesting our food in factories instead of in our intestines.

It’s only now that we are appreciating the deleterious effects these technological “advances” have had on our weight and on our health. In Chapter 3, “A Diet You Can Live With… For Life,“ I discuss the health and character of a Mediterranean society that thrived without many of our modern advances, and I show you how we can learn from this remarkable example.

We Must Act Now

If you’re like me, you find how we got into this sad state not only depressing but scary. But there is hope if we take action today. Because we finally understand so much of what has gone wrong, we can use our advanced technologies to turn things around. We now know that our increasing waistlines, poor physical fitness, and worsening health are not different It was 2003, and my husband had very high blood pressure that wasn’t being controlled, even with medication. I was very overweight and knew that we both needed to make a change. The South Beach Diet had just come out, and I went to the bookstore to look over a copy. The first thing I turned to was the recipe section. It was great. I love to cook and was thrilled that I didn’t have to give it up.

After reading the book, I realized that I ate way too many bad carbs all day, like crackers and cookies. Once I stopped eating enriched white flour, I noticed a complete change in everything about me, including my mood and energy level, and I started losing weight. Within a year, I lost 45 pounds, and my husband lost 20. Although he still takes medication for high blood pressure, it’s now under control.

Now I’m the go-to girl at work for healthy-food questions. When we have luncheons, everyone knows they can count on me to bring in something healthy. I have learned how to take bad carbs out of a recipe and replace them with good carbs. I am passionate about telling people to read food labels! Don’t be fooled; buy only whole-grain products. If it says “enriched white flour,“ find something else.

In 2005, we had an 11-year-old foster youth come to live with us. He was overweight and already taking medication for high blood pressure. He lived on junk food. We took him to a doctor, who told us that he shouldn’t go on a diet—he should start living a healthy lifestyle. I decided to give him the same healthy food my husband and I were eating, but I told him he could eat as much as he wanted. He also started exercising. Simply by eating the right foods and being more active, he started losing weight fairly quickly. By the end of 4 months, he was off the blood pressure medication, and by the time he left us 18 months later, he had lost 30 pounds. While living with us, he learned how to read food labels and make good food choices. I hope he continues to live a healthy life. My husband often jokes that I should open my home …

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The South Beach Diet Supercharged: Faster Weight Loss and Better Health for Life Paperback – April 28, 2009 Review “It's hard not to like a program that promotes a healthy diet and promises faster results in less time.” ―Web MD Expert Review…

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kristinsimmons · 6 years ago

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Obsessive Measurement Disorder: Etiology of an Epidemic

By KIP SULLIVAN JD

Review of The Tyranny of Metrics by Jerry Z. Muller, Princeton University Press, 2018

In the introduction to The Tyranny of Metrics, Jerry Muller urges readers to type “metrics” into Google’s Ngram, a program that searches through books and other material published over the last five centuries. He tells us we will find that the use of “metrics” soared after approximately 1985. I followed his instructions and confirmed his conclusion (see graph below). We see the same pattern for two other buzzwords that activate Muller’s BS antennae – “benchmarks,” and “performance indicators.” [1]

Muller’s purpose in asking us to perform this little exercise is to set the stage for his sweeping review of the history of “metric fixation,” which he defines as an irresistible “aspiration to replace judgment based on personal experience with standardized measurement.” (p. 6) His book takes a long view – he takes us back to the turn of the last century – and a wide view – he examines the destructive impact of the measurement craze on the medical profession, schools and colleges, police departments, the armed forces, banks, businesses, charities, and foreign aid offices.

Foreign aid? Yes, even that profession. According to a long-time expert in that field, employees of government foreign aid agencies have “become infected with a very bad case of Obsessive Measurement Disorder, an intellectual dysfunction rooted in the notion that counting everything in government programs will produce better policy choices and improved management.” (p. 155)

Muller, a professor of history at the Catholic University of America in Washington, DC, makes it clear at the outset that measurement itself is not the problem. Measurement is helpful in developing hypotheses for further investigation, and it is essential in improving anything that is complex or requires discipline. The object of Muller’s criticism is the rampant use of crude measures of efficiency (cost and quality) to dish out rewards and punishment – bonuses and financial penalties, promotion or demotion, or greater or less market share. Measurement can be crude because it fails to adjust scores for factors outside the subject��s control, and because it measures only actions that are relatively easy to measure and ignores valuable but less visible behaviors (such as creative thinking and mentoring). The use of inaccurate measurement is not just a waste of money; it invites undesirable behavior in both the measurers and the “measurees.” The measurers receive misleading information and therefore make less effective decisions (for example, “body count” totals tell them the war in Viet Nam is going well), and the subjects of measurement game the measurements (teachers “teach to the test” and surgeons refuse to perform surgery on sicker patients who would have benefited from surgery).

What puzzles Muller, and what motivated him to write this book, is why faith in the inappropriate use of measurement persists in the face of overwhelming evidence that it doesn’t work and has toxic consequences to boot. This mulish persistence in promoting measurement that doesn’t work and often causes harm (including driving good teachers and doctors out of their professions) justifies Muller’s harsh characterization of measurement mavens with phrases like “obsession,” “fixation,” and “cult.” “[A]lthough there is a large body of scholarship in the fields of psychology and economics that call into question the premises and effectiveness of pay for measured performance, that literature seems to have done little to halt the spread of metric fixation,” he writes. “That is why I wrote this book.” (p. 13)

A short history of Obsession Measurement Disorder in medicine

I read Muller’s book because I share his astonishment at the persistence of the measurement craze in the face of so much evidence that it is not working. Over the three decades that I have studied health policy, I have become increasingly baffled by people who promote various iterations of managed care in the face of evidence that they don’t work. In search of an explanation, I have, as Muller has, read books and news stories about the misuse of measurement in other fields, particularly education and banking. I have been especially baffled by the managed care movement’s enthusiasm for measuring the cost and quality of all actors in the health care system, an enthusiasm that emerged in the late 1980s when it was obvious that the propagation of HMOs, the movement’s founding project, was failing to control inflation. [2]

By the 1990s the enthusiasm for documents that handed out grades to insurance companies and providers on “consumer satisfaction,” mortality rates, etc. had become an obsession. Proponents of “report cards,” as these documents were called, hoped that “consumers” would read them and reward the good actors with their business and punish the bad actors by leaving them. That, of course, did not happen.

Frustrated by consumer disinterest in report cards, managed care proponents, such as the Medicare Payment Advisory Commission (MedPAC) and the Institute of Medicine (IOM), declared in the early 2000s that it was time to punish doctors and hospitals directly by rewarding them if they got good grades on crude measurements and punishing them if they didn’t. The term they used to describe this direct method of punishment was “pay for performance,” a phrase borrowed from the business world. By about 2004, that phrase had become so common in the health policy literature it was shortened to “P4P.”

The complete absence of evidence that P4P would improve the quality of medical care didn’t matter to MedPAC and other P4P advocates. [3] As evidence has piled up over the last decade indicating P4P doesn’t reduce costs and has mixed effects on quality, P4P proponents, true to form, have ignored it. [4]

Taylorism: Ground zero of the epidemic

It is impossible to identify a single Typhoid Mary responsible for the metrics-fixation epidemic, but it is fair to say a very important Typhoid Mary was Frederick Winslow Taylor. Muller identifies the rise of “Taylorism” in manufacturing in the early 1900s as a primary cause of the epidemic. Taylor, an American engineer, studied every action of workers in pig iron factories, estimated the average time of each action, then proposed to pay slower workers less and faster workers more. According to Taylor, determining who was slow and who was fast and paying accordingly required “an elaborate system for monitoring and controlling the workplace,” as Muller puts it. (p. 32) Taylor called his measurement-and-control system “scientific management.”

“Scientific management” assumed that managers with clipboards could distill the wisdom of their work force into a set of rules (later called “best practices,” another buzzword catapulted to stardom in the 1990s) and enforce those rules with pay-for-performance. The outcome of “scientific management,” according to Taylor, was that “all of the planning which under the old system was done by the workmen, must of necessity under the new system be done by management in accordance with the law of science.” (Muller, pp. 32-33) Here we see the beginning of the double standard now prevalent in health policy: People who flog faith-based P4P schemes hold themselves out as the bearers of “scientific” values (“evidence-based medicine,” to use the lingo invented in the early 1990s), while doctors who criticize metrics madness are said to be stuck in a “paternalistic culture.” [5]

The obvious corollary to “scientific management” was that leaders of corporations didn’t need any hands-on experience or training in the production of whatever it was their corporation produced. If you had a degree from a business school that taught “scientific management,” it shouldn’t matter to Sunbeam, for example, that “Chainsaw” Al Dunlap had no knowledge of how appliances are made. As long as he knew “management,” he was qualified to be Sunbeam’s CEO. Decades after Taylorism arose, this same logic would justify allowing managers of insurance company executives, Fortune 500 companies, and government insurance programs who never went to medical school to measure and micromanage doctors.

By the 1950s, this notion that standardized data in the hands of managers trumped experience had become deeply embedded in American business culture. By the 1960s, reports Muller, it had spread to the US military (Robert MacNamara’s background in accounting got him a job running a car company, and from there he jumped to the Pentagon where he and his “whiz kids” told the generals to count enemy corpses). By the 1980s it had infected other government agencies and much of the non-profit world, and by the late 1990s it had infected the services sector, including medicine.

Measuring the doctor and patient from afar

“Nowhere are metrics in greater vogue than in the field of medicine,” writes Muller. (p 103) The following statement by report-card and P4P guru Michael Porter, which Muller took from an article Porter co-authored for the Harvard Business Review, is a good illustration of how P4P proponents think and talk.

Rapid improvement in any field requires measuring results – a familiar principle in management…. Indeed, rigorous measurement of value (outcomes and costs) is perhaps the single most important step in improving health care. Wherever we see systematic measurement of results in health care … we see those results improve. [p. 107]

From this excerpt plus other sections of the Harvard Business Review article, we learn that Porter is absolutely convinced it’s possible to measure “outcomes and costs” accurately, and then divide cost into quality to derive “value.”

Note first the voice-of-God tone. God doesn’t have to document anything, and neither does Porter; there are no footnotes in this lengthy essay. Note next the grand assumption that improvement is only possible if “results” are measured. How do we know this? We just do. It’s a “principle of management,” says Porter (no doubt going all the way back to Frederick Taylor). Third, note the misrepresentation of the evidence. It simply isn’t true that “wherever” managers conduct “systematic measurement” of “performance” by doctors and hospitals, costs go down and/or quality goes up.

Muller compares the groupthink represented by Porter with research on both report cards and P4P schemes. The small body of research on report cards finds they have no impact on “consumer” behavior or patient outcomes. The large body of research on P4P indicates it may be raising costs when the costs providers incur to improve “performance” is taken into account, and it has at best a mixed effect on measured quality.

Muller suggests that the net effect of P4P on the health of all patients, that is, those whose care is measured and those whose care is not measured, is negative. Sicker patients are the ones most at risk in a system where P4P is rampant. Because the measures of cost and quality upon which P4P schemes are based are so inaccurate (because scores cannot be adjusted with anything resembling accuracy to reflect factors outside provider control), it induces a variety of “gaming” strategies, the worst of which are avoiding sicker patients and shifting resources away from patients whose care is not measured to those whose care is measured (“treating to the test”).

To illustrate how P4P damages sicker patients, Muller devotes two pages to the damage done by Medicare’s Hospital Readmissions Reduction Program (HRRP). This program, which began in 2012, punishes hospitals that have an above-average rate of 30-day readmissions (admissions that occur within 30 days of a discharge from a hospital) for patients with a half-dozen diagnoses. Muller reports that the HRRP has clearly had two negative effects. First, it has incentivized hospitals to keep sick patients away for at least 30 days after discharge, and if that’s not possible, to let them in but to put them on “observation” status, which means they are not counted as “readmitted.” [6] Second, it has led to the punishment of hospitals that treat sicker and poorer patients.

When Muller publishes a second edition of this book, he’ll no doubt add a page describing research done since his book was published showing that the HRRP appears to be killing patients with congestive heart failure (CHF). CHF was one of the three diagnoses that has been measured by the HRRP since it began (readmissions for heart attack and pneumonia were the other two).

Reversing the epidemic

Muller ends his book with a series of recommendations. He suggests, for example, that measures be developed from the bottom up and that financial rewards and penalties should be kept low if they are to be used at all. He does not attempt to offer political solutions. For this I do not criticize him. His book, which must have required years of research, is a valuable contribution to the largely one-sided debate about P4P in medicine, a debate which has only recently become more audible.

Here are my two cents on the politics of this issue. Groups representing doctors and nurses must take the lead in rolling back measurement mania. Doctors and nurses have great credibility with the public, and they have to cope every day with the consequences of measurement mania. They should focus on rolling back the P4P schemes now inflicted on the fee-for-service Medicare program because Medicare is so influential (“reforms” inflicted by Congress on Medicare are typically mimicked by the insurance industry). Groups working to reduce the cost of health care or improve quality of care for patients should also join the fight. They too have an interest in undermining the tyranny of metrics.

Of course, it would be nice if those who make a living promoting the inappropriate use of measurement would practice what they preach and examine their own behavior to see how it could be improved. Here’s a question that people in that business might pose to themselves now and then: Would you like your work to be subjected to measurement of its cost and quality by third parties, and would you like those third parties to alter your income based on the grades they decide to give you?

Footnotes:

[1] Just to test NGram, I entered other terms. “Automobile,” for example, rises up from zero mentions just before 1900 to a peak during about 1938-1942, then declines rapidly so that the rate by 2000 (the last year on the graph) is equal to the rate of 1910. “Database,” on the other hand, stays at zero mentions until about 1970, then skyrockets in the late 1970s.

[2] Accurate measurement of the cost and quality of insurance companies and providers was an essential element of “managed competition,” a proposal introduced in 1989 by Alaine Enthoven and enthusiastically promoted by Paul Ellwood (the “father of the HMO”), insurance industry executives, Bill and Hillary Clinton, and the editors of the New York Times, to name just a few of Enthoven’s most influential disciples.

[3] A 2006 edition of Medical Care Research and Review devoted entirely to the emerging P4P fad stated, “P4P programs are being implemented in a near-scientific vacuum.”

[4] We are seeing rare exceptions to the P4P groupthink only in the last two or three years. In January 2018, MedPAC formally voted to reverse its decision to recommend P4P at the individual physician level. Donald Berwick, a leading proponent of measurement, announced in 2016 that it was time to reduce the reporting burden on doctors by 50 to 75 percent and to eliminate P4P at the individual level.

[5] The IOM, for example, has peddled measurement and control of providers for decades on the basis of no evidence, yet it maintains a “roundtable” of P4P disciples the IOM deems to be “science-driven.”

[6] “Observation stays” were designed for Medicare beneficiaries who were not clearly in need of inpatient care but who were not clearly ready to go home either. Such patients are typically placed on the same wards with admitted patients but not treated.

Kip Sullivan is a member of the Health Care for All MN advisory board, and of MN Physicians for a National Health Program.

Obsessive Measurement Disorder: Etiology of an Epidemic published first on https://wittooth.tumblr.com/

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isaacscrawford · 6 years ago

Text

Obsessive Measurement Disorder: Etiology of an Epidemic

By KIP SULLIVAN JD

Review of The Tyranny of Metrics by Jerry Z. Muller, Princeton University Press, 2018

Muller, a professor of history at the Catholic University of America in Washington, DC, makes it clear at the outset that measurement itself is not the problem. Measurement is helpful in developing hypotheses for further investigation, and it is essential in improving anything that is complex or requires discipline. The object of Muller’s criticism is the rampant use of crude measures of efficiency (cost and quality) to dish out rewards and punishment – bonuses and financial penalties, promotion or demotion, or greater or less market share. Measurement can be crude because it fails to adjust scores for factors outside the subject’s control, and because it measures only actions that are relatively easy to measure and ignores valuable but less visible behaviors (such as creative thinking and mentoring). The use of inaccurate measurement is not just a waste of money; it invites undesirable behavior in both the measurers and the “measurees.” The measurers receive misleading information and therefore make less effective decisions (for example, “body count” totals tell them the war in Viet Nam is going well), and the subjects of measurement game the measurements (teachers “teach to the test” and surgeons refuse to perform surgery on sicker patients who would have benefited from surgery).

A short history of Obsession Measurement Disorder in medicine

Taylorism: Ground zero of the epidemic

Measuring the doctor and patient from afar

Reversing the epidemic

Footnotes:

[3] A 2006 edition of Medical Care Research and Review devoted entirely to the emerging P4P fad stated, “P4P programs are being implemented in a near-scientific vacuum.”

Kip Sullivan is a member of the Health Care for All MN advisory board, and of MN Physicians for a National Health Program.

Article source:The Health Care Blog

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sherristockman · 8 years ago

Link

Creative Imaging and Other Mental Tools Can Turn Worry and Anxiety Into Confidence and Happiness Dr. Mercola By Dr. Mercola Worry may well be one of the most common causes of suffering in America. Besides being troublesome in and of itself, worry is also a contributing factor for overeating, alcoholism, smoking, drug abuse and many other compulsive disorders. In this interview, Dr. Martin Rossman, author of “The Worry Solution” book and CD set, provides simple and practical tools for addressing chronic worry. Rossman has a long-standing interest in the practical importance of attitudes, beliefs and emotions in mind-body medicine. His awareness of the impact of worry came early in his career. After graduating from medical school in 1969 and finishing his internship at a county clinic in Oakland, California, he ran an urban house call practice for about a year and a half. He initially started doing house calls in order to find out why people were having such problems implementing healthy lifestyle changes. “I saw the effects of poverty, ignorance and lack of opportunity, which creates a great deal of stress, depression and anxiety,” he says. “[P]eople are trying to get through the day and manage their stress. All of these things, be it cigarettes, sugar, alcohol or drugs, temporarily relieve the pain of depression and anxiety. The trouble is, one, they’re short-acting so they tend to be addicting, [and] they don’t address the cause or solve the problems … The second thing is that over time, the toxic effects of these medications, alcohol, drugs or cigarettes, start to override the beneficial effects. It’s what I call “toxic coping efforts." Anyhow, I was treating all these people that were really creating their diseases by the way that they were coping, either through junk food, or sugar, or too much food, or alcohol, or drugs, cigarettes and so on. Deciding I needed to get better at helping people learn how to change their lifestyle, I started to study motivational psychology and ways to help people care better for themselves and learn how to change habits that were costing them in terms of their health. That’s been my passion for the rest of my career.” Mind-Body Health His investigations led him into the holistic health movement. In time, he incorporated a number of different complementary strategies, including acupuncture, Chinese medicine, nutrition, and a variety of mind-body healing strategies, all of which led to the creation of “The Worry Solution.” Science has repeatedly shown that anxiety and stress take a profound toll on health, and may even be a more significant influence than poor diet. Some studies suggest as much as 75 to 90 percent of illnesses have some sort of emotional underpinning. “It’s pretty amazing,” Rossman says. “When you look at it, there are the direct effects of stress, which are significant. When I talk to physicians, I sometimes say ‘A huge part of the job of a primary physician is to try to tell what isn’t anxiety and stress’ … Then there are the indirect effects, which are the biological and physical manifestations of the poor choices in eating, the excessive alcohol, smoking of cigarettes, the taking of drugs and so on. Including the fact that when you don’t make those good lifestyle choices, you end up on a half a dozen different medications … Then you start treating the side effects of the medications. They don’t really cure those diseases. That’s why they’re chronic diseases. The cure, if there is one, is really, for many people, a pretty radical change in lifestyle and that often begins in the mind.” The Power of Visualization Imagery is the natural language of your brain, which is in part why visualization and guided imagery exercises are so powerful for changing thoughts and behavior. Most successful people, be it actors, business people or athletes, have learned — either through instinct or training — to use their imaginations on purpose. According to Rossman: “Imagery, which seems so invisible and ethereal and airy-fairy, is one of the most powerful faculties we have as human beings for not only changing our behaviors, but changing our minds, which changes our physiology.. It changes our body. It changes our health.” Your imagination can also be employed to help you set goals, stay on track, and develop a deeper self-awareness about what and how you think. “I teach people how to use imagery on purpose, for the sake of better health and healing, as well as being successful in life,” Rossman says. “The very first skill I teach in “The Worry Solution” — and I think this is very important — is how to turn it off. Because the default position of the imagination is to worry, to look for danger, to look for problems. The human brain has a decidedly negative bias. The reason it has that is because the very first and most important job of the brain is to keep you alive.” Indeed, imagination allows us to remember and learn from our own and others’ mistakes, and it allows you to imagine what MIGHT happen. However, this strength can easily become our own undoing if left unchecked. Rossman’s book is not about stopping worrying altogether, which may be impossible, but rather learning to separate out what’s useful to worry about and what’s not. Finding Your Way Back to Neutral First, however, you need to learn to “put your mind in neutral,” using what Rossman calls the three keys to calmness: breathing, relaxation and visualization. To do this, simply breathe and relax your body part by part; then imagine being in a beautiful, peaceful place where you feel safe. This could be either a real or imaginary place. Spend 10 or 20 minutes there to interrupt the stress response. This will disengage your fight or flight response, allowing your physiology to return to equilibrium, or what is also termed “the relaxation response.” This is a compensatory repair, renew and recharge state that brings you back to balance. As noted by Rossman: “So-called primitive people don’t live in a constant state of arousal like we modern people who have so much input, so much news, so much social media … They might get attacked, they might run into a dangerous beast, they might get stressed for a while, and then they go back into neutral. We almost never go back to neutral unless we adopt a practice: a yoga practice, a mountain mindfulness meditation practice, a deep-relaxation practice, or a guided imagery practice. We really need that. The first thing I teach people is how to interrupt their imagining and then use your imagination to go into neutral. Then I teach them a series of skills beyond that to solve problems to stimulate healing in the body, to access their inner wisdom … [T]he book is complete in itself but I also made a set of two CDs where I give people nine guided imagery processes that I describe in the book. It was my attempt to provide a home study course for people. How can I learn to reduce my stress, manage my stress, get to sleep more easily? How can I use this tool? The book gives you the science and the explanations of the case histories, but the CDs will actually lead you through the processes that will make it pretty easy for you to learn how to do this.” Most Americans Are Too Busy for Their Own Good Rossman stresses the importance of allowing more time for relaxation, communication, relationships and taking it easy. “There’s almost no other country in the world that works like we do in the United States. It was just startling to me,” he says. About two decades ago, statistics revealed Americans work more days and longer hours than the Germans and the Japanese — two countries well known for their hardworking cultures. “We overtook them about 25 years ago and it hasn’t slowed down,” Rossman notes. Most European countries also have six to eight weeks of vacation every year — vacation that employees MUST take. This is virtually unheard of in the U.S., and those who are allowed a certain amount of vacation often do not take it for one reason or another. In some countries, mid-day siestas are also the norm, and everything simply shuts down for a few hours. “We’re way off the spectrum. We try to do more and more. We try to know more and more. We try to be involved more and more. We have to learn to go the other way, at least some of the time. Turn it off. Because now what we’re doing is we’re missing sleep. The daytime stress has gone into the nighttime … This just compounds the stress response and the toll of stress. This ends up getting seen in the doctor’s office. Ninety percent of the time — because the doctors are also highly stressed and are being compressed into an unrealistic mode of practice — the answer is pharmaceuticals. We can do better than that,” Rossman says. What If Your Body Could Speak? One of the least effective ways to initiate change in someone is to tell them what to do. One of the most effective is to allow the answers to rise into conscious awareness from the inside. This is one of the great powers of guided imagery. For example, if you’re having heart trouble, imagine that your heart could speak to you. What would it say? What does it want? If you have chronic headaches, imagine your head or brain speaking to you. What does it need in order to not hurt so much? “It’s quite remarkable what comes from people. That knowledge is actually inside the body or in the unconscious,” Rossman says. “If people will get quiet and listen, they very often know what they need in order to get back into a more comfortable and healthier kind of lifestyle. I find that when I work with people that way, and in that relationship, I’m honoring the wisdom that’s built into their body and I’m showing them how to access it … When it comes from the inside out, people treat it differently than when they’re being told to do it by someone else … It has an authenticity and people are often willing to listen to that and start to change.” How to Implement the Serenity Prayer Another essential core of Rossman’s program is the serenity prayer: “Lord, grant me the serenity to accept things I cannot change, the courage to change things I can, and the wisdom to know the difference.” This mantra-like prayer, which goes back to Roman times, can be used whether you engage in other prayer practices or not. It’s essentially just a call for wisdom, courage and serenity. “When I show people how to list their worries, how to separate them into those things that they could possibly change if they acted on it, and those things that no matter how badly they’d like to change, there’s nothing they can do to change them … it’s a way of actually activating and using the serenity prayer very actively,” he explains. To do this, create three columns. In column one, mark down things you worry about that you can change if you do something. In column two, put the things you cannot change, no matter what you do, and in column three, the items you’re unsure whether you can influence the outcome of or not. Rossman then uses the following processes to address the items in each column. • Effective action planning process: For worries in the first column, where you know you can avoid a certain outcome by taking a specific action, Rossman uses a planning process to help you take the necessary steps that will alleviate your worry. • Positive outcome imagery: For worries in the second column, i.e., things you cannot change, Rossman uses positive outcome imagery to turn the worry into a positive intention or prayer. In a nutshell, you take your worry and imagine how you would like it to turn out. In other words, you’re creating an intention that is hopeful and positive. • Inner wisdom meditation: For the third category of worries, where you don’t know whether you can do something about it or not, the answers may be gleaned through meditation. “We all have an internal guidance system,” Rossman says. “When push comes to shove, when you’re in a tough situation and you have to make an important decision … what is it that you eventually come to lean on? Everybody that I’ve ever talked to says ‘You know, I get the facts straight. I make the best analysis I can. But then I’ve got an inner voice that tells me which way to go … When I don’t listen to that voice, I get in trouble. When I listen to that voice, it’s a reliable guide.’” Get Your Worries Out of Your Head and Onto Paper Another helpful strategy to clear your mind of worries is to write them down, either on paper or electronically, depending on your preference. By writing it down, it’s easier to let go of it mentally. An analogy can be made between your mind and a computer. Now and then, you need to defrag the hard drive. Your brain also needs to clean out periodically and reorganize the information in order to not get bogged down with unnecessary bits of data. Writing things down can be surprisingly effective. “First thing that I have people do is write down everything that you’re worried about: the big things, the little things, the petty things, the huge things. See if you can just do a mind dump and write everything down that you’re worried about. That itself is very useful,” Rossman says. “The next step is to divide them. Take those worries and divide them into the things that you could possible do something about, something you can’t possibly do anything about on a practical level, and things you’re not sure about. Then we go into the steps of how to deal with the ones you can, how to deal with the ones you can’t, and how to deal with the ones you’re not sure about. But that writing process is surprisingly helpful for a lot of things … One of the things that writing it down always does is it takes it out of the invisible and it makes it visible. When you write it down, it actually brings it out of your head and brings it out into the world where you can see it and review it.” Imagining the Future You Want Rossman first learned about positive outcome imagery from Dr. Rachel Remen, who recommends it for cancer patients. A cancer diagnosis raises a lot of fears and worries, even when the cancer is known to be relatively curable. When images of death, dying and side effects come up, recognize these thoughts and feelings as fear. Your fears are legitimate, but they do not necessarily mirror reality, and this is an important distinction to make. “It’s only a fear. It doesn’t mean that’s what’s going to happen, because over 50 percent of cancers are even now curable … I teach people how to create an image of the outcome they would rather have. It might be an image of them five or 10 years down the line, enjoying their grandchildren or being in their doctor’s office, seeing that they have very good results and that they’re healthy and they’re doing the things they love to do,” Rossman says. “When the fear comes up, you sort of mentally … use a red circle and a slash, like a no smoking sign … You kind of stamp at that fear with that mental image of the red circle and slash. You move it out like it’s a slide. You move in the slide of the outcome you would prefer to see. What you’re doing is you’re kind of voting. You’re saying ‘Here’s my fear; here’s my hope. Which one do I want to put my energy into?’ Given that you’re making the choices, you’re doing the treatments and so on, it doesn’t behoove you to invest your energy [into] your fears. When your fears come up and you learn how to recognize them, say ‘Yup. Those are my fears. I’m not going to concentrate on that. I’m going to move it out. I’m going to move in my image of what I hope will happen.’ Energize that. The anxiety level [then] goes down very, very quickly.” The interesting thing is that the more your fears come up, the more positive imagery you end up doing, which often ends up having a very positive effect. You can also raise the impact of these visualizations by adding other sensory components, such as using your hands to wipe the fear away, putting your hand out as a stop signal, or verbalizing “No!” in addition to visualizing the “no-go” sign followed by your positive outcome. More Information There’s no doubt in my mind that worry — and the stress and anxiety it causes — can have a significant influence on your health. In fact, recent research even shows that worrying about your health can make you sick if you weren’t before. If you struggle with persistent worries, or have cancer or other chronic illness and resonate with this material, I strongly encourage you to pick up Rossman’s book, “The Worry Solution,” and the accompanying CDs. You can find additional resources on his website, TheHealingMind.org, including guided imagery audios that can help you prepare for surgery and childbirth, reduce anxiety, help you get better sleep, and more. Another book and CD set by Rossman called “Fighting Cancer from Within” specifically addresses the emotional stress-related and mind-body issues surrounding cancer. His first book and CD set, called “Guided Imagery for Self-Healing” also teaches you how to respond to your body in a way that helps with healing that you can apply with virtually any illness. These are all resources that, for a very inexpensive price, can change your life for the better. And to be clear, I personally reap no financial benefit for promoting these kinds of materials — only the satisfaction of knowing I played a part in helping people get better. “That’s what it’s about really,” Rossman says. “[Guided imagery] is inexpensive. It’s non-toxic. It’s compatible with every other form of treatment. It’s something that we should have been learning in kindergarten, but we don’t.”

#VitalityPath

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kristinsimmons · 6 years ago

Text

Obsessive Measurement Disorder: Etiology of an Epidemic

By KIP SULLIVAN JD

Review of The Tyranny of Metrics by Jerry Z. Muller, Princeton University Press, 2018

Muller, a professor of history at the Catholic University of America in Washington, DC, makes it clear at the outset that measurement itself is not the problem. Measurement is helpful in developing hypotheses for further investigation, and it is essential in improving anything that is complex or requires discipline. The object of Muller’s criticism is the rampant use of crude measures of efficiency (cost and quality) to dish out rewards and punishment – bonuses and financial penalties, promotion or demotion, or greater or less market share. Measurement can be crude because it fails to adjust scores for factors outside the subject’s control, and because it measures only actions that are relatively easy to measure and ignores valuable but less visible behaviors (such as creative thinking and mentoring). The use of inaccurate measurement is not just a waste of money; it invites undesirable behavior in both the measurers and the “measurees.” The measurers receive misleading information and therefore make less effective decisions (for example, “body count” totals tell them the war in Viet Nam is going well), and the subjects of measurement game the measurements (teachers “teach to the test” and surgeons refuse to perform surgery on sicker patients who would have benefited from surgery).

A short history of Obsession Measurement Disorder in medicine

Taylorism: Ground zero of the epidemic

Measuring the doctor and patient from afar

Reversing the epidemic

Footnotes:

[3] A 2006 edition of Medical Care Research and Review devoted entirely to the emerging P4P fad stated, “P4P programs are being implemented in a near-scientific vacuum.”

Kip Sullivan is a member of the Health Care for All MN advisory board, and of MN Physicians for a National Health Program.

Obsessive Measurement Disorder: Etiology of an Epidemic published first on https://wittooth.tumblr.com/

0 notes

kristinsimmons · 6 years ago

Text

Obsessive Measurement Disorder: Etiology of an Epidemic

By KIP SULLIVAN JD

Review of The Tyranny of Metrics by Jerry Z. Muller, Princeton University Press, 2018

Muller, a professor of history at the Catholic University of America in Washington, DC, makes it clear at the outset that measurement itself is not the problem. Measurement is helpful in developing hypotheses for further investigation, and it is essential in improving anything that is complex or requires discipline. The object of Muller’s criticism is the rampant use of crude measures of efficiency (cost and quality) to dish out rewards and punishment – bonuses and financial penalties, promotion or demotion, or greater or less market share. Measurement can be crude because it fails to adjust scores for factors outside the subject’s control, and because it measures only actions that are relatively easy to measure and ignores valuable but less visible behaviors (such as creative thinking and mentoring). The use of inaccurate measurement is not just a waste of money; it invites undesirable behavior in both the measurers and the “measurees.” The measurers receive misleading information and therefore make less effective decisions (for example, “body count” totals tell them the war in Viet Nam is going well), and the subjects of measurement game the measurements (teachers “teach to the test” and surgeons refuse to perform surgery on sicker patients who would have benefited from surgery).

A short history of Obsession Measurement Disorder in medicine

Taylorism: Ground zero of the epidemic

Measuring the doctor and patient from afar

Reversing the epidemic

Footnotes:

[3] A 2006 edition of Medical Care Research and Review devoted entirely to the emerging P4P fad stated, “P4P programs are being implemented in a near-scientific vacuum.”

Kip Sullivan is a member of the Health Care for All MN advisory board, and of MN Physicians for a National Health Program.

Obsessive Measurement Disorder: Etiology of an Epidemic published first on https://wittooth.tumblr.com/

0 notes

kristinsimmons · 6 years ago

Text

Obsessive Measurement Disorder: Etiology of an Epidemic

By KIP SULLIVAN JD

Review of The Tyranny of Metrics by Jerry Z. Muller, Princeton University Press, 2018

Muller, a professor of history at the Catholic University of America in Washington, DC, makes it clear at the outset that measurement itself is not the problem. Measurement is helpful in developing hypotheses for further investigation, and it is essential in improving anything that is complex or requires discipline. The object of Muller’s criticism is the rampant use of crude measures of efficiency (cost and quality) to dish out rewards and punishment – bonuses and financial penalties, promotion or demotion, or greater or less market share. Measurement can be crude because it fails to adjust scores for factors outside the subject’s control, and because it measures only actions that are relatively easy to measure and ignores valuable but less visible behaviors (such as creative thinking and mentoring). The use of inaccurate measurement is not just a waste of money; it invites undesirable behavior in both the measurers and the “measurees.” The measurers receive misleading information and therefore make less effective decisions (for example, “body count” totals tell them the war in Viet Nam is going well), and the subjects of measurement game the measurements (teachers “teach to the test” and surgeons refuse to perform surgery on sicker patients who would have benefited from surgery).

A short history of Obsession Measurement Disorder in medicine

Taylorism: Ground zero of the epidemic

Measuring the doctor and patient from afar

Reversing the epidemic

Footnotes:

[3] A 2006 edition of Medical Care Research and Review devoted entirely to the emerging P4P fad stated, “P4P programs are being implemented in a near-scientific vacuum.”

Kip Sullivan is a member of the Health Care for All MN advisory board, and of MN Physicians for a National Health Program.

Obsessive Measurement Disorder: Etiology of an Epidemic published first on https://wittooth.tumblr.com/

0 notes