Should your review of doctors be taken seriously?

Recent articles highlight challenges with holding providers accountable for the care they deliver. One of the major thrusts of efforts to transform the American healthcare delivery system has been to become more patient-centered and to allow patients to provide feedback that matters.

Emblematic of this is the emphasis on patient involvement in the final rules for the Shared Savings Program accountable care organizations (ACO).

Echoing former Centers for Medicare & Medicaid Services Director Don Berwick's plea on the behalf of patients ("Nothing about us without us"), the ACO final rules emphasize patient engagement in governance, quality improvement and the individual doctor/patient interaction.

Follow the link for the rest of this blog

http://www.hospitalimpact.org/index.php/2013/01/30/is_patient_empowerment_the_next_step_for#disqus_thread

The Humanities vs. Science Question Revisited

Two of my favorite quotations are the 19^th century neurologist Jean Martin Charcot’s “Theory is good, but it doesn’t prevent things from existing” and Albert Einstein’s “In theory, theory and practice are the same. In practice, they are not.” 

These two statements summarize the tension between a medical science that thinks it can explain everything and my own experience that an alternative theory of the mind is needed.  I explore these issues in great detail in a five part essay titled Human Understanding, Randomness, Free Will, and Delusions found here http://www.thedoctorweighsin.com/human-understanding-randomness-free-will-and-delusion-part-i/, http://www.thedoctorweighsin.com/human-understanding-randomness-free-will-and-delusion-part-ii/, http://www.thedoctorweighsin.com/human-understanding-randomness-free-will-and-delusion-part-iii/, http://www.thedoctorweighsin.com/human-understanding-randomness-free-will-and-delusion-part-iv/, http://www.thedoctorweighsin.com/human-understanding-randomness-free-will-and-delusion-part-v/ and in a two part essay titled The Humanities vs. Science linked here http://www.thedoctorweighsin.com/the-humanities-vs-science-part-i/ and http://www.thedoctorweighsin.com/the-humanities-vs-science-part-ii/

I first started worrying about this controversy when I read Francis Crick’s Astonishing Hypothesis:

“You, your joys and sorrows, your memories and your ambitions, your sense of personal identity and free will, are in fact no more than the behavior of a vast assembly of nerve cells and their associated molecules.” 

This subject of humanities vs. the sciences was not on my mind last night when I settled in by the fire to read “Escape From Spiderhead,” the fourth short story in George Saunders’ new collection Tenth of December.  By the time I had finished this 37-page short story, I understood that Saunders had captured the essence of what is wrong with Nobelist Crick’s theory.

The main character Jeff is subjected to scientific experiments as part of his punishment for a violent crime; the investigators inject VerbaluceTM, VeriTalk TM, ChatEaseTM and ED556 in Jeff’s MobiPakTM and observe the results.  A few pages into the story, I realized we are in the future and the scientists are testing Crick’s Astonishing Hypothesis.  By manipulating Jeff’s “nerve cells and their associated molecules,” the investigators make Jeff fall passionately and physically in love with two other subjects, Heather and Rachel.  By changing the chemicals in the MobiPakTM they can make all of the subjects feel nothing for their former lover. 

In follow-up experiments, Jeff is devastated when Heather dies after Jeff is told to give her DarkenfloxxTM.  The head scientist tells Jeff:

“In science, we explore the unknown.  It was unknown what five minutes on DarkenfloxxTM would do to Heather. Now we know.  The other thing we know…is that you really, for sure, do not harbor any residual romantic feelings for Heather.  That’s a big deal, Jeff. A beacon of hope at a sad time for all… My guess is, ProtComm’s going to be like:  ‘Wow, Utica’s really leading the pack in terms of providing mind-blowing new data on ED289/290.’”

In a twist at the end, Jeff validating his humanity finds an unexpected way to refuse to participate in such experiments on human beings.

Saunders’ story gives me more reason to reject Crick and embrace Marilynne Robinson’s conclusion in her Dwight Harrington Terry Foundation Lectures on Religion in the Light of Science and Philosophy at Yale.  She believes that there is a mind separate from the brain, there are things unknowable in this world, and that the humanities can still teach me things that science cannot explain:

“As proof of the existence of mind we have only history and civilization, art, science, and philosophy. And at the same time, of course, that extraordinary individuation.”

           

The Downsides of Setting Professional & Personal Goals

http://www.hospitalimpact.org/index.php/2013/01/07/title_85