Who we are emerges out of the dynamic interplay of what we are (the person), where we are (the situation), what we say we will do (intentions), and what we do (actions). Medicine has built a model of disease with a focus on the person in a hospital or a clinic and their intentions. In… Continue reading Worlds Far and Wide, Near and Close
Tag: healthcare
The Person and the Situation
It has almost become a truism to attribute the causes of diseases to social determinants of health (SDOH). By one estimate, SDOH account for 60% of premature death in the United States. According to the CDC, SDOH are the conditions in the environments where people are born, live, learn, work, play, worship, and age. While… Continue reading The Person and the Situation
The Wanderer
A core functionality of biological organisms is to track regularities in the environment and utilize those regularities as a substrate for predictions. In general, organisms that can identify markers of risk, danger, and safety and respond appropriately to those markers are better adapted than organisms that lack this functionality. Thus, the largely reflexive fight-flight-freeze responses… Continue reading The Wanderer
Evidence of, Evidence for
In the human world, ideas and concepts are more robust and impactful than anything organic or material. Concepts and ideas often outlive their originators. As culture, language and their embedded concepts multiply and diverge, exchange and reconvene, they shape our world in unpredictable ways. One concept that has evolved to loom over all aspects of… Continue reading Evidence of, Evidence for
Culture Clash
William Faulkner wrote, “all human behavior is unpredictable, and considering man’s frailty...and the ramshackle universe he functions in, it’s all irrational.” Despite this claim, scientists from disciplines ranging from economics and mathematics to anthropology and psychology have laboriously attempted to uncover patterns within the morass. Game theory is one such approach that starts with the… Continue reading Culture Clash
I err, therefore I am
When talking about the human mental capabilities, in The Symbolic Species, Terrence Deacon stated that “biologically, we are just another ape. Mentally, we are new phylum of organism.” This wondrous and unfathomably complex organ - the brain - has enabled us to become the most dominant species of the planet. With a unique capacity to… Continue reading I err, therefore I am
Nature, red in tooth and claw
In Wealth of Nations first published in 1776, Adam Smith stated that “it is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own interest. We address ourselves, not to their humanity but to their self-love, and never talk to them… Continue reading Nature, red in tooth and claw
Fisheries, forests, & emergency care
In my last essay, I made the case that emergency care in the United States is better classified as a common rather than a public good. Due to the passage of the Emergency Medical Treatment & Labor Act (EMTALA), emergency care became non-excludable and because it is resource constrained, it is rival. Patients are streaming… Continue reading Fisheries, forests, & emergency care
Tragedy of the ED Commons
In his landmark article, Tragedy of Commons (1968), Garrett Hardin asks, “Is ours a finite world? [If so], a finite world can only support a finite population.” In Hardin’s parable, a single group of herders shares a common pasture. The pasture is large enough to support many animals, but not infinitely many. Rationally, each herdsman… Continue reading Tragedy of the ED Commons
Super Ants
The biologist, Nigel Franks, wrote, “the solitary ant is behaviorally one of the least sophisticated animals imaginable...if 100 army ants are placed on a flat surface, they will walk around in ever decreasing circles until they die of exhaustion...yet put half a million of them together, and the group as a whole becomes what some… Continue reading Super Ants
The Map is not the Territory
It is hard to even fathom let alone comprehend the size, scale, and complexity of the universe. It takes light 91 billion years to traverse the diameter of the observable universe. That is approximately six times longer than the age of the universe itself. Similarly, the amount of information in the world vastly overwhelms the… Continue reading The Map is not the Territory
The Suitcase of Empathy
Marvin Minsky called words that carry a variety of meanings "suitcase words." Empathy is such a word. Over the last ten years, research into empathy has exploded. The number of research papers in psychological journals, on the topic, has increased dramatically and popular interest in the concept matches what is found in these journals. A… Continue reading The Suitcase of Empathy
Thrashing in the Emergency Department
The work of an emergency physician is an exercise in multitasking. We see multiple patients in parallel and respond to all the responsibilities that come with this patient care in addition to being aware of new, potentially sick patients. A typical workflow includes signing EKGs of new patients, documenting on a patient encounter, responding to… Continue reading Thrashing in the Emergency Department
Medicine, the science of uncertainty
In a recent article, it was estimated that at least $200 billion is wasted annually on excessive testing and treatment. The impact of the overly aggressive, extraneous care is not only financial in nature but also generates mistakes and injuries believed to cause 30,000 deaths each year. In 1979 the founders of the field of behavioral… Continue reading Medicine, the science of uncertainty
Desktop Medicine
As I discussed in my last post, Claude Shannon defined information as the number of bits needed to communicate an arrangement or state of a system. The fundamental problem of communication is not to make oneself understood, but to reproduce “at one point either exactly or approximately a message selected at another point.” The destination… Continue reading Desktop Medicine
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