Mobile Stroke Unit, 4th in the country

Cool Stuff Ahead!

Our Neurosciences and Stroke team worked with our telehealth program, bought a souped-up ambulance, installed a portable (PORTABLE!) CT scanner, and now we can send this ambulance out on any 911 call that sounds like it may be an early stroke.

Unlike current state-of-the-art facilities that take 30-60 minutes AFTER the patient arrives in the Emergency Department to diagnose a stroke, rule-out a bleed, and administer tPA, the clot-busting drug (so called “door-to-needle time”), we now have NEGATIVE door-to-needle times.

In other words, we’re driving to the patient, performing the CT scan IN THEIR DRIVEWAY at home, transmitting images to our neuro-radiologist, using a 2 way video link between neurologist and patient, finalizing a diagnosis, and administering life-saving tPA right there in the driveway. BOOM. “Needle” time occurs before “door” time. Watch the video link above for details. So proud of our teams and the technology we develop to support outstanding patient care.

Storytelling and Science, #2

webpanel_storytellingimage: http://firstpersonarts.org/storytelling/

Increasingly, I am frustrated and dismayed that one of our presidential candidates had to profess: “I BELIEVE IN SCIENCE.” Has it come to this? Does a democracy necessarily give such freedom as to devolve to the “freedom to be ignorant and believe whatever you read on the Internet”?

Over the years I’ve gradually improved the presentations I’ve given, by reading and hearing great speakers. Steve Jobs at Stanford, Barack Obama, Ken Robinson (on education), Jill Bolte Taylor (a neuroscientist’s personal stroke story). And I contrast them with the presentations I’ve heard in college, medical school, from physician colleagues and scientists. And the difference is … STORY (or lack thereof).

I believe this is also true to some degree among physicians. Even though all humans think in Narrative, we confuse it with our many meanings of “story.” Scientists demote “story” and “narrative” to second class citizens, in favor of dry statistics and ‘p-values.” WHY? I think it is to the detriment of our purpose: to FIGURE STUFF OUT, to TELL PEOPLE ABOUT IT, and to HAVE IT MAKE A DIFFERENCE IN OUR LIVES.

This is a long (and far from complete) journey for me, but some of the books and website I’ve read and would highly recommend, include:

Houston, We Have a Narrative (why science needs story) by Randy Olson

in which the author indicates that there is a way to boil down stories to: one WORD, one SENTENCE or one PARAGRAPH. He also references Joseph Campbell’s The Power of Myth and the Hero’s Journey, and many other time-tested narratives, and claims (very successfully) that story and science belong together, and all of us need both to survive into the future. I hope you get as much out of these as I am starting to (referring to myself as the flawed protagonist, who faces a daunting challenge, and must solve his personal flaws to overcome this challenge; read the book to understand).

So cool. Just like learning how human anatomy works in medical school: you never look at other humans the same way again.

Whoever Tells the Best Story Wins

The Power of Myth by Joseph Campbell

Stories Worth Telling (a 62 page PDF guide for nonprofits)

The Storytelling Culture and the Sacred Bundle  from the newsletter Free Range Thinking, written by Andy Goodman, dedicated to improving Public Interest Companies.

The Sacred Bundle, for example, describes how American Indian tribes would constantly relocate. At every new temporary settlement, the chief would carefully unwrap the cloth sack, gather the tribe around him, and take out objects from “the sacred bundle” one at a time. He would hold each one up: “this stone was from the river where our tribe first came together.” And he would tell that story. “This feather was from the head-dress of our bravest warrior. He died protecting …” and so on. This retelling at each new location made that settlement home, and the common knowledge ran through the tribe, and all members grew to know it by heart.

What an incredible, simple thing. I am striving to create this sacred bundle, for our large and growing organization. In our Digital age, is it sufficient to have a “virtual” sacred bundle? Do we need physical, tangible objects to remind us from whence we came? Can storytelling save science and healthcare?

 

Storytelling in science, good or bad idea?

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Borrowed from First Person Arts dot org

I was once reprimanded by the daughter of a patient, who called me after our visit with her father. I had casually remarked “What a fascinating story!” in response to a long, involved recounting of his illness, his travels, his experiences with other healthcare providers, ending with his visit to my office. I had thought this was a kind reflection of his efforts to stay healthy.

Instead, his daughter informed me later, My Dad thinks that you don’t believe him when he tells you things.

It gave me great pause. The word “story,” to my patient, implied that his narrative was fabricated.

I never used that word in the exam-room again.

This is my personal interaction with storytelling in healthcare. The words “story” and “storytelling” are heavily laden with history and meaning, sometimes unintended. Many, perhaps most scientists I know and respect, stick to presenting the facts, devoid of story, for precisely this reason: you can’t argue with facts, and stories are the realm of fiction and politics and dreamers, with “no place in science.”

I’m coming around to the idea that this is not only untrue, it is harming science.

We, as scientists, physicians, informaticians, MUST accompany our science and facts with stories. Our world revolves around stories. My current favorite quote by Muriel Ruykeyser:

The universe is made up of stories, not atoms. 

I’ve been devouring books and online treatises on this topic. More on this in BLOG 2 of STORYTELLING IN SCIENCE next week.

 

At the heart of healthcare: caring

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A Letter to the Doctors and Nurses

In this incredible, short letter, a young man reminds us what outstanding healthcare is all about. Caring not only for our (sometimes critically ill) patients, but also their spouses, their families, sometimes even their cat! Don’t miss this.

This puts into perspective our efforts in Healthcare Information Technology. In my view, the world is changing quickly. Technology improves. Software improves. Regulations … well, don’t improve, they change, they increase. Someone said   Change is easy, until you change something I care about.  Yes.

So often, our EHR efforts are met with resistance. We are often the face of Change to our physicians and nurses. We should remember, this letter links us back to our common goal, caring for patients, easing their suffering. I recall hearing the saying, in healthcare:  To cure sometimes, to relieve often, to comfort always. 

Others have written about the 20 percent physician (caution: huge 100+ page pdf), and I have had my worries about IBM’s Watson or other machine learning devices coming to take my job.

In my ideal world, the perfect EHR works behind the scenes to improve quality, safety, but otherwise disappears, and allows human connection and caring. This is our aspiration. Thank you Peter DeMarco, and your wife, for reminding us of the best of ourselves.