Seeing What We Believe

“I’ll believe it when I see it.”

That was a frequent comment in my parents’ house when I was growing up. Essentially what they were saying was that they valued action, not talk. Although it’s a good line and reflected their values, there’s only one small problem - it’s not really true.

We tell ourselves that we believe what we see because it feels like it must be that way, and to an extent, our brain is hardwired for it to be so. The unconscious brain (the portions that require no thought such as staying balanced while walking) can handle up to 11 million bits of information per second. Here’s the interesting part – visual data takes up 10 million of those bits. In other words, our brain spends over 90 percent of its energy interpreting information that comes in from our eyes. Because vision takes up so much energy, the brain is constantly trying to simplify things, cut corners, make assumptions and reshape things into that which is familiar.

The anatomy and organization of our brain explains why. Light comes in through the front of our eyes and strikes the retina at the back. The retina generates millions of tiny electrical impulses that go to the back of the brain, which immediately compresses the information by a factor of 10. From there, those electrical impulses travel to a middle portion of the brain, where they’re once again compressed, this time by a factor of 300. Having now been compressed by a factor of 3,000 (10 x 300), yet another new set of impulses are passed into an area just below where the impulses are interpreted and the brain decides what the image actually represents. Even then, the image processing isn’t complete. Even though the brain is now interpreting information that is only 1/3,000th of what it was when it first struck the retina, it now has to decide if what it is interpreting actually makes sense. Thus in a final step, the brain compares it to memories of what it has seen in the past against this new image. From that comparison it subtracts out what it believes should not matter and what it cannot comprehend which results, finally, in an image that it believes makes sense. So, with apologies to my parents, it’s not a matter of believing it when you see it - but rather seeing it once you believe it.

The ability of the brain to manipulate information coming from the outside world plays out in our personal lives all the time. For example, when we fall in love we see only the best of that person even though the imperfections we fail to see are just as present then as they are later when reality sets in. We fail to see them because acknowledging that imperfections exist isn’t consistent with what we believe at that moment. The same phenomenon can also play out in our work lives. For example, what do you believe about Mercy and how does that compare to what you are seeing?

Perhaps a co-worker is out for the day. You were told they were sick but could they have been let go? There weren’t any graham crackers in the hospital unit’s kitchenette…could that mean we’re down to our last pennies? Factors like less revenue in health care, implementation of Obamacare and increased government regulation create a certain level of fear. That fear can make minor things with little significance appear ominous.

I would like to know how you feel. Think about what you believe about Mercy and then compare it against what you see. Please let me know about some of those beliefs and how what you see enforces or goes against those beliefs. Email me at alan.scarrow@mercy.net or contact me on Twitter at @DrScarrow.

Optimism and Pessimism

Recently I read “Zero to One,” by Peter Thiel, the co-founder of PayPal. The gist of his book describes how today’s most successful organizations think and plan for the future in a rapidly changing world. One particular section I found interesting was Thiel’s contention that the world’s population can be grouped into four points of view. 

The first group is the indefinite pessimists. These people are pessimistic about the future but have no idea when the bad ending will come, so in the meantime they figure, “Why not kick back and have a good time!” Thiel says this describes many Europeans today. 

Next are the definite pessimists. These people are also pessimistic about the future and are convinced the grimness will continue to worsen significantly in their lifetime. As a result, they save as much money as they can and hope it’s enough to outlast the bad times. Thiel says this describes many of the Chinese today. 

The third group is the definite optimists. Thiel says this was American’s viewpoint from the 17th Century up until the 1960s. Definite optimists are serious about their future – they make plans and they believe they’re capable of influencing events occurring around them. This mindset, he contends, is what allowed American engineers, soldiers, scientists, doctors and businessmen to conquer disease, go to the moon, win wars, create innovative products and empower others to do the same. 

The last group is the indefinite optimists, which Thiel says describes most Americans today. We believe the future will be better – we’re just not sure how. As a result, we don’t make any specific plans. 

If we’re able to make a bit of money, we don’t know what to do with it, so we give it to a bank, which in turn, doesn’t know what to do with it, so the bank gives it to institutional investors. Likewise, they don’t know what to do with it, so they spread it out amongst a bunch of companies, and the whole process repeats itself. 

The point is, Thiel says, is that because we have almost unlimited options on what to do with the money, having the money becomes more important than anything we can do with the money. Thus, making the money is an end in itself rather than a means to accomplish other goals. 

That’s a lot to think about, but it made me wonder about the mindset of people within our organization... 

When you think about the future of health care, our organization and your role within our organization, what are you optimistic or pessimistic about? Why? Which of these four groups resonates most with you? I’m interested in your thoughts. Please email me at alan.scarrow@mercy.net.

Time

The older I get, the fewer things seem worth waiting in line for. Line of cars at the gas pump? I can probably make it to the next one. Drivethrough lanes backed up? Meh, I wasn’t that hungry. Put on hold with customer service? Please, I’ll just go to their website! 

I think two things are driving this behavior: First, the older I get, the more I value the time I have, and waiting doesn’t feel like it has much value. Second, there’s a “spillover effect” from my online experiences. 

For example, I can order nearly anything I can reasonably think of from Amazon.com, in the size and color of my choosing, delivered to my front porch tomorrow. Cool song on the radio? iTunes, 15 second download, done. No waiting, no hassles. My unconscious thought that connects the dots… everything worth having should be like this. 

Of course it wasn’t always this way. There was also a slower cadence to life. Need something new to wear? Find the Sears catalog, fill out the form, take it to the store, wait two weeks and voila – the merchandise appears. It was a different world, and most of us understood the meaning of “good things come to those who wait” or “one step at a time.” Today, it just all seems too slow. 

The same phenomenon is playing out in our organization. Paper charts? Gone. X-rays on film? That’s so 2005. Prescription pad? Good luck tracking one down. Drug companies used to give out free pens – back when they were allowed to do so and we would actually use them. Paper, film, pens – they all just slow things down. I want things on one screen, directly in front of me, one session, log on, click some boxes, electronic signature, done. No waiting, no hassles. 

Or not. There are still things I do – or I request my patients to do – that seem like a complete waste of time. For example, if you come to my clinic you’re going to fill out a bunch of forms that I will go over, some of which you have probably already filled out in another office on another day for another provider. 

Certainly there are compliance and safety reasons why we must repeat, reorder, remind, redocument or reestablish, and my use of Epic’s full capability clearly leaves a lot to be desired. But it makes me wonder, what are some things you do in your job that seem like a waste of your time? At least let’s list these things and make sure they’re necessary before we just resign ourselves to making sure they’re completed. 

After all, the biggest waste of time is doing something well, which doesn’t need to be done at all… like waiting. Let me know your thoughts. Please email me.

Balance

We’re busy, very busy. Over the past several months, our inpatient census has run high. In our clinics, our providers see a lot of patients. In part, this is a sign that our organization is healthy; more people than ever before are choosing us and entrusting the care of themselves and their loved ones to us.

This also means that in some areas of our organization, our co-workers are short staffed and working exceptionally hard. That’s not so healthy. It often makes the rest of life very difficult. Thus, thank you to everyone who’s working overtime, filling in and making sacrifices to keep our hospitals and clinics functioning. It’s an added burden and one that doesn’t go unnoticed. While the personal meaning we find in our work, as well as the camaraderie we share with our colleagues can make even the most difficult times seem less so, there is a limit – it’s when a work-life balance feels like anything but that.

When our lives get out of balance there are many people who end up paying the price. After all, there’s no such thing as quality time with our loved ones just like there’s no such thing as an efficient relationship. The fact is that quality moments are born from the same substance that all moments come from – time. The more time we spend with our families and friends the more likely we are to have those special moments that we remember. Thus spouses, children, close friends and relatives are the ones who see less of us when work takes more of us.

Work-life balance means different things to us at 24 and 34 and 54 and 74. The work priorities that we may have when we’re young often take a back seat to marriages, children, close relationships and other choices that come along as we get older. What was once important may start to feel less so as life unfolds and we become misers with the time we once spent so freely. Time that may seem better spent with those who love us unconditionally.

Of course none of this changes the fact that most of us want and need to work. Meaningful work can give us a sense of purpose, fill us with excitement, be a source of accomplishment, grow our self-esteem and provide us with the opportunity to become better people. Which leads to these questions: Are you still able to strike the right balance between your work at Mercy and the rest of your life’s priorities? What seems to push you off balance, and what do you do to regain it?

I hope you’ll share your thoughts with me – I’m interested in your thoughts. Please email me at alan.scarrow@mercy.net.

Nothing, Something, Anything and Everything

“I cannot do everything, but I can do something. And I will not let what I cannot do interfere with what I can do.” – Edward Everett Hale

What do you find yourself thinking about most of the time? If you’re like most of us, chances are it goes something like this: If you’re in your 20s, you’re probably very concerned about what other people think about you. If you’re in your 30s, you’re less sensitive about what others think about you, but if you’re in or past your 40s, you have finally realized that nobody was thinking about you in the first place because, the fact is, we think about ourselves 99 percent of the time. That’s not a criticism, it just is. It’s in our nature.

Yet there are times, for some more than others, that we’re able to see things from another’s point of view to feel what they feel. That ability to empathize with others is also part of our nature. Empathy is the foundation of what makes us capable of helping others and of finding solutions for their problems. Our capacity for empathy is largely responsible for our ability or inability to take good thoughts and turn them into great actions.

In this, our 125th year of Mercy in the Springfield Communities, we have set a goal to collectively demonstrate our capacity for empathy. Our goal is to provide 125,000 hours of volunteerism in our community. With 10,000 co-workers, each one of us needs to provide 12.5 hours over the course of the next year to achieve that goal. It’s certainly a worthy goal and no doubt will help our communities in significant ways. Let me give you just one example of how that contribution can make a difference.

Today in Greene County, we have just over 285,000 people. Of those, 18.7 percent or 53,000 are living below poverty level. Their annual household income is less than $10,000. They make hard choices between paying for food, medical care and utilities. This is the population served by Ozarks Food Harvest (OFH). In a typical week, OFH serves meals to 30,000 individuals in 10,000 different households. Across the entire Ozarks region, OFH annually provides free meals to more than 261,000 needy individuals. Those are staggering numbers – large enough to begin feeling like we can’t do everything - that the problems are too big for one organization, let alone one person, to make a difference even with 125,000 volunteer hours. In those moments, it’s easy to slip back into the part of our nature that thinks of ourselves first. If it’s not affecting us, it’s not our problem, and the easiest thing to do is nothing.

Now let me tell you about a group of individuals in our community who have decided that nothing is not an acceptable answer. Through a program of OFH, dozens of individuals from around our community have come out to my family’s farm near Rogersville and donated hundreds of hours over the last 18 months to grow food in our raised beds and high tunnel greenhouses. All the food they raise goes directly to OFH to help feed thousands of needy people. These volunteers have come from Texas, Oklahoma and all over the Ozarks region to plant, weed, clear, harvest, water and fertilize. It’s hard work, but I promise that you’ve never seen a group of happier people in your life. They simply love knowing that their time and labor is helping someone who needs to eat. They’re showing empathy in its most basic and beautiful form. They’re doing something.

And yet, the problem is still immense. Last year, OFH volunteers grew nearly 6,000 pounds of food on our farm. It’s one of many efforts OFH makes on an ongoing basis to meet those huge needs. Clearly, OFH and their volunteers cannot do everything, but they’re doing something, and if all of us can do something, then together we can accomplish anything.

I encourage you to get out there and do something. Volunteer where you see a need. Make a difference. Need ideas? Learn more here. Or email me at alan. scarrow@mercy.net or on Twitter @DrScarrow.

Things That Won't Change

Recently, I posted an article on my blog entitled, “What You Know Just Ain’t So,” which discussed things we believe to be true but when tested over time and with deeper questioning, just don’t hold up. That type of critical thinking is necessary in order for us to accurately look at our reality – to see things as they are and not as we might want them to be.  

Yet, an analysis that shows the flaws in our thinking, doesn’t, by itself, help guide us down the correct path. After all, highlighting all the closed roads on a map won’t get us to our destination. To choose the best path for our journey, we need to know the roads that will be open when we need them. In other words, to set the right course, we must know the things that won’t change with time. 

Jeff Bezos, the CEO of Amazon, eloquently makes this point. He noted that people are always asking him about what’s going to change in the next 10 years, but they never ask him about what’s not going to change in the next 10 years. He says, “…the second question is actually more important of the two because you can build a strategy around the things that are stable in time.” Because Mercy is going through a strategic planning process, that statement made me think about what won’t change in health care over the next 10 years. 

The best way to come up with such a list is to take the perspective of our patients, since they’re the ones who will ultimately choose what has real value over time. It’s hard to imagine a future where a patient would prefer to wait longer to talk to a provider or obtain test results, have less confidence in their quality of care, have more unanswered questions about what treatment plan they should choose, pay more or have more hassles about paying their bills. In short, the best future for Mercy will be one where we seek the opportunity to be faster, more convenient, more trans- parent, higher quality and less costly. No problem, right?

Think about that challenge for a moment. What do we need to do to realize a more “customer friendly” future? To start, we’ll need to care for people where they are as patients, not necessarily where we are as providers. That will mean being accessible online and in person, on phones and tablets, at their home or work, days and nights, week- ends, holidays and vacations. When patients want information or answers, they’ll expect it to be immediately avail- able, just like the products and services they’re used to getting on demand today. When they get a test or image, they’ll expect it to be interpreted and explained in the moment, that they’ll be billed the amount they were promised up front, that the results will be easily interpreted and a plan of care established quickly. If referrals are made, the expectation will be that they’ll happen promptly and if they have problems with a service, there will be someone to listen to them and take action quickly. When a procedure or surgery is necessary, it will be scheduled promptly, performed expertly and with the least amount of discomfort possible. If it can be done in an office without anesthesia, that would be preferable but always with minimal pain, invasiveness and time away from home or work. They’ll expect to be treated with respect and in a manner that befits an organization that wants to retain their loyalty.

Perhaps that seems like a tall order for our organization, but before writing it off as fantasy, consider this...If you’ve ever tried the Uber transportation service, you may have been as impressed as I was on its simplicity, transparency and responsiveness. Through the Uber phone app, you input where you are, where you want to go, select a driver who has already been vetted by Uber, rated by prior passengers and is close to your location. Both you and the driver can see each others’ pictures and locations via GPS to know the time of arrival. Typically, within a few minutes, the driver pulls up, you travel to your destination, pay through the app, rate the driver, the driver rates you as a passenger (warning: don’t act like a jerk), and voila’ – done! It works brilliantly.

But after my last Uber experience, I was struck by one question. Why is it that suddenly, in the era of Uber, there are all these drivers just waiting to take me wherever I want? Before Uber, if you needed a taxi and were waiting at any place other than a high-traffic area, it was a hassle. Most likely you called a taxi dispatch that sent a message to a cab that may or may not be available at that moment. There was no feedback on where they were or when they’d get to you and you didn’t know what exactly to look for, nor did they. What changed?

I would submit there are two things that made Uber possible and popular. The first is technology. Uber cannot happen without GPS. With GPS, nearly anyone with a driver’s license can become an Uber driver. In the taxi era, one of the driver’s valued skills was knowledge of where places were and how to get there. Today, those skills are less valued as one doesn’t need local road knowledge to follow the directions of GPS. The passenger says where they want to go and the software takes care of the rest.

Of course the next step on this path is to eliminate the human driver all together. With self-driving cars as envisioned by Ford, Apple, Tesla, Google and others, the long-term need for drivers of any type – Uber, passenger, truck or otherwise – is questionable. But while the driver may be optional in the future, it’s the second component that makes Uber itself irreplaceable. Uber makes the experience feel safe. By showing pictures of drivers and passengers, providing feed- back on locations and time of arrival, secure method of payment, rating their past Uber experiences, tracking locations with GPS and recording all that data, the Uber experience feels safer than any taxi experience I can remember. That sense of safety is key to making Uber valuable to travelers and gives it staying power in the market.

Think about how the technology behind Uber and its popularity apply to health care. In that same blog article on “What You Know Just Ain’t So,” I discussed a company called Ayasdi that’s helping Mercy put together care paths for about 80 different illnesses, based on real data from our own patients. These are not care paths put together by wise men stroking their chins while extolling the virtues of what they believe to be best practice, but actual data. The end result of that work will be care paths that provide the best evidence on how to care for a particular disease that achieves the best outcome at the lowest cost.

Now, pause for a minute and think about this... do you need to be a physician to follow a care path? How about a physician’s assistant or nurse practitioner? How about a nurse? Nurse’s aide? If the diagnosis is correct and the care path instructions are clear, outside of an acute care setting, what’s the need for any of those traditional providers? Why wouldn’t a patient just follow the care path on their own until they ran into a problem they couldn’t solve themselves? While Uber and GPS put power in the hands of the passenger, why wouldn’t patients want and utilize that same type of power by having state-of-the-art care paths to guide them through management of their illnesses?

If, like me, you’re a provider and that last statement makes you fear for the security of your professional future, go back and think about the second part of what makes Uber successful. They make it feel safe. Managing your health when you aren’t terribly sick is not that difficult if you’re armed with adequate information and a plan. But when good health fades and more complicated illnesses loom, managing your health can be both scary and difficult. In those moments, patients want to know they’re safe and not alone. Is my health care team behind me? Can I talk to them quickly when I have questions? Will they provide good advice to me when I need to make a tough decision? When I need more than just advice, will the hospital, experts and all the technology I need be there for me?

As it always has been, Mercy’s answer to all those will be “yes.” That’s the service we’ll provide, the feeling of safety we’ll give, and the sense of value for which we’re known. That’s why we, as providers, will remain vital and why Mercy, as an organization, will thrive for generations to come.

Certainly health care has more complicated problems than that posed by an antiquated taxi system, and it’s always dangerous to apply simple solutions to complicated problems. Still, as we look to the future and contemplate what will not change, it’s sometimes the simple lessons taught by the experience of others that resonate the most. Let us vow to build a future at Mercy that serves our patients by making it something they want and are thankful to have when they need it the most. It’s an honor to be on this journey with you.

What do you think? Email me at Alan.Scarrow@mercy.net or on Twitter @DrScarrow.

What You Know Just Ain’t So

In 1937, the great American inventor and businessman Charles Kettering said, “It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so.” My hunch is that if Mr. Kettering were alive today he would want to double down on that belief.

History is full of examples where that which was once universally accepted as the truth was eventually replaced with equal conviction of the exact opposite. In 1615, Galileo was placed under house arrest for writing that the earth circled around the sun. Today anyone alleging the opposite with conviction would be considered a lunatic.

In 1846, Ignaz Semmelweis, a physician from Vienna, was put in prison and eventually beaten to death after trying to convince other physicians that patients were dying from infections due to physicians not washing their hands. Today physicians who insisted on not washing their hands before and after touching patients would have a hard time finding employment anywhere in the world. Up until 1982, every respected physician in the world was absolutely convinced the human stomach had far too much acid for bacteria to survive. That is until pathologist Robin Warren showed that wasn’t true for the bacteria H. Pylori which, by the way, also happened to be the cause of stomach ulcers. Warren won the Nobel Prize for his discovery and has saved millions of people from suffering the pain and disability of stomach ulcers.

For those of you who are old enough to remember a rotary phone, how about these former beliefs:

• Japan will dominate the world during our lifetime due to its manufacturing and management prowess. (Today, the Japanese stock market is about the same level it was in 1985.) 
• The encyclopedia is the most important and reliable source of knowledge. (True, unless you consider this thing called the Internet.) 
• Every major city has one morning and one afternoon newspaper in addition to radio and television stations. (Raise your hand if you were born after 1980 and have either read a printed newspaper or sat down to watch the evening news in the last six months…I thought so.) 
• High inflation is a permanent part of American economic culture. (Thanks, but we’d prefer a 2 percent mortgage over a 16 percent mortgage.) 
• And finally, medical doctors have it made. (I’ll let your mind run where it wants to with that one.)

Here are some things I thought were absolutely true until just recently: 

Only a human could possibly win a game of Jeopardy! Not so much. IBM’s Watson, a question-answering computer using a cluster of 90 servers with 2,880 processors and 16 terabytes of RAM, beat the all time Jeopardy! winner Ken Jennings. 

Here’s another - health care providers are the only ones who can accurately diagnose illness. Who else, after all, can talk to patients, examine them, review labs and imaging studies, think about a differential diagnosis and make a treatment plan recommendation? Well, it turns out, the Cleveland Clinic, Sloane-Kettering and WellPoint all think Watson will eventually be better than human providers, and they’ve invested their money in Watson to do so. After Watson has a query posed that describes a patient’s symptoms and other related data, it reviews the patient’s health record for pertinent history, labs, images, notes from other care providers, treatment guidelines, clinical studies, research materials and comparisons to other similarly situated patients to come up with a differential diagnosis and treatment plan. 

If all that seems like it’s a long way from Springfield, consider this: Mercy has worked with a company called Ayasdi to review the data from our millions of patient records in Epic to come up with care paths for the diseases we most commonly treat. The result? After the Ayasdi computers combed through millions of our data points, they have created treatment plans based on a subset of all those patients who had the best outcomes under our care. The big question now is what will we do with this new information?

Now, let’s add this. Today the Mercy Virtual Care Center (VCC) in St. Louis is remotely monitoring the care of many patients who have multiple complicated medical conditions. Each of those patients has Bluetooth-enabled monitoring equipment in their home for data like heart rate, temperature, respiratory rate, oxygenation, blood pressure, blood sugar and weight, which is automatically uploaded into Epic and transmitted to providers at the VCC. When their results start to fall out of line, these patients receive phone or video calls from VCC providers who put treatment plans in place before an adverse event occurs. 

Can you see where this is going? If, like me, you believed that the diagnosis and treatment of human illness was squarely in the hands of other human beings…well, maybe what we know just ain’t so. We are in a time when many things, formerly done by thinking human beings, can be reduced to a computer software algorithm, replaced by a robot or outsourced to those who can do it better, faster and cheaper. 

But before some of you get a sinking feeling in your gut and make predictions about the apocalypse, think about these things: The biggest increases in the labor force have been in education and health services, which have doubled as a percentage of total jobs since the 1970s. During that same time, employment in professional and business services was up 80 percent and hospitality and leisure services are up 50 percent. Today, there is a clear trend toward more employment in industries that value human interaction. 

The trend toward thinking being done by computers while humans focus on social interaction is also clear. The analytic skills of math and science are ever more susceptible to low cost competition and software. College graduates with high cognitive skills are using those skills less. Since 2000, the amount of brainpower required of college graduates has decreased and in 2012 reached the same level as 1980. Cognitive skills are still important, but those who use their cognitive skills in addition to showing an ability to build relationships, brainstorm, collaborate and lead are in a superb position to thrive. 

We’ve evolved from the industrial era, to the knowledge era, to the relationship era. As people who’ve dedicated our lives to the care of other people based on our ability to use our knowledge to form a caring relationship with them, this should make us feel hopeful. 

The fact is, change is inevitable. The way we do things, how we achieve our goals, even where we carry out our service to others is going to change. Those changes don’t make us a victim, however. If we accept those changes, adapt our thinking around those changes, create and maintain meaningful relationships with each other, as well as those we serve, we become the masters of our fate. Although there is much we don’t know about our future, when we actively engage in creating that future, there is a lot less to be fearful of, and a lot more to look forward to. Just think of what we will do together.