Tuesday, November 25, 2008

The Product and a Person

After my recent post about time spent at home for this medical adventure compared to the longest periods I’d ever spent off work before—having babies—Kearney pointed out that this time, I’m more like the baby than the mother. In a lot of ways, this is true, as it’s my brain this time that is adapting to new circumstances. Kearney pointed out: “You underwent some pretty shocking physical trauma, during which your brain got all mushed about, and then in some respects it had to re-learn how to control your body (especially the right arm/shoulder, balance), process language, etc. Think about how much time new babies spend sleeping while their brains do all that new stuff, especially given that new brains are designed to be extremely plastic. Yours isn't really designed for that per se, but it's doing a darn good job anyway.” This perspective, which makes a lot of sense, would then make the “new me” the product of this adventure, as well as still a person who liked to be greeted, acknowledged, respected, etc.

Meanwhile, a physician of our acquaintance told us, in the nicest possible terms, that it is “ignorant and unfair” to suggest that physicians pursuing evidence-based medicine (EBM) aren’t caring. That seems right: the more I’ve thought about this, the more it seems that many of the unintended consequences we’ve experienced from, say the quest for identity above all else in medical interactions, stem from the systemic implementation of the EBM findings, not necessarily the caring (or not) of individual participants in the system. So maybe the evidence-based management findings are even more relevant than on first thought. That’s because the implementations of EB medicine that reduce humanity and strive for consistency would then be the artifact of management decisions, not necessarily individual care providers. There’s some evidence to support the view, then, that the evidence-based management literature might be recommended to the health-care leaders implementing findings from evidence-based medicine. I talked yesterday with some folks in a large medical system and one of the topics we visited were the problems that have resulted from the system’s implementation of pay-for-performance incentives in a number of layers. The evidence-based management literature is very clear that individual financial incentives are not a great way to get better performance—they’re just easier to implement than coherent, meaningful systemic change.

This week has brought more advances in the healing of the incision, such that there’s now really only one remaining small (1-2 inches) sore section; some of this improvement was brought by Michael pulling what seemed to be some ingrown hairs elsewhere. Within hours after his work, the swelling subsided, and that section is hard to find any more after it had been troublesome since the beginning. The scalp is still sensitive/numb, but the progress is so great on the incision that we’re feeling optimistic indeed about the prognosis for the rest of it.

I’m still learning to balance my energy with tasks to be accomplished, so that’s it for today. More soon.

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