On Surgery, etc.: Revenge of the Nerds

I laughed out loud. Several times. This is, objectively, really funny. About why docs are slow to social media.

On Surgery, etc.: Revenge of the Nerds

A Phalanx of Mobile Apps: Just What the Doctor Ordered

                                                                                                                     "The Cavalry Charge" -Frederick Remington 

"Civilization advances by extending the number of important operations which we can perform without thinking about them. Operations of thought are like cavalry charges in a battle — they are strictly limited in number, they require fresh horses, and must only be made at decisive moments." - Alfred North Whitehead An Introduction to Mathematics

There's a simple reason the phrase "there's an app for that" has become so trite so quickly: it's a useful expression. But I think the utility of the expression, beyond Apple's branding brilliance, comes from a deeper place: it's primal. 

Using an app in place of a thoughtful operation is, to borrow Whitehead's phrase, like mounting a cavalry charge, but without having to refresh the neural horses. 

Since our brains are finite, capable of only so many cavalry charges a day, progress is two-pronged. It both increases the number of cavalry charges, and continuously promotes the brain to the vanguard. The more apps come along, the more operations are completed, and the more the brain is liberated from mundane operations and promoted to the forefront of what really counts in our day. Crucially, I don't see apps as dumbing us down, but rather, as smartening us up to perform previously unreachable operations of thought.

Today, when I'm faced with the need to operate thought, a little voice asks if "there's an app for that"? It's really not a modern question, but a primitive reflex rustling about in the wisdom of Whitehead's statement. Humans have always sought tools to solve problems that buy us more time to solve more problems (that buy us more time to solve more problems, á la Ray Kurzweil). We corralled herds of mammoth off cliffs to save the time and effort of hunting them one-by-one. There's no real difference when we use the Chipotle app to save the time and effort of waiting in line. 

Much has been made of the impact of apps on healthcare (See Kent Bottles's post for a trove of examples). But I believe the biggest impact has yet to be richly explored, and that is the  the quantified self movement. 

Briefly: consider that monitoring the effects of our behavior clearly benefits our health (See Thomas Goetz's The Decision Tree blog for examples). The trouble is, we behave all day long, and continuously monitoring our the effects of our behavior would use up a lot of cavalry charges. Given that chronic disease is the costliest aspect of healthcare, and that lifestyle choices such as diet, exercise, and smoking are key contributors to such chronic conditions as congestive heart failure, diabetes, and chronic obstructive pulmonary disease, then a phalanx of mobile apps might be just what the doctor ordered.

Relieving the Echo Chamber: HCSM Discussion We Need to Have to Move Forward

In his recent post Social Media and Health Care: Discussions We Need to Have," Dr. Howard Luks laid bare an early challenge facing health care and social media: the "echo chamber" where the same issues get "regurgitated, over and over."

How do we move beyond this?

I propose that the early adopters and trendsetters within the health care and social media community establish a rough curriculum.

Below, I've roughly parsed the issues Dr. Luks raises:

1: Introductory Level Issues:
        What is important about health care becoming social?
        What is a rough sketch of the major issues at play?
        What are the tools?
        What are the examples of those tools in action?
     
2: Second Tier Issues:
        What specific areas of health care represent low-hanging fruit for social media?
        What are the examples of people already applying social media to those areas?
        What might "disruption" mean for the medical establishment?

3: Third Tier Issues:
        What is professional behavior on social media?

4: Fourth Tier Issues:
        How to manage HIPAA concerns?
        What is the doctor-patient relationship on social media?
        What kind of medical decision making is appropriate when and where?

I see the echo chamber improving when there is a centralized, widely endorsed, place to which experienced HCSM-ers can direct the less experienced.

Perhaps this could be a website that structures this content so that the user can access the level of insight appropriate to their experience with the issues?

Perhaps this site could be made pedagogical with some brief and directed youtube videos?

Or, have I completely missed the boat here and this content already exists in centralized, organized form?

Cosmic Significance in the ICU

My ICU attending was waxing philosophical about life and death and the meaning of it all.

Awesome.

It interested me that he took the Stephen Hawking position:

"The human race is just a chemical scum on a moderate-sized planet orbiting round a very average star in the outer suburb of one among a hundred billion galaxies."

Who could disagree that we are NOTHING...?

David Deutsch, that's who. In his TEDTalk "Our Place in the Cosmos,"* Deutsch interprets the opposite conclusion from the same facts. Again, roughly paraphrased:

We are staggeringly special. Statistically speaking, the universe is so empty that, if you were to be dropped off at random somewhere within it, you'd be fantastically lucky to be any near a galaxy, let alone within it, let alone near one of its billions of stars, let alone on the surface of a rocky planet, or one with an atmosphere conducive to liquid water.... Who could disagree that, as subjectively aware beings, we are THE MOST (insert descriptor hear) things we know of in the universe?

I like the David Deutsch interpretation.

Most interestingly of all, back in the ICU, I found myself in complete agreement with my attending's conclusion, although for the opposite reason.

Attending: Life is insignificant, why would we lecture our patient about how to live it?

Deutsch: Life is so important, who are we to lecture our patient about how to live it?

*I couldn't recommend this TEDTalk more strongly. Deutsch exercises the most compelling use of a visual aid to sear a ver profound point into his audience's thinking. Awesome. And his book, The Fabric of Reality, is really quite something too.