Monday, January 30, 2023
ISSN 2765-8767
  • Survey
  • Podcast
  • Write for Us
Daily Remedy
  • Home
  • Articles
  • Podcasts
    A conversation with Dr. Selwyn O. Rogers, trauma surgeon and gun policy expert

    A conversation with Dr. Selwyn O. Rogers, trauma surgeon and gun policy expert

    November 25, 2022
    A conversation with Dr. Kyle Fischer, policy director for the Health Alliance for Violence Intervention

    A conversation with Dr. Kyle Fischer, policy director for the Health Alliance for Violence Intervention

    November 25, 2022
    A conversation with Dr. Edwin Leap, physician writer and emergency medicine physician

    A conversation with Dr. Edwin Leap, writer and emergency medicine physician

    November 8, 2022
    A conversation with Mr. Omar M Khateeb, innovator in medical device sales

    A conversation with Mr. Omar M Khateeb, innovator in medical device sales

    October 31, 2022
    A conversation with Miss Smriti Kirubanandan, passionate healthcare strategist

    A conversation with Miss Smriti Kirubanandan, passionate healthcare strategist

    October 23, 2022
    A conversation with Mr. Michael Johnson, legal expert in physician contracts

    A conversation with Mr. Michael Johnson, legal expert in physician contracts

    October 23, 2022
  • Surveys

    Surveys

    Does inflation affect how you use your deductible?

    Does inflation affect how you use your deductible?

    by Jay K Joshi
    December 12, 2022

    Survey Resutls

    How strongly do you believe that you can tell when your provider does not trust you?

    How strongly do you believe that you can tell when your provider does not trust you?

    October 16, 2022
  • About Us
  • Contact us
  • Support Us
No Result
View All Result
  • Home
  • Articles
  • Podcasts
    A conversation with Dr. Selwyn O. Rogers, trauma surgeon and gun policy expert

    A conversation with Dr. Selwyn O. Rogers, trauma surgeon and gun policy expert

    November 25, 2022
    A conversation with Dr. Kyle Fischer, policy director for the Health Alliance for Violence Intervention

    A conversation with Dr. Kyle Fischer, policy director for the Health Alliance for Violence Intervention

    November 25, 2022
    A conversation with Dr. Edwin Leap, physician writer and emergency medicine physician

    A conversation with Dr. Edwin Leap, writer and emergency medicine physician

    November 8, 2022
    A conversation with Mr. Omar M Khateeb, innovator in medical device sales

    A conversation with Mr. Omar M Khateeb, innovator in medical device sales

    October 31, 2022
    A conversation with Miss Smriti Kirubanandan, passionate healthcare strategist

    A conversation with Miss Smriti Kirubanandan, passionate healthcare strategist

    October 23, 2022
    A conversation with Mr. Michael Johnson, legal expert in physician contracts

    A conversation with Mr. Michael Johnson, legal expert in physician contracts

    October 23, 2022
  • Surveys

    Surveys

    Does inflation affect how you use your deductible?

    Does inflation affect how you use your deductible?

    by Jay K Joshi
    December 12, 2022

    Survey Resutls

    How strongly do you believe that you can tell when your provider does not trust you?

    How strongly do you believe that you can tell when your provider does not trust you?

    October 16, 2022
  • About Us
  • Contact us
  • Support Us
No Result
View All Result
Daily Remedy
No Result
View All Result
Home Uncertainty & Complexity

War Elephants of Healthcare

Jay K Joshi by Jay K Joshi
August 8, 2021
in Uncertainty & Complexity
0

The war elephant was the heavy artillery tank of antiquity. Some of history’s greatest empires, from the Carthaginians of North Africa to the Mauryans of India, utilized the war elephant to devastating effects.

But for all their strengths, the war elephant had one fatal flaw – it was unable to confront uncertainty. Daring soldiers would approach with torches most elephants have never seen or produce unfamiliar, raspy sounds to frighten the animal – with surprising effectiveness.

In the end the uncertainty overcame the strength of the war elephant. And what appeared as an insurmountable weapon of war deteriorated into an unwieldy beast, as capable of exacting self-inflicted wounds as casualties to the enemy.

This is the nature of uncertainty, capable of transforming perceived strengths into actual weaknesses when approached by something new or unfamiliar.

Something many of us experienced during the COVID-19 pandemic. Uncertainty crippled massive healthcare systems into debt ridden organizations living and dying through government aid. It destroyed the belief that patients will always seek care, whether in good times or bad. And it eroded trust in federal healthcare institutions that long served as the voice for healthcare public policy.

Uncertainty is an inescapable reality of healthcare that we have largely ignored, until we could no longer afford to. The impact of the pandemic became too much to bear. And if we are to truly implement the lessons learned from the pandemic towards the future of healthcare, then we need to integrate frameworks of uncertainty into healthcare.

But healthcare is already rife with frameworks. You could even say the field has too many frameworks already. Whether it is creating protocols for patient care, or designing algorithms to streamline clinical decision-making for routine patient care, healthcare – more often than not – has a framework for most situations.

But it is a framework for the unfamiliar, unknown situation that can add the greatest value. Whether it is a protocol to handle uncertainty, or a database for reporting unknown presenting symptoms, we need to systematize the reporting and management of uncertainty.

This requires a shift in culture. Not unlike the shift towards acknowledging and reporting errors. For decades, healthcare had created a culture of Darwinian, intellectual competitiveness. In which an error was seen as a sign of weakness, or of a weak mind that, conceivably, a smarter physician or nurse would not have made. Yet instead of eliminating errors, this culture simply swept errors under the table, denying their presence altogether.

But once committing an error became culturally acceptable, we began to find errors more easily, and address them more effectively.

Uncertainty is not much different from errors. It is simply a matter of semantics. Uncertainty produces errors, as errors come from situations in which what is unknown exceeds what is known, and the uncertainty overwhelms the decision-making – leading to a wrong decision.

In this manner, uncertainty can be seen as a cause for many errors. And if we are acknowledging errors to be inherent in healthcare, then we should acknowledge uncertainty to be inherent in many decisions that lead to healthcare error.

Study uncertainty as a discipline within healthcare much like it is studied in engineering. Most engineering fields acknowledge error and have developed sophisticated risk and error minimization frameworks which acknowledge uncertainty. And by acknowledging uncertainty, engineers optimize it.

In healthcare we do not even acknowledge uncertainty. As a result, we have no means to optimize it. If we encounter a patient with fatigue, pale composure, and dizziness, then we may reflexively consider anemia as a possible diagnosis and initiate a work up that involves drawing lab values such as serum hemoglobin. Depending on the acuity and severity of the symptoms, we may consider a cardiovascular or neurovascular work up for a heart attack (myocardial infarction) or a stroke, respectively.

We use the uncertainty of the symptoms, balancing the acuity, severity, alongside the constellation of symptoms to determine what course of action to take. This line of thinking predisposes to action, meaning we address uncertainty incrementally, trying to eliminate it by ordering test after test, imaging after imaging.

Some is good, more is better. But whatever we do, we tend to overdo.

The problem is that we never actually address the uncertainty. We merely wish it away by ordering and testing, hoping we understand the presenting symptoms well enough to know what the treatment should be.

Most of the time, this approach actually works. But in those rare moments when it does not work, we will find ourselves confronting a war elephant of healthcare. A situation in which the uncertainty overwhelms what we think we know.

The rare moment when the blood work and imaging work up produces something other than anemia or some cardiovascular or neurovascular disease. The rare moment when what we assume to be true or certain is anything but that.

Those are the moments when we need to rely on frameworks of uncertainty to standardize our approach to what we do not know. Every aspect of healthcare has established standards of care through which we think through an issue – a presenting set of symptoms, a public policy issue, or a hospital guideline.

These standards structure clinical thinking to eliminate uncertainty overtime decision over decision, which mostly has worked quite effectively. Until they do not. Until we meet a war elephant.

We need to add provisions in these standards and protocols to account for uncertainty. Make uncertainty an acceptable aspect of real-time decision-making in healthcare, and not a last resort default when all other viable options have been exhausted.

Many forward thinking medical schools train students to think about the cost-effectiveness of ordering a test or an imaging study, balancing the value of a test or study relative to its cost – as an opportunity cost. We can easily incorporate uncertainty into a comparable opportunity cost framework. Openly discuss the perceived value of ordering something or taking some action relative to the uncertainty addressed through that order or action.

From that shift in perspective, we can create new frameworks or modify existing frameworks that encourage us to think in terms of uncertainty. And embrace it as an integral part of healthcare.

So we will be ready for the war elephants of healthcare.

ShareTweet
Jay K Joshi

Jay K Joshi

Dr. Jay K Joshi serves as the editor-in-chief of Daily Remedy. He is a serial entrepreneur and sought after thought-leader for matters related to healthcare innovation and medical jurisprudence. He has published articles on a variety of healthcare topics in both peer-reviewed journals and trade publications. His legal writings include amicus curiae briefs prepared for prominent federal healthcare cases.

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

Videos

YouTube Video VVUxUDVQenU5RTFjUVFKNDY2ZlBmdFB3LmdVUm55WVpqRmNn This is a video about Elemental/Essential Frameworks of Healthcare Law

00:00 Elemental/Essential Frameworks of Healthcare Law
Load More... Subscribe

Expert vs. Lay Testimony

Visuals

NADAC (National Average Drug Acquisition Cost)

NADAC (National Average Drug Acquisition Cost)

by Jay K Joshi
January 29, 2023
0

We list the acquisition price of drugs that are covered under the Medicaid Drug Rebate Program - effectively, how much does the government pay for common drugs utilized by patients on Medicaid. Drugs listed are from A-CH.  

Read more

Twitter Updates

Tweets by DailyRemedy1

Newsletter

Start your Daily Remedy journey

Cultivate your knowledge of current healthcare events and ensure you receive the most accurate, insightful healthcare news and editorials.

*we hate spam as much as you do

Popular

  • Letter to the Alabama Board of Medical Examiners

    Letter to the Alabama Board of Medical Examiners

    0 shares
    Share 0 Tweet 0
  • Prosecuting Doctors as Drug Dealers

    0 shares
    Share 0 Tweet 0
  • Why Our Prescribing were for Patients’ Best Interests

    0 shares
    Share 0 Tweet 0
  • Malicious Prosecution and Fabrication of Evidence

    0 shares
    Share 0 Tweet 0
  • My Respect for the Law

    0 shares
    Share 0 Tweet 0

Daily Remedy

Daily Remedy offers the best in healthcare information and healthcare editorial content. We take pride in consistently delivering only the highest quality of insight and analysis to ensure our audience is well-informed about current healthcare topics - beyond the traditional headlines.

Daily Remedy website services, content, and products are for informational purposes only. We do not provide medical advice, diagnosis, or treatment. All rights reserved.

Important Links

  • Support Us
  • About Us
  • Contact us
  • Privacy Policy
  • Terms and Conditions

Newsletter

Start your Daily Remedy journey

Cultivate your knowledge of current healthcare events and ensure you receive the most accurate, insightful healthcare news and editorials.

*we hate spam as much as you do

  • Survey
  • Podcast
  • About Us
  • Contact us

© 2023 Daily Remedy

No Result
View All Result
  • Home
  • Articles
    • Contrarian
    • Financial Markets
    • Innovations & Investing
    • Perspectives
    • Politics & Law
    • Trends
    • Uncertainty & Complexity
  • Podcasts
  • Surveys
    • Survey Results
  • About Us
  • Contact us
  • Support Us

© 2023 Daily Remedy

Start your Daily Remedy journey

Cultivate your knowledge of current healthcare events and ensure you receive the most accurate, insightful healthcare news and editorials.

*we hate spam as much as you do