Tuesday, April 02, 2013


Investigated over 300 deaths: meaning?

A recent list of news headlines might not seem ambiguous at first glance.  We probably all read it according to what we wish to find.
Coroners, I do believe, must investigate hundred of hospital deaths in the course of their careers.  In fiction, whistle-blowers and other heroes take--or have thrust upon them--investigative initiatives.  Surely the Brazilian nurse, or doctor, or both were such heroic investigators.  Or were they?

Would "suspected of 300 hospital deaths" have been too hard to think of? Or must we suppose that it would have been "investigated more than" in the opposite case. 

The meaning of "over" in this case could be in association with either
  1. "investigated": was or would be investigated over something, meaning (to be) investigated because of something.
  2. "300": over 300 something is investigated (did investigate) more than 300 something.
The ambiguity arises because the rationale for investigating is stated using a number, and "investigated" could be either a past active form (as "did investigate") or a present participle (as "is being investigated"). There are many ways to avoid this ambiguity. For one, a simple change from "300" to "hundreds of" (or "scads of") would suffice, since "over hundreds of" does not make sense, making it clear what was meant is "investigated over." Another possibility is to remove "over" by writing "suspected of" instead of "investigated over," as suggested above.

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Monday, April 01, 2013


Collective Medical Learning (and its future)

This needs some more thought and writing to pull it into a sensible form with a cogent argument; I hope to make that transformation soon. The objectives, consequential questions, and sources I wanted to include are here. But this is not really a note yet, this is just notes.--Maurice

Over the past few years, an accumulation of observations suggests the need ask whether medical society is learning its lessons from its experience, particularly from its failures. Or whether it could and should be learning more, and more readily. The set of observations accumulated by this observer will be presented in summary fashion below, with brief notes as to why they are included.
Medical Society
The collective "medical society" is perhaps not a usual term, so should be explained. It is deliberately chosen for its vague inclusiveness. The subject at hand is what Russ Ackoff aptly called a mess, a complex system with multiple stakeholders. In our "medical society" we have doctors and patients, but also patients' families, hospitals and their owners and administrators, pharmaceutical and other laboratories, medical equipment makers, and insurance companies and other healthcare mutualisers; and perhaps others. It is vast, with boundaries often unclear yet interests often very narrow. In such a mess, where should the responsibility for collective learning reside? Shouldn't it be shared, with each stakeholder contributing according to his abilities? Or should it be the business of regulatory agencies, as in one of the exhibits below?

"Contemporary medical society should be learning more from its experience. It remains to determine how could that greater learning should be achieved?"
That is the topic suggested by the observations.
The Accumulated Clues
The exhibits leading to the asserted need include:
Given those exhibits, this observer arrives at these points and derived questions:
  1. More autopsies, rather than fewer, would probably be worth doing.
    • But how much would they be worth, what would their value be? How can it be assessed?
    • Is there a strategy (or policy) that can optimize selection of those to perform?
    • How should more autopsies be paid for?
  2. Cadavers are still needed for medical students.N.B.: That was from another exhibit, missing above!
    • What is the relationship of cadavers for medical school to those autopsied? Do autopsies performed in anatomy labs of med schools have any research value, or do they serve only to provide concrete experience to the students?
    • If one (such as I) considers his organs too worn to be worth transplanting, and wishes to either give his body to a medical school or have it autopsied, how should he choose? Or should he leave the ultimate choice to his heirs, who might prefer autopsy if the cause of death is likely to be interesting (surprising)?
  3. The question of who is to blame for the decline in autopsies is interesting, but unlikely to be the most expedient way to reverse the trend. Is it economics? Religion? Big pharma in collusion with the HMO and insurance companies? Who benefits? Interesting, but more important is what society loses and finding ways to restore effective learning practices to the medical sector (to the sector collectively, not to each individual in the sector).This is just a restatement of the futility of trying to untangle a mess: there will always be other candidates for blame.

Topics for Further Study

It could be interesting and useful to frame this mess in Argyris and Schoen's learning types model. Most likely, individual stakeholders are predominantly Type I. Is it possible to get the regulatory agencies to Type II (double loop learning) and a role as facilitator and mentor? Or will professional clans fight hard and cling to sectarian power, whether or not it is in the common interest?

Leftovers --please ignore

The Mislede
A joke heard many years ago starts by asking "How many social scientists does it take to change a light bulb?" (Moreover, a clever recent short essay addresses the question "How many historians ..."). The old answer was "Social scientists don't change light bulbs, they try to explain why one is burnt out."
That may not be the best introduction for the question at hand but the part about figuring out why there had been a failure brought it to mind.
While somewhat fun and catchy, that joke did not provide an analogy useful making sense of what was to follow.
Stuff that somehow was transformed ...
from sentences to attributes of some weird tag, in the course of html parsing and checking and style rewriting. Probably hopeless (and useless) to try to put back together again.
--="" a="" about="" alone="" and="" be="" because="" begin="" but="" by="" coroners="" could="" cure="" die.="" diseased="" do="" doctors="" does="" effectively="" enough="" explain="" hard="" introduction="" is="" it="" line="" make="" many="" medical="" misleding.="" more="" nbsp="" not="" obvious.="" one="" ow="" patient="" people="" perhaps="" punch="" question="" reply="" seriously="" society="" suitable="" take="" that="" the="" then="" they="" to="" too="" tries="" unfair="" way="" we="" whether="" why="" would="">

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