Without compromising patient dignity and HIPAA, I wish to relate a short story about the breakdown of technology and the importance of the human touch:

A patient had been brought into the ICU primarily presenting with a few signs/symptoms of hypertensive crisis.  Since the patient had been intubated, the patient could not communicate verbally.

With the attending physician flanked by medical students and residents and nurses, several attempts to lower the blood pressure were made. But to little avail.

As I entered the room, it was clear to me that the etiology might be simple (a writhing body can give it away): pain.

So I did what I do – which is to call idiots idiots – and asked to assess this patient quickly. I looked at her lines. Had another nurse turn her from side to side to see if anything was in the way.

And you know what? Somebody had left an uncapped needed in her bed, which had impaled itself into her buttocks.

Sure enough, once removed and pain medication administered, the BP resolved in short order.

Needle in the ass.

I asked the residents and medical students to forever remember “needle in the ass” whenever they were stumped or frustrated in combing through data, algorithms, etc.

As our technology and knowledge expand, it’s very easy to forget that brains are, by far, the most powerful wet machines on the planet.

What I did wan’t spectacular or genius. But it was awareness of what’s in front of you and unflinching curiosity regardless of what the machines tell you.

And that’s the point.

Needle in the ass!

When I read such predictions I chuckle at the naivety of those who make such pronouncements. The computer advocates do not really understand medical care and diagnosis.

I agree with Dr. Centor: it is a laughable proposition, but not entirely for the reasons we may think.

I’ll build even further on Dr. Centor’s reasons for why robots won’t replace most of what doctors – or nurses and other HCPs – do.

• Robots and other technologies can add value to medicine and reduce certain workloads.
• But: as technologies shift burdens away from the routines of HCPs, new opportunities for physicians to expand their roles increase.
• Not only will the roles of HCPs increase, but their relative ratio of what they do compared to what technology can do will likely remain stable (whether there is some inherent constant or not is hard to tell).

The question for our time isn’t: “How will technologies reduce what HCPs do?“

No, the crucial question is: “How will technologies free up the degrees of  freedom for physicians and nurses to play even larger roles in Healthcare?“

By claiming that robots will “replace” what physicians do, there is implicit an ideology that forgets the very reason for having human beings do any kind of work in medicine in the first place: Humans are the core beings who link all of technology together – language, digital extensions of fingers, computation, compassion, etc.

That is to say: Human beings aren’t just human beings: we have been parts of technology for hundreds of thousands of years already. It’s just that the hyper-connectivity of social media, coupled with the ever-growing powers of raw computational power – and the algorithmic overlays they make possible – are just making it clearer to us now than ever before.

The paradox of powerful computational machines – for all of their ability to store data and information – is that they ignore, by default, all of the ‘hidden’ data that are visible to us.

We don’t need robots and other technologies to do what we already do – that defeats the whole purpose of engineering them in the first place. We need to build them to do the things that we don’t do.

Just as airplanes are not artificial birds, robots shouldn’t be artificial humans. Airplanes are very different from birds – there’s just a tiny aerodynamic similarity between airplanes and birds – and yet airplanes help us to accomplish a lot more work than we could without them. So too aught it be with artificial Healthcare.

Airplanes didn’t replace birds. Nor should they.

So the next time someone claims that doctors and nurses will be replaced (or partially replaced) by robots, retort with the question: “So, tell me, what is your understanding of what these people do?”

The interesting thing is: no one person knows everything about what health providers do – or can do. That’s where the true excitement for the future of Healthcare is open to be experienced. That’s when novel ideas about better Healthcare can take flight.

A former girlfriend of Techcrunch founder Mike Arrington alleged in a Facebook update that he abused her. Now, allegations of abuse happen all the time – many true, many untrue. And, as often is the case, when ‘celebrities’ are involved news travels fast. In fact much of what spreads is uninformed and infantile – and the surrounding discussions evade the core problem.

Domestic Violence is a tough topic to discuss: it’s poorly understood, our legal and political systems are arcane, and our culture still has yet to grasp the nature of violence – especially violence against women and children.

What’s disturbing about the allegation against Mike Arrington is that the tech blogger and Silicon Valley culture has been almost dead-silent on the matter. This silence is not attributable to “waiting for the facts to come in” – no, this is a community that will latch on to the slightest gossip with fury. So why so silent in this matter? What’s up with that? Here’s the SERP for Google Search in News more 2 days after the story broke.

Well, I think it’s important for the subject of this story to become a bigger story for two reasons: 1) We need to bring Domestic Violence out of our systemic denial of it and 2) the tech industry *is* important and leadership is essential – if we have poor leadership then we have both poor technology and poor uses of those technologies. So the two go together here.

If  unconfirmed ‘facts’ can be tarted up in Infographics, embedded on tech blogs, and spread virally via social media, then why on earth would a topic as important as Domestic Violence get barely any traction?

The Tech industry should not be run by Misogyny. This is a community that had Red Avatars in support of Marriage Equality on millions of social media accounts. But how on earth can we expect to have Marriage Equality if we can’t even solve the problem of Domestic Violence? You tell me.

So below is Loren Feldman eloquently outlining the problem. Loren is one of the smartest people in tech – many people fear him for some reason, but I think that’s just their insecurity. But this post isn’t about Loren – I post his video here, however, because the question is: Why is Loren pretty much the only person in tech to speak up?

Is Mike Arrington so terrifying to the tech community? I never met him, so I can’t be a judge. But really – why so silent? And where’s Arriana Huffington in all of this?

So, for what it’s worth, here’s Loren’s video. I hope you watch all of it. I hope the *topic* of Domestic Violence gets a lot more public attention in Silicon Valley because the things it produces will influence us for a very long time. If those who want us to accept their ideologies of Open Source, etc. can’t speak up on Domestic Violence, then what credibility do they have? How can we trust that they will fight for all human dignity? Why should we listen to them?

We can’t claim Social Media and Tech is “revolutionary” if important topics are thrown into the shadow because of personalities being afraid of facing real problems or focusing on drama. It’s the 21st Century. It’s time for us to grow up. Because children who never grow up eventually hurt children, and the cycle never ever ends.

Loren’s video:

I’m not saying that technology and media necessarily cause this. But the current state of hardware and software have not at all taken into account the way our brains and bodies work. These technologies have had very specific histories behind them – they did not just arise out of nothing.

The designers, the programmers, the sellers…none have invested the time, effort, and knowledge into how these tools can work *with* us. Instead we are supposed to adapt to them. Not only that, but the ideology of Silicon Valley implies that you are a ‘luddite’ or ‘lagger’ for not heading the command to adapt – as if we’re the idiots for not conforming to their autistic-like view of the world (I use ‘autistic’ in its general, not clinical sense here – this isn’t a reference to autism).

Why should that be? Why must we have to adapt to an electronic Paper Clip? Why must we have to adapt to 140 characters? Why must we Like when we actually Hate?

We have reached a time, however, when we are being left with little choice: soon everywhere you look (if not already), people will be either staring at screens or *through* them. Reality will be augmented, while connection with reality will be reduced. (Reduced connection to reality is a simple description of clinical psychosis.)

I am not be alarmist here. I am telling you that this will be the case.

You can ignore me.

Or you can think about it, look around, and decide to be passive…or ask “What is to be done?”

You will see more isolation. Unless you are one of the isolated. You simply will not see it – much as you can’t see the back of your own head.

And that’s the problem – this worsening of mental illness will worsen even more because it will be left untreated.

Up until now, our struggles have been against tyrants of old, or in more recent times, the Communists or Fascists.

But what do you do in a world where your fellow human beings are tethered to electrons, glass, and flickering lights?

I’m not a life coach or guru, so I can’t tell you what to do.

All I can say is: mental illness in our world will worsen, social media will continue to play a contributory role, and you may be victim if you aren’t already.

Whatever your center is – whatever that thing is that makes you *you* – know where it is.

And when you walk among other human beings who know their center, you’ll recognize each other.

And you will remember what true friendship was supposed to be all about.

It wasn’t about technology. And Technology wasn’t supposed to be about friendship.

How did this perversion of the two happen? How have we let it happen? How?

I enjoy writing and using this tech stuff to communicate . But I’m very concerned about where things are headed.

I wish you well if you find yourself in the world I see arriving. I really do.

As for me, meditation seems reasonable.

Try sitting with yourself for 5 – 15 minutes. See how long it takes for you to get uncomfortable doing that – just sitting doing nothing.

Think about why that is.

It’s a fascinating question: Just why does it get so uncomfortable to sit with yourself doing nothing?

Social Media won’t help you with that. Only silence and discipline and a desire to find out.

(Comments can be emailed – it’s more social that way.)

When we think of *violence*, we typically think of blood, or force, or other forms of physical brutality.

We may even think of other forms of violence – emotional, sexual, economic, political, ideological.

There are, however, more forms of violence which elude our conscious notice.

The image you see here – a beautiful girl with nice legs, elegantly poised; her knees burnt from carpet-play. For misogynists , it’s a humorous and cute conduction to “Flirt” (unconsciously) with Vodka. A whole lotta *V* going on.

For feminists – and everyone concerned with violence against women (which includes the use of their bodies as marketing vectors) – the image is one of clear violence, degradation, and disgust. Political pornography of a rotting and socially alcoholic world.

There is, however, something to be learned from this image – a lesson which we can uptake by comparing it to the common images presented to us (without our permission) everyday.

In an odd and paradoxical way, this particular image is “honest” in comparison to the typical Victoria’s Secret posters. “Honest” in the sense that the violence isn’t hidden from us. Yes, we could imagine a sexual partner proud of his/her rough endeavors the night before, as implied by the woman’s faint bow of satisfied desire. But we know it’s a fake – we know clearly that it is a marketing attempt to link Vodka and Vagina.

We must turn our attention to the other kinds of images – the “dishonest” images, the ones we take for granted, the ones we’ve evolved a desensitized (but porous) armor against. It is a violence much worse than the image of carpet-burns on a pair of delicate knees.

The images of those Victoria’s Secret women do not explicitly convey victimization – yes, we may say “this is victimization and violation of women”. But the critical point is that the “bareness” of their bodies conceals the violation. Whereas the image in this post bears the stigmata of “rough sex”, the “cleaner” images conceal the wider and deeper violation of the viewer. This is what we must face.

For every moment we pass an image or video or idea of a woman-object (or man-object for that matter) intended to cull or instill a sense of desire for some other object, we are violated. Not to be asked permission is to be violated.

It is this accumulation of violations which fuel an already-bipolar culture. It is a culture of social depression where hypomanic pursuits attempt to lift and save it from its collapse.

So let’s think about this – whether we are male or female, gay or straight – we are caught up in this shining cycle of sexual violence of our bipolar culture. Since we were children, we have been violated to the point where we don’t see the violence. But it’s there. We must open our eyes, lest we continue to be prey for violators.

Those images that don’t have the carpet-burns explicitly displayed? Those are the truly violent images. They are not merely acts of violence against women. They are acts of violence against all of our world, and they keep inflicting wounds that have, over time, sunk deep into our unconsciousness. It does not matter if we feel “offended” or not (I am a straight male and I readily admit to liking the Victoria’s Secret ladies, but that does not mean I am not violated by the images presented to me without my permission).

We are self-inflicting these wounds – a behavior horribly consistent with manic-depression.

The worst kind of violence is the violence shining in front of us but nonetheless hidden from our view – from our deep eye.

For this violence invades and infiltrates our minds, reshaping how we live and work and play – and even influences the health or sickness of our sexual lives. This worst kind of violence is a part of a larger violence which informs our politics, ideologies, policies, etc. It is these things which manifest or amplify the visceral violence-on-the-ground around our world. This is why it is a “worst kind of violence”.

Every act of violence begins as an un-acted idea.

Every idea becomes and image before it becomes an act.

Every image of a human used as an object inserted into our minds without our permission is a shining act of violence.

We no longer aught to be blinded.

I started the the first clinical Twitter chat for physicians.

I am an advocate for the (intelligent and creative) use of social media in Medicine and the rest of Healthcare.

I am the first clinician to sit on the first advisory board of Mayo Clinic Center for Social Media.

Although I am a nurse and many of you only listen to other physicians (that’s cool, I get that), we nurses tend to be the most social in the industry and we are the ones who have your back – which is why it’s fitting that you receive this letter from a nurse.

I mention these things because I want you to know that I am in no way a Luddite in the area of “Social Media Healthcare”.

I am happy that more and more of you are starting to understand that social and other digital software can have important roles to play in connecting with others in your field, communicate more continuously and effectively with your patients, help to close gaps in care, quicken your search for vetted and timely information, and otherwise be part of a fast-evolving 21st Century of Medicine.

But I do have concerns.

I think there are too many people on the Web offering advice to you on how to use social media. Most of this advice is just regurgitated advice from people you may never have heard of before, but who got famous years ago simply because they were the first to voice their ideas before anybody else. (If you want names, I’m happy to oblige – just email me: Info@HealthIsSocial.com.)

You really don’t need “How To” tips on blogging or Twitter. If you aren’t experienced, then just create accounts, experiment, and Google for a few videos or posts that give you the basics. That’s all you need. Oh, I’m confident that you’ll be told otherwise – but those folks, well-intentioned as they may be, don’t understand that you’re smarter than that.

You’re bright – you got through organic chemistry and medical school and years of residency.

You’re also frustrated – most likely, you didn’t sign-up for what you’re presently doing.

Take that brilliance and that frustration and forge new ways of using these tools. Avoid the contamination of mediocre minds who believe in tricks and tips to game things.

I can give you advice – but my advice is for what I do (and I wouldn’t recommend what I do and how I do it to most people). I do what I do because it’s what I do. If you follow the common advice, you’ll follow the same advice everybody else follows – nobody will see what makes you different, and you’ll eventually be abandoned no matter how temporarily ‘successful’ you feel.

Do what you do and do it the best way possible.

Think about the subtle problems and opportunities stemming from the presence of the technological and media changes transpiring now. Think about ethics and therapeutic communication and medical education. Lend *your* freshened perspectives. Heck – talk about things that nobody else has talked about!

Rather than learn bad habits from the get-go, take advantage of your lack of experience. It’s okay to make mistakes that don’t cause harm and violate the privacy and dignity of others.

We have been given tools that *can* change our world and to help make Medicine and the rest of caring better.

It’s not too late.

If you don’t give us fresh paint on fresh canvases with your wisdom (or humble ignorance even), experience, science, and humor, then we will be stuck with the voices of those who copied and pasted sloppy ideologies into Healthcare Social Media.

You’re better than that.

Give us the truths that are more enduring and universal than the actualities of your experiences.

The Medicine is the Medium.

Don’t let these media become the medicine.

Don’t let-down the patients out there who deserve the highest-quality information, insight, leadership, and nudging they deserve.

Lift them up.

Yours sincerely indeed,

Phil Baumann, RN

All effective Medicine is violence.

The Side Effect is central to the Treatment.

Hospitals are temples of lost opportunity.

Information wants to be cured.

The virus is smarter than the virologist.

Psychology is caustic astrology.

The Placebo Effect encapsulates lethal doses of truth.

An incurious nurse is a guard at the summer camp of death.

Positive imagery is the quack’s avatar. 

Tech without touch is autistic Fascism.

Health is the profane language of negentropy.

Cancer is a misplaced gerund.

Dark humor is the shadow of a bright caregiver.

Life Science reveals the absurdity of artificial systems.

Where the elders die is how the young will grow.

Detachment is Caring.

- @PhilBaumann – @HealthIsSocial

(These Proverbs of Health will continue to grow.)

When these things happen to others, we too can suffer vicariously.

Often, we need to talk-out what happens – to validate our feelings with others, to express our anger or grief, to take the edge off the pain of vicarious suffering.

I won’t mention a specific event (if you find this post in a few years, look at its publish date and you might surmise what happened shortly before this post went up). The truth of things, however, is more enduing than their actuality – thus no need for me to reference the event that lead to this post).

Today’s media – Facebook, Twitter,  Blogs – and the hardware through which we access them – laptops, tablets, smart phones – provide wide-open lenses, ears, and mouths into and out of the world.

These technologies and media have their place in our world.

But we are still human – and just because these tools are in our graps, it doesn’t mean we *have* to use them to voice every single fear, anger, despair, etc..

Madness is a howling in the wind that never ends when fed.

It’s okay to be silent.

In fact, perhaps Silence – its Art and Practice – will be what distinguishes those of us who know how to grieve from those who don’t.

We are creating a media world that never forgets – an inhuman feature of a human creation.

Elephants – those wide-eyed, big-eared, loud-trumpted mammalian cousins of ours: ever see them grieve over their dead? Even with their fantastic memories, they approach and respect their dead in silence. They are as mystified by death as we are, and are beautifully silent in that painful ignorance.

It’s the task of those alive to rescue the dead from forgetfulness.

It’s the task of Silence to resucue the living from remembering too much.

Crowdsourcing. 

The Open Web.

The Wisdom of the Crowd.

These are a few of the buzz-phrases that have infected Healthcare discussions over the last few years. I know some smart people who glorify the idea of Crowdsourcing, and it’s rather sad.

The idea of Crowdsourcing – that we can arrive at solutions, approximations of solutions, or sentiments about solutions – sounds wonderful. But at its root, it constitutes a dangerous emerging mythology. It’s a mythology that has Silicon Valley and tech bloggers by the grip. Crowdsourcing has become one of the pseudoscientific, Retweetable fodder found on TED Talks and TED MedX. I long stayed away from these talks – and I’m happy that I’m not associated with them, now that The Onion has them nailed. It was only a matter of time that these conferences, along with their jingoistic hypomanias, would receive the mockery they deserve.

Anyhoo, today, more than ever, we need Science – not mythology – in Healthcare.

I ask you: what, exactly, is the mechanism of Crowdsourcing that would make it work? Does Crowdsourcing have some inherent magical core that somehow arrives at the right solution to a problem? What are the fundamental laws of physics that govern these mechanics?

Oh. I see. Can’t answer those questions, huh? Well that’s a problem indeed.

You see, what has happened in Medicine and Healthcare has happened elsewhere in Social Media: a word offering a promise and a hope for democracy has been taken at face value with no critical questioning.

THE RAND CORPORATION MISLEAD SILICON VALLEY

Yes, Crowdsourcing may work: but only under very limited conditions under a limited set of variables – and even then, the results require validation of some kind.

[Video Link if it's not showing in your browser of bad choice.]

To simply generalize Crowdsourcing as possessing some universal power to solve problems or help populations of researchers collaborate better or bring forth more democracy into the world – well, that’s what’s called the logical fallacy of Overgeneralization.

The error which the proponents of Crowdsourcing commit is that they misunderstand and mis-apply the neuronal foundation of consciousness. That is, they assume that just because our consciousness arrives out of the collective dynamics of individual neurons (which are not conscious themselves), so too can a similar kind of consciousness (or Wisdom of the Crowds) emerge in other contexts.

But that’s a fatal leap of logic. The Web is not a conscious entity, nor will it ever. Nor is a group of human brains – a crowd is not a consciousness. An aggregation of individual brains, thrown together into some mass of size N, does not ex nihilo produce quantum leaps in problem-solving.

The consciousnesses which our brains produce arise not simply out of a critical mass of dynamically interacting neurons, but out of the evolutionary design-spaces of how those interactions work.

Similarly, a Crowdsourced solution – if it exists – doesn’t arise out of a mass of individuals. No, *if* it works, it works because of the right kind of foundational design-space that allows it to work.

Here’s the fundamental danger of the misinterpretation of crowdsourcing’s role in the Healthcare: as more and more people are duped into the belief that Crowdsourcing has more value than individual thought, and effort, and reason, then we will end up placing the self into siege. I ask you: is not the ultimate purpose of Healthcare to liberate an individual from the collective sieges of pathologies?

This is not a time for the individual to surrender her genius, passion, and discipline to Open-sourced algorithms of Close-minded Crowds. That we live in times where technologies can help us to extend what we can do is the very reason why we must become even more individuated, not less.

There comes a time in a physician’s, a nurse’s, or a biochemist’s career when the solitude of the self rescues the truth from the threats of violent ignorance.

Why so many physicians, scientists, academicians, and others who should know much better believe in Crowdsourcing prima facie is beyond me.

If you’re a smart person and you blindly believe in Crowdsourcing, why stop there?

Why not just go all the way into mythology, believe in magic wands, and call forth all the Healthcare fairies to solve our problems at one fell swoop?

Yup, that aughta do it, Homer.

#

@PhilBaumann

I take the right medication at the wrong time
and cuss up a storm of pornographic tweets.
Reader, should I blog these moments,

share them on Facebook, snap a gram
and add a hashtag for you to follow?
Where are you? Who are you? What do you follow?

I wonder how a community of patients -
healers holding hands around a fire -
can survive the the digital light of electrons.

My fingers hurt as I write out the pain.
I wonder what your fingers touch,
if the tips of yours touch mine through the glass

or if there is only the idea – the belief -
that by writing out our mutual pain
we become healers holding hands.

I write out the pain, perhaps you read it in.
I could keep this writing going,
releasing the pain, drip by electronic drip.

We could be happy this way and call it kindship.
But I bet if we met face-to-face in a cold snowy field,
our mutual pain would melt as the kindle stoked the wood.

#

Phil Baumann