Without the need for words, this graphic encapsulates the problem with physical, paper-based health records.
Electronic health records (EHR) are very much a basic requirement for modern healthcare delivery. The advantages are numerous.
Multiple user access: The physical record can be viewed only by one user at a time. The EHR canbe seen by any number of authorised users.
Multi-site access: Like all electronic information, the EHR can be viewed anywhere—across cities, states, countries, …
Indestructible nature: With adequate backups (and that’s a given today), the EHR is everlasting. Physical records deteriorate over time, even in the most controlled of environments.
Space saving: The Medical Records Department of earlier times occupied vast spaces, yet always needed more. EHRs: You know the answer.
Graphical interface: With well-designed user interfaces, data capture can be made more efficient. Any number of devices and methods are available to make the task easy.
Custom views can be tailored to meet the demands of specific practise styles.
Decision support systems (DSS): Decision support systems can be built into EHRs. If you need to look at a lot of different types of data in a complicated medical situation, a DSS can be very useful.
Data analysis and reporting: No modern hospital can function without continuous monitoring of a number of clinical outcomes. Handwritten records are much harder to analyse than EHRs.
Knowledge building: Data mining, machine learning, and artificial intelligence can all be used to build knowledge bases that are highly relevant to a given practice environment.
Coding and billing: Sophisticated coding systems like SNOMED-CT can be smoothly integrated with EHRs.
BUT, doctors don’t like electronic health records!
Doctors, including many who see themselves as tech-savvy, resent using EHRs. They feel that it interposes an unwarranted presence between them and their patients. Almost uniformly, doctors have to spend more time working with digital records than paper. They feel that EHRs have worsened, rather than improved, clinical care delivery.
Is it okay to choose being a doctor, as a profession, despite knowing all the sufferings and struggles?
This is a very important question that you are asking.
The stock answer from any young person who is asked “Why Medicine?” is that they would like to relieve pain and suffering in people. Anything else sounds awkward, even if sincere. If the truth be told, the major attraction is the good standard of living that medical practise gives to its practitioners.
At the age of 18 or so, when you make this career choice, it’s virtually impossible for you to feel the emotions that Medicine can wring from you. As you get into the practice, the demands can get quite overwhelming. One of two things happens:
Most often, you numb yourself and keep going, hating yourself for the inability to appropriately respond to the emotional needs of patients—often their only real need.
Or, you can’t handle it any more and drop out of Medicine, or go into a sub specialty where you don’t have to deal directly with people.
To be fair, there are any number of doctors who genuinely care for their patients and go the distance for them. The trick is to feel the emotion but not get swallowed up by it. True empathy is a verb—action, not a noun—emotion.
The way we select young people for a career in Medicine makes no attempt to assess this emotional competence. The sole criterion is the ability to score highly on an absurdly difficult entrance exam. Little surprise then that the public sees doctors as cold-hearted, money grabbers.
Here’s my advice to any young person considering Medicine as a career.
If you think that a lifetime of listening to and watching people in pain and suffering is likely to be too much, then do something else with your life.
If you have the ability to feel other’s pain, and, without letting it get you down, do everything to help them, then that’s all you need for a medical career. Keep with it and you will be a terrific doctor.
Should doctors discourage the trend of “Second Opinion” resorted to by the patients, after consulting the doctors of their choice? Shouldn’t the doctors refuse to entertain such patient, and send them back to the previous doctor?
Absolutely not. Offering a patient the option of a second opinion is one of the major tenets of ethical medical practice. A patient always retains the right to seek confirmation or rebuttal of the diagnosis or treatment offered by the primary doctor when there is lack of confidence, for whatever reason.
Any doctor who is secure in their own reasoning and judgment should not feel threatened or insulted by the request. It’s equally important that the second doctor treat the request with due respect and not belittle the first decision or portray the primary doctor as ignorant or inferior.
If the second opinion concurs with the first, ethics demands that the patient is firmly encouraged to return to the first doctor for further management. The patient; however, retains the right to stay with whoever they feel is in their best interest.
A study of almost 6800 patients reported in 2015 showed patient-initiated second opinions led to recommended changes in diagnosis for about 15% and in treatment for about 37% of participants. The larger number of treatment differences is not surprising; a substantial amount of disagreement exists in treatment choices for common conditions. Close to 95% of patients reported they were satisfied with the experience.
Confidence in the skills and integrity of your doctor is the foundation stone for success in treating patients. Lack of trust, triggers the “nocebo” effect. The patient expects harm and, much like in the placebo effect, enhances chances of an unfavourable outcome when there is a lack of perfect trust in the doctor.
This is a very complex question. Here’s how I would address it.
From a purely statistical standpoint, the risk of any procedure (intervention) needs two essential inputs:
A comprehensive list of all the things that can go wrong. At least to some extent, such lists are available. The only, truly unacceptable risk is that of dying (mortality). All else is relative and a matter of perspective and expectations.
A hard look at data for every procedure and the creation of a 4-way table: Exposure vs. non-exposure; outcome present vs. absent. This will allow us to establish odds/ risk ratios. An objective number can then be used to gauge the likelihood of any outcome from surgery. These statistics are available (though hotly debated) for many common surgical procedures. Examples include: wound infection, deep vein thrombosis, urinary infection, pneumonia, and so on.
The moment you start hitting patients with these numbers, most often their eyes will glaze over and you will lose them. Most patients don’t want “just the facts.” You do have to discuss them, but in general, practical, down-to-earth terms and language.
Enter, comorbidities: Fine and dandy, but these numbers are muddied by co-existing diseases that can alter (usually adversely) established risk; common examples are heart disease, high blood pressure, diabetes, obesity, age, previous illness, and so on. To make it worse, a combination of comorbidities is not merely additive in terms of risk; they multiply risk.
So, you get the picture? Even experienced surgeons can rarely explain the risks of surgical procedures completely. Knowing that surgeons, as a breed, are poor communicators, you can “do the math”.
Here’s my take.
Leaving risk aside and looking at outcomes—what the patient really needs—I would look at the issue from two standpoints.
Will the operation completely or significantly improve the problem at hand?
To what extent will you be able to go back to all that you did (activities of daily living-ADL) before the surgery? Be wary of unrealistic promises (Doc, can I play the violin after my surgery? Sure! Terrific, I couldn’t earlier.)
Remember: Risk is only a proportion, a probability at best, not a guarantee. Adverse outcomes, as far as the patient in concerned, either happen or don’t: 0 or 100%.
“It’s a truth universally acknowledged” that employees resent meetings and try their best to avoid attending them. Surveys show that as much as fifty percent of people in an organisation believe that they are a waste of time. Executives can spend up to 20 hours a week on them. They interfere with productivity; time spent could have been put to better use. But, no enterprise, big or small, runs without periodic meetings.
We Don’t Like Meetings and We Don’t Want Them Gone
Still, when asked if meetings should be abolished altogether, the same number of people reply that it would not be a good move. They feel that meetings are essential for maintaining a democratic spirit. Ideas should be aired, discussed and modified by groups of people; otherwise, the management style will be seen as autocratic.
Two factors are at work.
1. Parkinson’s Law of Triviality — Meetings have agendas. Items on an agenda vary in importance from critical to trivial. Professor Northcote Parkinson, him of the much quoted, eponymous law, also described a constant characteristic of meetings: The Law of Triviality.
There is an inverse relationship between the importance of an item and time spent on discussing it. Plans for a large investment on a major expansion will get passed over in a few minutes whereas a half hour or more will be spent on arguing about a new coffee dispenser in the lounge. It’s easier to talk about something that you are familiar with than something beyond your knowledge limits. (This law is also called “ the bike-shed effect ” based on a popular anecdote.)
2. More People, Less Effective the Meeting: There is also an inverse relationship between the number of people attending and effectiveness of a meeting.
The optimal number is 5. As the number increases, meetings become more and more unproductive. At 20, chaos reigns; from here on — 20 or a 100 — the number in the room doesn’t make a difference. It’s imperative that only those who can contribute effectively to the discussion be invited to take part. This is one element that is seldom carefully addressed.
The challenge, therefore, is to structure meetings to make them matter.
First, and For Ever, No “PowerPoints”
Jeff hates PowerPoint (or any other flavor) of presentation app. He believes that “ Powerpoint-style presentations somehow give permission to gloss over ideas, flatten out any sense of relative importance, and ignore the interconnectedness of ideas. ”
That’s an earth-shaking diktat for all of us who automatically reach out for these tools when making a presentation.
Well Structured Narrative
The man says, in a much-quoted memo that he sent out: “Well structured, narrative text is what we’re after rather than just text. If someone builds a list of bullet points in Word, that would be just as bad as Powerpoint. The reason writing a good 4 page memo is harder than “writing” a 20 page Powerpoint is because the narrative structure of a good memo forces better thought and better understanding of what’s more important than what, and how, things are related.”
The fundamental argument is not so much about the medium itself — Powerpoint or written document — as the need to think critically and clearly.
Here’s how it’s done
Step 1: Writing the Narrative
The person or group responsible for the meeting, spends a good amount of time producing a 4-6 page, tightly reasoned, carefully worded, written narrative. (More on how to do this in another post).
Step 2: All Those Needed for the Meeting Gather at an Appointed Time.
Step 3: Read the Narrative for 30 Minutes.
The document is NOT distributed ahead of time.
Everyone present now gets a copy of the document and spends 30 minutes in silent reading. They note down their observations, comments, opposition and so on, now.
Wouldn’t it be more efficient if the document were to be given in advance?No, says Bezos; “Just like high school kids, executives will bluff their way through the meeting, as if they’ve read the memo, … you’ve got to actually carve out the time for the memo to get read — and that’s what the first half hour of the meeting is for.”
Step 4: Discussion Begins Now.
The document is used as the anchor for all that follows. It’s easy to keep all members tightly focused on the task at hand with everyone being on the same level of knowledge about the agenda. The event acquires both magnitude and direction.
Meetings have been given a bad rap. Some of the reasons are valid. In order to extract maximum effectiveness, Jeff Bezos of Amazon uses an unique structure for all meetings in his organization. In summary, here’s how he does it.
Prepare a carefully-written, 4-6 page narrative about the topic for discussion.
Invite the smallest possible number of people for the meeting. Limit invitees to those who can make meaningful contributions.
Circulate the document at the start of the meeting and give everyone present half an a hour to carefully read and annotate the paper.
Tether discussion to the contents of this document.
Designate one person to be responsible for summing up the discussion and to provide an action-taken report.
The sole purpose of meetings is to create change, hopefully for the better. Like any tool, meetings are neither good nor bad in themselves. It’s how we use them that matters.
“The meeting of two personalities is like the contact of two chemical substances: if there is any reaction, both are transformed.”― Carl Gustav Jung
“There is nothing to writing. All you do is sit down at a typewriter and bleed.” ― Ernest Hemingway
But then, we are not talking about writing like Hemingway or Nabokov or Alice Munro. You have come up with a project. You are sure it’s a winner. You work at a company like Amazon and to take it forward you have to first write about it in a 4-6 page narrative. This document will serve as the pivot for all discussions about the project, something that your colleagues and bosses can read with ease and grasp the ideas you are putting forth.
What are We Looking At?
First things first, we must be in tune with Jeff Bezos’ recommendation. “Writing a good 4-page memo is harder than “writing” a 20-page Powerpoint … the narrative structure of a good memo forces better thought and better understanding of what’s more important than what, and how, things are related.” Powerpoint presentations are banned at Amazon. Meetings, when needed, have to be structured around a pre-prepared, carefully thought out, flowing narrative.
The prospect of writing a business narrative is daunting to most of us. We baulk at the act because we have never received training for it. Writing with clarity and flow is hard work. Even Hemingway viewed it with trepidation.
Most narratives, business or fiction, have a typical structure. Once we get familiar with this simple scaffolding, the process of writing becomes natural and effortless. Let’s look at a 4-step method of producing a business narrative that even Jeff will smile at.
Step 1: Where are We Now?
As Julie Andrews sang, “Let’s start at the very beginning.” What was it that provided the original impetus or spark for putting forward this proposal? Write about it in simple words. The starting point could be one or more of many things. Maybe it was:
Pain points: Write about whatever produced discomfort in your present situation: things that make you uncomfortable, wary, anxious, frightened or angry.
Dangers ahead: There may be lurking threats to the organisation which you feel need prompt and proper handling.
Opportunities: Maybe it’s about things that present a lucrative prospect and could be harnessed for the good of the company. Describe it.
Innovations: In a rapidly changing business world, it may be that you feel the present set up does not encourage new ideas. To survive, you sense that innovation has to be nurtured.
Competition: Today’s world is brutally competitive. You know that other groups are sniffing at your heels. We have to start moving faster and farther than them
The number of starting points are limitless but you will have a single, specific item. Identify it and write in detail about it.
Step2: Where are We Headed?
If you don’t know where you are going, one thing is certain: you won’t get there. Describe your goal and ambition. There are many frameworks for outlining this section. A popular one is the “SMART” mnemonic:
S = specific – be clear about what you want.
M = measurable – assess results by objective means.
A = assignable – allocate specific people for specific tasks.
R = realistic – stay within your ways and means — don’t over reach.
T = time bound – be hard nosed about deadlines.
Step3: The road map
We live in the age of Google maps. You wouldn’t stir out anywhere new without first getting a road map. Your narrative must talk of three things.
The various steps that need to be taken to get to the goal.
The time limit and deadlines for each step.
Obstacles that are likely to pop up en route and your plans for working around or over them. Anticipate road blocks.
Step 4: What will it Look Like when You are There?
“Are we there yet?” — the constant refrain of children on a road trip applies to your narrative as well. Don’t just go with gut feelings. Refer back to the stated goals and make sure that you have reached every one of them. Take a hard look.
Use objective methods of assessment.
List the benefits and joys of having reached your destination.
Pitch it against the list that started your journey.
Not Just for Business Narratives — be an Ace Speaker
Storytelling is a sure-fire way to capture attention. Anytime you need to make a presentation, convert it into a story and you will hold your audience during your talk. The framework that we just saw can be used to rephrase an idea into a narrative. With a little imagination, a boring sermon can be transformed into a tale of how the idea was born, its goals, the path to implementation and the view from the top. Like the ad says: “Just do it.”
You don’t have to use the steps in the order listed. You can play around with it for dramatic effect. For instance, you could open with a vision of what the end looks like, shift to the reason for starting the journey, talk about the road and end with what your goals were. Play around with the four steps and see which order suits the spirit of the narrative
Come Back to Papa Hemingway
You don’t need a vast vocabulary or a smart turn of phrase to write well. Hemingway said this when putting down Faulkner: “Does he really think big emotions come from big words? He thinks I don’t know the ten-dollar words. I know them all right. But there are older and simpler and better words, and those are the ones I use.”
Write from the heart. Focus on:
Brief paragraphs — each one containing one idea, each paragraph flowing logically into the next.
Anticipating objections and addressing them ahead of time.
Redrafting your manuscript many times. Be a ruthless critic of your writing, logic and flow. Every word must have a reason to be there.
Writing well is the best way of thinking well. Which is why anything written is given far more value than spoken words. Penned sentences linger as a legacy of a human being, sometimes well beyond the life of the person who wrote them. To disseminate great ideas, you need to write captivating stories.
“After nourishment, shelter and companionship, stories are the thing we need most in the world.” ― Philip Pullman
A carefully-crafted resume is the keystone of a job application. A large number of employers will also ask for a covering letter. Most, often, you will use a standard template: a few lines dashed off thoughtlessly.
Why Bother With a Covering Letter?
Giving a lot of time and attention to the covering letter might appear old-fashioned in an age when applications are submitted online. Still, a well-written document can make you stand out amongst a crowd of applicants.
The covering letter is a single-page letter of introduction — yourself, to the hiring manager. It is a carefully-crafted argument for why you are the best person for the job.
Remember, applications are scanned for specific keywords, phrases and qualifications, often by apps and bots, before being passed on for review by humans.
When Do You Send A Covering Letter? Always.
Quite often, a covering letter may not be mandatory. Don’t take this as an opportunity to slip out. Always send one.
No Templates, be Creative
Although you can recycle some portions of the letter, the bulk of the message should be one-of-a-kind, targeted at the company and the job you are applying for. Resist the temptation to automate the document.
Use this outline for writing your letter.
Begin with the usual salutation, a name preferably, or the designation of the person doing the hiring. Increasingly, there is a tendency to be informal: a “Hi” or a “Hello” rather than the “Dear …”. Judge the nature of the organisation before you decide. If it’s a young, start-up, open to fresh ideas, stay informal. If it’s a well-established company, then a more traditional style of address.
STEP 1: Start with Them, Not Yourself.
It’s customary to start by talking about yourself. Don’t. Your resume will do that. Do some research on the organisation and learn what their mission/ vision is. Point out how your ambition fits with theirs. Keep the tone enthusiastic but not over-powering. As the Taoist saying goes, pointed, not piercing.
STEP 2: Talk About the Job and How You Fit the Description
Show that you have understood the nature of the job and the specific requirements of you. Describe how your skills suit the position. How do they solve a problem or address a pain point for the company?
Many a time, tucked somewhere in the body will be a question or task assigned to you. The employer uses this as a check to see if you have scrutinised the application well. Make sure you respond and highlight your response.
STEP 3: Close With a Call-to-Action
The last paragraph should be a single-line recap of the company, the job and your fitness for the position. Give a contact number or email address, even if it’s there in the resume.
Keep It …
Short – not more than 2 or 3 sentence per paragraph.
Succinct – don’t use grandiose or flowery language.
Neutral in tone – don’t be fawning, effusive or stiff.
And Don’t Forget to …
Spell check, grammar check, obsessively. Nothing negatively portrays you as much as a sloppily-written document, full of spelling mistakes and poor grammar.
There’s no question that the resume is the make-or-break factor in your application. Remember though that an outstanding covering letter could deliver the tipping force to your effort at getting a job.
Looking for work can be very disheartening. Finding your perfect job takes a lot of courage, persistence and ingenuity. Steve Jobs said:
“If you haven’t found it yet, keep looking. Don’t settle. As with all matters of the heart, you’ll know when you find it. And, like any great relationship, it just gets better and better as the years roll on.” ― Steve Jobs
Albert Einstein, Mark Twain, Marie Curie, Nelson Mandela, Thomas Edison, Virginia Woolf, “Che” Guevara, Anne Frank, Leonardo da Vinci: a list of famous people with a diverse range of interests. What did they all have in common? They maintained personal journals through their lifetimes.
Who’s Got the Time to Write Daily?
First, a popular myth has to be dispelled. Journal writing need not be an unremitting, daily effort. The association of journaling with conventional diaries, segmented by days, is, most likely, the reason for this misconception. Daily journaling quickly becomes a chore that is easy to give up.
Instead, only record what you want to remember. Make it an exercise in capturing and archiving thoughts, emotions and ideas coming from within you. Write about interesting people, conversations, meetings, books, lectures, places — anything that captures your attention. Over time, the collection will become a resource that will act as a secure helmsman to steer you through the turbulence of life.
It’s best to keep it as a private record although, we are so much richer for many of them having been published. Anne Frank’s The Diary of a Young Girl is the most well known example of the power of a journal. There are many more.
Why Should You Keep a Journal?
Journaling should be a collection of ideas rather than a chronological log of quotidian events. Putting your thoughts down on paper (or as digital bits if you prefer) unburdens your memory, a notoriously fallible storehouse. Journal writing is a powerful productivity and self-improvement tool.
There are numerous benefits to keeping a journal.
Problem solving: Writing is a tool for thinking clearly. The effort of transforming what’s in our heads as disjointed notions into words clarifies ideas and concepts. Spending fifteen to thirty minutes in this effort allows you to see the problem in distinct, easily grasped pieces. Organising them and making sense out of the puzzle becomes an easier task.
Decision diary: Get into the habit of making entries for the more significant decisions you make in your life. Put down brief statements about the following items:
— The nature of the situation that needs a resolution.
— A list of the possible routes of action.
— The pros and cons of each of them.
— Your choice and why you did so.
— What tradeoffs did you have to make?
— What do you expect from this selection?
As the diary grows, review your entries now and then. You will get a good insight into your decision-making process.
Stress reduction: Studies have shown that regular writing reduces stress. Anxiety and depression can be alleviated to remarkable degrees by expressive writing and pouring out deep emotions.
Physical ailments: The benefits are not limited to behavioural problems. Many common disorders manifesting with pain and limitation of daily activities can respond to a simple recording of symptoms and feelings. Recognising pain and discomfort as something distinct and reportable goes a long way to augment healing processes within yourself.
Gratitude journal: Regardless of how bad things look, there are still so many others which are going right for you. You don’t have to be a Pollyanna;there is much to be grateful for. Write them down in your journal. The effects on your overall wellbeing can be substantial.
Self-discipline: Regularity in writing is an act of self-discipline and will power. It builds up resilience in all other aspects of your daily life.
Despite its popularity, there’s ample evidence that undergoing therapy with a trained analyst may be no more beneficial than talking to someone, even a friendly bartender. A well-nurtured personal journal is all you need. The list of winners at the head of this article, and many more, is proof.
How Do I Go About It?
The straight answer: Use whichever method or tool works for you.
It’s best to keep the process as simple and handy as you can: from just a notebook (a Moleskin, if you wish) to drawing, sketching, mind-mapping, visual thinking, photos, voice recording or any of the dozens of digital tools that are available for the purpose.
Apps like Evernote or Bear are fantastic for the ways and means by which you can organise and manipulate your entries. There are apps like Journal One which are specifically designed for the purpose.
The trick is consistency. Stick with whatever gives you the most value for the effort.
How Often Should I Review My Journal?
Once again, there is no hard and fast rule. Whenever you do look back, chose a time when you are calm, rested and still. Although there is a huge temptation to look when times are turbulent, you may not get the most out of your writing at these moments. Nevertheless, let your intuition direct you.
You must let your journal be a guiding lamp in your progress through life. No one can know and understand you better than yourself. It’s not unusual to be taken by surprise at the profound nature of your observations.
Stephen King Says
“Writing isn’t about making money, getting famous, getting dates, getting laid, or making friends. In the end, it’s about enriching … your own life, as well. It’s about getting up, getting well, and getting over. Getting happy, okay? Getting happy.” ― Stephen King, On Writing: A Memoir of the Craft
You’re confident that this year, you will persist with your New Year’s resolutions through the year. Come February: “Maybe next year, I’ll show more control. I will give this year a rain check”.
Why are we so bad at sticking to our goals? Why are we so short on self-control and will power?
Willpower is a finite resource; we have a fixed capacity for the trait. A large body of studies exists in support of the limited nature of self-control. Like a battery, you can run out of charge (and risk damaging the device) if you drain it to the limit. You can charge a battery again and start over, but with self-control, each attempt at pushing yourself to the hilt leaves behind a strong residue of negative feeling which makes the next effort tough to start.
The key is in using will power (the battery) in short spurts and building up your resilience (the snowball).
If your resolution is to get fit enough to make a 10 km run with comfort, you don’t start by trying to run the distance on the first day. The fatigue and soreness which follows will dissuade you from trying again. You start by running a small length and stop while you are still feeling good. You increase the distance by moderate amounts every few days, remaining at all times within your comfort zone. Surely, but surely, you will reach the 10 km goal and feel good after it. This positive feeling will sustain your exercise effort over a long time.
If you are starting a weight reduction diet, don’t jump cold turkey into the 800 calories, no-carb programme. You will fail. Start with cutting out sugared drinks first, then the white bread and keep extending the list, a few days at a time, item by item. Weight loss will be slower, but you are much more likely to stay on the diet and shed kilos in the long term. Each sustained success will boost the next onward sally.
There is a welcome bonus to this tactic. When you build muscle, the workouts at the gym are of value when you need to do other challenging physical activities. Likewise, will power gained from one endeavour will extend to other personal changes that you kick-off. Self-confidence and enthusiasm build with each victory.
The bottom line: you have to train yourself to become a snowball using momentum from short bursts of the battery.
[Previous studies account for] the mechanism through which self-control affects individual behavior in the short-run, with two competing models. The first model, “ego or resource depletion model” views self-control as a perishable resource, which is depleted following an initial self-control act, hence impeding self-control ability in the short-run. On the other hand, the second model views self-control as a “knowledge structure”, where this knowledge is accessed following any initial self-control act, and it serves as motivation for improving self-control ability in the short-run. (https://doi.org/10.1016/j.jebo.2017.10.021