Welcome to the human condition: we want everything to change; yet we still want to be able to carry the old baggage around with us.
i.e. We say we want to change everything from the ground up – except for all the old habits that dominate our lives completely.
St. Augustine had a prayer about this: “O Lord, make me chaste. Just not yet.”
Any leader in business is going to run into this with his or her people, from the beginning, every day, forever and ever. It isn’t ever going away.
It’s like the Higgs Field of humanity; it’s just there.
Image from Dominic Roy at National Geographic.
This great picture is both funny and worrying. The posture of this owl fighting against the wind seems to me like the perfect evocation of the usual entrepreneur in France.
There’s what you do. And then there’s who you are.
Remembering this is terribly important. Maybe the most important thing of all.
This image for Zappos is about that transition, about bringing larger meaning to the work they do.
Because if you don’t have that big picture, it makes it hard to get excited about the day to day.
But if you do – if you have that deep sense of purpose – work becomes joy.
A street art worth 100 poems by Ernest Zacharevic.
A recent article by the title How to Prevent Overdiagnosis, published in Swiss Medical Weekly, accurately sums up the issues about overdiagnosis.
Overdiagnosis, as defined in the summary is the diagnosis of an abnormality that is not associated with a substantial health hazard and that patients have no benefit to be aware of.
In their conclusion, the authors, mainly from the Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland, provide a perfectly concise 5 bullet points overview of overdiagnosis issues:
- Overdiagnosis is mainly the consequence of a technology-driven medicine that aims to improve patient outcomes by detecting disease in its earliest form.
- Overdiagnosis is of growing relevance in population dominated by chronic conditions having long pre-clinical stage.
- Although early detection has been shown to be beneficial for several conditions, it also increases the probability of finding insignificant abnormalities, whose treatment is not associated with any benefit but can harm the patient.
- Moreover, overdiagnosis diverts healthcare professionals from caring about other health issues and generates costs.
- The increase in healthcare costs, the over- and underutilisation of some care, the debates about the effectiveness of several screening, and the growing role of patients in medical decisions require concern about overdiagnosis.
A column from Sep 6, 2011 by Dr. George Lundberg and Dr. Clifton Meador about a set of 22 false assumptions, practice failures, and everyday clinical errors that they believe are common in modern medical practice:
- Lack of appreciation of the phenomenon of physician persuasion and its hidden power. The placebo effect is scientific, potent, and worthy of use.
- Lack of understanding of the power of prevalence or pretest probability in the diagnostic process, leading to frequent false positives and “overdiagnosis” of nonexistent diseases.
- Lack of understanding that many disease processes are gradual and progressive — not "on or off" signals; analog and not digital. This leads to great confusion about when to diagnose and treat. For example, at what percent stenosis is an artery "diseased" and in need of treatment?
- Incorrect assignment of reductions in death rates and increasing life expectancy to curative medicine rather than to preventive efforts.
- Medicine has a tendency to remove many physicians from relying on direct experience and personal observations and replace this with a reliance on indirect information. This leads to an over-reliance on lab and imaging findings by both patients and doctors.
- Lack of long-term clinical outcome data, stratified by gender and age, leading to an inability to obtain a truly informed consent.
- The mind-body dichotomy, present since René Descartes in the 1600s, holds erroneously that the mind and body are completely separated. This false separation leads us to believe that the lack of evidence for disease in the body of a symptomatic patient confers a diagnosis of mental disease: Thus the non-helpful statement to the patient, "Don’t worry, it’s all in your head."
- Lack of appreciation for what is scientifically established versus what is still in the thought stage of development.
- A failure of medicine to recognize what it can effectively treat and what it cannot, and admitting that some diseases have no effective treatment.
- Failure to recognize that the fields of human biology and clinical medicine overlap but do not coexist. Schools of medicine are becoming more schools of human biology and less schools of clinical medicine.
- Absence of a test that will distinguish well from sick. The lack of a test leads to the erroneous assumption of sickness as the rule of thumb for almost all patients.
- Lack of a blood or urine test that can measure mental status. Dementia can be missed in up to 20% of admissions to hospitals.
- Lack of full understanding of the intense secondary gain of illness.
- Fallacy of the first lesion found being assigned importance, whether or not it is the cause of the symptoms.
- Fallacy of any lesion found being sufficient to explain symptoms.
- Failure to stop a drug or treatment when it is not helping.
- Failure to identify what abnormality or test result is to be followed to determine success or not, when someone is being treated.
- Failure to look for little signs of improvement and stick with the treatment rather than change it too soon.
- Failure to know a patient well enough to know what their wishes are in terminal or hopeless situations.
- Failure to recognize and advise the family when a condition or situation is futile and should move to palliation and comfort care.
- Failure to keep the number of drugs to a minimum.
- An exaggerated and unfounded fear of malpractice suits with abdication of professional responsibility just to avoid any chance of being sued.
And, number 22, perhaps the most important to today’s society:
Many of the false assumptions listed here can be found in Clifton Meador’s book "A Little Book of Doctors’ Rules" published in 1992 by Hanley & Belfus, out of print, but still available at Amazon.
Les articles de la rubrique "Logique et calcul" de Jean-Paul Delahaye publiés dans le journal Pour la science sont disponibles pour la période 1991-2013 : http://www.lifl.fr/~delahaye/pls/
Tine explique que Charlie Hebdo, épuisé dans tous les points de vente en France, va finalement tirer à 5 millions d’exemplaires.
Mais encore faut-il se souvenir comment fonctionne ce truc !
Il y a le succès des marches Charlie. Un peuple angoissé qui se regroupe après avoir été attaqué par trois mujahidin et superbement immortalisé par le photographe Martin Argyroglo …
Et puis il y a ces gens, enfermés dans la cage aux fauves, comme cette enfant yézidie de 6 ans dont la blondeur et les yeux bleux sont comme une insulte pour les fanatiques.
Youssef Boudlal, photographe pour Reuters décrit sa rencontre à Fishkhabour, sur la frontière Irako-Syrienne :
I remember the scene well. It was the day that I arrived at the Iraqi-Syrian border crossing of Fishkhabour.
With shocked, sunburnt faces, men, women and children in dirt-caked clothes were struggling in temperatures of over 45 degrees Celsius (113 Fahrenheit), waiting patiently for local Kurdish aid.
At first, I focused my camera on a group of women sitting on the ground, but when I turned away I saw this little girl.
I took one shot of her there and as she saw me, she gave me a smile. I captured another frame of her with her mother.
I was drawn to her wild beauty in this terrible situation. There is a kind of intensity, distress and sadness in her eyes.
I know that she is 6 years old because I asked her mother, but unfortunately I didn’t ask for her name. The family was coming from the Iraqi town of Sinjar, fleeing Islamic State militants.
It was really sad not only to see this girl, but also to see the hundred others who were dirty, exhausted, and sitting amongst garbage in the heat.
I have been in Iraq for over a week now. It’s my first time in the country, and though I have been to many conflict zones, nothing compares to seeing these displaced people.
I wonder what their state of mind can be as they walk for miles and hours through the mountains with a few of their belongings.
I would be very curious to see the blonde girl who I photographed again. I wonder what will become of her. I wonder what will become of all the others.
Deux textes optimistes pour bien commencer l’année :