Strategic thinking is strange for most people. We hear the words without a clue what they mean.
And why should we?
For many, strategic thinking sounds like psychobabble at best, one more way to control clinical medicine.
Many doctors go into leadership out of frustration. They take a pay cut to trade a day in clinic for the boardroom. Tired of reactive, failing organizations, they take the lead to refocus on things that matter.
Organizations do not fail because they aim at the wrong target. They fail because they do not know how to aim. They point guns they have never used at targets they cannot define. God help anyone who questions their efforts.
COVID has caused two pandemics. The first infects our bodies. The second corrupts our minds. A respiratory virus caused the first; a mental virus the second.
We can beat the first pandemic with reason, science, and experimentation.
People will need comfort with ambiguity, uncertainty, and changing information. But it is not impossible to beat. We must embrace the exploratory nature of trial, error, and experiment.
The second pandemic cannot be beaten in the same way. It must be abandoned. We can inoculate against the nonsense caused by fear, but it will require hard work to learn things long ignored. Although fear caused the second pandemic, the disease itself manifests as political nonsense.
Mask Intolerance
What can we do about COVID19? We swab, social distance, and hand wash. But we have no treatment. Our entire plan rests on preventing transmission while we wait for a vaccine.
Masks seem a reasonable way to block a respiratory virus. But not everyone agrees. Despite public recommendations, some simply refuse to wear a mask.
This exasperates politicians and those working on the front lines of care. Even if we do not have perfect evidence, masks seem the neighbourly thing to do. Maybe we have no choice but to force people to wear them?
Mask Laws: Necessary or Nonsense?
Mask laws are not the same as masks. While obvious to most, some find this nuance strange, almost mischievous. They attack anyone who doubts the wisdom of mask laws, by flinging out evidence in support of masks. Even if we knew that masks worked perfectly (which we do not), we would still need to debate whether we should pass a law about them.
Some insist masks are the same as seatbelts. Seatbelt laws save lives. But aside from both being things that people wear, seatbelts and mask are entirely different.
Seatbelts protect drivers and passengers, not the pedestrians they run over. The causal connection between exposure and outcome for seatbelts is clear for those riding in the car. Continue reading “Mask Laws: Necessary or Nonsense?”
His abdomen gaped from sternum to pubis. Fat pushed up against the bed rails.
The crater in his gut held a wedding cake’s worth of gauze: a sponge soaking up yellow fluid. Tubes, lines, drains, and leads – with monitors attached to half of them – buried our patient. Aside from gnarled toes and mottled ankles, only a few square inches of skin showed.
“There’s nothing surgery can’t make worse,” someone said, sotto voce. Most of us missed the point.
As a surgical resident, I remember the rush of adrenalin, the anticipation of opening an abdomen. Our goal was always the same: get in before the staff surgeon finished scrubbing.
But staff never rushed into a new case. They would ask questions, walk down for coffee, then ask almost the same questions again. They hunted for any possible reason to not operate. It drove me nuts.
Proof of Exudate
Surgeons fix things on the sickest patients (often at 3 a.m.), which no medicine can cure. They operate when certain nothing else will do. Ideally, surgery is not just the right treatment; it is the only treatment.
I watched my Chief Resident operate on my first case as a resident.
“Wahoo!” he yelled.
A trickle of pus had oozed out behind his knife. The pus proved he chose wisely. The pre-operative uncertainty – Does this patient really need an operation? – was gone. He whooped with relief.
Flu Vaccine Fiasco
Surgeons avoid surgery until certain there is nothing better. They do not cut because they can but because they must. Nothing else will do.
Bureaucrats do the opposite. They build bureaucracy because they can, not because they must. It is what they do.
Apparently, the Ministry of Health (MOH) sends out flu vaccine directly to pharmacies across Ontario. Individual pharmacists have vaccine shortly after the MOH release.
