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The future of palliative care - Issue #2

No algorithms, no bots, no cats. Just a few inspirations for change.

The future of palliative care

March 4 · Issue #2 · View online
In many respects, we've arrived. Yet what we know now won't get us to the next level. So I'm looking for signals from the future, & I'm curating them here.

No algorithms, no bots, no cats. Just a few inspirations for change.

1. Why your collaboration isn't working.
As the complexity of our work ramps up, so does the importance of collaboration. But what i was taught–to be agreeable, rational, and instrumental [“See we all agree that the patient comes first, right?”]–is wrong. Collaborative problem solving, studied in a nifty empirical study in Nature, is all about strong social ties. Those tiny gestures & moments, accumulated over time, matter. Proof point: the Norwegian Olympic team in Pyeongchang. 
The Ski Team That Sleeps Together Wins a Lot of Gold Medals Together - The New York Times
2. A new definition for an old problem: who needs PC?
If we want to expand palliative care upstream of specialty consults–& we won’t really change US health care unless we do–we need to know who we should target. The wonks call this ‘the denominator problem’. If we can’t define who needs us, we can’t tell whether we’re reaching them. At a think tank in Banff, Amy Kelley proposed a empirically derived definition for serious illness: high risk of mortality AND negative impact on QOL or daily function OR excessively strains caregivers.  

The denominator problem
3. Touching someone in pain = inter-brain coupling?!?
In the #MeToo era, clinicians might be excused for exercising caution about touching a patient. Should doctors hug their patients? It’s been a data-free, wake-me-up later issue. But it’s way more complex than I imagined. Pairs of people (one receiving a painful hot stimulus) were hyperscanned with EEG; their brainwaves showed brain-to-brain coupling in a network associated with analgesia and empathic accuracy. Presence, the kind that matters, involves inter-personal coupling–perhaps the self-other distinction is being blurred. We extend ourselves, non-physically. [If you don’t have institutional access, check here.]
What inter-brain coupling looks like
What inter-brain coupling looks like
Brain-to-brain coupling during handholding is associated with pain reduction | Proceedings of the National Academy of Sciences
4. Outside clinic walls, a grim financial landscape.
The finances of working Americans leaves them worried that they won’t have access to medical care. In a national study of 1518 working Americans aged 21-64, 70% are not confident they can afford health care without financial hardship. For women 85+, out-of-pocket spending consumes 83% of their average Social Security income [Kaiser Health News]. Yikes. To my fellow clinicians: could trust be harder to build when your patient thinks you’re living in an alternate, cost-free reality?
5. Idaho allows insurance that flouts Obamacare. Ugh.
Idaho, a red state, just told insurers that they could sell policies that don’t comply with Obamacare regs. Like: short term health plans, exclusions for preexisting conditions, from foot problems (a surrogate for diabetes) pregnancy, at cheaper rates. And Alex Azar, Secretary of US Health and Human Services, isn’t doing anything to stop it. Sarah Kliff in Vox: “If the federal government doesn’t intervene, other red states will likely follow in Idaho’s footsteps…” The kind of person who gets hurt? Working people with existing conditions. [Check below for Sarah’s podcast]
How Idaho became ground zero for the war against Obamacare - Vox
6. Ack! Could millennials be the new face of change?
“Like most people in middle age, I regard young people with suspicion.” Tim Kreider, whose latest op-ed ran in the NYT today, makes some interesting points about the students of Parkland: “To them, powerful Washington lobbyists and United States senators suddenly look like what they are: cheesy TV spokesmodels for murder weapons.” Lesson: in complex systems, you really can’t predict where the next change will originate. 
Go Ahead, Millennials, Destroy Us - The New York Times
This project is possible because of the John A Hartford Foundation. But the views, opinions, and recommendations are my own.
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