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The future of palliative care - Issue #7

Peter Drucker famously said 'culture eats strategy for breakfast.' So this week, a collection on cult

The future of palliative care

April 8 · Issue #7 · 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.

Peter Drucker famously said ‘culture eats strategy for breakfast.’ So this week, a collection on culture for changemakers. Forward this to a friend so they can subscribe too.

Hmmm, yes.
Hmmm, yes.
1. The next clinician-patient shift: team to corporation?
“The relationship between patients and doctors has radically changed. Apart from true emergency situations, patients’ expectations now reflect the larger 24/7 insta-culture of wanting everything now.” The flip side of the medical mega-mergers could be a deep disruption in how clinicians practice, and a troubling signal about the future. There’s a reason Troyen Brennan has moved from Yale to Harvard to Aetna to CVS. 
The Disappearing Doctor: How Mega-Mergers Are Changing the Business of Medical Care - The New York Times
2. What we talk about shapes what patients do.
I hear a lot of hand-wringing about the culture of medicine, but invoking the term ‘culture’ is a kind of hail mary discussion point in the world of biomedicine–it’s there, but elusive. now Jennifer Temel’s group has drilled down on what culture means to changemakers in PC: her latest analysis of early PC for cancer shows clearly that what PC clinicians talked about (& documented) correlates with outcomes. We are all constructing culture all the time. 
Stories, routines, and influence: the cultural levels of PC?
Stories, routines, and influence: the cultural levels of PC?
Defining the Elements of Early Palliative Care That Are Associated With Patient-Reported Outcomes and the Delivery of End-of-Life Care: Journal of Clinical Oncology: Vol 36, No 11
3. How does culture promote high performance?
The Financial Times tapped The Culture Code, by Daniel Coyle, as one of its books of the month: Coyle starts with a terrific story of how a group of kindergarteners beat biz school students in a contest of how to build something they’d never seen before–from spaghetti, scotch tape, and a marshmallow. Why isn’t medicine like this? The Culture Code: The Secrets of Highly Successful Groups eBook: Daniel Coyle: Kindle Store
4. A new way of defining culture: tight vs loose.
Michele Gelfand, at the University of Maryland had a game-changing insight, first published in Science [pdf]: cultures can be characterized as ‘tight’ (strong norms, low tolerance for deviance) or 'loose’ (weak norms, high tolerance for deviance).  The US, interestingly, differs quite dramatically from west to east: the left coast scores loose. Is this related to the way patients wish to end their lives? Perhaps this explains why physician-assisted dying was first legalized in one of the loosest states in the US.
Tightness-looseness across the 50 states
5. An age at which death no longer requires explanation.
Barbara Ehrenreich’s new book, Natural Causes, is about realizing what medical care is for–and what’s it’s not. She’s done with ‘killing ourselves to live longer.’ It’s a bit like Zeke Emanuel’s notorious essay about throwing in the towel at 75, with more humility. You might have seen a prior essay in Harpers that was a fantastic polemic about her experience with breast cancer that stripped away the investor-driven, starry-eyed view of what most medical technology does. A new perspective for an aging society?
When do you know you're old enough to die? Barbara Ehrenreich has some answers | Life and style | The Guardian
6. What the absence of punctuation really means.
The millenials have invented a new language. Feeling left out? That’s intentional :)
Millennials destroyed the rules of written English – and created something better
This newsletter is made possible by the John A. Hartford Foundation. However, the views, opinions, and recommendations are mine alone, including this stunning video illustrating the effect of culture, from the Atlantic
This experience of being trapped by culture is happening in our field too.
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