Being mortal – Atul Gawande

Just finished reading ‘Being Mortal’.  I guess in your 50s ‘being mortal’ seems to have some more immediate relevance than in your 20s!  Atul Gawande’s book is an excellent, thought provoking read.

Only learn through experience

Much of the book focuses on the options available as people get older or as their health deteriorates.  And for all of us it is difficult to anticipate how we may feel about these developments until we experience them on a personal level – most often firstly in context of relatives and friends and then, more directly, in person.

Gawande is a medic and a prolific writer.  And this is not the first of his books I have read.  He is keenly aware, as a doctor, of the approach taken by medics: analyse the symtoms and look to implement a fix.  But he shares his concerns about where this approach leads in the case of very ill or very old people.  He is not promoting euthanasia.  And he writes from a very personal perspective – patients he has looked after and his own father’s illness, treatments and death.

Quality of mortal life = independence?

Being Mortal asks questions about later life – how we all seek to maintain quality of life and how this requires the ability to think and act independently.  Right now as I write this I am contemplating whether I will watch a football match, watch the Open golf championship, go for a walk, go to the cinema, what I will cook for dinner, etc.  and all of these options are available to me (and I take this for granted).  But if illness means that I am dependent on others then I lose much of this independence and quality of life.  And in this context re reviews options around assisted living and nursing homes.  His comparison of living at home (supported by family), assisted living and nursing home living provides lots of food for thought.  And at this stage in my life I would have little appetite for the third option.  But statistically this seems where we are all headed.  So Being Mortal is suggesting we have not yet got this right.
The examples Gawande includes around complex, expensive, intrusive, limited benefit treatments provided to patients in the throes of advanced illnesses are challenging – for medics, family relatives of ill persons and the persons themselves – not to mind the insurers and health providers.  We are well familiar with the analyses of grater life expectancy, older populations, more instances of chronic illnesses, more options for treatment of same.  But they need to be understood in context of quality of life and independence.

I learned a lot about palliative care and its role through reading the detail of some of the examples in the book.  And its a much more broader science and engagement than I had appreciated.  I am not sure how well it is really understood.

All in all an excellent book – and good material for anyone.


GAA backdoor alive and well

Watched two ‘backdoor’ games this afternoon.  Tipperary hurlers were very relived to run out tow point winners over Clare.  Both are fine hurling teams – although netiher playing particularly well today.  But we got a great contest with Clare coming back from several points behind, only to have Tipp score a couple of points to close out the game in the last three or four minutes.  After that watched a thriller football match between Mayo and Cork.  Cork have been poor until today.  They same back strongly in the second half of today’s game against Mao – forcing the match into extra time (after scoring two goals to close the deficit). Extra time was very close – and probably Mayo’s experience saw them through by one point.

So, because of the backdoor, these teams had an extended season and improved by having additional competitive games.  And I believe Tipp will be strong competition for anyone in a semifinal while Mayo have again availed of the backdoor route to prepare them for what should be an excellemnt quarterfinal against the winners of Rocommon and Kerry.

Greystones to Bray or What can I do for you?

Yesterday morning (Sunday) I finally completed the Greystones to Bray cliff walk.  Drove to Greystones, parked there and walked back to Bray. Beautiful, cliff side walk -about 8km from centre of Greystones back up to the DART station in Bray.  Comfortable walk of approx. 90 minutes – no difficult climbs and lots of great views out to sea and up and down the East coast.

Because of some of the ongoing building work in Greystones it was not absolutely apparent where best to access the cliff walk – but one of the very friendly locals quickly sorted this out for me.  The path itself was quite muddy and wet under foot – not an issue so long as you were wearing reasonable walking shoes or runners.  And the view back to Greystones from the cliff walk was excellent.

Have now been living on south side of Dublin for over 20 years – and hard to believe had never done this walk.  And with the option to drive one way, walk the other and then take the DART back to collect the car – it all works very well.

Very much looking forward to doing the round trip later in the year – on a sunny, clear day, rather than yesterday’s overcast, damp day.

The DART

And the only hitch: the DART from Bray to Greystones seems to only run once per hour in a Sunday (at this time of year).  And no one seems to be on hand at the station to tell you to take the Rosslare train (sometimes) – because it stops in Greystones and there is no DART for another hour.  But as the helpful assistant at the DART stations said ‘what do you want me to do?;  All I could say was ‘I don’t want you to do anything.’

If you have not yet done the walk – get out and enjoy it.  And when you get back to Greystones lots of options for a coffee or something more substantial.

Secretary key to efficiency in work

Where has the secretary gone?

Progress in the workplace seems to have included disappearance of the secretary in many offices.  I can type pretty well.  And I can use MS Office pretty well – at least when I am using Word I know about rulers, styles, headers, track changes, page and section breaks.  So, within reason, I can produce a reasonably well presented document – be that Word, Excel or PowerPoint (without being a guru).  But I am more productive when I have a personal assistant or secretary.

The more I look about in workplaces the more I wonder have we taken away too much secretarial support.  Are execs spending too much time scheduling (and rescheduling) meetings, generating meeting notes/ actions, updating action plans, opening, reading, filing and replying to correspondence, making travel arrangements, etc.

Yes – much more of it is electronic correspondence.  But there are still filing requirements.  And – yes, the document management systems and wordprocessing software is supposed to do the tracking, storage and retrieval.  And the shared diary systems are supposed to support arrangement of meetings.  But I still wonder.

Many of the interactions with colleagues work better when not just a piece of software grabbing time in your diary – sometimes the secretary or personal assistant just makes it work better.

Managers

And then there are those layers of management we have taken out – in order to be more efficient.  As a result we have flatter structures – with some immediate benefits.  But what about the loss of time for coaching, supporting, encouraging?  Or the lack of time for senior executives as they are pulled into tasks previously managed by those layers of management?

Work is a complex social environment.  People use the technology differently – even the same people use it differently at different times of the same day.  It’s not only sales people who resist loading everything into CRM – all sorts of people have provisional appointments they do not enter in the diary, times they are hoping to manage – perhaps to get away early, to pick up the kids, to catch up with a friend at lunch time.  Sometimes the secretary can manage all of this and make it happen better for everyone.

I would be lost without email, shared information, MS Office – but there are lots of things I need to get done which happen better and faster by having an assistant.  And I think there are lots of other people – across lots of the companies with whom I have worked – who are spending time on the wrong things for the lack of effective secretarial support.

Collaboration

We are back to looking at how to make collaboration work more effectively – and part of the secret is having the right resources in place.  I have spent thirty years looking to streamline and improve work processes through use of technology – be that email, network shares, social media, cloud, personal productivity tools.  But we need to keep focused on the goal – and if more administrative support is what it takes – in spite of the technology – then we should t least be open to this.  The technology should empower people – the execs and the support team.  It probably enables a smaller group to provide more administrative support.  But for now at least, ti seems to me to have led to some questionable practices – pulling execs away from focusing on their greatest added value.  I think more organisations may need to revisit their practices ans structures.

 

Death of Cancer – Vincent C deVita – Review

Did not finish ‘Death of Cancer’  thinking we have arrived – if the death of cancer is arrival. But a fascinating insight for the layman into the work and times of a leading oncologist over the last 40 years.

Would not be qualified to comment on his explanation of cancer and the various patterns of development – but all seemed logical, if somewhat frightening.

Great feel for the journey of a somewhat frustrated cancer killer – one who feels that FDA regulation has unnecessarily delayed treatment of many patients.

Story is personal – in dealing with a number of family and close personal friends and their cancer battles. Indeed his own story features in the end of the book.

I think the overall message is very positive – with the reservation that cancers continue to mutate and that many times patients may struggle to get the best treatment: because doctors may be over conservative, may not have the skills/ resources available to them or the latest potential solutions may be tied up in FDA type regulation.

But a good read and reasonably informative.

Adopting the emerging healthcare technologies

Emerging healthcare technologies: not a surprising piece. The focus is on Electronic Health Record (EHR), Cyber security, Accountable Care Organisations, Population Health analytics, Remote care, mobile and wearable technologies.

Mobile, cloud, analytics – all core to developing and delivering effective and efficient healthcare solutions.  And, of course, given the current cyber security threats, security is a prerequisite in implementing and expanding dependence on technologies such as cloud and mobile.

Seems that the electronic health record must be a core foundation of making all of this work for the patient, healthcare providers and society at large.  We need a way to aggregate, consolidate, cross correlate the data. This will provide better solutions for patients and improved care.  But this access for providers to patient data should be controlled by the patient.

Security

I have always thought of security as an enabler rather than a hindrance or obstruction.  Cloud and mobile in healthcare make this case.  Interestingly i see cloud as offering greater security – with the opportunity to leverage real in-depth security expertise, not necessarily available internally to healthcare providers.  And cloud and hosted solutions offer lots of simplifications in supporting mobile access to data.

Analytics

Much of what we have seen drive data analytics has come out of the mobile/ cloud/ social developments – tracking and analysis of data captured on mobile devices and through end user participation in social platforms.  Healthcare is data intensive – with more and more of the data captured electronically and potentially available for analysis.  The tools for capturing the data and the tools for storing, analysing and displaying the data have advanced hugely in recent years.  Providers who do not have the ability to capture/ analyse/ understand the data will find themselves significantly disadvantaged in competing with other providers and negotiating with buyers of their services (patients, insurers, government, whoever).

Challenges

Great opportunities for all healthcare providers to improve the quality and relevance of their offerings, the method of delivering their services and to acquire new business remotely  -through new healthcare technologies.  But the challenges should  not be underestimated – traditional models for Information Technology delivery will prevent organisations leveraging the opportunities available. Providers need to be more dynamics, adopt new technologies and new methods of delivery.

 

 

Day 5 M2M

Sitting here with rest of the gang in Innishowen Gateway Hotel in Buncrana, having had sandwiches and soup.

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About to head off at 1.30 for the last 40km to Main Head.

Joined by Prof. Hill for the last leg. Great sense of achievement for the group.

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And the beautiful weather has lasted the 5 days.

M2M Day 1 cycling

Of course Day 1 actually start in Kilmacud Crokes at 4.30am.

After a 7 hour bus ride we hooked up with the support team at Mizen Head, unwrapped our bikes and set out.  A broken chain within 1 minute and a puncture within 1 km of the start tested everyone’s resolve and patience.  But after this we got going and headed off to cycle through breathtaking scenery of West Cork and South Kerry.

A demanding route for day 1 of the M2M – through Durrus, Bantry, Glengarriff and Kenmare.  Two tough climbs for the group – Caha Pass (Glengarriff to Kenmare) and Moll’s Gap, Kenmare to Killarney.  The descent from Moll’s Gap takes in the stunning views from Ladies’ View and some beautiful views of the Lake as we pressed closer to Killarney.

wp-1464872248425.jpgAnd at the end of the day, the run in from the bottom of Moll’s Gap through to Killarney tested the group.

We stayed in the Killarney Plaza – and a quiet night was had by all: knowing four more days cycling ahead in the M2M.

 

 

Thank you to all my M2M sponsors

Just wanted to use this post to thank all my sponsors for this week’s Mizen to Malin cycle..  Looks like we will be blessed with great weather – wish we were out cycling this morning!

A particular thanks to all my colleagues at Hermitage Medical Clinic who held a special breakfast this morning and have been very generous in their sponsorship and encouragement.

And, as always, for anyone else out there who would like to be a sponsor: my sponsorship page

Looking forward to loading up the bike tonight, packing the sun cream and off to the sunny south west (Mizen Head) with my fellow 51 cyclists at 5.30am tomorrow.

Mizen