Making Sense of the Topic Are L.A.'s Hospital's Safe?

by B.J. on 7/16/2008 12:47:00 PM 1 comments Print this post

What I saw in this lecture was a very real tension between the real suffering of the patient and the heavy dose of expectations and standards to be met within these enormous factory-like hospital systems.

The topic centered around hospital-induced infections in Los Angeles.

The panelists, three. One from the people's perspective, a patients-rights advocate. Two from the practitioner's perspective, a director from UCLA Medical Center and some kind of Risk Management/PR person from Kaiser Permanente.

The fireworks officially set ablaze when the patients-rights advocate demands transparency in hospitals.

"Transparency" in the sense that the general public know of the shortcomings and limitations that hospitals and doctors have. Transparency is just another means of making sure that the hospitals are "accountable." "Accountable" meaning reliable and trustworthy.

Trustworthy hospitals mean that doctors, nurses, and other caregivers are treating their patients/everyone well.

Treating their patients/everyone well. Keyword "/everyone."

Meanwhile, on the flip-side, from a doctor or health-care giver's perspective, what the patients' rights advocate was advocating was probably just one more teardrop of annoyance to a bucket load of them. I felt that with every joke the UCLA Medical Center guy was making and the corresponding audience laughter on topics such as making the patients pay for their care.

Years of medical school, internships, paying loans, generally in attempt to help people's wellbeing, 24-hour workdays, no holidays or weekends, seeing countless patients a year and having to treat everyone individually. It's only a matter of time before everyone becomes anyone, which you don't mean to, but you're too tired to care. On top of that, hospitals in LA are going bankrupt and closing down. There seem to be less and less doctors and other resources around to do anything.

But these people on the outside, the patients, their advocates don't see any of this struggle. They probably struggle to, but that isn't seen at all and even more variable outside of the hospital context. Not when that medical practitioner's top-rated hospital is moving into a billion-dollar state-of-the-art facility in the broken neighborhood of Westwood. This prestige and wealth only serves as fuel to the fire --- more reason for the advocate to run full force at the system yelling at the practitioner to stop fucking up! If they can fight the big fish, the patients will be heard.

All that the UCLA dude and Kaiser woman could talk about were the way they managed their hospitals. He was keen to point out that he was like a "mayor" of a small town. The woman was proud to report that they had taken steps in Kaiser to improve safety as adapted from the airline industry, which I thought was something of an odd connection to make from a patient/consumer perspective because airlines give no shit at all about how you're doing even if you do pay to be pampered. Actually, on second thought, maybe there is a connection after all!

They were very specific about the management improvements they've implemented in each of their hospital systems. They were very much in love with the systems implemented. UCLA dude was happy to talk about all the numbers achieved in his time as top dog. #3 rated Medical Center in the United States. Hitting the 99th percentile on public health measures intra-hospital.

Essentially, he was hitting on stuff that patients don't give a beer dump about, which he actually knows intuitively and mentions, but as a defense mechanism has to bring up anyway. All he could point out were these rankings and numbers, which is impressive. But anytime someone's argument of defense relies entirely on numbers, usually there's something weak underneath the argument. Numbers and standards ideally should never be an ends to meet, especially in a field that depends on individual well-being.

...but unfortunately it seems that's what these large bureaucratic systems inevitably entail...some blind adherence and satisfaction to an abstraction, numbers that are highly relative, which say virtually nothing about the quality of care. There's nothing wrong with him or any other hospital manager focusing on numbers as a means to show that you're doing well, but as long as these hospitals are overworked and remain underresourced thanks to the HMO system, they're never going to progress to a level where doctors en masse will see eye to eye with patients.

Inicidentally, UCLA guy mentioned that 1 out of 3 people still wouldn't recommend UCLA Medical Center to a friend, but it's odd that this wasn't a focus of the discussion.

Inevitably, the UCLA and Kaiser people's involvement with the management end elicits talk about the responsibility laying with individuals. System works fine, our standards work fine, its the individuals who fuck up. Individual doctors, whom they weren't going to talk about at all in this public lecture setting. And the faceless individual impatient patients. This is where the tension flares up.

In addressing the specific concern of hospital-induced infections, Kaiser woman could only stress the importance of washing hands, as if this was the cure to AIDS. UCLA man said washing hands was important but not visiting the hospital was probably best. Patient advocate presses on these big level administrators to give more specifics about how things apply to the patients.

With so much rancor flying between the patients-rights advocate and the hospital admins, it usually means that both sides expect too much from each other and don't get what they want.

The patients expect too much from the hospital admins/doctors/staff, and hospital admins/doctors/staff expect too much from the patients.

Patients expect doctors to be nice, they want better working facilities, they expect everything to be perfect, they don't pay etc. etc.

However, it's always easy to blame the individual patient for being in the wrong. What makes it appear this way is that patients usually aren't the united front and powerful organization that a hospital is. An impersonal, methodologically organized group of people who have been in the business for years dealing with numerous people can't possibly be wrong over some individual patient's judgement can they?

Moreover, there's this American idea that you must pay for everything with money. Like other industries, it also seems as though patients should pay for all the work and extra anguish that doctors go through. It's a business, no free lunch. Patients should be grateful for whatever service they get and being so open to taking patients in.

Patients are "consumers" in the sense that they do demand a limited resource --- the doctors' service. However, they are NOT consumers in the sense that they will keep demanding a good or service. They are not really ready, willing, and able consumers, but people who believe that they are not well and thus seek an avenue to be well.

There is not much sympathy in American public discourse for patients, and this extends towards the attitude toward the patient in the hospital.

Judging from my mom's stories and the discourse in this dialogue, hospital staff seem to expect that patients should understand what they personally go through as doctors/etc. They seem to expect patients to know how things in the hospital work. They expect patients to check for conditions online as if they were the ones who went to medical school and could diagnose and treat themselves. And the kicker is that they actually want people out of the hospital. Doctors thinking everyone is invested in healthy like they are, expect too much of their patients, so they get tired and frustrated as well.

Thus the equilibrium of tension between doctors and patients in LA hospitals continues. It seems that nobody really gets what they want at a hospital, but it's there because it's business. What strikes me is that doctors really don't want patients to come to the hospital cause they have enough people coming over, but they also want to make sure that they keep up business, especially if they could pay for it.

In the end, the management folks at UCLA and Kaiser could only talk about how patients need to "arm" themselves with information.

There isn't much taught in the public discourse about handling health crises yourself. The internet and google search might be changing that a bit, but not everyone has the internet nor search abilities necessary quite yet. People generally aren't wired to practices of folk remedies, etc.

In America's education system and public discourse, we see and we learn that it is hospitals that we must go to first for any and all health care needs. It's the most visible object. So then here comes the patient expectation system. It's big, it's grand, somebody's got to know something when you go there, right? Doctors know what they're doing, they're rich, they'll help me.

People generally DO NOT want to be in the hospital, but they simply do not know any viable options and hospitals seem to have been marketed as the place to be when sick. There isn't any curriculum in schools for home remedies, alternative medicines, and public health measures are kind of a joke.

The business of healing strikes me as crisis-oriented, kind of like calling a plumber to unclog your sink. It makes me wonder whatever happened to the home visit doctor that I would see in Lassie and other assorted 50s television shows.

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by B.J. on 10/24/2007 10:36:00 PM 0 comments Print this post

When you're a businessman, you can be whoever you want.

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Deconstructionist's Handbook

by B.J. on 7/27/2005 09:15:00 PM 0 comments Print this post

That's what I named my History 2B notebook back in May. A tattered blue notebook that cost a dollar but would be worth well over a billion for every 2 cents I chipped in. It is the key to artificializing all that has been naturalized and naturalizing all that has been artificialized. It contains the key to tripping, ripping, skipping almost any piece of information that attempts to present itself as powerful.

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by B.J. on 7/15/2005 01:23:00 AM 0 comments Print this post

Never Mind

Despite my linguistic justifications earlier, there was NO reason to see Lords of Dogtown and all its Eurocentricity. I guess I was more hyped up on the documentary than that idiotic movie.

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by B.J. on 5/28/2005 10:13:00 PM 0 comments Print this post

I'm Not a Psychologist but. . .

I don't think it's a good thing to be falling asleep just thinking about what you're going to write for your 10-page term paper worth 45% of your grade due on Tuesday that you have not started on.

I've already written more in this entry than that paper.

The dog days of studenthood. I hate this paper. I this class.

Once I get over with this and hopefully pass, I will probably completely forget how much it sucks to be put in this position the next time I am in a predicament like this.

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by B.J. on 1/13/2005 02:11:00 AM 0 comments Print this post

Being a Doctor in Western Society

Man (this isn't a letter to god or the Man, I'm just saying),

I wish I was studying to become a Medical Doctor.

But as with engineering, I don't have the technical skills in physics or chemistry.

And you know what ? I don't give 2 shits about technical skills (maybe 3, but definitely not 2) !

All I really wish is that I could first learn the practical skills of healing people/making cool shit, i.e. motors, and subsequently after having learned these practical skills, then learn the technical skills and manipulations with math. Those technical skills would be so much more useful then because I would know exactly what I'd be looking for in the math instead of learning what isn't useful and only finding out later. I don't really like learning what's abstract first because that which is abstract has no practical meaning to it.

From all the time I've been in a hospital (and I'm still taking a stab in the dark because I've never been to med school and don't work in a hospital), those mathematical/technical skills seem to be kind of useless for doctors in their day-to-day workings (correct me if I am wrong). Not that the technical skills wouldn't help, but all this energy they spend on learning technical skills in college seems to be a waste when most of their skills seem to rely on intuition, not mathematical skills. They have a know-how. These doctors work with their hands --- that's how surgeons operated prior to the organization of the Hotel Dieu. A work with hands, with the same kind of respect a plumber today would have in working with his hands. These surgeons knew more practical stuff than their physician counterparts, who learned Latin and the medical traditions of Hippocrates, but didn't learn to actually deal with patients. Lesson is that technical skills are useless until actually applied --- even my practicing Ph.D math professor in the summer said that.

Learning these abstractions/technical skills/math first without there being any relevance first is about learning the rules without even playing the game first. Those rules don't mean a thing if you don't know what's going on. I mean you learn some rules, but you just play the damn game, and then learn the rules as you go along. Same thing should be done with medicine/engineering: learn how to heal/do cool shit and then learning the technicalities.

If we did things my way, way more people would probably be doctors as well.

So why do we keep this system in place then ?

Well for one, I doubt most of the doctors today would go for my plan that since they basically had to be *functionally insane* (meaning they crazy but a crazy that is revered because it *appears* to contribute to society) for 12 more years after graduating high school. They obviously acclimated well and made it to be some of the top dogs of society. I doubt that most of them would want their knowledge to be known by everyone or else many people wouldn't waste money on their services. The worst of them, the most emotionally unintelligible of them, would dismiss me as a some kind of social science hack.

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More on the Artificiality of Everything

by B.J. on 6/14/2004 08:04:00 AM 0 comments Print this post

I am writing this as a response to how I stay manage to "stay happy" at least for some periods of time more so than a call for some random reader just to forget problems.

In the first post about this 2 days ago, I established how I thought everything has been constructed by humans and how everything being constructed by humans is funny.


My whole blurb on this artificality of everything is because I think that life shouldn't be too dramatic as if some petty actions determine your survival, especially with the type of life we've (meaning my friends and I) been blessed with. Being dramatic over things like relationships, etc. Basically life's only as dramatic as you make it (again, speaking for my middle class friends). I'm guilty and probably will be guilty as well.

Thinking of dramatics such as crying and taking "family values" brings me to discuss "life problems." College kid "life problems" consist of dealing with roommates, poor time management. Outside of a friend/relative dying, break-ups, getting fired, finances not being met, and maybe failing a tough class given that you gave effort, I don't see how there are other problems in college from a macro (look-at-the-rest-of-the-world-and-see-how-you-stack-up- perspective) these college kid problems are not that big a deal. (Then again, I had little to do because I have engaged in so little.)

When I think of college kid problems and them overreacting, I always imagine a person scrapping the garbage to survive in Somalia and look at that in contrast to the college stupid ass who ODs every weekend.

I'm not saying that college kid problems are not tough, but that I definitely know people have it worse and that college kids (I'm thinking white and Asian folks) really don't have it so horrible it may help to throw things back in perspective before taking things so dramatically. (Oh, hopefully, I'll be able to live up to what I say)

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Artificiality of Everything

by B.J. on 6/12/2004 11:23:00 PM 0 comments Print this post

Everything around me is constructed. "Everything" meaning my ideologies, information I take in, religions, the clothes. Knowing that "everything" around me is constructed just makes this whole business we call "life", stock full of these "everythings", funny as hell because every time I think of humans constructing things I think of little babies with their building blocks mixing and mishting (made that word up) their random letters and blocks (Sometimes, they may form words). Oh, those (err, us) cute ass humans.

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by B.J. on 8/27/2003 08:56:00 AM 0 comments Print this post

NASA Culture

According to a report compiled over the last few months, the "lax culture" of NASA is to blame for the Columbia explosion on January 16, 2003, which killed 7.

No.

Not to completely shake off what happened and be an insensitive bastard, but human nature is directly to blame. We are imperfect pieces of shit before the beholder. However, the most blame should be on the government. Too much pressure is put on these NASA scientists, and I would imagine that it would be tough to not slack for a second. These scientists felt the pressure even when the agencies cut down on its workforce:

"NASA isn't the only villain in the report. The board also blamed the White House and Congress for failing to ensure that NASA's budget keep pace with inflation over the past decade. To cope with the crunch, the agency slashed its work force and relied increasingly on outside contractors."

Disasters like the Challenger and Columbia are examples of why downsizing in general is just a bad idea. The less people you have, the more relaxed and less structured a task is. The less structured a task is, the more unreliable it is that the task will be completed successfully. To meet with high standards (that should be rules), NASA needs more structure and more workers especially since they hold people's safety in the balance. Even the best of the best fuck up.

I'm sure loved ones of those directly involved in the tragedy would agree.

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by B.J. on 8/14/2003 06:04:00 PM 0 comments Print this post

[Edited 11/07/03]

Standards: Compiling the 'Busting Standards' Posts

So here's my official position on standards: they are only needed when they prevent someone or something from getting hurt, which then becomes a rule because rules are about making things fair. Standards can be rules, but rules cannot be standards. [note: But then rules are to be looked down upon to because they only have in mind a certain group of people when they are concocted]

One reason I trash standards and define rules and standards is because I see people getting crushed like Zion I's microphones by trying to live up to standards.

I started off by trashing the notions of "interesting", then explored what made "scientific facts", then dissed the "experts" who concocted some of the "scientific facts" for not accomplishing anything innovative, explored the "specificity" required in becoming an expert and knowing the scientific facts, and now I'm here rounding it all up. It's all to the History of Randomness class. If you are ever going to UC-Santa Cruz make sure to take this class in the Spring, listed as HisCon80Q or Science As Cultural Practice. The class is a daily journey into the mind !

What Constitutes Interesting ? - June 11, 2003

Exactly What are Facts ? - June 24, 2003

Experts Really Don't Do Shit - July 3, 2003

Specificity Creates Standards and Destroys Lives - July 19, 2003

There's a Personality to Being Old ? August 9, 2003

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by B.J. on 7/11/2003 11:40:00 PM 0 comments Print this post

You Are Really Not that Smart

Today was my first day on the job, working from door to door, asking people in Pasadena if they want to give air pollution a good kick on the ass. It was alright, nothing special. But one person I confronted door-to-door pissed me off in particular. She made me feel like a kid, by smiling smugly and then spilling her credentials.

I don't care if you graduated from MIT and John Hopkins. You're still from planet Earth, eating, sleeping, shitting like the rest of us and there's nothing that you know that can't be figured out without a little more specialization. I could still kick you and your dalmatian dog on your melon heads so hard that your eyeballs would pop out. Then I'd throw a Beaver at you and make sure it would chip away on that head of yours. It can't be that filled up, you're just the beneficiary of being adept with society's norms and institutions.

"I know more science than you ever will, honey." Doh.

OK, if you were truly a smart, and intelligent academic, you'd: keep an open mind, and actually enlighten me on what actually works better. What is better and more cost-effective than solar energy ? If so, why haven't you shared it with us neanderthals ? Are you primed to make a lot of money from this secret ? Why aren't you doing this for the good of society ? You were probably bullshitting me anyway, and I can't believe I fell for that.

Anyway, today, ozone levels are going on at 200. That is extremely unsafe air quality. Air pollution is contributing to that, and the earth is slowly becoming a melting pot. . .

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by B.J. on 6/27/2003 07:44:00 AM 0 comments Print this post

This Better Be Good

I am officially confused about what the hell the Chicago Bulls are doing.

Yesterday, they picked another point guard named Kirk Hinrich when they already have a perfectly fine, and even sometimes dominating point guard in Jamal Crawford when the team had a pressing need at the small forward position. Jamal had just gotten over a point guard controversy albeit in a tragic manner with Jay Williams sustaining potential career-ending injuries to his pelvis in addition to his broken leg. Jamal and Jay were fighting and scratching for playing time throughout all of last year, with Jamal eventually winning the battle. However, with an injury-plagued team, Jamal and Jay eventually started playing substantial minutes on the court together, engineering some hard fought wins against the Eastern Conference Sacrificial lamb, I mean Nets, the Bucks, and the 76ers.

Those hard fought-wins thru Jamal and Jay are probably what got our general manager excited about drafting yet another point guard to replace Jay. Hinrich apparently can shoot the "rock", and play some 'd', which could hopefully take pressure off the towers that are Eddy Curry and Tyson Chandler. And unlike Jay, he could probably accept his role. Maybe this team's primed to become like the Dallas Mavericks, who use Nick the Quick Van Exel and Steve Nash or the Sacramento Kings, who use Bobby Jackson and Mike Bibby. So maybe all in all the team would benefit from this pick. And maybe, just maybe one of the incumbent small forwards (Jalen Rose, the on/off defender and Eddie Robinson, the athletic freak) has made strides to his game. Ha. Maybe. . .

Maybe they picked Kirk "Harry Potter" Hinrich to trade him for that pressing need of a small forward : ). Or trade Jamal : (

I officially don't know, and like the notoriously secretive full of surprise Jerry Krause days, I'm intrigued and mad.

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by B.J. on 6/24/2003 10:18:00 PM 1 comments Print this post

[Edited on 11/07/03: Don't take this post to be an establishment of facts, but rather as a springboard to new ways of thinking. Stuff in this post seems to be only half true, but I wanted to sound smart as this young college first-year and give a general viewpoint on something that was arching my mind. I still agree with the premise of this post: Always always always question facts and how they facts were formed]

What Is a Fact ?

(Inspired by my History of Randomness (Science As Cultural Practice) class and Writing 001)

What counts as a scientific fact and why and how ?

I define scientific facts as "things known to a large amount of people in the same way." They should be about what happened and the context of what happened. Knowing [exactly] what happened and its context is what the law profession has been based upon. And that's where it should stay.

Facts as a concept has been legitimized by the law profession and now everyone in the science field tries to act like they know what happens. But they are omitting the part of facts about what actually happens and its context. They are merely taking the results of what happened and its context. People are not looking at the process of how a fact is formed, and therefore not getting the whole story. And not getting the whole story is what will keep us running in circles for cures to society's ailments physical and social forever.

For example, people in science thought DDT was the answer to prevent crops from being eaten by insects. DDT did kill insects as hoped, except that people didn't look at what DDT actually did. It was a neurotoxin; it fucked up the nervous system. Worst of all, it was hard to remove from the human body. As a result, DDT is now a banned pesticide. This is all an example of how looking at "scientific facts" as answers rather than as concoctions by humans can kick us in the ass. They need to look at the whole picture, not just results. By looking at the whole picture, they'd be more open and receptive to a more diverse amount of opinions. With more opinions, they'd be more likely to bump into a discovery than the wasteful crap they do now.

What scientists often fail to do is know things in context. A physics major named Josh revealed the mystery that they didn't need to understand the history of physics to actually do it. It was kind of funny how we then observed with God's lightning aura-ful awe his physics book as a strange alien artifact rather than as more bullshit work, the way he probably saw it. It seems like he's on pace to understand the science's standards well, but probably accomplish nothing earth-shattering. [And this is where anthropologists come in]

Scientists seem to get lost in their "practice" as they succumb to the laws and standards of their field. For example, they probably won't try some chemicals on AIDS or SARS based on history that it could cause other diseases. This kind of specialization to the standards could possibly prevent them from discovering new things. What if it a possible cure in exploration would cause disease in those of Mexican descent, but not Columbian descent ?
It's specialization with only a certain population in mind (most likely white America) that bars them from doing anything.

When you really look at it, discoveries in science have been made through chance, and then gradually improved and tinkered with. The first car engine in the world was 7 feet tall. So was the computer. Experiments are only as useful depending on how realistic their conditions are. People didn't make them because they needed something like it; stuff was developed because the inventors were trying to find a use for it. The scientists in question from the medical field on the other hand are basically making things to do something in trying to find answers to these specific questions. And when scientists formulate things to specifically combat other things, they eliminate other avenues by which to combat other things.

It's a trip that we can't find answers when we need them most, but when they're unneeded, they're all over the place, and we develop a dependence on them. In other words, do we really need to know how big J.Lo's ass is ? How ironic that the least innovation is developed in medicine, arguably the most important field of science. Those humble scientists will tell you we don't know shiet. And often when we don't know anything, we'll stick to what we interpret as facts.

And science and its facts has this dominating domino effect on the social world. We're taking comfort in these "facts." "Facts" that could hold us back because we don't know it's whole effect. Facts like DDT once being an effective pesticide. We've got to get the whole picture, and so when I graduate from either UCSC or UCLA, call me up, and I'll ring you in on histories and science and stuff like that.

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