I’m on the Mayo social media center’s External Advisory Board, so I’m required to write something yearly, and this was it – timed to coincide with my trip next week, though I didn’t know they’d time it this closely.
An important part of this post is the illustration – an updated version of a graphic I’ve used for years, highlighting that medical knowledge has shifted from being a closed system to an open network. This concept is widely known in high tech, but can seem downright alarming to people in medicine. I don’t fault them – it’s their training, and the idea of a closed system carries with it great responsibility. But it has changed, and it’s important to understand.
Please read the post (it’s not long) to understand the increasingly apparent impact this change is having on the practice of medicine. Please.
Not coincidentally, the graphic was first created by Dutch colleague and now friend Lucien Engelen, who conceived and produced the TEDx Maastricht conference where I did my TED Talk four years ago. And the first version of this graphic was produced a year before that, back in 2010. Thought leadership is thought leadership.
#2: The stages of a scientific field: Thomas Kuhn’s framework for how a field becomes a science organized around a paradigm, and then, sometimes, realizes that “anomalies” mean the paradigm is no longer sufficient to serve the field’s needs.
The purpose of this project is to examine whether medicine needs to become more methodical – more scientific – about what we mean by patient engagement, and what factors determine how well it works.
The role of unexplained observations
Science depends on its findings being … dependable! Section 2 of Structure, “The Route to Normal Science,” begins:
In this essay, ‘normal science’ means research firmly based upon one or more past scientific achievements, achievements that some particular scientific community acknowledges for a time as supplying the foundation for its further practice.
Let’s add line breaks and boldface, to spotlight the elements of thought: Continue reading →
Revised March 12, adding Hacking’s “structure” passage.
This is #2 in a new series “Proposing a new science of patient engagement,” using the landmark 1962 book The Structure of Scientific Revolutions by Thomas Kuhn as its framework. If you haven’t read the first entry, please do, including its dozens of comments, which have links to valuable ideas and resources.
In an upcoming post I’ll lay out briefly why it seems this project is needed. I say “seems” intentionally; this must be a shared exploration. As I said in #1,
My goal is … to have science move forward methodically in its thinking. Maybe we need a new science – a new way of understanding what needs to be measured and optimized – or maybe we don’t. I just ask that we examine the evidence together.
This post will lay out, briefly, the stages Structure describes for the progression of science. I’m doing this first because that framework provides the context for my assertion that we have a problem – a scientific problem in the field of medicine – that may require formally (and rigorously) changing our conception of who is capable of what in the patient-clinician relationship.
As you’ll see, a shared conception of how things work is exactly what a paradigm involves.
Kuhn’s view of the progression of a science
From Ian Hacking’s widely praised introduction to the 50th anniversary edition of Structure:
Structure and revolution are rightly put up front in the book’s title. Kuhn thought not only that there are scientific revolutions but also that they have a structure. …
Here is the sequence: (1) normal science…; (2) puzzle-solving; (3) paradigm…; (4) anomaly… (5) crisis and (6) revolution, establishing a new paradigm.
In three weeks at the Mayo Clinic, as their invited Visiting Professor in Internal Medicine, I’ll be delivering the most fascinating talk of my career. I’ll be formally starting the process of examining whether we must all agree that there’s a hole in the dominant paradigm of how medicine works, and whether we must solve this together by creating a new, scientific approach to patient engagement.
To start, please watch the four minute video below. For convenience, and to make it more searchable, at bottom of this post is a transcript.
To do this I’ll be using the 1962 book that brought the word “paradigm” into popular use: The Structure of Scientific Revolutions, by Thomas Kuhn. His definition of paradigm was much more strict and rigorous than the trendy loose word we throw around today; he studied numerous scientific revolutions (Newton, Copernicus, etc) and identified a regular, repeated structure to the process by which a scientific field takes form and then, sometimes, realizes a revolution is needed.
The process is both scientific and sociological – a fact that annoyed the crap out of scientists who believed that they are solely logical. From Wikipedia: Continue reading →
Open data, sort of: In a post on the Health Affairs blog, some big brains from Brookings talk about how open data can help end over-treatment and high-cost treatment when science doesn’t support either one. In my opinion (which I shared in a comment on the post) they left somebody out in the data-share: patients. “How Open Data Can Reveal and Correct the Faults in Our Health System”
That which does not kill you … might still kill you: Dr. Aaron Carroll takes up the question of what are called the social determinants of health on his Healthcare Triage YouTube channel. Here’s a link to a post on The Incidental Economist with that video, and some other perspective on the topic. “How Long Are You Going to Live?”
Overwhelmed by over-treatment: One of our friends, Shannon Brownlee, is a globally known thought leader on ending medical overtreatment and shared decision making. From her view on the leadership team of the Lown Institute, she’s seen all the science on why overtreatment is still a pernicious issue in US healthcare. Her op-ed on the subject from DrKevinMD: “Fixing overtreatment: Lone rangers need not apply”
“Let Patients Help” – hospital board edition: In a piece on the NY Times Upshot blog, Austin Frakt says that hospital boards need to have more clinical expertise on them, so that treatment guidelines in the facility don’t wander off the evidence-based/quality-outcome reservation. We think he left out an important consideration: *patients* on hospital boards. “In Hospitals, Board Rooms Are as Important as Operating Rooms”
Less is more, health IT edition: On the HL7 Standards blog, Michelle Ronan Noteboom looks at the idea that too much is way too much when it comes to several things, including portals and medical treatment. “When Less Is More in Health IT”
You can get it at Lowe’s: Not hardware, although they do certainly have plenty of that. In this piece on the Health Affairs blog, Bob Ihrie and Alan Spiro take a look at how Lowe’s retooled their employee health insurance coverage with an eye on behavioral economics, trust, and relationship dynamics. “Engaging Health Care Consumers: the Lowe’s Experience”
Tattoo you: I (Casey) have been making the health IT event rounds lately as a patient voice on panels about health tech and patient engagement. Since I took a very out-there step related to my own health data, my appearance in the room can start some interesting conversations. An example, by Jim Tate in the HITECH Answers blog: “Patient Engagement: I Tattoo, Therefore I Am”
Lab coats – yes or no? A meta-analysis of the study data available on patient satisfaction scores and physician attire shows that patients are likely to rate a doctor who’s dressed professionally higher than one who isn’t. What’s your thinking there – would you prefer a tie (which can be an infection vector), or are scrubs OK with you? From Lena Weiner in HealthLeaders Media: “Physicians’ Attire Linked to Patient Satisfaction Rates”
From the This Will Never Get Old desk: A film director and his wife took to YouTube back in 2010 to illustrate the user experience when you’re a patient booking healthcare, setting that illustration in the context of air travel booking. The results were, and are, hilarious. The New Altons on YouTube: “If air travel worked like healthcare“
On JibJab.com, from my sister, the jazz singer Suede, to augment my 65th birthday post this morning: One of my all-time favorite party songs, “Celebrate,” customized with faces of my family peeps. From left to right below: (Email subscribers, click here)
My granddaughter, y’all!! Zoe
Some guy who just turned 65 TODAY.
My daughter Lindsey
My wife Ginny (bustin’ moves like she used to do, before her bone problems)
Sugar high: Dr. Abigail James, a neuroscientist and educator who’s known globally for her thinking on the science of learning, points out the results of a Yale study on energy drinks and school children, and shares some tips for parents on weaning their kids off the sugar/caffeine rush. “Sugar high: It’s REAL”
Data geek hacky sack: Our longtime friend Brian Ahier is a health IT geek extraordinaire. Here’s a profile of his upcoming booth-babe appearance at HIMSS15, which includes his belief that health IT is an evergreen bipartisan issue. And a call to develop a wearable that counts hacky sack kicks. From Healthcare IT News: “Brian Ahier: HIE-vangelist, hacky sack extraordinaire”
Healthcare hackathon for CEOs: This showed up in my Facebook news feed today, and I was fascinated. In Denver, a dedicated man named Tom Higley – a real Renaissance man: attorney, musician, tech entrepreneur – has a very interesting event underway this week, where 10 CEOs will listen to 10 “wicked” healthcare ideas, and then incubate a solution to one of them in 10 days. From the Denver Post: “Sold-out production gives 10 CEOs 10 days to build viable health startup“
“Birthday candles”. Licensed under CC BY-SA 3.0 via Wikimedia Commons
Updated – see modified population graphic
Some people moan about adding years. I love ‘em. Today I’m 65, and I want lots more! I wanna get old!
We the old and many
are coming for you!
Did you know more than half the humans who’ve ever been 65 are alive today? That’s partly because medicine keeps saving people like me, who tried to die in middle age. Thanks, medicine; now get ready for lots of us getting older, happily, with chronic conditions. (I myself have slightly elevated blood pressure, and I’m just emerging from “obese.”)
Like my classmate Jay Pollack, who posted on Facebook that he’s getting a pacemaker because medicine saved him twice in ten years.
Have you thought about my question last September about taking care of all the old people? Or how about Pew Research’s new book Next America, which depicts among other things how America’s classic “age pyramid” is becoming rectangular? Each band in the graphic is a five year age group. We used to have very few 80+, and now it’s commonplace: (Graphic modified 10pm ET)
This 51 second animation accompanies my article last week in the BMJ, “From Patient Centred to People Powered: Autonomy on the Rise.” The video expresses, concisely, a slide that for years I’ve presented in 3-5 minutes. It’s an idea first published back in 2010 by Lucien Engelen, during the same time period when he was preparing for the TEDx Maastricht event in April 2011 where I spoke. It shows how the flow of valuable information has changed, which makes new things possible, as in all other parts of life.