Although it was incredible to see The Overlook brought back to the screen, it may have been better to let it rest. Kernel Claire retired from the Salty Popcorn cob in with full honors, but was lured back to the shine of the silver screen and the Salt of the Popcorn a mere four years later. Credit has been given to photographers where known — images will be removed on request.
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Soul Sucking The True Knot. Ewan McGregor. Not Scary Not Scary. Prev Main Blog Next. She and her colleagues developed a twenty-two-question survey known as the Maslach Burnout Inventory, which, for nearly four decades, has been used to track the well-being of workers across a vast range of occupations, from prison guards to teachers.
In recent years, it has become apparent that doctors have developed extraordinarily high burnout rates. In , fifty-four per cent of physicians reported at least one of the three symptoms of burnout, compared with forty-six per cent in Female physicians had even higher burnout levels along with lower satisfaction with their work-life balance.
A Mayo Clinic analysis found that burnout increased the likelihood that physicians switched to part-time work. It was driving doctors out of practice. Burnout seemed to vary by specialty. Surgical professions such as neurosurgery had especially poor ratings of work-life balance and yet lower than average levels of burnout.
Emergency physicians, on the other hand, had a better than average work-life balance but the highest burnout scores. The inconsistencies began to make sense when a team at the Mayo Clinic discovered that one of the strongest predictors of burnout was how much time an individual spent tied up doing computer documentation.
Surgeons spend relatively little of their day in front of a computer. Emergency physicians spend a lot of it that way. As digitization spreads, nurses and other health-care professionals are feeling similar effects from being screen-bound.
There are messages from patients, messages containing lab and radiology results, messages from colleagues, messages from administrators, automated messages about not responding to previous messages. The rest she deletes, unread. As I observed more of my colleagues, I began to see the insidious ways that the software changed how people work together.
None of this was possible anymore. The doctors had to do it all themselves. As the chief clinical officer at Partners HealthCare, Meyer supervised the software upgrade. An internist in his fifties, he has the commanding air, upright posture, and crewcut one might expect from a man who spent half his career as a military officer. He still sees patients, and he experiences the same frustrations I was hearing about. Today, patients are the fastest-growing user group for electronic medical records.
In one project, Partners is scanning records to identify people who have been on opioids for more than three months, in order to provide outreach and reduce the risk of overdose. And the ability to pull up records from all hospitals that use the same software is driving real improvements in care. Meyer gave me an example.
A recent study bolsters his case. Researchers looked at Medicare patients admitted to hospitals for fifteen common conditions, and analyzed how their thirty-day death rates changed as their hospitals computerized. The results shifted over time.
In the first year of the study, deaths actually increased 0. But after that deaths dropped 0. Indeed, the computer, by virtue of its brittle nature, seems to require that it come first. Brittleness is the inability of a system to cope with surprises, and, as we apply computers to situations that are ever more interconnected and layered, our systems are confounded by ever more surprises. By contrast, the systems theorist David Woods notes, human beings are designed to handle surprises. Last fall, the night before daylight-saving time ended, an all-user e-mail alert went out. The system did not have a way to record information when the hour from 1 A.
This was, for the system, a surprise event. The only solution was to shut down the lab systems during the repeated hour. Fetal monitors in the obstetrics unit would have to be manually switched off and on at the top of the repeated hour. Medicine is a complex adaptive system: it is made up of many interconnected, multilayered parts, and it is meant to evolve with time and changing conditions. Software is not.
Things You'll Need Doctor's kit. Big technology companies are already circling to invest in IKS Health. Trailers and Videos. The University of Wisconsin found that the average workday for its family physicians had grown to eleven and a half hours. By Atul Gawande. Listen to the patient's heart again.
It is complex, but it does not adapt. That is the heart of the problem for its users, us humans. Adaptation requires two things: mutation and selection. Mutation produces variety and deviation; selection kills off the least functional mutations. Our old, craft-based, pre-computer system of professional practice—in medicine and in other fields—was all mutation and no selection.
There was plenty of room for individuals to do things differently from the norm; everyone could be an innovator. But there was no real mechanism for weeding out bad ideas or practices. Computerization, by contrast, is all selection and no mutation.
For those in charge, this kind of system oversight is welcome. Gregg Meyer is understandably delighted to have the electronic levers to influence the tens of thousands of clinicians under his purview. He had spent much of his career seeing his hospitals blighted by unsafe practices that, in the paper-based world, he could do little about.
A cardiologist might decide to classify and treat patients with congestive heart failure differently from the way his colleagues did, and with worse results. That used to happen all the time.
But those processes cannot handle more than a few change projects at a time. Artisanship has been throttled, and so has our professional capacity to identify and solve problems through ground-level experimentation. The answer is that the two systems have different purposes. Consumer technology is all about letting me be me. Human beings do not only rebel.
We also create. We force at least a certain amount of mutation, even when systems resist. Consider that, in recent years, one of the fastest-growing occupations in health care has been medical-scribe work, a field that hardly existed before electronic medical records.