healthcare

you never know

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We never really know what knowledge is going to come in handy. I might never need to know that molluscs have teeth, or what kind of teeth they have, but knowing doesn’t hurt anything. But, other than the joy of knowing for the sake of knowing, can it actually help?

Well, one never knows. I think it might have been in Imre Kertész‘s Fatelessness, or possibly in Ta-Nehisi Coates‘s Between the World and Me, or maybe even neither (although each contains some aspect of this theme): you go through life and start to realize, possibly even lament, all those things you could have learned but didn’t because you didn’t see their applicability or value.

In my last job I had to learn a great deal about laparoscopic surgery and specific lap procedures. Being the “all-in” type (as well as the one responsible for drumming up themes, ideas and topics – as well as often ghost-writing the posts – for a blog that internal folks rarely understood the purpose of) I dove into research and studies about laparoscopy and its uses, technologies and tools … and blah blah blah. Sure, this made it easier for me to do my job, much easier to talk to the former clinicians within the company who were responsible for marketing lap-specific products and also to talk to clinicians externally (to whom we were selling). But beyond that, I saw no real scope for applying this knowledge elsewhere. Did that stop me from going wild like a pig at the research trough? No.

And wouldn’t you know that after I spent significant time and effort inhaling laparoscopy, a friend would require a hysterectomy and had been told by surgeons in her country that, because she had never had a child, she would have to have the full open surgery? I’m no surgeon; heck, I am not even a healthcare professional. But I was reasonably sure, given the evidence and research I had just spent months combing through, that it was absolutely possible for her to have a laparoscopic hysterectomy. I gathered the evidence I could find, sent it her way and told her to push back and ask more questions.

This is perhaps the other important note: We don’t know, we are not experts, so we fear pushing back. We tend to trust the specialists in whom we place our care and well-being, and we doubt that their advice is given because they are trying to fool us… but there are other institutional matters a healthcare professional weighs in diagnosing and offering treatment. In this case, the friend’s surgeon perhaps did not have the most up-to-date information or was not capable of performing the laparoscopic procedure himself. Or, as is often the case, the healthcare system and its practitioners will try to push the cheaper option, even if it is riskier and involves longer healing times. We are often at our most vulnerable and afraid in these situations, so less likely than ever to push back: who are we, untrained mortals, to push back against the education, expertise and experience of these medical professionals? But who else is going to advocate on our behalf?

Still, I am happy to say that she did push back, armed with a bit of evidence. (Ironically, one of the world’s leading experts on laparoscopic hysterectomy procedures comes from her tiny country but practices in the US….) And she was referred to a surgeon with the appropriate expertise and had the procedure laparoscopically, with a much shorter recovery and healing time.

And here I go back to the point: I never imagined that the knowledge I gained in my last job, which was so far outside the boundaries of anything I imagined doing in my career, would have a real-life pay off. And yet, that knowledge I gained might well have been the most important thing I ever learned in a workplace in terms of how great a difference it made in someone else’s life and well-being.

Photo (c) 2006 Amanda Graham used under Creative Commons license.

Innovation v Invention – Not knowing how to change things when you work from a template

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As long as something is deemed sufficient, even if imperfect, no one will change it. Most people who work in technology or in any field that relies on innovation know that “innovation” is rarely, if ever, borne of someone expressing a specific need and someone else finding a way to meet that need. Sometimes innovation comes from hidden needs – the solving of a problem. Those who express their problem but don’t have ideas for or even an expectation of finding a solution are eventually met by those who have framed their problems with a solution in mind, developed solutions and introduced these solutions (or sometimes introduce solutions for problems that were somewhat hidden).

There are, of course, other innovations that are so novel, so innovative, that they create whole new things, new paradigms, new ways of seeing, perceiving, gathering information, organizing the world and living in that world. These tend to be things that are widely perceived as “crazy”, such as statements like “every home will have a personal computer by whatever year”. This seemed so outlandish, unnecessary and beyond the realm of possibility at the time. But there were visionaries who could see the potential for personal computing. We have seen the same with the smartphone, spearheaded by Apple, and other connected devices. We used to have crazy long-distance phone charges just to speak to someone who lived in the next county – and even though we all hated it, it is not like the majority of us tried to devise innovations to liberate ourselves. True innovation is often vision and a means to liberation (not just a run-of-the-mill solution to a problem). It anticipates a solution for many problems or features that we want to use long before we have the problem or want the features. Steve Jobs and Bill Gates are written about ad nauseam as the forefathers of this sort of thing – mostly because they have been the front-men and are identifiable figures. We don’t often hear about the thinkers, geniuses, programmers who have come up with a lot of the inventions (tech oriented or not). But real innovation usually changes the world.

This is where I have a lot of problems with normal corporate life. Most companies have adopted “innovation” as a buzzword and concept – have tried to weave the idea into the corporate behaviors, running workshops on how to think about and teach approaches to “innovation”. But this is just not how it works.

In a somewhat related area, I recently read an article about why we don’t have better condoms. The most “revolutionary” development in the condom-making arena in the last 40 years has been synthetic latex condoms (since latex allergies are serious, and one wouldn’t want a latex allergy to prevent someone from having safer sex…). (Durex apparently used the word “revolutionary” in its marketing of a polyisoprene condom.) This is not innovation, at least not by its modern, accepted definition. Perhaps if we think of the literal definition of “innovation” – it is a bit like “to make new again/improve”, in which case, making small, incremental changes and improvements IS innovative. And polyisoprene is a variation of an existing product and existing material. True innovation, as the word is used, should be called “invention” – meaning that you will end up discovering something completely new and different from what anyone could have imagined. Some completely new material that totally changes the game.

Condoms have never been the most interesting topic for anyone – and because, until the onset of the AIDS crisis in the 1980s, condoms were seen primarily as a non-invasive birth control method (not something gay men were particularly into), they were not something anyone really needed to talk about. It was also not high atop anyone’s “let’s revolutionize this design/material” agenda, going back to the point that if something is sufficient, there is no real reason to fast-track change or seek to think about it in a new way. Indeed, at the height of the AIDS crisis, real innovation had to go into something more urgent – seeking viable, life-saving treatments for the disease itself. (It was not entirely clear early on, before the virus and its spread was fully understood, that condoms could act preventively.)

“If you believe Danny Resnic, hard at work on his Origami condom, polyisoprene is a symptom of Americans’ failure of imagination when it comes to condoms. “When I first told people I was developing a new condom, they went, ‘Well, what could be different about a condom?’ ” he said. “They couldn’t imagine anything different, because there’s never been anything different.” Resnic thinks men have become desensitized by latex condoms. “They’ve come to accept that level of sensation as the maximum.” If they use condoms at all.”

I would argue that lack of invention in many areas comes down to this same lack of imagination. There seems to be no shortage of imagination in technology. And while changes occur frequently in areas like healthcare and pharmaceutical/medical device development, the regulatory and legal requirements, costs, lack of “sexy factor” and human factors considerations make this field much more difficult to operate in. Real change seems to occur only when there is a loud enough public outcry or public health emergency (the response to HIV/AIDS in the 80s – only because the gay community and its few supporters were vocal, organized and demanding enough or to some extent in response to Ebola, which some argue came belatedly). Some “imagination” is not as possible to implement – and certainly not as swiftly as one would desire – in healthcare and medtech.

When looking at something as “boring” to most as condoms, we have a working template, and very few people have the interest or imagination to change or improve it.

The American way – a light extinguished

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“Keep, ancient lands, your storied pomp!” cries she
With silent lips. “Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tost to me,
I lift my lamp beside the golden door!”

-Emma Lazarus, from “The New Colossus”

I like to ignore the realities of America now that I don’t live there, but it is true that what happens in the US does affect the world.

Brainwashing in the US begins early. Most people don’t think of it that way – and even rather anti-American people I meet in Europe sometimes think I am going too far when I describe the US system as a form of slavery (especially if one compares it to actual slavery, which of course is an entirely different, toxic and horrifying institution/monstrosity). It might be better to call it indentured servitude, with the indenture owed to student loan companies and increasingly inhumane workplaces. People are too brainwashed to know that that is the machine they are a part of – indoctrinated into the idea that they are would-be millionaires (as John Steinbeck said, ““Socialism never took root in America because the poor see themselves not as an exploited proletariat but as temporarily embarrassed millionaires”) or that “anything is possible” if they work hard enough – and taught from an early age to value material goods over anything else, so that, unless they are actually hit by real hardship, an average American thinks he is prospering because he managed to buy … a new Jeep or something.

I often tell the disembodied and soulless story as one in which you are born and are told from the earliest time that you must get an education, so you go to public school (or whatever form you attend) and basically learn how not to think while a lot of nonsense is hammered into your head and creativity is systematically removed – stay in line, be quiet, color inside the lines, do what everyone else is doing, no that is not the right interpretation of this, there is only one right answer and only one way to get there). Then you are told you have to go to college or else you will not get a job. You go into great debt to do so. Naturally after that your hands are tied by the debt, so you take whatever job you can get rather than whatever job will make you happy – but you are also convinced that you will be happy if you buy the aforementioned Jeep. And of course unquestionably America is the greatest country in the world (and if you question it, get out because you’re no patriot!), so it does not matter that you don’t have the money or time to travel to see the world. You have a Jeep you can drive around with since you have cheap oil! And since you are stuck wherever you are anyway paying your student debt, you might as well do what everyone else does. Buy a house. Get married. You might start to question whether you are happy in your job, but you know you won’t find another one easily anyway … and now you have a kid or two, so you need to stay in your job to keep your healthcare. Then you play the tug-of-war with yourself about whether you can be a good parent, whether you have enough money for their daycare, whether one of the parents should leave their job (if there are two parents, of course) until you enroll your own kid into the same system that produced you just the way you are now and the same story repeats. And repeats and repeats.

This story, even if it differs from individual to individual, is somewhat amazing to incredulous Europeans, who actually don’t think of the details and intricacy of how this average American mind is formed/created. They often just imagine that “Americans are dumb” (broad strokes of generalization, of course) but fail to take the whole system into consideration. When I tell this story to the average American, it is equally amazing because the semi-awake one never thinks about the fact that each chain in the link of his life is some spot where he has been further handcuffed into the, shall we say, chain gang? University costs – mostly free in much of Europe – healthcare – largely free in Europe – daycare subsidized by the state – lots of vacation time and maternity/paternity leave … sure, taxes are slightly higher (but honestly not that much) – and most do not feel like they are enslaved by their jobs. You can leave any time without risking health coverage. These too are generalizations, especially in this era of steep austerity cuts and unemployment at unheard of rates in much of mainland Europe (Scandinavia is not quite in the same position).

The general theme here, though, is that there is a tremendous freedom to this and an impetus to then really think. But how could an average American be expected to think with that whole backstory forming and informing his life?

The American lifestyle and system creates a certain kind of constant fear. Fear of losing one’s job, fear of violence, fear of being sued, fear of in any way being out of step with the norm. I thought about this one night as I was driving my long-distance commute back home and saw a guy hitchhiking trying to get from a town called Bengtsfors to Årjäng (none of which will be familiar to or mean anything to anyone reading this). It may not be charitable of me not to have offered a ride since I was driving right through Årjäng. But hitchhiking is dangerous territory. I have no idea if this guy posed any danger, and maybe anywhere in the world, it would be foolish to chance it, but even if it were almost a guarantee that it would have been safe, I still would not have done it. You can take an American out of America but not shake the full American paranoia out of them. I have more than my share of this paranoia, assuming that everyone has bad or dangerous intentions and ulterior motives. Being American has taught me never to trust anything.

Maybe it is crazy and sounds like I am looking for the boogieman around every corner, particularly in the working world. Somewhere in me, I find it fun to search and apply for (and interview for, if called) jobs. It did not start as a fun hobby – it was more out of necessity when I searched like mad to find a job (as was always the case in my earlier life – applying for 100 jobs and getting maybe one interview or something). But eventually when I did not need to worry about it anymore and did not need a job, I decided it was partly fun, a bit of a game and one can always use interview practice (and potentially a free trip somewhere). But it was partly this paranoia showing its face – companies go under, companies downsize, industries change – you need to be ready and out there and know what the bloody hell is going on. Be ye ever ready, right? And I am.

Before the big crash of 2008, I was living in Iceland and actually went on a lot of interview trips around Europe… Dublin, Antwerp, Brussels, Paris, Copenhagen, Stockholm, Luxembourg, Amsterdam, London, a few times to Helsinki… cannot complain. While it is not always practical, it usually pays off. I have never once been blindsided. If you are paranoid (and/or American) enough, you will always see the writing on the wall and READ IT.

One of my freelance/side “careers” has ended up being job counselor/life coach/resume-and-interview consultant. Not that I ever wanted to do that. Europeans especially need a bit of coaching in this department because they have never experienced the dog-eat-dog American work culture (and I hope they never reach a point that they experience something quite like that). But Europeans are too soft, and there is no doubt that some things in Europe are slowly moving in a more American direction (although I don’t think it will ever go to the extremes). In my last job, there was a huge reorganization a few years ago, and something like one-third of the company was laid off. When this happens, employment laws offer considerable protection, and most decent employers extend protection and assistance beyond what the law requires. Despite the “helping hand” and the clear signs everywhere that change was afoot, those affected by this first reorg (which they euphemistically called “right sizing”) were completely blindsided because they have never been taught (how nice for them) to read the signs of what is coming. I think most aware Americans in a corporate environment are always paying attention to little things because paying just a bit of attention may pay dividends one way or another. Of course Europeans might be told pointblank that change is coming but never imagine that it will have any effect on them. Many of them were devastated in the first round of layoffs, even though they were poised to get at least half a year of pay (even if they got a new job the next day, they would still get the full pay). And the Norwegian economy was not affected much at all by the global economic downturn – so most people found jobs immediately. Their sense of panic was almost cute in its “working world naivete”. Not that I think it is great that I am so on my toes and ready for anything all the time.

It turned out for the best, of course, when I was sort of part of a later “right sizing” process. I was, as always, prepared. It was rather hilarious when my manager called me to give me the “bad news” – kept saying stuff about how I must feel so devastated and would feel it when the shock wore off. But all these strategies and acute situation awareness enabled an automatic prewarning. I was not shocked; I was not surprised. I was ready.

As we know (or should know), life is not defined by work – or should not be. Somehow, this is where American life and “ideals” derail. Increasingly, people work and work and don’t get anywhere and won’t be able to afford (in terms of time or money) some way out of the situation they are in (this is probably already the case, and I am just out of touch). When I consider that people who work in the service industry do not come close to earning living wages, I am appalled. But the system is set up this way – to glorify and maximize corporate profit, to supply consumer demand for impossibly cheaper and cheaper goods sold in stores staffed by people who cannot afford to eat.

Lovely. What a happy Thanksgiving, America.