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social, health, political imagery through the lens of George J Huba PhD © 2012-2019

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May 21. 2020: it has been 47 days since I wrote this post. It is as true now as it was on April 4, 2020.

Every time I watch one of Donald Trump’s coronavirus briefings it makes me want to cry. We have 100s of thousands of superbly trained, highly competent, deeply committed healthcare workers every day who work on saving people who have contracted COVID-19 infections while not having a clean face mask to put on, a clean protective gown, simple hospital supplies like nasal swabs, and a test to diagnose whether someone has contracted the disease.

The national stockpile of relevant equipment is either empty because the Executive Branch of the federal government forgot to purchase needed items or the federal government is hoarding it. Our non-functional national stockpile of medical supplies and equipment is now being managed by the President’s son-in-law, an individual with no healthcare training, and who has engaged in various shady financial dealings in the past 10 years.

The level of incompetence is so high it is unbelievable. The president announces a new voluntary CDC recommendation to wear a face mask and then states that he will not look good while he is sitting at his Resolute Desk meeting with kings, queens, and dictators so he will not wear one. He tells us megarich individuals who own professional sports teams want us to come out to their mega-stadiums and sit shoulder-to-shoulder.

Trump always fails to explain how special our healthcare workforce is and never expresses the truth that he has asked them to work in very hazardous conditions by not purchasing medical protective clothing and shields.

We need to issue presidential orders to make needed protective and treatment equipment and supplies by a specified deadline or go to jail. Make companies who fail to produce needed supplies and equipment ineligible for any emergency funds or rebuilding assistance. The basic logic is that if a company refused to make need equipment and supplies need to save patients and healthcare workers they are ineligible for financial assistance.

The mind map shown provides a status report on where we are today, April 4, 2020.

I have written about this topic more than a dozen times since 2012.

I know that adopting visual thinking rules has made it much easier for me to weather the storms of cognitive decline and neurocognitive disease. I know that the same techniques are useful for caregivers and healthcare providers.

Think about making a small investment in time to explore the methods I recommend. Your initial attempts require no more “equipment” than a couple of pens or pencils and the back of a used envelope.

Think about entering the healthcare system as a patient. You get handed 5 pages of tiny font sheets to fill in with your address, person paying the bills, the medical history of yourself and two generations back every time you go in, You scribble out answers into tiny boxes and hand the forms back. Then they give you 3 small-font pages of legal disclaimers and conditions to read and approve.

Next a nurse takes you aside for a blood pressure reading, a weight assessment, and various other information. He scribbles all of the resuolts into a chart.

Next up the doctor enters. She scans all of the paper you filled out and what the nurse wrote down, and then starts asking you questions in a shotgun approach. When you comment that the answer is still what you wrote down 5 minutes earlier, she is not impressed.

Later the doctor gives you instructions. She goes fast but alo types the suggestions into an EMR (electronic medical record). You may lose the form (common with the cognitive diagnoses I have), not understand everything in the report, and not be able to read 2 point text. but at least you can recover what she wrote.

Don’t they always say a picture is worth 1,000 words? Don’t most people agree with that statement?

For the current aging birth cohort (boomers), images are a way of life. Photos were available when we were born and financially accessible to most by the mid-1960s. The number of pictures increased in newspapers and later on the Internet over the past 50 years. Immediate images and videos from the ubiquitous smartphones have been available to the majority of world-wide families for the past 5 years.

Home black and white television sets became very common in the 1950s and color televisions in the late 1960s.. By the 1990 many US homes had more than one television set. In the 2000s screen (flat panel) sizes at least doubled in size in most homes. 700 channels and 3 TV sets and and nothing on.

We all use images constantly and reading text is going down. We primarily get our news from pictures on the Internet, in print media, and shared with friends or on social media. Pictures are used to influence our attitudes, behaviors, preferences, and to sell us products.

I have been working hard at creating and using images in my own healthcare for the past 9 years after I was diagnosed with a progressive neurocognitive disorder.

About six months ago I had a PET scan of my brain as well as my fourth MRI since 2010. I now have two neurologists. The secondary one (a cognitive neurologist who ordered the scans) emailed me a one page written report wit the results. No images were shown on that report. At my following appointment she discussed the report with me. She commented that there were no images to see. I then asked her if she was going to correct the conceptual typo in the report. In the first summary paragraph of the report it said that my PET scan was normal; the remaining two-thirds of the report gave numbers that indicated portions of my brain were not functioning well. Then the first paragraph was repeated at the end but this time the summary was identical in all but one word which said that my scans indicated significant problems. The doctor sent an email to medical transcription while I was there pointing out the problem.

I asked to see the scan and was told that there was nothing for me to see. I was more than a little surprised by that (well a lot surprised!). I had thought that it would be cool to see which parts of my brain were goners and which were lighting up.

A month later I saw my primary neurologist who has been in charge of my care for more than 9 years. I asked her if she had read the report on my PET scan and last MRI. I explained that I was really surprised that the other neurologist told me that there was nothing for me to see. So she then went to her large clinical display, called up my file and showed me sequential MRI and PET scans. It was pretty easy to see changes in my brain over time. Nice pictures, too. I learned a lot about my treatment and disease progression over time.

A picture is worth 10,000 words. Five scans over 10 years is a treasure trove.

Visual patient-provider information exchanges can be aided by images. Self management and that by a caretaker can be aided by images. Memory can be enhanced with images. An understanding of the problem may be more easily achieved by family members and the patient when supported by images. This is a win-win-win-win situation.

The system I used for creating images to manage information allows me to manage myself better, relieve stress I put on caregivers, understand medical research better, and communicate with my doctors clearly. It primarily uses mind maps. Both neurologists have concluded that I use my techniques to compensate for some of my neurological (brain functioning) problems.

There are about 700 posts on this web site about issues in using mind maps, how to do it, my experiences, and “real” examples of using visual thinking methods as my cognitive functioning declined.

Oh … It should be noted I estimate that using visual methods of processing medical information for ONE YEAR are very inexpensive in comparison to ONE Emergency Room visit, ONE primary health care visit, ONE week of a patient’s period of acceptable cognitive functioning, ONE day of wasted homecare, ONE day out of work for a family caregiver. Now let’s multiply that by the number of Americans receiving healthcare through self pay or public insurance programs (Medicaid, Medicare, others) or private company managed health insurers.

Here’s another mind map about how the healthcare system might be made better (and less expensive) by incorporating health care information into mind maps and passing them around among patients, caregivers, family members, friends, physicians, nurses, and other healthcare professionals.

Click the image to expand the mind map.

I looked at this application when it first came out a couple of years ago.

It has improved significantly.

This is easier to use than my favorite program iMindMap. It is also a lot less expensive.

[Do not confuse this app with Xmind 8, which is the more complete but harder to use version. Xmind 8 is much more expensive. Xmind ZEN produces more attractive maps and works MUCH better on small screens (mobile phone, pads).]

I will continue to use iMindMap 11 because of its status as the very best mind mapping app and I use all of its features. If you do not need all of the fancy options, this is a very good program for a beginner (and expert).

Click on the mind map to expand it.

Xmind ZEN

The Veterans Healthcare System is the most important one we have in the USA.

VA

One thing that all of the cable news networks and newspapers agree on is that issues of veterans’ health are ones on which all members of Congress seek to achieve a consensus. An interpretation of this that I have heard from the TV pundits is that all members of Congress, whether veterans or not themselves, respect those who risked their lives to protect the United States and police the world. Another interpretation I have heard is that all members of Congress need to face constituents who value service in the military and would not vote for a potential member of Congress who does not protect those rights. I prefer the first interpretation, although I would also accept the second. Veterans have earned lifetime healthcare services and those services should be the very best that the medical and social services can provide.

I was very happy to see the strong reaction of Congress to the poor candidate nominated recently to head the Veteran’s Administration. A doctor who has managed a staff of 70 healthcare providers is probably inadequately prepared to run a large federal agency with hundreds of thousands of employees, 9 million patients, facilities across the US, and many political entanglements. Just because you are the personal physician of the US presidents and praise the current president’s health in spite of his all-fast-food diet, borderline obesity, and behavior that indicates high levels of stress does not mean that you should be rewarded with a job in charge of the quality of the healthcare of 9 million veterans. And no doctor who hands out medications on airplanes without prescriptions or having personally met with the recipient (patient) and is accused of inappropriate interpersonal behaviors is deserving of being trusted with the health of our veterans.

For once, Republicans and Democrats agree that the candidate was not qualified to head the Veterans Administration. And they achieved this conclusion by consensus.

So the nominee did the right thing and withdrew from his candidacy after a lot of pressure from the White House.

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Wouldn’t you like to see our elected representatives act with similar wisdom and common sense every time they make a decision? CONSENSUS!

Tinkerbell thinks so.

tbell

And I am wishing upon a star.

 

 

  • 22 MILLION people lose healthcare insurance (final House Trumpcare Bill)
  • 23 MILLION people lose healthcare insurance (first Senate Trumpcare Bill “repeal and replace”)
  • 20 MILLION people lose healthcare insurance (second Senate Trumpcare Bill “repeal”)
  • 16 MILLION people lose healthcare insurance and premiums go up 20% immediately for those who must buy individual insurance  (proposed Senate Trumpcare Bill “skinny proposal” to be voted on today)
  • 7,000 honorable, competent, and patriotic enlisted men and women “fired” from the US uniformed services because they are transgendered; they will lose their employer provided life insurance
  • 1 Attorney General currently being viciously shamed in the media hourly by the President
  • 1 Vice President mirroring the President’s viciousness
  • 1 Secretary of State currently under attack from the President
  • 1 FBI Director fired
  • 1 Special Counsel likely to be fired
  • 100s of BILLIONS of $dollars possibly illegally transferred from Russia to individuals associated with Trump and the Trump campaign
  • 1 Country under cyber-attack by the Soviet Union (whoops, Russia) and whose President is acting as if the Soviet Union is America’s BFF rather than a “gas station with nukes”

Those numbers are numbing and scary.

Numbing Numbers

The numbers listed below could counteract those listed above.

  • 435 members of the US House of Representatives that could impeach a sitting president
  • 100 members of the US Senate who could convict a US President and Vice President and Cabinet Officers of “high crimes and misdemeanors.
  • 1 President who could resign at any time
  • 1 Vice President who could resign at any time

We see so many of these ridiculous numbers every day that the country seems to have become numb. That’s a very bad thing indeed.

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ObamaCare revised/enhanced?

Trump/RyanCare another draft not submitted to Congress?

Within the extant and mythical healthcare plans, additional dementia care services need to be included. Most are cost-neutral or may actually save money while providing better patient outcomes.

Case Management makes existing healthcare services (doctor visits, medications, emergency care) work better. At a very small cost that should actually SAVE money, case management can provide better total patient care, cut unnecessary emergency room visits, and achieve better medication outcomes. What isn’t there to like?

Dementia Caregivers are most often UNPAID, female family members forced to juggle their own jobs/finances, families, and general lives to care for a loved one. Support is required for Dementia Caregivers in the forms of training, support, advice, and FINANCIAL COMPENSATION for their services. They do the work, they should get paid for their time. An upgraded system of paid family caregivers should make DementiaCare more effective and reduce other costs in the healthcare system to such a degree that it will be cost-neutral. An unnecessary hospital stay or emergency room visit can cost as much as $10,000 — $20,000. A family caregiver could be paid for 500 hours at $20 per hour for $10,000. Train family caregivers, pay them, and you have a cost neutral system. What isn’t there to like?

Mental Health issues often lead to huge patient distress, anxiety, and medical management problems. They can frustrate caregivers and lead to nonadherence to medication recommendations. Therapy and counseling can help patients and caregivers as well as cutting overall medical costs. What isn’t there to like?

Group Adult Daycare can provide needed respite for family caregivers as well as important social and recreational experiences for patients, thus enhancing their lives and to some degree ability to function independently. What isn’t there to like?

The following mind model provides some details. Click the image to expand it.

 

One way that healthcare communication can be made more effective is to supplement or replace traditional pages of small-type textual information with graphic displays such as mind models (AKA mind maps), sketches, graphs, and infographics.

This post focuses on mind models (mind maps). The same general arguments would apply to sketches, graphics, infographics, and other visual information methods designed to promote a more effective patient-oriented healthcare system with more complete, accurate, and easy-to-understand information for all.

If you are not familiar with mind models (mind maps), you should look at the mind map at the bottom of the page first (Footnote).

To expand the graphics, click on the images.
effective-healthcare-mind-models

 

Footnote

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Healthcare (medical, health, mental health, nursing, and other health professions) mind models (or mind maps) are not the same as those plain old “knowledge” mind maps you are used to seeing.

When you start to put a compelling and artistically sophisticated mind map together that gives symptoms for diseases or recommended treatments or medical information ranging from how to put on a bandage to how deal with your elderly mom’s dementia, you have entered the realm where misinformation can hurt people. Most of the health and medical information mind maps on archival websites like Biggerplate.com have errors of content ranging from being out-of-date to misleading to downright harmful. It is not necessarily enough to read something even from a definitive source and mind map it. Rather, you have to identify definitive sources and then know how to evaluate their claims against more recent research and regulations and criticisms by credible sources.

Being called (by yourself or another source) a professional or expert or inventor mind mapper does not mean that you are qualified to mind map health or medical information. It takes at least 22 years of total education to get through the formal training and supervised practice to meet the requirements of most types of professional health-related licensure in the USA. Physicians and nurse practitioners may need to complete as as many as 32 years of formal education and supervised practice. All licensed healthcare professionals are subject to requirements for continuing education requirements after completing training and licensure in most US jurisdictions for most fields.

So before you decide to read a book on dementia and make one of your wonderful artistic mind maps, think about whether you have the necessary professional training and experience to read the relevant research and clinical literature accurately and with the perspective and sophisticated judgment that can reject erroneous claims. And when you start to make claims that mind mapping or some herbal supplement or yoga or cognitive training or crossword puzzles or some exotic mumblings you heard in Haiti can cure or treat or prevent dementia, make sure you realize that if you provide false information you may be hurting people and possibly incurring a financial liability. I respect and use mind maps (and especially Huba mind models) from people who clearly have expertise in healthcare, medicine, psychology, and related fields. I do find the mind maps of “professional mind mappers” and mind map “inventors” and mind map developers to be very poor in their content when they try to stray into healthcare-related content they really do not understand and do not stay in the areas of management consulting, training, and brainstorming where they made their fortunes.

This is a consumer-beware situation as no one regulates mind maps and their content.

A mind model (AKA mind map) looking at the issues that can arise because healthcare mind maps are not typically within the expertise of individuals identified as expert mind mappers who have not been trained in a health-related field.

Click on the image to expand it.

A Healthcare Mind Model (Mind Map) Must Be More Than A Regular Mind Map

DGS_Robots-04

This is another recording of my own development of mind maps to illustrate that this can be a way of communicating ideas while having cognitive impairment. I can develop models like this in less than an hour and have them published immediately on my web site.

Other posts in this sequence are

Part 1

Part 2

Part 3

Part 5

Part 6

Verbally I cannot get two sentences in a row out of my mouth so as to explain these ideas to others. Were I to try I would also be distracted by everything going on around me and probably experience great anxiety and coughing fits. You would also find it difficult to interact with me because you would want to end all of my sentences, be unable to look at me because my face goes into a fierce expression most interpret as anger when I am thinking, and be off-put because I often go into repetitive body movements (tapping fingers and feet and rubbing eyebrows) when I get moderately anxious (or worse).

This medium works. I attribute this both to the benefits of the mind mapping for everyone whether cognitively impaired or not and also to the fact that using these techniques I seem to be able to access parts of the brain that for me are less damaged than many of the other skill centers (such as speaking clearly or understanding others verbalizations or recalling the words I want to use to answer questions until 90 seconds later). Using it also makes me anxious, but much less so than trying to express myself in even small social situations.

Very importantly, the mind map lets me continually see my prior train of thought as I work. I don’t have to try to remember what I thought about 30 seconds, or 10 minutes, earlier because it is right in front of my nose on the computer screen. This is a HUGE assist.

The map is compressed so that 8 minutes appear as 1 minute. Just watch the video unfold. Then you can look at the final map more clearly using the static map.

The final mind map is shown in static form below. Click to expand.

Visual Thinking-Communication  Mind Maps Needed in the  Healthcare System

In Part 1, I discussed the benefits and costs of providing training to Persons with Dementia, Dementia Caregivers, and Healthcare Providers to empower them to use mind mapping methods.

I noted that unlike the traditional trainings given to primarily business users, healthcare workers and patients would need training which covered BOTH how to develop an effective mind map and specific ways to use the mind maps to enhance patient-centered care and patient-provider-caregiver communications and documentation.

I think that the minimal training in aggregate for the three stakeholder groups can be summarized in the following mind map. Note that not all modules (topics) are necessary or appropriate for all three groups.

Click mind map to expand.

Suggested Training  Topics for  Use of Mind Mapping by  Persons with Dementia,  Caregivers,  Healthcare Professionals

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I have argued for several years, especially in my book “Mind Mapping, Cognitive Impairment, and Dementia,” that communication among persons with dementia, their caregivers, and healthcare providers can be greatly improved by using visual thinking methods.

Mind maps are probably easier to understand for many persons with dementia than the traditional forms, small font information sheets, lists of to-do items, pharmaceutical labels, and guidelines. Mind maps can be used for visual journals and diaries that can still be understood at later stages of the disorder.

To use these methods effectively, it is imperative that healthcare providers and caregivers be trained in effective mind mapping methods. While many medical students are shown how to mind map, the techniques used are actually very ineffective ways of visual outlining that employ few, if any, of the real strengths of the method. These outline maps are clearly not appropriate for persons with dementia. Hence caregivers and healthcare providers need to be trained in “real” mind mapping methods AND how to communicate with these methods with persons with dementia.

Most of the trainings and mind mapping books and web sites are oriented to business users, especially at the management level. I have yet to find training sessions especially geared to both the mind mapping and patient care and management issues implicit in healthcare and caregiving. So how should we train healthcare professionals and caregivers to use mind maps effectively for the benefit of the person with dementia? The following mind map is a set of suggestions for how to train such individuals effectively. The trainings are designed to produce mind mapping experience specifically focused on patient care and management of those with dementia.

Click on the images to expand.

Training  Dementia  Caregivers  and Healthcare Providers to  Mind Map 3DTraining  Dementia  Caregivers  and Healthcare Providers to  Mind Map

2015-04-07_11-33-24

The majority of the posts on this blog are about using visual thinking methods — of which I think that by far the best is #Buzan-style organic mind mapping — to understand, explain, evaluate, and communicate about healthcare. A lot of my own thinking has focused on using visual thinking techniques to potentially improve the quality of life of those with cognitive impairment and dementia.

Tony Buzan and Chris Griffiths and their colleagues and staff at ThinkBuzan have done a very comprehensive job at getting many of Buzan’s ideas embedded into a general purpose computer program (iMindMap) which provides a general visual thinking environment, of which mind mapping is a special part. There are many computer assisted mind mapping programs, but I have concluded that iMindMap is by far the best for creative visual thinking and communication, in no small part because it fully incorporates Buzan’s theory and theoretical implementation.

Like scientists and management consultants and educators and healthcare providers and patients and patient caregivers and students and many others, illustrators struggle with how to best use visual representations to support better thinking and communications.

Which brings up this beautifully conceived and executed little book that I have found to be mind expanding and liberating in how to develop and use a series of illustration techniques and “tricks” to look at things differently when trying to make creative breakthroughs.

Whitney Sherman is the author of the book “Playing with Sketches” which provides 50 exercises which collectively will change the way you think about creating images to understand and communicate ideas.While Ms. Sherman wrote the book for designers and artists, the techniques will be just as useful for visual thinkers in science, education, medicine, industry, and other fields. The beauty of Ms Sherman’s exercises is that in showing you fairly simple ways to make hugely informative and well designed images, the tools will themselves suggest many applications to visual thinkers of all types.

And, I have found that Ms. Sherman’s techniques can be used by the severely artistically challenged (of which I am one); the techniques are ones for Visual THINKERS, not necessarily artists and designers.

I have mentioned this book before in much less detail, but in the months I have used the methods, I have found that they WORK very well to facilitate creative visual thinking. For me they have promoted a breakthrough in how I see the visual thinking canvas.

Get the book, try some of the techniques (pick a random one here and there to start), discover that great artistic talent or aptitude is not required, and see how the techniques fit the information you study in search for better healthcare or disease prevention or decision making or facilitating creative group processes.

In partnership with Tony Buzan’s techniques for organic #mindmapping and Mike Rohde’s framework for #sketchnoting, the techniques codified by Whitney Sherman provide very powerful visual thinking tools.

Ms. Sherman’s website is http://www.whitneysherman.com. She tweets at @Whitney_Sherman. The book is available from major online book sellers.

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I will be posting some examples of using the sketching techniques of Ms. Sherman to developing assistance and communication techniques for those with cognitive impairment or early-mid stages of dementia.

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Walmart today eliminated health insurance coverage for 30,000 workers who work less than 30 hours per week. Trader Joe’s, Target, and Home Depot had already done the same.

What do you think a low wage employee at Walmart or Target or Trader Joe’s or Home Depot would do if their employer offered them the opportunity to work 31 hours per week instead of 29?

I smell a rat that the Republicans are calling Obamacare and I would call the GOP (Non-)Insurance Plan. Either way, many US workers are screwed by the actions of these big employers.

And who works for Walmart and Target and Home Depot and Trader Joe’s? When you shop there do you conclude it is the elderly who still need to work in their 70s because they never worked at companies that ensured that they would have enough funds in their retirement or high school dropouts (often single moms) or the disabled or recovering drug abusers or those with mental health issues or an over-representation of minority workers, many of whom are recent immigrants? I do.

So these big box stores are basically selecting an unempowered, vulnerable group of workers who can be paid minimum wage (or close to it), denied healthcare plans, and work under what often appear to be draconian conditions. Who pays to fix this? You and I pay taxes to provide Medicaid (and Medicare Disability) benefits to those who have nowhere else to go, and of course you and I also provide additional services to dependent children in the families of these Walmart and Target and Home Depot and Trader Joe’s employees. All of the money you and I pay to fix the Walmart mess is  so that billions of dollars more can go to benefit a half dozen of the wealthiest Americans holed up in Arkansas.

We need to get this fixed. It is very clear that neither American political party has the acumen, motivation, humanity, and pure “guts” needed to right this situation once and for all.

Walmart and Home Depot and Trader Joe’s and Target will notice it if their sales come down 10 percent as a consequence of the poor treatment of their employees. Heck, they would notice if the sales came down 1 percent.

This is not a Democrat or Republican or Independent or “I don’t vote because it doesn’t matter” issue. This is not a minority issue nor is it an elderly issue nor is it an immigrant issue. The issue is quite simply that it is not right to tell a worker who goes into a fairly hostile work environment, works hard while there, and wants to continue to work instead of being dependent on public programs that they cannot work more than 29 hours a week because the company can make a lot more money by employing lots of “almost full-time” workers rather than full-time workers because it can deny workplace worker benefits.

These companies are causing their workers great pain and suffering by not paying living wages and providing enough hours to workers so that they can qualify for benefits and keep their families out of public programs. After all, the American dream is that working hard 40 hours a week will permit your family to enjoy at least a moderately comfortable life and provide your children with a good education and you with adequate healthcare and savings for retirement.

Your elected officials aren’t going to do anything. YOU can find other retailers that treat their workers fairly and buy your dog food, clothes, medications, motor oil, music and video disks, garden supplies, vacuum cleaners, condoms and lube, aspirin, watches, and cameras there. And I am sure there is a humane company who will sell you all of the power tools you want at the same price as Home Depot and also provide its workers with health insurance.

Make a loud enough noise and some alternate vendors are going to come out and show that they do pay their workers fairly and they would be glad to sell you the same goods you can buy at Walmart or Target or Home Depot or Trader Joe’s at the same or better prices. The free market is a powerful force for good as well as having a potentially dark side.

Capitalism is a great thing. Give your business to a humane company that will sell you the same stuff as the big box stores while also making the lives of their workers better and you will be practicing Humane Capitalism that rewards businesses for having great prices AND good conditions of employment.

My dog is not going to be eating Walmart food any longer. Hopefully your dog will not be eating it either. And I am no longer searching through those big bins of $3.99 DVDs in search of a movie with lots of plane, train, and automobile crashes.

After all, Walmart is already the worse kind of a train wreck imaginable.

The_Zombie_Angry

 

I drew this mind map in 2011 when I was disgusted with the lack of a organized process to develop a national consensus on what was needed for meaningful healthcare reform. I think this as true in 2013 as it was in 2011. Stylistically, I could redraw this map better now than in 2011. But everybody has to start somewhere, so I resisted that impulse.

I would note that some (all) of these scientist “types” are found in the US Congress (whether scientists or not).

Everybody in Congress wants the peanuts and bananas and too many act like King Kong.

Also note that I have been on consensus panels with all of these types.

Scientific Consensus Panel on Healthcare at the Zoo

I was sitting in the office of an individual designated as an “essential” federal employee at mid-morning on November 14, 1995. We were meeting at the US Department of Health and Human Services, Health Resources and Services Administration main offices in the Parklawn Building in Rockville, MD.

My federally funded Evaluation and Technical Support Center for a HRSA Initiative on Implementing the zidovudine protocol for preventing HIV transmission from HIV-positive mother to her child during birth was meeting with 10 federal grantees the next day in Baltimore. The meeting was mandated by the HRSA funding agreements.

Each project had at least three staff in transit to Baltimore (most by air) for the meeting the next day. At least one representative of each project was a woman living with HIV/AIDS; this was mandated.

The bell rang at noon in the Parklawn Building. The loudspeakers had started squawking earlier reminding all non-essential employees that they must exit the building by noon. Guards came through the building reminding people to leave. It was eerie to be in the second-largest US federal office building with almost no other people around.

I met with the essential employee, the head of a very large program on HIV/AIDS treatment. She could not tell me whether to have the meeting the next day. While she could guarantee that the representatives from the projects would have their travel reimbursed she could not tell me whether the scheduled meeting rooms, scheduled food service, and other costs would be covered although she would allow me to pay for costs already agreed to through contracts with the hotel. She did note that we could not use use the meeting room we had paid for nor eat any of the food we had pre-paid. The meeting would no longer be a federal meeting. Everybody there was just a private citizen meeting because they wanted to be there after being stranded by having flown to a mandatory federal meeting that was cancelled without notice. No federal employee, however, could be at the meeting because they were not working and they were not allowed to go to any activity that could be construed as federal “work” since they might then demand payment for their time.

I had to tell this to about 50 attendees at 9 am on Wednesday morning. The Maryland Dept of Health agreed to let the group use space at their offices 15 or so blocks away. Everyone walked over there in freezing rain. Maryland made available a conference room that could seat about 12 comfortably, about 25 uncomfortably, and the rest squeezed in and stood. The State Director (part of the group) lent us her personal 10 cup Mr Coffee to brew coffee. In trying to make enough coffee for 50, I broke it, and when I returned to California, I sent her another one by FedEx because I was a little annoyed that she got very upset that I had dropped the $20 machine and had announced to 50 people that I was the reason there was no coffee.

After about an hour or so of chaos and having everybody totally upset — as they should have been — about having about 15 women with HIV (many with advanced stage AIDS) in an overheated claustrophobic facility along with another 35 people in an overheated claustrophobic facility, I decided that the company I owned would personally guarantee the costs for the meeting facilities and food that had already been paid — if the government asked for the money back from anyone because I had decided that those who had come to Baltimore in good faith could meet in the rooms already paid for and eat prepaid food that was going to be thrown out. As I recall this was probably close to $5,000 or more. Fortunately no one ever asked me for the money back and since I over-ran our budget by far more than $20,000 (which we never billed) in part because the feds had totally screwed up the process, that we were even. And, no woman with HIV had fainted or otherwise hurt herself during the meeting because we did not have healthy conditions.

The grantees were — as would be expected — totally pissed off. The initiative ran for several more years, but in a fairly “inefficient” way. Chaos. The feds went back to work after Thanksgiving, but then went out again for more than a month starting in mid-December when Newt Gingrich and Bill Clinton still would not do their jobs. When the budget was settled in mid-January, the government announced it would pay all of the federal employees for all days they had been sitting at home in Maryland and Virginia and the District playing in the snow and worrying about their personal finances.

A demotivated, angry workforce went back to work to deal with a number of demotivated, angry contractors and grantees. It wasn’t the same for another two years.

Obamacare was passed by a majority of the US Congress, all of whom had been elected by the majority of their constituents. It was signed into law by a President elected by the majority of the US electoral voters as specified in the Constitution. When the Constitutionality of Obamacare was challenged by those who did not like it, the majority of the Supreme Court Justices, each confirmed when appointed by a majority of the US Senate, decided that Obamacare was constitutional.

Each step of passing Obamacare into law was done according to the specifics of the US Constitution.

Those attempting to derail Obamacare by using certain procedural technicalities in ways never intended and just plain silly, are acting in opposition to the approved Affordable Care Act passed by the Congress and approved by the President and the Supreme Court according to the procedures specified in the US Constitution.

Are those in Congressional representatives holding the budget hostage Congressional “Leaders” or (in words attributed to Al Gore) “terrorists?”

Today, I hope that the US government will decide to “feed” those sitting around waiting for their US Congress and Executive Branch to meet their Constitutionally assigned responsibilities that the elected officials of the United States have sworn to uphold. Fortunately World War II vets in wheel chairs were allowed to look at the barricaded World War II memorial on the federal mall today (the barriers were lifted by Congress members in front of TV cameras); my further hope is that all of the veterans in VA hospitals get fed dinner tonight whether or not the TV crews are parked in front of the facilities.

Those elected officials who claim that their Tea Party is as much against “taxation without representation” as the founders were in 1776, obviously have not read the Constitution resulting from the actions in 1776.  Thankfully, a majority of the Supreme Court justices and the President were in school that day.

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ELIMINATING AIDS FROM THE PLANET  G J HUBA PHD  JULY 2012

One thing I have always feared about nursing home or home healthcare is that somebody who barely knows me would park me in a wheel chair or on a couch watching endless reruns of I Love Lucy or the Price is Right. Or ask me to endure hours of Kenny G or Hayden. Heck, if I have to watch TV for the rest of my life, at least put Battlestar Galactica or the college World Series on. Or Wynton Marsalis. Or Rocky and Bullwinkle.

Click on the figure below to expand. Seriously tell your caregivers and family members what you really like so they don’t have to guess. And so that they might remember you. As you really were.

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Click on mind map to expand.

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There are a number of things that can be done to cut the cost of healthcare while, at the same time, freeing doctors and others to do their jobs better. These improvements cost almost nothing to implement [if all of the constituencies and politicians do not compete to be King Kong].

Visiting legislator who stumbled across this web page? Here’s your chance to act like a grown-up and represent the people of the world, not drug companies nor major research universities nor individual “researcher” egos and retirement funds.

Click on images to expand.[almost free] strategies to improve healthcare

Cartoon Rabbit - Giving A Thumbs Up

The Old …

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The Current …

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And the Ideal

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  • Click on images to zoom.
  • Note that both the placement of the circles AND the front to back placement are significant and intentional.