MIPS

1. ——— is slow (2 pph/patients-per-hour), and really limits speed efficiency and quality and safety. It is harder and takes much more time to document and enter orders using ———  than any other EMR I have used wity includes: Cerner-Powerchart, VA-VistA, Epic, and even paper (T-sheet, Generic Template). Of all the documentation tools I have used, ———- is the absolute worst and slowest and most dangerous.  I can’t believe a company that is so focused on numbers can at the same time employ such an inefficient system like ———.  Honestly, the fastest documentation system was using generic paper templates (3.5 pph) where HPI, ROS, PE, and orders could be filled out with a pen in an unabtrusive manner while getting the patient history.  You leave the room and orders and most of the chart was already done.   As far as EMR goes, EPIC is the best (2.8 pph). 

2. The Emergency Department should be allowed to give verbal/written orders to our nurses which can be later cosigned . ED physicians face continual interruptions by nurses. Instead of a quick response like “yes” or “make it so” to a question like “Can I give 1000mg tylenol to Rm 21 for fever?”, the ED physician is forced to stop what they are doing,  interrupting our train of thought, and enter this order.  These interruptions lead to mistakes.  The interruption is a result of the fact that only one order can ever be entered  in at one time by the physician (even with 2 ——— screens open).  This is a significant bottleneck.  Also, many times ED physicans are forced to leave a patient bedside to enter orders instead of giving verbals or having written orders taken at the bedside. Many other services at ———take written verbals except for the ED.  All other hospital I have worked at accept verbal/written orders.

3.  ———needs more rooms.  We have an excellent new ED faculity, but are forced to see patients in a chair in the hallway because all our ED rooms are continually filled with admitted patients boarding in the ED (10-15 nightly).  It is unfortnate that the new ED was not designed to provide more rooms than our old ED.  This was an unfortunate oversight.   We had already outgrown our new ED even before moving in.   The ED physician is scrutinized for almost every aspect of our decision making.  Who gets scrutinized for not planning to supply enough staffed rooms in the hospital and ED?  

4. I am supportive of following all hospital, federal, national protocols and guidelines.  However, the ED and hospitalist are easy targets.  We are too busy working to even speak up for ourselves.  It seems that if healthcare can easily divert attention onto the ED, then everyone’s attention is diverted away from other issues.  In my opinion, the ED is neither the problem nor the solution, we are just easy.  

When the insurance mandate and penalty associated with the Affordable Care Act was being debated by the Supreme Court, the justices asked the question again and again, “Can the Federal government punitively require people buy brocolli”.  The federal government can prohibit harmful behavior, but does it have the right to require and punitively enforce what it deems to be good behavior?  This issue came up in Canada with proposed penalties for persons failing to use gender neutral pronouns ‘ze’ and ‘zir’. Now with MIPS, the federal government is penalizing/fining doctors for not complying with MIPS requirements. Is this fascism?

Thank You

Globalist knowing funded ISIS

https://www.theguardian.com/commentisfree/2015/jun/03/us-isis-syria-iraq

https://www.nytimes.com/2017/08/02/world/middleeast/cia-syria-rebel-arm-train-trump.html

https://www.zerohedge.com/news/2015-05-23/secret-pentagon-report-reveals-us-created-isis-tool-overthrow-syrias-president-assad

“According to the newly declassified US document, the Pentagon foresaw the likely rise of the ‘Islamic State’ as a direct consequence of the strategy, but described this outcome as a strategic opportunity to “isolate the Syrian regime.” 

https://levantreport.com/2015/05/19/2012-defense-intelligence-agency-document-west-will-facilitate-rise-of-islamic-state-in-order-to-isolate-the-syrian-regime/

https://www.judicialwatch.org/press-room/press-releases/judicial-watch-defense-state-department-documents-reveal-obama-administration-knew-that-al-qaeda-terrorists-had-planned-benghazi-attack-10-days-in-advance/

https://levantreport.com/2014/09/13/isis-as-u-s-creation-the-clearest-authenticated-video-evidence-to-date/

https://www.npr.org/sections/thetwo-way/2013/05/09/182665171/top-u-s-official-meets-with-rebels-inside-syria

https://youtu.be/yGaSghFK0nI

https://www.cnn.com/videos/world/2015/07/30/abdul-jabbar-akidi-free-syrian-army-intv-amanpour.cnn

Apache Helicopter escorts ISIS

Iraq Army ordered to retreat

Bulgarian Weapons, Silkway Airline, Purple Shovel

Church and State

A.  We live in a very narcissistic society, where a larger number are playing by different social rules.  One side believes the rules of society don’t apply to them because they are better, smarter, richer, G-ds choosen, more connected, etc; and the other side believes the rules don’t apply to them because identity politics tells them they are a victim of oppression.  Everyone playing by the same rules leads to greater social capital and cooperation. 

1. Let’s lay down the rules of social order (virtue)

2. Let’s keep them (personal responsibility)

3. Let’s all play the same game. (few exceptions)

4. Let’s reinforce that social order through our support of positive art and media that reinforces the rules instead of undermines them. 

B.  Capitalism vs. Marxism is a false dichotomy.  The rich do have a duty to help the poor or underprivileged.  The real question is whether it’s the government’s or religion’s job to administer social justice.  According to James 1:27, the job of social justice is religion and this is because government can’t legislate/mandate positive behavior (accountability).  Government can tax and redistribute, but they can’t rehabilitate.  Consequently, government entitlements make people entitled and enable the poor to stay poor.   I believe in a separation of Church and State, and the Stare needs to get out of the business of religion.  Religion needs to start doing its job (welfare and virtue). 

Only religion can mandate positive behavior (the government shouldn’t require people buy and eat broccoli).  But this may be the whole point and aim to get us to that point.   Government protects by punishing harmful behavior.  But more and more, government is beginning to punish what it determines to be lack of performing beneficial behavior.  Dictating behavior and enforcing behavior/practice through penalty = fascism. 

1. Obamacare mandates purchase of health insurance and fines lack of purchase.

2. MIPS: fines doctors 10% if they depart from practice guidelines. 

3. Canada tried to fine people who failed to use gender neutral pronouns. 

Free Market without the Capitalist

Do we think it possible that capitalism vs. communism might be a false dichotomy?  Power corrupts and absolute power corrupts absolutely.    America was created on the foundation principle of the separation of powers. Why did America successfully divide political power but accept a gross consolidation of economic power?  How do we have a free-market system without the capitalist?  How to we get billion-dollar Microsoft, without Bill Gates?  (no offense to Bill Gates).  But Bill Gates and the controlling stock holders of Microsoft may have elected power (dollars), but they have no term limits. 

The key is finance/banking reform.  A major issue behind the American Revolution was control over our own credit and currency. Instead of consolidating economic power into the hands of a “robber baron”,  an equitable economic system would grant credit based on the combined credit of all the members of a corporation and all the members of a community and the projected revenue of their venture (projected sales or ear-marked taxes).   Each member of the community or corporation would then become a stock-holder/partner and entitled to benefit from future profits.  

Conspiracy Theory: Patriarchy

https://youtu.be/TmNSlF7lcaw

One side argues that there exists inequality and oppression in the world.  Feminists claim the source of oppression is conspiracy of patriarchy. The other side seems to deny that a men-based conspiracy exists but the results are individual and based on competence.

But this denies that there does exist evil in the world, and that evil does organize and is organized.  Organized evil is the source of much oppression.   That said, despite the organized evil in the world, anyone’s first priority and defense is personal responsibility, virtue and competence.

The feminists cries out against the materialism of the Western culture, but much of what feminists call for is materialistic.  

My wife is very accomplished professionally. However, I will never equal her innate ability to comfort and nurture our children.  This doesn't mean there isn't a dad out there that is better than the mom at nurturing children, but generally speaking, women’s brains and dispositions are wired to be better at these tasks. On the flip side, there are physical tasks that I am generally better at then my wife just based on the fact that I am 6’1”, 220 lbs and she is 5’5” ans 120 lbs. 

Men do generally need to work and provide for their families because they more easily find meaning in this way. I’m nor saying men can’t be a stay-at-home dad and find meaning but its not as easy.  Stay-at-home dads are not just working against arbitary social norms, but also working against biology. 

The feminists talked about being judged on breastfeeding—if at all, how long, how short, etc. But its not men who judge this. Ita other women judging other women.

Apart from the debate about if man-made climate change is real, is responsible for increased erratic weather, and if its affecting a lot of people.  And apart from humans being able be helped to do anything about it unless we adopt BYU cabon-capture technology.  And apart from the economic and liberty consequences of implementing policies to limit CO2 wgich may negatively affect more people more severely than bad weather did. The best thing about being human is our capacity for adaptability. If we develop skills, and virtue and self-mastery we can be better adaptable to changing economic situations, climate, downturns in market, and even war. 

We need to be and can be more resilient and avoid throwing up our gand feeling like helpless bictims to powerful forces that our beyond our control.  Instead of focusing on improving personal skills we are fooled into thinking backing some political movement or internet personality is going to shift the global tide.  The truth is, the best attitude and action plan to addoot is to expect that global tides will likely shift against us at some point and prepare evey day to be ready for it. 

Are you worried about global warming?  What can tou do about it personally?  1. Put solar on your house 2. Drive a used hybrid or LEAF.  3. Don’t live anywhere neer a flood zone or forest fire zone or on a major EQ fault, or in the path of a hurricaine. 

I do agree with Jordan Peterson that people adopt many of these ideologies (climate, PETA, socialism, femanism) as pseudo-morality as a way to find meaning: to feel important, feel like they are a good person and look good to others. 

We live in a very narcissistic society, everyone is playing by different rules.  One side believes the rules of society don’t apply to them because they are better, smarter, richer, G-ds choosen, more connected, etc; and the other side believes the rules don’t apply to them because identity politics tells them they are a victim of oppression.

1.•Lets lay down the rules of social order (virtue)

2. Lets keep them (personal responsibility)

3. Lets all play the same game. (no exceptions)

4. Lets reinforce that social order through our art and media instead of undermining it. 

The argument is made that increased diversity in decision making process in a company leads to greater success. No one is arguing against diversity.  Diversity is good, but diversity is more than just skin color. However, in the quest for greater diversity, destroying company culture will also destroy a company.  Quotas can destroy company culture because it destroys values and promotes favoritism. 

7 favorites that diminish company culture, social capital, cooperation:

1.Sloppy Talent Acquisition Practices (not qualified)

2.Inconsistent Reward Mechanisms (equal pay)

3.Behaviors That are Tolerated

4.Playing Favorites

5.Pulling the "Firing" Trigger to Slowly

6.Ignoring Your Star Players

7.Inauthentic Value Systems

https://www.inc.com/brent-gleeson/7-effective-ways-to-destroy-your-company-culture-without-even-realizing-it.html

Interesting discussion about believing in God and individual value (inherent dignity) and Marxism/Socialism/Social Justice and can you be Christian and trans, or Christian and a Marxist.  I am impressed with Catherine McGregor.  She comes across as very thoughtful, sincere, level-headed, mature, and well-spoken.  But this false dichotomy of socialism is not whether rich have a duty to help the poor or underprivileged (they do), but whether its the government or religions job to administer social justice.  According to James 1:27, the job of social justice is religion and this is because government can’t legislate/mandate positive behavior (accountability).  

Only religion can mandate positive behavior (the government shouldn’t require people buy and eat broccoli).  But this may be the whole point and aim to get us to that point.   Government protects by punishing harmful behavior.  But more and more, government is beginning to punish what it determines to be lack of performing beneficial behavior.  Dictating behavior and enforcing behavior/practice through penalty = fascism. 

1. Obamacare mandates purchase of health insurance and fines lack of purchase.

2. MIPS: fines doctors 10% if they depart from practice guidelines. 

3. Canada tried to fine people who failed to use gender neutral pronouns.