Wednesday, April 10, 2019

Suicide Rate in Utah

https://www.cdc.gov/nchs/pressroom/sosmap/suicide-mortality/suicide.htm

Here are the state suicide numbers for 2017.  Utah has had an alarming increase in its suicide rate. However, while 1 suicide is too many, it appears from the data that the rate is proportinal to its western neighbors. 

https://www.sltrib.com/news/health/2018/04/07/utah-needs-a-better-strategy-to-prevent-suicide-a-researcher-is-about-to-spend-years-talking-with-grieving-families-to-design-it/

Some  critics of the Church of Jesus Christ of Latter-day Saints wish to blame the Church for higher suicide rates.  It seems if there is any negative trend in Utah (bankruptcy, SSRI use, etc), critics want to blame the dominant religion.  

However, the article above discuses preliminary results that increased suicidal rates in Utah have to do more with 1. Altitude 2. Rural 3. Western State 4. Mental illness 5. Opioid epidemic 6. Criminal record 6. Utah cutting counseling services for suicide in 2009. 

The study is interested in looking at suicide rates among the LGBTQ population to see if there is a corelation between sexual orientation and possible social stigma.  While LGBTQ populations are known to have higher suicide rates already.  This increased risk is true for all states, including California.  Additionally, it doesn't make sense to blame recent increased Utah suicide on Church policy because there have been no changes in Church policy on this issue.  

https://www.cdc.gov/media/releases/2018/p0607-suicide-prevention.html

This CDC article reports that suicide rates have increased in all US states since 1999.  This increase cannot be attributable to increased social stigma towards LGBTQ individuals because acceptance and tolerance on these issues is generally higher than it's ever been. Yet, we don't seem to be seeing improvements.



Wednesday, March 06, 2019

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






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.” 







Apache Helicopter escorts ISIS
Iraq Army ordered to retreat
Bulgarian Weapons, Silkway Airline, Purple Shovel

Saturday, March 02, 2019

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.