My blog represents my personal experiences and perspectives. This includes many anecdotes from my medical practice. I have been scrupulous to anonymize these anecdotes and to avoid ever belittling or making fun of patients. (I often make fun of and criticize myself, my colleagues, and the institutions where I have worked.)

My proposed treatment for our COVID-19 pandemic

PeterElias
23 Mar 2020

The impact of the COVID-19 pandemic across multiple spheres of American society is a novel event. Some have used the term black swan, Taleb's term for an event that can't be anticipated because it is outside the realm of experience. I prefer to think of it as a gray rhino, Michele Wucker's term for the big and obvious thing coming at you that you don't want to acknowledge. I think of this as a threat to our society writ large, not just as a threat to our economy or even just to public health. I think those narrow framings guarantee inadequate analysis and response.

Stay connected

PeterElias
18 Mar 2020

As the severity of the novel coronavirus becomes obvious to more and more people, and as they begin to grasp the depth and duration of the changes in daily life that will be required of all of us, it is worth thinking about the need to protect and strengthen the social fabric on which we all depend. In fact, the changes are likely to be so profound that they provide an opportunity for a 'reboot' into a new 'operating system' better designed for our future than our past.

This snippet nicely expresses what I hope anchors our core values going forward:

Nazis and forgiveness

PeterElias
17 Jan 2020

My family, friends, and colleagues know I speak out or act up when I see something I think is wrong. When asked why, my usual answer is that I was raised to examine and question things, to seek information, to make up my own mind, and to always behave in a way that is true to my values.

This explanation is true but incomplete, as it fails to convey my belief that silence is a form of acceptance and can be tantamount to endorsement.  I offer an anecdote from my childhood as an illustration of what I mean.  

Running in the rain...

PeterElias
4 Sep 2019

Me (in my head): You should go for a run.
Me (in my head): But it's raining.
Me (in my head): What's your point?
Me (in my head): But it's raining.
Me (out loud): I should go for a run.
Spouse: Why don't you?
Me: It's raining.
Spouse: Oh.
Me: I used to like to run in the rain.
Spouse: What changed?
Me: I got older.
Spouse: But what changed about running in the rain.
Me: I don't relish discomfort anymore.
Spouse: LOL.
Pause...changes into running gear.
Me (back from run in the rain): That was great!

Systemic inequity

PeterElias
8 Apr 2019

This is a brilliant article.  It focuses on health inequity, but applies quite well to to a wide range of things, including education, justice, housing, voting, finance, and governance. Here's my distillation of the message:

"...we must build a deeper understanding of racism as a system of advantage — otherwise our ... efforts are bound to simply remain diversity and inclusion projects."

An Obsession with Metrics

PeterElias
16 Feb 2019

I precipitated a recent online discussion about healthcare’s obsession with measurement (quality metrics is the current buzz phrase) when I quoted two aphorisms that highlight some problems with metrics and targets:

Goodhart's Law: "When a measure becomes a target, it ceases to be a good measure,"

Campbell's Law: "The more a metric is used, the more likely it is to "corrupt the process it is intended to monitor."

One comment rubbed me the wrong way because it implied that measurement reduces harm:

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