Thursday, May 31, 2012

"That's just how it is"- health funding

Over the last few days I have been at a conference about the use of simulation in training health professionals. There has been a heavy emphasis on patient safety and the effectiveness of training under pressure with realistic clinical scenarios. Simulation means good training without endangering real patients, bystanders or the actual participants. The conference was wonderful, but there were hidden memes.

A dominant theme was that to run these simulations requires much preparation, co-ordination of staff and ultimately money. Many people were openly discussing how much more effective would be their training program (and ultimately how much safer would be their trainees) if they had more money. The meme was "but that's not going to happen". The explanation? "We can't do anything about this underfunding" (hidden meme)

Whenever an adverse event occurs to a patient, often what follows is a  Root Cause Assessment (RCA) which involves looking at all the factors that led to the error, including understaffing and underfunding.

A good root cause analysis of tight or declining funding for the education or health care sector (eg TAFE threats in Victoria) would challenge the assumption that "money is tight and that's just how it is"

That's what root cause analysis is supposed to do... make the assumptions explicit and examine them.

So let's do it. Let's have an open public discussion about resource allocation. How do we as a society want to spend our money? Are we apportioning our expenditure appropriately, when our healthcare system is threatened by degradation of our standard of care and training?

I am not against defence expenditure. I think countries should defend themselves (I don't believe that offensive activities eg-Afghanistan and Iraq wars are really defense. I think true defensive strategies don't require this sort of activity). But let's have the discussion, and every time there is a medical conference where everyone knows that healthcare money is not adequate, lets have the keynote speakers encourage the health profession to bring on that public debate. My guess is that our priorities would change and we could still have adequate national security. We will never know what is possible if we don't push for this debate to happen.

Meme-  "it's too complex.. we better trust those who know" (the politicians and the military strategists). This is worth challenging too.

Let's become those who know.

Monday, May 28, 2012


Hi. If you are reading this you might be interested in memes (units of meaning), words, ideas, and how we experience ourselves.

I am particularly interested in the memes we adopt as truths, and the effects of these. Some truths I believe are really worth unpacking, and urgently.

One widely held example is that "depression" is a disease, caused by an internal deficit, that results from weaknesses that are largely predetermined biologically and triggered by events.

I believe that we must consider the possibility that our (often well intentioned) efforts might unwittingly be perpetuating or exacerbating the sadness that goes with oppressed spirit.

Is this really the illness of "depression" or a process of "doppression" exacted on others by the way we interact with them?

What if doppression was more readily "curable" by identifying and having others recognize these oppressive practices as unwittingly harmful and committing to changing them, guided by those suffering from the effects of these actions? What if the collective awareness held by the "doppressed" held the secret to societal reform and a path away from bullying or abusive practices to which we have become desensitized and blinded?