Adonis Diaries

Posts Tagged ‘George Cluny

Is it the less information the better in critical split-second decision cases?

ER of Cook County Hospital (Chicago)

ER of Cook County Hospital (Chicago) on West Harriston Street, close to downtown, was built at the turn of last century. I was home of the world’s first blood bank, cobalt-beam therapy, surgeons attaching severed fingers, famous trauma center for gangs’ gunshot wounds and injuries…and most famous for the TV series ER, and George Cluny

In the mid 90’s. the ER welcomed 250,000 patients a year, mostly homeless and health non-insured patients… Smart patients would come the first thing in the morning to the ER and pack a lunch and a dinner.  Long lines crowded the walls of the cavernous corridors…

There were no air-conditioners: During the summer heat waves, the heat index inside the hospital reached 120 degrees. An administrator didn’t last 8 seconds in the middle of one of the wards.

There were no private rooms and patients were separated by plywood dividers.

There were no cafeteria or private phones: The single public phone was at the end of the hall.

One bathroom served all that crowd of patients.

There was a single light switch: You wanted to light a room and the entire hospital had to light up…

The big air fans, the radios and TV that patients brought with them (to keep company), the nurses’ bell buzzing non-stop and no free nurses around… rendered the ER a crazy place to treat emergency cases

Asthma cases were numerous: Chicago was the world worst in patients suffering from asthma…

Protocols had to be created to efficiently treat asthma cases, chest pain cases, homeless patients…

About 30 patients a day converged to the ER complaining of chest pains (potential heart attack worries) and there were only 20 beds in two wards for these cases.

It cost $2,000 a night per bed for serious intensive care, and about $1,000 for the lesser care (nurses instead of cardiologists tending to the chest pain patient…)

A third ward was created as observation unit for half a day patients.  Was there any rational protocol to decide in which ward the chest-pain patient should be allocated to? It was the attending physician call, and most of the decisions were wrong, except for the most obvious heart attack cases…

In the 70’s, cardiologist Lee Goldman borrowed the statistical rules of a group of mathematicians for telling apart subatomic particles. Goldman fed a computer data of hundreds of files of heart attack cases and crunched the numbers into a “predictive equation” or model.

Four key risk factors emerged as the most critical telltale of a real heart attack case:

1. ECG (the ancient electrocardiogram graph) showing acute ischemia

2. unstable angina pain

3, fluid in the lungs

4. systolic blood pressure under 100…

A decision tree was fine-tuned to decide on serious cases. For example:

1. ECG is normal but at least two key risk factors are positive

2. ECG is abnormal with at leat one risk factor positive…These kinds of decision trees…

The trouble was that physicians insisted on letting discriminating factors muddle their decisions. For example, statistics had shown that “normally” females do not suffer heart attack until old age, and thus a young female might be sent home (and die the same night) more often than middle-aged black or older white males patients…

Brendan Reilly, chairman of the hospital department of Medicine, decided to try Goldman decision tree.  Physicians were to try the tree and their own instincts for a period.  The results were overwhelmingly in favor of the Goldman algorithm…

It turned out that, if the physician was not bombarded with dozens of pieces of intelligence and just followed the decision tree, he was better off in the allocation to ward process…

For example, a nurse should record all the necessary information of the patients (smoker, age, gender, overweight, job stress, physical activities, high blood pressure, blood sugar content, family history for heart attacks, sweating tendencies, prior heart surgeries,…), but the attending physician must receive quickly the results of the 4 key risk factors to decide on…

Basically, the physician could allocate the patient to the proper ward without even seeing the individual and be influenced by extraneous pieces of intelligence that are not serious today, but could be potential hazards later on or even tomorrow…

Mind you that in order to save on medical malpractice suits, physicians and nurses treating a patient must Not send the patient any signals that can be captured as “contempt”, feeling invisible and insignificant

Many factors are potential predictors for heart attack cases, but they are minor today, for quick decisions…

No need to overwhelm with irrelevant information at critical time.  Analytic reasoning and snap judgment are neither good or bad: Either method is bad at the inappropriate circumstances.

In the “battle field” the less the information coming in, the less the communication streams and the better the rapid cognition decisions of field commanders…

All you need to know is the “forecast” and not the numbers of temperature, wind speed, barometric pressure…

Note: post inspired from a chapter in “Blink” by Malcolm Gladwell

Up in the air: Be my co-pilot, firing by internet, and George Cluny?

The movie “Up in the air” is good; it is the most powerful harrowing story of America of what I have watched so far.  Internet came handy for firing employees by video “conferencing”. 

Yes, you can legally fire a person a thousand miles away on internet.  A fired worker was crying bitterly on camera and the girl snapped him out of his misery like a drill Sargent: “Get hold of yourself!  Go get your personal stuff and leave the building.”

The movie “Up in the air” is good. The girl who graduated cum laude from Cornell also had a few courses in psychology:  She felt deep down that the fired woman was too cool listening to the verdict and that she might put to execution her warning that she is going to commit suicide jumping off a bridge. 

Obviously, George Cluny the man, like the stereotypical man, is not that sensitive: It never occured to him that one of these fired people might actually commit suicide and he comforted the edgy new assistant off her premonition.

The movie “Up in the air” is good; it is the most harrowing story of America of what I have watched so far.  Cluny’s dream is to break flying the one million miles mark.  He simplified his traveling habits; he carries cases so that he won’t waste 35 minutes on airport check points every time he has to board a plane. 

Cluny still has to take off his shoes and belt when entering the X-rays barrier; (I think “undesirable looking” foreigners would be asked to undress and pull down their pants)

Cluny’s character is never to show physical outrage and destroy a hotel room or any other rooms like in most movies as a US character is pretty frustrated.  And I like that:  Every time an US film exhibits a raging destruction scene, I feel that the rage is not real and totally unfounded.  I hate to see frequent destruction scenes for stupid excuses. 

Cluny’s talk shows make sense to US society for unburdening one’s life of consumerism products:  They sound total nonsense outside the US borders.

Now you have Cluny’s sister getting married.  The fiance is having cold feet; that’s normal.  Cluny is dispatched to save the situation with his sweet talking. The guy tells Cluny: “I had this moment of silence last night by myself and I got into thinking.  After slaving for many years to taking care of the potential kids then, I die.  So, what’s the point?”   

Cluny says to the distraught guy: “There is indeed no point.  But it is nicer to live with a co-pilot.”  The fiance replies (as usual): “Nice touch” and he hurries to kneel in front of bride: “I love you so much.  Please, be my co-pilot.” 

Knowing that most of the serious and difficult tasks are done by co-pilot then, there is no problem to keep driving as long as you are not under the influence. 

There are occasional problems, actually so very common, but impossible to happen to parents; like one of the kids dying

In these situations, the co-pilot is out-of-order to be of any assistance, and within a year divorce it is. The co-pilot heaps all the blame on the wretched driver who did nothing but following directions and never looking back or reflecting on what is going on.

Yes, Cluny is to keep flying, living alone, smiling cleverly to beautiful women who are far smarter than he ever realized, and resume firing people by his new acquired internet techniques.




July 2022

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