Adonis Diaries

Posts Tagged ‘split-second decision

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

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 Clooney

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…

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 early artificial programs)

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”, like feeling invisible and insignificant  https://adonis49.wordpress.com/2012/07/26/what-type-of-hated-surgeons-gets-harassed-with-legal-malpractice-suits/

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

Diary of a potential volunteer day-work in Rashaya (Lebanon): Or May be Not!

Saturday, Sept 17, 2011.

I woke up at 4:30 am and got busy preparing a large bag for a volunteer day-work in the village of Rashaya in west Bekaa Valley.

Rashaya is the gateway for hiking expeditions to Mount Haramoun (Hermon) or Jabal al Rab (over 3,500 meters in altitude), where Jesus supposedly was transfigured and showed up alongside Elias and someone else…

I have another larger bag for sleepover occasions that I used once in the last 10 years.

This program is a grant from Italy and coordinated by the ministry of social affairs.  The project is to refurbish all the 140 doors of the shops of the Old Souk…The program is for a series of 3-day volunteer works until the doors are done…

Ironically, this project was delayed twice. Why?

Every week, the minister Fa3our is either sick or busy to show up in Rashaya to have his picture taken. A few NGOs got pissed off and refused to participate any longer in that project. We have hundreds of NGO: They train people on how to fill and complete forms for grants…and very few other “useful” things…

I wore the T-shirt for this targeted project.  Let me think; I guess this is the only T-shirt I have that says “volunteer work”.  As if I am that stupid, at his advanced age, to physically get on my knees to rub and paint stupid doors…

I have been witnessing horror stories: University graduates in their late 20’s and 30’s, not finding steady jobs, or even temporary paying jobs, registering for volunteer projects with promises of free outing and free food…

I was supposed to be on the road around 6:15 am, but without warning me, Cedric decided that this time is too early.

I got in the car by 8 am and headed up toward Majdal Tarshish (1,200 meters in altitude), another road that links the seashore to the Bekaa Valley, beside the “Arab Highway” that passes by Aley, and has not advanced a single mile in the last two decades.

We crossed two dozen heavy trucks carrying loads from three big quarries in Majdal Tarshish.  I wish these trucks will dump their cargoes at a very useful public work, in order to justify these unlicensed quarries to keep functioning freely outside laws and regulations.  The trucks are either Abil Lama3, MSC, or non-marked.

We stopped at a small restaurant in Majdal Tarshish that serves breakfast of manakeesh, fresh vegetable, cheese, eggs, bread on saj… It turned out that the owner is the uncle of Father Simon, director of the private and religious school of St. Joseph in Cornet Chehwan.

Father Simon was the rector of the private Christian Maronite school of St. Joseph in Kornet Chehwan; he is now managing the religious association Caritas targeting needy communities and families: I am not sure this organization is transparent enough to verify that donated money is reaching the proper destinations.

We got back on the road at 9:30.  Ten minutes later, we had a flat tire. We used the spare tire that was not suitable to continue our trip.

I always warn people to borrow new cars for long trips.  We could see the Bekaa Valley down there; we saw a huge column of black fumes reaching 100 meters in the air: Was it a fire or an industrial complex…?

On our way back, we had to bypass the trucks.  The speed signs on the return way said 30 km.  I guess the signs were meant for the trucks, but we had to deal with this ugly reality since nothing was specific.

Cedric saw a tire shop in Bikfaya and got a deal to change two tires for $105 each.  Cedric dropped me home and went ahead to withdraw money…

The day was not a total loss: Days are never a loss to me, as long as I manage to post articles, read books, tend my garden, and do house chores…

Adrea is at the beach: She returned from a 3-week vacation in London, visiting her sister Joanna.

Chelsea refuses to study and joined the scouts’ activities this afternoon.

Raymonde is beside herself on how to control this Chelsea, the latest of 6, who dreams to be an actor in Hollywood…

I posted two articles and working on two other articles. Saturday, Sept 17, 2011.

Note: I almost forgot: I had my head shaved yesterday.  For over a year, I grew long hair and attached a ponytail.  I feel relieved, light, and energized.

I wake up looking as I looked before going to bed, no fuzzy hair every which way…. Many think that shaving my head was a drastic statement, sort of “I am still daring community common opinions...”.

This idea of shaving head was not originally in the plan: I am not an artist, or in the art business. It was a split-second decision, but I certainly love the interpretation.  I believe that extreme behavioral statements, Not political opinions, are the salt of mankind life.

Actually, I had my head shaved for a couple of weeks, three years ago, just to see how my head looked like, and if it was round enough and in nice shape…People didn’t like my head, my shaved head, and I was unable to get impartial feedback. (I think my shaved head is ugly and Not fit for esthetics)

At least, the skin of my head recovered health and got tanned for a while, for the first time in my long life. I intend to keep shaved the sides of my head, for the time being.


adonis49

adonis49

adonis49

October 2020
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