Navigating Healthcare – Patient Safety and Personal Healthcare Management

Has Kindness Gone?

Posted in behavior, Compassion, Empathy, Incremental, Inspiration, life, social media by drnic on February 25, 2019
Dalai Lama
No Better example of Kindness in Action

Where has the Kindness Gone

As someone remarked to me just recently

The kindness has gone

It can certainly feel that way sometimes and while my general position is to think like a proton – always positive it has been challenging over the last few months to maintain this position.

I posted this over the weekend: “You don’t have to attend every argument you are invited to”

And around the same time, Linda Stotsky (@EMRAnswers) posted this: “In a world where you can be anything, be kind.” #SundayThoughts #SundayBrunch #SundayMorning

Both received a fair amount of (mostly) positive endorsements which affirmed my view that there is a desire of many/most to be positive, but was followed by some posts from Casey Quinlan (@MightCasey) and Dave DeBronkart (@ePatientDave) highlighting this horrific expose on the people employed to do content moderation that reads like a horror movie (The Trauma Floor).

However it was the piece on NPR Radio: Anger Can Be Contagious – Here’s How To Stop The Spread by Alison Aubrey (@AubreyNPRFood) – which in some respects feels titled incorrectly because the ultimate point is that:

Kindness is transmissible

That reaffirmed my belief that the kindness is there is just not getting through.

I’ve lost count over the last few months of the repeated instances of individuals and groups jumping in, oftentimes absent facts excoriating the latest target and the inevitable mass of people who then jump in on both sides, certain of their position and argument. In some cases, the action or behavior was mean or unkind and the mob certainly made sure to let that individual know often succeeding in trashing someone’s personal and work life creating meme’s that live on forever. There are plenty of examples but I see little point in calling further attention to them, the individuals and groups but rather focus on how we can all perhaps contribute to a kinder world


Almost every time these instances occur I am reminded of an advert (Points of View) from the 1980’s for the Guardian newspaper, that thanks to the wonders of the internet time machine are available to view. At the time it hit a resonant note with me emphasizing the importance of perspective and the lens we all view life through – everyone’s lens is different and shaped by personal experiences, connections and emotions many of which are invisible to others

Incremental Steps to a Happier Kinder World

Taking a page form my daily meditation teaching and one of their guidance points as you start to feel overwhelmed or anxiety approaches they say


  • S is for Stop
  • T is for Take a breath
  • O is for observe, referring to observing whatever caused the stress or anxiety
  • P is for Proceed


2) Try to Put Yourself in Someone Else’s Shoes

And I’d add another step in the process – try and imagine yourself in the other person’s shoes. I always encourage taking a walk in someone else’s shoes in an attempt to get a sense of what might be driving their thoughts and ultimately their behavior. We are all imperfect (at least I know I am and there are plenty of opportunities for improvement and reflection and my life is replete with mistakes and things I regret in hindsight).

If you observe something or someone behaving badly – it might be hard to imagine yourself in their shoes and to explain the behavior or actions but if nothing else trying to do so will always inform you and any response you have.

3) Do Something Nice for Someone Else

Given that kindness is transmissible try being kind to people online and in person. A simple smile aside from helping lift your own mood helps lift others moods and in most cases, people respond by smiling back which lifts your mood further.

Take a leaf out of the “Pay it Forward” movie and find something to do for someone else – you might be surprised at how good it makes you feel

Anger leads to more anger. But a single act of kindness can help stop the spread. story at

Has Kindness Gone? was originally published on Dr Nick – The Incrementalist

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Stemming the Tide

The Opioid Epidemic

Drug Overdoses and Prescription Misuse
The Opioid Epidemic by the Numbers

130 people die from an overdose of an opioid every day in the United States. Death from overdoses reached a staggering 47,600 people in the United States in 2017 – to put that into perspective that’s a 130 people per day, or 1 person every 11 mins, and now in the top 10 causes of death in the United States. The problem has been getting worse with an increase in preventable opioid deaths of 26% in 2016 which is only overshadowed by the 544% increase we have seen since 1999.

The background and causes to the problem are varied but in many cases, the start of addiction begins with medically prescribed medication and far too frequently end tragically with death from overdose. With the rising incidence, the epidemic is having a wide impact with barely anyone left untouched.

Opioid Epidemic
Jim Kopetsky and his Parents

For some struck by tragedy, such as Ed Kopetsky, the CIO for Stanford Children’s Health, Lucile Salter Packard’s Children’s Hospital, they have turned devastation into a drive to action. Ed sadly lost his son, Jim, to an overdose following a history of exposure to opioids that dated back to high school. Take a look at the video of two of the stories from CHIME members here.

“If we can save just one more person from that addict path by speaking up and using our voices and using the power of CHIME and the power of the people all united to try to change, I think we will make a difference”

Together with his colleagues and friends from CHIME they formed the CHIME Opioid Task Force. Their mission is to harness the unique insights and assets of their healthcare leaders and institutions to make a real difference to address the crisis. They are united in their goal of combatting the increasing addiction and growing mortality of the Opioid Crisis by raising awareness, publicizing leading healthcare practices, providing data for medical research, policy advocacy and leveraging our leadership talent in unique and powerful ways.

NTT DATA Give Back

NTT DATA has a long history of giving back to worthy causes and this year at HIMSS19 as joined forces with The CHIME Opioid Task Force, DisposeRx (who offers a unique and safe method for disposal of unused or expired medications) and Luster Mosaics to create a mosaics picture from individual user-contributed pictures posted on Twitter and Instagram.

For every post using the hashtag #NTTDWhyICare NTT DATA is donating $5 (up to 15,000) to the CHIME Opioid Task Force and will use the pictures to create a unique mosaic image live on the show floor. To get involved, simply snap a shot, post it to Instagram or Twitter using #NTTDWhyICare with a statement about why you care.

You can click here to create a tweet with the correct hashtag

Or this link:

Join in at HIMSS 2019

Stop by booth #3301 at HIMSS19 in Orlando to see the mosaic as it gets put together and see if you can find your picture. While you are there, pick up a DisposeRx packet and see how easy and effective it is to safely dispose of any medication in your home.

Come join us for a reception on Wednesday, February 13 at 5:00 pm EST at the NTT DATA HIMSS19 booth #3301 as NTT DATA and DisposeRx present a check and reveal the completed hashtag-driven social media mosaic art to the CHIME Opioid Task Force.

If you’d like to donate directly to the CHIME Opioid Task Force, you can do so here


Stemming the Tide was originally published on Dr Nick – The Incrementalist

Mindfulness and Meditation

Mindfulness and Meditation

This week we are focusing on mindfulness and meditation and why it is important for your health. People that include mindfulness and meditation in their daily routing find they are better able to deal with pain, have improved immunity, sleep better, lower their blood pressure and have less inflammation.

What are the Incremental steps to get you into a regular habit of mindfulness and meditation – the first step is to find what works for you. What’s the best time and where is the best place that works for you? Once you have decided where and when, like most other incremental steps it requires you to take that first step. It can be hard and one of the important things is to understand that you don’t have to do it for very long – even a few seconds can be helpful and then work up to longer times.

There are a range of apps you can download to help you start including some great free apps and I talk about some of those choices and options
Here are 5 free apps you can download that can help you get started

Can I ask a favor – if you like the video, please subscribe to my channel, and if you don’t leave me your feedback/thoughts on how I can improve things

Mindfulness and Meditation was originally published on Dr Nick – The Incrementalist

Happy Birthday to my Best Friend

Posted in Inspiration, Kenya, life by drnic on April 19, 2017


I married my best friend and today is her birthday. This post: If You Want To Be Successful, Marry Your Best Friend detailed exactly why.

In this world of individualized culture that focuses on independence and self-reliance I am happy to say I am not. We are one and success and failure is our success and failure. We are programmed to have relationships and to belong — for those of you skeptical or feeling like you need independence you might just be suffering from the “dependency paradox”. I give up nothing and gain everything.

people who are more dependent on their partners for support actually experience more independence and autonomy, not less

This is what I would term “Healthy Dependency” and something that contrary to some viewpoints that see this as a negative quality in a relationship it is not but rather makes me a better person, stronger and more independent, successful and happier. I depend on her — we share the ups and downs of life and travel this journey called life together

Happiness is an experience best shared and I am lucky to be sharing this with my best friend and wife

Palazzo Vecchio with Uffizi in the Background

“The need for someone to share our lives with is part of our genetic makeup and has nothing to do with how much we love ourselves or how fulfilled we feel on our own. Once we choose someone special, powerful and often uncontrollable forces come into play. New patterns of behavior kick in regardless of how independent we are and despite our conscious wills.”

I love traveling this road with you and wish you a very Happy Birthday — We are One

Or the African version from this African boy

Happy Birthday to my Best Friend was originally published on Dr Nick – The Incrementalist

How Americans Die

How Americans Die This is a fantastic visual presentation of data that you can look at in more detail on the Bloomberg Site If the embedded page does not work head over there directly here

The main points highlighted

  • The mortality rate fell by about 17 percent from 1968 through 2010, years for which we have detailed data…Almost all of this improvement can be attributed to improved survival prospects for males
  • The surge in for 25- to 44-year-olds was caused by AIDS, which at its peak, killed more than 40,000 Americans a year (more than 30,000 of whom were 25 to 44 years old)
  • AIDS was the single biggest killer of Americans who should otherwise have been in the prime of their lives (Sobering Statistic)
  • 45- to 54-year-olds are less likely to die from disease, they have become much more likely to commit suicide or die from drugs
  • How does suicide and drugs compare to other violent deaths across the population? Far greater than firearm related deaths, and on the rise. (Suicide and has recently become the number one violent cause of death) – (Sad Statistic)
  • The downside of living longer is that it dramatically increases the odds of getting dementia or Alzheimer’s
  • The rise of Alzheimer’s and other forms of dementia has had a big impact on health-care costs because these diseases kill their victims slowly. About 40 percent of the total increase in Medicare spending since 2011 can be attributed to greater spending on Alzheimer’s treatment

They do a great job of slicing the data by cohorts of age groups showing how much we have improved mortality and how our 25 and under age group is benefiting from the health improvements with the lower mortality and higher life expectancy than any other cohrot

Thanksgiving, Decency and End of Life – Be Thankful you had the conversation now #health

Patients deserve the same standard and car that doctors receive when they need treatment. But as I have said before (Doctors Die Differently and more recently Treatment Creep in Medicine – sucking Decency out of Patients) we remain challenged especially when it comes to dying.

This piece by Dan Gorenstein, How Doctors Die: Showing Others the Way touched on these issues in a moving a thoughtful way.

Dr. Elizabeth D. McKinley’s battled breast cancer for 17 years but this past spring discovered the cancer had spread to her liver, lungs and brain. Her choice was to undergo more treatment that would have potentially debilitating and mind altering effects on her or change course, accept death and work on getting the best out of what was left of her life…as she put it

..time with her husband, a radiologist, and their two college-age children, and another summer to soak her feet in the Atlantic Ocean…“a little more time being me and not being somebody else.” 

And some of her fight was with her own family – the non-medical members

clinging to the promise of medicine as limitless

And the medical members of her family (her husband is a radiologist)

looking at her disease as doctors, who know the limits of medicine

Its not a difference in the effects of disease and death but rather an advantage of knowledge and information that lead to truly informed decisions “doctors have control over their quality of life before they die and this sadly is control that eludes most other members of society” and it would appear especially try here in the USA. More than half of deaths take place in hospital and not at home surrounded by people we love which is the way most say they want to “go”.

So if you do nothing else this Thanksgiving – take the time to talk about the subject with the people you love and create and advance directive or living will. In many respects no better way to be thankful than to set out what is important and let everyone know, now when you are fit and healthy.

Wishing you all a very happy family and friend fill Thanksgiving

Doctors Die Differently

It was this podcast, “The Bitter End

From the awesome radio show radiolab that covered a topic that people are often reluctant to discuss but is an important part of our reality…as they say there are few things in life but birth death (and taxes) are at the top of the list.

The piece included a review from the Johns Hopkins (Study of a LifeTime) of people’s desires when it comes to life saving treatments especially as it relates to end of life:

Preferences of physician-participants for treatment given a scenario of irreversible brain injury without terminal illness. Percentage of physicians shown on the vertical axis. For cardiopulmonary resuscitation (CPR), surgery, and invasive diagnostic testing, no choice for a trial of treatment was given. Data from the Johns Hopkins Precursors Study, 1998. Courtesy of Joseph Gallo, “Life-Sustaining Treatments: What Do Physicians Want and Do They Express Their Wishes to Others?”

For some simple questions such as:

  • Would you want CPR administered
  • Would you want Artifical Ventilation administered
  • Would you want Dialysis administered
  • Would you want a Feeding Tube used

Physicians were fairly uniform with 80% declining all of the above therapies. The only question that physicians were uniformly in favor of was the administration of pain medication.

But ask the same question of the general public and the numbers are reversed on every therapy (except pain management where there is agreement)

Its not that doctors don’t want to die, its just that they knwo they know enough about modern medicine to know its limits, importantly they have talked about this with their families as they want to be sure that no heroic measures will be used during their last moments in this reality.

In this excellent piece: “How Doctors Die; It’s Not Like the Rest of Us, But It Should Be” Ken Murray elegantly discusses this discrepancy

The challenge is clear and effective communication on a topic that we are reluctant to take on:

It’s easy to find fault with both doctors and patients in such stories, but in many ways all the parties are simply victims of a larger system that encourages excessive treatment. In some unfortunate cases, doctors use the fee-for-service model to do everything they can, no matter how pointless, to make money. More commonly, though, doctors are fearful of litigation and do whatever they’re asked, with little feedback, to avoid getting in trouble.

My personal technique when I was practicing was to use the benchmark of my own family. Depending on the age fo the patient I would ask myself the questions:

What would I do if this was my <insert name of close family relative>


What would I do if this was my son/daughter
What would I do if this was my spouse
What would I do if this was my mother/father/brother/sister
What would I do if this was my grandfather/grandmother

It may seem simple but it worked for me, and still does. The principle applies with general discussions between family members and realtives.

I knwo this seems morose and depressing but remember death is not alwasy the worst case scenario.