Eat what you like

Day 103: Monday

Morning, Tim!

It’s been a while. I could feign a delightful, planned summer hiatus but you know better than that. Perhaps it was your takedown of language’s role in morality but you know full well that’s even more laughable than the summer hiatus line… No, instead it was just an unfortunate end of what had been a fairly stable habit. I hope to rebuild the blog-writing muscles, so bear with me over these first few posts!

Yep. It’s gonna be a rough start.

“The great seduction confronting every individual or family or church or political party or enterprise of any kind in every age is the idea that we no longer need to change. We think, there’s nothing really major about me or my tribe that God would want to reform. I’m sure he wants to work on those people, but not me. That’s a delusion.” – Rev. Dr. Dan Meyer

That seems to me to be about right. I was recently reading Sapiens. It was an interesting read. The author, Yuval Noah Harari, had a knack for laying out his arguments as follows: Fact A, Fact B, Fact C — Therefore X. X was controversial. How did he get there? X as a conclusion seemed was so far away from the original 3 premises.

One piece of text that stood out was an articulation of Buddhism. At it’s core, the idea was that the mind naturally craves more in all situations. And all suffering arrives from craving. The goal, then, would be to rid the mind of any conception of “good” or “bad” and simply acknowledge things as they were — a body sensation, a feeling, the circumstances that brought those about, etc. Acknowledge, but not label.

While familiar, I haven’t studied Buddhism to any great degree, so I asked a few friends who have to give their take. They suggested it probably isn’t the most fair representation — which makes sense. I felt the same way about Harari’s take on Christianity. That said, regardless of religious affiliation, I see this mindset play out in the culture around me at work.

I’m not sure how to segue here. I haven’t yet figured out how to articulate how I see this, how to point to tangible examples. Yet it seems if true, if we do in fact see ourselves as the stable force and the world as what needs changing, we’ve lost perspective. We make up this world — and rather than expecting some outside thing to change, we need to reflect that in what we can control. That is, if we want a world that is more relational and filled with joy, laughter, and empathy, we need to put down our phones, step away from the artificial “connection” and look up at those we interact with every day. If we want to understand issues of race, gender, or political differences we must stop spending 9% of every day on Netflix and 1/16th on Facebook and instead hold conversations with those in all walks of life.

It’s trite at this point to talk about a filter bubble. Yet with all of the time spent on websites that track our every click to feed us information that we like, it seems vital to talk about it. Mary Roach discusses how “People like what they eat, rather than eat what they like.” This harkens back to the question

Which came first, the chicken, or the word we use to distinguish said young-domestic-fowl-raised-for-meat-and-dairy-products from the so-called “egg”?

Yet in this case, the answer seems clearer — we form our tastes around what we are given. Regular exposure makes things more palatable.

Extrapolating a touch, this is the exact phenomenon that should terrify us when it comes to a digital age. When our every click is known, and we get our news from a feed that is tuned to give us what we’d like (so we spend more time there…), we begin to like what we see. And the algorithm is tuned (because that is how the company is incentivized) to give more information like that. And so we don’t get exposed to anything outside of our circle, our delicate bubble.

Let’s tie these two ideas together more concretely, this time in reverse. We are fed a stream of information that we like — not because of anything external, but because that is what we are fed. When we then come to ‘like’ it, we get more and more of it. This is how we come to see the world — this is “right”. When we are exposed to something outside of this, we don’t see it as us needing to change, because it goes against our whole world (…which just so happens to be made up of the same things we ‘like’ and see repeated every day). And so rather than striving toward any change, we create a world that revolves around ourselves, a world where we sit in the center and the ‘other’ should conform to us.

That’s not tight logic. It’s not crisply written. But if there is a smidge of truth there — oof. Because I’m not in the right. Any glimpse in the mirror tells me I’m not perfect, that I do need to change. It’s the look that sees someone who lies, someone who is slothful at times, overly egotistical and ambitious at others. Someone who struggles with lack of understanding of race, gender, and a host of other issues. Taken to a literal mirror, someone who is obviously gluttonous. I need to change. Not just the world around me, but me within that world.

I don’t want to simply like what I eat. I want to take the time to understand what is good, what is nourishing, and to eat that. I want to eat what I like — with the recognition that taste isn’t the only element of “like”, and that some things I like not because they taste good at first but because I need them to make me a healthier member of the human race.

Until tomorrow,

Zak

p.s. I made some tea to set the mood for writing. However, like blog writing, it had been a while since I’d made a cup of loose leaf and I was out of practice. I made a lot of it, and it was dreadful. A lot of scrolling says the parallels between my tea drinking and blog writing may not have stopped where I would have hoped…

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Drinks have WHAT?!

Day 95: Friday

Morning, Tim!

I’m in a class on the US Healthcare system with students from numerous academic areas — business, law, public policy, social services, and medical. It’s a remarkable experience to have each of those perspectives represented in a dialogue.

We recently had a delightful conversation about social determinants of health, particularly within a rural setting. Social determinants are all of the things outside of your actual health that impact the person — their ability to retain housing, get transportation as needed, obtain food, clothing, etc. Coming from the business side of things, I’m always pleased when I hear others so passionate about others — thinking about how to set up society for human flourishing on a macro level while making a significant difference on particular individuals on a micro level.

Our dialogue around social determinants quickly turned to responsibility (and for good measure, genomics was brought in to make sure we had clinical determinants!). Questions ranged from personal responsibility — how much should the individual be held accountable for their own health — to that of a society, which naturally had substantive dependencies on the answer to personal responsibility.

Responsibility is fascinating. We each want to believe we have so much control, and act accordingly. We take credit for our actions (at least when good!) and blame others for theirs. We hand out awards for success, perhaps even a shiny medal. Yet, at the same time, we recognize that this responsibility might be overstated. When pushed, we recognize that there are myriad factors that impact each of us, shaping how we act, shaping who we become.

One of those factors for me was my childhood spent in a rural setting. I learned a lot there. I learned about simplicity, about living within means and not in abundance. I learned about working with your hands, about hard work. I learned about taking care of others in the community, because that’s what neighbors do.

There were also things I didn’t learn. Like that drinks had calories.

Tim, I didn’t learn drinks could have calories until I went to college.

Yes, we are shaped by much around us. And for some, that impact is particularly negative, and something we should strive to recognize and address. Yet the story doesn’t end there — for others, there are opportunities to be uniquely positioned to make an impact.

I’m feeling a weight to think more about rural healthcare. There’s got to be a way to bring health and vitality to rural communities.

Or at least let them know that drinks have calories…

Until Monday,

Zak

It’s like Uber for Healthcare

Day 89: Wednesday

Morning, Tim!

Though not feeling poetic today, I love when I have enough energy and mental capacity to thoroughly enjoy my work.

I’ve been working on Non-Emergency Medical Transportation (NEMT) solutions recently.

A bit of background, followed by why I’m interested:

NEMT has traditionally been provided by an array of parties — ranging from taxis to shuttle buses, volunteers to high-priced ambulances. These services are needed not only for patients but for health systems, insurers, and tax-payers. Because transportation to and from an appointment can be a binary limiter on whether someone is able to receive care, the patient certainly has a stake. Importantly, though, because the patient’s health might otherwise deteriorate, health systems and insurers should also care, as handling sickness before it worsens is in almost every case less costly — even if it means multiple visits. Surgeries, scans, lab tests — they are all more expensive than a simple office visit to ensure someone maintains health. Tax-payers in turn should care, as their dollars are going to providing services and care for substantive portions of the population, both young and old.

The challenge of providing transportation fascinates me. Not only because I can throw out tons of transportation puns, getting on a good roll before someone tells me to put on the brakes because they can’t handle it and I have to stop (That derailed quickly). And not just because everyone in my line of work is talking about ‘the next Uber for healthcare’ when in fact, Uber could be the next Uber for healthcare. No, it’s in part because there are substantive operational considerations (i.e. if a patient is late to an appointment and backs up everyone else; if a patient is sitting in a bed waiting to be discharged but doesn’t yet have a ride, and so the hospital cannot use that bed; etc.). Yet the above stakeholders could also be interested for numerous other reasons — perhaps brand (look at how convenient we are!), patient experience (no one likes to wait around), or to better keep a broad population healthy and happy (taking patients to the pharmacy, community center, or beauty salon). It can be not only an issue of ‘sexy’, new solutions like Uber to make headlines to further a health system’s reputation, but also applying that same technology to address the social issues arising as barriers for those who often need care the most.

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There are tons of companies flooding the space, and it’s an exciting time to be looking at this work. I think it’s most exciting because of it is so broadly applicable, with the ability to interest so many.

Until tomorrow,
Zak

Control Freak Who

Day 74: Monday

Morning, Tim!

I really appreciated your capturing of The Importance of Being Named Ernesto – hilarious.

I wanted to start today with a knock-knock joke.

Knock-knock

Who’s there

Control freak, now you say control freak who

It’s tough to not be in control. I tend to think I can do it better than others. Oh, you’re looking something up on your phone? I should too — just in case. Or research that purchase. Or find it in the cabinet myself (…after you already said we didn’t have any left…). I’ll make the decision on when a work product is good enough, when and if we should meet to get further input. If people would just let me do it, it’ll turn out better!

But come on, that’s not even close to true. First, I don’t have the time to be that great at everything. Second, even if I did, I’ve proven myself time and again to be terrible with control, as evidenced by my waistline, grades, or lack of recognition by Todd, the front desk guy at my gym. I make mistakes times and again, and yet grasp for control all the more.

“Autonomy and control are cardinal virtues of the west” – David Brenner

There are gobs of self-help books. We also have a pretty good idea of the things we should be doing — be it exercise, education, sleep, putting down our phones more often, caring about others more (and not just in an academic or theoretical way…). So why aren’t we able to do these things, simply by ‘willing’ them?

I’d propose that by ‘willing’ we often mean lacking desires that are often against what’s ultimately best for us, and, when they do appear, be able to deny them anyway. In the case of cake, wow is that stuff good. But I probably shouldn’t eat 3 pieces. In fact, it would be best (…at least easiest…) if I didn’t have a desire for 3 pieces, but rather just one. Moreover, if I did desire 3 pieces, it would be great to say no. That would be control, an exercise of will.

Within that example, we need two things. The first we already noted was a sense of control, the ability to act on the ultimate desire. The second, then, is the actual desire we want to act in accordance with. I think that’s a confusing piece — because if we have ever changing second-order desires (the things we want to desire), then we don’t have time to build the habits necessary to actualize those.

Changing our second-order desires is ultimately like building habits. They take time and commitment, and only truly change if built over a period of time.

As a Christian, this is actually a beautiful thing. It means that we get to set our second-order desires once — in alignment with Christ — and then spend the long hours, full of falling short, in relationship with God ever-marching on. It’s by ceding our control that we actually might change into what we’d like to become.

Until tomorrow,

Zak

Costing a leg

Day 54: Thursday

Morning, Tim!

Silly Josephine…

Tim as you well know I work in healthcare. Thinking about healthcare as a business feels kind of grimy at times — you are making money off of those who desperately need help, many times in order to live. That said, having worked with a lot of Catholic hospital systems, the usual saying goes “No margin no mission”. In order to operate, in order to help all of those people, they need to have the financial backing to do so. They certainly have a lot of write-offs each year, essentially donating care back to communities; but it’s no news that in the U.S., healthcare is expensive, and many people are paying all they can afford in medical bills.

I’m not sure how I’m supposed to think about making money off of others’ misfortune. In one hand, I’m helping them extend life; in the other, the cost of that extension is often a poor quality of life, constantly fretting about bills and work.

I recently came across some articles about financially backing legal cases. I asked a friend of mine with a law degree to explain in a bit more detail, but the gist is that there are many wrongs done to people – e.g. abuse, discrimination, etc. – done by a corporation that has quite a bit of money. If the individual were to sue, there are legal ways for the corporation to spend those dollars quickly prolonging and “drowning” the individual, making it effectively impossible to sue in many cases. There are some lawyers who will work on a contingency basis, not getting paid until the individual does — but they typically have caps far smaller than would be necessary to take on a corporation.

The linked article discusses financially backing some of these cases. Now I certainly don’t have enough money to bankroll anyone’s legal case, but the idea still intrigues me. If real harm was done, shouldn’t there be some recompense paid? The same problem we saw above begins to arise, though – in order to operate like this, the financial backer would need some form of compensation, thus taking a portion of what would go to the individual. There’s this feeling of doing good while simultaneously lessening the good done.

I’m not sure there’s any way around it within healthcare. Hopefully make it cheaper to deliver care, I suppose. It’s just unfortunate that there’s a cost to doing good.

Until tomorrow,

Zak

Volcanos and Good (Women) Doctors

Day 34: Wednesday

Morning, Tim!

Today I defend your cacophony of structuralism with (giant [and well drawn…]) earplugs!! I then attack your base (well played) with a giant bottle of vinegar (I contemplated having a man jumping on the bottle to squirt it out as if it were a water blob, but wasn’t able to accurately portray that…). So yeah…take that.

Day 3: Under siege

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My base is defended by earplugs (alternatively it could be headphones and listening to all about that bass…). Your “base” is being attacked by a spritzing bottle of vinegar. 

While fun to draw on my phone, I may need to print out next time…silly big fingers…


One article that has received a fair amount of attention the past couple days calls out disparities in physicians, most notably a quality of care gap favoring female physicians.

“Salaries for female physicians average some $19,879—eight percent—lower than male physicians. At academic hospitals, male physicians receive more research funding and are more than twice as likely as female physicians to rise to the rank of full professor.”

Justified by something, perhaps quality? Nah…

Female physicians actually tend to provide higher-quality medical care than males, according to research released today. If male physicians were as adept as females, some 32,000 fewer Americans would die every year—among Medicare patients alone.

An interesting find. I’m not a clinician, but were I to pursue that route I’d easily be a part of the higher paid statistic – I’m male. Not a part of this study, but I’m also white and tall, each giving me undeserved advantages, privileges. Something isn’t right about that.

But the interesting piece about the article isn’t just the observation that the pay gap is obviously undeserved. At the end of the day, it’s better for patients – they get better results. What is it that brings this about? Is it a communication style? Perhaps an intelligence level of the subset of women self-selecting into the field? Time spent with the patient? Compassion? Less ego?

It’ll be interesting to learn more as they dig in to this.

Until tomorrow,

Zak

First and best, for 100 years

Day 28: Wednesday

Morning, Tim!

I work with a lot of entrepreneurs. Most of the companies I interact with have been around for less than 5 years, many for only 1, and each are in ongoing development mode. They are passionate about the work they do and, being in healthcare, oftentimes have a personal story about why they do the work they do. It is wonderful work – entrepreneurs have said they want to make a difference, that the current way of doing things wasn’t good enough on it’s own, and that they want to contribute to making it better.

In thinking about what makes at least some of these companies successful as they scale, I’ve been primed to look at Amazon first, and recently received another example in Patagonia that is similar, yet with some key differences. I recognize the immediate thought may (should) be “But Zak…those aren’t startups”. Correct. But they are both led by entrepreneurs who have control and who have established what success looks like for their companies.

Taking Amazon first, Bezos saw Amazon wasn’t great at working internally when one team needed access to what another team was working on. Perhaps the means of getting there are a bit unsettling, but Bezos mandated that teams had to create interfaces to connect with one another, and that all communication must be through these interfaces. For context, Bezos was taking away any shortcuts – it was more work to create these interfaces (particularly backwards, in many cases). When your vision is to be around after 100 years, though, you build it right – no need for shortcuts, you build it to last and to scale. By forcing teams to create this infrastructure to support Amazon.com, they had also built it for the rest of the world – AWS allows for Amazon to build tech infrastructure that others would use, and they know others will use it because they use it. They are their first and best customer (and…it’s nice when your best customer is the largest online retail giant). Amazon has also done this with their distribution infrastructure, figuring out how to fulfill 2-day delivery all across the US. By building it to meet their own needs, they can just as easily meet others (because they intimately know the needs and challenges faced).

Turning to Patagonia, Yvon Chouinard founded the company because he didn’t like the equipment available to him for climbing. Wanting better gear, he made it – realizing others would want it, he made more and sold it. He did the same for clothing, finding that he couldn’t find elsewhere the clothes he himself would want to wear. The jackets not built to last, nor built for quickly changing weather. The shirts were too bland, the shorts not sturdy. As he created, he also brought on others who, like him, did the activities he wanted to create a company to support. Who better to know what the surfer needs than the guy who, rather than be in his job, mostly just wants to surf all day. While not a clean comparison (Patagonia employees aren’t themselves a best customer in the way that Amazon.com is for AWS, not supporting with nearly the same size/scale) and I’m over-simplifying, but the end-result is similar – Yvon created a company that values doing it “right”, as if they were going to be there in a 100 years, and made products that they themselves wanted in order that they might better do their passions/jobs.

I’m not sure what this looks like for healthcare. In advising health systems, it looks like first and foremost creating a system that the individuals themselves would want to go to. Perhaps that means there is more personalization – whether genomics or simply knowing I prefer Zak to Zakary when I come in. Perhaps it’s a focus on making things safer – perhaps by reducing unnecessary variation in supplies so people can become better experts, perhaps by enforcing hand-washing. Perhaps it’s building a workplace that supports its employees – a workplace that clinicians want to go to, even though the work they do every day is physically and emotionally taxing. I’m not exactly sure how to put this into practice for entrepreneurs within healthcare, but it’s something I think about. Perhaps making medical records more accessible, or innovating within chronic disease or mental health is relevant.

Anyway – I like the idea of creating things that will last, not because of “legacy” but because it’s inspiring to act in a way that is rewarding – to “do it right” and feel satisfied in the work done because it wasn’t for short-term gain or one that took shortcuts. It’s admirable to put in the work, having the discipline to do it right – even more so when empowering others to do that work in their daily lives with you.

Until tomorrow,

Zak