values, ethics, morals are left in tatters
conveniently sacrificed on the alter of economic greed
moral responsibility is abdicated in fiscal matters
bruised and cast aside for their misdeeds
it's not me, just following orders
it's not my department
I was just the warder
its all in separate compartments
careers built on careerism and obedience
orders coming from persons above
no regard for others, expedience
non ideological, and no thought of the actions thereof
as good as saying the devil made me do it
its gods will
the cry of the uncaring hypocrite
is enough to give the victim a chill
as the the chorus beats its drum
and the new song cuts to the core
the new mantra now oft chanted has become
oh for a few dollars more
Climbing Out of Your Family Tree
The apple falls how far does it fall where does it land? what does it do when it lands? Can you climb back up? or do you want to climb a new tree? did you fall with planned intent as far away as possible? Are you planning on taking root where you fell to grow a new tree? although you better be careful not to take root near a snake pit or apple orchard
© 2016 Michael D Emmerich
Sounds of Separation
the sounds of separation reverberate across the valleys and the vales, to some they are sounds that integrate to others, they lower the veil Oh to have the adhan chanted in the same tower from which the bells toll daily instead the sounds that ring out, rip the air apart their ringing reaffirms our separation slave bell, unity bell, prayer bell, it tolls regardless the tolling of the bell that divides the minaret, mosque, synagogue and cathedral shout out and chant; a call for unity, that divides the bells toll for those who are near to hear the sounds of separation. the division bell continues to ring out oh for the sounds of peaceful silence
© 2016 Michael D Emmerich
TECHNOLOGY IN MEDICINE
TECHNOLOGY IN MEDICINE
Past, Present and a Possible Future – Help or Hinder
Published in Sanguine, journal of the ECSSA June 2015
Technology in Medicine, a topic many in EMS chat about, and if we have been in service for 20 years plus, we have then been privileged (or cursed) to see significant changes across the board with regard to equipment, patient care, protocols and drug therapies. Many of us have actively pushed for change and new equipment; be it with regard to fluid therapy, bleeding control, pain management and airway management. As one who has been active in certain areas pushing for change, we sometimes miss the most crucial approach to patient care; neatly summed up by Hippocrates (400-ish BC)
Cure Sometimes. Treat Often. Comfort Always
The classic approach to patient care has always been underpinned by the following:
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Arrive at a diagnosis by patient consultation and physical hands on examination
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Confirm ones diagnosis via various diagnostic devices
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Reaffirm ones diagnosis by means of special investigations
Will technology change this approach for better or the worse?
If we look back at history, we see that not all new technologies have been readily accepted by the medical community. Many were viewed (are viewed) with suspicion. In the 1930’s some doctors doubted an X-ray image of the chest was as reliable as a physical examination. Devices threatened to replace the diagnostic expertise of the traditional doctor. Many doctors have valued their clinical experience over machine-produced information. Other technologies initially failed because doctors or patients found them impractical. The ECG was only useful when it became portable and reliable enough to be used at the patient’s bedside.
We need to also seriously review our progress in Medical Technology with regard to changes that offer only incremental benefits but at much higher patient care cost. The focus must be on evidence-based product development, manufacturers have to be able to show their products and new technologies will add value to their customers. Does new technology automatically translate into better patient care and most importantly improved patient outcomes.Plus we need to ask the question; who is their customer, the patient or the medical practitioner? If we as practitioners treat our patients as customers, they will act like customers, we need to be very careful of venturing into a quagmire such as this.
The entire patient/medical practitioner relationship is also changing, as the patient has access to a wider range of medical information, our patients are possibly smarter (maybe). Patients have access to more medical information, with the end result, that at times, they might be less trusting and prone to ask more questions of their medical practitioner. As practitioners we must be open to this new questioning patient and be willing to answer more questions than we did in the past.
Taking cognisance of all of the above: what is the health care practitioner to do?
There is an acknowledged gap in the “bench to bedside” cycle of medical discovery and its implementation in clinical practice, which can mean a gap of years changing “what we know to what we practice”.Hence the treatment of patients in an emergency setting should not only be concentrated on developing new technologies, but must also involve proper training and skills development; medical talents needs to be honed. New technologies MUST always mandate new skill sets, protocols and procedures.
An area of import in my opinion in medical development is patient information. The more information we have on the patient at hand, will allow us to render more appropriate patient care. Information and knowledge management is critical in helping with the decision making process and thereby improving patient care. Many medical practitioners believe that patients should take an active role in managing their own health information, because it fosters personal responsibility and ownership and enables both the patient and practitioner to track progress outside scheduled appointments and at times of a medical emergency. Patient smart cards is one way to grapple with this issue of information. It will allow patients to upload their health records via a flash drive and carry their information with them in their wallet. Information may be accessed through cloud-based storage and encrypted systems anywhere in the world, or plugged into medical smart readers. Medical practitioners can update to cloud technology in real time and the patients own medical doctor can be alerted to changes in the cloud files.
Another key area where technology can aid us in having more information at our fingertips is via a “differential” diagnosis or problem list, which is accessed via the cloud and links to our patient file and further information we input. After we have reviewed the patient “history” and examination. (e.g. is this appendicitis? a urinary tract infection? constipation? inflammatory bowel disease?) The practitioner must then troll his memory banks and innate knowledge base, or one may need to consult texts/online sources to check up/confirm their thinking. Cloud based technology could aid us and speed up the confirmatory differential diagnosis. As their is no doubt much room for improvement in the current approach, with many practitioners currently relying on their tacit knowledge base at the frontline which, while mostly effective, is subject to human error. Once the differential diagnosis or problem list is drawn up, then a related treatment plan could be formulated, and treatments in the form of procedures and/or prescriptions for medications may be suggested by our cloud database.
Emergency Medicine must continue its current academic trajectory, to keep pace with the challenges that technology brings to our patient care. If academic training lags behind the technology curve our practitioners and therefore our patients will be the poorer. We must ensure that there is now technology/practitioner gap as we continue to push the boundaries in improving our patient care. The danger of technology, is that it has the ability to make us lazy and self reliant. It has become noticeable in certain areas of emergency medicine how our reliance on technology has allowed us to forget the three cornerstones of good medicine, diagnosis, confirmation and reaffirmation; of which the diagnosis and confirmation are reliant on us having a hands on approach to our patients (which is becoming a dying art). Good solid diagnostic skills will always be an essential tool of medicine, especially emergency medicine, we forget this at our and our patients peril.
The Fading of the Day
Inspired by the song On the Turning Away by Pink Floyd; I paused to write this poem
Light is changing to shadow
And casting it’s shroud
as the day fades to gray and then shifts from gray to dark before we long for the promise of a new day we need to cling to the dark even when it is dark, it's not dark yet as it is always darkest, just before the dawn as a new day beckons with promise, on the morn the shadow shroud enfolds the world in gray and teases with a promise, as the gray flickers to dark with the dark is a promise of a new day when the morning slivers slice back the dark that sense of expectation, that it is never dark there is always a new beginning no matter how dark yesterday felt today can be the brightest day yet as we continually move through the cycle of life light dark light dark …. light
© 2015 Michael D Emmerich
The Sonnet of Silent Conversations
“I’m there, you’re there
We are silent in each others presence”
A thought I pondered on which led me to write the sonnet below ..
the beautiful silence between lovers the solace in the silence where words are not needed to uncover the hidden messages of compliance the beauty of the silent bonds that tie two stars into the same orbit an orbit that does not require one to respond other than in a soft touch or knowing look as a means of expressing ones love intimate hushed companionship, as such reinforces the strength of silent conversation the intimacy of conversing by touch heightens the silent smiles and wink of flirtation unity in our silent separateness leads to stronger ties that bind
© 2015 Michael D Emmerich
Is Religion the Greatest Threat to World Peace?
With or without religion, good people can behave well and bad people can do evil;
but for good people to do evil — that takes religion.
Nobel laureate Steven Weinberg
The day we as a global nation choose to live for causes and not support ones that are worth dying for; will truly be a great day. Sadly it is a long way off. It will take tolerance and peace having to become more sacred than dogma and blind unquestioning arrogance for that to occur. When questions can be asked without having to fear for ones life, or risk being shouted down in the name of some religion…as they fear the questions (or maybe it is the answers the fear), that will be a day to treasure.
The religions that dominate our world today are made up of fossilized dogmas, that have been excavated from the mud of our past. They hale from a by-gone era when man created religion in an attempt to better understand his world. We now have science, evidence based research and rational questioning minds, which is the antithesis of many religions. This bygone dogma was forged in a world and culture so foreign to the one we live in today, but yet those beliefs are still held as sacrosanct and untouchable. As a result of this outdated dogma, evil deeds are allowed to breed, not by distorting or changing the teachings of scripture, but by obeying them. There is much material in every religious tradition that teaches violence, intolerance and hatred.
When a person believes, truly believes, that they know God’s will, they become almost impossible to reason with. Scientific research and evidence is thrown out along with rational thinking and the bath water. This is because most religions teach that faith – belief not supported by evidence – is not just acceptable but commendable, and is the sign of a virtuous person. Reasoning with a person in the light of the above becomes nigh impossible, as religious morality is not grounded in humans needs and desires, but in the will of god. Beliefs that weren’t based on evidence to begin with usually can’t be changed by evidence. Hence religious faith becomes very dangerous; when a religious believer chooses a course of action that’s evil or harmful, efforts to persuade them to stop will be futile. After all, if God has told them to follow a certain path, any opinion to the contrary is the devils work, and must be resisted, forcefully if needs be.
Religious leaders (and many of their followers), from all religions; oppose abortion, birth control, gay adoption, same-sex marriage, woman’s rights, euthanasia, to mention but a few — they want to control how people are born, marry, raise families, how they die, who they vote for, what to eat/not eat and which wars to fight. They want to barge into ones life during our most private moments and impose neigh, force and demand an adherence to their rigid, paternalistic creed. They know best how life should be lived, they have no qualms in seeking to intrude upon the lives of others at the most important and personal of moments.
Differentiating the evil that religion can perpetuate and the goodness in some people who practice religion seems fair up to a point, but how can one, for example, be both Catholic and good given the Vatican’s hundreds of years of torturing and murder, and currently, its favoring image over children? It is akin to being a good Nazi, which is exactly what its pope believes himself to be. When you base your “faith” in books that brim with divine violence, like the Old Testament, doesn’t that lead to more violence, at least in the defense of your “faith”
Sadly religion is never about what humans really need, but about what “god” supposedly needs humans to believe and do. The fact that religion is not about human needs is exactly what makes religion so pernicious. In other words, no matter what you believe, you do not have the right to hurt or curtail the rights of others, or to disproportionately benefit yourself at the expense of others.
It’s a far nobler a pursuit to wrestle with questions of ethics than to evade our responsibility and just parrot edicts that were written down thousands of years ago. It’s too easy to not have to really think about the consequences of our actions when we can just point to a book and say “but God said so.” We don’t understand maths because we take it on faith, in all other realms of our universe, we do not use faith as means of understanding its inner workings. Leaving it to faith is coping out, and it is the same as throwing up our hands and saying I don’t need to know, and deciding that some higher power will reveal all to us in good time. In my opinion, that stance does not get us any further as a species. It only leaves us standing still; unable to progress and make life better for everyone.
In closing let me end with a philosophical statement… which turned into a religious statement … and then totally ignored by religions…
‘Do unto others what you want done unto you.’
Confucius
557 BC, From the Analects 15:23
“One should always treat others as they themselves wish to be treated.”
3200 BC, From the Hitopadesa
Zombie Giveaway!
Source: Zombie Giveaway!
An Idiot Wind Blows
a wind is sweeping the land no wait, across our planet the wind blows through the halls of power no country is sacrosanct mediocrity our new political watchword on a good day! on every other day we would be considered blessed to have mediocre leaders the wind of the bigot the ignorant the illiterate autocrat blows with vigour no stone left unturned all that stand in the way bashed, broken, ripped apart theocracy takes flight the hot air of idiocy blows with venom from the open gaping vacuous mouths of our elected leaders even when they are eloquently hoisted on their own petard their praise singers and chorus lines run to the fore like court jesters of old the halls are silent laughter is absent intentions are real, deceitful wrestling power and control from the blind electorate who have realised to late the error of their ballot cross has now become a cross they cannot bear
© 2015 michael d emmerich
The Red Light Train
rain falling, mist rising, darkness beckons. I clamber out of bed to join the red light train bare feet on a cold concrete floor soon shod feet on a metal pedal as you push down, to join the red light train cresting the dark hill the train stretches out before you you latch onto the back sometimes with care other times with annoyance so begins your day, for most, so begins everyday the train has life and pace of its own each day is a new train, always dynamic, ever-changing it moves at its own unique pace like a slinky, up and over the rolling hills expanding and contracting moving at the pace of the slowest Like life... the train does not encourage one to look beyond the red lights getting on and off causes frustration, it takes time, patience and determination once you commit, you're hooked that's why it's refreshing to not ride the train everyday Like life..... one needs change, new challenges, new trains a chance to ride the rails alone, breaking new ground create your own red light train trail-blaze your own path create new uncharted rails be your own red light train driving into a new sunrise
© 2015 Michael D Emmerich
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