Sunday, February 28, 2021

Imagining the Post-Pandemic Workplace

Millions of Americans are working remotely during the pandemic.  Many of them would have never believed that they could perform their jobs away from the office.  I’m one of them.  But we all now acknowledge that the basic structure and function of the workplace has been forever altered. This transformation was inevitable, but the pandemic was a potent catalyst to bring it about at, shall I say, ‘warp speed’? Did we really believe that in a world with remote robotic surgery, driverless cars, personalized genetic medicine, exploration of Mars, Alexa and the explosion of artificial intelligence, that we would continue to commute to brick-and-mortar offices each day?   It was only a matter of time before the physical workplace would be recalibrated.  

The disruption has been monumental and to a great extent irrevocable.  While I do believe that there will be some backward adjustment after the pandemic has largely resolved, I do not expect a return to the status quo ante.  Do you think that DoorDash will be out of business then?

And as occurs after every disruption and innovation, there will be winners and losers.  The printing press came about in the 15th century.  Good idea?  Probably yes, but it may have been a job killer for many.

Johannes Gutenberg - Job Killer

Many industries are very nervous now.  If you have earned your fortune up to now in commercial real estate, you may not welcome the prospect that your high-priced office space will no longer be in high demand.  Indeed, huge companies are leaving NYC in search of more economical alternatives.  Will stage theaters and cinemas ever return to full capacity now that most of us have enjoyed these experiences from home?  The hospitality industry has taken a body blow and will do its best to stagger up in the coming year or two.  Would you want to be an investor in a sports stadium now?  Investors may need to factor in that future pandemics may be lurking.

But it’s a good time to be in the vaccine business.  If your manufacturing company could adapt to produce personal protective equipment (PPE), you probably could have run 3 shifts of workers.  Remember when we couldn’t find sanitizer left on the shelf?  Those companies really 'cleaned up'.  Grocery and restaurant delivery services can barely keep up with the demand.  And with all of us hunkered down in our homes, it has been a good season for Netflix and other streaming services.  On-line retail was already doing well pre-pandemic, but they have reached the stratosphere.  How do you think Zoom fared this year?

We are all aching to return to ‘normal’, but the normal of tomorrow will be quite different from the normal of yesterday.  And just when we start to get used to the new normal, guess what will happen?

Sunday, February 21, 2021

The Importance of the Medical Receptionist

I am writing this now, prior to the pandemic, from my new favorite coffee shop not far from where I live and work. It’s called Couchland and is located in Wickliffe, Ohio.  As the name suggests, every seat is comfortable.  The large space has several couches and plush armchairs that beckon customers to sink in and stay a while.  This is quite different from many of the other coffee shops I patronize, where upon entering, I scan the room like a seasoned detective to see if any of the few comfortable chairs that are present are still available. Otherwise, I must enjoy the discomfort of a hard wooden chair, a larger version of what I sat on in 3rd grade. 

It’s a cat and mouse game as customers compete for premium seating in an adult version of musical chairs.  And, there are rules of etiquette that at times require adjudication.  For example, is it permissible to plop your backpack on a favorable available seat before standing in line to order?

When I stroll into Couchland and gaze upon the surfeit of comfortable options, my mood leavens. In other words, I like the vibe.

The initial impression upon entering an establishment is so critical.   This is just as true for physicians’ offices as for a coffee emporium.   In many ways, the medical receptionist is the keystone of the operation.   (Recall from your grade school days would happens to an arch if the keystone is removed.) The receptionist sets the tone and will largely define the patient’s experience.   The job is easy when patients arrive in a friendly and carefree manner.  But his or her professionalism is tested when patients, who may be ill and anxious, are challenging to handle. 

I have been so fortunate in my career to be surrounded by such a capable and caring staff.  I credit them to a great measure with whatever success I have enjoyed.  And, if there is a day when I have missed the mark, my staff’s attentive manner can help to minimize its effect. 

Indeed, I have heard many times in my career that a patient has left a physician whom the patient really likes because of what is described as rude or dismissive treatment from the doctor’s staff.
So, if you are one of those folks who ‘sets the tone’, I salute you.  And, if you are one likes me who depends upon them, I say thank you.

I've really missed Couchland during these days when I have been hunkered down sipping java on my own couch.  But soon I hope to once again sink into one of their comfy couches, reading my newspaper and sipping a cafe mocha. 

Sunday, February 14, 2021

Should We Pay People to Get Vaccinated for COVID-19?

I read recently that Kroger, who runs a grocery store chain, has joined with other retailers in paying employees who receive a COVID-19 vaccination.  The $100 payment should serve as an incentive for employees to roll up their sleeves.

There is an ongoing debate whether employers can or should mandate COVID-19 vaccinations for their employees.  The state of play now is that employers are encouraging, but not requiring vaccines, as mandating vaccines creates legal exposure for employers.  For example, if you require that an employee is vaccinated against the worker’s wishes, and a complication occurs, is the employer responsible?  Can an employee be disciplined or terminated for failure to vaccinate if there are no vaccines available within a reasonable distance?  And mandating vaccinations may be complicated when workers are unionized.

The right to refuse treatment is a bedrock medical ethical principle that I support.  For example, if I advise an individual with acute appendicitis to proceed with surgery, this patient has a right to decline, assuming that the patient is competent, and I have properly informed the patient of the risks and benefits of the reasonable options.

This right, along with all of our rights, is not absolute.  If refusing medical treatment has a public health dimension, then the issue becomes more complex.  And the terrain can be murky.  If a parent refuses to have his school age child vaccinated against communicable diseases, this right collides against the rights of other children and personnel in the school.   Indeed, it is for this very reason that school districts can require students to be vaccinated.   If a parent objects, then they are free to home school their youngster.

How much will you pay me to mask up?

This is why the failure to wear masks when advised to do so is not just a personal decision.  It puts other as risk.   I don’t object if someone chooses to become inebriated at home.  But it’s quite different if this individual decides to operate a motor vehicle on city streets. 

While no vaccine or medical treatment is 100% safe, and there may be unknown vaccine risks that will emerge later, I recently received the 2-shot Moderna series enthusiastically.  The only incentive I needed was my belief that I would be much less likely to become infected and to infect others.

If a hundred bucks is a necessary incentive, and a business has the will and resources to expend on this effort, then good for them.  We’re familiar with similar strategies, such as paying kids to do homework.

Should we also pay people to be honest or to be polite or to stop at red lights or to be on time for appointments or to observe speed limits?  What should the per diem reimbursement be for wearing a mask?

In other words, should we pay folks to do stuff that they should be doing for free?




Sunday, February 7, 2021

Where is Biden's Bipartisanship?

 There are many concepts and activities that we understand, but yet we have difficulty defining. 

In 1964, Supreme Court Associate Justice Potter Stewart in an attempt to define pornography and obscenity stated that ‘…I know it when I see it.’   Indeed, this phrase has been embedded in pop culture and is used in circumstances far removed from it’s initial prurient reference.

How would one define bipartisanship?  If a bill passes with the votes of 100% of one political party and captures only 1 or 2 votes of the opposition, can the outcome fairly be regarded as bipartisan?  How much support from the other side must exist before the ‘B-word’ can be invoked?  While I don’t have a precise threshold in my mind on this issue,  I don’t think that just a couple of votes is sufficient.

Joe Biden was elected in part because of his promise to pursue unity and bipartisanship.  How many times have we all heard about his decades of reaching across the aisle?  He pledged to us during his campaign, and reiterated forcefully in his inaugural address that he will work as hard for those who didn’t vote for me as those who did.

'I give you my word as a Biden.'  Hmm...

I suggest that there is a widening gap between President Biden’s performance and his prior pledges.  He has issued dozens of executive actions with more to come despite telling us in the campaign that he opposed the overuse of this technique.  It's always edifying to monitor how folks’ views ‘evolve’ when they are governing and no longer campaigning.  (Think of all those candidates who campaigned for term limits until they were elected.)

I am disappointed that President Biden has basically shut out the Republicans in the crafting of his $1.9 billion stimulus bill.  First, there are real policy disagreements on his proposed bill even among Democrats.  Larry Summers, a top economist in the Obama administration, has publicly stated his concerns on the economic risks of the plan.  Ten serious Republicans – not partisan bomb throwers – came to the White House to share their views on the issue with president.  Clearly, this was for show as the Democrats have been racing alone and in lockstep to ram the bill through using the reconciliation process, a mechanism to pass the bill without the need for a single GOP vote.  Couldn't they have pursued a bipartisan compromise first?  The Democrats didn't even to through the motions of consultations here making clear that a partisan victory was their modus operandi.

Is this what we can expect henceforth?

What happened to the unity thing?  The stimulus bill was such a ripe opportunity for the Biden team to make good on their campaign promises to us.  There was a deal to be made here, or at least attempted in good faith.

What is unity?  I’ll know it when I see it, and this isn’t it.





Sunday, January 31, 2021

Variant COVID-19 Strains Coming to America

 This past week, I received my 2nd Moderna vaccine uneventfully.  Leaving science aside for a moment, I marveled that a small amount of clear liquid thrust into my upper arm could shield me from a contagious and invisible invader.  Indeed, with the many public health failures we have suffered this past year, the development of safe and effective vaccines in record time has been a monumental scientific triumph.  Obviously, these successes were the result of decades of medical research and development that created a ladder that today’s scientists could ascend.  This is how medical science works.  While it is true that medical breakthroughs can occur ex nihilo – out of nothing – more typically new scientific achievement builds on prior successes and failures. 

We've added a few more rungs this past year.

Even with the advent of vaccines, this remains an uneasy time.  Yes, there will be additional vaccines added to the armamentarium.  Johnson & Johnson’s single-dose vaccine is expected to be granted emergency use authorization by the Food and Drug Administration in the near term.  But, new potential disease threats have appeared and others are surely lurking in the shadows.   We are aware of variant strains of the novel coronavirus in the United Kingdom, South Africa and Brazil.  Do we not think that these and yet undetected mutant strains are already present in other corners of the world?  While many of these variants may contain innocuous mutations, others may confer advantages to the virus with respect to transmissibility and virulence.  At some point, we may need to call for Operation Warp Speed 2.0 to create new vaccines and therapeutics to combat new viral threats.

I feel that we are engaged in global cat and mouse conflict.  It seems unfair that the goal posts are shifting.  But disease and illness are unfair.  They strike and afflict the innocent.  But, we are not defenseless.   We have robust protective techniques available as public health experts have admonished us for months.

The scientific community and the public have learned so much this past year.  And without doubt, these lessons will save many lives when the next pandemic strikes.  We’ve created a few more rungs in the ladder that scientists and researchers will climb in the future.

Sunday, January 24, 2021

Donald Trump and the Butterfly Effect

We are all familiar with the ‘butterfly effect’, describing a phenomenon when a seemingly trivial action – a whisper, a smile, a compliment or the fluttering of a butterfly’s wing – causes a soft ripple that can reach a distant continent.  You simply cannot calculate the power and reach of a simple act of kindness. Here’s how it works. 

You are in line waiting to buy your first coffee of the day and you discover that the stranger ahead of you has paid for your order.  You are moved by this this simple act of generosity.  Your mood elevates.  You wonder why such an idea never occurred to you.  You ruminate over this on your drive to work.  You greet your secretary who has been under stress and very distracted over her spouse who is recovering at home after surgery.  You think about what that must be like for her and her family.  It’s Thursday morning and you send her home for the rest of the work week so she can help her spouse get well.  The secretary is overcome with gratitude.  After her return to work, she feels that she wants to emulate the kindness that you showed her.  See receives yet another e-mail from her local food bank, only this time she feels the urge to participate and she does so.  Three families she will never meet will now receive food.  A child from one of these families ends up becoming very wealthy and makes it her mission to give back.  And, with a hope and a prayer, the chain keeps extending one link at a time.

The flutter of a wing can change the world.

Of course, the butterfly effect can also create a chain that leads to darkness.  The impact of an unkind remark a scowl, idle gossip  or a vengeful act can reach far beyond the original action.  Since the ultimate negative effects appear unconnected to the first action, the creator of the first link in this dark chain is unaware that he bears some responsibility for the damage that he seeded.

What might the cumulative effects be of leaders who failed to step up for truth, dismissed and excused dishonesty, supported those who trafficked in baseless conspiracy fantasies, rejected mask wearing and other public health measures during a pandemic, challenged the results of a repeatedly verified presidential election, told an alt-rite group with a history of violence to 'stand back and stand by', fired government officials whose transgression was to tell the truth, whipped up tens of millions of supporters to ‘take back our county’ and voted to reject a state’s electoral vote count?

You don’t think that all of this could lead to a violent insurrection, do you?

As of a few days ago, there's a new butterfly in town.