TBU: True But Useless- Avoid at All Cost When in Decision Making Mode

The COVID-19 response requires collaborative meetings and fast decision making.  

Over the last several months I have participated (both internal and external to my institution) in multiple meetings and have witnessed a broad spectrum of managerial styles and results.

As is well known, an effective meeting requires an agenda, clear actions items, a mediator to effectively guide the discussion and an underlying respect for staying on time.

A major threat to effective decision making is TBU (True But Useless) information, as coined by the brothers Chip and Dan Heath in the book Switch. TBU is a saboteur of efficiency and clarity as it clutters both focus and facts that lead to a decision.

 

Minimizing TBU in meetings requires a disciplined and aware mediator who both politely and consistently redirects the discussion back towards immediate relevance. The rest is noise.

Avoid TBU.

Equipoise: Word of the Day

Equipoise, a balances of forces or interests, is the word of the day.

The need for equipoise in our response to COVID-19 (with a Reminder to Reason) is cogently explored in this New England Journal of Medicine perspective.

In our rush to 'do something'-  we act on anecdotal evidence, not considering the clinical biases of anchoring and availability.  Treatments may be hastily prescribed absent quality supporting evidence.

What is needed is balance: to act swiftly yet with caution and reason.

NPR All Things Considered: Masks 101

Masks 101, by way of NPR All Things Considered. My brief radio interview is available here.

Open the Universities Up this Fall? This Could Get Tricky

Source: Al Jazeera

My employer, Virginia Commonwealth University, is exploring all options for returning students to campus in Fall 2020. This issue is not unique.

An essay on re-opening universities, with a recipe for how to do it,  was published today in the New York Times (available here). 

I have no issues with the points raised which include COVID-19  testing,  contact tracing, social distancing strategies etc.

One element was conspicuously absent in the essay: student health services. These campus, ambulatory clinics are neither prepared, staffed nor integrated with local health systems to provide a coordinated public health response to COVID-19 across a student body, particularly in large state universities. The role of student health, public health departments and local health systems must be clear when thousands of students return to campus.

This could get tricky.

COVID-19 y El Personal De La Salud: Sociedad Argentina de Infectología (SADI) Webinar

Para quien puede interesar, el webinar sobre COVID-19 y el personal de la salud. 

Fue un honor compartir el programa con mis colegas argentinos.

Para el video en You Tube, haga clic aqui.

Collateral Damage: Effect of the Pandemic on Patients Without COVID-19

Without doubt, the current pandemic is impacting patients without COVID-19 by way of cancelled appointments, delayed elective procedures and less aggressive care for hospitalized cases. Some patients may simply avoid urgent hospital care out of fear of contagion.

Uncertainty is getting the worst of some of us. Typically, healthcare providers make decisions based on risk to the patient. Now medical decisions are commonly made on perceived risk to the provider. This is the equivalence of a world turned upside down in medicine. We have seen this before at the onset of the HIV/AIDS epidemic.

For a thoughtful perspective on the collateral damage of the pandemic on patients without COVID-19, I refer you to this article recently published in the NEJM.

We will soon enter a time of living with COVID-19, one where we will need to become comfortable in providing the standard of care for all patients, with or without COVID-19.

VCU Convalescent Plasma Protocol for COVID 19 Treatment

Click here for the WRIC Channel 8, Richmond, VA, news story on the use of convalescent plasma for COVID-19 treatment.

Thank you to all of my colleagues, especially to Dr. Jeff Donowitz, for operationalizing this compassionate use protocol for us and our patients.

 And, of course, we are looking for convalescent donors.