ZVlogg 025 | Free Will

One of the great things about producing Tha’ ZVlogg has been the flexibility to talk about WHATEVER I want, and then trying to tie that subject back to the practice of healthcare (or not). For the current episode, I’ve been thinking a lot about the nature of free will (or the lack thereof) lately and how it might apply to our interactions with patients, colleagues, and ourselves. So I decided to vlog about free will. Or more accurately, my unconscious brain determined I would blog about it, and my conscious brain became aware of that determination, and made up a story to explain how “I decided” to do it. But I’m getting ahead of myself. Check it out in the 25th episode of Tha’ ZVlogg…you have NO CHOICE after all!

Think I’m crazy on this subject? Think again. Here’s a great “Cliff’s Notes” type summary of Sam Harris‘s short book on the subject.

  • T forbes

    this was great. But I hear you say that free choice is and can be manipulated by the environment? One of my theories in why hospice pts live longer is because a RN comes in and the first thing we say is I am not here to change your behavior just support you and manage any symptoms you might have…the caring relationship continues and the pt – many times gets better…the ethics of caring…to feel cared for…nursing does this so well and having 4th year med students with me when they are doing their palliative care rotation – I think that they are trying to incorporate more caring/nursing into their practice which is a good thing. So if you – in your turntable ground-breaking ideas, if you incorporate the ethics of caring- the patient will start to choose differently….so the obnoxious crackhead? You have to care for him. You have no choice. Hahahaha

  • cmlburnett

    Did I somehow not hear you mention addiction at all? I believe the prevailing attitude toward addiction by the learned is that it’s not a moral failure, thus is not purely of free will choice: biology has significant influence on the addicted. Perhaps it is an easy argument for heroin and its ilk, so why not things less potent than heroin like, say, sugar? Dopamine!\n\n\nI have not read Harris’ book, so I am at a disadvantage here. I see free will as a spectrum. On one end is an addict taking another hit and the other is choosing where to live when you move. In between: eating the donut. Dopamine compels you, but learned knowledge of calories in vs. out tells you to pass on the donut. Maybe tomorrow instead.\n\n\nYour talk about changing the direction of the storm for an obese patient reminds me of the realization I had that that is the power behind motivational interviewing and why it can be more powerful than spewing factual knowledge. Sometimes recognition of what compels a patient to make choice X is necessary to stop making choice X. I agree with you that recognition of what causes burnout is necessary in order to avoid being burned out, but I’m not sure if we agree because free will is an illusion. Again: haven’t read the book!\n\n\nPS: your video composition reminded me of Nothing Compares 2U by Sinead O’Connor. :)\nPPS: Sinead was down with internet slang before the internet knew about it.

    • A) thanks for the great thoughts, take a peek when you get a free section at the summary/cliffs notes for the book as they pick up the main arguments on free will quite well.\n\nB) Sinead O’Connor…indeed: https://www.youtube.com/watch?v=EX1Ovx8guCg

  • Angela Ronson

    Freewill-yes/no? Me replying to u. Where does that come from? U didn’t exist before, so there is no genetic memory. Now what if I told u I’m taking the time to type this all with 1 finger? The argument that I took 14yrs to get 1 arm to move doesn’t stand up. What if I told u I was dx’d as PVS, sent home to die n I didn’t? Is that pre-conceived? The govt doesn’t think so. I’m still in a coma in their papers. As far as the medical system goes…I get what I need to stay alive, but that is only cuz I’m conscious. If I siippped into unconsciousness, n I have, my family only knows to call 9-1-1. That means PVS ppl die if there is no one there. That’s not free will. I’m still alive, tho. What is that? Yes, the medical system has some problems. It will keep u alive, tho. Free will in that? Not rly. There is some…maybe not to treat.

  • Here is some research by John Anderson (from CMU, back in1983) on the “bubble-up” that you mentioned in your Vblog.. “A spreading activation theory of Memory” http://act-r.psy.cmu.edu/wordpress/wp-content/uploads/2012/12/66SATh.JRA.JVL.1983.pdf\n\nThis is the stuff I studied in grad school. Trying to always apply this stuff to the design of usable EHRs and other enterprise applications. \n\nOn another topic:\nWith the recent CMS announcement ( http://www.healthcareitnews.com/news/meaningful-use-will-likely-end-2016-cms-chief-andy-slavitt-says ) that Meaningful Use is likely going to be phased out, I’m scared that EHR vendors will abandon their usability testing and user-centered design process (if they even had one) because it is no longer required. Many EHRs really suck as you so eloquently (lol) described in ‘EHR state of Mind’. But w/o some nudge towards an improved user experience many of the shitty EHRs will only get worse as they add more and more features on top of an already poorly designed information architecture. 20+clicks to order a doxy? how about 50!\n\n Usability in healthcare is critical to patient safety, BUT way too many vendors have short-cut their “Safety-ehanced Design” (ONC’s euphemism for Usability) in order to get their clients Meaningful Use funding. MU Stage 3 has some teeth with regards to SED.\n\nIs it just greed? Do EHR vendors choose to ignore the research and develop a product that doesn’t match the mental model of their users? Or are they just uninformed? Do they choose to be uninformed? Is ignorance really Bliss? \n\nI’ve had the tag line as a email signature “Usability starts with you” for a while–and I remember when one senior developer wrote back that it ends in “Y”\n\nAt least in healthcare the why is obvious – it saves lives. See the Joint commission alert 54 ( http://www.jointcommission.org/sea_issue_54/ )


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