Sunday, December 30, 2007

What is the strategic purpose of an Emergency Department?

  • It is a safety net to catch anything that may fall through the cracks of existing services
  • It deals with accidents to reduce sequelae
  • It seeks to resolve emergencies


Emergency Departments do not exist to serve primary care needs, social care needs and/or long-term care needs. In practice, they serve all three these functions.

Wednesday, December 26, 2007

New Year Resolutions

Today I was asked about New Year Resolutions: I said that I had given up on them in favour of new week reviews. Everyday is difficult enough if one has to focus on good habits, balance and small wins.

Monday, December 24, 2007

One Bin, One Queue

I have alluded to my life map before: it is a move towards “one bin, one queue” living. It is one response to TIABIM (Taking Into Account and Bearing In Mind) given our current cognitive deficits and it makes New Year Resolutions obsolete because one is always pruning.


I have said that I added “Build Wisdom” with subnodes for knowledge and judgement. Knowledge is overrated and liable to expiry so we need just-in-time knowledge rather than a whole corpus of uncertain utility, but this is a problem that time will solve. Judgement is a bigger problem and I do not know how to design a process that improves it.


Any suggestions?

Thursday, December 20, 2007

Problems with our electronic patient system

  • It isn’t used: data is not entered
  • Data is entered incorrectly and not corrected
  • Data is duplicated
  • Patients are duplicated and episode data are allocated to one or another patient record rather than both
  • It takes time and effort to learn
  • Greater use requires greater bandwidth and storage
  • Data integrity is an issue
  • Authentication for entry, editing and access remains unsolved

Wednesday, December 19, 2007

The desert teaches many things:

  • That life is constant flux – the landscape is always changing
  • That life is both fragile and hardy and that it can persist in the most inhospitable environs
  • That preparation and vigilance go hand in hand
  • That necessity is a hard teacher
  • That basics matter
  • That nature is indiscriminate


Tuesday, December 18, 2007

GK Chesterton

"We have seen the truth and it makes no sense."


G.K. Chesterton

Wednesday, December 12, 2007


In all the discussions of H5N1 I have not seen any mention of the probability of bird to wild non-human primate cross infection. Discussions about avian in vivo mutations that would allow easy human-to-human spread seem to me to restrict unnaturally the virus’ path to dominance.


We believe that HIV is descended from SIV. Co-infection with H5N1 and SIV is likely to occur before any human flu pandemic and genetic exchange between the two is likely to be disastrous for humanity in terms of both the HIV and the flu pandemics. Such a scenario predicts recurrent, not singular, flu pandemics with repeated high mortality.


For the powers that be: a flu pandemic is closer than anticipated and will likely be worse and recurring.

Monday, December 10, 2007


Newton’s first law is the law of inertia; extended in a simple fashion it is the law of the status quo. Newton’s law of universal gravitation is fundamentally also Coulomb’s law of electrostatic attraction, which is not to say that the macro and the micro necessarily behave in the same way, but rather to remind that different scales and spheres may share fundamental properties that are unnamed and unrecognised.


That is perhaps a clear manifesto of a lumper.


Problems may be peculiar to their contexts but the experiment seeks to generalise, to abstract rather than make concrete. If the specific can educate to the abstract then that generalisation can be more widely applied specifically: algebra is genie to arithmetic. I am being clumsy and inarticulate. It takes genius to be simple, clear and I am tired and frustrated.


Simple problems allow for simple solutions. Even complex problems allow for simple solutions: the Gordian knot was cut.


I do not know if my problem is simple or complex; it’s boundaries, it’s density or it’s field. Step one: define the problem. Some problems defy definition. Where disagreement exists and one cannot simply agree to disagree because action is binary and mutually exclusive how does one proceed without insanity?

Saturday, December 08, 2007

Proposed Blink Communication chart

If you could only communicate by blinking a letter and word chart would be very useful. This is a proposed simple chart based on letter and word frequencies in English.


Blink for Row – Column – Letter/Word


eta dlc pbv

oin umw kjx

shr fgy qz

The of and to that