gwennie

my oldest book and a prized and true “Habseligkeit”

Guidebook for Rome printed in 1610

(two of my loves rolled in one)

pokotopokoto:

dio benedica il voltaren

Amen

how to get a boyfriend

theadventuresofmichaelpawlak:

neptunain:

put peanut butter on a pinecone and roll it in bird seed. hang it up outside. wait.

I vouch for the effectiveness of this, I’ve never gotten into a relationship in any other way.

pleoros:

Taken on May 26th, 2013, this was a dissipating low precipitation thunderstorm near Broken Bow, NE that produced one of the best lightning shows I have ever witnessed in my storm chasing career. Even more beautiful was when the lightning lit up these incredible mammatus clouds in the night sky. These type of clouds are often associated with severe thunderstorms, and their ominous and foreboding appearance is a message to all that severe weather may be on its way. Photographer: Anne Goforth

pleoros:

Taken on May 26th, 2013, this was a dissipating low precipitation thunderstorm near Broken Bow, NE that produced one of the best lightning shows I have ever witnessed in my storm chasing career. Even more beautiful was when the lightning lit up these incredible mammatus clouds in the night sky. These type of clouds are often associated with severe thunderstorms, and their ominous and foreboding appearance is a message to all that severe weather may be on its way. Photographer: Anne Goforth

http://en.wikipedia.org/wiki/Kandahar_(2001_film)
for your Sunday

Venus

anexquisitenymph:

by Mercuro B. Cotto

anexquisitenymph:

by Mercuro B. Cotto

natgeotravel:

Reflections: A young boy casts a striking comparison to an aging man lost in a book on a ferry in Istanbul. 
Photograph by Merve Ates, National Geographic Your Shot

natgeotravel:

Reflections: A young boy casts a striking comparison to an aging man lost in a book on a ferry in Istanbul. 

Photograph by Merve Ates, National Geographic Your Shot

trigonometry-is-my-bitch:

A Rotating Pendulum spinning using angular momentum

trigonometry-is-my-bitch:

A Rotating Pendulum spinning using angular momentum

jayparkinsonmd:

What is unique about how Sherpaa doctors practice medicine?

You can think of Sherpaa like a corporate medical practice in the cloud. When an employee health issue arises, employees launch the app, create a case, tell us their story, answer our questions, and see their plan. When an employee has a new message from our doctors, they get an email saying they have a new message and they should go to the app to read it. Ninety-eight percent of all communications our doctors have with our patients is done via asynchronous, private messaging within our app. The other 2% is via the phone. It’s essentially secure email within our app. Needless to say, this type of communication is one everyone in the working age population is far too familiar with.

First, let’s define how this is markedly different from the traditional way of practicing.

Sherpaa is online and asynchronous vs. real-time and in-person. Traditionally, communication between doctors and patients is done in real-time in an exam room with time spent on the case dictated to the patient by the doctor. Patients must think on their feet and answer questions upon command without the luxury of contemplating the question, or looking up terms they don’t understand. Although this is how it’s always been done, it’s highly ineffective and inefficient. Granted, there is some value in in-person body language. But that is relatively rare. The vast majority of patient-physician communication is matter of fact.

Sherpaa leverages checklists when taking a history vs. not. Although most doctors are average history takers, there is risk in not having a standardized process of taking a good history from the patient. When taking a history is unstructured and not part of a formalized, repeatable process, things can get missed or you can go down a rabbit hole. At Sherpaa, when a patient reaches out to us with a chief complaint of, say, abdominal pain, all of our patients are asked the same questions, depending on their gender. We’ve created a standardized way to take an accurate, complete history. For the top 200 chief complaints, we’ve created protocols to ask the right questions— questions that rule out the serious issues but also cover all bases and lead us to the right diagnosis. This ties back in to the issue of real-time and in-person. The only way to do this is with a checklist. Essentially, Sherpaa, at almost every point in the process from history taking to treatments, utilizes the concept of a checklist. A checklist is what enables 45,000 commercial planes to take off and land every day with years in between crashes. The same should be used in healthcare to effectively take a history and treat most appropriately.

Sherpaa doctors can take a time out. Just as patients need to sit back and think about the questions being asked them, doctors sometimes need to do this too. If doctors are in an exam room with a patient trying to ask the right questions and stumble upon a situation that either stumps them or is something they don’t have a ton of experience with, how do they, in real-time, educate themselves about the best way to diagnose and treat? Remember, doctors don’t and can’t know everything. Because Sherpaa is asynchronous, our doctors can also take a time-out and read up on the condition and/or how best to diagnose and treat it. It’s extremely valuable and safe.

Sherpaa leverages all diagnostic tools, including time. Doctors have tools to make an accurate diagnosis— asking the right questions, ordering the right blood or imaging tests, conducting a skillful physical exam, and, finally, leveraging the passing of time as a diagnostic test. For example, diseases often have a relatively predictable course. Doctors sometimes say, “well, I don’t know exactly what this is now, but if we wait 12 hours and see how things develop, we’ll have a much better idea.” The problem with this is how the healthcare system isn’t set up to leverage time as a diagnostic tool. A visit separated by 12 hours is double the cost. It’s an opportunity to bill twice, when it should be simply billed once. With Sherpaa, we always have a direct communication line to the patient at all times. As doctors, if we want, we can say to the patient, “we don’t know exactly what’s going on, but with your permission, we’re going to reach back out to you in 8 hours to check in and see how you’re doing.” And, then, 8 hours later, we send a check-in message to the patient to get an update. The passing of time is a wickedly powerful diagnostic tool that doctors who practice traditional medicine simply can’t employ. If you are discharged from the ER, good luck trying to reach that same doctor 8 hours later to give them an update on your condition. So Sherpaa doctors leverage time and they also have the luxury of ordering the right lab and/or imaging tests. Every day, we send people to Quest or LabCorp to get their blood drawn or to radiology centers to get imaging. Those results are then sent back into Sherpaa’s platform and our doctors diagnose and treat accordingly. Since our doctors never see a patient in-person, we can never do a physical exam. But that’s ok for 70% of our cases. One of the four rules of practicing Sherpaa is, “if you are in any way uncomfortable, get the patient seen in-person fast.” And that happens 30% of the time.

Sherpaa treats in an evidence-based way. In the same way we’ve built 200 protocols for taking an accurate history, we’ve also built about 200 treatment protocols based on the best available evidence. You would be highly surprised to know that 90% of everything a doctor does is essentially hearsay, folklore, wisdom, and faith. There is very little scientific evidence backing up the majority of what doctors do. So we’ve taken what little evidence there is in western medicine and created protocols around them. Essentially, safety checklists again. This standardizes care and allows us to understand its efficacy by tracking outcomes. Was this treatment plan effective? What was the outcome? With an always-on direct communication line with the patient, we have the luxury of gathering outcomes and understanding how effective our treatments are. Traditional doctors don’t. Once you’re out of their office, you’re gone and it’s on you to make another appointment to update them on your outcome. That’s wrong.

Sherpaa leverages data. Since 98% of what we do is online text communication, we have access to massive amounts of analyzable data from which we can learn. Because the rest of healthcare happens verbally in real-time, that is lost data that can never be used to study and improve best practices. Sherpaa is a vast medical practice full of usable data that can be used to help us get better and better. This allows us to understand “If the patient answered yes to this one question, the diagnosis of x is 90% likely. If the patient answers yes to these 5 questions, x diagnosis is 99% likely. If the patient is treated with this treatment plan for x diagnosis, there will be a 96% cure rate.” This data-driven practice of medicine simply can’t happen anywhere else in healthcare. It can only happen because we can analyze online communication and iterate on best practices.

We’re building something that happens nowhere else in healthcare. It’s quite astounding, unique, and powerful. Once you see it in action as a doctor or as a patient, you understand how revolutionary it truly is.