The Future of Futurism: The Perils of Positive Thinking

by JEFF GOLDSMITH (7)

My career as a “futurist” began in 1986, in response to a request from the Editor of the late Hospitals magazine to write an essay on the US Health System in 2036.  You can find that essay here.)  Some of the 33 year old forecasts  included:

  • The patients of the 21st century will be connected to their physicians or hospitals by webs of telemetry similar to those used in cellular communications; perhaps these communication webs will be coordinated or monitored by computer systems that could trigger responses in advance of crises. 
  • “Intelligent” clinical information systems will become the hospital’s operating core. . . These systems will monitor patient conditions on a real-time basis, tracking physiological signs and incorporating test results, comparing patient responses against profiles gleaned from vast clinical data bases, and assisting the patient care team in evaluating and planning care 

Unfortunately, I also talked about “writeable laser disks”  and forecast that  “by the early 21st century, government financing may be a distant third as a source of U.S. health funds, behind (in order) individual patients and corporate employers.”  You can’t win them all!  

In this essay, I was following in the footsteps of corporate seers such as Alvin Tofler (Future Shock, 1972) and John Naisbitt (MegaTrends, 1982) who captivated managements and boards with bold and optimistic forecasts of a changing world.   Their forecasts were bold but vague, leading some wags to suggest that the three keys to successful futurism were: be optimistic; never make specific numeric forecasts and never give a date by which your forecast is supposed to come true.  I violated all three of these rules in my 1986 article.

“The Future Ain’t What it Used to Be”

In the ensuing 33 years, we’ve seen a ton of changes in US healthcare, but often not the ones we futurists forecast.  The biggest change has been the relentless and unchecked rise in expense, causing fiscal indigestion for state and national governments and rendering care for tens of millions of Americans into a luxury good.   

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Why Did Susan Warren Die?

By KIP SULLIVAN (30)

On April 17, the Minnesota Supreme Court published an opinion holding that doctors who deny services to patients may be sued even if they did not have a doctor-patient relationship with the patient. The decision drew expressions of surprise and consternation from observers inside Minnesota. Many malpractice experts had expected the court to conclude that patients cannot sue doctors unless the doctor had actually treated the patient. But in this case, Warren v. Dinter , the court held that a hospitalist [1] who refuses to admit a patient to the hospital may be sued for causing the death of the patient even though the hospitalist never laid eyes on the patient. 

The court sent the case back to the district court for trial. 

The defendants listed in this case are both the hospitalist, Dr. Richard Dinter, and the Fairview Range Medical Center in Hibbing, a small town on Minnesota’s Iron Range. The plaintiff is Justin Warren, the son of Susan Warren, a woman who died at the age of 54 one day after being denied admission to the Fairview hospital.

This is an odd case, and a complex case. It raises at least three questions worthy of extensive public debate. In the next section I will recite the basic facts of this story as they were reported by the opinions of the Minnesota Supreme Court and the Court of Appeals. In the section after that, I will discuss the three issues.

What we know about the death of the plaintiff’s mother

On the morning of Friday, August 8, 2014, Susan Warren visited Essentia Health Clinic in Hibbing. The clinic is part of the 15-hospital-75-clinic chain called Essentia Health that extends over much of northern Minnesota and Wisconsin. The clinic is about a block away from the Fairview Range Medical Center, the only hospital in Hibbing, one of 12 owned by Fairview Health Services a hospital-clinic chain that sprawls over the eastern half of Minnesota. 

Warren was suffering from fever, chills and stomach pain. A nurse practitioner at the Essentia clinic, Sherry Simon, drew some blood from Warren and sent it to a lab. That afternoon the lab reported that “Warren had unusually high levels of white blood cells, as well as other abnormalities,” as the court put it (p. 3). (Unless I note otherwise, “the court” refers to the Supreme Court, not the Court of Appeals.) Simon concluded, naturally enough, that Warren had an infection and needed to be hospitalized immediately. However, rather than send Warren straight to the ER of the Fairview Range Medical Center, Simon called the hospital “to seek Warren’s admission.” (p. 3) Simon’s call was routed to Dr. Richard Dinter, one of three hospitalists on call that day. 

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Juliana v US: Gov Lawyers Argue “No Fundamental Constitutional Right to a Stable Climate System”

DAVID INTROCASO

Three weeks ago the 9th US Circuit Court heard oral arguments in the Juliana v. the US case filed in 2015 by 21 children who petitioned the court to require the federal government to protect their Constitutional rights to life, liberty and the pursuit of happiness by addressing the climate crisis.  In its defense, the US argued the plaintiffs have “no fundamental constitutional right to a stable climate system,” or a “climate system capable of sustaining human life.”

It appears plaintiffs’ lives are in fact not protected.  A recently published essay in The New England Journal of Medicine by Harvard’s Dr. Renee Salas and her colleagues concluded, “climate change is the greatest public health emergency in our time and is particularly harmful to fetuses, children and adolescents.”  This is because recent reports including the US’s National Climate Assessment, the United Nations’ (UNs’) Intergovernmental Panel on Climate Change’s (IPCC’s) “Global Warming of 1.5ºC” and Lancet’s “Countdown on Human Health and Climate Change” all describe in agonizing detail rapid atmospheric warming from currently 1º Celsius to 2º Celsius within the next few decades is causing increasing flooding, wildfires, disease, starvation, forced migration and war.  According to a recent Carbon Brief study, the carbon budget of a child born today will have to be one-eighth that of one born in 1950 if today’s child wants to live in a world that is less than 2º Celsius warmer.

The Juliana case along with numerous related others was decades overdue.  Since Ronald Reagan, the Republican party has denied or worked to undermine the life-extinguishing effects of atmospheric warming.  President Trump summarized his recent 90-minute discussion on the topic with Prince Charles by stating, “the US right now has among the cleanest climates.”  (The US ranks 10th in the world in air quality.)  He refused to recognize climate science stating, “I believe there’s a change in weather and I think it changes both ways.”

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