Why Won’t They Talk to Each Other?

by Rick Austin August 31, 2011 01:26 PM

This has pretty much nothing to do with public health, but lots to do with the health of our healthcare system. However, watch me loop it around at the end and tie it up with a pretty bow.


I went to the hospital this weekend. I was watching TV on Saturday evening, and got a little discomfort around my chest and neck that felt like a pinched nerve or a muscle pull from sitting awkwardly. It persisted, and I thought, well, I’m 55, and all these little pings, creaks, and groans start to mean something. So, I trundled myself off to the local emergency room and told the admitting nurse I was having a little chest discomfort.


Front of the line for you, sir! The ER doc listened to my chest, did an EKG, did a chest x-ray, and told me everything looked fine, but he was going to admit me for observation because, you know, chest pain.


Three hours later, deep in the middle of the night, we have a room ready for me. The next morning, the cardiologist orders another EKG and a CAT scan. Still nothing, but the cardiologist notices a small filmy place on my lung which might be a little fluid, which might be incipient pneumonia, so the hospitalist overseeing everything orders a pulmonology consult. The pulmonologist sees both the filmy spot and what might be an inflamed lymph node, which could cause the referred chest pain.


For the next 12 hours, the cardiologist doesn’t talk to the hospitalist, who doesn’t talk to the pulmonologist, and nobody talks to the nurses, who are still dutifully administering the nitroglycerin patches ordered by the ER doc, who thought I had a cardiac problem. Since I apparently don’t, the nitroglycerin starts to crater my blood pressure, puzzling everyone, but especially the cardiologist, who is afraid I won’t be able to do a full cardiac stress test because my blood pressure is so low.


I mention the nitroglycerin patch to the hospitalist, he removes it, my blood pressure recovers, I take the cardiac stress test, and once again everything is fine. I leave, 36 hours later, with a follow-up appointment for the pulmonologist in hand.


And, with an elegant flourish, we bring this back around to public health. This not talking to each other thing is epidemic. Researchers don’t want to talk to their stakeholders, the NIH doesn’t want to talk to the CDC, and nobody wants to talk to the Department of Education, which is doing some yeoman work in knowledge translation. It’s inefficient, it’s counter-productive, and it’s dumb.


What’s the solution, dear readers?


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Bayh Dole: A Different Time, a Different Environment for Knowledge Translation

by Rick Austin August 25, 2011 12:32 PM

David Phipps, our Canadian wrassler at the recently completed NCHCMM in Atlanta, made brief mention at the end of our panel discussion of his idea for a re-imagined Bayh-Dole Act for social sciences knowledge translation. Before the conference, he blogged about it here.


In the near future, we’ll be getting David and Pimjai Sudsawad, our other panelist, back together for a podcast on this topic. In the meantime, David has blogged further about his idea here, and I wanted to comment on a specific point.


David mentioned that his closing point on the panel presentation was, “Develop an engaged community sector and elect a government that will listen.” Here’s the thing: In 1980, when the original Bayh-Dole Act was ratified, both houses of Congress and the White House were held by Democrats. Further, the atmosphere in Congress was substantially different, and bipartisanship on contentious issues was less of a foreign concept.


Now, to be clear, as some liberal bloggers have pointed out, when it comes to preserving and extending the status quo, today’s Washington political class is firmly, monolithically bipartisan. But on contentious social issues, it suits the theatrical requirements of Washington to divide along partisan lines. And believe me, federal government involvement in social sciences and health research at the university and foundation level represents a contentious issue, ripe for theatrical posturing. Behind the scenes, however, the National Institutes for Health, the Centers for Disease Control, the National Science Foundation, and many more government agencies go right on conducting their research business, albeit without really talking to each other.


The question I pose is, absent any support from the political class, what is the mechanism for stimulating a conversation amongst these busy agency players about the importance of knowledge translation to furthering research? What do you think?


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The Difference Between Talking About It and Doing It

by Rick Austin September 10, 2010 10:30 AM

Pop music who-datJason Mraz has a popular song on the radio in which he attempts to rhyme “giving it my bestest” with “divine intervention.” I can live with that, but then, a verse later, he spews out “… and it’s our God-forsaken right to be loved…”   Hmmm. Where was his manager? Where was his producer? For that matter, where was his mother?  “Umm, Jason, honey, ‘God-forsaken’ means that God has abandoned you. Perhaps you meant ‘God-given?’ And if you use ‘God-given,’ it improves the meter of the verse!”


I think you could share Humpty Dumpty’s famous quote (“When I use a word, it means just what I choose it to mean -- neither more nor less”) from Alice in Wonderland with this guy, and his expression would tell you, ‘well, yeah, that’s obvious.’ At which point I’d have to send him out behind the barn with a big dictionary and orders to look up the definition of "irony." 


My point, and I do have one, is that as a communications/media/PR person, I'm deeply committed to the idea that Words Mean Stuff.  Nitwits like Jason and his posse of enablers don't get to make money off of pop detritus as breathtakingly brain-dead as this. At least not off of me.


But …


While words mean stuff (segue alert), sometimes we get too wrapped up in finding le mot juste (segue almost here). Case in point (there you go!): This article in Implementation Science identifies 46 different terms that are used to refer to what we like to call knowledge translation. The CIHR didn’t coin the term knowledge translation, but they popularized it in 2000, then morphed it into "knowledge translation and exchange.” Now, there’s a whole other Canadian group which is deeply invested in describing what they do as “knowledge mobilization.” Then, there’s the 800-pound gorilla, the National Institutes of Health (you get to weigh 800 pounds by carrying around steamer trunks loaded with cash), which views what they do - clinical and translational science - as completely separate from the CIHR, the CDC, and everybody else. That just ain’t so. We’re all trying to get groups of people in different configurations (neurologists, acute care nurses, parents of children with diabetes, teenagers with HIV, teenagers who don’t wear their seatbelts, city councils, cigarette smokers, and on and on) to listen, absorb, and act on information that is beneficial. The end user is different, the most effective channel is different, but it’s the same activity.


Am I just being hopelessly naïve to think that it might be profitable, maybe even interesting and enjoyable, for these disparate parties in Canada and the United States to sit down and pick each other’s brains?

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