Thinking Citizen Blog — The Best Metaphor — Triage? Or Do You Have A Better One? What Are The Best Triage Tools Of All Time? What Should You Focus On Today, Now?
Thinking Citizen Blog: Thursday is Health, Health Care, and Global Health Policy Day
Today’s Topic: The Best Metaphor — Triage? or do you have a better one? what are the best triage tools of all time? what should you focus on today, now?
Metaphors are bridges to understanding. And the basic units of poetry.
So what is your favorite health, health care, or global health related metaphor of all time?
In the past, my favorite has been the upstream/ downstream parable — the point being to go upstream to identify and eradicate the root cause rather than just alleviate the symptoms. My last post on this was almost a year ago — in May 2024 (see first link below). That post connects the parable to the Heckman curve (return on investment on an intervention versus age of the child) as well as to a bar chart contrasting the determinants of health versus spending on health. If you are not familiar with these concepts please, check out the post.
But let’s get down to today’s order of business — triage.
Life is all about choosing, prioritizing, and allocating your time. How good are you at triage? What milestones in your life taught you the importance of it?
Were you ever a triage nurse? What rules of thumb did you find most useful? What are the most common mistakes?
In this crazy time with rampant policy chaos the order of the day, what issue deserves your attention today, now?
Why? In medical terminology, what is your “differential” for what ails our country and the world? Remember what a “differential” is in medicine?
This is AI’s definition: “a systematic process a doctor uses to identify the most likely cause of a patient’s symptoms by comparing and contrasting different possible diagnoses. It’s essentially a list of potential conditions that could be causing a patient’s illness, ranked from most likely to least likely.”
So what’s at the top of your differential? What is the logic?
Experts — please chime in. Correct, elaborate, elucidate.
THE FIRST DESCRIPTION OF MEDICAL TRIAGE IS FROM AN EGYPTIAN PAPYRUS DOCUMENT FROM 1780 BCE — below the “Ambulance Volante” of the Napoleonic army
1. “Modern triage grew out of the work of Baron Dominique-Jean Larrey and Pierre-Francois Percy during the reign of Napoleon. Larrey in particular introduced the concept of a “flying ambulance” (flying the this case meaning rapidly moving) or in his native French “Ambulance Volante.”
2. In World War I, the Belgian surgeon divided patients in three categories: Those who are likely to live, regardless of what care they receive; Those who are unlikely to live, regardless of what care they receive Those for whom immediate care may make a positive difference in outcome.”
THE CURRENT US ARMED FORCES TRIAGE SYSTEM
TRIAGE IS ABOUT SAYING “NO” OR “NOT NOW” — the applicability of the metaphor to parenthood, teaching, and politics
1. Saying no or “not now” is hard for parents whose screaming child is demanding their total and immediate attention.
2. Saying no or “not now” is hard for teachers who must learn to make big mouths shut up so that every voice in a class can be heard.
3. Saying no or “not now” is hard for politicians assaulted by battalions of lobbyists crying “Mommy, mommy, me, me, now, now.”
EXAMPLES OF DIFFERENTIAL DIAGNOSES — are you a physician? a nurse? what graphic or other tools have you found most useful in your clinical practice? Are you a medical school professor? What is the best handout you have ever seen or used related to explaining the meaning of triage or differentials?
1. Abdominal pain: appendicitis, gastritis, inflammatory bowel disease, bowel obstruction.
2. Fatigue: anemia, thyroid disorders, depression, or heart diseas.
3. Headache: primary (migraine, tension, cluster) or secondary (brain tumor, infection)
SOME RELATED CARTOONS — do you know of a better one? if so, please share.
Thinking Citizen Blog — Three Images: Upstream/Downstream Parable, The Determinants v Spending…
https://en.wikipedia.org/wiki/Triage
https://en.wikipedia.org/wiki/Dominique_Jean_Larrey
https://en.wikipedia.org/wiki/Antoine_Depage
https://en.wikipedia.org/wiki/Differential_diagnosis
QUOTE OF THE MONTH
“Make your own Bible. Select and collect all the words and sentences that in all your readings have been to you like the blast of a trumpet.”
- Ralph Waldo Emerson
My spin — then periodically review, re-rank, and exchange your list with those you love. I call this the “Orion Exchange” because seven is about as many as any human can digest at a time. Game?
LAST FOUR YEARS OF POSTS ORGANIZED THEMATICALLY
ATTACHMENTS BELOW:
#1 A graphic guide to justice (9 metaphors on one page).
#2 “39 Songs, Prayers, and Poems: the Keys to the Hearts of Seven Billion People” — Adams House Senior Common Room Presentation, (11/17/20)
NB: Palestine Orion (Decision) — let’s exchange Orions, let’s find Rumi’s field (“Beyond all ideas of right and wrong, there is a field. Meet me there” Rumi, 13 century Persian Sufi mystic)
YOUR TURN
Please share the most interesting thing you learned in the last week related to health, health care or health care policy — the ethics, economics, politics, history….
Or the coolest, most important thing you learned in your life related to health are or health care policy that the rest of us may have missed.
Or just some random health-related fact that blew you away.
This is your chance to make someone’s day. Or to cement in your mind something really important you might otherwise forget. Or to think more deeply than you otherwise would about something that matters.
