Friday, August 31, 2012
Thursday, August 30, 2012
Confusion is a lack of clarity in thinking with inattentiveness; delirium is used to describe as acute confusional state; stupor a state in which vigorous stimuli are needed to elicit a response; coma a condition of un-responsiveness…..
Some interesting definitions from the “Forgotten art of Medicine”….But are these terms only relevant for the body only, What about institutions, organizations,. Industries, churches, and even families….
Confusion can come up over a period of time, due to long standing deranged internal functions which should have been clarified and sorted out earlier, many a times out of a “lack of discipline. Hepatic encephalopathy is an excellent example – years of “Alcohol intake and destruction of Hepatic cells” leads to a slow build up of “NH4/3” products and other “confusion creating chemicals” and one slowly moves into a confusional stage. Many a times precipitated by sudden crises….
Delirium is an acute onset of a confusional state – though thought of due to acute “metabolic” or other factors, basic underlying issue is usually un-attended pre-existing illnesses. Many of the acute precipitating events might have been un-avoidable, but if underlying pre-existing illnesses are taken care of, even a precipitating event should not lead to Delerium. What can one do to prevent “Delerium” – early recognition of an “underlying potential risk factor” and Pro active protection against potential precipitating events….
If untreated you slide the slippery slope into Stupor, a state where one has become “in-sensitive” to normal stimuli – you need a “painful stimuli” or “loud voices” to attract attention, and many a times the attention received itself is in-adequate to respond intelligently. You need proactive management to carefully guide the patients out of Stupor. Occasionally like in Hypo-glycemia, one could snap out suddenly, if sugars are corrected, but generally it takes much more effort to come out…
And the final stage is one of Coma – which either leads to “death” or a Persistent Vegetative Stage – the latter more discomforting than the former. former, at-least you know that there is an end in sight, the latter, one is uncertain, what the end would be like, how long it will prolong – is uncertain…One is unresponsive to all what is happening around you – what ever the decibel of the stimulus be – you are oblivious to the context and the situation….
In life and organizations, - confusion – comes out of information over load; multiplicity of inputs, inability to focus and being pulled in different directions….what is lacking is – the lack of “systemic thinking” and “Objective assessment” due to a runaway brain…under the influence of multiple voices! All you need is – come back to the one voice – the focus of what you are called and kept for….if not identified and treated early enough; one might descend the slippery slope to life and organizational in-effectiveness – the equivalent of “Delirium” and or “Coma”….
Health care in India is in the Stage of “confusion” – are we a service industry, art or science, commodity to sell and cash for delivery vs cash less delivery systems, privatization Vs public ownership and right to health….and many more such issues….clouding our thinking…
Charitable and Christian health care – has already passed this stage into the slippery slope – and some are in the stage of Delirium, due to the sudden context changes, Stupor due to un-attended issues of leadership, governance and management and some is in irreversible coma – waiting for the final and inevitable….Though there is “external growth” that is not a sign of “internal health always….
What we need today – are disciplines of “understanding the context”, a practice of “facilitated reflection,” a “guided repositioning” of institutions and programs, and a “pro-active returning” to the “One Reason” we are in health care – “Moved with Compassion” and to “Share the Pain”….
Would we have the courage to do this….?
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