Ep39 -- Time Band-Aids

 I think my favorite living theoretical physicist is Carlo Rovelli.  I know what you're thinking. Come on Craig, how can you pick just one favorite theoretical physicist?  But Ravelli makes it easy. Having written several books that might not make every deeply complex idea. Completely understandable. But often get very close. And at the very least help me get a little better grip on what I don't understand at all.  For example, when he tries to explain the relationship between time and gravity. That time moves more slowly, the closer you are to the center of a massive object.  He explains it's kind of like running down the beach and into the ocean.  When you first enter the water, your feet and your ankles and your knees decelerate more than the rest of your body, which then tends to fall over into the water.  He also does a really good job of explaining Einstein's special theory of relativity. Which says that time moves faster or slower for objects that are moving relative to each other. Now. Ravelli didn't originate the mirror clock thought experiment. But he does explain it quite well.  Imagine you have a sort of clock that is composed of two mirrors, one above the other. And there's a photon of light bouncing up and down between them. At, of course, the speed of light. Which is a constant 186,000 miles per second.  So there's that photon going up and down, up and down, up and down. 

Now put that mirror clock on a spaceship. And let's say it's traveling perpendicular to you either left or right. Now, if you trace the path of that photon. When the ship is moving. It's not moving straight up and down and up and down, but rather at a diagonal, depending on which way the spaceship is moving. And the faster it's moving the broader that diagonal movement is the wider. 

It is.  So if the speed of light is constant.  And that photon now has to travel a little farther before it hits the top of the mirror. Then a little farther down before it hits the bottom of the mirror. Then each ticking of the clock will take more time.  So for us standing there on earth. The clock appears to slow down.  Now imagine there's someone on that spaceship to that person sitting next to the clock. It's still ticking away. 

Normally up, down, up, down, up, down. And if that person were to travel close to the speed of light, say two and a half years away from Earth and two and a half years back. They'd returned to earth five years older.  But for those of us on earth. We'd be 35 years older. It's crazy. Right. But that's how the world actually works.  So this week, I'm going to look a bit at this gap between our perception of how time works and the actual relativity of it. And use that as a metaphor for how we can both get more comfortable with uncertainty and discover ways to gain some control over those uncertainties in our lives and use those skills to enhance our resistance to the gas lighters out there in the world.  Stay tuned.  

I'm Craig Boreth and this is The Great Ungaslighting, a podcast about how we all get conned into accepting a human culture that's out of sync with our human nature, and how we can fight back and put the kind back into humankind.  

But first, a word about a sponsor.  

This week's episode of The Great Ungaslighting is not brought to you by Epic.  I'm not a doctor, I don't play one on TV, but if you are a doctor odds are pretty good you use Epic as your electronic health record or EHR system, or at least have some contact with their databases. Epic provides the patient records and billing database software for almost 40% of hospitals in America.  It also maintains and sells access to a database of 216 million patient records, which is just under 80% of the US population.  You might think an EHR, like Epic, would be a blessing for busy doctors, streamlining consultation notes, facilitating communication between doctors, avoiding potential drug interactions, recognizing epidemiological patterns, and so on. And while all those things are possible with Epic, recent articles about the company have shown that doctors aren't especially crazy about it.  For one thing, recent research has shown that doctors spent two hours on data entry into EHRs like Epic, for every one hour of direct patient care.  Pulmonologist David Bor at Harvard called it "a giant time sink."  Robert Kuttner who wrote a piece last week in The American Prospect on Epic said that, "most of the dozens of people I interviewed were scathing in their description of the demands Epic puts on doctor's time."  So how does a product that so many doctors hate become the dominant player in electronic health records? Well, that's because doctors aren't their customers. Hospital CEOs and administrators are.  And whatever Epic lacks in creating efficiency, it is excellent at generating revenue.  

I should say, calling out Epic might be a bit unfair. It's not really their fault that our healthcare system, and our economy in general, is designed in such a way that products that make their users' lives miserable can be successful because they make their users' bosses rich. Epic does exactly that with a practice known as upcoding,  which became a thing after the creation of the prospective payment system for Medicare reimbursement during the Reagan administration.  Have you noticed that so many things that are royally screwed up these days got their start in the Reagan era?  Well, the prospective payment system provides hospitals with a lump sum of money for treatment of a given condition and severity of illness. This was intended to incentivize efficiency, since, if the hospital could treat the patient at a lower cost than the reimbursement amount, they could pocket the difference.  But what this also encouraged was upcoding or categorizing patients at a higher severity level or with multiple illnesses to collect higher reimbursements than a patient's condition warrants.  Here's a truly amazing example of how that can be done.  In 2020 a hospital in Colorado locked all of its doors, except the entrance to the emergency room.  Therefore, every single patient who entered the hospital, even those coming in for simple routine care, were categorized, and their cases submitted for reimbursement, as emergency patients.  And there are countless other examples of hospitals overcharging Medicare, and Epic makes it incredibly easy for them to do so.  Remember, I mentioned all those medical records that Epic maintains? Well, those records aren't just anonymized, reasonably well, though not a hundred percent reliably, and sold to researchers, they also allow hospitals to upcode based on your full medical history. So, for example, based on a patient's history, Epic can automatically upcode diabetes with no complications to diabetes with kidney failure and collect an extra $375 in reimbursement for the visit.  

As the use of electronic health record software took off about 10 years ago,  the effects on billing became apparent. Between 2014 and 2019, billing for inpatient visits at the highest severity level increased by almost 20%, while billing at all other levels decreased. At the same time, the average length of hospital stay at the highest severity level went down, while lengths of stay at all other levels stayed the same.  Now it's possible that hospitals just got better at treating their most critical patients, but what's more likely is that hospitals expanded their definition of critical to include less sick patients.  So once again, we see as with so many other public programs that try to save money by being run more like businesses. In the end,  they cost the public more and deliver worse results. And yet somehow, the very serious adult-in-the-room business types running things always end up doing very, very well.  

And we're back.  

We all know that our perception of time changes based on what we're doing. A week of vacation goes by way faster than a week of work. Most new parents are told and universally disbelieve, the old maxim that the days are long, but the years are short.  And an eight-hour flight in first class goes by way faster than an eight-hour flight in coach, or so I'm told.  And time certainly seems to accelerate the older you get, I guess because each additional year represents a smaller percentage of your lifespan than the one before it.  But I think most of us fail to appreciate that we actually have some control over how the passage of time feels to us.  

For example, at the beginning of this school year I started to drive a different route when I drop off my son at school. And that route took us through an intersection where a homeless guy would sit with his dog with a sign asking for any help people could provide.  The first couple of times I saw him, he nodded and flashed me a peace sign, and I just felt like I wanted to help this guy out a little bit. So the next time I went to Target to pick up something, I grabbed like 10 bucks worth of stuff for him, including some treats for the dog.  So before I saw this guy, I'd approached that intersection, praying that I catch the green light and not get stuck there just as the light would turn red. Right, it's really annoying when the car in front of you is the last one through and you've got to wait there for the full length of the red light.  But now when I had this little bag of stuff for this guy and his dog, that's exactly what I wanted to have happen. I'd approached the intersection on the green light,  slow down just a bit when previously I'd hit the gas, and hope that the light would turn yellow and I could stop right there and hand over the stuff I had for this guy.  And finally one day that's exactly what happened. So I rolled down my window, and this guy was super appreciative and I told him there was something in there for the dog too. And he said, thanks, and by the way, the dog always eats. He said some days he goes hungry, but the dog never does, which I thought was really sweet.  

Another more mundane example of this I was waiting for a friend to come over in like five minutes and the dishwasher needed to be unloaded. Now, I have to admit, I really don't mind cleaning up the kitchen. I find it meditative and rewarding to end up with a clean kitchen when I'm done, but I hate unloading the dishwasher.  So I thought, let me see if I can get this done before my friend gets here. And I was like racing through the dishes. Glasses go here, the plates go there, the silverware goes there and boom, got it done in record time, and with a minute to spare before the doorbell rang.  

So we can consciously manipulate our perception of time. And while it may seem like a pointless exercise, I think the more we can feel a sense of control over anything in our lives, the better we're likely to feel about ourselves and the world that's swirling all around us.  And I really don't think it matters exactly what you're feeling control over. It's kind of like when you're stepping up to the tee to drive a golf ball, or if you're taking a foul shot in basketball. If you visualize in your mind, the perfect drive or the perfect shot, from your mind's perspective, it's not all that different from when you actually do those things.  So when you register that sense of control, I don't think your mind is all that concerned about whether you're unloading the dishwasher or you're inspiring your clients or students or kids to do exactly what you want them to do.  It feels good and positively affects how you think of the outside world.  

And I really think it is this sense of control, or more importantly a lack thereof, that's really at the core of so many Americans feeling untethered and looking for someone to convince them that there's a simple black-and-white world out there, where there's an explanation for why you feel like you're losing power or status, and there are people to blame for that feeling. 

You can gain power simply by believing something that people who you think look down on you don't know and probably don't want you to know.  In other words, conspiracy theories.  And there's research to back this up.  Jennifer Whitson at UCLA has done a lot of research on how we are more likely to see patterns and to imagine conspiracies and unfounded explanations for things when we're made to feel powerless, buffeted about by random occurrences outside of our control.  Dr. Whitson summarized her research in this area this way:  "people see false patterns in all types of data, imagining trends in stock markets, seeing faces in static, and detecting conspiracies between acquaintances.  This suggests that lacking control leads to a visceral need for order. Even imaginary order.  

So I think the big takeaway is none of us can always feel in control of everything. The question is what do we do about that? It seems obvious to me, the only healthy goal for all of us should be to gain whatever control we can over the things that are reasonably within our grasp,  and to do what we can to get as comfortable as possible with the fact that there's an awful lot out there that's just beyond our control and comprehension. And that's okay. We just need to be very wary of anyone pedaling easy answers, particularly those that make us feel comfortable and righteous and correct without asking any tough questions or demanding that we show our work.  

Well, that's it for this week. If you liked this episode, please share it with a few friends you think might also enjoy it.  And until next time, be kind to yourself, cut each other some slack, and use your damn turn signal.