Killer Lag.

My boys spend years online playing team warfare games with their friends.  Occasionally I’ll hear a screech emanate from the back room, “Lag. Lag! LAAAAAGGGG… oh no - Noooooooo!!!!!!  … (softly, bitterly) I’m dead.”  I look at my wife and we chuckle.  Ah, the innocence of youth, believing that screaming at the computer can improve its refresh rate.  “Lag” means that the normally fluid motion of your on-screen character has become suddenly halting and jerky, while the rest of the virtual world continues to stream by in real time, creating a strobe-light effect; the distant enemy you were lined up to snipe has, while you were frozen in place, suddenly jumped to three feet away. You might catch a glimpse of his K-Bar plunging toward your neck before lag strikes again and by the time your aging computer or dribbling internet catches up to real time your character is a lifeless, bleeding bundle of loser.  It’s a feeling of powerlessness during a high arousal state that makes you want to kick the wall, pull out your hair, and weep. It’s so infuriating there’s a meme circulating the internet claiming “Guns don’t kill people.  Lag kills people.”

                I was struck by this while editing a clinical skills checklist the other day.  The skill was oral suctioning, a routine, 15-second task wherein you grab a plastic wand called a Yankauer, turn on the suction machine, insert the wand in someone’s mouth to suck up excess saliva & whatnot, rinse out the wand & turn off the machine.  It’s as simple as vacuuming your windowsill.  This checklist broke it down into 39 steps, each step deeply researched and verified as “best practice” which means if you skip a step you obviously have no business caring for patients.  Seriously, skipped steps are what regulators drill down for when auditing charts and the punishments usually far outweigh the “crime”.  I imagined how this checklist would flow as an instructional video, maybe a 5-second clip for each step, and I chuckled when I realized what the finished video would look like: Lag.

                I sobered quickly when I made the mental leap to patient care in general and I sucked in my breath when I realized this is why healthcare is so slow and providers want to kick the wall and pull out their hair – checklist-driven healthcare regulation and the fear of litigation is causing patient care lag!   Your 4-hour visit to the Emergency Department consists of 30 minutes of actual hands-on care and 3 ½ hours of doctors, nurses and imaging specialists slumped in front of a computer protecting themselves from censure and litigation by checking every box, dotting every i, crossing every t. With government-mandated EHR (electronic health records) - which consist entirely of checklists – for civilian medicine, this lag and its accompanying frustration is only going to get worse.  Time magazine this week includes an article on doctor burnout and suggests a solution might be talking out their frustrations with a trained counselor or spiritual mentor.  Would that work for my boys after an infuriating lag session, I wonder?  I can’t imagine it would, if they went right back into the virtual battlefield with the same slow processor.  What they require is not a sympathetic ear; it’s no lag.

  In my experience military medicine (I don’t know about the VA – I’ve never worked with them)  is much more fluid than civilian because they globally standardize their training, globally standardize their checklists, keep checklists to a minimum, trust their providers with broader scopes of practice, and - perhaps most crucially - give care without concern for lawsuits.  Without the crippling regulatory burden and the cross of “patient satisfaction” carried by civilian healthcare they’re remarkably more limber and dynamic when they engage with damaged humans.  Even they, however, could benefit from a technology upgrade.

We’ve already moved to voice-recognition software for doctor’s dictation, what if that was combined with motion-recognition (think Wii or XBOX Kinect) and instantaneous actionable feedback (think Laerdal’s HeartCode instructorless CPR class) for real-time virtual charting and skill verification?  Add “best practice” skill sets culled from millions of real life videos coalesced by informatics gurus to create one global motion-capture database and voila – no more need for human healthcare workers – everything can be done perfectly by robots, just like making cars or bottling beer!  Sigh.  Maybe one day.  I wonder, would patient satisfaction scores would improve?

Of course, we’d all be out of a job, but we wouldn’t be slaving under the sword of Damocles, so we’d have that going for us, which is nice.  Maybe I’d just hang out in my underwear and play video games all day on my virtual reality headset.  I’d be poor, so it would have to be an older model though, bought second-hand.  Nah.  Couldn’t do it. The lag would absolutely kill me.