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Preview: The Medical Case of the Pain Opioid Epidemic and its Components  

We must accept that the political system, whether local or federal is easily corruptible. Although there are various processes and systems in place for checks and balances, there are many situations where the usual mechanism fails. Failure can be intentional or at times the unintended consequence of well-meaning legislation or change in the environment. Yet the current clinical status requires a more immediate approach.  Like our bodies, consistent corruption of DNA is handled through a surveillance system and mobilization of elements of the immune system that are general and specialized. Once potential harmful legislation is introduced, the surveillance system can mobilize citizens, a system to better engage this system.


The Medical Case Presentation represents a framework that summons our fellow citizens to address the challenges confronting us as individuals, as communities, and as a nation.  The Medical Case Presentation includes multiple features to engage citizens. Similar to the diagnostic and treatment tools in the hands of medical clinicians, these features can be thought of as a diagnostic and treatment elements for engaged citizenship. In the coming weeks, we will introduce some of the elements and how they are used in addressing the challenges of the opioid epidemic. The effort is a work in progress, links to content at various stages of development are provided. They include the following:


Shrink the Government: Ongoing reflections about the psychological/cognitive aspects of political life. We will explore the psychology of the citizen, political elites, public institutions and related organizations, and other stakeholders in our political ecosystem. Where Shrink the Government was initially a stand-alone blog where I had planned to make observations about our politics, the reborn Shrink the Government will encompass a larger and more activist agenda and provide a treatment plan to support a number of initiatives. The activist plan includes the development and deployment of The Case Presentation, “My Political Tool Box for the 21st Century” to more effectively engage within the Political Ecosystem. There are many areas (symptoms) in our political landscape that would benefit from “Shrink the Government”. While improving our political environment is the goal, we will start by focusing on a very specific yet devastating problem, The Pain Opioid Epidemic, to “develop the civic muscle” and test our the approach which will then be applied to Cancer of the US Political System and other Diseases of the US Political System.


Vision: One of the challenges confronting our nation is the lack of shared collective vision for the United States of America. America does well when its leaders and citizens are inspired by a unified vision. We examine the vision for opioid-related challenges. Establish a vision for the individual, community, nation and the international community

The vision of Optimal Care: The  individual suffering from opioid use disorder/ addiction

The vision of Optimal Pain Management: The  individual suffering from acute pain


My Political Ecosystem  In order to actively participate in our politics, we need to be informed about political and public institutions, our representatives and other government officials. This easy-to-use tool provides a snapshot of the political system where citizens can learn about their representatives, organizations and other relevant aspects of their local, state and federal (or global) systems. The Ecosystem view assists citizens in developing a richer understanding of the social and political systems affecting their lives. Utilizing an ecosystem approach to identified challenges, My Political Ecosystem provides a user-friendly tool to better understand and engage with the various relevant stakeholders. The citizen can learn about their representatives, organizations and other relevant influences on their local, state and federal (or global) systems and more easily engage with them. The citizen can learn about their representatives, organizations and other relevant aspects of their local, state and federal (Global) systems. In order to actively participate in our politics, local, state and nationally (Globally) we need to be informed about political and public institutions, our representatives and other government officials. My Political Ecosystem provides easy access to your specific ecosystem from local to national as well as the tools to actively participate in our democracy.   Our representative system of government is based on We the People actively taking part in our government.  There are many ways that we can all be engaged to make our collective lives better.


My Political Toolbox: When it comes to our political life, the potential of digital technology has the potential to enrich American Democracy and provide the tools for 21st-century solutions to the challenges confronting the United States. From participation in the political process to engage citizens in decision making and policy formulation, digital technology can be leveraged on the local, national and global level..   We discuss utilizing digital technology to strengthen our democracy by improving citizen engagement. Current technology allows us to rewire the body politic through information technology. These tools allow unprecedented opportunity to get access to information, mobilize, challenge misinformation provide for a more deliberative dialogue. Where previously only well-connected individuals and organizations were engaged now more of the public can get engaged.


Citizen Brief: A citizen-focused document, the Citizen Brief presents relevant social and political information to support social and political engagement. A complete Citizen Brief provides a vision for an issue, reframes the problem, provides data, and discusses the various issues and proposals available. These actions can be personal, social or political. Due to its emphasis on continual reassessment, the Citizen Brief is uniquely positioned to address systemic changes over time. The Citizen Brief is associated with an activist agenda to address the identified challenges and powerful barriers that stymie efforts to confront social challenges. The particular items in the Brief are linked to an action plan for citizen engagement.


The Checklist Manifesto: Being a citizen is challenging and complex. Checklists have been used to improve outcomes in various fields. We introduce the checklists to facilitate taking action and interacting with various stakeholders. Developing a checklist for the various stakeholders is a continuous process.


The Tracer: Tracers are designed to “trace” the care experiences that a patient had while at an organization. It is a way to analyze the organization’s system of providing care, treatment or services using actual patients as the framework for assessing standards compliance. Patients selected for these tracers will likely be those in high-risk areas or whose diagnosis, age or type of services received may enable the best in-depth evaluation of the organization’s processes and practices.  Using the tracer framework, we create an imaginary course (Flow) of the various patient types within the overall health care and hospital ecosystem and then each particular area within the hospital. The specific examples we provide are motivated by evidence-based optimal care and best practice. We highlight challenges and focus on resources, assessment, handoffs, interaction with external stakeholders (insurance, criminal justice).                                                                                                                                                                                                                                                                                                                                                         Health of the Nation:  An annual gathering in Philadelphia organized by Citizens4Health, an organization motivated by the belief that citizen engagement will contribute to solutions to the big problems that confront our nation, Health of the Nation provides a different approach from the current toxic political debate on how to address the challenges facing our healthcare system (and our nation).


Progress Notes: Madison and other framers were aware of the need for updating the framework of the constitution as the realities change. For Jefferson, he believed that there should be constitutional conventions every 20 or so years. Madison was concerned about the danger of opening up the structure of the constitution to the “People”,  as well as the loss of expertise and accumulated knowledge and experience. 


Take Action: Additionally, it is clear that there are many "patient" and “citizen” focused interventions that can stem from various symptoms of the epidemic.  The challenge we face is providing a process that will achieve the best outcome with acceptable unintended consequences. Providing the right engagement tools and framework, citizens, patients, consumers, healthcare professionals, public servants, and politicians, working together can achieve great results addressing the challenges facing our nation. Here are a number of areas for taking action: 

Get Personal: Action that will allow you to achieve the best personal outcome in addressing the challenge of Pain, Opioid Use, and Opioid Dependence.
Get Social: Actions that will impact the availability of evidence-based, best practice interventions that you can undertake  to address the challenges of Pain and Opioid Use in your community (Social Ecosystem)
Get Political: Actions you can undertake within your political ecosystem to have a meaningful impact on the Pain-Opioid Epidemic.
Contact Us to take part in the treatment plan and Forum

Shrink the Government

Psychological insight about our politics 


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