3. Systematic Care Components

150831  Horizontal support & Dr Begree

When I arrived at Singapore, it was a part of Malaysia as one nation. When I left there on that visit, Singapore was an independent nation, city.  I was giving courses in Singapore and my courses were highly related to demonstrations at that time.   I was sent by the company as an inventor because it was a radical change of habits of dentist’s way.  They had learnt that fit with their previous dental equipments that were produced in 1890’s when railroads started.  Big factories were established at that time and Ritter was one of the biggest ones.  All the equipments were made in assumption that dentists were standing.  All the working people were standing those days.  Even when bookkeepers wrote books, they were standing.  Standing was identified with human body at work.  Then people thought they could sit while they were working.  This idea of being seated grabbed people’s attention and it saved lots of leg strain of course.  And there were problems related to that.  Air vehicle’s vein was a common problem from standing for long hours at one place all the time.  We were made for walking but not for long term standing.  Body did not evolve for standing in one position for long time.   So walking is more natural.  It came down to two ideas on seating position.  The major company in US took that advantage right way and had a different idea than I did.  If a dentist is to be seated, a patient is in a reclined position.  And the trunk is reclined and the head goes along with the trunk with a little bit of variation.  I thought that a patient body, the spine of backbone, should be horizontal.  That was a big conflict between this huge company which was campaigning for this very strongly.  It was highly organized in US and they decided that I was an enemy for what they stood for.  It became a fight between the reclined backbones vs horizontal backbones of the spine.  They were very upset with what I came up with because they had lots of planning for how to tilt patient chair in different angles.  I rejected tilting of a chair and by going to horizontal, I simplified lots of parts they needed.   I unified tools that would fit for horizontals so operator’s body weight support, patient’s body weight support and tools are one unit.  It was the key to what Morita thought as a major invention and they promoted it.  A part of the promotion was to send the inventor around the world to explain it so I was sent.   With all the contacts, I was surprised at that time how strong the company can be.  Morita had wholesalers which covered the complete nation or perhaps a couple of small nations.  And they relate to factories and the factories relate only to the wholesalers.   In turn wholesalers sell to dealers which are local and dealers claim they handle services.  That didn’t work well because I came up with too big unit when they put them altogether and it caused a quite bit of problem.  But Morita decided to go into the global market and I was sent all over, Australia, New Zealand, Europe, everywhere except the country I was born and schooled which is US.  I was not welcome back there because of the large company’s activity so I stayed away from US.  I was well known by much of the rest of the world but not known in US.  Later deans or presidents of schools in US, University of Maryland, University of Minnesota, University of North California and University of Missouri, caught an attention and they found out what I was doing.  When they took an interest, I had links and I was put into US that came quite bit later.

Another key person in my life I met during that time I was traveling around was Dr Begree whom I met in Edinburgh, Scotland. He was a professor there.  After I demonstrated there, he invited me to his home for lots of questioning.  After I answered to his questions, he decided to leave Scotland because he felt things were very conservative there and it was very difficult to change things.  So he went to Canada.  He first went to the East Canada, Toronto, teaching some concept of mouth clinics there.  Then he went to the west and became the Dean of University of British Columbia where I met him again.  We got closely related and he took a trouble to come to Japan because of his interests in what I had come up with.  He is the one who decided that my concept should be introduced to WHO and would see David Barmes who has the same initials as mine, DB.  David Barmes was the first contact I made from WHO.  The HQ of WHO was in Geneva, Switzerland and I spent plenty of time there.   My concept was centered on fingers and forearms with associated views and I specified views and specified finger points in digits and we call them all mi points.  It was an introduction of digits in numbered order – digital order.   Next campaign is how far we can identify and specify things with digits.  That still remains as my present interest of concern today, how we can handle that.


151021  Value of masked eyes tests – Part 1

Masked eyes tests, like Dr Dan Butterfield did. He was not a mouth clinician but he was an abdominal surgeon. Abdominal means the whole area, not only a stomach. The data I collected from him would be useful, that was masked eyes test.  Dan Butterfield had a strong interest in the design of our clinic in Atami.  He was a clinician and caught a really strong interest.  I met him as a stranger sitting side by side at a restaurant counter in Tokyo.  As strangers we introduced each other, and we found out that we had the same origin.  I told him I was basically identified as a surgeon specializing in a mouth and I found out he was a surgeon.   Whatever caught his interest, next day he decided to see the clinic where I was working in, ie. Empire Clinic.  The following year, I moved to Atami and he came back the following summer.   He was at Harvard Univ. and he had 4 months open in summer.   He had an impaction problem that was a buried one, and I had to cut the bone to get to it.  He was a very curious type, and had a mirror watching the whole thing.  He was a curious type, so he wanted to see exactly what I did it.  That was the first meeting.  Another thing happened at that time was that a heavy lamp fell on his heel and ruptured his Achiles tendon.  That tendon was needed to operate his foot.  If it is not properly done, you would be lame for the rest of your life.  He called me and said that he ruptured his Achiles tendon, and I recommended someone he can see.  I knew a doctor who worked in a hospital.  But it’s interesting that the person who worked in the hospital was also from Harvard U.  There was another incident happened right away.  He had to extend his stay in Japan, because he had to stay in the hospital.  It takes a long time for the tendon healed.  He became very curious in what I was involved in and he was a writer.  Politically we had very close understanding each other in many things.  For example, later when the Vietnam War started, he was one of the first doctors who belonged to Doctors Without Borders.  That fits in my thinking.  We had close understanding each other in many things.

151021  Value of masked eyes tests – Part 2

He took much interest in my design concept. I conducted masked eyes test with him.  I regret I did not have a video of that test.  I asked him what were the procedures he most commonly performed, and he said appendix removal.  I asked him how long it takes to do it, and he said his average time is 18 minutes.  He had the data.  That is from the first cut of the tissue to the closure.   We went to a hotel next door where there was a lot of space and nothing could influence his movements.  I asked him to go ahead and do (pantomime) appendix removal and I had a stop watch with me.  His image was very strong, because he finished in very close to 18 minutes.  I was watching him and made two notes.  He was almost standing, but slightly bent because he said he had a high stool at Harvard.  The next thing I noticed was that every time he shifted to his left, he pulled his elbow to his body, and when he came up, his elbow was loose when he shifted to right.  I asked him the reason for it, and he said it was because of an earth current there, but they did not use an earth current anymore.  He was not aware he was doing that.  That awareness came simply because he was not using his eyes.  If he had his eyes opened, that awareness would not be that strong.  Another thing I noticed was that occasionally he jerked.  He jerked 4 or 5 times during the procedures.  He said that a retractor was pulled by a nurse but it would slip.  The retractor was made by casting and they slip, and he had to grab it and put it back in place.  He was doing this for years and years and he was never aware of it.  So masked eyes tests make you aware of things you were never aware of.  It really upset him when he found out.  So he went back to Harvard and told a professor ‘we don’t use the earth current anymore, and why it is there for.’  He also mentioned about the casting for a retractor.  But the professor became angry and said that ‘We have been doing this for years at Harvard, and everyone gets well with them.  No one questioned what we do at Harvard.’  And then Dan resigned his position from the conflict he had with the professor.  He got an interested in engineering because of the question I was working on, and he became a resident surgeon of MIT.  At MIT he found that engineers are always questioning and measuring, and they are nice to work with.  Masked eyes tests change his life.  When he came back, I moved to Atamai.  What interested him in Atami was we did not have a door in our clinic.  When people walk in the hall way, they could see a receptionist and people in the waiting area.  We did not have a door to a consulting area, either.  It was wide open and he liked that.  At that time every medical clinic in US had a door, and they had to have privacy.  I did not have any closure of anything, unless there is absolute reason for it.  This is what masked eyes tests make you aware of these things.   We are so much distracted by what we see and we cannot be aware of things.  It changes the order of awareness.  It makes you aware how our body relates to space, and determine how much space we have.  One of the first tests was how we determine the space of the reception area.  We counted number of steps.  We had data to get average length of a step. We got data on what is the most natural direction to walk from the entry to interface with a receptionist.  How it is related to the remaining areas in the clinic.  We collected lots of data on that, collected in Japan by our group.  So the Japanese group was at the beginning collecting lots of data, and then chain spread to other countries, mostly in Europe and then Australia and New Zealand.  This spread came generally from wholesalers. But this comes up with the constant of chain. The chain is going to be global. It can be seen as a global chain.

151014  Reason for masked eyes test

What masked eyes test is used for primarily? One is from a proof point of a designer who is dealing with how to identify what human space is.  The starting point of human space is based on measurements from the surface of human body and what can be measured from human body.    Designers are designing units of space, or it could be talking about a complete clinic or hospital, but they would say how this idea of a human space is derived.  It comes back to the base of what we call a station or immediate surrounding of human being. From a view point of users, they only feel by touch of what they cannot see with masked eyes test.  It can also include use of tools.  For example, if you talk about human space dealing with people on a street, they would have a tool of a cane or stick, by which they tap to find out where they are going.  They do this as the width of the body, that can be seen as a test of human space.  But we are dealing with human space used in health care settings.  Our test is dealing with how to fit with a person, as he fits with other people and how they fit with tools.  The main problems we deal with is how the human body fits with tools and how the human body fits with others.  Sometime we call “mi-mi” or “me-mi”. “mi” is a person working and “mi-mi” would be more than one person, and how they fit together.  For example, an operator with an assistant, they have to know how the assistant fits with the operator when they are working closely, which would be a human space.  Human space for one person is one thing, and it has to fit with other things, and then both are using tools, and then how the tools fit together. We sometimes call them tech, which is broader than tool itself.  How human bodies fit together and how they fit with tools – that’s the problem we would see tested in the name of masked eyes test.  Masked eyes test is more useful than open eyes test, because with open eyes test, we can be easily distracted.

150619  Reason for existance of GEPEC

The main reason for existence of GEPEC is to spread worldwide findings on the subject of pd. pd can be defined as outcomes from input to proprioceptors and changes of tissue stretch that stimulates proprioceptors.  How this thing started? It started from the problems we had with variations we saw. We had a chain of clinics and we were studying why there is such difference in control conditions of surgeons (=operators).  They have many different ways of performing the same procedures.  Surgery is a very serious subject, because it means cutting and dissecting human bodies.  We are focusing on mouth surgeons at this staring time.  But it applies to all surgeons and beyond that.  It is not only surgery, but in terms of any data collection for finding problems in people’s bodies, you have to be able to have procedures for that in the field of health care.  In the chain of clinics we made, we were comparing the accuracy of outcomes and the productivity of surgeons.  Why are there such variations in productivity or different factors?  Accuracy of outcomes is very important, and we are getting on surgery retreatment rates. If we have a problem of accuracy of outcomes, we can expect higher of retreatment rates.  It is a huge cost in the field of health care, and how much saving do we have in the field of health care, if we can find an answer to this?  Finally we decided the key to this is what we call pd, ie. proprioceptive derivation.  Pd is a short term for it.  If it becomes well known and spread widely, it will be  significant.  It is important to spread it, because the accuracy of outcomes by pd decreases retreatment rates.  It is the first thing, but goes farther than that.  We found settings for healthcare have certainly established habits of healthcare providers.  The person who became quite excited about what we have been working on was Dr. Mike Dougherty, and he said we should organize to move this in a very big way.  But we have been holding on this for the time being, but we’d better start on, and we should really get going on this.