Tom Peters’ State of Health“care”

TP’s Healing & Wellness Manifesto2005 (1) Acute-care facilities are “killing fields.” (WE KNOW WHAT TO DO.) (2) Shift the “community” focus 90 degrees (not 180, but not 25) from “fix it” to “prevent it.” (WE KNOW WHAT TO DO.) (3) There are two primary aims for “all this”: Wellness-Healing. (WE KNOW WHAT TO DO.) (4) I’m mad as hell and I’m not going to take it anymore. (I KNOW WHAT TO DO.)

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Tom’s HealthCare 2

Healthcare’s 1-2 Punch 1.Hospital “quality control,” at least in the U.S.A., is a bad, bad joke: Depending on whose stats you believe, hospitals kill 100,000 or so of us a year—and wound many times that number. Finally, “they” are “getting around to” dealing with the issue. Well, thanks. And what is it we’ve been buying for our Trillion or so bucks a year? The fix is eminently do-able … which makes the condition even more intolerable. (“Disgrace” is far too kind a label for the “condition.” Who’s to blame? Just about everybody, starting with the docs who consider oversight from anyone other than fellow clan members to be unacceptable.) 2. The “system”—training, docs, insurance incentives, “culture,” “patients” themselves—is hopelessly-mindlessly-INSANELY (as I see it) skewed toward fixing things (e.g. Me) that are broken—not preventing the problem in the first place and providing the Maintenance Tools necessary for a healthy lifestyle. Sure, bio-medicine will soon allow us to understand and deal with individual genetic pre-dispositions. (And hooray!) But take it from this 61-year old, decades of physical and psychological self-abuse can literally be reversed in relatively short order by an encompassing approach to life that can only be described as a “Passion for Wellness (and Well-being).” Patients—like me—are catching on in record numbers; but “the system” is highly resistant. (Again, the doctors are among the biggest sinners—no surprise, following years of acculturation as the “man-with-the-white-coat-who-will-now-miraculously-dispense- fix it-pills-for-you-the-unwashed.” (Come to think of it, maybe I’ll start wearing a White Coat to my doctor’s office—after all, I am the Professional-in-Charge when it comes to my Body & Soul. Right?)

Excerpt from Tom Peters’ Presentation to Healthcare CIOs: “Quality”: COULD IT TRULY BE THIS AWFUL ?

CDC 1998: 90,000 killed and 2,000,000 injured from nosocomial [hospital-caused] drug errors & infections

HealthGrades/Denver: 195,000 hospital deaths per year in the U.S., = 390 full jumbos/747s in the drink per year. Comments: “This should give you pause when you go to the hospital.” —Dr. Kenneth Kizer, National Quality Forum. “There is little evidence that patient safety has improved in the last five years.” —Dr. Samantha Collier Source: Boston Globe/

“This should give you pause when you go to the hospital.” “There is little evidence that patient safety has improved in the last five years.”

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1,000,000 “serious medication errors per year” … “illegible handwriting, misplaced decimal points, and missed drug interactions and allergies.” Source: Wall Street Journal / Institute of Medicine

As many as 98,000 Americans die each year because of medical errors despite an unprecedented focus on patient safety over the last five years, according to a study released today [Journal of the American Medical Association]. … Nationwide the pace of change is painstakingly slow. …” —USA Today/

“Hospital infections kill an estimated 103,000 people in the United States a year, as many as AIDS, breast cancer and auto accidents combined. … Today, experts estimate that more than 60 percent of staph infections are M.R.S.A. [up from 2 percent in 1974]. Hospitals in Denmark, Finland and the Netherlands once faced similar rates, but brought them down to below 1 percent. How? Through the rigorous enforcement of rules on hand washing, the meticulous cleaning of equipment and hospital rooms, the use of gowns and disposable aprons to prevent doctors and nurses from spreading germs on clothing and the testing of incoming patients to identify and isolate those carrying the germ. … Many hospital administrators say they can’t afford to take the necessary precautions. ” —Betsy McCaughey, founder of the Committee to Reduce Infection Deaths (New York Times/ )

Various studies: 1 in 3, 1 in 5, 1 in 7, 1 in 20 patients “harmed by treatment” Demanding Medical Excellence: Doctors and Accountability in the Information Age, Michael Millenson

“As unsettling as the prevalence of inappropriate care is the enormous amount of what can only be called ignorant care. A surprising 85% of everyday medical treatments have never been scientifically validated. … For instance, when family practitioners in Washington were queried about treating a simple urinary tract infection, 82 physicians came up with an extraordinary 137 strategies.” Demanding Medical Excellence: Doctors and Accountability in the Information Age, Michael Millenson

YE GADS! New England Journal of Medicine/ Harvard Medical Practice Study: 4% error rate (1 of 4 negligence). “Subsequent investigations around the country have confirmed the ubiquity of error.” “In one small study of how clinicians perform when patients have a sudden cardiac arrest, 27 of 30 clinicians made an error in using the defibrillator.” Mistakes in administering drugs (1995 study) “average once every hospital admission.” “Lucian Leape, medicine’s leading expert on error, points out that many other industries—whether the task is manufacturing semiconductors or serving customers at the Ritz Carlton—simply wouldn’t countenance error rates like those in hospitals.”—Complications, Atul Gawande

“In a disturbing 1991 study, 110 nurses of varying experience levels took a written test of their ability to calculate medication doses. Eight out of 10 made calculation mistakes at least 10% of the time, while four out of 10 made mistakes 30 % of the time.” Demanding Medical Excellence: Doctors and Accountability in the Information Age, Michael Millenson

Hospitals Pay Appropriate Attention To Medical Errors Yes ………………………………. 1% Aware And Trying Hard ……... 8% Aware But Tepid Response … 22% No ……………………………….. 25% An Inexcusable Tragedy …….. 44% Source: Poll/tompeters.com

Welcome to the Homer Simpson Hospital a/k/a The Killing Fields

Tom’s Cold Fury at Healthcare “Professionals,” Especially Acute Care Operatives 1. You are killers: “Quality” remains a bad joke. 2. Pick off bunches of Low-hanging Fruit. (E.g., Tom’s 1 st Executive order as Your Next President: Providing a Handwritten Prescription is punishable by not less than 60 days of Hard Time.) 3. The “science” in “medicine” is often fanciful: Most “scientific” “treatments” are unverified. (So quit the knee-jerk denigration of alternative therapies—trust me, Breathing Meditation beats Univasc; Good Nutrition beats Lipitor; Regular Exercise beats bypass surgery.) 4. You continue to obsess only on after-the-act “fixes,” the automatic resort to Chemicals and Knives, rather than P-W-H-C … Prevention-Wellness- Healing-Care. 5. Your Mindful Lifelong (mine) Failure to focus on P-W-H-C will probably cost me a decade of longevity, Canyon Ranch/Lenox not withstanding. THAT PISSES ME OFF. (For one thing, I need those 10 years to spread the P-W-H-C Credo to “health‘care’” “professionals.”) 6. You are hereby ordered to stop using the term “healthcare”: You haven’t earned the right to utter the word “care”! 7. $$$$$ Are Not the Issue/Excuse I: Quality Is free!!! (There are MANY who are … Getting This Right … without Buckets of $$$$$.) 8. $$$$$ Are Not the Issue/Excuse II: Planetree Alliance/Griffin Hospital “Models The Way” … on P-W-H-C … Every Day. IT CAN BE DONE! 9. ALL THESE PROBLEMS CAN BE FIXED! WE KNOW HOW! THERE ARE NO EXCUSES … EXCEPT LACK OF GUTS & WILL! “It’s Attitude, Baby!” 10. All “members of staff”—regardless of “professional discipline”—are Healing Arts Practitioners. OR TURN IN YOUR EMPLOYEE BADGE. NOW /La Jolla

TP’s Healing & Wellness Manifesto2005 (1) Acute-care facilities are “killing fields.” (WE KNOW WHAT TO DO.) (2) Shift the “community” focus 90 degrees (not 180, but not 25) from “fix it” to “prevent it.” (WE KNOW WHAT TO DO.) (3) There are two primary aims for “all this”: Wellness-Healing. (WE KNOW WHAT TO DO.) (4) I’m mad as hell and I’m not going to take it anymore. (I KNOW WHAT TO DO.)

Tom’s HealthCare 2.5

We all live in Dell-Wal*Mart- eBay-Google World!

We [almost] all live in Dell-Wal*Mart- eBay-Google World!

“Some grocery stores have better technology than our hospitals and clinics.” —Tommy Thompson, HHS Secretary Source: Special Report on technology in healthcare, U.S. News & World Report (07.04)

“We’re in the Internet age, and the average patient can’t their doctor.” Donald Berwick, Harvard Med School

“ Our entire facility is digital. No paper, no film, no medical records. Nothing. And it’s all integrated—from the lab to X-ray to records to physician order entry. Patients don’t have to wait for anything. The information from the physician’s office is in registration and vice versa. The referring physician is immediately sent an telling him his patient has shown up. … It’s wireless in-house. We have 800 notebook computers that are wireless. Physicians can walk around with a computer that’s pre-programmed. If the physician wants, we’ll go out and wire their house so they can sit on the couch and connect to the network. They can review a chart from 100 miles away.” — David Veillette, CEO, Indiana Heart Hospital (HealthLeaders/ )

Tom’s HealthCare 3.0

H5N1 Tom Peters/23October2005

“ We may not be interested in chaos but chaos is interested in us.” —Robert Cooper, The Breaking of Nations: Order and Chaos in the Twenty-first Century

H5N1

3D/350M

Grim tail of the distribution of outcomes: 3 days to circle the globe; up to 350,000,000 deaths

Kroll/SARS: “don’t over-react” Kroll/H5N1: “devastating” Source: Newsweek/

Sample Actions Brief self (CEO) Project Manager as “Asst to CEO”/Attends all Exec Team meetings Plan ASAP Risk Management job elevated (min: RM consultant) Discuss with Board (on every agenda?); non-Exec Board designee? Medical Officer on Exec Team? Info Dissemination strategy explicit, reviewed regularly (update 100% of employees regularly) Engage Clients/Vendors Review “JIT” issues/impact Discuss with Banker/s “Key person”/“first responder” plan Community involvement

The (Obvious) Fix(es) …

TP’s Healing & Wellness Manifesto2005 (1) Acute-care facilities are “killing fields.” (WE KNOW WHAT TO DO.) (2) Shift the “community” focus 90 degrees (not 180, but not 25) from “fix it” to “prevent it.” (WE KNOW WHAT TO DO.) (3) There are two primary aims for “all this”: Wellness-Healing. (WE KNOW WHAT TO DO.) (4) I’m mad as hell and I’m not going to take it anymore. (I KNOW WHAT TO DO.)

About Time! 100,000 Lives Campaign* *Don Berwick/Institute for Healthcare Improvement

The Benefits of … FOCUSED EXCELLENCE Shouldice/Hernia Repair: min, 1% recurrence. Avg: 90 min, 10%-15% recurrence. Source: Complications, Atul Gawande

“ Our entire facility is digital. No paper, no film, no medical records. Nothing. And it’s all integrated—from the lab to X-ray to records to physician order entry. Patients don’t have to wait for anything. The information from the physician’s office is in registration and vice versa. The referring physician is immediately sent an telling him his patient has shown up. … It’s wireless in-house. We have 800 notebook computers that are wireless. Physicians can walk around with a computer that’s pre-programmed. If the physician wants, we’ll go out and wire their house so they can sit on the couch and connect to the network. They can review a chart from 100 miles away.” — David Veillette, CEO, Indiana Heart Hospital (HealthLeaders/ )

“The nearly 1 billion people online worldwide—along with their shared knowledge, social contacts, online reputations, computing power, and more—are rapidly becoming a collective force of unprecedented power. For the first time in human history, mass cooperation across time and space is suddenly economical.” —BW/

Power Tools for Power Solutions/ Strategies! —TP

Oh Canada! “Ontario To Split Health Ministry” —Headline/Globe And Mail/06.05 (New ministry will focus on Prevention/Wellness/Eldercare)

“Companies Step Up Wellness Efforts: Rising health costs provide incentive to promote healthier employee lifestyles” —headline/USA Today/08.05

“Prevention Program At Dow Chemical Aims To Save Money” —IBD/08.05

TP’s Healing & Wellness Manifesto2005 (1) Acute-care facilities are “killing fields.” (WE KNOW WHAT TO DO.) (2) Shift the “community” focus 90 degrees (not 180, but not 25) from “fix it” to “prevent it.” (WE KNOW WHAT TO DO.) (3) There are two primary aims for “all this”: Wellness-Healing. (WE KNOW WHAT TO DO.) (4) I’m mad as hell and I’m not going to take it anymore. (I KNOW WHAT TO DO.)

TP/BW: Hard is soft. Soft is hard.

“Hard Science/Technology abetted by the Human/Healing Touch”?

“Hard Science/Technology abetted by the Human/Healing Touch”? Or: “The Human/Healing Touch abetted by Hard Science/ Technology”?

What is In Search of Excellence all about?

What is In Search of Excellence all about: People. Emotion. Engagement. Empowerment. Caring.

What is In Search of Excellence in Healthcare all about?

What is In Search of Excellence in Healthcare all about: People. Emotion. Engagement. Empowerment. Caring.

TP’s Healing & Wellness Manifesto2005 (1) Acute-care facilities are “killing fields.” (WE KNOW WHAT TO DO.) (2) Shift the “community” focus 90 degrees (not 180, but not 25) from “fix it” to “prevent it.” (WE KNOW WHAT TO DO.) (3) There are two primary aims for “all this”: Wellness-Healing. (WE KNOW WHAT TO DO.) (4) I’m mad as hell and I’m not going to take it anymore. (I KNOW WHAT TO DO.)

Planetree: A Radical Model for New Healthcare/Healing/ Wellness Excellence

“It was the goal of the Planetree Unit to help patients not only get well faster but also to stay well longer.” —Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

“Much of our current healthcare is about curing. Curing is good. But healing is spiritual, and healing is better, because we can heal many people we cannot cure.” —Leland Kaiser, “Holistic Hospitals” Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Determinants of Health Access to care: 10% Genetics: 20% Environment: 20% Health Behaviors: 50% Source: Institute for the Future

The 9 Planetree Practices 1. The Importance of Human Interaction 2. Informing and Empowering Diverse Populations: Consumer Health Libraries and Patient Information 3. Healing Partnerships: The importance of Including Friends and Family 4. Nutrition: The Nurturing Aspect of Food 5. Spirituality: Inner Resources for Healing 6. Human Touch: The Essentials of Communicating Caring Through Massage 7. Healing Arts: Nutrition for the Soul 8. Integrating Complementary and Alternative Practices into Conventional Care 9. Healing Environments: Architecture and Design Conducive to Health Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

1. The Importance of Human Interaction

“There is a misconception that supportive interactions require more staff or more time and are therefore more costly. Although labor costs are a substantial part of any hospital budget, the interactions themselves add nothing to the budget. Kindness is free. Listening to patients or answering their questions costs nothing. It can be argued that negative interactions—alienating patients, being non-responsive to their needs or limiting their sense of control—can be very costly. … Angry, frustrated or frightened patients may be combative, withdrawn and less cooperative— requiring far more time than it would have taken to interact with them initially in a positive way.” —Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Press Ganey Assoc/1999: 139,380 former patients from 225 hospitals 0 of top 15 factors determining P atient S atisfaction referred to patient’s health outcome PS directly related to Staff Interaction PS directly correlated with ES (Employee Satisfaction) Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

“Perhaps the simplest and most profound of all human interactions is KINDNESS. … But if it is so simple, it is surprising how frequently it is absent from our healthcare environments. … Many staff members report verbal ‘abuse ’ by physicians, managers and coworkers.” —Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

“Planetree is about human beings caring for other human beings.” —Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel (“Ladies and gentlemen serving ladies and gentlemen”—4S credo)

2. Informing and Empowering Diverse Populations: Consumer Health Libraries and Patient Information

Planetree Health Resources Center/1981 Planetree Classification System Consumer Health Librarians Volunteers Classes, lectures Health Fairs Griffin’s Mobile Health Resource Center Open Chart Policy Patient Progress Notes Care Coordination Conferences (Est goals, timetable, etc.) Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

3. Healing Partnerships: The Importance of Including Friends and Family

“When hospital staff members are asked to list the attributes of the ‘perfect patient and family,’ their response is usually a passive patient with no family.” —Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

The Patient-Family Experience “Patients are stripped of control, their clothes are taken away, they have little say over their schedule, and they are deliberately separated from their family and friends. Healthcare professionals control all of the information about their patients’ bodies and access to the people who can answer questions and connect them with helpful resources. Families are treated more as intruders than loved ones.” —Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

“Family members, close friends and ‘significant others’ can have a far greater impact on patients’ experience of illness, and on their long-term health and happiness, than any healthcare professional.” —Through the Patient’s Eyes Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

“A 7-year follow-up of women diagnosed with breast cancer showed that those who confided in at least one person in the 3 months after surgery had a 7-year survival rate of 72.4%, as compared to 56.3% for those who didn’t have a confidant.” Institute for the Future

Institute of Medicine/ “Crossing the Quality Chasm” Respect for preferences Involvement in Decision Making Access to care Coordination of care Information and education Physical comfort Emotional support Involvement of Friends and Family Continuity of care Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Care Partner Programs (IDs, discount meals, etc.) Unrestricted visits (“Most Planetree hospitals have eliminated visiting restrictions altogether.”) (ER at one hospital “has a policy of never separating the patient from the family, and there is no limitation on how many family members may be present.”) Collaborative Care Conferences Clinical Guidelines Discussions Family Spaces Pet Visits (POP: Patients’ Own Pets) Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

4. Nutrition: The Nurturing Aspect of Food

Meals are central events vs “There, you’re fed.” * *Irony: Focus on “nutrition” has reduced focus on “food” and “service” Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Kitchen Beautiful cutlery, plates, etc Chef rep Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Aroma therapy (e.g. “smell of baking cookies”) Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

5. Spirituality: Inner Resources for Healing

Spirituality: Meaning and Connectedness in Life 1. Connected to supportive and caring group 2. Sense of mastery and control 3. Make meaning out of disease/find meaning in suffering Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Griffin: redesign chapel (waterfall, quiet music, open prayer book) Other: music, flowers, portable labyrinth Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

6. Human Touch: The Essentials of Communicating Caring Through Massage

“Massage is a powerful way to communicate caring.” —Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Mid-Columbia Medical Center/Center for Mind and Body Massage for every patient scheduled for ambulatory surgery (“Go into surgery with a good attitude”) Infant massage Staff massage (“caring for the caregivers”) Healing environments: chemo! Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

7. Healing Arts: Nutrition for the Soul

Planetree: “Environment conducive to healing” Color! Light! Brilliance! Form! Art! Music! Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Florence Nightingale/Notes on Nursing/patient’s need for beauty, windows, flowers: “People say the effect is only on the mind. It is no such thing. The effect is on the body, too” Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Griffin: Music in the parking lot; professional musicians in the lobby (7/week, 3-4hrs/day) ; 5 pianos; volunteers ( hrs arts & entertainment per month). Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

8. Integrating Complementary and Alternative Practices into Conventional Care

CAM (Complementary & Alternative Medicine): 83M in US (42%) CAM visits 243M, greater than to PCP (Primary Care Physician) (With min insurance coverage) W-Educated-Hi inc Don’t tell PCP (40%) OTA: <30% procedures used in conventional medicine have undergone RCTs (randomized clinical trials) Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Griffin IMC/Integrative Medicine Center Massage Acupuncture Meditation Chiropractic Nutritional supplements Aroma therapy Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

9. Healing Environments: Architecture and Design Conducive to Health

“Planetree Look” Woods and natural materials Indirect lighting Homelike settings Goals: Welcome patients, friends and family … Value humans over technology.. Enable patients to participate in their care … Provide flexibility to personalize the care of each patient … Encourage caregivers to be responsive to patients … Foster a connection to nature and beauty Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Sound Texture Lighting Color Smell Taste Sacred space Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Access to nurses station: “Happen to” vs “Happen with” Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

The Eden Alternative* *ElderCare

The Ten Principals of the Eden Alternative 1. The three plagues of loneliness, helplessness, and boredom account for the bulk of suffering among Elders. 2. Life in an Elder-centered community revolves around close and continuing contact with children, plants, and animals. These ancient relationships provide young and old alike with a pathway to a life worth living. 3. Companionship is the antidote to loneliness. In an Elder- centered community we must provide easy access to human and animal companionship. 4. A healthy Elder-centered community seeks to balance the care that is being given with the care that is being received. Elders need opportunities to give care and caregivers need opportunities to receive care. Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

“The Eden paradigm allows elders to care for animals, birds, and children as well as each other.” —Susan Eaton, Harvard/JFK school Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

The Ten Principals of the Eden Alternative 5. Variety and Spontaneity are the antidotes to boredom. The Elder-centered community is rich in opportunities to sample these ancient pleasures. 6. An Elder-centered community understands that passive entertainment cannot fill a human life. 7. The Elder-centered community takes medical treatment down from its pedestal and and places it into the service of genuine human caring. Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

The Ten Principals of the Eden Alternative 8. In an Elder-centered community, decisions should be made by the Elders or those as close to the Elders as possible. 9. An Elder-centered community understands human growth cannot be separated from human life. 10. Wise leadership is the lifeblood of any struggle against the Three Plagues. For it, there can be no substitute. Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

“The most basic question we need to pose in caring for others is this: Is this a loving act?” —Leland Kaiser, “Holistic Hospitals” Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Conclusion: Caring/Growth “Experience”

Care! Control! Connect! Engage! Grow! De-stress!

Learn more about Planetree/ The Planetree Alliance:

TP’s Healing & Wellness Manifesto2005 (1) Acute-care facilities are “killing fields.” (WE KNOW WHAT TO DO.) (2) Shift the “community” focus 90 degrees (not 180, but not 25) from “fix it” to “prevent it.” (WE KNOW WHAT TO DO.) (3) There are two primary aims for “all this”: Wellness-Healing. (WE KNOW WHAT TO DO.) (4) I’m mad as hell and I’m not going to take it anymore. (I KNOW WHAT TO DO.)