Cardiac Screening

October 31, 2014

The American Heart Association has once again concluded that sophisticated and expensive heart screening is not practical or appropriate as a precondition for youth and young adults to participate in competitive organized sports.
On Sept. 14, 2014, the AHA online publication Circulation stated:

Sudden death among 12 to 25-year-olds is “a low event rate occurrence.”

“There is insufficient information to support the view that ECGs in asymptomatic young people for cardiac disease is appropriate or possible on a national basis for the United States, in competitive athletics or in the general population.”

“At present, there is no mechanism available in the United States to effectively create national programs of such magnitude, whether limited to athletics or including the wider population of all young people.”

“There is insufficient evidence that particularly large-scale/mass screening initiatives are feasible or cost effective within the current US healthcare infrastructure . . .”

“The ECG . . . cannot be regarded as an ideal or effective test when applied to large healthy populations.”

“An additional, but unresolved, ethical issue concerns whether students who voluntarily engage in competitive athletic programs should have advantage of cardiovascular screening, while others who choose not to be involved in such activities (but may be at the same or similar risk) are in effect excluded from the same opportunity.”

The AHA’s Sept. 14 AHA writing group “does not believe the available data support significant public health benefit from using the 12-lead ECG as a universal screening tool. The writing group, however, does endorse the widespread dissemination of automated external defibrillators which are effective in saving young lives on the athletic field and elsewhere.”

Holding Back

February 24, 2015

I wrote last week in this space about the positive place for disagreement in organizations; and I held back on pushing the topic a bit further.

Sometimes an organization leader has to hold back. Sometimes the leader needs to recognize that the organization has more disagreement than it can handle and that taking on another topic for which much disagreement is likely would be like drinking from a fire hose.

In Leadership on the Line (HBS, 2002), authors Ronald Heifetz and Marty Linsky write that “leadership requires disturbing people – but at a rate they can absorb.”

Heifetz and Linsky describe the need to “orchestrate the conflict” in four steps:

  1. “Create a holding environment” – a safe place to interact.
  2. “Control the temperature” – turn the heat up to get people’s attention, and turn it down for them to cool off or to catch up.
  3. “Set the pace” – not too fast that we leave too many people behind; not too slow that we lose the vision and momentum.
  4. “Show the future” – remind people of the “orienting value” – that is, the positive reason to go through all the negative rancor.