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Demystifying Medicine One Week at a Time

Category: advocacy (page 1 of 14)

Public Libraries

Artist’s rendering of Central Library. It turned out as good as it looks.

In Tulsa the flagship downtown Central Library just re-opened after a three-year renovation.

It’s been spectacularly re-designed and updated with all of the latest library technology. It includes the nation’s only (to this point) embedded Starbucks Coffee–a plus or minus depending on your viewpoint. (Some academic libraries at universities already contain them.)

A recent newspaper article profiled another important feature of the Tulsa library: A full-time social worker.

As you may or may not know, depending on where you live and how much you use your public library, urban libraries are often visited by people in transition–those that are jobless, homeless, and who frequently have stable or unstable mental illness.

After all–libraries are free, have resources, generally have available computer time and tutorials, and kind librarians who can help with requests.

Many libraries now have social workers and other representatives of social service agencies that can help with issues like finding places to live, regular sources of food, and employment options.

I was glad to read about Deborah Hunter in Tulsa. Her story is all the more poignant because she’s driven by the fact that her own daughter was diagnosed with schizophrenia–a challenge that propelled her to get a professional degree.

I love our new library, and I’m glad that the library and Tulsa’s Family and Children’s Services are doing what they can to offer help to those in need.

Health is More than Health Care

When we think about achieving good health, it’s natural to think of visits to the doctor for “checkups” and age-appropriate interventions like vaccinations or cancer screening.

But here’s something you might not know: The “health care system” as we know it, an American industry on which we collectively spend $3 trillion annually, only accounts for one-fifth of our overall health.

Twenty percent? How can so much spending impact so relatively little of our well-being?

 

Well, it turns out other factors collectively have a much greater impact:

 

Genetics: To whom we are born impacts our health profoundly. If our parents are blessed with long, healthy lives, then we are much more likely to be, too.

 

Education: The better our education, individually and collectively, the more we can achieve in life. Education is tied to income (something we all know), but it also correlates directly to health outcomes in aggregate. Cutting investments in common and higher education is sabotaging our children’s future — not just in earning potential, but in real health: more suffering and earlier death.

 

Employment: The ability to earn a living wage means that people can be financially solvent and participate in the consumer economy. Given a choice, almost no one would choose handouts. People want meaningful work — work that employs our skills and engages our minds.

 

A diverse economy that grows new businesses means more job opportunities that not only pay the bills but allow us to invest in our families, homes, and communities.

 

Environment: It’s well known that those residing in certain Tulsa ZIP codes have life spans on average 11 years less than those in more affluent parts of the city (This difference has actually lessened from 14 years over the last decade.) Mayor G.T. Bynum has made reducing this disparity one of his administration’s central goals, as celebrated in a recent editorial in this newspaper.

 

We also know that when our neighborhoods are safer, we increase the likelihood that we will move our bodies more — which along with nutrition is the single greatest predictor of good health.

 

And of course: Nutrition! Access to healthy food and safe water is something that most of us take for granted. But many areas north, east and west of downtown Tulsa are literal food deserts — places with greater than two-mile gaps between locations where fresh fruits and vegetables can be purchased. And our Tulsa public transportation options barely ease this burden.

 

Nutrition and exercise are the two health determinants over which we have the most direct individual control. (How are you doing with those New Year’s resolutions so far?)

 

We can’t choose our parents, or therefore our genetics. But collectively, if we are in agreement that we want Tulsa to be a place of improving health, we do have a lot of say in how we manage our neighborhoods, our food supplies and our educational attainment.

 

At the University of Oklahoma-University of Tulsa School of Community Medicine the curriculum emphasizes study and advocacy of these so-called social determinants of health — beyond the “traditional” organ-based pathologies. We believe that interdisciplinary understanding of these factors — which can lead to exorbitant stress — will help to reduce the burden of ill health in our population as we age.

 

Tulsa has an opportunity to become a “Blue Zones” city like Shawnee and Fort Worth, Texas, recent cities that have contracted with Healthways to make structural changes to spur better health. The Blue Zones idea comes from the discovery of the five places in the world where citizens live the healthiest and longest lives because of exercise (walking most places), nutrition (more plant-based diets), and social connectedness.

 

We have the ingredients here in Tulsa to take on such a challenge, and working through the updated Community Health Improvement Plan that will soon be released by the Tulsa Health Department, we can all choose to live healthier lives — both individually and as a community.

 

Amazingly, we can do all of this regardless of our need to interact with our “health care system.”

 

Note: This essay appeared as an op-ed in today’s Tulsa World

Gleaning up after Thanksgiving

food-bank-frontWith the holiday season upon us, our thoughts often turn to those in need — of food, clothing and shelter.

I recently attended the Oklahoma Food Security Summit and was struck by a presentation about the practice known as gleaning, a term I’d never heard before.

The U.S. Department of Agriculture defines gleaning “as the act of collecting excess fresh foods from farms, gardens, farmers’ markets, grocers, restaurants….or any other sources, in order to provide it to those in need.”

In other words, getting food that would otherwise go to waste to those in need. This is how many food banks originated.

I interviewed Katie Plohocky, co-founder and director of Tulsa’s Healthy Community Store Initiative about one of its programs called “Hands 2 Harvest,” which is a gleaning effort for much of Tulsa.

In a nutshell Plohocky gathers volunteers to go to local farms and harvest crops that would otherwise be left to rot or plowed under because of minor blemishes or lack of farm labor. She then either sells this produce in her mobile grocery or distributes it to the Community Food Bank of Eastern Oklahoma or other local food pantries.

One of the things Katie and I discussed was how food distribution often is misaligned between food available and folks’ needs. Seems like there should be an app for that…

Also because of the season, the ever-reliable Oklahoma Policy Institute posted this video debunking myths about food insecurity. Great minds, as they say…

Anxiety

How are you feeling post-election?

In the practice of medicine, we use validated questionnaires like the PHQ-9 to screen for depression or the GAD-7 to screen for anxiety.

My wife, a family doctor, administered the GAD-7 to a patient of hers this week; post-election, I started wondering how many Americans could be diagnosed with generalized anxiety disorder* right now.

Go ahead and take the quiz yourself:

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What’s your score?

A score of five or more indicates mild symptoms. Ten or more moves you to moderate. Fifteen or more means you are highly likely to have diagnosable anxiety disorder–what the experts call generalized anxiety disorder.*

If you’re in this highest category, think about getting help. You can start with your primary care physician. She can help you directly or refer you to other community mental health resources that can be helpful.

*Generalized Anxiety Disorder (GAD), according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5):

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
B. The individual finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):
Note: Only one item is required in children.

  1. Restlessness or feeling keyed up or on edge.
  2. Being easily fatigued.
  3. Difficulty concentrating or mind going blank.
  4. Irritability.
  5. Muscle tension.
  6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

We Used To Sell Cigarettes in Hospitals

nurse_1471846fNice article in STAT, a relatively new Boston Globe-affiliated publication devoted entirely to health care. Melissa Bailey reminds us that ‘candystripers’ used to sell cigarettes to patients to comfort them while hospitalized.

How quaint.

She goes on to point out 5 practices that will seem just as antiquated. Soon, we hope.

  1. Advising doctors NOT to say, “I’m sorry.” Hospitals still do this. It can be seen as an admission of guilt, the thinking goes.
  2. Have prescription labels that don’t indicate what the medicine is for. How smart. And not even close to standard at present.
  3. Not washing our hands in front of you every time. ‘Nuff said.
  4. Spending more time typing than talking and listening to you. We can hope, can’t we?
  5. Easily getting your medical records, without your having to pay, wait, fill out forms, or just be hassled like you’re asking for state secrets.

I think this is an excellent list. There are no doubt dozens more. (Why do we awaken people in the hospital so often?) What are your ideas for health care pet peeves you’d like to see abolished?

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