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Demystifying Medicine One Week at a Time

Category: health & wellness (page 1 of 10)

The ‘One Stop Shop’

“How can you expect patients to look after their health, when they don’t know where they will be living next week? You can not separate people’s physical health from their psychological, social and spiritual health.”

So asked community health nurse Ruth Chorley, in an article by Rachel Pugh in the Guardian.

The story reported on a local program in Oldham, one of the UK’s National Health Service districts, in which nurse specialists work to help people whose social and economic problems prevent them from managing their health.

From the story:

Chorley is a focused care practitioner – one of four employed by Hope Citadel Healthcare, a not-for-profit community interest company, to lead a pioneering approach to delivering healthcare to the most needy families in its four Greater Manchester NHS GP practices, by filling in the gaps between health and social care.

I think this small scale NHS experiment is one right way to truly improve a  community’s health.

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

e-Patient Dave

406px-Dave_deBronkart-20091229Last week I had the good fortune to meet Dave deBronkart, a man known throughout the world by the simple moniker “e-Patient Dave.”

Dave’s story is widely known: diagnosed with metastatic kidney cancer at age 56 in 2007, he was given a prognosis of six months to live. By scouring the internet and crowdsourcing ideas for newer therapies (and their pitfalls), Dave tried an at-the-time-experimental therapy (with an efficacy of 20% back then) called IL-2.

Happily, it worked. Next year Dave will reach his tenth anniversary of being cancer free.

The world is a much better place with Dave in it. Taking the full measure of his experiences in health care, Dave has become one of the leading voices of participatory medicine — the (not-so) revolutionary idea that patients should be directly involved in their own health care.

He is now a sought after public speaker, thinker, advocate, and collaborator.

He gave a TED talk in 2011 that you can view at the bottom of this post. Last year, I shared a blog post he wrote about his wife Ginny’s amazing experience undergoing quadricep-sparing bilateral knee replacements from orthopedic surgeon Howard Luks.

One thing I always thought was that the term ‘e-patient’ referred to ‘electronic,’ as in ’email.’ In fact, Danny Sands, who has long been Dave’s primary care doctor, is one of medicine’s earliest adopters of using email to correspond with his patients. He also was instrumental in setting ground rules for its use (e.g. never use email in an emergency).

But as I found out in preparing to meet with Dave, the “e” in ‘e-patient’ actually stands for

  • EMPOWERED
  • ENGAGED
  • EQUIPPED
  • ENABLED

Dave and the e-patient movement, united behind such advocacy groups as the Society for Participatory Medicine (S4PM) seek to use the collective power of engaged clinicians and patients to find the best available help at the time it’s needed.  From the S4PM website:

Participatory Medicine is a model of cooperative health care that seeks to achieve active involvement by patients, professionals, caregivers, and others across the continuum of care on all issues related to an individual’s health. Participatory medicine is an ethical approach to care that also holds promise to improve outcomes, reduce medical errors, increase patient satisfaction and improve the cost of care.

There’s no doubt that there are people in my profession who still cling to the ideal of the doctor being the repository of information, who view the patient as more of a passive ‘customer.’

For some patients, too, this is still a comfortable model. And that’s OK, if that’s what you want. But there’s a whole world of engaged docs and patients out there that want to interact in many of the new ways: via email, through social media, using patient portals (special protected systems that allow you to reach your health care team or look at results), even video chats (telemedicine, anyone?).

I learned some of Dave’s interesting backstory: He graduated from MIT, calling his time there ‘vocational school.’ That’s because his best takeaway skill was typesetting — he was trained to typeset the school newspaper. Throughout the 70s an 80s Dave held a number of jobs in the field, where he found one of his best skills was being a translator: explaining engineering-speak to the sales people, and explaining the needs of sales people to the engineers.

I spent more than two hours with Dave — including an interview in a library followed by a lunch. The man is a tour de force. I look forward to continuing our dialogue.

In Medicine, Less is Often More

Dr. Rita Redberg at #Lown 2016

Dr. Rita Redberg at #Lown 2016

Fewer visits.

Fewer tests.

Less harm from what we find, and less harm from any subsequent treatments.

Less cost.

More engagement with your own health, and what you can do to make it great. You can do it yourself.

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