Demystifying Medicine One Month at a Time

Category: Tulsa (Page 2 of 3)

Caring Center is a Win-Win

Bama stacks wwwThe Bama Companies of Tulsa, Okla. made what I see as an historic announcement last month.

The company, a privately-owned global manufacturer of pies, biscuits (McDonald’s) and dough (Pizza Hut) has more than 1000 employees.

CEO Paula Marshall believes in second chances, making a practice of hiring parolees and those (particularly women) out of treatment for chemical dependency.

Marshall noted that there is a critical threshold, at 3-4 months of employment, where tardiness and absenteeism start to occur in many of these new hires — often resulting in termination or resignation.

Since it’s costly for the company to recruit and train new talent (Marshall puts the number at $5500 per employee), she figured it is wise to invest in helping employees surmount the challenges they face in maintaining employment — factors outside the workplace — like childcare, financial planning, transportation, and counseling.

[For decades the company has offered in-house medical services, which will continue with the new initiative.]

The company frames the decision to open it’s “Caring Center” as a business decision, but it’s clearly one with a heart.

To me, the plan reinforces the idea that it’s not strictly what happens within the walls of a medical setting that impacts people’s health. It’s the social determinants of health that have a bigger impact on health– education, environment, employment, access to adequate nutrition.

Opinions on the project vary. Some say Bama’s ‘Caring Center’ is nothing more than a glorified Employee Assistance Program (EAP). But in my view, EAPs are usually handled by 3rd party contractors, have limited uptake, and are focused more exclusively on mental health (important, to be sure, but not as broad as Bama’s effort).

Others ask, “Why not simply pay the employees more?” That is indeed a laudable goal. But arguably it’s the educational efforts and resource-matching that the Caring Center provides that will make more of a difference in employment sustainability. If an employee can keep his/her job, s/he will have more opportunity to climb the economic ladder. Bama, for example, like many companies, seeks to retain and grow talent from within.

Only time will tell if Bama’s Caring Center is impactful or not. Marshall has set the bar at what seems like an achieveable level: She hopes to lower the rate of employee loss from 8/10 to five or six out of ten to achieve financial success for the company. But if she succeeds, that’s many lives that will be impacted.

Will more companies choose to make these types of investments?

People of the Book

51LnzMAiHuL._SY344_BO1,204,203,200_Doctors are a group that prize scientific evidence in plying our trade — whether making recommendations to our patients or arguing with each other about how to interpret and act upon our profession’s ever-growing body of research.

I find it pretty easy to lapse into the rationalization that “the latest evidence” is usually right, and therefore should heavily weight both our actions and our “knowledge base.”

But a new book challenges this rationalizing — pointing out that over the decades, many assumptions about best medical practices later come into question and are thrown out — a process known as “Medical Reversal.”

I blogged about this before, as several articles in this genre stood out to me. Now that line of research has been turned into a book: “Ending Medical Reversal,” by Vinay Prasad and Adam Cifu. I was delighted to be asked to review this book for Johns Hopkins Press, and glad to see that they’ve published it (in fact, they used a statement in my review as a blurb (!) on the book jacket).

If you like to know how medical knowledge gets disseminated, communicated, retracted, and paved over, then this will be an enjoyable read. The NYTimes just reviewed the book, with a recommend, only questioning the rather esoteric title, suggesting instead that the book be called “OOPS!” or “Are You Kidding Me?”

I like those.

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This past week I had the opportunity to meet the great Roz Chast, author of the award-winning graphic memoir “Can’t We Talk About Something More Pleasant?”

She visited the Tulsa City-County Library as part of a series of programs put on in conjunction with Clarehouse, a local not-for-profit hospice. The goal of the series is to increase awareness and dialogue about improving care for people at the end of life.dr john schumann 3

A Fundamental Health Disparity is Reduced

tulsa_disparityWhen we talk about disparities in health care, there are many: access to care; the costs of care; the quality of care; and of course, the outcomes of our crazy, ill-designed, patchwork health care “system.”

Perhaps no disparity is more stark than that revealed by a regional analysis of how long people live on average, compiled by zip code. Our life spans, after all, are a complicated product of our health —determined as much (more!) by societal and economic forces as well as health care.

A decade ago in Tulsa county, we found that the life expectancy of people born in zip code 74126 was on average fourteen years less than those born in zip code 74137.

This is not unique to Oklahoma. The Robert Wood Johnson Foundation conducted similar analyses for other metro areas and found gaps of fourteen years in Kansas City, and an astonishing twenty-five years in New Orleans.

Knowing what we now know about the importance of early childhood in brain development, educational attainment, and health outcomes, many think that improving this fundamental disparity will take generations.

Some good news, then: the Tulsa Health Department re-did the analysis-by-zip-code and found that the gap had diminished–by three years!

The analysis only reports the outcome of a reduced life-expectancy gap. As to the reasons why, we can only speculate.

One editorialist looks at the community’s openness about its failings and its collective investment: $46 million over the last decade from public and private sources to build infrastructure (clinics, offices, etc.) and bring health care professionals to areas that lacked them.

This is pretty heady stuff, to be honest. It shows that collective action in pursuit of a complicated goal has to be pursued on many fronts. And most importantly, that we still have a long way to go.

Reaching for the Stars

Several months ago I had the great fortune to be appointed Interim President of a university campus.

As graduation season (and summer) is upon us, I want to share a heartwarming video made about one of our graduates, Lyda Wilbur, who earned her doctorate in education. She attained this while serving as principal of Mitchell Elementary, a local public school in Tulsa, Okla. Dr. Wilbur’s story of perseverance is truly inspiring. In the story below, you’ll learn about a field trip her 6th graders took to the state capital. Many of the kids had never been out of their hometowns before.

Click on the video to watch:

Dr. Wilbur’s efforts to enrich the lives of her students address one of the fundamental determinants of health in our population — educational opportunity.

Disparities

In honor of MLK day, health care disparities merit mention.

The National Institutes of Health have several good webpages with different analyses of what health disparities are and in what instances they exist in the U.S.

Health disparities are gaps in the quality of health and health care that occur linked to socioeconomic status, racial and ethnic background, and education level.

As but one example, in Tulsa County, Okla., if you’re born in a north Tulsa neighborhood (see the dark zip codes below), on average you’ll live fourteen years less than you would if born further to the south.

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When I’m reminded of this fact, it shocks me that we live in 21st century America. Then I realize that this occurs in many more places. Something to think about as we enjoy our day off.

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