The Ins and Outs of Health Care

WEB SITE LAUNCH

2010-12-28T12:46:00.001-05:00

Check out my new web site at www.HeleneFuchsAssociates.com

BRING BACK WHAT??

2010-11-09T19:46:00.003-05:00

Bring Back Home Economics Education

That’s the title of an article by Alice H. Lichtenstein, DSc (Tufts University) and David S. Ludwig, MD, PhD (Children's Hospital, Boston) in Journal of the American Medical Association. 2010; 303(18):1857-1858.

I couldn’t have said it better myself, so I am excerpting sections of the article here in my blog.

“Home economics, otherwise known as domestic education, was a fixture in secondary schools through the 1960s, at least for girls. The underlying concept was that future homemakers should be educated in the care and feeding of their families. This idea now seems quaint, but in the midst of a pediatric obesity epidemic and concerns about the poor diet quality of adolescents in the United States, instruction in basic food preparation and meal planning skills needs to be part of any long-term solution.
Michelle Obama's "Let's Move" campaign—with its emphasis on improving the quality of food and beverage in the schools and the community—is a welcome and historic step. However, better choices in schools will ultimately have limited effects if children do not have the ability to make better choices in the outside-school world, where they spend the majority of their time when young and which they inhabit when older. If children are raised to feel uncomfortable in the kitchen, they will be at a disadvantage for life.
Even more than before, parents and caregivers today cannot be expected or relied on to teach children how to prepare healthy meals. Many parents never learned to cook and instead rely on restaurants, take-out food, frozen meals, and packaged food as basic fare. Many children seldom experience what a true home-cooked meal tastes like, much less see what goes into preparing it. Work schedules and child extracurricular programs frequently preclude involving children in food shopping and preparation. The family dinner has become the exception rather than the rule.
An informed generation of children may also influence the eating habits of US families, just as tobacco education causes some students to discourage their parents from smoking.”

PLANT A RADISH, GET A RADISH...

2009-12-22T12:25:00.005-05:00

"Food choices are often...difficult to articulate yet strongly held." I second this statement by Natalie Angier which can be found in today's New York Times Science Times section. When people inquire why it is that I'm a vegetarian - a question that is typically posed while we are sharing a meal - my reply is "Because I don't like to eat dead animals." Natalie Angier let's us know that "Brussels Sprouts Like to Live, Too." I know this. I've known this for a long time. As long as I've been a vegetarian. Thanksgiving 1971 to be precise. I found the snippets of information, in Ms. Angier's article, about plants and their quests and mechanisms for staying alive fascinating. Turns out plants can be quite sophisticated.

So, I'm not eating dead animals but I am eating sophisticated dead plants. And so are you. Now what?

I recently learned about civic dietetics which integrates social, environmental and economic sustainability aspects of food choices into dietetics. Civic dietetics is a phrase coined by Jennifer Wilkins and you can read about it in the Journal of Agriculture and Human Values which I became aware of in Ashley Colpaart's piece in Tufts Nutrition.

Let's learn more about civic dietetics and about the amazing world of vegetables. Let's continue to forge ahead and figure out how to feed the citizens of the world - with food that is likely to be of plant origin. A challenge? Yes. Imperative? Absolutely.

THERE WAS AN OLD WOMAN

2009-07-10T19:33:00.001-04:00

And every time she came to see one of her providers at Brigham and Women’s Hospital her medical record was not to be found. This story pre-dates electronic medical records and so her hard copy medical record was ordered when she was scheduled for an appointment. Each time the Medical Records Department insisted it was missing. Yet when the nutritionist or nurse or doctor walked into the exam room, there it was. When she finally arrived for her appointment, so did her medical record. Sure enough, there she was carrying her three volume medical record in a paper shopping bag. “They’ve lost it too many times, so now I just take it home with me and bring it in when I have an appointment. This way I also get to read it and know what is going on.”
She knew the value of a personal health record, and one that was interoperable at that. She was a fan of participatory medicine a woman ahead of her times.

AN EXTRAORDINARY AGENCY

2009-06-16T09:40:00.003-04:00

That’s how one patient of Circle of Caring at The Hospice of the Good Shepherd described the organization in a recent letter to the editor of The Newton Tab. Roz Bessell of Natick, MA declared that “There is a special feeling of safety and security when one is in the hands of these amazing and outstanding people. I feel very fortunate and blessed despite my difficult illness to be a patient of the Hospice of the Good Shepard, Circle of Caring.”

As a new member of the board of Circle of Caring at Hospice of the Good Shepherd I have become immersed in a popular topic that is getting lots of attention. Listen to the National Public Radio series aired on Talk of the Nation the week of April 27, 2009 which addresses issues of death and dying including the latest trend – home funerals. Latest trend?? Isn’t that how funerals were conducted before the funeral home industry took over?

Another inspiring Circle of Caring story was highlighted in the Boston Globe. An article featured Evelyn Raphel, a current hospice patient who is an accomplished sculptor. Rabbi Carol Glass, HGS’s chaplain, suggested the idea of an exhibition of Ms. Raphel's art. Through the encouragement, hard work and compassion of Ms. Raphel’s team at Circle of Caring at Hospice of the Good Shepherd she was able to show her work one last time.

Unlike the traveler in Robert Frost’s poem - The Road Not Taken - I am able to travel various health care paths, including health IT, Health 2.0, nutrition science, etc. I am glad for my journey with Hospice of the Good Shepherd and a chance to support its mission and extraordinary work.

FOOD FOR THOUGHT

2009-03-27T14:26:00.003-04:00

Eat food
Not too much
Mostly plants

Words of wisdom from Michael Pollan who spoke earlier this week “In Defense of Food: The Omnivore’s Solution” at Tufts University, home to the nation's only graduate and professional nutrition school, the Friedman School of Nutrition Science and Policy.

Pollan’s haiku reminds me of a news item I heard recently. There’s a new trend – more people are eating at home. This trend is driven by the current economic situation, not necessarily by the public’s interest in good nutrition. The problem folks are facing is that they don’t know how to cook. Their kitchen is a foreign land. So they are taking classes at cooking schools – a booming business in the middle of the recession.

Since you don’t need to go to cooking school to warm up take-out or follow the instructions on a packaged prepared food, I’m assuming that they are interested in cooking with raw ingredients. It is my hope that they “not eat too much” and “mostly plants.”

On the subject of plants, June is just around the corner and so weekly farmer’s markets will return to neighborhoods in New England. Which also means it’s time to sign up for a CSA (Community Supported Agriculture) share. First Lady Michele Obama put shovel to the soil to start a White House kitchen garden, the first since Eleanor Roosevelt’s victory garden. And Agriculture Secretary Tom Vilsack broke ground for The People’s Garden which will be sustainable (using composting waste from USDA cafeterias and recycling it back for use in the garden), organic and will serve the community by donating produce to local food banks.

Eating well is a core factor in good health. So these trends are worth celebrating and sustaining: growing edible gardens as exemplified by government leaders, and cooking at home as demonstrated by citizens around the country.

Bon appetit

More From Health Care Community Discussion

2009-02-18T14:29:00.003-05:00

NOTE: The opinions presented in this blog entry are based on the participants of a Health Care Community Discussion that I conducted and do not necessarily represent the opinion of the author of this blog.

MAJOR PROBLEMS WITH HEALTH CARE IN THE US
Participants of the health care community discussion identified the biggest problems in the health system as: prevention, affordability and access, lack of integration, disparities
and medical errors.

PREVENTION
The current system is focused on treating disease, not promoting health. Participants felt that health insurance companies do not focus on prevention. Payors have no incentive to promote health care on a long range basis given that members move from one health plan to another. Participants recommended that payors cover the cost of preventive services.

Providers contribute to the problem by not making prevention a priority. “Patients have to take it upon themselves to focus on exercise and diet since these are not areas that providers focus on. As a patient, it takes a lot of work to practice prevention on one’s own, to get reliable information.” Participants recommended that pediatricians, geriatricians and primary care physicians - the doctors in the best position to promote prevention - receive better training in prevention. These providers need to put particular emphasis on nutrition, exercise, and screenings.

AFFORDABILITY AND ACCESS
Participants felt this is an issue particularly for those covered by commercial insurance, where costs – premiums, deductibles, copayments, etc. - are too expensive. “Have Medicare for all,” one participant offered, adding “what do the private insures provide that Medicare doesn’t?”

Participants also remarked that it is complicated to choose caregivers; to know where to start when entering the system.

LACK OF INTEGRATION
“Health care is too disorganized; it lacks integration.” An example was: how to coordinate communications between different providers. Solutions offered included electronic medical records, personal health records and proper health IT systems.

DISPARITIES
Age and disability were the two disparities discussed among the participants. Age: coverage is better once Medicare kicks in. Disabilities: people with disabilities have a particularly difficult time finding providers who have the knowledge and skill to treat them.

MEDICAL ERRORS
Participants have experienced medical errors themselves, know of others in the same situation and are aware of it as a significant health care problem. They mentioned misdiagnoses and adverse drug events as major issues. Implementing quality improvement measures in all stages of the health care continuum is a must. Also, participants were in favor of a pay-for-performance system.

PUBLIC POLICIES TO PROMOTE HEALTHIER LIFESTYLES

CITIZENS’ BILL OF HEALTH CARE RIGHTS
Participants felt that there should be a Citizens’ Bill of Health Care Rights which would include a “floor” of coverage and minimum benefits. Examples include an annual exam and comprehensive health audit. The challenge is how to encourage and enforce this policy and whether it should be a state initiative or a federal program.

Implementation needs to be a two-tiered approach – educating the public and educating and training primary care providers (physicians, nurse practitioners, etc.) Educating the public should include traditional methods of communication and as well as taking advantage of web 2.0 and social media tactics. Training programs, that offer CEU’s, should be available for primary care providers to encourage compliance with The Citizens’ Bill of Health Care Rights

MENTAL HEALTH
Participants expressed several concerns about mental health and associated disabilities.
They raised the following issues about mental health:
· Patients self-pay which is quite costly
· There is a trend for therapists to not accept insurance
· Therapists who do accept insurance are typically not reimbursed according to their fee structures
· There is inconsistency in caring for behavioral health issues from insurer to insurer

In summary, the whole person needs to be treated - mental and physical care needs to be integrated.

Health Care Community Discussion Results - Part I

2008-12-24T15:23:00.000-05:00

“Prevention needs to be a force in the health care system,” said one of the participants at the Health Care Community Discussion that I recently conducted. Prevention was a theme of our discussion. The Obama-Biden Transition Team is interested in knowing if attendees are familiar with the types of prevention services American should receive - mammography, flu shots and cholesterol screening - and had they gotten the recommended prevention. I’m glad to report that all the female participants have had a mammogram and all participants had flu shots and cholesterol screening this year.

Another participant said that “Health care begins at 65,” elaborating that once Medicare kicks, people are more likely to seek health care services since many were uninsured or underinsured.

Another area of concern is the disorganization and lack of integration of health care services. Electronic medical records, and particularly personal health records, along with improved health IT systems was offered as a solution.

The Obama-Biden Transition Team is interested in compelling personal stories from attendees about the need for health care reform. One participants said “I had to breakdown [caused by bipolar disorder] to get help. I needed a diagnosis before getting good care.” Another member of the group conveyed a story of newborns that were given a drastic overdose of medication.

More results to follow.

Health Care Community Discussions

2008-12-11T23:20:00.001-05:00

A few days after the election, the New York Times ran an article that included the following “Health Care – An Overhaul Will Have to Wait.” Today President-Elect Obama announced Senator Tom Daschle as Secretary of Health and Human Services AND Director of the [new] White House Office of Health Reform. Obama said “the time has come this year in this administration to modernize our health care system for the 21st century…If we want to overcome our economic challenges we must also finally address our health care challenges.” Perhaps health care will not have to wait after all.

Obama and Daschle intend to “make health care reform an open and inclusive process…to bring Americans into the conversation from the grass roots up.” To that end they are encouraging us to hold Health Care Community Discussions and to invite friends, family and colleagues to participate. And so I decided to do just that. Tom Daschle will be attending some of the Health Care Community Discussions and when I filled out the form on www.change.gov I made a compelling case for him to be at mine. Stay tuned. I’ll let you know if he’ll be there and I’ll let you know how it went.

Vax and Vote

2008-10-26T15:00:00.003-04:00

One of the things I enjoy about my work is the variety of projects with which I get involved. Heidi L. Hoffman, MPH (Health Care Consulting and Management Support) asked me to work with her on a project to develop an Immunization Action Plan for the Massachusetts Department of Public Health. She was engaged by MDPH who received a grant from CDC to support this initiative. The goal is to increase adult and adolescent immunization rates in the Commonwealth.

So there I was on Friday morning at Shrewsbury, MA Town Hall with a diverse group of health care professionals (providers, payors, administrators, etc.) all of whom are committed to getting out the vax . This was the first of five regional meetings that MDPH is conducting around the state. We’re looking for input from various parties about the strengths and weaknesses of current efforts to increase immunization rates and the opportunities and obstacles to doing so. All health care is local and this is exemplified by “Community Immunity” a campaign we heard about that the City of Worcester Board of Health has implemented.

Several non-traditional ideas came out of the meeting about how to make access to flu shots convenient. Vax and Vote was one of the more innovative ones. Why not get your flu shot at the same location where you vote? For now, get out and vote AND get out and get vaccinated.

Back to the Future, Forward to the Future

2008-10-19T12:51:00.000-04:00

Personalized Medicine: Hi-Tech, Hi-Touch, Maximum Engagement. That was the title of the conference - hosted by The Massachusetts Health Data Consortium - which I attended on Friday.

One of the topics was Concierge Medicine which most certainly falls into the hi-touch category - house calls, same day visits, doctors on call for their own patients. Personalized medicine that is reminiscent of another era, of times gone by. Albeit, as pointed out by one audience member, Concierge Medicine is limited to those who can afford to pay a significant out-of-pocket fee.

Then we heard about Personal Genomics. Definitely hi-tech and yet how much more personal can you get than having full knowledge of your own genes? A different kind of personal, however. One of the speakers pointed out with optimistic excitement that the combination of genetic test results and electronic health records means that doctors don't have to see patients in order to diagnose and treat them.

Perhaps we need to go back to the future where face-to-face patient-doctor relationships can thrive and couple that with the forward to the future promise of genomics. I’m encouraged by the possibility that this allows for a shift away from reactive medicine to early detection, and better yet, preventive medicine.