Checking Email

It's 10:30am and I haven't eaten a thing. I have though checked my email twice, both for work and personal accounts. As if an hour is going to make a difference. Email, or the checking of email, somehow slows down time. It becomes imperative to check it regularly, though it's only been 1/2 an hour, an hour or two. You can do a lot in that amount of time, but the sense of urgency isn't warranted. As Tim Ferriss quipped in premonition four years ago, email is distracting and time-consuming if checked more than twice a day at regular intervals.

Gentle Nudges

The idea of a "gentle nudge" being an effective way to change behavior makes more sense when you first think about what a "nudge" is.

A nudge usually starts with, "You should". "You should make your bed", "You should work out", "You should get a new job". It's really unasked-for, free advice that has a one-time affect of being annoying. Nudging someone in the right direction rarely does the trick.

A gentle nudge, on the other hand, can make a world of difference.

First, it's gentle, so instead of starting with, "You should", you start with the benefit first. "Did you know that 88% of successful people make their bed?" (relative association). "Let's take the stairs, beat you to the top!" (competitive motivation). "The market's getting better, it's the best time to start something new" (contextual benefit).

Second, you can gently nudge more than once. Repetition is the key to behavioral change, personal or otherwise. Automating gentle nudges can be extremely powerful. A motivational quote on your fridge, a phone alert to take your medication, scheduling a mid-day walk on your calendar are some of the most basic ways.

Jane Sarasohn-Kahn says it best:

Health is mobile, and health care is local. The So-Lo-Mo phenomenon plays beautifully into the world of moms, who are their families’ Chief Household Officers. Mothers have been the key determinants of health and health care consumption in their households, and mobile gives them the platform that makes their health decisions more efficient and even engaging.

Know what you eat

“Yet Americans watch 35 hours of television a week, according to a Nielsen survey. (Increasing amounts of that time are spent watching other people cook). And although there certainly are urban and rural pockets where people have little access to fresh food, about 90 percent of American households own cars, and anyone who can drive to McDonald’s can drive to a supermarket. But perhaps most important, a cooking repertoire of three basic recipes can get anyone into the kitchen and beyond the realm of takeout food, microwaved popcorn and bologna sandwiches in a few days.”

Cut-and-dry advice from Mark Bittman that seems sensible enough. The staple stir-fry, salad and rice/lentil combo are basically how I got started cooking again. In NYC, fighting the urge to eat out is difficult. It’s too easy to get great restaurant food and on top of that, grocery trips seem outrageously expensive and you wonder about the cost/benefit.

Bottomline: You know what you put in your food. Salt, oil, fat, and a clean kitchen is up for grabs at a restaurant. The peace of mind you get cooking at home is worth it.

To be continued...

Blogging will resume. When and where even I don't know yet. Thanks to all who followed along. I've learned a lot through blogging and hope to learn a whole lot more and contribute back in the future.

Will the financial crisis make you more or less healthy?

Almost every issue has two sides to it. Its enlightening when you see both at the same time and get to figure out which side you fall on. For example, you would assume that the financial crisis is negatively affecting our health. Jane Sarasohn-Kahn agrees and just yesterday posted stats on the key sources of stress and how to manage them.

Opening up my RSS reader this morning, one of the the first articles I saw was by Jason Shafrin talking about how the bad economy may be good for our health. This is mainly because people eat out less, drink less and go to the doctor more. There are more interesting details in the post.

Overall, I believe what the source of the financial crisis argues for is more real value. Building on equity not debt, growing our savings acccounts, holding others more accountable for their actions. Just as there was a free-riding debt-laden groupthink surrounding the nation prior to the crisis, now there's more agreement around growing a solid foundation for the country.

Bottomline: Recognizing we're stressed and why lets us handle it better. Realizing the benefits of stepping back from the rat race and taking time out for ourselves and our families is equally as beneficial. Perspective will make all the difference in the coming years.

A Scraped Knee

The scenario is you go into your doctor to get a scrape on your knee looked at, cleaned and bandaged. The nurse sees you and sends you on your way. Your visit is over. The doctor's office submits a bill to the insurance company, gets paid for the procedure and care under the nurse's ID and everybody's happy. Perhaps.

What if the nurse probes further into how you scraped your knee (assuming a simple fall)? Maybe you tell her you've been having back problems lately or haven't been getting much sleep at night. Maybe you offhandedly mention an ear infection or she smells a hint of alcohol on your breath. There's a multitude of possibilities. The above could result in a referral to the orthopedist, a sleep specialist, an ears/nose/throat doc (ENT), or a social worker, respectively.

The way care is delivered right now though is very incidental. Patients are rarely looked at from a holistic sense of "what else is going on in their lives?" A lot of it has to do with how doctors are paid (fee for service) and the medical home model is one effort to correct that by getting insurance companies to pay additionally for coordination of care. This is what PCPs have been doing pro bono till now. Paying for a central model though builds in many other benefits:

• Pooled resources
• Central point of contact
• Change in perception
• Enhanced communication
• Better monitoring
• Standardized Best Practices

I'm a big fan of the shift in thought processes around care, incorporating both allopathic and holistic approaches and figuring out what works long-term as opposed to what gets the patient out the door. Other externalities that will emerge with this and other similar models are support services becoming involved, increased patient education and advocacy and assistance on the financial end. Its a mission statement that a whole lot of parties can converge around. A scraped knee is not always what it seems. Health and well-being has many layers. Exposing them is the first step to making them work for the person, not necessarily the patient.

A Visual Web Stroll

NYTimes graphic on risks associated with 10 different causes of death:























Google's venture into the browser business; Chrome:




















Be a teacher, find a teacher - The eBay of teaching:

Reminding Patients To Take Their Medication

Patients being non-compliant with taking their medication negates the value of going to the doctor, creates confusion in setting up treatment plans and in the case of antibiotics teaches the exact bacteria you're trying to kill how to fight back (MRSA).

Luckily, next generation devices such as Zuri aim to help remind patients to take their medication and also provide an electronic record of time and dosage to the doctor. Real-time interfacing with your medical provider is the only way to monitor medication activity successfully.

Here's more from the WSJ.

...the Zuri, an iPod-sized device that sends patients reminders to take their medications and records their compliance, which users and, if they choose, their doctors can track through a companion Web page.

Intel's care-management tool, called Health Guide, combines an in-home patient device with an online interface that doctors can use to monitor and remotely manage care. The in-home patient device collects readings from specific models of wired and wireless medical devices, such as blood-pressure monitors and glucose meters. It then displays the data for the patient on a touch screen and sends the readings to a secure host server, where health-care professionals can review the information and provide feedback via video conferencing and email.

Meanwhile, Microsoft is working with home-health and fitness-device makers to integrate vital-signs data into HealthVault, an online service the software company recently launched that allows consumers to store, manage and selectively share medical data.

The Secret To Happiness

8:00: What's bad about having too many choices
15:06: The Secret to Happiness

The whole thing's worth watching.

Hellooooo Health!

Jay Parkinson to me is the definition of a brazen careerist. Health care is a very conservative sector that's eons behind in technology, rife with political machinations and just filled with complexity on all ends. Dr. Parkinson has single-handedly taken on the industry and changed the paradigm from health care to patient care in less than a year. There's a lot of history behind this, and rather than rehash it in prose, I'll hyperlink to milestones that have led to the launch of Hello Health, Jay's company. Safe to say, this model of care delivery is not going anywhere and may spark a revolution in the years to come.

• Original Website & Philosophy - In a nutshell, doctors making house calls like the old days with an iPhone packing in the patient records instead of a briefcase.
  

• The Video Brief - Think medical Facebook. Why not just add your doctor as a "friend" on a privatized network and message him with a problem?
  

• Summary Article on Hello Health Launch - Scalability is occurring one doctor at a time and I only foresee trailblazing growth in the future.

Bottomline: While most of us are used to email, IM, Facebook, iPhone, Google and overall internet-based communication, health care has only just turned on the computer. Jay Parkinson has skipped decades by providing patients real-time access to primary care services. The progress is exponential considering the industry context. The start-up's in Brooklyn, but at this rate Hello Health might be in your neighborhood sooner than you think.

Health Insurance Potholes To Watch Out For

Each insurance company is different so first thing figure out coverage restrictions.

• Do they cover routine visits or only sick visits?
• What's your deductible and how much do they cover before and after you meet it?
• How are inpatient hospitalizations covered?
• What about surgeries (major v. minor, inpatient v. outpatient)?

The first two are important to know from the get-go, but for the rest its good to just have the benefits and coverage guidelines printed out or bookmarked somewhere for reference purposes.

Few other things you'll come across after going to the doctor are prescriptions, labs, and image results.

• Does your insurer have a discounted formulary for prescriptions or pharmacies they contract with? (HUGE savings here)
  
• Does your doctor send your labs out to a company that's covered by your insurer? If not, you could owe a lot of money for processing your lab results. Worth checking both with your doctor and insurance company on this one!
• Who reads and interprets your images (MRIs, X-rays, CT scans, etc.)? Same as labs, if the diagnostic imaging company or the doctor interpreting your image results is not covered under your plan, you'll get a separate fee.

Whoa!...I know. I've lost $750 and several brain cells dealing with the issues above. Now I annoy secretaries, nurses and insurance representatives to no end BEFORE and DURING my doctor's visit so I can avoid major money and time headaches AFTER the fact. Its like the law. You don't realize how powerful it is until it impacts you personally. No wonder 59% of doctors support a single-payer national health insurance system!

Providing patients the means to monitor their own health

An elderly coworker recently mentioned her participation in a home-based, digital, disease management (DM) program sponsored by Blue Cross Blue Shield. At first I was astounded that an insurer would sponsor this. While there's always been a clear business case for prevention and monitoring to avoid chronic care costs in the long-term, insurance companies haven't been exactly eager to jump on board. They might be starting to see the win-win though:

"Keeping [at-risk] patients stable and quickly getting them care when it's needed can reduce hospitalizations and cut the insurer's medical costs. And since the savings come from improving the patient's health and quality of life, programs such as Blue Cross' "Your Heart Matters" are generally popular with participants."

That's from this article detailing how the above congestive heart failure (CHF) program works remotely from patient's homes.

"Every morning, Sedaris steps on a special digital scale beside the bed in her Raleigh home and answers a series of questions. Is she swollen or short of breath? Has she taken her medicines? The scale, provided by her health insurer, ships her weight and other data to a nurse's computer at Blue Cross and Blue Shield's disease management center in Winston-Salem. Any suspicious results -- an overnight weight gain of just a pound or two is a signal that Sedaris is retaining fluid that may strain her heart -- and the nurse is on the phone. She'll talk with Sedaris and, if necessary, send her to get medical attention.

The technology to remotely monitor patients' pulse, weight, blood pressure, blood-oxygen levels, general mobility and other indicators is already widely available. The declining costs and increasing use of high-speed Internet service should only accelerate acceptance of monitoring devices."

This is incredible! For more, here's another personal example from the Healthcare Economist.

Your Future Doctor will see you Now

I wrote a post recently on needing a medical facebook (and medical twitter) to improve communication between patients and physicians. Jay Parkinson not only does this real-time for his patients, but he also sees them in their home, face-to-face for as much time as deemed mutually necessary. I wonder if the time saved from ridding himself of inefficiencies in communication has something to do with it.

"On the doctor side, I have a facebook-like platform that allows me to see and receive client updates and communicate via email, IM, video, and SMS with my clients and colleagues. We don’t do eVisits — we simply communicate normally via a whole range of communication options to help streamline healthcare delivery."

Hello Health!

Weekend Smörgåsbord

1. Tyler Cowen's link to RateMyCop.com

2. TEDBlog's mirror therapy for phantom limb pain

3. DMX on Obama (Ctrl+F "Obama")

4. Calculating your RealAge

5. Slate on the 25th Amendment loophole: 2 presidents for the price of 1!

A Mortgage-Backed Life

As I'm washing dishes today, I'm constantly thinking of what I have to do next. Go to the bank, get a car wash, go workout, get something to eat. The list continues. I'm on autopilot with my shoulders shrugged and brow creased. Getting to the next thing is more important than what I'm doing now. I'm not enjoying the process.

We always seem to be trying to get to the happy and fun moments without giving much thought to what we're experiencing now. So often I hear "just gotta get through the day", or "same shit different day". Your job or whatever you're trying to get out of the way may be terrible, annoying, or boring, but its the attitude you have towards it that'll make it easier to handle. Unless you have an alternative (which, if you did, you would grab right away and not complain), the task still has to be done.

Owning what you do always helps. When you really personalize something, make it your responsibility, realize your name will be on it, you start paying more attention. Think about owning a car or house versus renting either one. You just take better care of the thing you own because ultimately its you who'll have to fix it if something goes wrong. Even with such a simple thing as washing dishes, if you say to yourself, "if I don't pay attention to this and do it well, I'll be eating out of a dirty plate and might get sick", you'll be that much more focused.

I read about this "ownership perspective" a long time ago when I was perusing books that helped you narrow down your career choice. One of the books kept bringing up the fact that no matter what you choose to do, from engineering to auto sales, own that job and make it yours. Don't go in thinking you're getting paid to work. You're renting yourself (your human capital) out. Go in owning that job! Think like the owner and see what you can do to improve the place, ask questions, make suggestions, get a comment box going, whatever gets you involved.

Applying this point of view to your career is too big of a start. Keep it simple. Now how many things popped in your mind while you were reading this? Start there...

It's About Time

Time Out of Mind is simply a wonderful article. Author Stefan Klein makes a strong and articulate argument against the notion that "time is money".

"Believing time is money to lose, we perceive our shortage of time as stressful. Thus, our fight-or-flight instinct is engaged, and the regions of the brain we use to calmly and sensibly plan our time get switched off. We become fidgety, erratic and rash.

Tasks take longer. We make mistakes — which take still more time to iron out. Who among us has not been locked out of an apartment or lost a wallet when in a great hurry? The perceived lack of time becomes real: We are not stressed because we have no time, but rather, we have no time because we are stressed."

After taking a couple of economics courses, you invariably come to realize that the "cost" in opportunity cost is in fact stress. Applying the "no free lunch" principle makes perfect sense when you're making a calculated decision on which alternative might be best for the growth of your business. But does it realistically apply when you're calculating your free time in terms of dollars? "My free time is worth _______." Its really not, because its free! It only costs as much as you think it does. Hence the stress.

Quick elaboration. Suppose you get paid $10/hour and all your overtime is pre-approved. Now you have to valuate every extra hour beyond 8 hours as being worth $10, otherwise you lose it. Therefore, any activity you might choose to do outside of your work time has to be worth more than $10 to you. But what if you take a break because you're tired? Or go grab a sandwich? Or just do nothing? Some might say that these activities make you more productive and energetic allowing you to work more hours later. That's one possible rationalization. But is it even necessary?

The moment you choose to pursue an activity outside of work, your acceptance of the cost is intrinsic in your choice. Borrowing from economics once again, that cost is sunk. If you decide to focus on it, you only end up causing yourself stress above and beyond the $10 you already decided are worth losing. So then, would it be appropriate to say that opportunity cost is in the mind of the perceiver?

Trendy Disruptive Marketing

Dove's self-esteem fund sponsors the two videos below. If you haven't seen them yet, they're definitely worth a couple minutes of your time. There's been a lot of debate about whether this is some sort of "altruistic" marketing to fuel sentiment against mass media depictions of women.

Keep in mind this is marketing. Just like any other company selling any other product. But Dove has caught on to all the female angst that's been building up over the past few decades against the fashion, diet, exercise industry to make us all look like twigs. And why not? It does in fact sell:

"According to Information Resources, Inc., sales of Dove soap brands grew 7% to $281.3 million from Jan. 1 to Nov. 5, 2006; Dove hair care products sales grew 13.3% to $102.5 million; and Dove skin care products and lotions grew 16.2% to $117 million in that time period. Unilever posits that one in every three households uses a Dove product."

EVOLUTION


ONSLAUGHT

Google Health Teaser

Google recently developed a partnership with the Cleveland Clinic to test its Google Health application.

Today, Google released a few teaser screenshots!

Should your PCP be your Friend?

“The real price of everything, what everything really costs to the man who wants to acquire it, is the toil and trouble of acquiring it.”
--Adam Smith

It depends on if you think your car mechanic should be your friend. You see either professional about as frequently, mainly in times of distress. But the key difference is that your primary care practitioner (PCP) is your gatekeeper to the rest of the medical world, so it is worth your while to develop a strong relationship with one. You'll realize just how important this r'ship is when you move out of town, change your insurance, and oh yeah, get sick.

PCP shopping is essential. I just posted about the website, Vitals, which helps you do just that. There are many other sites that do the same, including the one your insurer most likely provides you (the most important!). You'll get a pretty long list of internists, family practitioners and general practitioners in your area and pretty soon you'll be scratching your head wondering just who to go to. Its pretty hard to compare doctors the way you compare cars and electronics. There's no consumer reports for physicians...at least not one that's agreed upon. But in general, keep in mind the following when making your choice:

1. Call and see how long the wait is before the next appointment. If its longer than 3 weeks, they're either really good or really inefficient. Double check if the doctor is on vacation or on service at a local hospital. That should give you a better idea of how they allocate their time. Then its up to you if you want someone reputed or someone reliable.
   
2. If you do choose the busy doc, ask who will take care of you instead when you absolutely have to come in. It could be another doctor, the head nurse or a resident. Either way, you have that much more information to work with.
   
3. Ask the secretary for a recommendation, then call again the next day and ask a different secretary. See if they'll let you speak briefly to a nurse and get her recommendation. This'll also let you know if they do phone consults either with the physician or the nurse. This way you can get triaged in quicker when you're sick.
4. See if they have an electronic medical record (EMR). This indicates many things about the practice; they're up-to-date, they're willing to spend the money to stay that way, and they want to be organized.
5. What about a website?? Do they partner with your preferred pharmacy? Can you refill your prescriptions online? Make an appointment online? Get test results online? Do they provide a personal health record (PHR) to help you organize your own health record and communicate your problems as they're happening?

Notice how none of the above goes into quality of care or bedside manner. There's very little out there to provide you with such metrics...again, its forthcoming. Who would've thought picking a doctor would be such a chore!? But its like anything else. You get what you put into it. And that all depends on how you answer the question above.

Get your Vitals Taken

George Van Antwerp posted a positive review for this site, Vitals.com, and I have to agree with him. I looked up some of the physicians I had worked with in the past and found out more about them than I ever knew before. It was startling at first to see their age, years of experience, and where they went to college. Then I started thinking about the ever-steady finding that more experienced physicians are simply better practitioners, so why shouldn't patients be aware of these characteristics?

Anyway, overall the site is really user-friendly. You can find a doc, figure out who to see for your problem and even rate the physician after your visit. Now it just needs critical mass.