Christina's Considerations

A Call to Healthcare Professionals: Contrary to what you’ve been taught, use social media

Way back in 2005, I began blogging.  After a couple of years, I got tired of explaining to my hospital administration and physician  friends "what's a blog?" and "why would I want to Twitter?"  Since all of the young people knew these answers, and the correct terminology, I thought I should write a book so that my peers could have more intelligent conversations with young innovative staff and recognize the value of emerging social technologies.  Now, whenever anyone wants to know "what's a tweet?" or "but, what about the risks/HIPAA/etc?", I just direct them to my  first book - published by Health Administration Press.  When they want to go deeper and she case studies of how other healthcare organizations are leveraging social tools I point to my book published by HIMSS.  In both cases, I attempted to educate, overcome fears and and build confidence in healthcare leaders who needed, and wanted, to move beyond "how we have always done it in healthcare."

So, when Dr. Mansour seemed to have a similiar observation on lingering concern among the medical community, I had to share his post.  He believes physicians especially are still timid and many have been consistently taught otherwise in school.  He is correct to share his vantage point as physician to help other physicians reflect upon and address their own concerns.     

Guest Post:  By Joshua Mansour, M.D. is a board-certified hematologist and oncologist in Stanford, California doing work in the field of  Hematopoietic Stem Cell Transplantation and Cellular Immunotherapy. Follow him on Instagram @DoctorJosh_MD

From the beginning of medical school, one of the first things “instructional videos” that we had to watch during orientation was about “social media” and what “not to do”.  There began this stigma and it was frowned upon to use social media if you were a healthcare provider. 

There are the obvious things that physicians should not do, such as post private information about patients, show a patient’s face without their permission, or exploit medically sensitive information.  But no one tells you what you can do and possibly what you actually should do. 

There is a new wave that has now taken over that we as a healthcare community and a community as a whole should support, especially if it is meant to help others. Most recently I have approached social media in a different way and gone out to explore what is available as a tool to help others.  What I’m finding has been mind-blowing and I am very excited to see where it continues to progress in the future. 

People are sharing their journeys, inspiring others, raising awareness.  There is a whole community of individuals working as a team to help others.  It is incredibly inspiring.  Before recently I had thought of social media as being full of people only posting pictures of fun trips or nights out, throwing out their opinions out into the open for people to see.  We now have social impact movements, live videos with question and answers for students, people showing their tough times and how they are overcoming them.  People are reaching out to others for encouragement, collaborations, and progress. Using it to spread the message.  With the busy days of many healthcare professionals, it is difficult for them to find the time to engage with social media and with others.  There are many healthcare providers that are making an impact and finding the time to do it.  

What we need to start teaching in medical school and in other schools in not only what not to do on social media, but how to use social media in a positive light.  This is something that is happening and only continuing to grow.  It is time to get on board but shine the light in a positive manner.  Teach students from early what to do instead of only what not to do.  You never know they may be able to influence people in a way like never before. 

Recently I have recently been able to connect with others across the world and learn new things about medicine and how it is practiced in those locations.  This will help me evolve as a physician as well and has helped my patients. 

 

Woodworking as Art Therapy for PTSD

Guest Post: Robert Johnson is a woodworking enthusiast whose passion for power tools is expressed through writing. He is the founder, owner, and main author of Sawinery.net, a blog site dedicated to his personal reviews of different types and specific models of saws. Through the years, his interest in woodworking expanded beyond tools, which started his quest to write about woodworking projects and fascinating stories of woodworkers as well.  He recently started to explore the power of woodworking as therapeutic healing art; especially for PTSD/CPTSD.

Some people might think that woodworking is a challenging hobby because of all of the work and tools that are used to perform the hobby. However, regardless of your experience woodworking can be quite beneficial. Not only is woodworking an art, but it is also known to be a form of art therapy for those who have had traumatizing past experiences and need something to keep their mind in a more positive state.

Believe it or not, woodworking can be quite relaxing despite the amount of technique that is used while carving designs and patterns into your choice of wood. It helps a person to work on improving their psychological imbalances in their life. People are able to work towards thinking more positively. It’s quite close to a typical psychotherapy session that one might take, but it is a more fun and interesting way to approach the hardships that you might be facing in your life.

Woodworking in the form of art is truly a great way to reduce stress as well as feel accomplished about the work of art that you have completed. So what are the details of how woodworking can be used as art therapy? Keeping reading for more details.

Crafting a piece that you like

You can actually start your art therapy by admiring a piece of art work that you find in an antique shop or online. Instead of purchasing the piece of wooden art, you can make it yourself. Just think of how good you’ll feel after creating a work of art that you admired. You may think it is impossible to do if you don’t have experience with carving, but patience and working slowly is best to achieve your desired results.

Engaging your brain

When taking part in woodworking as therapy, it has been proven that your brain is actually more engaged in a positive and creative way. This is good practice in helping you to not focus so much on the negative and focus more on the positive. You will naturally improve in your social skills as well as better understand your emotions.

Happiness

The main emotion that is most important when it comes to woodworking for art therapy, is happiness. Although there is a chance that you might become a bit frustrated while working on your wood carving art piece, keep in mind, in the end you will feel happy that you made the effort and you can tell others “Hey, look what I made!” It will be a wonderful feeling, and keep in mind the more you take part in this sort of therapy, the better you will get at carving your works of art.

Increased Self-esteem

Once you’ve completed your first woodworking project, you will find that your self-esteem has increased. When you know you have done a great job on a project that you have completed, you will naturally feel good about yourself. You will also begin to notice that you experience less stress and nervousness from anxiety.

Activities like this can also aid those with any chronic illness and the anxiety it brings; allowing them to be more focused and productive in their home and work lives.  If you have examples of other art therapies, please share them in a comment.

 

 

Why is no one using our patient portal?

A while back I wrote an article on why patient portals aren't being used.  It was written while I was in a fatigued frenzy as a patient trying to find a diagnosis.  Since then, I continue to experience the healthcare system and identify opportunities to improve communications with patients.  My most recent recommendation to home health organizations is to actually get a portal so patients can confirm treatment dates.  To practices who have a portal with forms to be completed prior to a procedure being scheduled, make sure they are the most current version and the save function actually works; to avoid wasted time and rework.

Here is the original article written for Multibriefs...

Patient portals and the functionality they offer have the potential to increase access to service, improve convenience and more effectively engage patients and consumers. They can also increase efficiencies for both patients and their providers.

It is for these reasons that most providers, payers and technology vendors have at least considered offering patients and consumers access to these online tools. Unfortunately, some of those who have adopted patient portals complain that they have made the investment, only to realize low adoption and utilization rates.

So, why might patients not be using your patient portal?

Many patients — especially those with low health or tech literacy rates — may have heard of your portal, but don't understand the benefits to them individually. Or perhaps, there are barriers to them acting to gain access; such as believing they aren't tech savvy enough or simply not having the motivation to change old habits.

Aside from providing access to a platform, the provider/payor/vendor also needs to invest in strategies that facilitate user education, training and adoption. In some cases, this requires turning to family caregivers who need access themselves in support of the patient, or who can help them learn and navigate the most relevant areas to them personally.

In other cases, the provider/payor/vendor needs to reflect upon the targeted population and the usability of the portal, its functions and offerings. A few examples of user complaints include:

It is difficult to register and gain access to the portal

Not enough relevant info — such as a list of imaging studies completed, but no access to the report or results

Staff and/or providers don't respond to messages in a timely manner — if at all

Appeals and grievances can be submitted through the portal, but the decision is mailed through the U.S. Postal Service, resulting in delays

A recent Black Book Research poll found that 96 percent of patients report leaving their doctor's office with limited knowledge of how to use the patient portal. Of the 40 percent who attempted to use the software in 2016, 83 percent said it was too complicated. For benchmarking purposes, this means only 7 percent of patients found the portal simple enough to use.

An excellent way to identify opportunities to improve your patient portal is to assess the portal design, functionality and alignment with your patient needs and interests. Some questions to reflect upon include:

Is there statement that reassures patients of the portal's security measures and privacy safeguards?

If there is a delay in when test results or reports are released to patients, is that clearly communicated?

Can patients complete routine questionnaires online and make periodic updates to their information?

Would an online appointment summary of key findings and/or follow-up add value for patients who don't remember everything the physician tells them during the encounter?

Is it easy for patients to see summaries, reports and results and forward them to other providers on their care team?

Are engaging tools and resources available to guide patients on self-management activities, such as suggested apps, medical device options/recommendations or multimedia educational content?

Can patients message both administrative and clinical staff to avoid frustrating call trees and phone tag?

Can users securely upload documents to attach to their messages or add to their medical record?

Another technique is to gain insight to the patient perspective by obtaining feedback from your population by asking a pool of patients to assist you with user testing. This would include feedback on the ease of gaining access, navigating the site, their assessment of resources and information, and completing transactions, such as requesting an appointment, messaging, bill pay, etc. User testing by patients and their family caregivers can also help you determine whether:

the site easy to navigate at home for all segments of the population

the portal accommodates the patient's, or family caregiver's, learning needs

the resources, information, functionality are relevant to the patient population(s) served and provide value to users

patients want to see other online tasks accommodated by the portal, such as requesting medication refills, bill payment

your patient want to upload data, such as glucose levels, daily weights or information from wearable sensors for trending and alerts to both the provider and patient when some intervention is needed.

Patients have become accustomed to this technology in other areas of their lives, such as retail, banking, travel and general communications. They expect it from their entire healthcare network, starting with their providers and payors of care.

Mental Health Informatics

The current issue of the Annals of Family Medicine includes two articles that deal with mental health and information technology.  There are many assumptions about mental health in the age of digital health, so perhaps the findings of this research will give patients and providers some additional insight  This will help improve decisions to support self-management activities.

Mental Health Apps - This study examined how mobile health apps frame mental health; including who is affected and how to manage symptoms.  Of the 61 apps identified, 34 (56%) addressed panic/anxiety/stress, 16 (26%) focused on mood disorders and 11 (18%) addressed well-being or other issues.  The two dominate findings are that poor or fragile mental health is ubiquitous and users can easily manage their health with apps.  However, the sufficient scientific data for the claimed benefits was not offered.  In addition, the representation of users does not match with the actual diversity found in the population of those with mental illness. 

Access to Clinic Notes - This study assessed patients who had access to primary care clinic notes through secure online portals.  Patients with at least one mental health diagnosis were compared to those without; and both had similar perceptions to online access to notes. Most patients had positive perceptions about OpenNotes and were similarly enthusiastic about the utility of reading their doctors notes online.

The results of both studies highlight  the importance of providers/physicians recognizing the risk and benefits of information technologies that are available to their patients.  In the case of apps, physicians will want to address use of mental health apps by their patients and educate them on normal mental states and the importance of supports when needed.  This is to challenge the possibility of over self- diagnosis and implication of individual responsibility for mental well being.  Conversations should include a limitations of app use and the importance of seeking clinical attention for important or enduring psychological distress.

Physicians may also want to consider that access to clinic notes may help patients engage more actively in their treatment and improve communication and build more trusting relationships.  It might also stimulate more non-judgmentally written notes to further strengthen the patient-physician relationship.  I would also add that clinical notes reflecting the conversation may also help patients improve their compliance with physician recommendations and the treatment plan. Yes, it may be appropriate to block some parts  available online for certain patients due to safety reasons, but in a family practice this should be a small population.

The findings from both of these studies do point to the increasing reality, which is that patients are going online and using tools for information and tools to better manage their mental health.  It is the responsibility, and in the best interest interest, of physicians to have informed conversations with their patients, as appropriate.

Another ZDoggMD... Through the Haze of Medical Marijuana

ZDoggMD, AKA Dr. Damania, is one of the coolest of the cool docs around.  It does make me happy to see him weighing in on the topic of medical marijuana.  Let him guide you through the haze and watch!  I do love the background smoke!

 

 

Advocacy and Activation

A couple of things happened in the last two days that made me think it is time for me to again mention patient advocacy; including self-advocacy.  First, the monthly meeting of Chronic Disease Coalition Ambassadors occurred and the importance of patient advocacy and even self advocacy came up.  The second thing to occur, beginning yesterday, was the potential delay in another treatment due to an "insurance authorization" issue.  I had already been digging down to identify the actual issue when the CDCA call occurred.

Across my career I've ensured that people had a shared mental model and understanding.  When it came to patients, I welcomed and encouraged them to identify advocates, or advocate for themselves.  But, what is advocacy?  It really is about speaking up, questioning, addressing concerns, asking for clarification, and ensuring that one's needs and desires are heard and understood. Healthcare professionals are human and make mistakes and sometimes these cause harm to patients.  Advocacy is a way to keep patients safe and minimize the risk of harm; or at least lessen its impact.

One place that I've turned for educational content that uses engaging video to help consumers and patients better advocate for themselves is the Joint Commission's Speak Up Initiative.  Below is just one of the videos, on the topic of identifying a family/friend advocate.  Videos also address scenarios and issues, such as, doctor visits, at home, preventing medication errors, reducing your risk of falling and more.

 

Back to my advocacy issue... I was told by the speciality pharmacy my treatments scheduled for next week would have to be delayed because insurance authorization for payment was still pending.   The disappointment and frustration I felt "activated" me and my first call was to the insurance company to check on the status of the authorization.  I was told that one had not been submitted by the pharmacy.  After a few more questions and some digging by the customer service rep, I was told that there was an authorization from January that covered my treatments through mid July.

So, I called the speciality pharmacy back to explain this and ask why they needed a new authorization.  They did some digging and found out that yes, next week's treatment is actually already covered.  In the process, I identified some opportunities for my insurance plan to improve their communication process and for the speciality pharmacy to improve their tracking processes.  In addition, I learned a bit more about how the authorization process works for these recurring treatments, so if this happens again, I'll be prepared to ask even better questions.

The result is that my treatment remains as scheduled and it won't disrupt my plans for the next few weeks.  Had I just accepted that initial phone call and the needed delay as fact, I would have been frustrated, stressed and a bit angry that I would have to cancel my plans for a little road trip to get away and rejuvenate.  

So, ask questions until something makes sense.  If the healthcare providers don't have answers, encourage or ask them to look into the matter and get back to you.  Follow up on leads that take you back to the person who has the information you need.  Also, don't be afraid to make a little noise and reach out to a supervisor, manager or even the chief executive officer, if something is especially important.

Educational Video on CBD

I've been struggling with where to find trusted information on cannabis and CBD; all while knowing video is more engaging.  I've now found Green Flower and their free videos on a variety of related topics.  My first one to watch was Autoimmune Disorders and Cannabis.

We all want to know we are doing the right thing for our health and that often starts with increasing our knowledge.  Once we understand more about our condition, alternatives, and options, the natural shift is to self-advocacy.  But first, we must learn and improve our knowledge.

I have attempted to post what I know or could learn about CBD, but maybe it is time for others to share their knowledge and expertise.  Watch this video to begin your CBD learning journey.  Lean more starting with this link!

 

Sober Grid: Addiction Recovery with the Aid of an App

As a child, I attended AA and Alanon meetings with my grandparents whenever I was visiting over the summer.  It was what we did, especially since my "born again" recovering alcoholic grandfather took pride in helping those new on the journey to sobriety or stumbling along the way.  Later in life, I learned more about addiction at a 158 bed psychiatric and chemical dependency hospital while leading operations.

In some respects, addiction recovery has been present across my entire life and career.  There were the emergency room patients... and additional family members.  So, when I learn of innovative tools to help those embarking on their journey or trying to avoid the potholes, detours and exit ramps, I do get excited.  SoberGrid, an app is my latest, and maybe, best  find because it incorporates the ubiquitous social media and mobile technologies.

A recent article covers the details of how it works, but here I want to share the highlights via images and links to the app for those who need it, or their caregivers.  

       

 

SoberGrid also offers a Provider Portal that allows EAPs and providers to connect with their alumni and stay in touch after treatment.  Watch this video!

 

Future of Mobile Apps: Location Services

Years ago, as I prepared to write a book on use of social media in healthcare, I signed on and really liked FourSquare.  They split the app a couple of years later and it lost value for me.  But, I still think about the possibilities of location apps in healthcare.  For example, how do I get from registration to the clinic in a large academic medical center.  Or, from one department to another in my local community hospital.

Now that I have my patient experience, including getting lost in the vast underground parking structure at UCLA - when walking and fatigue were huge challenges for me - I think about mobile apps for way finding again.  But, social and mobile has evolved, so I want to see more.

As I wander around some environment, I want an alert that I passed the hallway to the outpatient laboratory.  Or, a reminder as I exit the building that I forgot (due to brain fog) to stop by the pharmacy (instead of figuring this out when I get back to Santa Barbara from Los Angeles).  It would also be nice if I arrive early for an appointment (because I drive so far through LA traffic) that I be alerted to the onsite cafeteria or coffee cart, instead of me hobbling to the places I actually saw in Westwood as I drove onto the campus.  At least, I have a sense of the journey ahead of me.  And, perhaps as I'm staring at my tablet while having a Latte (yes, regular milk, please); I could also get an alert that I better start heading back to the building where my doctor is located if I want to make it there on time. 

New companies like, Radar, launched by two former FourSquare execs, may finally be able to give me what I'm looking for in a more robust app for healthcare or otherwise.  For example, I really enjoyed checking in when I traveled for business.  Why?  I then had a record of that great little restaurant I found in Minnesota and could make my way back their even if I forgot the name.  This reminds me I use to be a hospital administrator....

So, we have all of this equipment and instruments in the hospital, I keep signing purchase orders to buy more and stuff (expensive stuff) keeps getting lost.  Where is it?  My daughter's iPhone told us the location of the young lady who stole her phone.  Why can't we get a tracking app that tells us the portable vent was left in the UCLA ER when we transferred that really sick patient three days ago; or that it is still riding around in the ambulance - currently headed north on the 101 Freeway.  Perhaps, it might also reveal that some really expensive surgical tool that we "had" to have (and can't be found) is now sitting in the outpatient surgery center down the street.

As a volunteer, nurse or other staff member, I want to know where the wheelchairs are located --- and if anyone is sitting in them.  Because the hunt for a wheelchair is time consuming, and patients and other staff are waiting.  Some innovative staff have taken to hiding just one wheelchair for when it is needed.  If I'm standing in a hallway, I'd like to know there is a wheelchair in empty patient room 237,  or in the supply closet behind the nursing station.  And, if someone took my unit's wheelchair and didn't bring it back, I want to know who it was (because they scanned their ID) and where it is currently.

I'd also like to invite all of those visitors in the hospital to enjoy lunch in our healthy cafeteria with great food, instead of driving over to the In & Out down the street.  (Today, every dollar matters.) If they are with their loved one for prolonged periods of time, they might appreciate a message that tells them there are freshly baked cookies in the cafeteria, about the prayer service starting in the chapel  or the caregiver support group later that evening.  

I'd also like them to know about the gift shop.... and the ability to order online and have items delivered to the patient by friendly volunteers.  I don't want to hope that they actually pass by the gift shop and at that exact moment think, "oh, I should get a little gift." 

Getting back to that UCLA massive underground parking structure, perhaps that app could direct me to the parking spot closest to the building of my appointment. This is especially important when you can't walk very far, are a fall risk and haven't yet received your handicap placard (took 2 months).

So, Radar, I'm counting on you for more robust and relevant tools at my fingertips.  This means you will need to know where I am in space, where I came from and where I'm headed.  In turn, you will make my journey more efficient, effective and entertaining.

 

Healthcare Social Media - Its Impact on Patients

Since 2005, I've blogged as a healthcare administrator and along the way met some great blogger friends.  John Lynn of Healthcare Scene was one of the very first; because we shared an interest in healthcare social media, or #hcsm,  and the technologies #HITsm behind the various channels.

Many of us also had our patients in mind and envisioned ways that these tools could support them and their family caregivers.  But, naysayers would jump up and say "what about HIPAA".  My response was that my desire to learn more about my condition might be more important than any privacy concerns.

So here I am, a patient for this last year with a rare condition - formerly a healthcare administrator (Chief Operating Officer twice).  It is probably a little past time that I write a post focused on my #hcsm experience - that includes all #digitalhealth and #mhealth health.

1. As most patients do, we start with Dr. Google and I was no exception.  For months I googled my symptoms in an attempt to find a diagnosis that might fit with me.  My neurologist wasn't a big help, so I really only had me to advocate for myself.  Soon I came down to the one that seemed to make the most sense.  It often popped up as an option in my search results - Guillain Barre Syndrome (GBS).   In addition, my virtual second opinions also pointed to this condition and recommended next steps.
   

2.  There is only so much information that "reliable health sources" put out.  Think about it... written by a bunch of healthcare professionals who have probably never lived with a particular condition.  What I wanted to do was ask questions while I waited three months for my appointment.  I was a bit perturbed with my neurologist, so I wasn't going to call him.  Instead, I did what I suggested consumers do all those years -- find trustworthy information on social channels that fit their needs. 
3. My first stop was Facebook.  I joined two support groups for patients and family members impacted by GBS.  Next I searched for bloggers with GBS and a little later I added a third FB support group with more emphasis on exercise.  These were wonderful resources.  I learned there were others like me who never experienced the more severe onset of full paralysis.  I also learned helpful tips and more personalized information on what I might expect.  I was even able to finally ask my questions to an audience of people who shared my experiences.  It was a complete relief and helped me endure my continued delay in obtaining an official diagnosis and treatment.
4. Later, I searched for #guillainbarre on Twitter to see if I was missing any important information or new developments.  Again, I found people like me, helpful YouTube videos and more and more knowledge. Using hashtags really helped me dig through the noise of social media to get to the pearls of wisdom I needed.
5. As I could relax and my fears and anxiety of the unknown subsided, I could turn to finding tools to help me continue living my life in spite of functional limitations and other challenges.  It occurred to me I could start an online store to share knowledge about some of the new and innovative products I was finding.  It would offer one stop shopping for patients like me - and where else would I host this than on my blog.  I would test all items carried and write about the in blog posts explaining why they were chosen.  I'd also share this collection of products to help me with activities of daily living on Pinterest , Twitter, Facebook and Instagram.  This new focus on something I could do while stuck on a sofa all day energized me.  And, who knew, someone might actually make a purchase and maybe this could turn into a new profession when I was no longer so limited in my abilities.
6. Fast forward to today and Facebook and Twitter helped the Chronic Disease Coalition find me.  I was able to teach them about Guillain Barre Syndrome and was invited to become one of their new patient advocates.  It fits in well with my new role of helping those facing a new diagnosis.  While I still seek knowledge, I more often share my knowledge with those just starting on the journey.  I have also found that my 35+ years of professional experience has equipped me with some expertise on navigating the healthcare delivery system - that seems to be appreciated by those who are having challenges or hitting barriers to care.

So yes, #hcsm has an important role in promoting patient engagement and self advocacy.  Today's patients want information to help them make better decisions - both from professionals and other patients.  The videos, infographics and other multimedia also support those patients who have low health literacy... or simply prefer visual and audio learning.

Insurance and avoiding delays in care each new year!

Being an activated and engaged patient means you are constantly learning and becoming a better self advocate.  Just when things are sailing along smoothly, BOOM!

My new learning has to do with insurance coverage and the start of each new year.  In December 2017, I was scheduled for a new round of treatment by Kroger Specialty Pharmacy after  several series of treatment that had all gone smoothly.  I had dates in early January scheduled, and I waited.  Then, on the day prior to the start of my scheduled treatment, no box of medications.  I started by contacting my nurse (via text) and then the pharmacy by email.  Of course the nurse responded first, because most text messages are read moments after hitting send.

My nurse told me the treatment had been cancelled due to something related to insurance authorization.  Nothing had changed with my insurance and they had plenty of time to get the authorization.  So, what happened I asked myself.  After a few emails to people at the pharmacy, I learned about the following common practice.

For most of us, we sign up for insurance in the Fall, that begins at the new year.  Usually we have a choice of plans we can select from, or just keep the one we have currently.  In December my treatment was authorized.  But, the provider (doctor, hospital, therapist, etc) doesn't know if I'm still eligible or had a change in insurance plans and/or covered benefits.  So, they begin the process of checking eligibility and re-authorizing treatments scheduled to be delivered in the new year.  

The beginning of the year creates a back-log for providers and insurance companies due to many insurance changes and eligibility updates needed to make sure the treatment is still covered and policies have not changed.  But there are a couple of things engaged and activated patients can do to smooth the transition into a new year and avoid potential delays.

1. If you know you will have a change in coverage or insurance and you have appointments or treatment scheduled early in the year, give the provider your new insurance information as soon as you receive it.
2. If you have an appointment or treatment scheduled in the new year, even if you know your insurance plan or coverage hasn't changed, call your provider to ask if they have re-checked eligibility and gotten a re-authorization.  Remind them of the date of your scheduled care and ask them to confirm with you once they do have the authorization.
3. Once you know your provider has submitted an eligibility check and/or re-authorization, call or message your insurance company to check on the status.

In my case, there was also a communication breakdown because no one reached out to provide the patient with information that the appointments had been cancelled.  This means that my fourth tip is to call to confirm that the provider has everything they need and the treatment will occur as scheduled.  

Patients are their own best advocates and a little planning will help avoid any frustration and delays.

Nothing is just a tweet! #MeToo

In the heat of the moment and emotion, we can all say something ugly.  We are human.  However, what we say, or tweet, does provide a glimpse into our innermost thoughts and the true self.  Lashing out when someone doesn't agree with you, to me, is a sign of control and a bullying behavior.  I've seen it personally and in my professional life and it seems to be getting worse, instead of better.

I was planning to write about telehealth physical therapy today, but that can wait.  Instead, I want to shine a light on behaviors meant to control another - especially those that might not be so obvious to the masses.  The control is at the heart of the matter, whether it is the bully in the office (or on Twitter), the abusive parent or the rapist.  When this person feels a lost of control, that is when they are most likely to lash out.  Their behaviors too often are masking their own insecurities, which is rather ironic.  So while I can empathise with a bully and wonder what evils are in their past, I hold them accountable for not checking themselves and managing their behaviors towards others.

A few of my experiences with controlling people and their bullying to get me to submit to their wishes are listed below.  It probably isn't an exhausted list, since I've never really internalized the effect and seen myself as a victim.  Has the control freak negatively impacted my and other lives and livelihoods in some way, most certainly yes in some of the cases.  But, I always have left wondering about their emotional history and pity those who enable them.

1. Attempting to control a child or spouse by verbal, physical or emotional abuse only pushes them away.  At some point, they realize there is nothing they can do to please the person.  This is because they are an independent being and deserve to have their own self heard.  Adults need to find new approaches, or recognize they are the ones who need help and obtain that help, before they do long term damage to the bonds of the family. (I suspect we will see some issues of control from the parents in Perris, CA.)
2. The young surgeon who massaged my neck in front of the Chief of Medicine after a meeting, while we were talking committee business, was my most shocking #MeToo moment.  I grew up in the South and lived with being called "honey" and "dear", but knew the difference between it being derogatory or a naturally warm reference to me.  When you are turned down for dates, reminded that you have a wife at home and inject yourself into the world of another - increasing the risk to their reputation, you are being a control freak.  My guess is the massage was designed to push the advances to the limit and finally get me to accept (the control) when I felt my job or reputation could be jeopardized.  Sad little man!
3. The Virginia priest who one Sunday morning  told all that had freely gone to church that if they didn't believe everything the church taught (through his words) then we should get up and leave, because we aren't true Catholics.  Well, I don't believe 100% of anything anyone tells me... especially a priest.  I actually like to use critical thinking skills and decide for myself given all of the information available.
4. The director of nursing who bullied others to get her way, even if it meant ignoring regulations and safety mechanisms. If you objected or disagreed, your job was a risk - PERIOD.  Undermining the work of others, spreading untruths, interfering in job responsibilities and marginalizing when someone doesn't agree with you are all examples of control and bullying to get one's way.  
5. The new hospital corporation executive who cleaned house by eliminating the jobs of loyal employees and replaced them with his own "followers" wanted to control the culture and make the business ALL about the bottom line.  It was all about getting in line with the "new way" of doing business, even though that ultimately got him and the company in trouble with the feds.  That new way also included laying off one of the few women administrators three weeks after she returned from maternity leave.  How is that for improving diversity in the ranks of healthcare executives?  Caution, he is a governor now!

That brings us back to the tweet and what I see and hear of in the media today.  It is all "my way, or the highway" mentality.  You either believe/do/say what I want, or I'm going to threaten/belittle/undermine you to get what "I" want.  Critical thinking and standing up to the bullies is what is needed most in society today.  Standing up to the bullies also means not enabling them, and holding them accountable for their actions and words aimed at controlling others.

Slavery is wrong. Genocide is wrong. Domestic abuse is wrong. Sexual/racial harassment is wrong. The glass ceiling is wrong.  Bullying at school/work/church/etc is wrong. But, so is attempting to control my beliefs and views about the world around me.  It is this latter one that often gets society into trouble, and I see it coming. 

Think critically and think before you tweet! 

10 Ways Social Tools Improve the Patient Experience

My blog has taken a new shift to focus in on the patient experience from the patient's perspective.  Since I wrote an article on this for health professionals a couple of years ago, I thought this would be a great #TBT topic to revisit.

1. Access to social media:  I've been doing a fair amount of sofa and front porch sitting to elevate my feet and legs.  Access to my friends and family on Facebook has been an easy way for me to keep everyone updated over the last 6+ months.  Their likes and words of support make me smile.  More recently, as I began to have a more specific diagnosis, I've also found support groups of people with similar experiences.  I'm learning from them and recognize just how lucky I am that my condition isn't the more severe form.  The groups also provide an opportunity for me to support others with words of encouragement and my knowledge of the system.

2. Self-management:  As my condition progressed and my diagnosis evolved, I turned to the Internet to learn more.  In some cases, this lead to information on blogs , YouTube and other social sites.  I consider ways I can make accommodations to do at least some of what I use to do; and now share this insight with others who have functional limitations on my social sites. 

3. Communication needs: As noted in #1, I stay in touch with family and friends and have started communicating with others on this same, slow journey to recovery. 

4. Relevant information: Facebook, Twitter and Pinterest are all delivering relevant information based upon my shifting interests.  I appreciate the help and leads to things of potential interest. 

5. Right channels: Many of the sources I've found are also on my social sites.  Perhaps their social presence did contribute to more visibility! 

6. Listening skills: After one particularly frustrating day with @UCLAHealth I vented  on Twitter; and they were listening.  Humm, maybe I should tweet about the confusing signage on their garage elevators.

 Hi @Cthielst we apologize. Thank U for reaching out. Please fill out this form https://t.co/bDoOtijD85 so a representative can contact you

— UCLA Health (@UCLAHealth) June 27, 2017

7. Gathering intelligence: I'm currently using social sites to gather intelligence on patient needs - so I can consider solutions to help people stay active even with conditions that limit their physical abilities.

8. Multimedia messaging: I have found some excellent education information delivered  with video and graphics.  This includes "how-to" and what I need to know. 

 

9. Patient choice: I like the efficiency of social communications.  I still call my mom and dad, or other friends and family when it is more appropriate than a message on Facebook.  

10. Alignment effort: The experience described above has lead to my own social performance improvement; including a new Facebook page focused on my considerations for active living. 

How has social media helped you as a patient?  What do you think healthcare leaders need to know about social media and the patient experience?

Wireless: The Future of Medicine

 I'm preparing for my next Health Informatics course and added a new video highlighting the use of sensors and wireless devices for both consumer and clinician users.  I had not shared this on my blog previously, but it is worthy of your time to watch.

 

Telemedicine: Some Kids Might Not Be Too Eager

The Aw Phooey! episode of the Jetsons demonstrates how virtual visits or telehealth technologies might interfere with attempts to play hookie from school.  Parents, on the other hand, would find value in not having to interrupt their day for a potentially unnecessary doctor visit -- especially if means leaving work.  Yes, there is both good and bad to telemedicine - depending upon your perspective.

 

Compassion and Empathy in Healthcare

Another great video on compassion and empathy in healthcare from Cleveland Clinic; with a bit of a surprise at the end.

#MySantaBarbara and #socialbiz

The Santa Barbara Chamber of Commerce is hosting a business expo today and they plan to shine a light on social media.  I've been active on social sites since 2005 and sharing what I've learned with others in books, articles and as a speaker.  My real expertise is navigating the social challenges for industries where there is tremendous risk, such as, healthcare, legal, etc.

If you want to know where to start, start by reflecting and taking this brief social media self-assessment!

Design vs User Experience

I almost freaked out thinking I had lost a graphic that I use in my work with health informatics, as well as, performance and process improvement.  Just to make sure I don't electronically mis-place it again, I'm adding it to my blog to my blog where I collect interesting digital information.  In addition, I get to share it with you!

The lesson here is to design new processes and workflows with the needs of users in mind, instead of simply looking at some from our own narrow perspective.  If you don't know what users want and need, then ask them to try out the new process and workflow to see what they think and to provide feedback that can then be used to make adjustments.  That is user-centric design!

John Stossel: You can't email your doctor!

John Stossel was recently treated for cancer and he had a couple of observations about health IT and men needing to listen to their leading lady when they say "it is time to see a doctor."

Last year I thought I could message my doctor when she announced she now had secure messaging.  Silly me, she meant she could send me messages, but I still have to call her.  As for filling out forms, tel me about it!

We, patients/consumers/family caregivers, need one  place to enter information and then the technology to slice and dice the information for whoever needs it in whatever form they want.  I don't care.  I just want to fill in my address, phone number and medical history once and then update as needed.  Well said, Mr. Stossel!

Online Masters in Public Health

Back when I was working on my masters at a school of public health, I had to fight to be able to take my courses on a part time basis instead of full time like everyone else.  Why?  If I wanted an education, I needed to work to support myself and cover the costs that grants and loans didn't.  

Fast forward to today and we have online programs.  I think not only about needing a flexible schedule for those who have to work, but what about those in rural or remote areas who can't leave to go to school for family or cost reasons.  I moved back and forth between New Orleans and Baton Rouge, but I was young and single.

So, I'm happy to share this list of Online Masters in Public Health Care programs.  I'm on the faculty for two of these - Concordia University Nebraska and National University, but not in the Public Health Program.  

There really is no reason not to advance your education with the flexibility of today!

 

Social Media for the Physician Practice

Scripps Mercy Physician Partners invited me to present a webinar program to their members back in October on using social media in the physician practice.  It was a great event that even lead one of the physicians in the audience to create her Pinterest page as a place for her to share images for educating her patients.  

My Part 2 presentation is this week and it will be a deeper dive into the technologies for facilitating care processes.  If you watch the recording of Part 1, let me know what you think!  I'll add the Part 2 recording once it is uploaded by Scripps Mercy Physician Partners to their Physician Resource Center.

 

Connected Medical Devices: Overcoming the Challenges

Health Literacy: The power of infographics for patient safety

In 2008 The HELP Project of Bellevue Hospital released results of research on medication administration by caregivers of young children.  The found that graphics instead of text heavy narratives resulted in improved compliance with instructions.  They found that 47.8% of  caregivers (parents, sitters, etc) made dosing errors after standard medication counseling and 38% did not adhere to all instructions.  After they added pictograms to the medication counseling process the dosing error rate fell to 5.4% and only 9.3% did not adhere to all instructions.

The top graphic is an example of the pictographs used in the research.  They were simple, but effective.  Since then infographics have evolved and can be used to facilitate patient education while patients are still in the office or electronically via text, email, patient portal, social media, etc..  Two examples are included below. 

      

Video addresses revisions to screening guidelines for mammography

Recent changes to screening mammography guidelines have been controversial and confusing. Cedars-Sinai Medical Center attempts to shed some light on the matter for patients with a new YouTube video.

Social Media Guidelines & Best Practices

I've been noticing a lot of ER Residency Programs with Twitter accounts and have been following them.  I may now understand why there are so many ER residency program accounts when compared to other specialties.

The Council of Residency Directors Social Media Task Force  released Social Media Guidelines & Best Practices Recommendations and as they point out, “…use of social media among emergency physicians is unusually strong… emergency physicians have embraced the healthcare side of social media in a way not seen among other specialists. 

The guidance reinforces the fact that programs should have a communications plan/policy that proactively addresses the use of social media and potential issues and it should encompass:

• Target audience
• Purpose of the site, including educational objectives and explicit consideration of the function of the site such as degrees of access and interactivity planned
• Level of privacy and security required
• Issues of medical advice and redirection of patients to appropriate venues
• Plans to deal with adverse events, including spam, negative comments, complaints, and unprofessional behavior.

They also offer guidance on residency program-specific issues, such as:

• education to residents, fellows, faculty and other personnel; paying specific attention to professionalism, including personal reputation and medical privacy
• discourage policing activity; but if an issue involving personnel is brought to the program's attention, addressing it
• clarifying that the same standards of professionalism and privacy are required online as in person, but normal standards may not be sufficient to avoid misperceptions or legal issues.
• strongly recommending that people in a position of power/authority not initiate a personal online relationship with an individual in a subordinate position. Exceptions may be made for situations where it is appropriate for monitoring a remediation/probationary circumstance or for primarily educational group experience, such as with an online journal club hosted on a social media platform.
• reviewing considerations for whether a program should search for online information about prospective residents

This is a great resource for any academic setting, including teaching hospitals.