Well, Doc, I Must Confess...

Anytime I go to a doctor's office, a hospital or a pharmacy, I like to think of this as "fieldwork" for my area of expertise. Because I write about health care in the real world, it's important that I know what happens "on the ground" in the physicians' waiting rooms, the hospital floors and the pharmacy counter. 

Often, my contacts at the health system or the pharmaceutical company assume that processes go the way they are supposed to. However, this is one of the things I find so fascinating about medicine -- the human element always emerges. Sometimes systems can handle that, and sometimes they can't. 

I recently had surgery, and of course, I'm a better-informed-than-average patient. I scrutinized the recommendations, the doctor reviews and cross-checked whether I really needed the surgery. Having satisfied my questions, I scheduled it. Then I had to cross the incredible bridge of surgery prep. I read the "Patients' Guide to Surgery" produced by (someone like me) in the hospital marketing department. I read the handouts from my physician (even the parts crossed out by the nurse that didn't apply to me!)

And still, in this fieldwork, I found some mysteries. Why couldn't I wear nail polish? Did that include toe nail polish? I knew I couldn't eat anything after midnight, but not even tea? no water? This was arduous for a person who constantly hydrates like me. What I wanted more than instructions was the rationale. (See Gretchen Rubin's Four Tendencies -- I'm a Questioner.) I'm happy to comply when I know why! 

So I did my own searches on the internet. I asked my nurse friends and relatives. I looked at recovery yoga breathing videos. And I went in prepared. In fact, the last thing I remember before going under was talking to my nurses about all the services that my health communications company provides. #alwayshustling

But, not everyone asks the questions, even if they want to. And more importantly, how many people don't follow the instructions because they didn't read them, they didn't understand them or they fibbed about when they did them?

The answer to the nail polish question is: it can interfere with the pulse oximeter, so you need ONE nail free of polish, and it doesn't apply to the toes. 

The answer to the water question is more complicated. It's to avoid aspiration of food particles or liquid into the lungs while under anesthesia. But there's some controversy over whether two hours prior is enough time. More on that as the research evolves. 

This week, I interviewed a surgeon about the very same type of surgery that I had last week. I thought maybe I could just not mention it, but turns out -- I had to, because I have what's known in the industry as "lived experience." This is one of the most interesting challenges for medicine today, I think -- the integration of clinical knowledge and procedures with how things actually work in the real world. It's a constant striving to make things optimal (the cleanest incision, the tightest margins, the fastest recovery) while acknowledging that everyone has their own particular situation (their health history, their phobias, their home environment.) 

I'm happy to continue my fieldwork, but let's hope it's all outside the operating room for awhile!

Why Regionalism Will ALWAYS Matter

I went to a economic summit in Virginia recently...and there was quite a buzz from the people sitting around me. It wasn't about the economic data. It was about the speaker, who admitted he was from California, repeatedly calling a city in western Virginia "Stawn-ten."

Well, we are very particular here in the Commonwealth about the way things are pronounced (also, about being a Commonwealth!) Especially our inherited English city names. It's "Stan-ten." (Yes, we know there's a U in it.) It flags you immediately as an outsider, (or an unprepared speaker.)

My point? No matter how globalized we get -- there are some local things that show you are part of the community, that you are familiar, that you took the time to get to know us. I doubt this will ever change. Like the recent holiday gifts: I got Malley's Chocolates from Cleveland, and my husband got Esther Price Chocolates from Dayton. Are these Ohio candies all that different? Probably not, but our childhood memories are, and that goes directly to the brand.

It's the same with any marketing -- it needs to take into account the uniqueness of the people who live in a regional, and respect it. There is no one size fits all, and I think it's human nature to want to distinguish ourselves. We want to know that we are not like everyone else, personally and as a community. It's why local breweries are doing so well, why farmers markets are popping up everywhere and artisan goods are getting a premium.

Hospitals, once stalwart icons of the community, would do well to remember their roots as well. The trend toward larger system franchises offers more access and more resources, but health care is deeply personal, and that should always be in the forefront.    

Here, Take This!

For months, I've been carrying around a stack of papers in my planner. It's about four pages, stapled. It's my son's occupational therapy evaluation report. 

I'm not carrying it around because I need it for any reason. I'm carrying it around because of a highly annoying, yet highly prevalent health care issue: electronic medical records.

My son's therapy office emailed me the report. Great. I've used that method to share it with the school nurse and teachers. But I called my pediatrician's office and asked them how I could share that with them, and they said they could not accept it via email. 

But I could fax it. Ha! (I haven't used a fax machine in years. In fact, my office doesn't have one.)  

More importantly, it makes no sense to take electronic information, print it on to paper and then send it over phone lines to be filed and transcribed electronically on the other end. But this is evidence of our "inherited architecture" problems in health care. We can't all get on the same page.

Some people adopted EMRs early, even designing their own customized portals. Problems with different systems (both health and IT ones) led to sharing problems. With the migration of most big health systems to EPIC, maybe this will be smoother. 

But...the issues I've had are with the little guys. The independent therapy practice is not going to go EPIC. Just like my OB practice just faxed all my paper records to the hospital and they PDF'd them but couldn't search them. All the paperwork for kids' health at schools is on paper back and forth between home and school, then put in the computer there. These little glitches mean that there are redundancies and  gaps. 

We are stuck in the era of bumpy roads with EMRs -- they should be making things go faster, smoother and more directly to the right places. But, sometimes it rains and we're stuck in the mud. I finally delivered the paperwork to the pediatrician on Friday. I held it in my hand the whole time so I wouldn't forget. I would have been so mad if I left without giving it to them. But I also would have been so happy to have sent it to them via email in April! 

Health (Brand) Journalism: What is it?

 

The Society for Healthcare Strategy, Marketing and Development (SHSMD), one of my favorite professional organizations, creates a great newsletter. This month, there's a piece by Cheryl Welch about brand journalism in health care. She offers a case study of brand journalism by Spectrum Health, a Michigan health system that deployed an internal reporting team to create content for their Health Beat digital news site. This is a fantastic example of how things have changed in media to where organizations need to "be their own publishers." A health system is a great ecosystem for illustrating this concept, because a lot happens in hospitals, doctor's offices and nursing homes every day. There are triumphs and setbacks. There are innovations and routines. But one of the challenges for public relations and marketing departments is that they don't hear about these stories until someone thinks to call them. 

Internal reporting, AKA brand journalism, applies the same concepts that we learned in journalism school to tell human interest stories, in this case within the health context. These stories are not outright cheerleading for health system, but interesting, balanced and realistic stories of the people who are inside it, for whatever reason. 

I see this as a major trend in marketing and PR and it can be done well. One of the reasons this is a great tactic is that as Welch says " traditional media is disintegrating, our consumers are more demanding and savvy and the tech landscape makes it downright cheap to reach large audiences."

One caveat, of course: if you are going to do it, do it well. Get a photographer. Create a style guide. Avoid astroturf (fake grass vs. real grass.) Take the time to do rounds and listen for the best stories. Have a plan for the brand voice to come through in the right. Hire people who know what they are doing. Get permissions. And then....go tell those stories!

I Thought They Could Fix Anything....I Was Wrong.

A few weeks ago, I saw a great patient video discussing a woman in the MidWest talking about her snowmobile accident and she gave great feedback for the staff. But she also said "I knew I was hurt but I thought, 'it's 2015, I thought they could fix anything.'" She lost two of her fingers permanently. During the interview, she mostly kept her right hand over the left hand with the missing fingers. She talked about the confusion when her doctor told her that the fingers were beyond saving. But her comment on the perception of most people that hospitals in America can fix anything has stuck with me. We do have amazing trauma teams. We have technology that diagnosis quickly, stabilizes and can mimic functions that the body can't manage on its own. We have blood transfusions and intense surgical techniques. 

But we still can't do it all. When I gave a presentation recently on infectious diseases, I reiterated this to the audience -- avoiding getting sick is still really important. We can kill bacterial infections with antibiotics, but it's getting harder. We can't kill viruses with antibiotics though, and there are few anti-virals available. We have to be smart and avoid injury and disease -- and be grateful for the advances in medicine should we ever need them.  

Infectious!

After giving a presentation this week on infectious diseases and deciphering health information, plus attending an excellent SHSMD session on the handling of the Ebola panic, I have a few thoughts. 

1. Even if all of us who work in the medical field think that people should know something, it's best to go back to the basics. Like the super-basic foundations of science -- for example, that a virus and a bacteria are different things but both can make us sick. Or, that one study does not science make!

2. Internal communication is ultra-important in a crisis. It's not enough to reassure the public. You must communicate to your staff, your board members, your volunteers and anyone working in your hospital. Because your credibility goes in the toilet when you say "We're prepared" but the reporter interviewing nurses on the loading dock hears "We've had no training on this."

3, Fear is a strong motivator, even if people know they shouldn't be afraid. They are, and they want to play it safe. I heard from someone who was thinking of firing her nanny because the nanny's mom was a nurse. It sounds like an overreaction now, but if you recall earlier this year, we were a nation on the edge of our seats as to whether we'd have an outbreak or not.

4. Communication takes time. It can be laborious when you want to be doing (let's go!!!) but it will save you time in the long run. Return people's calls (especially reporters!) even if you don't have anything new to share. Tell your employees what to expect. I agree with Doug Levy (formerly of Columbia University Health System) who said "Communication can't solve everything but it puts you in the best position to catch flaws in your plan." 

Infectious diseases are a tough topic, but one that we will continually revisit. They won't go away -- but we can educate and we can prepare. Oh, and we can communicate! 

"I think the doctor said..."

I just read an article in the Journal of Patient Experience with this statistic in it: 

"Miscommunication between physicians and patients is the most common cause of medical errors and is responsible for more than 60 percent of sentinel events that lead to increased mortality or injury among hospital patients." 

Think about that. More than half of errors are caused by two people trying to communicate but failing to do so. And, I'm sure you've been there. I know I have. The doctor says to do something, in a regular tone of voice, and I'm not sure if it's a suggestion or an imperative statement. Or the doctor says "make sure to..." and I'm so overwhelmed by trying to remember it that I get confused. If you aren't in the habit of repeating it or writing it down, you may very well forget it. 

The journal article was about AIDET training (created by the Studer Group) for physicians. It seems simple but patients know that many of these steps are missed. 

A: Acknowledge (address each person in the room)

I: Introduce yourself  (and your role and your specialty)

D: Duration (how long will you be in the room, is there a procedure happening?)

E: Explanation (what's the treatment? what's the diagnosis?)

T: Thank You (appreciation for their time, questions, etc.)

In a hospital environment, these common courtesies can easily be overlooked, because everyone is in a rush. But it matters. It matters to patients, and it may prevent medical errors and miscommunication. That seems like a great reason to take the time to do it. 

Hospitals -- More than a Building, Part of the Community

I finally sat down to read the Community Connections publication put out by the American Hospital Association, a book full of ideas and innovations for health care leaders related to community programs around the country. The range of programs was interesting, from offering volunteer doulas to pet care during hospice to arranging for meals to be delivered home for food insecure seniors. I think that hospitals sometimes get a bad rap for their size and the amount of money they circulate in the community -- but they are often at the heart of communities in the United States in big cities and small towns.

I think that in our great cultural shift in health care we will see more partnerships and more preventive care -- both essentially important to our community health. From cultural health navigators who assist female refugees from the Middle East / Southeast Asia / Subsaharan Africa in Phoenix to training African American barbers how to measure blood pressure and serve as heart health advocates in DC -- identifying cultural barriers to health is important.

It's heartening to see things that didn't used to fall under "health" be recognized as part of our whole selves. For example, dinner programs for breast cancer support that include communications skills, nutrition, stress management, intimacy and finances, which both builds a sense of connection with the group but also recognizes that resources are needed for these challenges. A retreat for stroke survivors and their families meets similar needs in support, education and socialization.

Prevention is also more of a focus, looking to prevent falls and injuries by strengthening flexibility with exercise (Idaho), student health coaches for those with chronic conditions (Pennsylvania) and instruction for physically disabled individuals to play sports like fishing, swimming, wheelchair basketball and hand-cycling (Iowa.) A hospital in Oklahoma offers a drive-through flu shot clinic to encourage high risk patients. It's important to address the current issues while preventing future ones and there are many adaptations we can make to help keep communities healthy. I applaud hospitals for their innovation and compassion.