What Inspires You to Get Healthy? Hea!thrageous Is Listening

Did you know that nearly 40% of the doctors that are in practice right now are 55 years old or older?  About a third of the present nursing workforce is 50 years or older and 55% are considering retirement in the next 10 years.  That comes to a shortage of about 100,000 physicians and 300,000 nurses in the near future.

Sixty-six million Americans are in the baby boom generation.  They were born between 1946 and 1964 meaning they are between the ages of 66 turning 67 in 2013 and 48 turning 49 this year.

These numbers may not seem like anything to worry about…they’re just numbers, right?  Wrong.  What will happen when there are even fewer physicians and nurses available to treat and to monitor patients?  After approximately 50% patients right now are not complying with their treatment or taking their medications as prescribed.

0d55210Mary Beth Chalk is one of the people thinking about these figures and trying to create solutions now.  One of the areas she focuses on is the time between office visits. “The negative spaces of treatment are what happens between office visits…Treatment is what occurs in the office – managing is what a consumer has to do once they return to their lives…. think what technology can do to paint in the negative spaces of treatment! ”

Partners Healthcare has a lab that is searching for how we can solve the problem of not enough doctors for all the baby boomers.   Connected-health is one of the answers. “If we measure something about you and feed it back to you in a contextually relevant way, then we can motivate you to a healthier state,” says Dr. Joseph Kvedar, Director of the Center for Connected Health.  He is also co-founder with Ms. Chalk of Healthrageous, an m-health company that is an off-shoot of the Center at Partners Healthcare.

Ms. Chalk is also the Chief Engagement Officer at Healthrageous and she’s been learning a lot about what motivates people.  “We found that very few people are inspired to ‘manage their condition.’  Health is a requirement to realize hopes and dreams,” she says.  Patients must manage their health through medication or lifestyle changes, “what if [managing] is placed in the context of “’living’… what if we could join with and support their aspirations for their lives – rather than placing a burden of ‘managing’?”

Since Healthrageous’ was incubated inside of the Center for Connected Health –they are part of the tele-monitoring work that is being done there.  However Healthrageous is “leveraging personalized computing, biometric feedback, home_how_1segmentation, and digital coaching to help people be successful.”

“Our work is currently focused on monitoring and digital coaching for consumers with hypertension and Type 2 diabetes,” Ms. Chalk acknowledges.

With 59 percent of US adults looking online for health and drug information yet only 12 % of adults having proficient health literacy, self-monitoring may have significant educational benefits.  If health is made personally relevant to a person’s real aspirations, it becomes meaningful.  Self-monitoring can motivate, The patient question we ask at Healthrageous is ‘What is your inspiration for getting/being healthy?’” In other words self monitoring can teach an individual “ that my blood sugar is standing between me and seeing my daughter walk down the isle”,. Ms. Chalk states. ”Consumers are able to leverage our platform to manage chronic conditions (Type 2 Diabetes, Hypertension, etc) in a personalized way.”

Ms Chalk believes that next year, 2014, will be a new dawn in health consumerism in the US with the health insurance exchange. “Nationwide Insurance Corporation provides a discount for safe driving – what if I was incented for good health? You can scream “not fair,” yet Ms. Chalk believes that “every person can do something to improve their health.”

Are poor health outcomes the fault of the individual?  There are some who may be concerned about this idea. The Food Research and Actions Center’s review of the literature on obesity indicates that there is a greater risk of obesity for women and children (especially White women and children) of low-income who are suffering from food insecurity.) Neighborhood factors include a lack full-service groceries and farmer’s markets, expensive healthy food and inexpensive refined grain, high fat and sugary foods, greater availability of fast food restaurants, and, finally, fewer opportunities for physical activity because of crime, traffic, and unsafe playground equipment.  Research also reveals that cycles of food deprivation and overeating may also cause obesity because those who are eating less or skipping meals to stretch food budgets may overeat when food does become available, resulting in chronic ups and downs in food intake that can contribute to weight gain, especially metabolic changes that promote fat storage.  Other factors include high levels of stress and exposure to more marketing and advertising of fast food, sugary foods and sugary beverages.  Finally, the research notes that the poor have limited access to health care.

Ms. Chalk is sure that “technology will allow us to personalize the ‘something’ that we can each do to measurably improve our health.”  She suggests that “health disparities will be the engine of segmentation strategies – one size fits all no longer works.”

Are physicians and nurses ready for this revolution?  Clinician buy-in will come when Healthrageous demonstrates that “a solution can effectively engage patients in evidence-based lifestyle changes that result in improved clinical outcomes and reduced office visits, “ Chalk says.  Healthrageous is interested in “integrat[ing] physician approved alerts into their normal workflow to alert the physician…when a patient is not achieving optimal clinical outcomes.”  Finally, being able to see data trends over time is a big incentive for physician buy-in. “Physicians will have to see how new solutions improve their ability to impact patient outcomes without creating undo burden on their daily practice pattern,“ Ms. Chalk believes.

With the Baby Boomers aging, fewer clinicians and paid caregivers and 2/3 of our population overweight or obese, there is a need for many changes.  The CDC’s Thomas Frieden suggests policy changes to reduce the problem of obesity like instituting a tax on sugar-sweetened beverages; increasing subsidies for fruits and vegetables ane using zoning to keep fast-food restaurants away from schools.  He has proposed completely eliminating children’s exposure to food advertising on television.   Add to these changes the innovative technology that Healthrageous can provide and we may have a winning combination.    As Ms. Chalk says, “We are in a time of reformation! And reformations require courage and great minds!”  M-health, tele-health and connected-health initiatives can provide the support that is needed for big changes to come.


This summary is based on #HCHLITSS twitter chat held Thursday January 24, 2013

1) Fears, D. (2010) Retirements by baby boomer doctors, nursese could strain overhaul Washington Post  Monday, June 14, 2010 http://www.washingtonpost.com/wp-dyn/content/article/2010/06/13/AR2010061304096.html

2)  Pew, 2011 http://www.pewinternet.org/Reports/2011/HealthTopics/Part-4.aspx

3) The Food Research and Actions Center  (http://frac.org).

4) Frieden,  T. ,Dietz W., & Collins J. Reducing Childhood Obesity Through Policy Change: Acting Now To Prevent Obesity HEALTH AFFAIRS 29, NO. 3 (2010): 357–363. http://w.banpac.org/pdfs/sfs/2010/reduc_child_obes_11_04_10.pdf

50 March 20, 2012. Healthrageous CEO Rick Lee speaks at Stanford University VLAB Event: “The Uploaded Life” http://youtu.be/6_sj89cxuvo


Do Nurses Eat Their Young? What’s Wrong With Communication in Health Care?

The Workplace Bullying Institute defines Workplace Bullying as repeated, health-harming mistreatment of one or more persons (the targets) by one or more perpetrators that takes one or more of the following forms:

  • Verbal abuse
  • Offensive conduct/behaviors (including nonverbal) which are threatening, humiliating, or intimidating
  • Work interference — sabotage — which prevents work from getting done

040811_020 retouchedRenee Thompson, MSN, RN, CMSRN, nurse, author, educator and advocate for workplace change, is making it her mission to bring nurse bullying  to light.  In her question “Do nurses eat their young?” she shocks us into awareness of nurse bullying.  “I’ll do whatever it takes,” she asserts. “Enough of us who believe in kindness, support and nurturing each other can do it!  New nurses (and the rest of us) deserve to work in nurturing supportive environments…Bullying has no place in a profession dedicated to caring and compassion.”

So what is wrong with interpersonal and organizational communication in the health care setting? Bullying.  Why is bullying happening?  One theory suggests that since nurses are not valued in the workplace they feel powerlessness.  This results in bullying behavior.  Another points to nursing as a predominantly female profession with a forced hierarchy.  In this model, the cause of bullying lies in female competition for prized males.

Despite these notions, or perhaps because of them, Ms. Thompson speculates that medical and nursing school education may start the process. “Doctors and nurses learn separately, then are forced to work together without training. We wouldn’t do that with an All-Star basketball team,” Thompson says.  “Respectful communication is a skill that can be learned and it is just as important as clinical knowledge.”

Yet it is missing from the beginning.  “Nurse sand doctors don’t learn how to communicate respectfully with each other. Student nurses are not even allowed to speak to doctors when they are learning.”  It makes sense.  “When members of a team learn together, they learn to respect roles and work together.. all working towards the same goal…patient care.”

Research literature describes  nurses “as an occupational group, at considerable risk of violence-related workplace trauma” and recounts experiences of “harassment, bullying, intimidation and assault.”(1)

In her own research for her book, which Ms. Thompson conducted while developing student and new nurse residency programs, she heard horrific stories. In her research she encountered recurring themes. “Students and new nurses are the most vulnerable, but any time you change positions, you are at risk. We are still trying to sabotage, especially when the female is younger, thinner, more beautiful and smarter. While nurses are caring to patients, they can be horrific to each other.”

NursingA study of bullying published in Journal of Professional Nursing in 2009 reveals which departments  in hospitals were most likely to have bullying incidents and who were the perpetrators.  The medical-surgical and critical care units had the highest frequency of incidents at 23 and 18 % respectively.  Bullying incidents occurred within nurses’ first 5 years of employment.  Senior nurses were the highest percentage of perpetrators at 24% followed by charge nurses, nurse managers and physicians (8%).   This research confirms Ms. Thompson’s observations.  “Nurses know we eat our young.  Some nurses think it’s good to “toughen up” the new nurses. In reality it’s not. It decreases confidence and competence. “

In fact it seems to be a vicious cycle.  Those who are bullied lose their confidence and are more likely to be targeted.  Ms. Thompson identifies passive communication styles, like “frequent apologizing, avoiding conflict by keeping quiet, giving others priority” as characteristics of victims.  Other characteristics included being of a different gender, race, or from a different location.

Ms. Thompson has witnessed workplace bullying in the nursing profession.  The behaviors range from“overt-screaming, yelling and openly criticizing in front of others to covert-sabotage, backstabbing and undermining.” Bullying can be as simple as “being nice to your face, but then complaining about you to other nurses all night” or as complicated as “gathering a “posse” against you.”

A 2006 article in Nurse Inquiry suggests that there may be hidden processes at work causing nurse-to-nurse bullying.  The authors propose that health care organizations may actually be maintaining the status quo, recruiting nurses who support a top-down hierarchical structure.  Ms. Thompson uses an Italian saying “the fish rots from the head,” to describe her understanding of what is happening. She believes that many organizations rely too heavily on policy to solve bullying.  Without a robust program, zero tolerance policies don’t work. “Policies don’t solve problems – people do,” she notes.

Bullying can impact patient care.  “Organizations with a high rate of bullying have worse patient outcomes.** Many studies demonstrate bullying prevents nurses from asking for help and calling docs at nursing_02.sized3am,”  Thompson observes.   “I  know some nurses who feel they can’t rely on co-workers if they need help for patient.” Nurses who are bullied suffer physical, emotional and mental distress which is disabling, impacting their ability to effectively care for patients.  “Bullying is pervasive, destructive and nurses are suffering all over the world. I know because they call me!”

Patients are becoming aware of nurse bullying. They are asking questions about it. “They’re on to us! “ she says.  And Ms. Thompson is glad. “Awareness is vital to change. The first step for organizations is awareness. You have to know how bad it is first before you can take action.  We get numb to bad behavior, accepting it as normal. Too often we believe what the bully tells us.”

The most powerful intervention to stop bullying, she notes, is for witnesses of bullying to speak up. “We need to teach people how to establish peer-to-peer accountability.  A simple way is to just starting naming behavior. ‘You are screaming and yelling at me in front of others.’” Thompson proposes “skill development for managers and strong human resources partnerships.”.

StopBullying It sounds a lot like personal courage is key.  “What you ignore – you condone. It doesn’t matter if the aggression is aimed at you or someone else… Set behavioral expectations. You can’t assume everyone knows what respectful behavior looks like. So spell it out….[It’s true] confronting might not work. But not confronting NEVER works. We have to try.”  In speaking up, Renee Thompson has decided to do just that!

For a detailed discussion of this topic, see the transcript of the #hchlitss twitter chat that this summary is based on.

Several chat participants requested seminar information from Renee.  Please visit Renee’s seminar information page at http://rtconnections.com/events-2/bullyproofing-communication/ to learn more about her upcoming seminars in:

  • Irvine, CA: February 7th and 8th
  • Orlando, Fl: March 14th and 15th
  • Raleigh, NC: April 24th and 25th
  • Atlantic City, NJ: May 22nd and 23rd

If you are interested in reading Renee’s book, Do No Harm both the hard copy and the Amazon kindle version can be accessed at http://rtconnections.com/products/book/

1) Vessey, J., DeMarco, R., Gaffney, D., Budin, W. (2009) Bullying of Staff Registered Nurses in the Workplace: A Preliminary Study for Developing Personal and Organizational Strategies for the Transformation of Hostile to Healthy Workplace Environments Journal of Professional Nursing, 25, (5) , 299-306.

2)Hutchinson, M. Vickers, M. Jackson, D. Wilkes, L. (2006).Workplace bullying in nursing: towards a more critical organisational perspective.  Nursing Inquiry 13,( 2),  118–126.

**Aleccia, J. (2008).  Hospital bullies take a toll on patient safety.  http://www.msnbc.msn.com/id/25594124/ns/health-health_care/t/hospital-bullies-take-toll-patient-safety/#


Another Caregiver Conundrum…

A 2011 study in the Journal of General Internal Medicine brings to light another problem with caregiving.  The people that are hired to care for elders or disabled may not be health literate.  Health literacy  is  about understanding complex terminology.  7221509-question-mark-with-american-flag-and-dollars-illustrationIt’s about conversational competence like the ability to listen effectively, articulate health concerns and explain symptoms accurately.  It’s also about evaluating, analyzing and deciding about one’s own care. It’s not just reading.

A study conducted by Dr. Lee Lindquist in Chicago looked at the health literacy of 98 paid caregivers.   The group had higher health literacy than the average American  but had difficulty with complex medication regimes.  Sixty percent had difficulty accurately interpreting prescriptions and over a third of this group were not health literate.

Caregiving is an undervalued occupation.  Unpaid family caregivers provide the vast majority of care, in fact at the value of $375 billion.  Paid caregivers are often hourly wage earners.  It this study, their  average hourly wage was only $8.91.  The majority of the caregivers in the study were not Americans but were from other countries, 40% were Americans, 34% were from the Phillipeans and 19% were from Mexico and the rest were from Africa, Eastern Europe and India.

imgresAccording to the US government,

“This year, about nine million men and women over the age of 65 will need long-term care. By 2020, 12 million older Americans will need long-term care. Most will be cared for at home; family and friends are the sole caregivers for 70 percent of the elderly. A study by the U.S. Department of Health and Human Services says that people who reach age 65 will likely have a 40 percent chance of entering a nursing home. About 10 percent of the people who enter a nursing home will stay there five years or more.”

What ever happened to old school medicine? It’s still around…

“Nothing connects doctor & patient faster than a simple moment of pure listening. Not just waiting for your turn to talk, but real listening.”

Tweet by Dr. Steven Eisenberg, January 5, 2013

I wrote a post a year ago entitled “What happened to Old School Medicine?”  Perhaps, by putting my mourning  for my father “out there” I have started something in my own life.  My most recent experiences with physicians, specifically with  my child’s pediatrician, has been like walking into the past.  I have found “old school medicine” in Wellesley, Massachusetts.  I don’t live in Wellesley but I took the advice of my child’s school nurse and made an appointment with her children’s pediatrician.

This is an ‘old school’ practice:  two physicians share it.  We have only seen these doctors twice but they both spent a large amount of time talking and listening to us.  When I have had a question, I called the office and later that day, the doctor called me back.  That hasn’t happened in a long time.


And then, there are tweets like the one above.  Faith is a beautiful thing!

I won’t give up…

My child is a wizard…and a dragon rider…and a super hero.  He can play all these games with such agility that it boggles my mind.  So today when s/he asked me to join in on one of the games that he enjoys, I was honored and humbled and…nervous.

Above is the first 15 minutes of someone else’s play…I crashed the dragon into the ocean, into the rocks, pretty much every place it could be crashed.  Leaning right, leaning left, I kept trying to get into the experience and succeeded–in becoming nauseous with each flip and dip.

I’m hoping that I will be able to get the hang of it…my child’s disappointment heard in deep sighs and “MOM, you have to get back to the village” said in that sing-song tone of the despondent.  Yes, hopeless…

Yet according to research highlighted in New York Times Magazine, video game playing and other types of games can improve attention and fluid memory.  Since fluid memory is supposed to peak during young adulthood, it behooves anyone whose been 29 and holding for a couple of years to get playing.

So I shall persevere, overcome and increase my brain power with Lumosity and Riders of Berk!  And beat the pants off of those other repeating 29 year old (repeating) moms out there…. I challenge you!

A Few Health Funnies For 2013

1)kermit's md2)cartoon3)

sock joke


$375 Billion Worth of Value: Family Caregivers

“There are four kinds of people in this world: those who have been caregivers, those who currently are caregivers, those who will be caregivers, and those who will need caregivers.”

Rosalyn Carter

First Lady Rosalyn Carter is both philosophical and truthful when she describes caregivers.  There are 66 million adults in the US who are unpaid caregivers–nearly 30% of the adult population!

The Canadian Institute for Health Information estimates that there are 2 million unpaid caregivers in Canada. 

Caregivers are defined as either formal or informal. Unpaid caregivers are the informal type, helping others who, due to

photodisability, chronic disease or cognitive impairment, can’t perform essential activities on their own.  Informal caregiving is  performed by family members, neighbors and/or friends, often at home.   Natrice Rese is one of those millions of caregivers.

She worked in long-term care and home care until 2009 when she started family caregiving for her granddaughter, Maia.  Maia has a rare genetic disorder called Emanuel Syndrome, is developmentally delayed, totally dependent and non-verbal.  A website created by her daughter, Stephanie St. Pierre, provides support and information to others facing this disorder.  As Ms. Rese states, “Family caregivers aren’t just there 8 or 12 hours a day.  They live the job, breathe it, think it, sleep little…they need lots of support…  Caregivers contend with personal feelings, grief, exhaustion, fear, and cannot escape from it.”

PHA cknClaudia Nichols is the founder of Pilot Health Advocates, Inc, a private patient advocacy firm helping consumers navigate healthcare.  As a soon-to-be Certified Senior Advisor, she is keenly interested in how caregivers can be supported.  This support is critical now when  “the task of the family caregiver is swiftly morphing into performing sophisticated skilled nursing tasks, including dialysis management, administering IV’s, wound care (an especially difficult task for amateurs and professionals alike) and other professional skills,” she says.

In the US, the monetary value of services caregivers provide for free, caring for older adults, is about $375 billion per year. This figure is twice the amount spent on homecare and nursing ($158 billion)..  In 2007 the economic value of family caregiving was estimated at $375 billion, a figure that exceeded the total 2007 Medicaid expenditures of $311 billion and approaching total expenditures in Medicare of $432 billion.  That is almost twice as much as is actually spent on homecare and nursing home services combined ($158 billion).

The foundation of care in US and Canada is unpaid caregivers.  Yet these caregivers are at serious risk themselves.

Ms. Nichols notes,”Caregiving is stressful and demanding for both caregiver and recipient.  It is often consumes all free time

Informal/family caregivers are at risk for depression, other stress-related illnesses due to stress, fatigue and social isolation. Economic toll fails to account for emotional & financial impact of caregiving on caregivers themselves.”  Ms. Rese agrees, “Not only do family caregivers provide unpaid care, but they also are out of pocket for incidentals, supplies, medicines, on and on.” Ms. Nichols asserts, “The worst case scenario is that caregivers go bankrupt,have breakdowns, become estranged from other family members, become ill themselves.”

Family caregivers are often thrown into the unknown, Ms. Rese feels.  In Canada, 2007 statistics from the Health Council of Canada indicated that  40-50% of seniors with high needs have distressed caregivers.  These same statistics say 2.7 million family caregivers are over the age of 45, 60% of these are women and 57% are employed in addition to caregiving.  Of those, one third of the cared-for have high needs in mobility, physical and developmental delays and chronic conditions.  Twenty percent of those receiving care at home have dementia, requiring 75 percent more care.

Many caregivers are single parents themselves, usually women with children, and sandwiched between elderly family members.  Seven out of 10 caregivers are caring for someone over 50.

The complexity of caregiving has changed.  According to Ms. Nichols, “nearly half family caregivers performed medical/nursing tasks with for those with multiple imgreschronic physical anad cognitive conditions and 78% family caregivers provide medical/nursing tasks like managing medications including IV fluids and injection.  Caregivers found wound care very challenging, more than a third (38%) wanted more training.” The rationale for their  increased care was a desire to keep their family member out of nursing homes or long term care facilities.

The urgency of the situation for informal caregivers cannot be overstressed, Ms. Rese believes.  “There is a crisis already, no beds to place seniors in, family caregivers running out of steam, lack of funding.”

“There are four kinds of people in this world: those who have been caregivers, those who currently are caregivers, those who will be caregivers, and those who will need caregivers,” Rosalyn Carter stated.  Giving caregivers a voice and influencing a political climate that is focused on “cost-saving” is imperative.

The National Family Caregivers Association now renamed Caregiver Action Network is a place to start.  This organization was founded in 1993 by Suzanne Mintz and Cindy Fowler.  This group has truly brought about awareness of the caregiving experience, becoming the go-to organization for anyone interested in learning about family caregivers.  It was instrumental in establishing the National Family Caregivers Month in November and in 2000 the federal National Family Caregiver Support program was established.  Caregiver Action Network’s mission is to “promote resourcefulness and respect” for family caregivers.

As Suzanne Mintz recalled: “We wondered why no one seemed to be focused on the fact that helping a loved one with a deteriorating illness had a very real impact on not only the person with the illness, but also on those of us who were primarily responsible for helping them. We were family caregivers, and we wanted someone to reach out to us, to tell us where to find helpful information and advice, emotional support, and real hands-on assistance when we needed it. NFCA was created to educate, support, empower, and speak up for America’s family caregivers so that all caregiving families can have a better quality of life.”