Speaker Academy #19 (getting paid), cont’d

Update Nov. 20: overnight I received a courteous and complete reply. The funds have now been sent, and my bank seems to have been part of the problem, since a month ago. It would have been useful to know that – without that information there was no way for me to help. I’ll update again as the situation proceeds.

This is the latest in the Speaker Academy series, which started here. The series is addressed to patients and advocates who basically know how to speak on a subject but want to make a business out of it. I’ll try to be clear to all readers, but parts may assume you’ve read earlier entries.

In #16 (January) I said “For a small business, cash is king.” Then in June, #19 was titled: “What’s up with expense checks??”  To a small business (like a patient starting a speaking business), this is no small issue, and any event that wants to say it’s patient-centered needs to see things from the patient’s point of view. In #19, citing a then-current overdue item, I said:

I’ve used my own methods (very specific communication) for months now, and it’s not working. So, starting tomorrow, I’ll do the blogging that I said (in #16) I’ve never had to do: I’m going to paste in the entire email thread from the current worst offender, with no names attached. And if the money hasn’t arrived by Friday, the names get added. (Their next scheduled check run is Thursday, and I’m sure they know how to use Fedex.)

All those past due items cleared up within a month, through diligent management of each item (by my assistant Kristin and me). That takes more time, costing my business extra resources – exactly as described in #16: they keep the money, I lose interest, and I also expend more to get what they owe me. Most definitely a case of one party not keeping their side of the deal.

But today I received one of the worst examples ever. Continue reading →

Notes for @BCPSQC #QualityChat Twitter chat

BCPSQC web logoFor Wednesday’s “#qualitychat” Twitter chat here are a few notes.

A few notes from participants at the February event

  • “The BC Cancer Agency has led a provincial project asking patients for solutions to some of the lower Provincial Cancer Care Patient Experience scores.  It is a project to listen to the patient voice and implement some solutions that came from patients and their families. … [We have been] inspired to come together as a province to have a provincial approach and also, look at solutions that patients suggest. ” Sue Fuller Blamey Corporate Director, Quality & Safety, Provincial Health Services Authority and BC Cancer Agency
  • Let Patients Help “was sent to all Community Engagement Advisory Network members … It is also a resource that we like to share in our day to day work now.” Saori Yamamoto Community Engagement Advisory Network Co-ordinator, Vancouver Coastal Health
  • “It really brought things back to the patient and showed us THEIR perspective on healthcare.  One thing that really stood out for me what the emphasis on including patients as partners in their own care, full members of the care team.  It challenged the all-too-common thinking that they are just unknowing recipients of the care that “the experts” decide is right for them and showed that, not only are many of them intelligent and able to participate in the conversation and decision making, but also (and perhaps more importantly), that they are real partners in it, with as much knowledge and information to share re: the “problem” as anyone else on the team.” From a Quality Improvement Consultant
    • Note how this echos the thinking of the Mayo Clinic’s chief residents in this post

Post-event summaries

In less than an hour, moderator @Kevin4Quality (Kevin Smith) posted the after-event resources!

Thanks again to all for a great event!

“A union of forces between providers and patients”: Mayo chiefs name a patient as 2015 Visiting Professor

Boy, is this a thrill: the Chief Residents at the Mayo Clinic have invited me to be their Visiting Professor in Internal Medicine next March.

A patient. As Visiting Professor.  Is that a sign of the changing times?? The announcement is being made today, during the patient panel at Mayo’s sixth annual social media summit. Here’s their post, including a four minute video interview.

Here’s their press release – their words – then I’ll discuss below.

“A union of forces between providers and patients”:
Mayo chiefs name a patient as 2015 Visiting Professor

Continue reading →

How great and bad “experts” treat you in Mac care – and lessons for medicine

Henry Feldman

The great: Dr. Feldman (no photo of Eli is to be found!)

For the past year I’ve had a disastrously bad experience as a Mac user, to the point where I had long Facebook discussions on how to select a Windows “ultrabook” – super thin and light, like my current Macbook Air. The final (at last!) happy outcome, just last month, shows the difference between two things that are vital in medicine too:

  • Capable wizards vs clueless goons
  • caring approach, listening to the person who has the problem, and honoring his (my) observations and concerns.

Ultimately a friend at Beth Israel Deaconess (a doctor!!), Henry Feldman, and his colleague Eli Kaldany, figured out what my problem was – in August, nine months into the problem. (They saw me bitching on Facebook.) They nailed the problem in less than an hour. And, ironically, when another problem happened in September, I finally found someone capable at Apple – and discovered a bit of news I’ll share in a moment. Continue reading →

Speaker Academy #20: Message lessons from a video boot camp

Drew Keller at MayoThis is the latest in the Speaker Academy series, which started here. The series is addressed to patients and advocates who basically know how to speak on a subject but want to make a business out of it. I’ll try to be clear to all readers, but parts may assume you’ve read earlier entries.

I’m at the 6th annual Mayo Ragan Social Media Summit, in a session called Video Boot Camp. It’s conducted by former PBS producer Drew Keller, and his thinking about how to think out a video exactly matches my advice in this series on how to think out your speech.

Continue reading →

e-Patient Request: colon cancer treatments, NYC area

Latest in the occasional series of e-Patient Requests.

A friend writes (anonymized):

Someone I know was just diagnosed with colon cancer. Yikes.

It seems to have been caught very early (routine colonoscopy, no symptoms) and she is now going through the genetic testing/biopsy/CAT scan stage over the next few weeks.

She asked me if I knew anyone who could tell me who the best drs (colorectal oncologist-surgeons) are in the NYC area. I’d deeply appreciate any advice you can give me for her. Thanks.

I don’t know individual doctors and I don’t know anything about colon cancer, but I know I’ve crossed paths with many of you out there. I realized that my Communities page has information about gut conditions IBD and celiac, but nothing about colon cancer. Help! I need two things:

  • Information on patient communities, to add to my page.
  • General advice on how to decide who’s “the best doctor” (which leads to the question “what is ‘best’?”)

And let’s add a third:

  • What-all does a newly diagnosed patient need to know, to get oriented? For me it was reassuring to know the actual odds, first-hand, from others who were in my situation – other patients. (Plus, a lot of their advice didn’t exist on medical websites.)

I’m hesitant to ask for specific recommendations here, because advice from strangers may not be worth much; I know first-hand that in a good community, advice is cross-vetted by a larger number of people. So I’m most interested in that.

If you want to offer the friend specific recommendations, please email me via my Contact page.

WSJ: “Researchers are asking patients to help design clinical trials.”

Screen capture of Wall Street Journal

I could smack myself for not noticing this earlier, but it happened while I was at the ESMO conference in Madrid last month: Amy Dockser Marcus has another great piece on how medicine is truly starting to engage with patients as active contributors to improving healthcare. Woohoo!

The lede:

Scientists regularly sign up patients in clinical trials to test new treatments. Now, they are seeking patients to help them design some of those trials.

Patients and researchers can bring different perspectives to treating disease …

Doesn’t this dovetail deliciously with the presentation I blogged about, in my previous post?? Imagine: Scientists asking patients what they think is important! It seems clear that medicine is starting to act on the Institute of Medicine’s mandate in Best Care at Lower Cost:

A learning healthcare system is anchored on patient needs and perspectives.

Clearly, science is starting to act on the realization that patients are no longer the passive recipients of what scientists think.  (It also matches nicely Laura Landro’s front page WSJ piece in June, “Health-Care Providers Want Patients to Read Medical Records, Spot Errors”.

This is a major shift in the wind, and it’s spreading. Watch for more of this in the coming months.

How early should patient voices be heard in the research process?

Timeline graphic - when to involve patients?

Click to enlarge. Graphic by Bettina Ryll, MD/PhD, Melanoma Patient Network Europe (MPNE) in EORTC patient course 2014

I’m in Madrid at the ESMO Congress, “the European ASCO.” (ESMO is the European Society for Medical Oncology; ASCO is the American Society of Clinical Oncology, and its annual conference is huge, as is ESMO’s – over 18,000 attendees.)

Yesterday I led a session titled Meaningful patient involvement in clinical trial endpoints, and a couple of slides stopped me in my tracks. (If you don’t know the term “endpoints,” see discussion below. In short, it’s what they decide to measure, to see if a treatment is effective.)

The first slide here (click it to enlarge) points out a disconnect: the yellow triangle shows that today, patients are mostly involved toward the end of the process - after someone has decided what should be studied, and designed a trial to do that. At bottom right, in the blue band, we see that in this model the patient’s role is “doing things right.”

But the creator of this slide is German doctor Bettina Ryll (living in Sweden), whose husband died of malignant melanoma. Continue reading →

Slides and links for today’s presentation to Rotary Club of Seattle

Seattle Rotary web bannerUpdated 9/29 with the promised additions

Seattle has the world’s biggest Rotary Club - a lot of sharp, focused Seattle business people. Very different from my usual talk to a medical conference … I’m talkin’ to these people as patients and family members! So the content is different, and some is new this week.

Here’s the video (32 minutes):

Seattle Rotary #4, September 24, 2014 on Vimeo.

Two notes about the video:

  • The fonts didn’t upload correctly so some of the layouts overflowed. (30 years into desktop publishing and they still can’t make it work reliably!) An accurate PDF of the slides is on Slideshare.
  • Around 31 minutes I say that I’ll post my call to action online: our society needs mid-level managers who know how to create a team and produce a result! They’re on slides 50-56.

As promised, links to material cited in the talk:
Continue reading →

Another unmentionable: Who’ll take care of all the old people?

After reading this, be sure to read the comment from KP doc Wes Lisker.

This is for the “Unmentionables” panel today at Health 2.0 in San Francisco.  Susannah Fox blogged about this now-annual panel, which gets into “the real barriers to good health — all the stuff that nobody wants to talk about but which we know is at the center of people’s lives – and the future of healthcare:

We talked about financial stress, birth controlsexually transmitted diseases,how to increase physical activity among tweens, smoking cessation, how clinicians can have an authentic voice online, and supporting overall behavior change (just to name a few).

For today’s panel she asks for new unmentionables. Mine ties in to her previous post, “Prepare.”  It’s quick – please go read it, and especially note the amazing animated graphic that shows how the age mix in our population is shifting astoundingly as boomers age and don’t die.  Because medicine has gotten really good at saving lives.

Health 2.0 co-owner Matthew Holt @BoltyBoy pointed out it’s even more alarming if you add in the growth in population.  I decided to do that – I did some clumsy screen grabs and added some notes. Result:

1. The shift in percentage by age group:

2. Add the growth in US population, and add a blue bar on the side that shows the number of people 85+:

Who’s going to take care of all the old people??

The cost of assisted living and skilled nursing facilities ought to scare the crap out of you – as should the risks caused by the reality that people try to defer more care.  I commented on Susannah’s post with links from a Boston Globe article this Sunday about disasters in local assisted living places.

Who’s going to take care of all the old people??