Last week US News & World Report ran a “slide show” (series of short pages) with tips from 10 empowered patients. They’re all good – I recommend you go read them. (Click the graphic, or click here.)
Knowing that other patients would be giving lots of tips, for mine I decided to focus in mine on something that’s been on my mind a lot lately:
We’ve learned that the patient movement shares patterns with other cultural awakenings. Who knew?
I’m 64 years old. In the ’60s I learned that step one of empowerment is to know what you want. Step two is consciousness raising: Realize who’s saying what to whom, and what assumptions that might imply. Perhaps it’s what you’d like; if not, step three is to ask for it.
Enlightened patients (and clinicians) know that nobody knows everything – neither patient nor clinician – and approach it as a partnership, in what we call ‘participatory medicine.’
It feels a little odd to be teaching empowerment principles (which I learned in college long ago) to a mass market audience, but increasingly I see this is what we need to do.
This is no small issue – it’s not just about patient rights per se. If people haven’t thought about what they want, and haven’t become conscious of what’s happening around them, and haven’t asked for what they want, then when advocates request change, earnest physicians have every right to say, “Look, my patients aren’t asking for this.”
So think about what you want, and see whether things are going the way you want. That applies both in a hospital and in a doctor’s office – anytime you’re tending to someone’s health, including your own.
Click to visit the final post on the West Health site
West Health is a new initiative funded by Gary and Mary West, four separate organizations (read about them here), pursuing innovations in healthcare. The parent organization has a new blog on patient perspectives, “West Wire.” The first post on July 9 was an interview with friend / colleague / attorney Donna Cryer, then they invited me to submit a post.
I chose to blend the Institute of Medicine’s report Best Care at Lower Cost (which said our health system must be “anchored on patient needs and perspectives”) with California-style disruptive innovation, which is about serving the customer perspective. Their final post is here (edited to fit their word count); my original full text is below. My wording is more in-your-face than I usually am, but I chose my words thoughtfully, and I mean it.:-)
The system is squandering value in medicine.
Disrupt! Disrupt! Disrupt!
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Added later: on Twitter a number of frustrated Canadian patients expressed surprise at this, because of their own difficulties in the Canadian system. I’m obviously in no position to disagree – in hindsight, this post (which is indeed favorable about my specific encounters) may sound like things are perfect there. They’re not, as I said in the second sentence. That’s social media for ya.
But, what I did say here (about my experience) is just what I meant to say.
Some of my best events in the world have been in Canada. Things aren’t perfect there, by a long shot, but since they’re free of the enormous financial pressures of the American system, they’re focused on actually delivering care, and they’re years and years ahead of most of America at taking care of people.
This brief post is about two related events. In February I spoke in Vancouver at the British Columbia Patient Safety and Quality Council. About 10% of the audience was actual patients – something I’d seen earlier at the Saskatchewan Health Quality Council and at Kingston (Ontario) General Hospital. (In general, Canada wins the Patients Included badge bigtime.) That event was a keynote (standing ovation) plus a “roll up the sleeves” workshop the next day: “Okay, let’s go: where do we start?”
To further spread the message to people who weren’t there, here’s a link to their page where they posted the video and slides. (Some of the slides are edited into the video, but I move too fast, so they wisely posted the slides separately!)
Then something special happened: a neighboring group, Vancouver Island Health Authority, decided to kick it up to the next level. So I’m headed back there – less than five months later – for another event, at Island Health. They’ve been on a five year journey, totally admirable, with major cultural transformation that’s already a reality, and they’re still working at it. So it’s truly an honor to be invited back to work on their leading edge.
Here’s an inspiring video they produced about that journey.
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Click to go to the interview
Sometimes the wheels turn slowly. Last August I was invited to be interviewed for “WebM&M,” an online feature that I’d frankly never heard of. The invitation said
I’d like to invite you to be a featured interviewee on the topic of “The Role of Patient Advocacy in Patient Safety” for AHRQ WebM&M, the online case-based journal on medical errors and patient safety. The Web site represents the federal government’s major effort to educate practicing doctors and nurses about patient safety. Together with its sister site AHRQ PSNet, AHRQ WebM&M gets nearly a million visits annually. You can visit the site at http://webmm.ahrq.gov.
WebM&M is managed by Bob Wachter MD (blog, Twitter Bob_Wachter), with whom I’ve crossed paths a few times; I described his work and my impression in a post here a while ago, and let’s just say I’d jump at anything he recommends. So we did the interview, and it faded away into the backlog of things being processed (by somebody else :-)).
Then a few weeks ago, up popped the transcript, ready for review. A few quick edits, and voilá: In Conversation with…Dave deBronkart (“e-Patient Dave”). It includes an 8 minute excerpt of the audio.
Honestly, I’m thrilled to have been invited to do this. Thanks to Bob, to AHRQ (the Agency for Healthcare Research and Quality) … and to every single one of the clinicians and patient advocates whose thoughts and advice in these past seven years have given me these thoughts.
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A quick update – earlier this month I posted about presenting at the AANP convention (American Association of Nurse Practitioners) in Nashville. Here are links to the sites I mentioned. (I love it when people ask because they want to take action!) Continue reading →
Susan B. Anthony, ca. 1855 (“plus or minus 10 years” – Wikipedia)
“Feminism is the radical notion that women are people.” - Marie Shear, 1986. See other feminism quotes on the Wikiquotes page.
Recent speaking clients know that I often note the parallels between the patient movement and other cultural revolutions – the women’s movements, civil rights, gay rights, disability rights. (I mention disability issues less often, but it was disability advocate Ed Roberts who said in the 1990s, after years of struggle: “When someone else speaks for you, you lose.”)
As anyone who’s heard me speak knows, I don’t get overtly “radically” about it. But I’ve been at this long enough now that I do see patterns. And the patterns teach me that the way people see things now may not be how we’ll see them in the future … and it’s up to us all to speak the truth as we see it.
So when I returned from the week’s travels, my eye was caught today by Wednesday’s “This Day in History” in the Boston Globe:
In 1873, suffragist Susan B. Anthony was found guilty by a judge in Canandaigua, N.Y., of breaking the law by casting a vote in the 1872 presidential election.
The Feminist.org blog has a great post about it - here’s how they say they would have covered it, if they’d been around back then: Continue reading →
[Click to open PDF] Nurse Practitioner infographic from AANP.org/all-about-NPs
I’m speaking this morning at the annual meeting of Nurse Practitioners in Nashville. (5,400 of them!) I’ll have more to say after the event, but for now, check out this infographic. It’s one of the best information-packed posters I’ve ever seen … which is an indication of the professionalism and competence of the organization.
Nurse practitioners manage acute and chronic medical conditions (both physical and mental) through comprehensive history taking, physical exam, and the ordering of diagnostic tests and medical treatments. NPs (within their scope of practice) are qualified to diagnose medical problems, order treatments, prescribe medications, and make referrals for a wide range of acute and chronic medical conditions.
Everyone these days talks about the shortage of primary care providers - ironic, because people with better access to primary care have better outcomes (duh). And nurse practitioners do exactly that, in many different settings. In an increasing number of states, they’re finally being authorized to practice independently.
Check it out!
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.
I’m really not happy to be writing this, but push has come to shove. Two thirds of my expense reimbursements are past due, and fully a third of them are more than 90 days out. I’ve seen some people stretch payments at times, but I’ve never seen anything like this.
The stories I’ve been getting about “gosh, sorry, there’s nothing we can do about it” or “gosh, the only person who can write checks went on vacation” or “we only print checks on Thursdays and she was out when she came back from vacation” are familiar, but this year they’re much more common. What’s up, healthcare? Is The Big Ugly coming home to roost?
I wrote about The Big Ugly last year:
… something I’m starting to call The Big Ugly – a wave of suffering that will happen as the medical industry contracts, and everyone tries to find ways to maintain their income. Unfortunately when an industry shrinks, everyone can’t maintain the same income. As anyone knows who’s seen an industry die (like mine, typesetting; or steel in America, or what Detroit went through), it’s painful. Good people get hurt, and organizations fight for survival.
It’s interesting, because the people I work with, for the event are good and almost entirely on time with paying my fees. But expense reimbursements? They seem to go through a different approval and payment process. I mean, things get lost in the expense rabbit hole, and even my good-to-work-with friends are unable to extract them.
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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 I said “For a small business, cash is king.” This is especially true for patients who are trying to build a small business in speaking, with no financial backing. In this post I want to “spotlight the spotless” – my clients who have honored our partnership by paying every single invoice within the agreed time of 30 days. Thank you!! A couple of foonotes before we start:
- Date range: This is for events starting January 2013 and ending April 2014. (This May’s events haven’t reached 30 days yet.)
- I hope to dig back earlier, but before 2013 I was in survival mode and my records were sometimes not accurate. Meanwhile, clients – if you remind me that you paid promptly I’ll be glad to include you – just let me know!
- Special honor: Some clients are so great that they’re in a special category – they paid on-site or EARLY! (And they reimbursed my out-of-pocket expenses promptly.) So I’ll start with them:
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