e-Patient Dave

Democratizing Healthcare

Search Results for: "structure of scientific"

What I’m doing now

This is my public declaration of priorities, as inspired by the /now page movement started by Derek Sivers. I learned about this (as with so many things) from Susannah Fox.

Work:

I’m Chief Patient Officer for PocketHealth, a Toronto startup that’s beginning to “launch the rocket ship” and head for “escape velocity.” PocketHealth retrieves a patient’s medical imaging and puts it in the cloud, so the patient can download or share the image with anyone they want, anytime they want, at full diagnostic quality. It is my “gimme my damn data” dream incarnate, in radiology.

Patient data access:

I’m a co-founder and co-chair of the HL7 Patient Empowerment workgroup, specifically focusing on expressing the voice of the patient in the FHIR health data standard. (Learn what it is and why it’s important.) As with everything in the HL7 standards organization, all meetings and proceedings are fully open and transparent (though sometimes quite nerdy); you’re welcome to attend. Our workgroup’s home page is bit.ly/hl7patients and our weekly calls are at 1pm ET Thursday; our projects have lots going on too, and are happy to have new participating members.

My personal health:

After a failed cataract operation in 2020 I acquired glaucoma in 2021 and have lost peripheral vision in my left eye. I’ve been immensely frustrated at how ophthalmology is not participatory yet and am working on it. First steps: join the FitEyes e-patient community, and start measuring my eye pressure at home, instead of only at occasional doctor visits – same as people do with blood pressure, bathroom scales, baby thermometers etc. You can’t manage what you can’t measure; knowledge is power.

Speaking:

Before COVID squashed travel I spoke at and participated in 650 events in 26 countries. Zoom meetings are just not the same, but I continue to speak virtually (recent review), and as a careful / conscious / triple-vaxxed senior (with antibody level >2,500), I’m ready (eager!) to resume live events.

Thinking:

One motto I’ve acquired is “If you live long enough, things change!” This is a huge factor in my continuing work on changing the culture of healthcare: for care to achieve its potential we need to understand the assumptions that underlie how health and care are structured today.

Current fascination: “The evolution of who knows what.” Did you know there’s only been one century in all of human history where doctors actually knew what they were doing, and patients did not and could not? That century is over, and it changes how healthcare might achieve its potential.

Reading:

I listen to audio books and podcasts constantly, including three themes beyond news:

  • Healthcare’s evolution and limitations: The Structure of Scientific Revolutions, The Emperor of All Maladies, How Doctors Think, The Patient Will See You Now, The Anatomy of Hope, The Gene, The Hospital: Life, Death, and Dollars in a Small American Town
  • How business methods have changed since my early-career days in product management: Blitzscaling, The Effortless Experience, Radical Focus, Platform Revolution …
  • Anti-racist self-education: How the South Won the Civil War, The Mismeasure of Man, How to Be an Anti-Racist, Why I’m No Longer Talking to White People about Race…

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Beyond Empowerment: Patients, Paradigms, and Social Movements

It’s time to move beyond empowerment and engagement, and get to the deeper issues.

For 18 months it’s been increasingly clear that the nature of this work – at least mine – has moved beyond surviving cancer (though that’s great), beyond “Gimme my DaM data” (though that’s true). It’s time to examine the core beliefs that hold medicine back from achieving its potential – its mistaken conceptions about what patients can do and should be supported in doing.

So when Susan Carr, editor of the excellent Patient Safety & Quality Healthcare, asked last summer if we should do another piece, I proposed that we pick up where I left off in 2015 as Mayo’s Visiting Professor: let’s examine whether it’s time to formally examine “the paradigm of patient”; to rigorously ask whether establishment medicine’s conception of what “patient” means – especially what patients are capable of, and should be empowered to achieve – needs to be updated. If we get that wrong, then business and science and policy can’t possibly get it right.

The resulting interview is here – they made it their cover story! You can jump to that link, but if you have a moment, I’d like to say more about its background, and why this is important.

Problems in a paradigm are not to be taken lightly.

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Patient Engagement and Empowerment: A Culture War Begins (lecture at MITRE)

A Culture War Begins - title slideI’m starting 2016 with a series of posts that lay out “the arriving future” of health and care. Previous entries:

Technological advances are making new things possible, and our deepening conception of what medicine is about (and how best to achieve care) are changing our thinking about the nature of the work. We are truly shifting from “the doctor knows everything that needs to be known” to patients as potentially capable partners.

This is real culture change. Predictably, the establishment fights back: some people don’t believe it, some just don’t like change (especially change in their work), and some don’t like what they perceive to be a challenge to their authority.

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It’s time to adopt a good working definition of empowerment.

Source: dave.pt/worldbankempowerment1
Source: dave.pt/worldbankempowerment1

A major theme of my work last year was that it’s time to create a science of patient engagement (see blog posts) – a rigorous inquiry into what patient engagement is, what factors (parameters) increase it, which ones diminish it, develop some hypotheses that researchers can test. This was the theme of my visit to the Mayo Clinic as Visiting Professor in Internal Medicine in March and my tenure as NEHI’s Patient Engagement Fellow.

A science needs practical definitions. The Structure of Scientific Revolutions notes that until a field has an agreement on what a concept means, the practitioners in the field literally have nothing in common to talk about. I’ve seen that myself, when people talk about empowerment but the field goes nowhere.

It’s time for definitions.

Fortunately, a useful definition of empowerment exists.

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Quick year-end wrap – and winter retreat.

Christmas wreath HeatherKnitz

Through Monday, January 11 I’ll be on reduced availability, for a period of “retreat and think.” It’s not a full-bore vacation; I’ll be reading and writing (and blogging), but I won’t be responding to most emails.

I can still be reached for anything time-sensitive and I will still monitor contacts from media and potential clients, per the Contact page.

Year-end wrap:

Here’s a list of my favorites on this site from 2015.  I’ll repeat something I said in August:
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August: “retreat and think”

Cover of Structure of Scientific Revolutions 50th anniversary edition

For the month of August I’ll be mostly offline, for a period of “retreat and think.” It’s not a full-bore vacation; I can still be reached for anything time-sensitive (see my Contact page) but I’ll be less active online.

This year has already been full of change – Ginny’s knee replacements, Visiting Professor at Mayo, the first Patient Engagement Fellowship, new publications, and most of all, rethinking what “patient” means (and could mean), per the book that made paradigms famous: The Structure of Scientific Revolutions (right). Our movement is gaining traction, which means a change agent needs to rethink. This month is good for that (I’m only traveling to one event), so I’m going to dial back the dialog.

September will be amazing.

One reason to retreat now is that on August 28 the calendar flips from empty to packed.

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