Contributor: Elizabeth Ferguson – Graduate Intern, Emmi Solutions

“Reason itself is fallible, and this fallibility must find a place in our logic” –Nicola Abbagnano

Elizabeth Ferguson

Elizabeth Ferguson

Healthcare is becoming more patient-centered, and patients are responsible for an increasing portion of the cost of their healthcare.

Neither of these statements are news, nor do they adequately describe the magnitude of the shifts occurring in the healthcare industry that lead to them. What both points do highlight, however, is that patients—or really, consumers—play in increasingly important role in determining what and how much care is appropriate for them. Locating this authority with the consumer drives many of the outcomes healthcare reform hopes to achieve, and results in measurable improvements across metrics that everyone can agree are desirable. However, like the statements above, it’s not that simple.

Humans have evolved what is, by any standard an awe-inspiring ability to perceive and interpret the world. We observe and internalize patterns of occurrences and other human behaviors that then guide our own actions and reactions, we unconsciously weigh and balance potential outcomes, and we constantly learn and build on our comprehension of the world around us.

But, we’re also emotional. Molded by the culture in which we are raised and our individual experiences, humans reach subjective judgments that inform their perception. Despite our incredible aptitude for logic and reason, we are still emotional—think “fight or flight” response—before we are Vulcan-like logic machines. As Dr. Joseph LeDoux, author of “The Emotional Brain,” explains: “the wiring of the brain at this point in our evolutionary history is such that connections from the emotional systems to the cognitive systems are stronger than connections from the cognitive systems to the emotional systems.” In essence, emotion informs our logic more than logic informs our emotion.

One subject on which the primacy of emotion can dramatically affect judgment is accurate perception of risk. Humans are terrible at assessing how dangerous something is, and are very easily manipulated and biased. Consider the social media explosion of concern over Ebola here in the United States. Ebola is trending, and often the tweets and posts reflect fears and reactions, not reality. In reality, a host of diseases endemic to or common in the United States (meningitis, tuberculosis, West Nile Virus, hepatitis, influenza) pose a far more significant risk to Americans than two closely monitored and extremely isolated patients at Emory. But none of those other diseases are a hemorrhagic fever. Now that is scary.

What does this have to do with patient-centered healthcare or paying more out of pocket?

Actually, quite a bit. If we’re asking patients to be informed consumers of their own healthcare—to weigh pros and cons, to assess risk and reward, and to accept the ramifications of their decisions—then it’s essential that they really understand their options, and the risks inherent in each. We need to take people who may have little to no experience in healthcare and explain complicated topics in ways that are meaningful and relevant to them. Truly patient-centered medicine requires an educated consumer who carefully weighs options and makes a choice based on their preferences. Informed consumers also weigh the economic trade offs between quality and cost, experience of physician and appointment availability, and seeking out or delaying preventive care. We cannot expect to reap the rewards of patient-centeredness and cost sharing without providing support for these new decision-makers. They must be educated, and thus far, our healthcare system hasn’t proven adept at doing so. Continue Reading »

Contributor: Kirstin Brockenborough, Mutlimedia Health Writing Intern – Emmi Solutions

Kirstin Brockenborough

Kirstin Brockenborough

When you hear the phrases “sexual education” or “sexual health”, what pops into your head? Did “abstinence” immediately enter your mind? Maybe you pictured yourself sitting in a classroom, facing a flustered P.E. teacher trying to quiet a bunch of snickering teenagers watching a hilariously dated video littered with ambiguous metaphors describe the act of sex. Maybe you thought about that painfully real slideshow with endless pictures of STI outbreaks on various body parts meant to instill fear in those who even dare to think about having unprotected sex. It’s possible that nothing comes to mind at all but feelings of confusion or exclusion could have come about. Yes, I realize these are obviously specific but I know numerous people can identify with at least one of these instances.

I recall those precious memories of being a preteen girl obsessed with glitter, rushing home to watch 106 & Park, wearing my first “real” bra, and obsessing about my first kiss from a boy. I also remember those extremely cautious sex talks with my parents about sex, peeking through hands whenever a movie’s highly dramatic sex scene would play in theaters, and having to repeat words like “penis” and “vagina” during class without giggling. Going from that to immediately learning about unwanted pregnancy and HIV/AIDS was the most confusing time I’d had.

A recently published study within Global Public Health, An International Journal for Research, Policy and Practice suggests sexual education should be taught earlier in childhood. The study urges policy makers, educators, and parents to start sexual wellness conversations earlier. It examines how there are currently no policies or programs focused specifically on kids in the beginning stages of puberty in various countries around the world. Most sexual health programs are narrowly focused on preventing unwanted pregnancy and HIV-prevention. These topics are important but do not solely encompass all aspects of effectively promoting sexual wellness.

I think programs promoting self-positivity, diverse healthy relationships, and continuing efforts to eliminate the taboo around sex are all things that preteens should have as a foundation to build on into adulthood. It’s especially important for kids to know how to decipher confusing messages about sex from movies and TV shows, the internet, their parents, teachers, friends, and even strangers on the street.

What do you think? Should sexual education be taught at an earlier age? Let us know your opinion in the comments.

Kirstin is the Multimedia Health Writing Intern at Emmi Solutions. She is a Virginia native currently working on her bachelor’s in Broadcast Journalism (TV) at Columbia College Chicago. Kirstin plans to combine her interest in public health and multimedia skills to pursue a career in health communications.

Guest Contributor: Jeffrey McWilliams, MD

Jeffrey McWilliams, MD

Jeffrey McWilliams, MD

In the spring of 1954, Roger Bannister triumphed in an epic battle of man versus the elements. Banister, a runner at Oxford trained with a relentless pursuit of breaking the 4-minute mile. This feat had never been accomplished, being deemed impossible by all others. Dedication, commitment and focus paid off on that spring day, when Bannister became immortalized in history as the first man to run a mile in less than 4 minutes. Soon after this accomplishment, two other runners were also able to replicate this amazing feat. A once unheard of accomplishment soon became the measuring stick for success by runners everywhere.

An awesome history lesson, but how does this relate to our lives? What does this have to do with me? In every realm of society, there are standards. There are standards in education, healthcare and economics. In the hospital, we focus on core measures, time to treat and responses to patients’ needs. As individuals, we have unwritten measures on how we treat others based on our social expectations and affiliation with the ancient saying “do unto others as you would have them do unto you.” Standards are vital for a productive society.

Now I’m not suggesting we just strive harder to meet standards in all walks of life – instead I’m saying let’s take it to the next level. I suggest, like Bannister, we focus on being the standard, not limited by society’s definition or constraints. As parents, spouses and healthcare workers, let us raise the bar of what is expected. We should create the norm. Whether done at home or in the hospital, your influence can create a new standard.

Over the past sixty years, the four-minute mile has been broken many times with 17 seconds shaved off of the 1954 record. What if Bannister had said to himself, “Four minutes? That is crazy! There is no way that is possible!” What if he had not dared to question society’s constraints?

Better yet, what can we accomplish if we dare to strive for excellence? Dare to set the standards.

“If we all did the things we are really capable of doing, we would literally astound ourselves.” – Thomas A. Edison

Dr. Jeffrey McWilliams is the Director of Customer Service at Leading Edge Medical Associates in East Texas. He is a self-proclaimed advocate for changing the world one person at a time – whether it be a hurting patient or a selfless frontline medical warrior. Read more from Dr. McWilliams on advocatesofexcellence.com

Contributor: Diana Dilger – Senior Health Writer, Emmi Solutions

Diana Dilger

Diana Dilger

Dr. Craig Bowron recently wrote an insightful article in the Washington Post about why people are unable to sidestep aggressive treatment with their elderly loved ones, mostly focusing on the feelings of guilt most of us have around not doing “enough.” Having done extensive research on end-of-life care, including a ride-along with a hospice agency social worker, I couldn’t agree with him more. Most people don’t want to let their loved ones – and, if they’re being honest, themselves – down. Somehow putting their sick loved ones through aggressive treatment that’s hard on the body (and hard on the caregivers, both emotionally and logistically) feels more active and more loving than letting the loved one lay at home without professional medical attention.

But do they really have to die at a hospital? With hospice, people can die in a comfortable, familiar place, not shoved full of tubes, or poisonous or harsh medicines. There are medical professionals to attend to the discomfort of dying and help caregivers with logistical decisions. And I know at this point, many people know about hospice and its benefits. I’m not preaching any ground-breaking news here.

What may be less discussed is the fact that most Americans want to die at home (Time/CNN poll, 2000). And I know what we say in a poll or what we think about strangers dying or death as an abstract concept, or even sometimes our own deaths can be an entirely different ball game from when we’re faced with the death of someone we love. Suddenly the feelings of guilt, of responsibility, of wanting medicine to “step up” and somehow stop death or prolong life take over.

But as Dr. Bowron points out, medicine can only do so much. And just because a treatment could prolong someone’s life, does that make it worth it? At some point we have to ask ourselves, to what end? What will this procedure accomplish? Is this worth the suffering or discomfort it may cause? Continue Reading »

Contributor: Elizabeth Ferguson – Graduate Intern, Emmi Solutions I was a two-sport athlete—soccer and Shotokan karate—for the vast majority of my life, culminating in my early twenties. I played competitive soccer through high school and college and eventually co-captained the Amherst Women’s Soccer team. Concurrently, I traveled all over the country and the world to compete in karate, and was a national team member starting at the ripe age of 13. In 2009, at 21 years old, I co-captained the USA National Karate Team at the WKC World Karate Championships. At the end of Worlds, I stepped off the podium the Middleweight World Champion and promptly retired from competitive martial arts. A season later, my soccer career was over, as well.

Why? Largely because I had pushed aside a variety of nagging aches and pains for years, and convinced myself that this wasn’t the time to deal with them—that they’d go away on their own or I could just handle the pain and tough it out. The consequence?At 21, instead of minor setbacks, those aches and pains had become serious injuries.

It’s with that history that I read and appreciated Jeff Haden’s recent article describing his pursuit of ever greater cycling challenges, and the insight he gained from a truly near-death health scare. The lessons he described resonated with those I also learned the hard way. And the relevance of those lessons doesn’t apply only to those injuries accumulated through years of athletics; they apply to all varieties of healthcare. Despite having both an academic healthcare background and personal history highlighting the importance of preventive and non-acute care, I still find myself dragging my feet on making those appointments. And for that, sadly, I’m in good company.

Putting aside for a moment questions of access to and affordability of such screenings, procedures and doctor’s appointments, there is quite a bit of evidence—anecdotal and quantitative—that suggests people just don’t seek out non-acute care with the frequency they should. Why is that? The answers are complicated and multifaceted, ranging from the macro-economic to the psychological. There is, however, at least one major factor on which the literature—as well as Jeff and I, as evidenced by our athletic escapades—agree: Denial.

Traditionally, the tendency toward denial and delay of seeking healthcare has—not surprisingly—been more strongly associated with men, but recent research has complicated this widely held belief. Women, it seems, are also prone to delaying care, albeit with different rationale. Gender aside, the result of denial and the delay of seeking care is significant: decreased survival rates in cancer, stroke and heart disease, among other diagnoses. Early detection proves powerful, but is only possible if people participate in those kinds of care aimed at catching early stage pathologies.

Continue Reading »

Contributor: Hailey Merk – Client Services Intern, Emmi Solutions

I hear my name called by what appears to be a nurse at my last routine doctor’s appointment. She records my height, weight and blood pressure but, to my surprise, doesn’t leave to call in the physician after she’s finished. She explains that she is also a primary care provider and will be assisting me with my healthcare needs. I am surprised, but the entire visit goes smoothly and I leave a happily satisfied patient.

You may have experienced a similar doctor’s appointment since the implementation of the Affordable Care Act because physician assistants and nurse practitioners have been freshly integrated into the healthcare system as primary care providers. The ACA defines a primary care provider as “a clinician who provides integrated, accessible health care services and who is accountable for addressing a large majority of personal health care needs, including providing preventive and health promotion services for men, women and children of all ages, developing a sustained partnership with patients and practicing in the context of family and community.” These “new docs on the block” have the ability to help alleviate the shortage of primary care physicians being harshly felt throughout the healthcare system. They are working together with physicians to create patient-centered medical homes, to emphasize team-based care and to provide higher quality care to an amplified population of patients.

According to the National Conference of State Legislators, the Affordable Care Act will expanded insurance coverage and access to healthcare to about 32 million new patients by 2019. The Health Resources and Services Administration (HRSA) projects a shortage of 20,400 primary care physicians by 2020. In addition, aging and population growth are projected to account for 81 percent of the change in demand between 2010 and 2020.

HRSA currently designates over 6,200 Health Professional Shortage Areas (HPSAs) for primary care nationwide, in which over 65 million people live. Sixty-seven percent of HPSAs are in rural areas. The ratio of primary care providers to patients in these areas is less than one per 2,000. Physicians alone will not be able to care for this growing population of patients.

The major barrier arises from the residencies that medical students are required to complete before they can become a practicing physician in their field. There remains to be an insufficient amount of Medicare funds to put enough physicians through residency to care for the outstanding number of new patients. Continue Reading »

Contributor: Kirstin Brockenborough
Mutlimedia Health Writing Intern – Emmi Solutions

Kirstin Brockenborough

Kirstin Brockenborough

A couple of weeks ago, I saw this performance art piece that completely blew my mind away. This artist stood stoically under a bright, white light with a large bucket of ice water directly in front of them, while a slow, chilling song repeated “You gotta be hard, you gotta be tough, you gotta be stronger.” The song’s tinny drone was instantly followed by the artist completely submerging their head in ice water for what seemed like forever. As they slowly rose from the freezing ice water, they looked up to the bright light as if asking for guidance. With a couple of deep breaths, the artist submerged their head again for longer that time. I sat there in awe. This artist, whom I’ve never met, perfectly translated into art how I felt when I told my family I was suffering with depression.

“You’ll be okay.”

I received this aloof response after I finally gathered up the courage to acknowledge my depression I had for more than three years to my family. I don’t know what I was expecting from them, but it definitely wasn’t that. A blend of frustration, helplessness and shame washed over me as my mental illness was being promptly ignored. “But I’m not okay,” echoed in my mind.

Growing up, my knowledge about mental health was limited to only the serious mental illnesses, like schizophrenia and bipolar disorder, or what was over-dramatically acted on TV. My conservative family’s vaguely spoken belief of “we don’t have those kinds of problems” or “girl, you’ll get over it” played into the African American community’s stigmatization of mental health. It never occurred to me that other people of color ever had mental illnesses as well. I would eventually come to realize this group of people was bigger than I imagined, but completely invisible.

As a teenager, I didn’t know who to talk to or where to go for help with how I was feeling. I remained in helpless silence and isolation until a couple of years ago when I started attending college, and became more involved in the Chicago community. I volunteered at Camp Butterfly, which was a Chicago-based non-profit organization that provided young girls of African descent a safe space for emotional healing. There, I was finally able to openly discuss my experience of mental illness, and learn right along with the girls that it’s okay to ask for help. Through the organization, I found a slew of helpful online resources and organizations such as the National Alliance of Mental Illness that promoted mental wellness focusing on cultural sensitivity. Continue Reading »

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