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People Might Risk Their Lives For Video Games

If we had a power outage for a really, really long time, how would you fare? Really…could you go a really, really long time with out your computer, TV, cell phone over, say, your refrigerator? If you had access to a super powered generator what would you turn on? In other words, what would you find “essential” – things like refrigerators, the stove and perhaps a light or two…or technology.

A recent article in USA Today is quite illuminating. It turns out that many people, adult people, are so hooked on technology that in the case of a massive power outage they would actually put their lives and those of their kids at huge risk by turning on things like video games over truly essential items like lights and a refrigerator by running the games in a closed garage.

The USA Today article points out the highlights of a new study in this month’s Pediatrics about the dangers of gas-powered generators. The study notes that after Hurricane Ike, an ER in Houston treated 37 people from gas-generator-related carbon monoxide poisoning. Of those people, 54% were under the age of 18 and 75% of this group were playing video games.

This study highlights that our sense of “what is essential” has become skewed towards all that is plugged in. If our kids can not deal without technology for a bit, if we can not deal without technology for a bit, it’s time we took a collective big step back and realized that we actually can. It will feel strange and foreign for a day or so but life will go on because our “essentials”…food, shelter, oxygen, family…are met.

*This blog post was originally published at Dr. Gwenn Is In*

Here Comes The Sun – But Where’s The Sunscreen?

Heading out for a family walk over the weekend, we barely got beyond the end of the driveway before we quickly turned back…sunblock. We forgot to goop! A quick retreat back to the garage, we all lathered up and were on our way.

Over kill for such a mild sun day? Not in our experience. We’ve not only been caught off guard before and had “low intensity” sun days create rather intense burns behind necks, knees and arms, but have a family history of melanoma that haunts us ever time we step outside. My husband’s dad lost his life to melanoma. He was in the Navy and sunblock wasn’t what it is today, nor was the treatment for melanoma. He didn’t have the control we do today and would be really upset with us for tossing caution to the wind with our skin and our kids.

But, over 2/3 of adults are doing just that! According to a new survey out by Consumer Reports National Research Center only 1/3 of us are actually using sunscreen.

As reported by ABC news, there are 1 million cases of skin cancer a year and counting, melanoma, a year with 90% of those related to sun-exposure. We are truly playing with fire every time we step outside without sunblock on.

There’s nothing wrong with getting a tan if you some common sense and use sunblock – SPF 15 or higher with UVA and UVB protection. The key is to avoid becoming a french fry and to remember to reapply the sunblock liberally and often (each hour is the expert recommendation). As Dr. Doris Day, a NYC dermatologist interviewed by ABC noted: “You need to go through sunscreen…One bottle should not last a summer.”

Kids, too, need sun protection and it’s a myth that babies can not have sunblock applied to their skin. Infants older than 6 months of age can have the sunscreen applied to the entire skin and infants under 6 months of age can have sunscreen applied to very exposed area such as the hands and face in just the amount needed to cover those areas.

By the way, sun protection isn’t just for our weekend warrior moments. Think of it as part of your every day skin care. If your kids walk to and from school, they need sun protection. If you walk outside during your work day, you need sun protection. Many daily moisturizers now include SPF 15 and are great for that daily purpose where you need a bit of protection but not the intense protection as you do on weekends when outdoors more.

So, go ahead and get outside and get some sun…just do it safely and take the few extra minutes to apply sun protection. It’s fine to get a tan but no tan is worth dying for and that’s the point we all have to remember.

For more tips on sun safety for infants and kids, click here and here.

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*This blog post was originally published at Dr. Gwenn Is In*

Tween Overcomes Shyness To Go To Summer Camp


During the recent Mother’s Day weekend, I found myself driving north to New Hampshire to take a tour of an overnight camp my youngest daughter, almost 12, came home from school the prior week and announcing she “had to go to” this summer with her friends. While this is very age-appropriate, any one who knows my daughter who is reading this is at this very moment reading the last paragraph and shouting out loud “Get out! M…shy little M!!??” Yup…the one and only.

This is a child who used to talk about living at home “forever”.

This is a child whose dream college was “definitely in Boston…maybe Connecticut” – so she could come home and visit when she felt the urge.

This is a child who, until this year, “wasn’t a fan of sleepovers”. She used to explain “it’s a bed thing – I like my own bed.”

So, when this same child came home last week and started off telling me about her day with “So, about the summer…there’s this camp in New Hampshire…” I almost fell off my seat and I’m sure my heart skipped a beat.

Every relative who heard this story has had the same reaction. First, shock…”M??” then pure excitement (“All right, M!!”).

This isn’t a child who will be living at home forever – this child is growing up.

This isn’t a child who will just look at Boston or Connecticut for colleges some day – this child is starting to see a world around her and want to explore it!

This child is now a fan of sleepovers because “how else can you sleep somewhere other than home and be with your friends.” Good thing because the camp has bunks!!

So, never say ‘never’ when it comes to your kids. They bloom in the most amazing ways when they are ready, not when we think they are ready, and often do so when we least expect it. All we can do as parents is prepare for the unexpected and be their best cheering squad through their new found courage, excitement and interests.

BTW, I used to worry about this child, my previously shy, no longer little M. Not any more! This child has clearly emerged from her cocoon and sprouted wings that are sure to take her in many exciting directions – and we’re happy to help her snatch some air space to take a few practice runs before she’s old enough to really wonder from home. I hope you’ll do the same with your tweens and teens. Just like a new pilot takes many test runs before flying solo, our tweens and teens will need many new experiences with us close at hand, but just a bit out of reach, before they are finally on their own in the adult world.

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*This blog post was originally published at Dr. Gwenn Is In*

Kaiser Permanente’s Online Care System: A Model For Us All?

At Health 2.0, Ted Eytan, MD, and I talked for a bit about why Kaiser Permanente’s “virtual health care system” has had such great success. According to his bio, Ted is a family doc from DC with a background in “working with large medical groups, patients, and technologists to bring health care consumers useful information and decision-making health tools, to ensure that patients have an active role in their own health care.”

Ted is Permanente’s Medical Director for Delivery Systems Operations Improvement. Permanente’s online system strives to bring the doctor and patient together online via the electronic health record (EHR), decision making tools and communications tools such as email. It further empowers the patient to be an active participant in the health care system by having access to the EHR and being able to book appointments online, renew prescriptions, contact health providers, and see labs and tests. Eytan has a wonderful summary of the system and the demonstration they did at Health 2.0 on his blog here.

Here are the highlights of our chat:

Dr. Gwenn: What makes Kaiser work so well compared to other areas of the country, for example Massachusetts?

Dr. Eytan: The key difference between Kaiser and here (MA) is adoption.

Dr. Gwenn: Why is that?

Dr. Eytan: The important point to teach doctors is the customer service approach. We do things because the members want it. That should be the reason for all change in health care. If places focus on quality not customer service, the system won’t work well and nothing will change.

Dr. Gwenn: What has helped Kaiser be so successful?

Dr. Eytan: Three major points that have worked well in Kaiser’s system: accountability, physician leadership and valuing members.

1. At Kaiser we have 100% accountability over everything. We own up to mistakes when they occur and help physicians learn from them.

2. Kaiser encourages physician leadership to spark reform and help IT departments facilitate change: Physicians do have value and can create the clinical vision. They work with IT to facilitate the technological changes that need to occur to make the doctor-patient encounter work better and to make the physician’s work life more manageable.

3. Kaiser listens to members… members have advisory groups, teen groups: they are involved and their voices are heard at all levels and all ages.

Dr. Gwenn: How do you oversee the online world with patients?

Dr. Eytan: The patients are the customers and the EHR must be usable to them – that is the MO of the entire system. In addition, there is an online, full time medical director responsible for the patient interface. There is no other way to have a patient-involved online system without a dedicated staff overseeing that system lead by a physician.

Dr. Gwenn: What problems do you help the clinical staff anticipate with online care?

Dr. Eytan: With virtual care, patients will see lab results and parts of the EHR they are not used to seeing and that could prompt questions or concerns. There has to be commitment from everyone to be ready to answer those questions fro the system to work well for the patient. They provide a great deal of training and support so the clinical staff will be prepared for questions from patients they may not have had when patients were not so involved in their care and seeing so much of their EHR.

Dr. Gwenn: How does virtual care help the system?

Dr. Eytan: There are a number of important ways virtual care helps the system on many levels:

1. It builds confidence in the doctor patient relationship by fostering conversation.

2. There’s a database to give patient’s article-based information (Permanente uses the “healthwise knowledge base”).

3. They use true medical terms with patients and in the EHR that patients will Google. This helps patients be more savvy in the health care system and know what terms to search for should they seek more information or have questions to ask of the clinical staff.

Dr. Gwenn: What are the benefits of virtual care for the patients and the physicians?

Dr. Eytan: There are three primary benefits:

1. Online care helps empower the patients to be part of their care and shapes use with guidance from the staff.

2. Patients become so involved they become invested in making sure the EHR is accurate and often point out mistakes they note, such as typos.

3. Doctors can be more efficient by using pre-visit emails to organize their time.

Dr. Gwenn: What’s your take on the Health 2.0 vs. Ix (Information Therapy) debate during this conference?

Dr. Eytan: Useful, accurate information is the goal. Give people what they want, when they want it. All systems need to use more health 2.0 tools member to member. Ultimately the goal is to connect to the doc.

Dr. Gwenn: How can docs be more health 2.0 savvy?

Dr. Eytan: All docs should ask patients if they use the internet. It’s the 6th vital sign.

Dr. Gwenn: Many patients don’t live in a virtual health care system like Kaiser, how can they get from their system what you offer at Kaiser?

Dr. Eytan: Ask and demand! Most electronic medical record systems have the tools in place, like email, and just have to start using them. Patients need to ask for what they want. Physicians want to do a great job and hate waste.

My final thoughts:

With such great models such as Permanente in many areas of our country, it’s frustrating we can’t get similar systems everywhere. Perhaps it is not just the patients who have to “ask and demand” for what they want in the health care system. Perhaps it’s time docs everywhere stood up and demanded a system where docs were compensated well, treated respectfully, and had a system that actually supported good care.

*This blog post was originally published at Dr. Gwenn Is In*

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