August 15th, 2007 by Dr. Val Jones in Expert Interviews
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The Washington Post featured an article about how social networking tools like Facebook are influencing student socialization at college. Some say that the frenetic texting, online communications, and iPhone chatter are causing students to lose the ability to socialize normally in-person. Others say that technology levels the social “playing field” for introverts. I interviewed Revolution Health’s psychologist, Dr. Mark Smaller, to get his thoughts on the matter. Feel free to add your perspective in the comments section of this blog.
Dr. Val: The article
suggests that technology can become a social crutch, keeping people from making
new friends. Do you think that the
Internet can isolate students from one another?
Dr. Smaller: I think the long term impact of the Internet in
social interactions is unclear. For now
such technology does allow students to remain in touch with one another
instantly, but that’s not too different from what the telephone did for
previous generations. If anything, I’d
say that technology can interfere with isolation, especially for the new
college student away from home for the first time. If there is a propensity for isolation, any
activity in excess – reading, school work, drinking, etc. will become the means
to continue that isolation.
Dr. Val: Do you think
that social networking and Internet based methods of communication are
particularly healthy for introverts?
Dr. Smaller: Being able to communicate sincerely or
genuinely but indirectly and not in person may help the otherwise shy person. Some of our most brilliant artists and
writers have used their craft as a means to communicate to others in ways they
could not in social situations.
Dr. Val: Overall do
you think that socializing via the Internet is a good thing or a bad thing for
college students?
Dr. Smaller: One things is certain on and off the Internet:
relationships for children, adolescents, and adults can become quite intense
with this way of communicating because of fantasy and anonymity. Previous generations used the art of letter
writing to express intense feelings, followed by the telephone, and now online
communication. What they all have in
common is the essential human need to connect – including the satisfaction of
doing so and the frustration when it chronically does not occur.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 14th, 2007 by Dr. Val Jones in Expert Interviews
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In a recent study conducted by the Agency for Healthcare Research and Quality (AHRQ), it was argued that better primary care could prevent 4 million hospitalizations per year. This staggering potential savings – on the order of tens of billions of dollars – seems like a good place to start in reducing some of the burden on the healthcare system (and reducing unnecessary pain and suffering). I interviewed Dr. Joe Scherger, Clinical Professor of Family & Preventive Medicine at the University of California, San Diego School of Medicine (UCSD) and member of the Institute of Medicine, to get his take on the importance of prevention in reducing health costs.
Dr. Val: What do the AHRQ
statistics tell us about the role of primary care in reducing healthcare
costs?
Volumes!
Primary care works with the
patient early in the course of illness, maybe even before it has developed, such
as with prehypertension and prediabetes. Primary care focused on prevention
with patients keeps people healthier and out of the
hospital.
Dr. Val: What can individual
Americans do to reduce their likelihood of having to be admitted to the
hospital?
Prevention begins with the individual,
not the physician. 60% of disease is related to lifestyle. Bad habits such as
smoking, overeating, not being physically fit, and stress underlie most common
chronic diseases. If Americans choose to be healthy and work at it, we would
save tremendously in medical expenses.
Dr. Val: Are there other studies
to suggest that having a medical home (with a PCP) can improve
health?
The medical home concept is new and lacks
studies, but the work of Barbara Starfield and others have confirmed the
importance of primary care and having a continuity relationship with a primary
care physician. The more primary is available, the healthier the population.
The opposite is true with specialty care.
Dr. Val: Why did the
“gatekeeper” movement (promoted by HMOs) fail, and what is the current role of
the family physician in the healthcare system?
The
“gatekeeper” role failed because it restricted patient choice. Patients need to
be in control of the health care, which is what patient-centered care is all
about. HMOs put the health insurance plan in charge, something which was hated
by patients and their physicians.
Dr. Val: In your work with the
IOM (specifically in Closing the Quality Chasm) did the role of primary care and
preventive medicine come up? If so, what did the IOM think that PCPs would
contribute to quality improvement in healthcare? Did they discuss (perhaps
tangentially) the cost issue (how to reduce costs by increasing preventive
measures?)
Just before the IOM Quality Reports
came out, the IOM did a major report on the importance of primary care. The
importance of primary care and prevention are central to improved quality. In
the “Chasm Report”, the focus was more on the patients taking greater charge of
their health care, and the realization that primary care is a team effort, and
not just a role for physicians. The reduction in costs comes from making health
care more accessible (not dependent on visits) through health information
technology and the internet. Preventing disease, and treating it early when it
comes, are the keys to quality and cost reduction. Revolution Health is a
vehicle for this, consistent with the vision of the “Chasm Report.”
Dr. Val: How can patients be sure that they’re getting the best primary care?
First take charge of your
own primary care. The traditional patient-physician relationship was, “Yes
doctor”, “Whatever you say doctor”. Your care would be limited by the knowledge
and recall (on the spot) of your doctor.
Much better is a “shared care” relationship with your primary care
physician and team. After all, the care is about you. Be informed. Make your
own decisions realizing that the physician and care team are advisors, coaches
in your care. You may agree with them, or disagree and do it your way. By
having your own personal health record and being connected to resources like
Revolution Health, you are empowered to get the care you want and need.
Finally, choose your primary care wisely. Not just anybody will do. Your
primary care physician is as important a choice as your close friends. You need
to like and trust this person. Have a great primary care physician who knows
you and cares about you and your health care is in real good shape. But, no
matter how good she or he is, you still must take responsibility for your care.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 24th, 2007 by Dr. Val Jones in Expert Interviews
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A new study in the journal Sociology of Education suggests that obese girls are only half as
likely to go to college as non-obese girls.
I interviewed the study’s author, Dr. Robert Crosnoe, to learn more
about the relationship of weight, self-esteem, and peer popularity to the
education of young women.
Dr. Val: What did your study reveal about the impact of
obesity on the education of young girls?
Dr. Crosnoe’s response – audio 1
Dr. Val: How does popularity figure into the equation?
Dr. Crosnoe’s response – audio 2
Dr. Val: How do you explain the gender gap – that obesity
didn’t seem to influence whether or not boys went on to college?
Dr. Crosnoe’s response – audio 3
Dr. Val: What should we do based on the study results?
Dr. Crosnoe’s response – audio 4
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 27th, 2007 by Dr. Val Jones in News
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Interesting article in the New York Times about doctors talking about themselves too much. Apparently, some doctors spend precious patient interview time talking about unrelated personal information (recent vacation experiences, family members, etc.). In fact, a recent study in the Archives of Internal Medicine suggests that physicians annoy patients with these misguided attempts at building rapport.
We physicians are trained in medical school to be more humanistic and compassionate towards our patients – but we are not given specific direction regarding how to achieve those goals. And let’s face it, we’re kind of geeky in the first place, some of us lack social skills, and we’re under a lot of stress most of the time. The result? Awkward conversations about the most innocuous things we can think of to break the ice – vacations, daily routines, the weather… and perhaps a lot of wasted time.
The research study has its limitations, though. First of all, it only studied physicians in Rochester, New York. Now, my husband is from Rochester – so I dare not say anything unkind… but culturally speaking, the Rochester crew is a little more chatty and casual in their approach to conversations than folks in Manhattan or Boston for example. So there may be a cultural bias at play here in the research.
Second, it’s unclear how much the personal commentary bothers real patients. The conversations were judged by researchers listening to recordings of fake patients who had no previous relationship with the doctor. It’s entirely possible that regular patients might enjoy the personal aspects of the dialogue and actually look forward to hearing how the doctor and his or her family is doing because they have a caring, friendly relationship.
And finally, the study doesn’t address the issue of how to improve the doctor-patient relationship if self-disclosure is so unsuccessful. The poor docs in Rochester are going to be left with a self-conscious uneasiness about idle chatter – and will again not know exactly how to demonstrate humanism as recommended in their medical school training.
But, I must say – that if my doctor spent our entire session talking about herself, I sure would be annoyed, and rightly so. Still, I think I’d like her more if she told me something personal about her own struggles. There’s a balance here – and the complicated interplay of human relationships is hard to measure with standardized patients, audio tapes, and a small geographical location. If your doctor is too chatty, just redirect him/her. You know we do that to YOU all the time. 
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 15th, 2007 by Dr. Val Jones in Announcements, Expert Interviews
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I was recently interviewed about my blog (and this week’s edition of Grand Rounds) by Dr. Nick Genes at Medscape. For the curious among you – here is the full Medscape interview with Nick Genes (prior to editing). It gives you a little more information about Revolution Health…
1. You’ve
been involved in writing since medical school, for various audiences. Who are
you trying to reach with your new blog, and how have you found blogging to be
different than the other media you’ve worked in?
The best part about
blogging is that it’s a dialogue rather than a monologue. I find the interactive discussions and
heartfelt responses to be touching and engaging. My previous writing was more academic because
of the medium (medical journals) but now I’ve found that blogging is where I
can really be myself – there is no team of reviewers to scrub my words. So what you read is what you get!
2. I’m
very curious about Revolution Health, your role as Senior Medical Director, and
where you think this is all going. But all revolutions have their origins
somewhere, and yours seems to start… on a yogurt farm. Please share a little
of what that was like, and maybe what early influences have given you such an
interesting background. From small towns to New York City, from theology to medicine, it
seems like you’re living a very rich life.
Yes, I guess you could
say that my origins as a revolutionary are firmly rooted in dairy farming. Although it may not be immediately apparent
how the two are related, Internet startups and cattle herding have their similarities. First, you have to wear many hats – there is
no job too small or too large. If the
cows need milking, and the electric machines are broken, you do it by hand. If a cow breaks through the fence and wanders
off into town, you lure her back with short feed. If a large batch of yogurt curdles, you’ve
got yourself a gourmet meal for your pigs… you get the drift. In a large start up, all manner of unexpected
events happen – but the trick is to handle them quickly and efficiently, and
make sure the outcome is a win-win.
As far as my other
life detours… I guess you can say that I’ve been a victim of my own
curiosity. There are so many interesting
things going on, I just can’t help but want to try them out. In the past I’ve held jobs in the following
capacities:
A protestant minister,
NYC bartender, bank spy, food critic, doctor, cartoonist, computer sales
associate, yogurt mogul, nanny, motivational speaker, biophysics researcher,
graphic designer and revolutionary medical director.
So my life has
certainly been an adventure!
3. How did you get involved with this company? Did Steve
Case find you, or know you from before — or was there an application process?
Is the mingling of medical and computer technology folks going smoothly? Is it a
mix of hospital culture vs. laid-back internet start-up culture? (Foosball and
mountain bikes, or suits and meetings?) Can you make comparisons to your time
with MedGenMed?
A friend of mine had
interviewed at Revolution Health for an executive position and thought that the
company would be a great fit for me.
When I heard who was involved (including Colin Powell, Steve Case, Carly
Fiorina) and that the goal was to create a website to help patients navigate the health care
system, I thought – gee, this sounds serious, challenging and worthwhile. So I sent in my resume, got offered an
interview, put on a bright red suit and announced that I’d heard that there was
a revolution afoot and wondered where I could sign up. They hired me that same day (May 8, 2006) and
it’s been the most exciting job I’ve had to date!
About the “mingling”-
a very interesting question. There is a
hint of Foosball/mountain bike in the mix, but I think we’re a little more hard
driving than that. Since Revolution
Health is in its start up phase, there is simply too much work to do for people
to be playing Foosball. When I started,
there were 30 employees, now there are closer to 300. We are all working long hours on cutting edge
projects that I believe will make a big difference in supporting the
physician-patient relationship, streamlining the process of healthcare delivery
and improving accessibility to the uninsured and underinsured. Revolution has attracted some of the
brightest minds in the tech industry – and they are building products I could
never have dreamed of on my own. Since I have such an unusual background,
I’m bilingual in both techie speak and
physician speak, and this helps a great deal.
Because I understand what physicians and patients need, and can translate
that for the “creatives” we can build some really meaningful tools and products
together.
My time at MedGenMed
was wonderful, primarily because Dr. George Lundberg is a dear friend and
mentor. He has done fantastic work
creating a pure platform (no pharma influence or fees for readers or authors)
for open-access publishing. He taught me
to speak my mind, follow my gut and never compromise my ethics. His book, “Severed Trust” galvanized me into
action – to do my part to improve the damaged physician-patient relationship
that is at the core of our broken system (caused by middle men, volume
pressures and decreased time with patients).
After reading his book, I wanted to do something big – so I joined a
revolution.
3. Revolution
Health has some bold ideas about improving care for its members — getting
appointments with specialists, patient advocacy in dealing with insurance, and
of course, sharing information. What’s your job entail, as medical
director? Do you think you’ll find yourself making policy decisions that
could affect, directly or indirectly, chunks of the population? Could
you find yourself in a position where some specialists are not recommended
based on their insurance? Will Revolution Health have a formulary, will it
be evidence-based — or could could care be rationed ?
My job is incredibly
challenging and fun, and I rely on both halves of my brain for much of what I
do. We have 146 medical experts most of
whom I’ve personally recruited, I’m responsible for coordinating the medical
review of all the content on our portal (so that it conforms with
evidence-based standards), I facilitate relationships with major hospital
systems (such as Columbia University Medical Center), spearhead new product
initiatives (such as Health Pages for physicians), monitor and promote our 30+
expert bloggers, participate in writing press releases, creating podcasts, radio interviews,
identifying new partnership opportunities and much more.
I do think that
Revolution Health will greatly influence vast “chunks” of the population. And this is what’s particularly exciting
about working here. We really are
building a brand new navigational system for healthcare – and this will empower
patients to take control of their health and provide them with better
information and guidance in living their best.
I believe that Revolution Health will become the new virtual medical
home for physicians and patients, just the way that AOL grew to be America’s
Internet home. You log on first to AOL
to get your email, check your news, and get plugged in before surfing the
net. You’ll log in to Revolution Health
to track your health, connect with your lifestyle coach or physician guide, get
involved with a community of others like you, or track your loved ones’ health
issues through Care Pages. This is a 20
year project, so all of our plans and programming may not be apparent yet, but
the trajectory is amazing and I wouldn’t want to be anywhere else as a
physician today.
5. What are some of your favorite posts — something that
struck a nerve with readers, or captured something you wanted to express?
Please provide links!
My absolute favorite
post is the story of how my mom, a strong patient advocate, saved my life as a
baby. She refused to accept the
misdiagnosis I was given, and continued to nag the medical team until they
realized what was wrong and took me to the O.R.
If it hadn’t been for her persistence (or the incredible skill of the
surgeon who ultimately took care of me), I wouldn’t be here today. And maybe that’s why I’m passionate about
both good medical care AND patient empowerment!
Other posts that have
been well received are true stories from my medical training days. Some are controversial (like this one about
end of life issues and my first day as a doctor),
and others are warmer reflections. But ultimately, I just share what’s on my
heart and let the audience take away what they can from it.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
