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 25th, 2007 by Dr. Val Jones in Expert Interviews, News
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This is the weird correlation of the week: women who suffer with symptoms of morning sickness during their pregnancies may be less likely to develop breast cancer later on in life. A group of epidemiologists in Buffalo recently reported this finding at a scientific meeting (Society for Epidemiologic Research). No one is sure what this means, and I dare not speculate… but perhaps there’s some kind of link between a woman’s hormone levels produced during pregnancy, the nausea they cause, and the hormonal milieu that is the background for breast cancer? Or maybe this study has turned up a false association. Only time – and a lot more research – will tell. Of course, if anyone should speculate on this, it’s the breast cancer oncologists like Dr. Gluck. So I dropped him an email to ask him what he thinks.
Dr. Gluck said that first of all, the association between morning sickness and decreased breast cancer risk is relatively weak. So here’s what the numbers mean: For the average 50 year old woman, the standard risk for developing breast cancer is about 2% (one in
50). According to this study, that same woman (if she had severe morning sickness at some point during pregnancy), is about 1.4% (~30%
less).
Dr. Gluck speculates (and this is quite fascinating) that women with morning sickness are subjected to a hormonal milieu that may result in permanent alterations in their breast tissue. The breast tissue (having been exposed to surges of hormones, insulin, and changing blood pressure and blood sugar levels) might be less vulnerable to the genetic mutations that cause cancer.
We’ve known for a long time that women who have children are at lower risk for breast cancer than women who don’t… now it seems that there might be something about women who are really sick when they’re pregnant and decreased risk of breast cancer as well.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 16th, 2007 by Dr. Val Jones in Announcements
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Because Washington DC is the national headquarters for many heathcare professional organizations and advocacy groups, we host more than our fair share of medical conferences. Just a few weeks ago I attended Digestive Disease Week, where 16 thousand gastroenterologists descended upon our fair city from all over the globe. Sporting purple gift totes and oversized name tags, these docs moved like a great school of fish through the reefs of our convention center. At one point I was standing in the wrong place at the wrong time – a lecture let out just before lunch, and I was almost flattened by the wave of hungry purple people on a frantic quest to be first in line at the refreshment counters (the song, “one eyed, one horned flying purple people eater” kept dancing in my head as I ran for cover).
And I started thinking – gee wouldn’t it be easier to have a virtual conference where you could attend from the comfort of your own home? You could navigate to the information booths that interest you, you could attend lectures via telecast, and you could even opt in for goodie bags that could be mailed to you. No need to be stressed out and jostled by well meaning, but frantic colleagues. You could sit in your PJs with kitty or puppy nearby and click your way through a much calmer version of the educational experience.
And so the Revolution Health team discussed this idea and came up with the Online Health Fair. We invited a small group of advocacy groups to set up booths on our website to show others all the exciting programs they have going, and to spark interest in getting involved. The fair just opened and I think it’s a pretty neat idea – Revolution Health is donating money to the groups, based on page clicks. So the more people who go to learn about their favorite advocacy groups, the more they benefit.
So I would encourage you to check this out and let us know what you think – do you like this online health fair concept, or are you more of a “flying purple people eater” kind of person?
Here are the advocacy group “booths” at the fair:
Autism Speaks
American Kidney Fund
National Alliance on Mental Illness
IBS Self Help and Support Group
National Family Caregivers Association
The Wellness Community
National Foundation for Celiac Awareness
Asthma and Allergy Foundation of America
National Sleep Foundation
Society for Women’s Health Research
If this online fair is popular, we can create many more of them in the future. I think it’s great to support these noble groups, and the Wall Street Journal agrees. Tell a friend. 🙂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.
June 14th, 2007 by Dr. Val Jones in News
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It’s funny how cultures become obsessed with certain physical attributes. In the middle ages warts confirmed the identity of witches, a gap between the front teeth was considered pleasing, and a “heart shaped face” was the epitome of beauty. This past century we’ve vacillated between pleasantly plump to “rail thin” as a standard of loveliness… and in recent years women have become preoccupied with a new menace: cellulite.
Of course, no one had even noticed cellulite until the French coined the term 150 years ago. And unhappily that plague crossed the Atlantic in the 1960s, terrorizing pleasantly plump beauties from that day forward.
An entire industry has sprouted up to combat this dimpled foe – everything from massage to liposuction to caffeinated lotions claim that they will restore a smooth appearance to irregular thighs. Unfortunately, those promises are all empty.
Yes, that’s right – there is no research to suggest that any cellulite treatment has anything but the most modest of effects. The bottom line is that dimply skin is determined by your genes – same as your eye color – and that the majority of women have some degree of cellulite no matter how thin they are. Sure, estrogen can play a role – but basically there’s no escaping estrogen as a woman!
So if you’re one of those people who is a little more dimply than average – here’s what you can do:
1. Wear clothes that cover the dimples. Spanx and biker shorts can be worn underneath trousers and longer skirts to give a smoother appearance.
2. Adjust the lighting in your bedroom and bathroom – diffuse light doesn’t reflect shadows from skin imperfections as much. It’s amazing how lighting can emphasize (or de-emphasize) cellulite.
3. Stay fit and tone your body as much as possible. That way if the rest of your body is lean and firm, the cellulite won’t be that big a deal.
4. Recognize that you will always have cellulite. It’s not your fault, you didn’t cause it and you can’t solve it. Don’t waste your money on creams and treatments that don’t work.
5. Remember that the vast majority of guys don’t even notice cellulite (it’s virtually invisible due to their fixation on other anatomical parts).
6. Blame it on the French. If you fixate on your cellulite you are letting them win! Show those French your best laissez-faire attitude by completely ignoring this “disease” that they concocted.
I vote that we go back to the days before the invention of cellulite and live a carefree, confident existence.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
