Jen’s Posterous

Our goal, above all else, is to make care better for patients, and to make it patient-centered. Information policy and health IT policy should serve that goal.

From: "Blumenthal: Tear down walls that block information exchange | Healthcare IT News."

For almost 3 months I've been working with one of my favorite recovering MDs, Carlos Rizo, to try and figure out what being an epatient really means, and why some of us 'level up' from self directed, n=1 personal advocacy to become mentors and wayfinders for others.

Some questions that haunted us after we'd closed the latest Skype chat window...Do we need new nomenclature to describe the experience of being the focal point of goods and services along the healthcare delivery spectrum?

What does the 'normal' patient think of 'patienthood?' Do patients want/need to put an 'e' in front of it?

The central tenet of our exploration is that those who are at the receiving end of medical care are also at the receiving end of 'naming' or labeling within the global healthcare delivery system.

We tossed around plenty of name-calling and talked for hours about our own feelings regarding labeling and patienthood, but finally arrived at the brilliant conclusion that this study was too big for coffee-cup and Skype discussions to define.

The only way to see how people feel about patienthood - and determine whether or not subjective claiming or refutation of the terminology and connotations and baggage we posit it carries weight in brick-and-mortar vs. online communities of care - is to ask.

So that's exactly what we're doing.

Today the Redefining Patienthood Project launches with the first in a series of short surveys.

Please, if you have feelings on the topic, and the subjective sharing of patient experiential narratives online concerns you, participate.

Our goal for the survey series is 150 participants. I hope to count many of you among them.

I promise not to take more than 2 minutes of your day as you complete the form here:

http://myhealthinnovation.com/blog/archive/2009/11/redefining-patienthood

In every industry experts are "believed to have special knowledge of a subject beyond that of the average person, sufficient that others may officially (and legally) rely upon the individual's opinion."

Doctors, nurses, therapists and other allied health workers undergo rigorous accreditation, training, and higher education processes to become relied upon to deliver safe, effective care.

But, can patients be experts? And can they be regarded as such by healthcare workers?

Perhaps, but perhaps not.

Online sharing in peer 'expert' communities is well established with social networks designed for providers like WebMD and Ozmosis.

There now exists a wiki to help pharma and biotech researchers collaborate with peers: http://www.fiercebiotechit.com/story/wikis-open-drug-development-sharing/2009-11-23

But wherefore art the epatients?

We are helping each other in networks like ACOR, Patients Like Me, and Cure Together, but what is it that drives us outside our self-interested shells to try and change others' trajectories? To provide support, assistance, tools, all by first owning or refusing the traditional patient nomenclature?

And what happens if we accept the 'epatient' moniker? Do we consider ourselves experts with a specialty scope of practice? Should our 'patient' expertise be assessed in some way, by a national organization similar to the NBME? I for example might be considered Jen McCabe, eP, with a specialty in experiential orthopaedic rehab, after undergoing an assessment for knowledge of navigating the hospital system as a patient?

Or, how about this - do the titles matter? One hypothesis is that some claim the 'epatient' label because it allows us to establish a reputation as an 'expert' which we can then monetize.

In any case, does our patient experience, like many other events which shape us personally and professionally, become so valuable in the market that we might begin to consider it an asset instead of a liability?

In simple, accessible language, the goals of the Redefining Patienthood Project are to explore the following themes and questions:

1. What "expert" means today
2. What "patient" means today
3. Can patients be experts? Review of experiential literature and survey(s)
4. Patients claiming expert status - is it already happening?
5. What is the new definition/definitions of "expert patient" or "epatient?" Are the terms synonymous?
6. What prescriptions for epatients to advocate/engage in the real world of hospital interactions does the community recommend?

Disclaimer: I am not an academic. I do not have anything framed on my wall heralding my educational achievements other than a Bachelor of Arts degree (you'd have to look at photos of past whiteboard sessions to see where much of my learning happens). 

If you would like to discount these explorations of patienthood as a result, feel free to do so. I encourage you, however, to approach this project in the spirit in which it is intended - as an exploratory beginning approach to the topic, rather than an authoritative end-point.

Although I was headed to Georgetown to participate in the Master of Health Systems Administration Program, I deferred and eventually declined admission to continue 'real world' learning, including a current Kisaut fellowship at the Health Strategy Innovation Cell, Massey College, UToronto, where this project lives.

The desire to explore the power of naming and self-selected nomenclature for consumers in the healthcare planning and delivery ecosystem grew out of my own journey from patient advocate (in a local community hospital ED) to patient to activated patient to epatient advocate.

Some of you may be familiar with why I do what I do, but a detailed self-exam of my motivations and drivers is here:

http://healthmgmtrx.blogspot.com/2008/05/confession-why-i-believe-in-consumer.html

And now, for those of you who are located within the hallowed walls of the academe, the gritty details:

Paper working title = I Am A Patient, A Survivor, A Coach! An Exploration Of How Sufferers Become Students And, Sometimes, Thriving Experts in Navigating the Medical System

Authors = Jen McCabe, Carlos Rizo, Neil Seeman

Affiliation: Health Strategy Innovation Cell

Corresponding Author:
Jen S McCabe
Kisaut Fellow, Health Strategy Innovation Cell
Massey College, University of Toronto
4 Devonshire Place
Toronto, Canada

Initial Outline:
BASIC OUTLINE:

I. Introduction
Discuss current patient definitions (Web scan, Wikipedia, WHO)
State why is this study needed?
State what would this study add?
Briefly summarize what is know so far: Conduct a very short Literature Review of academic studies examining patient/consumer nomenclature in peer reviewed journals
Briefly summarize what do hospitals say: Conduct Brief Review of Hospital Marketing Language
Briefly summarize What do patients say: Extract definition from e-Patients.net
Discuss why Social Media may have new answers

[CR]: II. Methodology
What design suits better your research questions? Describe the survey
Why Twitter?
Why crowdsource?
What questions are we asking?
How are we going to analyze the responses?
How many people are we going to ask?

[CR]: III. Results
[CR]: IV. Discussion
[CR]: V. References
M5S 2E1

Some of our research questions:

1. Can patients truly become healthcare navigation experts?

2. Are or can patients be regarded as healthcare navigation experts by health professionals (both those who treat the patient individually and those who participate in the wider system of patient care delivery)?

3. What is the role of patienthood today? In and out of the medical system?

4. What drives patients to become advocates for self? For others? To mentor 'e-patients' (including 'emerging' and 'online' patients)

5. Is patienthood an outmoded term? Could we (patients and/or providers) benefit more by abandoning it? By revitalizing it? By revising it?

6. What do the current semantics of illness and recovery and healing look like? Does the current lexicon need to be challenged?

7. Is the 'position' power of being a patient underestimated? By providers of care? By fellow patients? By patients ourselves?

8. Is there a progression from epatienthood --> participatory medicine ---> choice/control aware care? If so, what does this look like (in theory and in practice)? And is there more than one model?

My ultimate goal is to end this project at a new beginning point - a crowdsourced, community-oriented redefinition of patienthood that will drive discussions about 'meaningful use' and access to health information, as well as how organizations like the US FDA will examine the utility of social media in experiential patient knowledge exchange.

If you'd like to join the researchers working on this topic, please comment below. Your rigor, your inquiring mind, your curiosity, your experiences are all valuable and valued here.

Even if you choose not to participate in the project via the survey or resultant commentology, I encourage you to wrap your mind around the following questions:

What does patienthood mean to you?

And is this a term that needs revising and re-envisioning by the grassroots social media communities who use it in both a positive and pejorative fashion?

Language, and the connotation and denotation of the terms we select for self-labeling, are powerful motivators for social change.

Re-examining patienthood in the spirit of personal advocacy that translates to public health activism deserves, I believe, to play a bigger role in the current debate about technology and communication of health data, don't you?

Yes, a Canadian insurance company decided to keep tabs on a woman it was paying sick leave benefits to, and lo and behold, that woman was having — wait for it — fun!

Nathalie Blanchard, a 29-year-old IBM employee from Quebec, took a long-term sick leave from her job after being diagnosed with major depression. Her doctor told her to try & have fun, and to take a sunny vacation to get away from her problems. She did just that while she received monthly sick-leave benefits from Manulife.

And she posted her vacation photos on her private Facebook profile. But recently, the monthly payments stopped.

Why? Because Manulife, her insurance company, found the photos and made the medical diagnosis — from a photo, mind you — that she no longer suffered from major depression. From a photo.

!!!!

What if your long-term health profile were a corporate asset of your health plan? What if, when you changed health plans, the new health plan had to pay the old health plan for the rights to insure you? Call this a health plan member's Net Asset Value.

From: "The Health Care Blog: Sell Patients like Baseball Players - Seriously ."

If I'm a 'star' patient with an MVP long term health profile (great biometric stats, low risk, great genetic indicators, etc) then health insurers should approach me (and my chosen agent) like the next Great Bambino, and attempt to woo me to their plan with a long term contract and low rates.

Interesting idea, but this would build a system that's predisposed against the sick, and getting ill isn't a bit like having a ton of talent in baseball.

Luckily, the Dutch system provides some examples of how we may do this right...provide MORE incentives for treating those who are sick to insurers and hospitals, not less (paying attention CMS?) so people want those kind of MVPs in their portfolios too.

The idea of health insurers controlling and trading my net asset value at will, to be sold and resold without my control like my student loan balances, makes me a commodity good in the healthcare marketplace.

And how, actually, is that any different than the scenario we've got today?

Take a look - data like whoa. Also note user friendly, non 1998 Windows fabulous user interface.

We're getting there, slowly but surely...

From: "Technology Review: Blogs: Delta-V: Designing Astronaut Gloves."

But this is one of them. Testing gloves that protect astronaut digits from the outer limits.

Speaking of the final frontier, imagine if US healthcare had a body like NASA in the 50s. Recruit the brightest engineers, rouse everyone for a mission impossible, and test every component, even a glove, with this level of exacting reason and an expectation that failure is not an option.

If we won't lose a man or woman in space, why is it ok to lose a man or woman in the hospital as a result of medical error?

We need a duct tape solution for healthcare. I'm betting it's engineers in the Valley who will figure out how to solve American healthcare's Apollo 13 scenario.

From: "Face value: Salesman of the irrational | The Economist."

Lessons from Jean-Claude Biver, Hublot watches:

1. Make your own stuff. Sell it if you must, but dole it out with due process to people you love and respect. Be master of your cheese, til the last piece is gone.

"His cheese can send the authors of Michelin guidebooks into rapture; Switzerland’s best chefs regularly call him begging for some. But he parcels it out only to family and friends, and to restaurants that he particularly likes. And he always refuses payment for the stuff. “If I don’t sell it,” explains Mr Biver, “then I will decide who gets it and who doesn’t. I will be the master of my cheese until the last piece.”"

2. A little bit of rationality helps sell irrationality.

" “You only desire what you cannot get,” he says. “People want exclusivity, so you must always keep the customer hungry and frustrated.”"

Not sure I agree on the need for hungry and frustrated customers...the Posterous crew does an amazing job of keeping me full and unfrustrated, and I respect them (and the tech/design that enables my Posterous experience) the more for it.

However, I did also hear recently advice to always have something go wrong at a conference (lose the wifi, turn down the heat, etc) so that organizers have control over what people are complaining about.

Personally, I'll go with the glass half full view and trust users over manipulating them every time.

But being master of your own product - and knowing when and why you sell it versus give it away - is a good gut check question to ask yourself in the mirror every morning.

From: "LeaderGap.jpg 640×476 pixels."

Minus 10 points for general 'composure.' :)

To sum it all up, successful entrepreneurs live in a distorted reality that they create for themselves. They have a vision that they pursue like food during a famine. Satisfaction is rare and never immediate. To be a successful entrepreneur, you need to live in a world that doesn't exist yet: the world that you want to create.

From: "Chrys Bader - Tales of an Entrepreneur."

On average, a patient admitted to an academic hospital with a heart attack had a cumulative effective radiation dose of 14.5 millisieverts -- about a third the annual maximum accumulation permitted for workers in nuclear power plants.

The average American can expect to receive about 3 millisieverts a year from ground radon or flying in an airplane.

From: "Just one heart attack leads to 725 X-rays | Health | Reuters."

"When the women were just looking at pictures of their partner, they actually reported less pain to the heat stimuli than when they were looking at pictures of an object or pictures of a stranger," said study co-author Naomi Eisenberger, assistant professor of psychology and director of UCLA's Social and Affective Neuroscience Laboratory. "Thus, the mere reminder of one's partner through a simple photograph was capable of reducing pain."

"This changes our notion of how social support influences people," she added. "Typically, we think that in order for social support to make us feel good, it has to be the kind of support that is very responsive to our emotional needs. Here, however, we are seeing that just a photo of one's significant other can have the same effect."

From: "Can thinking of a loved one reduce your pain?" via @Physorg