Health Semantics 101: "Cure" vs. "Heal"

It's challenging to explain to people in my family what I do for a living.

God love 'em, they do keep trying to understand.

Conversations about healthcare innovation and reform range from the dangers that result from penultimate our fear of dying (with grandmother Muz) to the dangerous spending patterns of our nation as a whole.

My sister Kate is now fond of saying: "Hey Jenny, can you hurry up and save healthcare already?" or, alternately, "Jen - Who killed healthcare?"

Recently several folks in my family joined Twitter to track work/life escapades, and communicate where we are (no matter where in the world we've landed) on any given Sunday.

Although I've found tweeting excrutiatingly valuable for work, I didn't expect family presence on Twitter to demonstrate professional relevance quite so quickly

After HealthCampPhilly (Saturday), my mom (@susanmccabe), who is a behavioral health nurse (going on +10 years now), saw a tweet I posted about 'cure' vs. 'heal.'

She left me this note in response:

"A cure is an expected, narrowly defined destination. Healing is a journey with unexpected twists and turns.

For a cure, the provider's role is pass or fail.

As a part of healing, the caregiver accompanies the patient on their journey, meeting them where they are at any given time, and having a supportive role even to the end.

There's always hope for healing."

-Susan McCabe, RN, 3.29.0

Do you see a doctor, go to a hospital, because you expect to be CURED or because you hope to HEAL?

My belief? A 'cure' happens to you. But healing is a process in which you, the person-who-is-also-a-patient, are the primary participant.

Yeah. This is all just wordplay.

But language matters, especially when we're talking about the little things like, oh, life and death. Healing and hope

Which process, curing or healing (both? neither?), do you feel is within your scope of control to manage?

Or do you feel locked out of participation in either?

 

 

 

"Singing" Bacterium, Swimming Algae - What a Wonderful World...

"...Recent observations of Synechococcus using atomic force microscopy show these creatures having tiny spikes or spicules that extend from the cell's inner membrane, out through a crystalline outer shell and into the surrounding water."


"Ehlers and co propose that these spicules can be made to vibrate by molecular motors within the cell and that this vibration causes nearby fluid to flow, generating movement (a phenomenon called acoustic streaming).

In effect, the bacteria "sing" themselves along."

 

MIT Tech Review: http://www.technologyreview.com/blog/arxiv/23214/?nlid=1890

 

Posterous #1 Tool Helping Me Share "Peeks" (Pronto) Into Healthcare, Science, Tech

Forgive my usual lack of eloquence, dear reader: this post is a quick and dirty story about getting results, and how Posterous has helped me do that.

Background: I've had a Posterous account for just over 2 months.

Since January 22nd, I've posted here 66 times. I have a tight crew of 15 subscribers, but have generated over 722 pageviews.

Q2 I'll begin tracking my sticky web of views from Posterous-generated content via Google Analytics (how many views on Twitter, Facebook, HMRx, and Posterous combined?).

My Posterous posts now generate roughly 300% more views of "Jenstream" content PER POST (thanks @tedeytan, @epatientdave for the nomenclature) than my Blogger-hosted site, Health Management Rx.

HMRx has been active for over two years this April. That's a LOT of time spent formatting/reformatting articles, finding interesting links and emailing them to myself, to drive an mean of between 30-90 views per posting day. Ouch. 

Posting at Posterous takes me an average of 15 mins, and the content I provide here is automagically pushed to my Facebook wall, forlorn and limping HMRx blog, and, far more importantly for my current projects - my Twitterfeed (@jenmccabegorman).

Pre-Posterous, if I saw a news article, blog post, etc. I thought worth sharing, I'd have to copy and paste the URL into an email to myself (jennifermccabegorman@yahoo.com), with a summary sentence (so I didn't forget my train of thought) and a few graphs on why it was important for healthcare innovation.

Then this usually sat in my inbox indefinitely awaiting action, unless I put a day/date/time tag on it with an obnoxious all-caps note to self BLOG THIS ASAP!

You can probably imagine how well *that* method worked out, and how many good meaty links ended up in the 'trash' section of my Yahoo mail account.

Then, once I finally decided to blog an item, posting at HMRx took me an average of 45 mins.

I could set the kitchen timer by this, and usually ran over and had to allot an hour to post via Blogger. What a pain in the a@#!

What does all this tell me? And why should you care?

It's this simple: Posterous works. It is the most effective tool in my significant cloud-based tech arsenal for spreading rhizomatic content, opinions, and links.

When I first took a look at Posterous, I wondered what possible value I could derive from, sigh, ANOTHER blogging site.

Then @garrytan told me about the autopublish function, and the sun broke through the clouds.

Holding hands with Twitter, Posterous let's me deliver a 1-2 punch of content - short and sweet? Tweet. Slightly more complex production? Posterous.

I'd pay for Posterous guys. It's not a blogging site. It's a complete self-to-content transition platform.

I'd pay more for Posterous than my Pro Flickr account.

Photos, after all, get me viewjoy and some small sense of relatively artistic accomplishment, but Posterous gets my professional life moving at warp speed.

Thank you, and keep up the great work. Yes. You haz a fan.

 

"Why I Quit Google" & Power of Design - Goog's Former Top Designer Doug Bowman

UPDATE: BOWMAN = TWITTER FABULOUS!

http://www.businessweek.com/the_thread/techbeat/archives/2009/03/its_official...

From Silicon Alley Insider

"Seven years is a long time to run a company without a classically trained designer. Google had plenty of designers on staff then, but most of them had backgrounds in CS or HCI. And none of them were in high-up, respected leadership positions. Without a person at (or near) the helm who thoroughly understands the principles and elements of Design, a company eventually runs out of reasons for design decisions. With every new design decision, critics cry foul. Without conviction, doubt creeps in. Instincts fail. “Is this the right move?” When a company is filled with engineers, it turns to engineering to solve problems. Reduce each decision to a simple logic problem. Remove all subjectivity and just look at the data. Data in your favor? Ok, launch it. Data shows negative effects? Back to the drawing board. And that data eventually becomes a crutch for every decision, paralyzing the company and preventing it from making any daring design decisions."


http://www.businessinsider.com/why-i-quit-google-2009-3

http://stopdesign.com/archive/2009/03/20/goodbye-google.html

"The Most Personal Device" by Doc Searls

Part I in an elegant case for codifying our online IDs as legally transferable assets:

"As creatures, we humans are distinguished not only by our intelligence and use of language, but also by two other remarkable characteristics: our mobility and our expansiveness. We are relatively hairless and walk on two feet because we are runners. A well-conditioned human can run indefinitely. We also expand our very selves though [sic] the things we invent, hold and manipulate. Our senses spread out through our clothes, our tools and our tech by a process called indwelling. When drivers say "my wheels" or pilots say "my wings", they mean it personally. The perimeters of our selves are not bound by our bodies. They extend to include the tech we use. To become expert is to enlarge ourselves, whether as carpenters, drivers, pilots, or whatever."

- Doc Searls is Senior Editor of Linux Journal, and a pretty nice guy, despite a penchant for luau shirts.

--I picked up my March 2009 copy at #sxsw, where Doc and I shared the backseat of the Super Shuttle from the Austin airport sitting for 20 mins.

---Doc and one of our good buddies from 31volts (thanks Marcel! Marc Fonteijn you rock!) helped us launch Nexthealth.NL on the backchannel at MoMo (during Doc's talk) in Amsterdam last spring.

----Doc - let me know how in the health VRM can help us make "patient" and "provider" seem as antiquated as "mainframe" and "minicomputer."

How Docs Will Get Paid in the Future: A "Cash-Only" Primer

"Will the current economic climate continue to increase the number of physician who go cash-only?  Seven out of 10 respondents to a MedPage Today online spotcheck think so."

Sitting with Dr. Jay Parkinson of Hello Health (@jayparkinson) and Jonathan Sheffi (@sheffi) munching tortillas in the sun last week at #sxsw, the three of us engaged in some verbal wrestling about how docs will be paid in the future.

My vote for reimbursement (one of them anyway) is to create a new class of DRGs (or ICTs on the WHO stage) and CPTs that pays docs for emedicine, telemedicine, and mHealth interactions.

Jay shot me down, saying cash payment is the way to move forward. Jay would know, since this is the model Hello Health is using.

While I agree with Jay that cash-only will be a primary restructuring tool for rebuilding the US healthcare system, I also haven't completely given up on the fact that we'll need to integrate BOTH revolutionary (cash only) + traditional (coding) methods of payment to ensure BOTH types of docs (revolutionary) + (traditional) are paid to interact with me as a patient where I live and work and play (online, in the cloud, on my mobile). 

For now though, let's focus on some of the basic aspects of cash-only practices. Rejoice! After reading this Posterous you too will be able include this kind of commentary in your stunningly interesting cocktail-party healthcare reform banter.

 

Just don't be surprised if your companions retreat to nebulous talk about environmental issues or how much the economy stinks...

All items in quotes below are from a MedPage Today article.

How many cash-only physicians are there? Good question.

"according to the CDC, in 2005-06, 11% of physicians had no managed care contracts."

Are cash-only physicians concierge practices?

Good question. Not necessarily, although cash-only physicians may ALSO operate a concierge like service...

"Cash-only physicians don't operate like concierge practices, said Jeffrey J. Denning, a practice management consultant in La Jolla, Calif. "Concierge practices charge an annual membership fee of $1,000 or so for increased access to the physician in an upscale office environment, then bill insurance companies or Medicare for services. Nothing much changes in a cash-only practice except getting out of the insurance billing business."

How do docs get paid in a cash-only practice?

At the point of service, via cash, although many will also accept checks and credit cards.

(MedPage recommends having staffers who handle the moolah 'bonded.' Funny. Do we bond retail store cashiers? Why would staffers at a medical practice be MORE likely to embezzle just because they haven't handled large amounts of cash at a docs practice?)

Many things in medicine are NOT simple. This is one thing that IS. Hope we see more cash-only practices.

How do docs figure out how much to charge in a cash-only practice?

Like any other small business. No, seriously...

"Like most small-business operators, cash-only physicians look at what competitors are charging, calculate the cost of doing business, then tack on enough to make a profit. Dr. Berry said he strives to keep fees "between the cost of an oil change and a brake job."

Starting a cash-only practice forces docs to operate in a more business-like manner in other ways:

"Physicians who drop third-party contracts typically have to advertise their practices until word-of-mouth kicks in. "

Why would docs want to operate a cash-only practice?

"Because cash-only physicians have lighter workloads than their peers, noted Judy Capko, a consultant in Thousand Oaks, Calif., they're better able to build strong healthcare partnerships with patients.

Patients, in turn, have easier access to care and are less likely to experience the rushed appointments that result when physicians see large numbers of patients to compensate for managed care's low reimbursement rates.


As a matter of fact, the cash-only practice model is so simple and intuitive I'm surprised it hasn't yet come under fire by the AMA or others looking to protect the current reimbursement way of life.

Doc-run and specialty hospitals (operating as, say, cardiac specialty centers) have been slammed by organizations (with big lobbying budgets) looking to protect the status quo. Accusations that these specialty hospitals get to 'cherry pick' the best patients abound.

I can definitely see the potential for cash-only docs getting whacked with the same sideways argument - "Cash-only docs can pick the 'healthiest' or 'best' patients, those who have cash out of pocket to spare, either because they're healthy or wealthy, leaving the 'sickest' patients covered by insurance to seek care elsewhere."

Even the MedPage article falls for this one: "The flip side of this, of course, is that cash-only patients must dig deeper into their pockets than patients who only need to fork over a copayment. "

First of all, who keeps cash in a pocket anymore?

Second, cash-only docs aren't picking the healthiest patients, but the healthiest patients may indeed begin to pick cash-only docs.

Wrap your mind around that one for a few...

New Medical Condition(s) for DSM V - "Southby'd" and "Southbabies" (#sxsw)

 It's a long travel day (12+ hours) from Austin, TX back to DC.

Travel snapshot: At the Charlotte airport a mulberry-haired Japanese woman in a strawberry pink hoodie is holding a large chihuahua as if that baby canine is the Holy Grail.

I'm sitting by a power outlet, plugging back in - mentally digesting my first SXSW experience and realize there is no easy way to describe this letdown.

One of my favorite things about Southby was the unexpected wordplay that results when you meet other geeky tech folks. Crowdsourcing new verbology at #sxsw is one of the least expected but most interesting side benefits of hanging with such a professionally diverse crowd in Austin.

My favorite term (before this afternoon) is from the soc-anth school. In the hallway talking about parties, a new friend suggested the noun "southbabies." This tags the, ahem, interesting crowd interactions between males and females at parties during SXSW, as in "some southbabies are gonna be made after this one."

In a slightly more professional vein, I'm proposing a new DSM condition to catalog the feeling of getting hit with the #sxsw whammy after the event - "southby'd."

You can use 'southbyd' as a noun (I feel so southbyd right now I need a banana bag) or a verb (I'm gonna Southby you if you don't show up at the Google party!)


south⋅by⋅d

[sowth-bi-d]

-verb, noun

1. the quality or state of feeling listless and unenergetic following attendance at the annual SXSW Film, Interactive, and or Music festivals in Austin, TX. Grade I experienced after attending one subfestival, Grade II experienced after attending two subfestivals, Grade III experienced after attending all three subfestivals. Grades I and II often require 24-72 hours of bed rest. Grade III may require hospitalization, IV fluids.
2.

Pathology. an abnormal mental state or disorder characterized by overpowering laziness, hunger, and lack of initiative following attendance at #sxsw.

Common usage: "Man, I'm so southbyd, I need a large Texas Breakfast with biscuits and gravy stat, and then I'm taking a three day nap."


Origin:

Related Words for : southbyd

Additional ethnographic info: From urban anthropological English+semantic web/event-contextual hybrid. Condition one experiences after attending #sxsw in Austin, Tx. Symptoms: lethargy, throbbing, blistering pain in lower extremities due to walking (often in inappropriate footwear for females), driving hunger for simple carbohydrates, particularly starches such as those provided by papas fritas. Strange cravings for McDonald's Egg McMuffin may be experienced, often between the hours of 11am-3pm EST.

 

Abbreviation: southbyd