Personal Health Goals

 

#IamAMuslim
Your goal needs to be realistic and worthy

As a person with MS, I’ve written that my personal health goals are to progress as slowly as possible and do nothing that will mess with my pathological optimism. People I talk with about personal health goals say it’s not easy to come up with personal goals.  What do I mean? OK, people who are well want to stay well.  Those who are acutely ill (cold, broken leg, stomach ache, etc.) want to get over it. Those who have chronic conditions want to manage as best as possible. Here’s a stab at a list of personal health goals. Continue reading “Personal Health Goals”

I’m So Discouraged

Several times this week I heard a variation on: I’m so discouraged, I thought I was doing better. I just keep sliding back. I really suck at this. The topics: meditating every day, losing weight, managing anxiety, soloing, recovering from surgery. I heard each from more than one person. Several people said it about multiple things. One person, me, said it about losing weight and soloing. Two things strike me here. First, sucking and second sliding back. Can’t we give ourselves a break and celebrate that we’re trying? I’m trying to meditate every day, lose weight, improve my mental health, solo on my sax!!!! Yippee for me. Yippee for us!!! Recovering, healing, learning, changing habits doesn’t happen in a straight upward line, steadily better. It’s two steps forward, one step back. It’s up and down, first wildly so, then smaller cycles of up and down, over time with forward progress. Looking at just 2 data points only frustrates us, since we tend to recognize the down after the up, rather than the up after the down. In each of the scenarios someone heard the other and provided a good job, way to go, keep it up, keep me posted, call me anytime

I honor you’re work of healing, learning, recovering. Good job, way to go, keep me posted, call me anytime.

Screen-Free Sabbath

Week 3 of my wife and my Screen-Free Sabbath. Feels pretty good. After the first week it feels like a relief.  I’m reading more books – paper and not Kindle. Turned off my e-mail and social media notifications. They were all still there at sundown Saturday. No emergencies. Sitting still more often – some alone, some with my wife.  Got my recumbent trike out, tuned up and rode it. Had to buy some paper Sudoku books. It affects my week as well. I’m looking at the phone less often, meditating more. Still using the iPhone for texts and phone calls-have only received a few. Using it when playing my sax: playing my recorded rehearsals, metronome, etc. Sitting on the bus or subway more often looking at people and not the screen. Noticing the blue sky and spring colors. My grandson freaked out: Will I have to do it too? All week? OMG. He’s relieved that it’s just Grandma and Opa and not him, unless he’s at our flat sundown Friday to sundown Saturday.  I’ve spoken to several parents who have 5-7p screen-free every day, others do a 24-hour period as we do.

Continue reading “Screen-Free Sabbath”

Engaged with Sax

Shopping for a new neurologist I had three screening questions:

  • What’s your response time to emails?
  • Do you use OpenNotes?
  • How would you work with my acupuncturist?

The first doc said, ‘I don’t use email, we don’t have a portal. What are OpenNotes? What do you mean you’re shopping for a neurologist? You either want me or you’re wasting my time.’ 

The second doc said, ‘If you email me, my nurse practitioner or I will get back to you within two business days. If you need us sooner, call my office.

Of course, we have OpenNotes. If I get something wrong, let me know. I know a lot about drugs and therapeutics and how they affect groups of people. But, I don’t know anything about you. My job is to learn more about you, and we’ll test different drugs and therapeutics and see what works for you. You are an experiment of one.

Oh, you use acupuncture? You’ll have to educate me. I don’t know much about that. I’m interested in anything that helps my patients. Seems like everything works for someone. And by the way, how’d I do? We could have some fun together.’
Continue reading “Engaged with Sax”

Changing habits – for people and payers

I love my health team. They help me stay tuned up with my chronic challenges and they get me through unexpected crises. Still, I  see them way too often. 3-5 times a month and I’ve never been an inpatient. Professional contact is a drop in the pond of my health. The rest of the time (also known as my life) I set and track goals and habit changes. I have questions about my plans and treatments. I deal with changes in my life that affect my ability to do the work of habit change.  I network and I research. I worry and I celebrate. I have tools to help me that are largely disconnected from my health team. I track steps with my iPhone, my diet with MyFitnessPal, the support communities of MyTreatment and PatientsLikeMe.  I can communicate with some professionals via portals and can receive one way data via OpenNotes, also with some professionals. Continue reading “Changing habits – for people and payers”

Life Happens or Expecting the Unexpected

The New York Times Magazine has an article this week about flexibility at work. Since I am a person with a chronic illness and disability and have been a boss to many teams, it seems like a no brainer to support flexibility at work. In fact, life requires flexibility at work. If you give care to yourself or anyone of any age you need flexibility at work. This can range from a haircut to periodic hospital admissions.  I used to think that there couldn’t be flexibility if you worked on a shift, say in an ICU, when your absence would make it short-staffed and less safe.  But then my teams realized that if we expected to need flexibility then we could design the work and schedules to accommodate the unexpected.  Rather, the need for flexibility became the expected. In my first management job as a manager of an ICU I noticed that nurses didn’t stop for lunch, let alone take breaks or go to the bathroom. Crazy. We can design this work so we can take breaks!! This morphed into no one needs to be on call all the time and then, sure, you can go to your daughter’s recital.  We can figure this out. I found that when flexibility was expected and given, people stepped up to allow it to happen for each other.  No work was planned that required just one person, we always built-in redundancy and clear written descriptions so someone else could step in at a moment’s notice. Certainly, hiring the right people is critical. Flexibility doesn’t work if you don’t trust that everyone gives their all.  Do you avoid hiring people with disabilities, chronic conditions, or full of life because you’re worried about getting the job done? I hope not.

What’s the Problem with the Experience of People at the Center of Care?

Wearing my many hats: e-patient, caregiver, nurse, informaticist, and leader, I am blessed with mostly positive experiences on my health journey.  At worst, my experiences are seriously annoying. This week, attending a benefit for MITSS (Medically Induced Trauma Support Services), I’m reminded that not everyone is so lucky. As I scan the industry several problems with the experience of the people at the center of care (patients, caregivers, clinicians, direct care and support staff) jump out: Continue reading “What’s the Problem with the Experience of People at the Center of Care?”

Habits – Health’s ingredients

Habits are the ingredients of health. My chiropractor tells me that my exercise habits should be sustainable. I need to keep them up no matter my life pace. Now I alternate days of 45 minutes of balance and core strengthening exercises  with 60 minutes of recumbent bike riding.  I could do that when working full-time and when not. Smiling and greeting you at a threshold is a habit. A habit for my mental health and yours. My newest habit is to stop putting food in my mouth every day at 7:08p.  Why 7:08?  No reason. This blog is a habit: one idea germ a week, 20-60 minutes of writing every Sunday for 3 years. Helps me keep my disorganized mind in order.

Nothing so needs reforming as other people’s habits ~ Mark Twain.

Data can motivate change. Changing data requires a change in life and work flow.

This fifth in a series of posts about health data thinks about the value we get from that data.  In my last post I said, The best data has value because it reflects or motivates action. Action to improve health and wellbeing of and reduce cost to individuals and populations. Action to improve life flow of persons at the center of care and work flow for people who work in health care agencies.   
Let’s think about times when data helped motivate action. At few years ago I weighed almost 200 pounds.  My primary care physician turned the computer screen toward me and showed me a graph of increase in my weight since I started seeing her 4 years before. A very dramatic line graph of weight increasing from 160 to 198 pounds. OMG. No wonder my new pants were getting bigger and I went from a belt to suspenders (I still have no behind to hold up my pants-the new weight did not give me more of a butt). I was motivated to lose weight. I kept a running spreadsheet of my weight, tracked my calories, changed my eating habits considerably, and lost 35 pounds in 2 years. Hurray. Data motivated me to start losing and keep losing. I bought several hand-made vests from Etsy to celebrate. Now they’re almost too tight again. Although I’ve tracked my weight since, tracking the data didn’t keep motivating me to keep the weight off.
When I worked for St. Peter’s Addiction Recovery Center in Albany, NY, managing the care of CDPHP members with behavioral health benefits, we saw that our rate of outpatient 30 day follow-up after inpatient addictions treatment was less than 30%. Outpatient follow-up is a HEDIS measure of NCQA (The National Committee for Quality Assurance accredits health plans). This Outpatient Follow-up measure made sense to us because we knew that a person’s success with sobriety was strongly associated with going directly from inpatient to outpatient treatment. Our Follow-up rate of less than 30% embarrassed us. It motivated us to make significant changes in our practice. We made sure that people in inpatient care had an outpatient appointment before they were discharged.  We stayed in touch after discharge to make sure they had transportation and child care to get to their appointment and if they didn’t make it, we recontacted and helped further.  The Follow-up rate increased to 75%. The data was meaningful, we looked bad, wanted to be better, and were willing to make significant changes to workflow. Increasing the score made us feel good about the changes we made. I don’t know if the Follow-up Rates are still so high. I’ve lost touch.
The moral of these stories is that meaningful data can motivate change.  Going from bad to good is pretty easy (Good to great is much harder). In either case changing personal or population results requires doing something really different about work flow, life flow and habits. Adding education, training, teaching is a weak intervention and usually doesn’t move the dial much. Sustaining improvement is a whole other challenge.

Personal risk management – When s***t happens

When I ask my doctors what worries them the most about my future health, both my neurologist and primary care doc say, they worry that I’ll fall.  Everybody faces risks – too little or too much medicine, anxious, scared, or melt-down, infection, stranded, lost, jobless, forget something important,  accident, heart attack, caregiver or neighbor moves, power goes out, no help when you need it – on and on the list goes.  While no one can anticipate or prepare for every risk, couldn’t we prepare for likely risks?  So for me its the risk of falling.  I stay as strong as I can, ride a trike that can’t tip over, walk with a cane, strengthen my core, get help for uneven surfaces, pay attention whenever I move, sit down when I’m dizzy, reduce clutter, don’t let anyone depend on me for balance.

Continue reading “Personal risk management – When s***t happens”