Talking About Health; Why Health Communication Matters

Why is spring break good for your health?

March 13, 2011

Ahhh, the joys of spring break. Yes, I have heard the, ‘must be nice… no one gives me a spring break’ and the ‘I remember when I was in college and got a break’ and the nearly audible hmphhs. All come from those who have not recently been in a college classroom as a teacher or student.

First, there is no clock, no ‘9 to 5’ or even ‘8 to 6’ timeframe associated with being part of higher education…not for students and not for professors. With email and texting and online course access, this reality has become even more starkly evident. I post content for my classes at any time of the day or night. Students email me their questions and update me on their status 24 – 7…

Now, if all that was involved in a college education was the time spent in a college classroom, plus the 3 hours to every one hour of in-class meeting for a student to earn an ‘A’ and a professor to prepare for that hour of class [this includes such things as planning and preparing the syllabus and course materials and exams, meeting with students online and face-to-face, grading their work]–that alone would be a lot.

For students, most students take 15 credits. For one three credit class, they will be in the classroom about three hours a week…so 15 hours for 15 credits. Add to that 15 times 3 or 45 hours for students working toward ‘A’s and…you get to 60 hours rather quickly. Add to the original 15 hours, 2 times 15 — two ours of time outside class for each hour spent in class found to be the average time necessary to earn ‘B’s…and you get to 45 hours a week…

And I don’t know a single student who doesn’t work outside the ‘job’ of being a college student. So add the number of hours that a student works in a paid job each week. Add to that the time spent volunteering and/or being a member of organizations that are part of community… Most college students spend hours every week in this role as well. Penn State “is the home of the largest student- run philanthropic even in the world”–THON [http://giveto.psu.edu/s/1218/index.aspx?sid=1218&gid=1&pgid=439]. Student commitment of time to this event is a yearround activity…

For professors, most tenured professors at institutions such as Penn State teach 6 credits a semester. This is considered to be 1/3 or 33% of their work expectations… When evaluated each year, 33% of the evaluation is judged by the teaching activities. So, 6 times 3 = 18, plus the 6 hours of time in the classroom…24 hours. [I find that three hours per credit hour of instruction I provide does not adequately cover the workload. Class sizes have grown and being more accessible through technology takes time, too.] But at any rate, if we hold to the idea that 24 hours is sufficient — on average across a semester to fulfill teaching responsibilities, that still suggests that 3 x 24 or 72 hours will be necessary to fulfill basic expectations. And, in truth, that is about what it takes… Often, more. We are evaluated for our research contributions as 50% of our work… There are no good explanations I can point to in order to explain what it means to do research…and be evaluated on it. I can say that knowledge as one of the greatest assets that the U.S. has comes from a systematic process that is judged by others, and that without it–well, where would we be?

So, yes, when spring break comes–I look at my desk…piled high from the semester’s activities to that point…and I make a commitment to try to see the surface before we begin classes again. I seldom make it. I didn’t make it this time either… But I feel ready to tackle it all anew… and that is why spring break is good for health…

What do you think about tobacco settlement dollars?

March1, 2011

It is a fascinating history filling volumes of research journals and books and ledgers… The tobacco settlement… It came to my attention again today as I was reading about Pennsylvania’s adult basic health insurance program.

Mostly, in the past several days, I’ve heard sound bites about the program shutting down and leaving Pennsylvanians uninsured. The shutdown in the stories I’ve heard seemed to be linked to state budgets and all that is going on there. Today, I had a moment to explore more about these soundbites and learned that…the program began under Governor Tom Ridge who used the State’s tobacco settlement funds [http://onevoicetulsa.com/index.php?ht=display/ContentDetails/i/4424680].

The tobacco settlement was designed to provide states with funds to address increased health care costs related to tobacco use…smoking. This was to include cessation programs as well [http://www.tobaccofreekids.org/what_we_do/state_local/tobacco_settlement/].

One might ask how we get from the the latter to the former? We all share higher health care costs linked to smoking…whether or not we smoke or have smoked. So perhaps it was a creative and even equitable program that the former governor introduced…

What if your doctor told you that not taking your medication could really cost you in the long run?

February 25, 2011

There is a lot of talk about too much pill-popping to address our health. Lots of stories go around about patients asking doctors for prescriptions. But the other side of the story is that almost half of us who receive prescriptions do not take them. And about 40% of us who do NOT even have to pay for our prescriptions because they are covered by insurance do not follow the doctor’s orders…

Drs. David Cutler and Wendy Everett discuss this dilemma in the article, ‘Thinking outside the pillbox — Medication adherence as a priority for health care reform’. [http://www.nejm.org/doi/full/10.1056/NEJMp1002305] Their analysis considers the fact that not taking the medications our doctors prescribe probably leads to lower quality of life and may shorten the number of years we live. They discuss the estimation that 89,000 Americans who have been prescribed high blood pressure medications and do not take it die prematurely.

And, not taking those prescribed medications…too often results in hospitalization that could have been avoided…adding up to $100 billion… How is that for a goal in talking about health and health care reform? Take your medication to avoid a costly alternative…time in the hospital.

Should those who educate our doctors include talk about cost consciousness?

February 24, 2011

In my piles of articles that I was sorting and filing today, I came across one written by Molly Cooke, a medical doctor. She published a piece in the New England Journal of Medicine [http://www.nejm.org/doi/full/10.1056/NEJMp0911502] that appeared in 2010, volume 362, pages 1253-1255. The article’s title is, ‘Cost consciousness in patient care — What is medical education’s responsibility?’

I was moved to print a copy of this article when it first came into my email on one of the many list serves to which I subscribe. I was reminded of why that was the case as I reread the contents. Dr. Cooke notes that while debate about costs of care has been a focus of society’s discourse relating to health for decades, medical education curricula seldom address how and when cost enters planning of diagnosis and treatment strategies.

Dr. Cooke addresses historical, philosophical, structural, and cultural explanations for this reality. One of the historical events relates to efforts for clinical pharmacists to guide doctors’ understanding about prescibing and testing. The ‘academic detailing’ veture, as it was labeled, made little difference in prescribing or other habits.

Dr. Cooke notes that doctors consider themselves to be patient advocates and, as such, want to focus on benefits for a patient, not the cost associated with accessing those benefits. Structurally, she describes an educational setting in which medical education students work in hospital settings where the primary goal is to get a patient out of the hospital. If discharge is the first aim, she believes that doctors learn to order any test they can to achieve that aim via evidence that a patient is ready to be let go. So, there is no time to learn about possible cost-effective approaches… Isn’t this a bit ironic? In the name of cost-saving, perform possibly unnecessary tests to discharge a patient sooner rather than later? If anyone has the data out there to show how that works out for the economic benefit of health care, pleasure share it…

Or will it be Pennsylvania trout that will be the canary in the mine for Marcellus shale?

February 22, 2011

There appears to be no shortage of articles about concerns relating to the environment and Marcellus shale drilling in Pennsylvania[e.g., http://blogs.wvgazette.com/watchdog/2011/02/16/is-the-marcellus-boom-a-good-idea/]. Fewer concrete examples exist of action in this area. One exception is the organization, Trout Unlimited. The organization is partnering with the State, where loss of funding and the economy has contributed to challenges in efforts to collect data regarding water quality in the State’s streams [http://www.tu.org/conservation/eastern-conservation/marcellus-shale-project].

Volunteers will be trained to collect water samples. That is an important first step. It is less clear what happens next. Where will the samples be evaluated? How will data be stored? It is important to plan for consistency and to identify now any problems related to evaluating the water samples. If we fail to plan now, then the findings will be suspect later. So certification of the folks collecting the water samples is important. But we don’t want their hard work and training to be lost in warehouses where samples stockpile with no one to evaluate and track them. We also don’t want results to be discounted because the assessment of samples isn’t consistent or valid…

Will cattle be the ‘canary in the mine’ for Marcellus shale drilling in PA?

February 19, 2011

What happens when fracking fluid used in the Marcellus shale drilling process leaks into water supplies used by cattle? The cattle get quarantined. Why? Well, because there is so much uncertainty related to the effects of the fracking fluid on the quality of the meat…that would eventually be available for us to eat.

This is but one unanswered question related to our food supply and the ongoing Marcellus shale drilling activities. The article at this link, http://www.marcellusprotest.org/node/51, raises questions about air pollution, as well… linking it to the death of plant life that would feed cattle…

At a recent meeting, I heard a question raised about the deer population. They, of course, drink from streams throughout the state. We cannot quarantine them…

Has anyone ever said to you, “I hope you might give this a try…”?

February 16, 2011

It takes some time to build new habits. It takes some time to break old habits. It is kind of like being out on the middle of one of the world’s largest suspension bridges… Go left? Go right? The paths may look the same but if you go forward instead of backwards, you at least get to see something you may not have seen before…

And when you go forward to try a new approach to being healthy, it can be like that as well. Sometimes, the way someone presents it to you can make all the difference.

Which seems to be a better approach? “If you show signs of concussion, you’re out of the game.” Or “Perhaps we can practice some new ways of tackling and see if you have fewer headaches after tough games.”

“You’re going to look like a piece of leather if you don’t quit spending so much time in tanning beds…” hmmm… Any other ideas about how to change that habit? Or telling youth, “You’re going to die if you drink alcohol…” And, “We’re going to test your blood for steroid use.” These kinds of direct statements–even when we might agree with the intent–don’t seem to give us any choice in the matter…and, well, most of want to have some say in things…

So, it’s worth a little effort to think how to talk about a health habit in a way that seems to leave some room for choice in the matter…

What does politeness have to do with talking about our health?

February 15, 2011

Adventure… ‘In the heart of Pennsylvania’s Laurel Highlands… ‘ We slipped and slid our way down an icy snowy road…

I bit my tongue as our four-wheel drive tackled the road… I have been on enough adventures to avoid disclosing my fear. I just held my breath.

Lesley’s Mountain View Country Inn… We found it.

We pulled into the drive piled high with snowdrifts. We pulled around to the back side of the inn…

We found an entrance and a light…

The inn “offers lodging and fine dining with a casual elegance and convenient access to”… area attractions…

Uhhh. Do you think they’re open? I asked my husband who planned the surprise getaway… ‘Sure…’ and out he popped to enter the door you see here… And he was right. How could I have doubted it?

As with questions posed in the past two posts, other questions–sometimes asked by doctors but also asked by our friends and family members and even our employers–include things like, “Why don’t you exercise everyday?” and “Do you smoke?” or “Do you drink?” Doctors may ask, “How many sexual partners have you had?” which is different than if our friend asked the same question or our parent asked…

The fact is that people usually try to be polite when asking questions…whether it is a question about the ends of the earth to which your romantic destination takes you…or… about health… At least, we think we are trying to be polite…

How are asking these questions relating to health like a sleigh ride…?

February 13, 2011

Seven Springs… A horse drawn sleigh ride… There is something very spiritual about riding through falling snow deep into the woods. And it can almost seem as if you’re floating right into the horizon…

Questions about health and health care can be like that… They go beyond the focus on illness or disease. They often go to the horizon of working in health care… Nurses working with doctors… “What’s that like?” And doctors talking to patients.

Have you ever thought about what it would be like yourself to be a doctor? Imagine asking a doctor, “Does talking to patients make you nervous?” What about asking patients, “Do you have trouble making ends meet?” Or, “Do you need financial help?”

In each of these cases, the way the question gets asked makes it hard to imagine that anyone could answer them honestly…

Why would anyone become a doctor if he or she gets nervous thinking about talking to patients? Perhaps that isn’t the best way to think about it. Why wouldn’t anyone get nervous at the thought of talking to someone about something so important and so personal as their health?

If you were a doctor, how would you go about talking to your patients in ways that respect their religious beliefs? What about breaking bad news, like a cancer diagnosis–wouldn’t that make you nervous? Every conversation is a little bit like going forth into a snowstorm…counting on someone to guide the way but preparing to make the most of the trip…

What’s wrong with these questions?

February 12, 2011

“What are you doing in your free time?” “What do you guys eat?” “Do you have a problem eating healthy?” “Why is tanning so important to you?” “Do you have an eating disorder?” “Do you think you have a problem with eating healthy?” “Do you choose white or whole wheat bread?” “How were you raised?”

Each of these questions has the potential to seem critical. Asking someone what they do with their free time…could be a friendly rapport-building question in the mind of the person asking the question. But it also has a risk related to seeming to imply that there might be a right or a wrong answer. And if that is true, if you ask me the question, I am going to want to appear to be the kind of person who spends my free time doing things that fit my sense of self. I don’t think of myself as “lazy” and so if I tell you that I like to watch “Survivor” or “American Idol”–will it seem like I am lazy?

And asking me what I eat–when, yesterday, today, over the holidays, when I eat alone, when I am at work? Again, there are so many ways to think about that question and how my answer may say something about me that I don’t want it to say. So, how about if I just say, “It depends,” is that helpful in suggesting how to guide my eating habits?

And what about tanning? I heard that you need some sunlight to get enough vitamin D to help avoid osteoporosis. So why shouldn’t tanning be important to me?

The questions and our answers are likely to be linked to telling us to change our behavior, and we have some instinct about that as well. Most of us like to make smart choices. So a little bit of coaching can go a long way toward helping… But, just telling us “to stop tanning,” or “don’t eat junk food,” or” find more time to exercise…” –well, we’ve heard it all before.

When we talk about health, it helps to think about the fact that most of want to be liked by others or at least to have a chance to show how what we do matches who we think we are…most of the time.