Writing prompt: Never underestimate the lives of old men sitting on park benches

Three elderly men sat on a park bench.

“Looks like a storm brewing.”

“Nothing to do with me.” The man in the middle asserted quickly.

“Didn’t say it did.” The first man returned slowly.

“You say that now, but we both know you don’t mean it.” He growled deeply. “Whenever there’s trouble you automatically think of me.”

“It’s just conversation! Besides, it’s not you that’s the real trouble-maker of our home.”

The heretofore silent man smiled, amused, as he patted the dog at his feet. His eyes were closed as he enjoyed the breeze passing through the nearby trees.

“And what are you smiling at?”

He sighed, opening his eyes out of habit. “Enjoying the day, brother.”

“Leave him be.” The man on the other end of the bench sighed. “You know he doesn’t get out often.”

“Do any of us?” The man in the middle grumbled. “I remember when we could have had a time of it on a day such as this one.” This was said wistfully and the other men nodded in agreement. Now, they just enjoyed the quiet.

A warning rang out, “Look out there!”

With lightning reflexes, the middle man caught something as it flew towards them. The contact made a resounding smack, but he barely noticed. Opening his large hand, he realized how wrinkled and faded it had become after all this time. He stared in fascination at the round object in his palm.

“It’s gold.” He whispered.

“It’s not.”

“It is. Look again!” He asserted, shoving it in the other man’s face. His hand shook, but whether from age or something else, who could say.

“It’s merely a ball.” The third brother’s calm voice interrupted.

“What did you think…?” The first brother began, then stopped as he looked again. He paled. “It really does look like an apple…”

“Can I have my ball back?” A youth stood in front of the men, shifting uneasily from one foot to another.

“Give the boy back his ball.” The third brother prodded the man next to him.

Eyes narrowing, the man with the ball looked critically at the youth before him. “Doesn’t look like a scamp…” He began, clearly unconvinced.

“Nothing like … your spawn…” The first brother’s eyes were wide as he leaned closer to have a better look.

“Is … there something wrong with him?” The youth asked uncertainly.

“My younger brother is reminded of an outing long ago. There was … another … yellow object…” The third brother paused. “It did not end well.”

The youth frowned, looking from one old man to the other.

“We’re frightening the boy.” The third brother sighed, shaking off the memory. “Here… catch lad!” Quick as silver  the man snatched the golden ball and threw it into the air.

Catching the ball, the youth looked again at all three old men before joining his friends that had walked over to see what was happening.

“Everything okay?” One of the boys asked.

“Yeah.” The youth shrugged.  “Just some old guys talking like they’ve never seen a ball before.” He scoffed.

The dog growled, shifting uneasily.

“Easy, Cerebus.” The man patted the dog. “They mean no harm. We should be getting back before we’re missed.” He heard his brothers grumble as they got to their feet and began walking behind him. They walked in silence for a time.

“You think they found out we were gone?” The first brother asked quietly.

The youngest brother shrugged. “What do you make of it, Hades?”

Hades heard the concern in Zeus’ voice, though he tried to hide it. He knew without seeing it, the worry in Poseidon’s walk. “It was merely some boys playing. But … you know all too well what comes of not inviting her.”

All three men shivered. If only people realized even the gods didn’t like to cross Discord.

Note: If you don’t already know it, check out “Golden Apple of Discord”

I Write

In fact, I’ve spent my career and life writing. There is nothing I will not write: proposals, grant applications, elevator pitches, press releases, slogans, collateral, advertisements, advertorials, customer service guidelines, technical columns, user handbooks, bed-time stories, poems, songs, and even fanfiction.

Now I write a blog.

There’s something about language … selecting the precise word to convey a specific action or emotion; describing a feeling so completely that a reader is unaware of any other; drawing that reader into a character’s mind and world so they want nothing more than to know what’s next…

There is nothing quite so heady as realizing that’s what’s on your desk for you to accomplish that morning. Every morning…

It is also humbling.

Never mind that some days it is the most daunting, overwhelming, disorganized ordeal attempting to write anything at all … some days it’s nothing you’d let anyone read.

But, this blog is about all parts of my life. My family has been quite clear: They want to read what I’m writing. So, here is an assortment of ramblings from various writing prompts and excerpts from various projects all for your entertainment.

Don’t say I didn’t warn you…

 

Innovation 101

I attended Ottawa’s first Hacking Health Hackathon a couple weeks ago. The place was humming with energy and it reminded me of my internet start-up days. The projects and teams were diverse, excited, and committed to their ideas.

It made me wish I had more time and energy to get involved because I learned a long time ago you want things to change, you have to get involved. Besides, as a patient, it’s my responsibility to ensure my perspective is part of all this innovation. And, I take that seriously.

However, something happened to me as I walked around speaking with the teams. I became less excited about the “innovation” which in many cases wasn’t anything new. There are many wait time tools, self-care monitoring tools, and the like already available. As a patient I was disheartened that there was so little participation from patients (the ultimate beneficiaries), including no patient representation among the judges.

And then it occurred to me: Yet again, people presume to know what is best for me.

I continued to smile and speak with people as I walked through the next room, but I couldn’t help but begin to look at the people and projects differently. I began to feel more uncomfortable about being there as a patient.

I took away two things from this event.

First, the greatest projects aren’t the ones that try (and fail) to solve the big stuff. The best aren’t trying to catch your attention and they sure aren’t innovative. Projects like the free flap monitoring floored me. Why? Simple, really. These teams took on something they could accomplish in a relatively short period of time. These projects have immediate impact on the quality of a patient’s life. You don’t need to convince the patient the benefit of this project, unlike so many of the apps.

These guys get patients.

There are projects that are not sexy. They are even boring. But, they are doing what needs to be done. Many cases, these should have been done a long time ago.

It isn’t all about innovation: Finding the new, the exciting, the panacea … it is about doing all the simple things that make the overall life of the patient better.

My second take-away is a two-parter. I should not be surprised that there is inequity in patient involvement because that has been the status quo for generations. Instead of leaving me dis-spirited, this inspired me. But, because there was little patient involvement, it got me to re-think what innovation really means.

Innovation is about change, revolution, upheaval, transformation, metamorphosis, and breakthrough.

Innovation doesn’t have to be a thing; it can be a new way of thinking.

Innovation isn’t the end; it is a means to an end.

Innovation can take tried-and-true from other industries because these ideas can be revolutionary or innovative simply by virtue of never having been done that way before in healthcare.

When you look at it that way, who wouldn’t want to be part of it?

However … you cannot bring innovation to healthcare … you cannot transform healthcare … without actively involving patients throughout the process. I’m not saying you won’t get it right without patients. I am saying whatever you do can be better with patients … if for no other reason than you get all stakeholders in the same room.

So, you want innovation? Be careful what you ask for. I’m a patient and I intend to change your opinions, revolt against your way of thinking, cause upheaval in the status quo, and transform the way we get things done.

I can’t wait to see what happens next…

The Thing About Hurdles

I used to love track and field as a youth. I loved to watch and I loved to participate. I loved the challenge of hurdles and long distance runs best.

I never could say what happened. All I know is the person next to me slipped, falling against me, causing me in mid leap to hit the hurdle right across the knees.

It wasn’t my first bad fall and it wouldn’t be the last. It was, however, the last time I ran hurdles. Although, now that I think about it… I’ve been dealing with hurdles of one kind or another all my life. So, maybe it’s not so much that we have hurdles we have to deal with, but rather how they come at us?

Fast forward to this point in my life… I often read that in order to be engaged, patients need to have more knowledge. I’m a patient and I’m telling you lack of knowledge may not be the greatest obstacle to engagement: It’s the constant barrage of hurdles.

In my quest for knowledge, I read a study in the American Journal of Managed Care (April 19, 2017) which found that 98% of patients want to receive their results online. Can’t say I’m surprised. Top reasons why: it saves time and we get more complete information. This is what I’ve been talking about for some time now!

Many patients do not mind receiving abnormal test results. While healthcare professionals continue to be concerned that without the face-to-face interaction and personal encouragement of such a visit (to receive lab results), patients are more likely to fail to plan their next treatment steps, it is clear patients want the information in their own hands. It’s called empowerment.

Which brings us to today’s particular hurdle: Extra charges for lab test results.

I received an invoice in the mail this week for a test that is no longer covered by OHIP. It’s for AST, a “relatively non-specific marker of liver disease and therefore has limited utility in the community setting”. So, maybe there’s good reason to exclude it unless the requesting physician is a hepatologist (as indicated on the invoice)?

I just want to know how else am I going to know that my liver function is still okay considering the nasty drugs I have to take for my RA? That piece of information was not included on the invoice.

So, in addition to this valid concern, this is the first I’ve heard of it and, according to the invoice, the decision was made in 2013, although it didn’t come into effect until April 2017.

I want to know where have I been for the last 4 years when I’m sure patients were being told about these changes?

I have a standing order from October 2016 and there was no mention of this change (and charge) from the physician nor from the lab that handled my requisition.

I’m one of those people who read everything, and I do mean everything, when I’m in a waiting room. Again, nothing in any of the physicians’ waiting rooms nor in the lab where I had my lab work done for the last 4 years.

Disappointed. Annoyed. Not surprised.

Some days it doesn’t matter how hard you try to keep yourself informed, educated, and knowledgeable, you still get stuck with a nasty surprise. It’s not that I don’t like a challenge, and I’m in this for the long haul (guess I still like that long-distance race). It’s just some of these hurdles seem so unnecessary. So easily avoided.

You want the best for patients? Don’t worry about abnormal test results. I have a support network for that. Don’t worry about unclear test results. I have google for that. Changes to what is covered and what is not? Now that I could have used a heads-up on.

Oh. That’s right… Guess someone did tell me… when I got the bill.

Is There Room for Patients on Your Bottom Line?

I’ve done my time as a senior executive. I get that the bottom line is what drives us. What I have to ask is: You do know customer service is part of that, right?

In any industry filled with opportunity in the form of big dollars, we often see numerous players. One only has to look on either side of any city street to see a variety of coffee vendors. Little wonder that if you don’t get your coffee as ordered and in a timely manner, you walk down the street to someone that understands you – the buyer – have the power. These guys get customer service.

The minute you walk into a bustling coffee shop, there is an energy that gives you a sense you are in the right place. Maybe it’s the music, the pleasant aromas, the smiles and chatter amongst people on both sides of the counter … whatever it is, that first impression has been made.

What’s the first impression in many healthcare organizations?

The minute you walk in, conversation stops. Your demeanor becomes more serious …. subdued. There is an absence of color, texture, and sound.

If it were only that, I think I’d accept it. Unfortunately, the atmosphere is off-putting and that includes the reception patients receive. It’s not rocket science people … smile, if nothing else.

We all have horror stories of bad receptions where the admin staff appears disdainful, unfeeling, and unprofessional in the initial exchange. Every now and then we get a good reception and what a difference it makes to the entire visit!

Case in point: A patient in front of me left the medical facility in tears because the staff member yelled that they didn’t know how long it was going to take and they were tired of being asked the question.

Rest assured, I didn’t ask the same question … but I wanted to.

Just last week, at the lab getting my blood work done, a technician assured the patient in front of me that they had a bed for her (for when she fainted giving blood), and that it wasn’t an uncommon request, and she shouldn’t feel bad about it in the slightest.

Maybe the different staff members were having bad and good days. Maybe some people just aren’t meant to be client-facing. And, maybe some organizations just don’t care about customer service. Because, if you care about your bottom line, you care about customer service, even if you aren’t getting it right.

One can’t help but posit: What can your healthcare organization do differently to better serve the patient?

As a patient, how do I get that experience of being served without being regarded as just a number? I realize we – the patients – aren’t in the same power position as coffee consumers, but wouldn’t it nice?

Patient Engagement and Other Mumbo-Jumbo

Say what you mean and mean what you say.

It sounds simple, but nothing could be further from reality in healthcare. That doesn’t mean we shouldn’t try, right? I have to wonder about the term “patient engagement”. I’ll be straight with you: it leaves me feeling confused at best, insulted at worst.

I’m confused about what you want from me, what I’m going to get out of this “engagement”, and where it will go. I’m insulted because it feels like whatever the goals and outcomes, they serve you, not me.

I’ve not been asked how I feel about the goals and outcomes my healthcare providers are looking to achieve through patient engagement.

I’ve not been asked what my goals are or what outcomes I want to see achieved. You do know my goals change regularly, right? What provisions have you made for that?

Let’s break it down …

First: We often see buzz words and phrases being tossed around because, well, they’re buzz words, which means they are the terms of the moment. Sure, they’re trendy and you sound cool and current, but if your end goal is a different response … you’ve missed your mark.

Second: When the association between words in a phrase is unclear, we tend to ignore it completely or at the very least be suspicious of the motives. I’m going to guess that neither is the goal … again, you’ve missed your mark.

Third: Patient engagement is a means to an end but not only do I not understand the end goal, we haven’t even had a conversation about what that end goal should or could be. Again … you’ve missed your mark.

Simply put, the word engagement is devoid of emotion. The words together don’t mean anything to me. I believe the intention is to engender feelings of warmth and caring, but they leave me confused, suspicious, and cold. Not a good start.

Engagement is a technical term to describe a relationship. It can be one-sided and if the two parties have not had a conversation about the end goal, then it is definitely one-sided in terms of decision making and power. And, because we have not had a conversation, and as a patient, I’m expected to be excited about this new “thing” that’s being presented, it is patronizing. It’s what we do to small children who are too young, too immature, and too inexperienced to know better.

Your language must be simple, clear, and honest in terms of the division of power and trust. This is not because we are incapable of understanding technical and academic language. Nor is it a matter of inadequate education. It is because the words we choose to outline our relationship matter.

To start, what do you know about the people you serve?

We may be patients, but we are so much more. Some of us are engineers, teachers, product managers, executives, technology gurus, software developers, and entrepreneurs. Many of us are also caregivers. We hold the hand of someone in need, we park the car at the doctor’s office, we wander the halls of the hospital looking for the correct department, and we listen to the instructions from the doctor or pharmacist.

What are you doing to tap into all that?

Answer that question and maybe we’ll get somewhere.

Here is the story I tell about the time the healthcare system got it right:

I was woken from surgery last year and although the procedure had gone satisfactorily, I had not reacted well to the anesthesia. There was the anticipated pain from surgery to deal with, but also overwhelming dizziness, nausea, and disorientation. I couldn’t speak. I could barely hear, let alone process what was being said to me.

But, I could see clearly.

What I saw was a nurse seeing me just as clearly. She made the decision to keep me overnight in order to monitor my condition. In my single lucid moment, she asked me if I was in pain. My words were slow, but I assured her it wasn’t too bad. I didn’t want to be a problem. I didn’t expect anything but to be left alone. Her response was I didn’t need to be in pain on her watch.

I have not felt so precious, so taken care of, since I was a child with my mother.

What that nurse did was validate my experience, my pain, my person. We both knew she could do nothing about why I was there or anything after I left. But, while I was in her care, I would be comfortable.

Not only had I no pain … I was safe in her care.

It is unfortunate this doesn’t happen more often.

You want patients engaged? Give them a reason. Hear what they are saying and instead of giving them all the reasons why it can’t be the way patients want it, ask yourself why it can’t be that way.

You want patients to be committed to their own health? Give them an experience like I had, because that nurse had a significant influence on my speaking up about patient engagement.

I believe you need to start with a conversation. And, to start that conversation, look at the patient like my nurse did. Do not be swayed by what you want for the patient, because in doing so you do not live up to the covenant of trust extended to you in your role as healthcare provider.

Does that mean we’ll get all the answers to solve all the problems with healthcare? Are you crazy? The problems are too big to take on all at once. All I’m talking about it changing the way in which we tackle the problems.

The solution is not patient engagement: It’s having real conversations.

So, watch your language.

Illusion of Choice

I was reminded of the illusion of choice the other day. My father-in-law was deciding on dinner from the “soft foods” available on the hospital menu. I was surprised at how many tasty sounding options he had, even if he was restricted to soft foods. While he agreed he had more options than you might think, what he really craved was a salad.

It brought to mind getting my then six-year old daughter dressed for school in the morning in a timely manner because it also involved the illusion of choice. The night before we would select two outfits and the next morning she could choose one of them. It was simple, straightforward and it worked, until … the day she refused to accept that there were only two choices available.

See, the illusion of choice only works when we accept that we will choose from the options presented. In my father-in-law’s case, he felt he had no choice so he will stick to the soft foods for another couple days. The alternative would be detrimental to his health and he accepts that reality. The day my daughter realized she had an entire closet of options, she demanded to know why she had to limit herself. And, really, that is the question: why do we impose limits, when should we simply accept this is good for us, and when do we push back?

Let’s apply this to a treatment plan or more specifically to medication that has been prescribed to treat an illness. While we may be presented with more than one option, generally physicians have a “go-to” drug to treat a particular ailment (when medication is warranted). As patients, we are often so relieved to be diagnosed and know we can be treated with medication, we go along with it and wait eagerly for relief from the symptoms of our disease.

Here’s a question: how many people read the warning labels on their medication? I’m not talking about just on the bottle, but the multiple pages pharmacists hand out. As I’m sure most of us have, suffice it to say these scare the beejeepers out of me and that’s saying something considering the medications I take regularly.

I know, I know. The drug companies have to list all the possible side-effects even if the odds we experience them are minsicule. Ignore for a moment the risk of stroke, paralysis, or other nasty side-effects and consider the ones that sound innocuous enough like dry mouth, headache, and upset stomach.

From experience, I can tell you that after months of not having a flare-up (of inflammation), I desperately want to get rid of these “minor” side-effects because I will have forgotten how bad it was before. And that’s when we begin to run into compliance issues.

I started with a discussion about illusion of choice so let me get back to it with this: when a patient feels the side-effects are at least as bad as the original ailment, they begin to waver in their commitment to comply with doctor’s orders. Let’s not forget that taking medications are also inconvenient and expensive (especially for those without a drug plan).

Not saying it’s right, just saying it happens. We begin to wonder if there are other options. Sometimes, instead of asking our doctor, we take it upon ourselves to determine what options are available and that is when we run into trouble. Whereas my daughter was checking out her entire closet for options, patients have google.

So what’s the point to all this?

There’s a natural progression that patients go through in their treatment plan. If you recall, my father-in-law decided the soft foods restriction was worth following and it wasn’t going to last forever. Not only that, this treatment was not ambiguous or subject to the individual’s case: you have abdominal surgery, you have restricted diet. Period.

It’s when a patient has a chronic treatment plan that things get a little messy. There is no end to the treatment. There is no single way forward because everyone reacts a little differently to medications. Just like my daughter who wouldn’t accept a two option restriction – take it or leave it – patients in a treatment plan for the long haul will push back and that can be viewed as a problem or an opportunity for greater compliance.

Remember: the underlying premise is that we all want a patient to get better, but what “better” means for one party may be different for the other. We all reach a point when we can’t just tell a person the way it has to be “for their own good”. The illusion of choice works well for a long time, but when a patient starts pushing back, you have to be prepared to change the options to ones that the patient accepts for themselves … and then support them in those choices.

The alternative will always be non-compliance.