by George J Huba PhD (Psychology)
The questions are simple.
The answers are not.
And, it is expensive to generate good data.
by George J Huba PhD (Psychology)
The questions are simple.
The answers are not.
And, it is expensive to generate good data.
The Veterans Healthcare System is the most important one we have in the USA.
One thing that all of the cable news networks and newspapers agree on is that issues of veterans’ health are ones on which all members of Congress seek to achieve a consensus. An interpretation of this that I have heard from the TV pundits is that all members of Congress, whether veterans or not themselves, respect those who risked their lives to protect the United States and police the world. Another interpretation I have heard is that all members of Congress need to face constituents who value service in the military and would not vote for a potential member of Congress who does not protect those rights. I prefer the first interpretation, although I would also accept the second. Veterans have earned lifetime healthcare services and those services should be the very best that the medical and social services can provide.
I was very happy to see the strong reaction of Congress to the poor candidate nominated recently to head the Veteran’s Administration. A doctor who has managed a staff of 70 healthcare providers is probably inadequately prepared to run a large federal agency with hundreds of thousands of employees, 9 million patients, facilities across the US, and many political entanglements. Just because you are the personal physician of the US presidents and praise the current president’s health in spite of his all-fast-food diet, borderline obesity, and behavior that indicates high levels of stress does not mean that you should be rewarded with a job in charge of the quality of the healthcare of 9 million veterans. And no doctor who hands out medications on airplanes without prescriptions or having personally met with the recipient (patient) and is accused of inappropriate interpersonal behaviors is deserving of being trusted with the health of our veterans.
For once, Republicans and Democrats agree that the candidate was not qualified to head the Veterans Administration. And they achieved this conclusion by consensus.
So the nominee did the right thing and withdrew from his candidacy after a lot of pressure from the White House.
Wouldn’t you like to see our elected representatives act with similar wisdom and common sense every time they make a decision? CONSENSUS!
Tinkerbell thinks so.
And I am wishing upon a star.
Those numbers are numbing and scary.
The numbers listed below could counteract those listed above.
We see so many of these ridiculous numbers every day that the country seems to have become numb. That’s a very bad thing indeed.
Trump/RyanCare another draft not submitted to Congress?
Within the extant and mythical healthcare plans, additional dementia care services need to be included. Most are cost-neutral or may actually save money while providing better patient outcomes.
Case Management makes existing healthcare services (doctor visits, medications, emergency care) work better. At a very small cost that should actually SAVE money, case management can provide better total patient care, cut unnecessary emergency room visits, and achieve better medication outcomes. What isn’t there to like?
Dementia Caregivers are most often UNPAID, female family members forced to juggle their own jobs/finances, families, and general lives to care for a loved one. Support is required for Dementia Caregivers in the forms of training, support, advice, and FINANCIAL COMPENSATION for their services. They do the work, they should get paid for their time. An upgraded system of paid family caregivers should make DementiaCare more effective and reduce other costs in the healthcare system to such a degree that it will be cost-neutral. An unnecessary hospital stay or emergency room visit can cost as much as $10,000 — $20,000. A family caregiver could be paid for 500 hours at $20 per hour for $10,000. Train family caregivers, pay them, and you have a cost neutral system. What isn’t there to like?
Mental Health issues often lead to huge patient distress, anxiety, and medical management problems. They can frustrate caregivers and lead to nonadherence to medication recommendations. Therapy and counseling can help patients and caregivers as well as cutting overall medical costs. What isn’t there to like?
Group Adult Daycare can provide needed respite for family caregivers as well as important social and recreational experiences for patients, thus enhancing their lives and to some degree ability to function independently. What isn’t there to like?
The following mind model provides some details. Click the image to expand it.
One way that healthcare communication can be made more effective is to supplement or replace traditional pages of small-type textual information with graphic displays such as mind models (AKA mind maps), sketches, graphs, and infographics.
This post focuses on mind models (mind maps). The same general arguments would apply to sketches, graphics, infographics, and other visual information methods designed to promote a more effective patient-oriented healthcare system with more complete, accurate, and easy-to-understand information for all.
If you are not familiar with mind models (mind maps), you should look at the mind map at the bottom of the page first (Footnote).
Healthcare (medical, health, mental health, nursing, and other health professions) mind models (or mind maps) are not the same as those plain old “knowledge” mind maps you are used to seeing.
When you start to put a compelling and artistically sophisticated mind map together that gives symptoms for diseases or recommended treatments or medical information ranging from how to put on a bandage to how deal with your elderly mom’s dementia, you have entered the realm where misinformation can hurt people. Most of the health and medical information mind maps on archival websites like Biggerplate.com have errors of content ranging from being out-of-date to misleading to downright harmful. It is not necessarily enough to read something even from a definitive source and mind map it. Rather, you have to identify definitive sources and then know how to evaluate their claims against more recent research and regulations and criticisms by credible sources.
Being called (by yourself or another source) a professional or expert or inventor mind mapper does not mean that you are qualified to mind map health or medical information. It takes at least 22 years of total education to get through the formal training and supervised practice to meet the requirements of most types of professional health-related licensure in the USA. Physicians and nurse practitioners may need to complete as as many as 32 years of formal education and supervised practice. All licensed healthcare professionals are subject to requirements for continuing education requirements after completing training and licensure in most US jurisdictions for most fields.
So before you decide to read a book on dementia and make one of your wonderful artistic mind maps, think about whether you have the necessary professional training and experience to read the relevant research and clinical literature accurately and with the perspective and sophisticated judgment that can reject erroneous claims. And when you start to make claims that mind mapping or some herbal supplement or yoga or cognitive training or crossword puzzles or some exotic mumblings you heard in Haiti can cure or treat or prevent dementia, make sure you realize that if you provide false information you may be hurting people and possibly incurring a financial liability. I respect and use mind maps (and especially Huba mind models) from people who clearly have expertise in healthcare, medicine, psychology, and related fields. I do find the mind maps of “professional mind mappers” and mind map “inventors” and mind map developers to be very poor in their content when they try to stray into healthcare-related content they really do not understand and do not stay in the areas of management consulting, training, and brainstorming where they made their fortunes.
This is a consumer-beware situation as no one regulates mind maps and their content.
A mind model (AKA mind map) looking at the issues that can arise because healthcare mind maps are not typically within the expertise of individuals identified as expert mind mappers who have not been trained in a health-related field.
Click on the image to expand it.
Better non-medical outcomes for person with dementia, low cost to train, low cost for software, huge benefit for the costs … what is there not to like?
This is another recording of my own development of mind maps to illustrate that this can be a way of communicating ideas while having cognitive impairment. I can develop models like this in less than an hour and have them published immediately on my web site.
Other posts in this sequence are
Verbally I cannot get two sentences in a row out of my mouth so as to explain these ideas to others. Were I to try I would also be distracted by everything going on around me and probably experience great anxiety and coughing fits. You would also find it difficult to interact with me because you would want to end all of my sentences, be unable to look at me because my face goes into a fierce expression most interpret as anger when I am thinking, and be off-put because I often go into repetitive body movements (tapping fingers and feet and rubbing eyebrows) when I get moderately anxious (or worse).
This medium works. I attribute this both to the benefits of the mind mapping for everyone whether cognitively impaired or not and also to the fact that using these techniques I seem to be able to access parts of the brain that for me are less damaged than many of the other skill centers (such as speaking clearly or understanding others verbalizations or recalling the words I want to use to answer questions until 90 seconds later). Using it also makes me anxious, but much less so than trying to express myself in even small social situations.
Very importantly, the mind map lets me continually see my prior train of thought as I work. I don’t have to try to remember what I thought about 30 seconds, or 10 minutes, earlier because it is right in front of my nose on the computer screen. This is a HUGE assist.
The map is compressed so that 8 minutes appear as 1 minute. Just watch the video unfold. Then you can look at the final map more clearly using the static map.
The final mind map is shown in static form below. Click to expand.
In Part 1, I discussed the benefits and costs of providing training to Persons with Dementia, Dementia Caregivers, and Healthcare Providers to empower them to use mind mapping methods.
I noted that unlike the traditional trainings given to primarily business users, healthcare workers and patients would need training which covered BOTH how to develop an effective mind map and specific ways to use the mind maps to enhance patient-centered care and patient-provider-caregiver communications and documentation.
I think that the minimal training in aggregate for the three stakeholder groups can be summarized in the following mind map. Note that not all modules (topics) are necessary or appropriate for all three groups.
Click mind map to expand.
I have argued for several years, especially in my book “Mind Mapping, Cognitive Impairment, and Dementia,” that communication among persons with dementia, their caregivers, and healthcare providers can be greatly improved by using visual thinking methods.
Mind maps are probably easier to understand for many persons with dementia than the traditional forms, small font information sheets, lists of to-do items, pharmaceutical labels, and guidelines. Mind maps can be used for visual journals and diaries that can still be understood at later stages of the disorder.
To use these methods effectively, it is imperative that healthcare providers and caregivers be trained in effective mind mapping methods. While many medical students are shown how to mind map, the techniques used are actually very ineffective ways of visual outlining that employ few, if any, of the real strengths of the method. These outline maps are clearly not appropriate for persons with dementia. Hence caregivers and healthcare providers need to be trained in “real” mind mapping methods AND how to communicate with these methods with persons with dementia.
Most of the trainings and mind mapping books and web sites are oriented to business users, especially at the management level. I have yet to find training sessions especially geared to both the mind mapping and patient care and management issues implicit in healthcare and caregiving. So how should we train healthcare professionals and caregivers to use mind maps effectively for the benefit of the person with dementia? The following mind map is a set of suggestions for how to train such individuals effectively. The trainings are designed to produce mind mapping experience specifically focused on patient care and management of those with dementia.
Click on the images to expand.
The majority of the posts on this blog are about using visual thinking methods — of which I think that by far the best is #Buzan-style organic mind mapping — to understand, explain, evaluate, and communicate about healthcare. A lot of my own thinking has focused on using visual thinking techniques to potentially improve the quality of life of those with cognitive impairment and dementia.
Tony Buzan and Chris Griffiths and their colleagues and staff at ThinkBuzan have done a very comprehensive job at getting many of Buzan’s ideas embedded into a general purpose computer program (iMindMap) which provides a general visual thinking environment, of which mind mapping is a special part. There are many computer assisted mind mapping programs, but I have concluded that iMindMap is by far the best for creative visual thinking and communication, in no small part because it fully incorporates Buzan’s theory and theoretical implementation.
Like scientists and management consultants and educators and healthcare providers and patients and patient caregivers and students and many others, illustrators struggle with how to best use visual representations to support better thinking and communications.
Which brings up this beautifully conceived and executed little book that I have found to be mind expanding and liberating in how to develop and use a series of illustration techniques and “tricks” to look at things differently when trying to make creative breakthroughs.
Whitney Sherman is the author of the book “Playing with Sketches” which provides 50 exercises which collectively will change the way you think about creating images to understand and communicate ideas.While Ms. Sherman wrote the book for designers and artists, the techniques will be just as useful for visual thinkers in science, education, medicine, industry, and other fields. The beauty of Ms Sherman’s exercises is that in showing you fairly simple ways to make hugely informative and well designed images, the tools will themselves suggest many applications to visual thinkers of all types.
And, I have found that Ms. Sherman’s techniques can be used by the severely artistically challenged (of which I am one); the techniques are ones for Visual THINKERS, not necessarily artists and designers.
I have mentioned this book before in much less detail, but in the months I have used the methods, I have found that they WORK very well to facilitate creative visual thinking. For me they have promoted a breakthrough in how I see the visual thinking canvas.
Get the book, try some of the techniques (pick a random one here and there to start), discover that great artistic talent or aptitude is not required, and see how the techniques fit the information you study in search for better healthcare or disease prevention or decision making or facilitating creative group processes.
In partnership with Tony Buzan’s techniques for organic #mindmapping and Mike Rohde’s framework for #sketchnoting, the techniques codified by Whitney Sherman provide very powerful visual thinking tools.
I will be posting some examples of using the sketching techniques of Ms. Sherman to developing assistance and communication techniques for those with cognitive impairment or early-mid stages of dementia.
Walmart today eliminated health insurance coverage for 30,000 workers who work less than 30 hours per week. Trader Joe’s, Target, and Home Depot had already done the same.
What do you think a low wage employee at Walmart or Target or Trader Joe’s or Home Depot would do if their employer offered them the opportunity to work 31 hours per week instead of 29?
I smell a rat that the Republicans are calling Obamacare and I would call the GOP (Non-)Insurance Plan. Either way, many US workers are screwed by the actions of these big employers.
And who works for Walmart and Target and Home Depot and Trader Joe’s? When you shop there do you conclude it is the elderly who still need to work in their 70s because they never worked at companies that ensured that they would have enough funds in their retirement or high school dropouts (often single moms) or the disabled or recovering drug abusers or those with mental health issues or an over-representation of minority workers, many of whom are recent immigrants? I do.
So these big box stores are basically selecting an unempowered, vulnerable group of workers who can be paid minimum wage (or close to it), denied healthcare plans, and work under what often appear to be draconian conditions. Who pays to fix this? You and I pay taxes to provide Medicaid (and Medicare Disability) benefits to those who have nowhere else to go, and of course you and I also provide additional services to dependent children in the families of these Walmart and Target and Home Depot and Trader Joe’s employees. All of the money you and I pay to fix the Walmart mess is so that billions of dollars more can go to benefit a half dozen of the wealthiest Americans holed up in Arkansas.
We need to get this fixed. It is very clear that neither American political party has the acumen, motivation, humanity, and pure “guts” needed to right this situation once and for all.
Walmart and Home Depot and Trader Joe’s and Target will notice it if their sales come down 10 percent as a consequence of the poor treatment of their employees. Heck, they would notice if the sales came down 1 percent.
This is not a Democrat or Republican or Independent or “I don’t vote because it doesn’t matter” issue. This is not a minority issue nor is it an elderly issue nor is it an immigrant issue. The issue is quite simply that it is not right to tell a worker who goes into a fairly hostile work environment, works hard while there, and wants to continue to work instead of being dependent on public programs that they cannot work more than 29 hours a week because the company can make a lot more money by employing lots of “almost full-time” workers rather than full-time workers because it can deny workplace worker benefits.
These companies are causing their workers great pain and suffering by not paying living wages and providing enough hours to workers so that they can qualify for benefits and keep their families out of public programs. After all, the American dream is that working hard 40 hours a week will permit your family to enjoy at least a moderately comfortable life and provide your children with a good education and you with adequate healthcare and savings for retirement.
Your elected officials aren’t going to do anything. YOU can find other retailers that treat their workers fairly and buy your dog food, clothes, medications, motor oil, music and video disks, garden supplies, vacuum cleaners, condoms and lube, aspirin, watches, and cameras there. And I am sure there is a humane company who will sell you all of the power tools you want at the same price as Home Depot and also provide its workers with health insurance.
Make a loud enough noise and some alternate vendors are going to come out and show that they do pay their workers fairly and they would be glad to sell you the same goods you can buy at Walmart or Target or Home Depot or Trader Joe’s at the same or better prices. The free market is a powerful force for good as well as having a potentially dark side.
Capitalism is a great thing. Give your business to a humane company that will sell you the same stuff as the big box stores while also making the lives of their workers better and you will be practicing Humane Capitalism that rewards businesses for having great prices AND good conditions of employment.
My dog is not going to be eating Walmart food any longer. Hopefully your dog will not be eating it either. And I am no longer searching through those big bins of $3.99 DVDs in search of a movie with lots of plane, train, and automobile crashes.
After all, Walmart is already the worse kind of a train wreck imaginable.
Click the image above to open a new window and access the list.
Healthcare Costs = f(Patient Level of Understanding Condition and Treatment, Condition, Type of Treatment)
click to expand image
I drew this mind map in 2011 when I was disgusted with the lack of a organized process to develop a national consensus on what was needed for meaningful healthcare reform. I think this as true in 2013 as it was in 2011. Stylistically, I could redraw this map better now than in 2011. But everybody has to start somewhere, so I resisted that impulse.
I would note that some (all) of these scientist “types” are found in the US Congress (whether scientists or not).
Everybody in Congress wants the peanuts and bananas and too many act like King Kong.
Also note that I have been on consensus panels with all of these types.
I was sitting in the office of an individual designated as an “essential” federal employee at mid-morning on November 14, 1995. We were meeting at the US Department of Health and Human Services, Health Resources and Services Administration main offices in the Parklawn Building in Rockville, MD.
My federally funded Evaluation and Technical Support Center for a HRSA Initiative on Implementing the zidovudine protocol for preventing HIV transmission from HIV-positive mother to her child during birth was meeting with 10 federal grantees the next day in Baltimore. The meeting was mandated by the HRSA funding agreements.
Each project had at least three staff in transit to Baltimore (most by air) for the meeting the next day. At least one representative of each project was a woman living with HIV/AIDS; this was mandated.
The bell rang at noon in the Parklawn Building. The loudspeakers had started squawking earlier reminding all non-essential employees that they must exit the building by noon. Guards came through the building reminding people to leave. It was eerie to be in the second-largest US federal office building with almost no other people around.
I met with the essential employee, the head of a very large program on HIV/AIDS treatment. She could not tell me whether to have the meeting the next day. While she could guarantee that the representatives from the projects would have their travel reimbursed she could not tell me whether the scheduled meeting rooms, scheduled food service, and other costs would be covered although she would allow me to pay for costs already agreed to through contracts with the hotel. She did note that we could not use use the meeting room we had paid for nor eat any of the food we had pre-paid. The meeting would no longer be a federal meeting. Everybody there was just a private citizen meeting because they wanted to be there after being stranded by having flown to a mandatory federal meeting that was cancelled without notice. No federal employee, however, could be at the meeting because they were not working and they were not allowed to go to any activity that could be construed as federal “work” since they might then demand payment for their time.
I had to tell this to about 50 attendees at 9 am on Wednesday morning. The Maryland Dept of Health agreed to let the group use space at their offices 15 or so blocks away. Everyone walked over there in freezing rain. Maryland made available a conference room that could seat about 12 comfortably, about 25 uncomfortably, and the rest squeezed in and stood. The State Director (part of the group) lent us her personal 10 cup Mr Coffee to brew coffee. In trying to make enough coffee for 50, I broke it, and when I returned to California, I sent her another one by FedEx because I was a little annoyed that she got very upset that I had dropped the $20 machine and had announced to 50 people that I was the reason there was no coffee.
After about an hour or so of chaos and having everybody totally upset — as they should have been — about having about 15 women with HIV (many with advanced stage AIDS) in an overheated claustrophobic facility along with another 35 people in an overheated claustrophobic facility, I decided that the company I owned would personally guarantee the costs for the meeting facilities and food that had already been paid — if the government asked for the money back from anyone because I had decided that those who had come to Baltimore in good faith could meet in the rooms already paid for and eat prepaid food that was going to be thrown out. As I recall this was probably close to $5,000 or more. Fortunately no one ever asked me for the money back and since I over-ran our budget by far more than $20,000 (which we never billed) in part because the feds had totally screwed up the process, that we were even. And, no woman with HIV had fainted or otherwise hurt herself during the meeting because we did not have healthy conditions.
The grantees were — as would be expected — totally pissed off. The initiative ran for several more years, but in a fairly “inefficient” way. Chaos. The feds went back to work after Thanksgiving, but then went out again for more than a month starting in mid-December when Newt Gingrich and Bill Clinton still would not do their jobs. When the budget was settled in mid-January, the government announced it would pay all of the federal employees for all days they had been sitting at home in Maryland and Virginia and the District playing in the snow and worrying about their personal finances.
A demotivated, angry workforce went back to work to deal with a number of demotivated, angry contractors and grantees. It wasn’t the same for another two years.
Obamacare was passed by a majority of the US Congress, all of whom had been elected by the majority of their constituents. It was signed into law by a President elected by the majority of the US electoral voters as specified in the Constitution. When the Constitutionality of Obamacare was challenged by those who did not like it, the majority of the Supreme Court Justices, each confirmed when appointed by a majority of the US Senate, decided that Obamacare was constitutional.
Each step of passing Obamacare into law was done according to the specifics of the US Constitution.
Those attempting to derail Obamacare by using certain procedural technicalities in ways never intended and just plain silly, are acting in opposition to the approved Affordable Care Act passed by the Congress and approved by the President and the Supreme Court according to the procedures specified in the US Constitution.
Are those in Congressional representatives holding the budget hostage Congressional “Leaders” or (in words attributed to Al Gore) “terrorists?”
Today, I hope that the US government will decide to “feed” those sitting around waiting for their US Congress and Executive Branch to meet their Constitutionally assigned responsibilities that the elected officials of the United States have sworn to uphold. Fortunately World War II vets in wheel chairs were allowed to look at the barricaded World War II memorial on the federal mall today (the barriers were lifted by Congress members in front of TV cameras); my further hope is that all of the veterans in VA hospitals get fed dinner tonight whether or not the TV crews are parked in front of the facilities.
Those elected officials who claim that their Tea Party is as much against “taxation without representation” as the founders were in 1776, obviously have not read the Constitution resulting from the actions in 1776. Thankfully, a majority of the Supreme Court justices and the President were in school that day.
One thing I have always feared about nursing home or home healthcare is that somebody who barely knows me would park me in a wheel chair or on a couch watching endless reruns of I Love Lucy or the Price is Right. Or ask me to endure hours of Kenny G or Hayden. Heck, if I have to watch TV for the rest of my life, at least put Battlestar Galactica or the college World Series on. Or Wynton Marsalis. Or Rocky and Bullwinkle.
Click on the figure below to expand. Seriously tell your caregivers and family members what you really like so they don’t have to guess. And so that they might remember you. As you really were.
Click on mind map to expand.
There are a number of things that can be done to cut the cost of healthcare while, at the same time, freeing doctors and others to do their jobs better. These improvements cost almost nothing to implement [if all of the constituencies and politicians do not compete to be King Kong].
Visiting legislator who stumbled across this web page? Here’s your chance to act like a grown-up and represent the people of the world, not drug companies nor major research universities nor individual “researcher” egos and retirement funds.
The Old …
The Current …
And the Ideal
BIG Data is coming (or has already come) to healthcare. [It is supposed to usher in new eras of research, economic responsibility, quality and access to healthcare, and better patient outcomes, but that is a subject for another post because it is putting the carriage before the horse to discuss it here.]
What is a data scientist? A new form of bug, a content expert who also knows data issues, an active researcher, someone trained in data analysis and statistics, someone who is acutely aware of relevant laws and ethical concerns in mining health data, a blind empiricist?
This is a tough one because it also touches on how many $$$$$ (€€€€€. ¥¥¥¥¥ , £££££, ﷼﷼﷼﷼﷼, ₩₩₩₩₩, ₱₱₱₱₱) individuals and corporations can make off the carcass of a dying healthcare system.
Never one to back away from a big issue and in search of those who value good healthcare for all over the almighty $ € ¥ £ ₨ ﷼ ₩ ₱, here are some of my thoughts on this issue.
Click image to zoom.
Content knowledge by a well-trained, ethical individual who respects privacy concerns is Queen. Now and forever.
topics and subtopics: who is a “health” data scientist? trained in healthcare? methodology research databases management information systems psychology? psychometrics other public health? epidemiology other medicine? nursing? social work? education? biostatistics? medical informatics? applied mathematics? engineering? theoretical mathematics? theoretical-academic statistics? information technology? computer science? other? conclusions must know content 70% methods 30% must honor ethics 100% laws practice privacy criminal civil federal state other greatest concerns correctness of results conclusions ethical standards meaningfulness validity reliability privacy utility expert in content field data analysis data systems ethics and privacy other member? association with ethics standards licensed? physician nurse psychologist social worker other regulated? federal hipaa state other insured? professional liability errors and omissions continuing education requirements? ethics renewal of licensure regulatory standards insurer commonsense laws go away if not well trained content field data analysis not statistics committed clean data meaningfulness subject privacy peer review openness ethics ethics ethics are arrogant narrow-minded purely commercial primarily motivated $$$$$ blind number cruncher atheoretical © 2013 g j huba
The USA has no highly visible, charismatic, scientifically-medically experienced, brilliant, and creative leader-spokesperson for federal healthcare programs. IMHO, the last one we had was C. Everett Koop in the 1980s.
Since being such a leader should be a Cabinet-level position, the best-qualified leader would get the same salary as an out-of-work former governor or political operative in the Senior Executive Service (about $200,000).
I favor a “healthcare czar” position to which the directors of various health-related US federal agencies report.
The effects of having a great leader with oversight on most major US healthcare initiatives would be huge. A positive thinking, creative individual should be able to get $100s of millions (or billions) out of the healthcare system while increasing quality. Instead of squeezing physicians on Medicare reimbursements we need someone who can squeeze the bureaucracy to lift money-wasting and unnecessary health regulations, squeeze the health insurance and big pharma industries to get-real about their profits, and energize the general public to personally address such preventable diseases as those related to obesity, alcoholism, tobacco use, and unwanted pregnancies. Such an individual could get cooperation from the press to research and write stories about positive system change.
Such a change costs only the small expenses of a search committee compromised of prominent health stakeholder groups, and the commitment of the President to health- and socialcare.
There are 100s of great medical-science leaders in the USA who can do a fantastic job of getting healthcare coordinated and understood by the public. Koop was a conservative, traditionally religious, Republican who took on the religious right over his medical conclusions that the reality of good medical practice in the USA had to get over homophobia and hatred of the homeless drug abusers in order to dampen the effects of the HIV epidemic. He also took on the major of lobbies of the tobacco industry in stating clearly that tobacco was addictive and responsible for millions of deaths. Koop’s politics were almost opposite to mine but the actions he concluded were necessary were the same as I would have taken from my liberal vantage points. Just as a conservative Republican can do an excellent job of guiding the healthcare system if she or he is a committed medical-scientist, so too can a liberal Democratic medical-scientist do a similarly excellent job.
Go ahead dismiss this idea. Then go back to reading my posts on your big Cinema Monitor from the company who had a charismatic leader and type your responses on a keyboard from the same company.
You want a great US national healthcare system that is efficient, treats patients and healthcare providers fairly, and stresses prevention and patient-centered care? Get a great leader. This individual will cost only about $200,000 per year and some ego stroking by POTUS and the Press. Let the unemployed former governors go find out what it is like to live on unemployment benefits and use Medicaid.
WTF hasn’t the search committee already started to form?
IMHO, as we used to say in the old days of computer bulletin boards …
In the current healthcare system, the people who most need help are the least likely to get it.
Think they need an annual physical, some vaccinations, antibiotics when they get an infection, a scolding when they get too fat, and a lecture when they smoke? Think again.
How do you deal with an individual who comes into an emergency room (or in the era of Obamacare, the office of a primary health provider) and is “sick.” Is it because they are homeless or abusing drugs or never had regular healthcare before or struggle with a psychiatric diagnosis perhaps developed as a survivor of rape, incest, or alcoholic parents?
Who do you think is in the current publicly-supported healthcare system of last resort? If that panhandler at the stop sign comes to see a doctor, the patient will typically be hungry, a chain smoker, unable to tell a coherent story or provide a medical history, and prepared to blame a doctor for not being able to fix all of the problems the person has encountered through life. Can you separate a life of living on the street while using drugs and eating fast food with lots of fat and cholesterol from what is found in a simple annual blood panel? Can you tell the medical patient to start eating in a healthy way (when the patient is homeless, has no job, has no money for Whole Foods Market)? Can you expect these patients to adhere to a doctor recommended treatment-intervention which might include lots of pills for an unhealthy lifestyle or because of HIV/AIDS?
High need patient-clients in the healthcare system have many needs and difficulties. Fix one and you see three more problems.
We need a system that can deal with patients-clients that have many of the problems shown in the mind map below. Concurrently. Simultaneously.
or alternately (same model, different way of viewing it) …
PS. I know that effective and cost-effective healthcare/socialcare agencies can be built because the US government has created dozens, if not hundreds, of these programs as “demonstrations” that the concept works. The program is then funded for about five years at a “fair” level and after five years receives no further federal funding (the program is then supposed to have a rich aunt or a “corporate” fund raising department). We KNOW that comprehensive service systems can be built, be effective, use resources appropriately and frugally.
It just takes a village.
Oprah, where are you?
by George J Huba PhD (Psychology)
Dementia is a time that gets extremely complicated for a person with dementia and their spouse, family, friends, new social acquaintances, healthcare providers, and caregivers.
Probably the biggest issue is that those who interact with the person with dementia expect the PWD to communicate in a way that is diminished but still like the way a typical person without dementia communicates just now at a lower level.
It is difficult to communicate with a person with dementia because their own experience of communications is now shaped by the brain changes and other symptoms of dementia. What about your Mom who no longer smiles when you say something she has always liked or when you bring her the pistachio ice cream she has always loved? Ever consider the possibility that she thinks she is smiling but has no control over nonverbal communication such as her smile. Brain damage of various types can cause the loss of nonverbal communication abilities or control of facial muscles.
Why does your friend always get overwhelmed and say something stupid when there are lots of other people around? Perhaps they can’t focus on what you are saying because there is so much noise and motion from distracting sources?
Ever wonder why your friend with dementia comes back with an answer to a question five minutes after you asked the question? Brain changes and damage during dementia may make it hard to retrieve information or think and a loss of a sense of time may mean your friend keeps working on answering the question long after the conversation has moved on.
In dementia, a daydream may be as vivid as something in the real world, and just as distracting. In dementia, you can’t deal with too much information because it distracts you and can’t “fill in the blank spaces” if you receive too little because your “executive functioning” has been destroyed. You tend to get anxious during a conversation not only from unpleasant topics but also from worrying so much about missing a word or forgetting a name or misinterpreting a suggestion as hostile when it was just a normal joke.
The physical and psychological consequences of dementia combine to make it seem that a person with dementia is speaking a different language. They are.
And yes, those 20 or more pills the person with dementia may take daily can affect the ability to speak clearly, pay attention, be sleepy, look like they are bored when they are not, or become even more anxious.
Additional thoughts are arranged on the mind map below.
Click on the image to expand it.
Always try to remember that the person with dementia is often not disinterested or misunderstanding you or too tired to think or extremely distracted in what you think is a peaceful environment.
And if you are a person with dementia, remember that your friend is not trying to mislead you or express hostility and disapproval. They are not trying to trick you or harm you or pick a fight. You might not remember a conversation your caregiver says you had 10 minutes ago, so get over it and trust the other person. Nobody is criticizing you as a person because you can no longer tie your shoelaces or your necktie.
All parties in a conversation with a person who has dementia need to realize that the “rules” for the social encounter have changed because of the disease. Both persons with dementia and their families and friends and caregivers need to realize that is just as hard for all parties to figure out this new “language of dementia.” But it can be done and when mastered can liberate everyone to some degree.
Learn to laugh and smile and enjoy the company of each other again. The positive emotions are still there but they may have to be expressed in different ways. Learn how to express oneself when one or more parties has dementia. It’s worth the time. For everyone.
#mindmap #mindmapping #dementia #Alzheimers @DrHubaEvaluator
In March 2018, @USNews and @AetnaNews published key results from their study of approximately 3,000 US counties. Each of these counties received a total score as an index of how healthy the community is as well as scores on 10 component parts of being a healthy community. Eighty indicators of community health were developed from standard, well-constructed, and valid datasets.
The Healthiest Communities rankings are based on well-collected longitudinal survey data from US government databases and those of well-established, not-for-profit organizations.
My professional conclusion is that the study is valid, reliable, and relevant. The index scores are based on a combination of expert judgment from independent professionals and data sources that are among the best available. Statistical analyses appear to be appropriate and expertly applied. Of course, as with all such studies, over time additional analyses can be made, interpretations can be added by experts of many disciplines not limited to health, and supplemental quantitative (numerical) and qualitative (judgment) data can be collected.
The report on America’s Healthiest Communities provides a summary of the top 500 communities. The remaining rankings are not revealed as the intent is to identify excellence and study it to establish models for other counties that are also working to improve the quality of life for their residents.
Data available on each community includes well-constructed indices of the following characteristics listed in the mind map below. Click on the map to increase its size.
I spent more than 25 years in my post-doctorate career studying the health of communities throughout the USA, including a) small “frontier counties” too small to be considered rural where there were 5 times as many cows as people and the trip to a doctor was more than an hour for more than 50 percent of the population; b) the fourth largest U.S. county in a location on the Mexican border; c) large-city neighboring “bedroom” counties; and d) healthcare systems in more than 100 other U.S counties. My work (in collaboration with my business partner Dr. Lisa Melchior and our staff at The Measurement Group) was primarily focused on developing high quality, effective, and accessible care and treatment for people with mental health problems, drug and alcohol abuse and addiction, HIV/AIDS, extreme poverty, unstable families, inadequate or housing, poor education, immigration status, criminal justice system involvement, dependence on public-supported health- and social-care systems, and legal unemployment with a subsequent dependence upon “illegal employment” such as selling drugs and sex work in order to support themselves and their minor children.
As we worked with health systems and clinics, what I concluded was that a very comprehensive service system with widespread support among residents, service providers, and elected officials was necessary to make a community healthy. It was clear that all of the major stakeholders in the system need to communicate clearly to the other stakeholders about what they could and could not do with available resources. Stakeholders needed to learn to how to leverage their resources with those of other stakeholders to provide better services for a lower cost. A permanent system of making decisions and sharing resources and improving services needed to be formed and nourished.
The basic components of our work included assembling data from sources such as surveys, focus groups, interviews, and public databases. We presented these data to groups of stakeholders and facilitated discussions on how various systems such as healthcare, public housing, law enforcement, and education-training could work together and share resources. Progress was monitored and evaluated and new cycles of data gathering, communicating, discussions, and program alterations were conducted.
The following diagram shows the steps our process went through in order to build a self-sustaining system of interdependent services and joint decision-making in order to make a community more healthy. Click on the mind map to increase its size.
It is often said that “it takes a village” to plan and implement long-lasting improvements in a community. It does, but it takes a few other things also as well. Click on the diagram to increase its size.