slow medicine – not can we afford it, but how can we not?

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The_Doctor_Luke_FildesBernadette Keefe MD

The Unease

Over the past few decades there has been an increasing disquiet among doctors and patients. Prior to the late 1970s (pre CT/MRI era) other than basic blood work and plain xrays, there was little in the way of testing for disease. However physicians were well equipped with a robust heritage of  patient bedside history-taking and examination skills. Adept physicians in elucidating a pertinent historical record and performing patient examinations were brilliant diagnosticians. Lavishly written patient narratives and exquisite physical examinations filled voluminous charts.

The late 1970s ushered in organized medicine, HMOs, regulations and abundant technological and medical advances. This potent combination resulted in a tremendous escalation in the volume and pace of healthcare. Physicians, once loved for their bedside manner and comfort (1950’s-1960’s) found, from 1980s-present that they were so rushed and burnt out they had little empathy to spare. Patients picked up on this and, coupled with little time to ask questions and (now) electronic medical records consuming their doctor’s attention, stopped feeling cared for. They stifled their questions and stopped buying into the therapies being proposed for them. (Note: Perceived lack of empathy has been shown to adversely affect clinical outcomes.)

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The Elite 8 – Summertime Edition

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elite-eight_waterBernadette Keefe MD

Introduction

In U.S. collegiate sports, “The Elite Eight“, are the final eight teams in the national tournament; two from each region. The outcome of those four games becomes, “The Final Four”. However, for this summer time edition of The Elite Eight, we’re talking about the revered “eight glasses of plain water per day” health dictum.

While optimal hydration is essential for health, and water is considered the “gold standard” of hydration, we do not need 64 ounces of plain water a day. We do, however, need 64 ounces or 1.9 liters of total fluid obtained via drinks and food for optimal functioning and health, especially during the warm weather and exercise.

Furthermore, what makes the eight glasses of water per day advice “elite”/special is that consuming a zero calorie beverage might just be the antidote to the current epidemic of obesity and Type 2 diabetes. Americans typically satisfy their thirst with sugary beverages. Shockingly, these drinks contribute the majority of our daily ingestion of sugar! Continue reading →

Health Literacy – Not “Feeling” It?

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Bernadette Keefe MD

Health Literacy – It’s still not catching on.

The Center for Disease Control and Prevention (CDC) defines health literacy as

“the degree to which an individual has the capacity to obtain, communicate, process and understand basic health information and services to make appropriate health decisions”.

 As a believer in improved general literacy for citizens, I have assumed that health literacy, achieved through quality health information, having been easily accessed and well understood, would be akin to the process of general literacy. But just as education involves more than the conveyance of information, it is similar for achieving health literacy.

Although considerable efforts have been made regarding the formulation and dissemination of health and self-care information, we are seeing little effect on health outcomes. All parameters of health and wellness in the U.S. remain stubbornly poor, including the high incidence of obesity, type 2 diabetes, heart disease, cancer, mental health, and addiction. Healthcare systems and healthcare professionals continue to tout patient engagement strategies and the importance of health literacy, but as Michael Friedman states in his excellent piece on the topic:

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Got Sleep?

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Bernadette Keefe MD

Introduction

The most recent data is that 20-40% of the U.S. adult population is sleep deprived: meaning they are not getting the recommended 7-8 hours of sleep per night. The consequences of inadequate sleep on both the individual and society as a whole, are significant. The worst of these include increased obesity, decreased attention and learning, increase in mood disorders, and an increase in accidents. Working against our desire for optimal sleep are our fast paced lives, inevitable work/life stressors, and 24/7 online media, entertainment, and socializing. Although these are formidable obstacles, we must make strides towards the holy grail of a “great night’s sleep” . 
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Robots/Robotics in Healthcare

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Bernadette Keefe MD

Introduction

Robots, through their combined “otherness” and “sameness”, capture the human imagination. However, the purpose of robots, and use of robotics, has always been, essentially, practical. Humans have used robots to do work since ancient times. It’s the capacity of robots to produce, on a consistent basis, over and over again, which makes them valuable. Now, with sophisticated software, robotic applications have shifted from the purely industrial uses, to include the service industries. With elegant algorithms, speech and facial expression abilities, and recognition, robots are increasingly interacting with us, on a more personal level, in everyday life.

The healthcare industry is under significant pressure from many sides. The major causes include: out of control costs and prices, labor shortages throughout the ranks, a continuous explosion of information and technology, and an increasingly sick and aging population. The promise of robots and robotic applications to help ease the labor gap, and improve efficiency and safety, has captured the attention of many in the healthcare sector.

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{Ultra}Processed Food: Too Sexy for Our Own Good?

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FrenchFries

Bernadette Keefe MD

“If we are what we do and what we eat, we’re potatoes: couched and fried.” – Ellen Goodman, Wall Street Journal

Introduction

Fast Food has a rich and storied history. In Roman times, through the middle ages, fast food, sold by venders, was a necessity, as many dwellings had no kitchen.

The British “Fish ‘N Chips” was popularized in the mid-1800s by coastal towns that needed to service the large trawling industry. The undisputed King of the Fast Food Industry, however, is the United States. With the introduction of the automobile in the early 1900s, there was ever greater access to fast-cook restaurant fare. America fell in love with “White Castle” hamburgers; the rest is history. America has the largest fast food industry, and, has peppered the world’s landscape with Subway, McDonalds, Kentucky Fried Chicken, Burger King, Starbucks, Dunkin Donuts, Wendy’s among others, whose outlets can be found in over 100 countries.

Due to its worldwide dominance of the Fast Food Industry, U.S. citizens are particularly immersed in the fast food culture, and sadly have “drunk the cool-aid”. While this essay addresses the effects of fast food and other ultra-processed food in America, similar consequences are occurring around the globe.

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Gamification in Healthcare – Let’s Play!

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Bernadette Keefe MD

 “Playing a game is the voluntary effort to overcome unnecessary obstacles.” (Bernard Suits)

Introduction

Game-play focuses and controls our attention, taps into our innate strengths, thrills us utterly, and compels us to greater resilience in the attainment of more powerful and effective skills. For these reasons, some believe that game-play is an invaluable tool to employ in tackling the biggest problems in our world today.

The ability of gaming to focus human attention so completely has attracted all those who wish to harness just a piece of that attention for their own ends. Business, education, and healthcare have all used gamification with the hopes of affecting certain desired behaviors. The goals of gamification in healthcare would be no less than to effect personal and societal behavior change, to achieve improved individual health, and the health of populations.

A flurry of aspirational papers and some early results propelled gamification in healthcare to a Gartner’s Hype Cycle * peak ‘hype’ in 2011-2013. Years 2014-2015 found gamification in healthcare in a period of disillusionment. Now the sentiment for gaming seems to be on the upswing, as more attention is being paid to high quality game design and targeted use.

 In this paper, I will give some history and context to game play, video game design, and the gameful mindset to show how gamification in health and healthcare can and does happen successfully when done well. I will also include demonstrative examples and a large number of references for further perusal.

What is A Game

Games are a structured “form of play or sport, especially a competitive one played according to rules and decided by skill, strength, or luck.” –wikipedia

The history of gaming goes back to ancient times and game-play is one of the oldest forms of social interaction. In essence, the games we play are a celebration of our potential, our dreams, and our innermost passions. Game-play is self-revelatory, and, at the same time, takes us ‘out of ourselves’.

The vast variety of game forms, both ancient and modern, speaks to the centrality of games, and game-play in human life. We play games seated, across from each other, standing, poised ‘in combat’ at the 50 yard line in stadiums, and across the world, in online video games. We stand, jump, kick, run for both online and offline physical games. ‘Exergaming’, the combination of video gaming and exercise, has taken individual and group exercise to a new level. The brilliant ancient Chinese game of ‘Go’, a territorial board game of strategy, is played with as much passion today, as it was several centuries ago!

Game-Collage

Collage of Non-Sport Gaming

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The Power and The Glory of Walking

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Introduction  

Walking

Definition: to move at a regular and fairly slow pace by lifting and setting down each foot in turn, never having both feet off the ground at once.-

Synonyms:  stroll, saunter, amble, trudge, plod, dawdle, hike, tramp, tromp, slog, stomp, trek, march, stride, sashay, glide, troop, patrol, wander, ramble, tread, prowl, promenade, roam, traipse

–Wikipedia

“What if a simple act could change the world?” – Born to Walk: The Transformative Power of the Pedestrian Life

Born to Walk – Trailer

Walking for Health 

The U.S. Surgeon General regularly announces public health campaigns, “Calls to Action”, which are deemed particularly important for the overall health of the nation. A “Call to Action” is defined as “a science-based document to stimulate action nationwide to solve a major public health problem”.

For 2015, the U.S. Surgeon General, Dr. Vivek H. Murthy chose walking as the focus, when he announced the ‘Step It Up’ campaign. The ‘Step It Up’ campaign was designed to promote walking and walkable communities. Here is the video which accompanied the launch:

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Sports/American Football & Concussions – A Love/Hate Bond

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Bernadette Keefe M.D.

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Introduction 

“If just 10% of the mothers in this country think that football is a dangerous sport, then that is the end of football” – The NFL 

The sports of American football, European football (U.S. soccer), ice hockey (a Canadian favorite), wrestling, lacrosse, and field hockey, among others, are associated with a significant risk of concussions. In the early 2000s, investigations of early, untimely deaths of several retired National Football League (NFL) players, showed similar microscopic findings in their brains. With this discovery, the disease of chronic traumatic encephalopathy (CTE), associated with multiple concussions on the football field, was introduced to the world.

Concussion, The Movie

League of Denial, The Documentary 

“You’re going to war with a corporation that owns a day of the week! “

Two books, one feature film and one television documentary have been released recounting the story of Dr. Bennett Omalu, the man who linked characteristic brain abnormalities, which he later named chronic traumatic encephalopathy, to the progressive dementia and erratic behavior in the pro-football players he studied. Countless scientific articles have been written, and the issue of traumatic brain injury in contact sports has now become front-page news. 

Concussion Movie Trailer 

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In Brief, Football: The History, The Violence, The Grace/Beauty

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1rst-intercollef-football-1876-Yale-Vs-PrincetonBernadette Keefe M.D.

Introduction -The Passion, The Inquiry

The Golden Game, the game that decides the 2016 National Football League (NFL) champion, will be played in Santa Clara, California, on Sunday February 7, before a stadium audience of 68,000 and a U.S. television audience likely surpassing 110 million (private TV sets).

Football is immensely popular in the United States. For many, it is a favorite past time and, is often dubbed America’s sport. Football is also big business, with tentacles reaching into two massive empires: media, through TV networks such as ESPN, and gambling, from Las Vegas back rooms to online Fantasy Football websites such as FanDuel and Draftkings.

Notably, football is a particularly violent game, one in which brute strength is as important as skill. The over-riding mission is to destroy/nullify opposing players who stand in the way of ball possession and goals. Injury is common in the sport, and can be severe.

As a Carolina Panthers fan, but also a physician, the violence in football has always been unnerving. For me, the sport’s allure is in the many graceful, athletic moves, especially the leaping, and reaching. For many others, however, it’s the cold, hard violence that thrills. As a prelude to my larger post on football, to be released later this weekend, I wanted to delve into the roots of the sport, and ask: Was football always so violent?

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#irishmed, Telemedicine and “Technodoctors”

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An inspired, and, cautionary guest blog on the impact, the value, and drawbacks of technology in doctoring – channeling the gifted Abraham Verghese –

A Medical Education

This evening (all going well) I will participate in the Twitter #irishmed discussion, which is on telemedicine.

On one level, telemedicine does not apply all that much to me in the clinical area of psychiatry. It seems most appropriate for more data-driven specialties, or ones which have a much greater role for interpreting (and conveying the results of!) lab tests. Having said that, in the full sense of the term telemedicine does not just refer to video consultations but to any remote medical interaction. I spend a lot of time on the phone.

I do have a nagging worry about the loss of the richness of the clinical encounter in telemedicine. I am looking forward to having some interesting discussions on this this evening. I do worry that this is an area in which the technology can drive the process to a degree that may crowd out the clinical need.

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