Health Literacy – Not “Feeling” It?

Posted on June 1, 2016 by Bernadette Keefe

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

Posted on April 4, 2016 by Bernadette Keefe

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!

Posted on March 16, 2016 by Bernadette Keefe

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!

Collage of Non-Sport Gaming

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Time to Decouple Fear and Health

Posted on January 21, 2016 by Bernadette Keefe

Bernadette Keefe M.D.

“Pseudo-dangers represent further opportunities to avoid problems we do not wish to confront….” – Barry Glassner, The Culture of Fear

Introduction

For a while now, I’ve been concerned about the increasing role that fear has played as a tactic in persuading patients to choose certain treatments in healthcare, and to adopt certain habits. Fear is also, often a dominant driver for patients in their health decision-making process.

Fear, however, is an unwanted distraction when making decisions. In contrast to a calm state of mind, it creates added anxiety and stress, in a citizenry already burdened with increasing stressors. How can adding to this be constructive, or further, even moral? How can healthcare decisions, made from fear, be in any way conducive to optimal health outcomes, or conducive to sustainable well-being throughout our lifespans?
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Tribes and Silos, and, Tribes VS Tribes in Healthcare

Posted on October 23, 2015 by Bernadette Keefe

Bernadette Keefe MD

“the point is to be together, to mix our differences”

@Bionicohand at @iMaginationCtr

Introduction

If there is one movement that describes the current wave of disruption in industries from media to healthcare and in-between, it is the breakdown of barriers and democratization of processes. However, to accomplish a smooth transition to more workable, inclusive systems that will serve all, there must be a change in culture, a meeting of the minds.

In the healthcare field, there are many stakeholders/ “tribes”, each holding disparate positions. In order to evolve together, we must tear down our walls and silos and form bridges between our tribes. Such radical action is necessary as many errors and misunderstandings in healthcare are, at their core, communication issues arising from stakeholders speaking and acting from isolated positions.

Amidst ongoing conversation about healthcare silos and the problems that they might be creating, comes the timely release of Gillian Tett’s, “The Silo Effect: The Peril of Expertise and the Promise of Breaking Down Barriers”. While Gillian Tett comes from a financial background (as U.S. Managing Editor and columnist at the Financial Times) she has been more widely recognized as a superb thinker and writer. (See NY Times book review and APM interview)

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Falls Prevention Day 2015: Will the real ______________, please stand up!

Posted on September 22, 2015 by Bernadette Keefe

National Falls Prevention Awareness Day ~ September 23, 2015

“Take a Stand to Prevent Falls”

Bernadette Keefe MD

“One of every three older adults falls each year, but less than half talk to their healthcare providers about it.” – Lawrence Z. Rubenstein MD, MPH Chair Geriatrics – U. of Oklahoma Health Sciences Center

Introduction

Tomorrow, September 23, 2015, the U.S. will celebrate the 8^th Annual Falls Prevention Awareness Day. The announcement on the National Council for Aging (NCOA) Falls Prevention Day website reads:

“The 8^th annual Falls Prevention Awareness Day (FPAD) will be observed on September 23, 2015 – the first day of fall. The event seeks to raise awareness about how to prevent fall – related injuries among older adults. The 2015 theme is Take A Stand to Prevent Falls and the official twitter hashtag for this year’s event is #FPAD15 Continue reading →

Our (Cultural) Sugar High

Posted on September 3, 2015 by Bernadette Keefe

Sugar-comparisons HIGH

Bernadette Keefe MD

‘We need to start talking about how our food supply is making many of us sick.”

“Sugar high” is the term used to describe the cascade of responses after eating a sugar load. A high sugar load, especially a pure sugar load, triggers is a rapid release of insulin to counteract the high blood sugar. With that response, glucose is absorbed into cells and the blood sugar plummets. We feel hunger with the low blood sugar and if we consume a sugary snack or meal, the cycle restarts. The taste of sugar is also ‘addictive’ over time. At this time we have a cultural sugar high, a palate tuned to the taste of sugar, across our nation and indeed the world. It has led to unprecedented levels of Type 2 diabetes and obesity. Continue reading →

The Radiologist – Clinician Relationship

Posted on August 21, 2015 by Bernadette Keefe

losing our marbles – the dementia epidemic

Posted on July 28, 2015 by Bernadette Keefe

By Bernadette Keefe MD

All of us have personally known or heard the familiar drill. Dad couldnʼt find his way home. Mom didnʼt recognize her best friend. More and more memory lapses are occurring. Thereʼs a kitchen mishap. Finally the trip to family doc with the dreaded questions: Is It Alzheimerʼs? Is It Dementia?

The answer is yes, and they have a lot of company.

4.5 Million in the US are currently living with Dementia. The estimated prevalence of dementia among persons older than 70 years in US was nearly 15% in 2010. It is estimated that by 2050 there will be 13 Million people in the US living with dementia. There was hope that the incidence might be tapering off and even declining (from data comparing 1993 to 2002), however with the recent sharp increases in prevalence of diabetes and obesity over the past decade, it is feared that the numbers may rise precipitously.

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Quadruple Aim: Care of the Physician

Posted on July 26, 2015 by Bernadette Keefe

By Bernadette Keefe MD and Matthew Katz MD

The classic ‘triple aim’ for healthcare is a framework developed by the Institute for Healthcare Improvement (IHI) that describes an approach to optimizing health system performance. IHI asserts that new designs must be developed to simultaneously pursue three dimensions which we call the ‘Triple Aim’:

Improving the patient experience of care (including quality and satisfaction)
Improving the health of populations, and
Reducing the per capita cost of health care

Numerous publications suggest that the list be expanded to a ‘Quadruple Aim’ to include: Improving the Care of and Experience of The Provider (ie MDs/other HCPs).

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