The Story

The Story is both the foundation and the capstone of civilization.

The Story is more than you probably realize. It’s not just a telling of a story in the traditional sense.

Medicine is a story.

Suffering is a story.

Healing is a story.

Science is a story: it’s got three parts – a guess, a test and a conclusion.

If the conclusion says the guess is wrong, that’s the end of the story. If it doesn’t conclude that the guess is wrong, then the story goes on to the next chapter.

The whole movement about empowered and engaged patients is ultimately about the Story.

Electronic Medical Records, Health Information Technology, Participatory Medicine, Comparative Effectiveness Research, Health Reform…they’re all inter-working parts of a grand story.

The Story isn’t always clear. Often muffled and depressing in fact. But all stories hold their hopes too.

When I speak of “the story”, I don’t mean it in the way that many marketing gurus utter it.

When I speak of the Story, I mean the way we make sense of our world.

When it comes to Healthcare, you and I are part of the Story.

We have our own stories and all of our stories relate – in some way – to each other.

It’s storytelling which we must enable.

If patients, patient advocates and providers don’t know how to tell their stories, how on earth can they be heard?

Remember: to tell great stories, you have to listen closely to the truth of what’s happening.

Tell. Your. Story.

Phil Baumann

Newsletter

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Healthcare Without Profit

Eternal debate: What economic system should be the platform for Healthcare?

Free market proponents: Competition and open choice lead to innovation, efficiency, equity, progress.

Single-payor proponents: Unification of resources leverages mass and engenders equality for all.

I won’t get involved with that debate here.

What I have to say relates to Art.

Underlying all economic theory are sub-theories, sub-assumptions about human motivations.

What economists almost always miss is the tricky nature of life. People change. One day he’s a Capitalist – and then something life-changing happens, and he reaches for Karl Marx for answers.

Yes, we need technicians in Healthcare. Yes, we need capital funding for projects. Of course!!!

What we miss all too often, however, is the Artist.

You see, the Artist eludes the stringent minds of the economists.

A nurse cares for people with as much attention as the painters at Lascaux.

We can – and should charge for providing care. It just makes economic sense.

But…

…But the Artist doesn’t care for making cents sense.

The Artist isn’t interested in rules.

The Artist isn’t interested in sterility.

The Artist isn’t interested in the price of a share.

No.

The Artist is interested in plumbing the depth and breadth of the human experience.

When the Artist looks upon the human body, she sees through her eyes what no x-ray machine can process.

The economics of our current capital system just don’t allow for Healthcare without profit. That’s a reality.

If you’re looking for justice in Healthcare, don’t expect the profit-seekers to change their ways. It’s not their thing – and they do have a role to play. Our world is not black versus white. (Besides, why would you want it that way?)

No, you’re better off looking for the Artists.

They’re everywhere, even though you might not see them.

Once nurses or physicians and other care-givers realize they are artists, the world of Healthcare will change.

Yeah, I know these words are bulls*it. But they’re spot-on.

I wish I could give you an example.

Wait, actually, I’ve an idea that’ll prove that *you* are a Healthcare Artist.

Right now there’s a big chance that a life-problem is troubling you – a loss, a divorce, a heartbreak, an ongoing frustration.

Take whatever it is, and in your artful mind’s eye cusp it within your hands – imagining it a puff of air, a fluff of nothing.

Hold that thought. Close your eyes. Slowly ball your hands around this problem.

Stay with it, motionless.

Now, whisper to yourself: “I am safe in this moment, and peace and health are always a breath away”.

Practice this, practice this, practice this.

There – you did it.

You created something out of nothing.

You created Healthcare without profit.

Phil Baumann

Newsletter

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Live-tweeting Psychotherapy

This is not a social media post. This is a question about health.

Twitter here is not to be taken literally – rather as a metaphor for contemporary communications and the culture of immediacy.

Gedankenexperiment:

You’re in psychotherapy. You and your therapist agree to have your session live-tweeted (by you, the therapist, or by an assistant). [Suspend disbelief – I know the professional problems here.]

What are the consequences of this live-tweeting?

  • On you?
  • On the public?
  • On the therapist?

It’s easy for extreme evangelists for “open healthcare sharing” to proclaim this would be beneficial because others suffering with problems similar to yours would hear your story. And they could support you too. And researchers would have novel insights and larger pools of data.

Perhaps.

But what if you were the victim of rape? What if you’re working out childhood abuse which only now you’re confronting, decades later?

What if a single reply – either from a jerk or a well-meaning follower – sets off a traumatic response or erases breakthrough insight?

See a problem?

I have more questions about this – and I plan to write more about it.

I’m also speaking at September 21 at #epatcon11 and plan to touch on the limits of communications in healthcare.

I like this Gedankenexperiment (or pre-gedankenexperiment) because it takes us to the extreme and forces us to more deeply question the world we’re living – and building.

Something to ponder after ten years of 9/11 individual and collective post-traumatic stress.

What do you think about psychotherapy in the public sphere? What are the benefits? What are the dangers?

Phil Baumann

Newsletter

484-362-0451

 

The Care Continuum

When thinking about health care, do we think of it in term of points, or steams?

You see, thinking about points of care creates a kind of thinking which is mechanical, isolated and disconnected from our true goal of providing care: healing.

Our bodies don’t work on a point system. Rather, everything is curvilinear and integrated and connected. These processes don’t just transpire within our bodies but through and around them: the electrons breathed off from a leaf have everything to do with the mitochondria in your cells.

Healing, the natural and artistic process of continuing care, works in steams. And just as those natural flows maintain and create life, our technologies and techniques and arts of health care must also flow together in tandem.

So: where are the key disconnects which we can link up right now using existing technologies and knowledge and experiences?

This is the key question we must ask when building EMRs, collaboration tools, social and other digital media…and, most importantly, when refreshing our thinking process when seeking to improve health care.

@PhilBaumann

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All Health Care Is Local

On the battlefield.

In the emergency room.

On your deathbed.

In the maternity ward.

In the pill you take.

In the taxes you pay.

In the premiums you  pay.

In the hand on that lever you pull on election day.

In the air you breathe.

In the food you eat.

In your sex life.

All health care is local.

…except

…except what happens in  my part of the woods affects what happens in your part.

The more we are connected, the smaller the world gets.

The smaller the world gets, the local gets global and the global gets local.

If I live in poverty, expect poverty to come closer to your home.

If I have an infection, expect those little critters to march your way.

If the local economy stalls, expect your insurance premiums to rise.

If the global capital system keeps weakening, expect unemployment in your town.

The blood cell has everything to do with civilization.

Once the circulation stops, the oxygen can’t get to the brain.

The fight for health care transformation isn’t in the halls of legislators.

No, it’s right inside you.

If we never abandoned our local communities, we’d never have a global health care catastrophe on our hands.

All health care is local.

So is disease.

@PhilBaumann@HealthIsSocialNewsletter

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For – Against – With

There are three ways to deal with Technology when thinking about its effects on our health, culture…future.

The first involves working for Technology. There’s no doubt that technology is advancing at such an accelerating pace that the gap between our powers and its may widen to the point where we have no choice but to submit.

The second – which is one conclusion from the recognition of the first – is to work against Technology. It’s not impossible that, if you extrapolate Technology’s advancement, that we will go extinct…that technology is an absolute enemy.

The third approach involves working with Technology, accepting both the inevitable good and bad of its unstoppable advancement and our right to be who we are in this world: human.

The first two approaches are easy to take:

  • If you like to accept things and let technology take care of your needs, no need to work too hard. At least at first. So work for technology.
  • If you’re a fighter, someone who refuses to submit to the power of the non-human, it’s easy to rage or flee. At least at first. So work against technology.

But the third approach – now that’s a challenge. It’s an art. It’s a discipline. It’s a skill to navigate the boundaries of the human and the technological. It’s an intelligence of where technology takes itself…and us. In other words: it requires leadership.

We humans are between Nature and Technology.

We embraced Technology in response to Nature’s nourishing cruelty. Our ancestors would not have survived into our special version without Technology. But now Technology too is emerging as a nourishing cruelty.

Just as Nature could finish us at any moment, so too can Technology.

And just as the answer to the dangers of Nature isn’t to destroy Nature, so too must we appreciate our situation with Technology.

This is the world individuals and organizations face with social and other digital technologies: work entirely for them, ignore or work against them, or figure out how to work with them.

For. Against. With.

Those are our choices.

Are you with me?

@PhilBaumann – @HealthIsSocial – Newsletter

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Will Social Media End Stigma in Health?

It’s an interesting question, given the origins of stigma.

You see, stigma is a social creation. The simplified version is something like this:

  1. The symptoms of a disease scare or mystify a group
  2. The group doesn’t understand (or doesn’t want to understand) what’s happening
  3. Ignorance, misunderstanding or fear create group tension
  4. The group seeks collective self-assurance or release in shunning
  5. The group needs a symbol of the shunning – a stigma

If you examine the history of stigmatized diseases, you’re likely to find this pattern. In fact, most of the stigmatizing wasn’t against “disease”, because whatever was stigmatized wasn’t identified as caused by biological factors.

You would think, however, that as societies gain knowledge via science and inquiry, that stigma would decline. And yet stigmas abound.

In our time, what effect do media have on social behavior? Specifically, will the use of social media enable the break-down of stigmas?

Might a benefit of social media be that people will find a mode of public facing where they can seek relief from the shame of stigma?

Silence has long been a fuel for stigma – traditionally, if the victims of shunning and stigma spoke of their suffering, their social groups would tighten the grip of the stigma.

Today’s media – perhaps because people can seek and find social groups beyond familiar ones – may just provide opportunities to assault the problems of shame and stigma which inflict such cruel punishment.

I’m wondering if any organizations are studying this aspect of health and media.

So, what are you thoughts? Will social media help to end stigmas? Or might they create new kinds? (Reminder: what has the power to heal has the power to destroy, and vice versa.)

@PhilBaumann – @HealthIsSocial – Newsletter

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Online Health Content: The Challenge of Interpretation

Is there quality health content online? I think that there is – you just need to know where to find it.

But the real challenge with health content online isn’t so much the content (although that’s a huge concern). The big challenge is Interpretation.

Health data without context isn’t information. Data is just data – it has no value in itself.

Information, however, is the relevant data needed to make a decision based on risk.

And this is where rests one of the hardest tasks of using the Web as best as possible in health.

In The Problem with Casual Medical Advice, Bryan Vartabedian (@Doctor_V on Twitter) raises a related point about the problem of limited context:

Everybody understands legalese.  Few, however, understand the complexity of a properly executed medical encounter.

This matter of interpretation in order to convert data into information is perhaps one of the ‘holy grails” of online medicine. I don’t know if we’ll achieve it anytime soon – not at least until our media and remote-monitoring technologies go Star Trek.

But there probably are some ways to problem-solve which medical schools and researchers may want to start exploring.

For now, though, getting more providers comfortable with being online is an important first step – that way they’ll learn how to port their patients into the right contexts of communication and collaboration.

As the public expects more physicians and other practitioners to engage them online – or at least have some presence – this problem of ensuring the proper contexts of interpretation will continue to need attention.

Perhaps this is something which Ted Eytan (@TedEytan on Twitter) and his colleagues can continue to do through the kind of work they did on The Permanente Journal. Do check out what they did – their work has been long in the waiting.

@PhilBaumann@HealthIsSocialNewsletter

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Mental Health Is Unhealthy

Once you separate the body from the mind, you split off the efforts to understand consciousness from science into mysticism.

For thousands of years, this separation has set the tone for how we understand what makes us tick. It’s created a deep chasm between our knowledge of “the body” and our understanding of “the mind”.

It’s no wonder, then, that “Mental Health” continues to be treated in a class of health that’s virtually disconnected from “regular” Health.

It’s why insurance companies got a way with disparity in policies.

The root word for health is whole. You cannot be whole if you are split.

Yes, “mental health” can be a convenient way to help distinguish from “bodily” health.

But here’s a problem: once you label something one way, it can be hard to remove the label even after it’s determined to be wrong.

For instance, someone may have an endocrine disorder which manifests behavioral signs and symptoms. By classifying the problem as “mental health”, there’s a chance that further investigation into the cause – looking at the endocrine system – is neglected.

This is where stigma originates too. Ignorance does that.

Our ancestors simply didn’t know that invisible particles whirring through invisible glial cells and synapses – working together at an incomprehensible power of complexity – could bring about consciousness. It was mysterious.

Our ancestors can be forgiven. We can’t – we don’t get to use ignorance as an excuse.

I’m not saying we don’t need certain ways of speaking so we understand each other; nor am I saying we don’t need specialists; nor am I suggesting we overdo reductionism.

What I am saying is that psychiatry has lagged behind other branches of medicine for too long.

Our fear of destroying mystery by learning the truth about ourselves is not a responsible stance. I think this fear of putting the “mind” under scientific scrutiny has cost us dearly in our advancement of making connections between how we think and feel with how we live.

Rather than using “Mental Health”, we need to use language which is more specific to the problem we’re trying to solve.

We don’t file cardiovascular disease or cancer under the phrase “Body Health”. Why should we file bipolar disorder or anxiety under “Mental Health”?

It’s all filed under “Health”.

The body and the mind have been separated.

That’s unhealthy.

@PhilBaumann@HealthIsSocialNewsletter

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Healthy Media

It’s so true that it’s a tired cliche: The medium is the message.

Marshall McLuhan’s proclamation almost 50 years ago has everything to do with our time.

Media are no longer intermittent parts of our lives.

Print, radio, television – you turned them on, you turned them off. You did the turning.

Today’s media – they stay on.  They’re sleepless faeries. They do the turning.

Each of these media has their own unique properties, possibilities, limits and uses.

What are the messages of these media? The media themselves.

The message of Social Media is Social Media.

So if the medium is unhealthy – addictive, misinforming, infiltrative, distracting – the message is unhealthy.

Those of us who want to make the best use of Social Media for healthcare, need a clearer language about how we can make the Web better for patients, providers, researchers, etc.

When we’re discussing the intersection of Healthcare and social media – whether a particular medium is good/bad for in a particular context – perhaps we should ask “Is this a healthy medium?”

WHAT’S HEALTHY MEDIUM?

It’s hard to understand what it means to claim “the medium is the message” because we’d like to think that the container and the content are different. The medium is the medium, we think.

Let’s think of it this way: What’s the message of a petri dish of bacteria? It’s the medium: the petri dish of bacteria.

The message of a gene is…a gene.

Healthy Media are those media which produce healthy messages. They propagate health.

The message of Healthy Media is Healthy Media.

If you’re looking for Healthy Media online, you’re looking in the wrong place.

So: what are Healthy Media? –

The cells in your body.

Your body.

You.

You are a healthy medium propagating the message of you.

THE MESSAGE OF HEALTH IS…

Sometimes the messages falter – bits and parts of you break-down. It may hurt. It may depress. It may kill.

But: there you are, all the while a propagating medium of health.

Can – and does – Social Media play an important part of staying and becoming healthy? Yes. And no. So you take the best and propagate the best.

But Social Media is not Healthy Media. It’s its own medium.

You, on they other hand, are a true social medium.

A healthy social medium.

What’s the message of your body? What messages are faltering?

Can you find other healthy social media – other you’s – to connect, share and help each other?

Because if you can do that, then you are building a network of Healthy Media.

Social Media isn’t the right phrase in Healthcare.

It’s Healthy Media.

You never thought of this before, but Medicine is about propagating Healthy Media.

Health Care keeps the Healthy Medium well; fixes it when it falters; and dignifies it when it dies.

You, my friend, are it!

You are a healthy medium.

You are the message of health.

The message of health is you.

@PhilBaumann@HealthIsSocialHealthy Messages from Hermes

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