The Myth of the Professionalized Patient

A sneaky business narrative has wound its way into health innovation. It's stolen the spotlight; taken our attention away from complex problems and made us fall in love with its  futuristic approach. 
Sol LeWitt - Wall Drawing 999 (Mass MoCA)

I'm naming this sneaky little narrative. I'm calling it The Myth of the Professionalized Patient.  A myth is powerful and sells transformation. A myth is always at the heart of any product we desire. That's precisely why the Myth of the Professionalized Patient is such a powerful one for industry and for government interests.

What traits does the Professionalized Patient possess?   
An archetype consumer, a master of health, the professionalized patient:
  • Demonstrates a sublime use of administrative tools
  • Gracefully tracks key data while complying with doctors orders (dispensed online in real time)
  • Is a model patient; he doesn't mind reading fine print online
  • Is highly literate and can negotiate the complexity of health care products and systems for self and others
  • Effortlessly adapts to (some say thrives on) change 

    You get the picture...

What's missing from this myth? 
We covet a clean, state-of-the art health system, but cold, clean, technical care is just one of many healing modalities appropriate to our system today.  It isn't the only one within reach.  

And yet now all all swept up into a tidal surge to become professionalized patients; expected to handle our burdens with dispatch and optimism, atop the desktop or mobile device.  No crying, no hugging, no eye contact allowed. 

Commentary aside, I believe that the Myth of the Professionalized Patient is accelerating us unconsciously toward adoption of a system that does not look out for our interests.  We won't even know what hit us when we wake up. 

Will patient engagement metrics (page views per month, number of e-mail messages sent, lab reports viewed online, etc.) be misconstrued and marketed as evidence encouraging the growth of online channels?  

With this will there come a potential to swiftly promote expansion of the electronic nurse-caregiver persona ... before we even meet her?

What about the big picture?  Do you find it alarming that the the more responsibility industry and government places on individuals to act like Professionalized Patients - to achieve desired health measures - the less responsibility these sectors will have for legitimately uprooting the social determinants of health that trap many of us at some point in our lives?

Pay attention. Since we are a fee for service system, the more these sectors are positioned to fine and/or penalize consumers for coming up short and not measuring up to the archetypal professionalized patient, their authority over us  grows. 

The story around the Professionalized Patient is bound to get more traction. It is futuristic, sexy and efficient. Who wouldn't want to believe? Yet human fallibility trumps tech efficiency.

Humans in the raw are not sexy. We age and don't like change.  We don't tell the truth, get sick and then have a hard time following doctor's orders.  We're busy and think we're right. We are distracted and want to feel better, have a good time and not work too hard.  It's not a selling story, really. It's just the story of health in 2013.


Making STEM education tasty

STEM education (Science, Technology, Engineering and Math) is being promoted as the cure for what ails American education and economic growth.  A parallel trend sweeping across our counties and cities is a push toward wellness and health activation, especially around movement and diet for overweight and obese children as young as preschool.

While these two distinct health programming trends are positive, I'd like to see the two campaigns commit to working together in service to the nation's children.  What power is there in science, technology, engineering and math alone? Without a healthy food system and ample consumer savvy for kids to steward their bodies and minds appropriately, we cannot advance the health, wealth and consciousness of our nation.  We will continue to invent outside of authentic social contexts, short-cutting some of the more challenging structural problems families face when trying to eat healthy while putting more pressure on children to do so on their own (while advancing their tech degrees).

How to adjust the current imbalance and inject the food context into the campaign to promote STEM education? I am not sure, but one super simple idea that keeps hitting me over the head is this: what if we consider adding the letter E for "Eating" to the STEM acronym? Could such a simple addition add STEEM to the health of our future world leaders? 

Sounds silly? Could be. But the idea that food and eating are captured in the existing STEM movement is misguided. Just Google the term STEM and check out the images that come up.  Or, have a conversation with a middle school-age girl and she and her peers might admit that it is much, much easier to excel in Math class than in self-care and nutrition, especially when much of a day is spent sitting and both parents work full time.

When we unite hard and soft science in a national promotion of science, technology, engineering, EATING and math, we re-frame the essential benefit of STEM disciplines. We give the conversation context and ... flavor.  The results could even be delicious. Here's why:

Envisioning the future requires a somewhat clear out-picturing of a social idea. The existing STEM narrative is missing a key social idea: food and table culture. My opinion as a mother and as a cook is that kids need more time at the table united by good food and restorative social connections.  They need their minds and their bellies fed with a better story than just Science, Technology, Engineering and Math. They need a North Star that tells the American Tale in a fresh new way. That excites them, that entices them to carry forth, to invent, and to honor the earth and themselves as living things in the process. Eating should be an explicit part of the new American narrative ...

So, if STEEM isn't the right acronym, pick another one -- or another way to emphasize what we're losing when we don't actively promote eating healthy to our children in the race to advance the sciences.

In other words, if a five-letter acronym feels exponentially more unwieldy than a four-letter acronym, remember that the Pentagon's strength comes from five modalities.  Whatever we call it, let's put eating into the strategy so that we may remove it from crisis-management mode. Because we won't win the "war on obesity" ...  but we can teach healthy eating that is pleasurable while leading the next generation into a more equitable nutritional landscape.  Kids can and do learn to respect their bodies and minds when we teach them how.

Ultimately, one of the top goals of STEM will be to dismantle -- not reinforce -- the current disconnect between the chem lab and the kitchen.  With eating integrated into the STEM framework, my hope is that resulting solutions will have much greater appeal.


Krista Tippett's On Being Challenge

Last week on American Public Radio's On Being, Krista Tippett closed her interview with Seth Godin with an experiment.  She asked her listeners to spread the word about her show to help grow her audience.

I'm willing to serve as an anonymous node in Tippett's online network this one time because I've been listening to On Being broadcasts for years and can vouch for the quality.  Tippett, along with the show's producers and editors, covers topics in depth and with sensitivity. She pushes me to examine my beliefs -- spiritual and otherwise -- in an engaging way.

It's said that the measure of engagement in a site/show is related to a viewer/listener's next steps. In other words, after one visits a site, was one engaged enough to take a next step? To follow along?  In health we call that activation.

After many On Being shows, I notice myself taking that next step.  I either purchase a book, check out a site or an idea online, refer others to the idea I was introduced to on the show, or in some very extreme cases, spend a half hour penning a blog post to help grow audience.  ...

I consider Krista Tippett an independent influencer and I wouldn't want her style to get too commercial. But a bigger audience for her show would be a good thing for the radio ecosystem, a system that is often subject to pro-growth metrics instead of more meaningful measures of engagement or "next steps" her audience members take when the show is over. 

On Being is uniquely positioned between big ideas and quiet conversations.  If you are interested in the next wave of thoughtful, contemplative communications, listen in.  Recent broadcasts include: 

Encountering Grief: A 10-Minute Guided Meditation with Joan Halifax
Elizabeth Alexander on Words That Shimmer
Brene Brown on Vulnerability

Oh, and don't miss scanning the blog posts. Without Senior Editor, Trent Gillis' quick post about photographer Ian Ruhter, I would never, ever have had the chance to cheer for his amazing work in Silver + Light.


Consumer experience makes it to the future of health!

"The Qualcomm Tricorder X PRIZE is a $10 million global competition to stimulate innovation and integration of precision diagnostic technologies, making reliable health diagnoses available directly to "health consumers" in their homes." source
Finalists for this grand competition will be only those teams earning high scores for consumer experience. Specifically, guidelines state:   

"To emphasize the importance of consumer use and adoption, only the five highest scoring teams from the consumer experience evaluation will be eligible to win."
With such clear context in the guidelines, congratulations are due to competition organizers. By putting a priority on patients and their experiences they are promoting a future health care transaction that leverages technology and human intelligence. The final paragraph of the competition guideline reads:

"The winners will be the (up to) three solutions achieving the highest diagnostic score regarding a set of 15 distinct diseases in a group of 15-30 people in three days (see Guidelines for full details). This diagnosis must be performed in the hands of a consumer, independently of a healthcare worker or facility." 
Learn more:
Read an overview about the Qualcomm Tricorder X-Prize
Get competition guidelines
Sign up to compete


Love needs a billing code

It's the simplest of ideas in health innovation: Give love a billing code.

I tweeted this in the spring of 2008 at Health 2.0 Conference in Boston.  Since then these words have been echoed, referenced and morphed by many friends and even by some I've never met in the industry.   

Love needs a billing code brings the idea of care and healing back to simple.  It rallies good people working in this space, reminding us why we started in health care in the first place.  The expression is activating too. It makes explicit a core value "To Love" that most of us presume is already present as an under layer in health transactions.

Love is not an industry standard.  The presumption that love is integrated into most health care transactions is flawed.  I am tempted to be flip and to say that profit is the reliable standard at work in the industry. While there is good reason to utter such a phrase, I know my tired soul is talking and I don't want to give voice to broken things.  I continue to dream the possibility of a more loving system end to end. One that is as big for love as it is in love with big data.

There are moments of love in today's health centers, doctors’ offices, and hospitals.  We see miracles and extraordinary feats of humanity so great that we cry every time we encounter them.  But my experience is that our health care ecosystem is unloving and … quite frankly … unlovable.

So why is there not a billing code to measure the caring potency of a health care encounter? Why is this idea dismissed as silly, as lacking gravitas, or as poorly matched with western medicine? Is love considered a downstream transaction? First see the doctor and then find the love you’ll need to heal?

We have walked on the moon, created unmanned drones to hit micro-targets far away, spent millions on challenges and prizes promoting health innovation, and yet we turn away from measuring the impact of love on the doctor and the patient. Why? This is a crime of omission.

Pink paper with question handwritten in black ink
  My question since 2008
Many consumers unconsciously approach medicine as if it were God's work.  Imagine what might happen if the industry - including insurance - actually caught up with us and started thinking of itself as doing God's work?  Not God 1.0’s work, but God 2.0, the caring, concerned, tech savvy and adaptive God who functions like a safety net?

What would happen when love met medicine? Would it lead to nefarious intent and abuse of power? Or would it perhaps be instrumental in creating a shift in consciousness? A shift inviting us to learn how to tolerate the unbearable losses and unexplained graces life, death and medicine bring into our lives. 

What if love had a billing code?