Archelle On Health

New Year. New Job? Not So Fast.

noreply@blogger.com (Archelle Georgiou, MD) — Tue, 06 Jan 2015 18:26:00 +0000

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The telltale sign that I’ve entered a new year is not the champagne corks on New Year’s Eve or the repetitive ~~2014~~ 2015 error on my checks. It’s the small but predictable influx of phone calls, emails and LinkedIn contact requests from long lost acquaintances during the early weeks of January who casually suggest, “let’s have coffee or a glass of wine sometime soon. Would love to catch up.” I’ve learned that these are code words for: “I am thinking of leaving my job and would appreciate some advice.”

“Career coach” isn’t listed in my LinkedIn profile, and there are certainly others who are certified and well-trained to formally offer this type of advice. Nevertheless, since I’ve successfully navigated through several 90-degree turns in my own career—from practicing clinician to a managed care executive to healthcare strategic consultant—I’ve navigated many of the very issues that these professionals are wringing their hands over as they contemplate leaving the economic security and stability of their job.

While each conversation varies as much as the brand of cabernet or the number of espresso shots I order in my latte, I have noticed some consistent themes in the advice that I share during these discussions:

1) Get clarity. The first question I ask as we’re settling in: “So why now? Why do you feel the need to change your job...now?” A basic question, but all too often, the answer is an emotionally jumbled set of complaints that include a dysfunctional work culture, an unsupportive boss, feeling unchallenged, the lack of future career opportunities, and being short-changed on their bonus or salary.

I poke and prod. Which ONEissue it is?

Is it the company’s quirks? Or are you in an industry that doesn’t turn you on? Do you feel unappreciated? Or do you have skills that aren’t being utilized? Is it your boss? Or is it you? Or both? Or do you simply mesh with a different kind of boss? Do you need your own attitude adjustment with a fresh start?

My advice: Force yourself to understand-- and be accountable to--- the specific issues that are driving your desire to leave your job. Just as you shouldn’t jump into a new romantic relationship without analyzing what went wrong with the last one, don’t jump into bed with a new employer without evaluating the dynamics of your current job situation.

2) Stay with your current employer...until you shouldn’t. Figuring out a transition from your job should start with a genuine exploration of all the opportunities your current employer may offer. Why? Regardless of your level of seniority, you own stock----institutional knowledge-- in the company where you work. That knowledge is a valuable asset, and re-investing it in the company is likely to get you your best return--financially, personally and professionally. I consider it a win when a conversation energizes someone to look at internal opportunities through a fresh new lens. I’d estimate that 80% of the individuals I speak to decide to pursue a new role in their organization.

What about the other 20%?

A few clearly say, “I’m done” and want to bolt. They won’t, can’t or refuse to drum up the momentum to pursue internal opportunities. My antennas become radioactive as I probe to understand what people, issues, or skeletons they are escaping. Like a divorce without marriage counseling, this scenario tends to suggest that there are significant irreconcilable issues.

Finally, there are those for whom I have the most empathy: professionals who are in a well-compensated, senior executive role with stellar performance and are appreciated. The problem? They feel stuck, pigeonholed into their current “expert” role and highly unlikely to get tapped for something bigger, broader, or different despite being ready, willing, and capable. While no one is immune, the individuals most likely to face this scenario have MD, RN, or JD behind their names. As they share their frustrations, their question to me is, “What is the risk of leaving?” My response: “What is the risk of staying?”

My advice: Recognize when the organization is incapable of appreciating your gifts and broader talents. And, when the risk of leaving is greater than the risk of staying, it’s time to go.

Whether you decide to explore new internal or external opportunities…

3) Find and use your genius. Everyone is and has a genius. It is the zone where your greatest passion meets your innate talent. When you're in it, you excel because it’s naturally easy for you. Typically, people confuse talent with title and academic designations. But, talent isn’t what you do; it’s how you do it. Mine is story telling. Figuring this out shortly before my transition from UnitedHealth Group, the “aha” helped me understand why I craved sales, public speaking, and the media. More importantly, this self-awareness has significantly shaped my consulting practice since I decided to only take on clients and consulting opportunities that leverage my communications skills.

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My advice: Commit some time to finding your genius. The process I used was a formal facilitated workshop conducted by GapInternational. At the other end of the time/investment spectrum and one of my favorites is from Oprah’s “O's 4-Step Guide to Discovering Who You're Meant to Be” (For the men reading this article…this exercise is not for women only.)

4) Compensation comes in different currencies. Beyond meeting your cash flow needs, your financial compensation package should be fair, market-driven, and demonstrate that the company values you. After that, put small incremental dollar differences (as well as title differences) aside and make your decision based on where you will have the broadest scope of influence and the greatest opportunity to have a societal impact.

My advice: DON'T do a Jerry Maguire.

Have a happy new year...commit to making a difference.

Archelle

Mind-Body (in my case Mind-Butt) Connection

noreply@blogger.com (Archelle Georgiou, MD) — Wed, 18 Jun 2014 21:15:00 +0000

Pap smear ✔

Bone density test ✔

Mammogram ✔

Tetanus and Hepatitis A vaccinations-up to date

Colonoscopy…no way, no how, don’t want it, don’t need it. I'd rather have colon cancer. I don’t have any risk factors anyway. Can’t I have a root canal instead?

These are the thoughts that swirled through my head starting at age 49 as I anticipated turning 50 and hitting the magic moment for this right of passage.

But, several months ago, the resistance disappeared. I made the appointment in March and didn’t think about it again until I had to start the prep at 4 pm on the day before my procedure. Drinking 64 oz of Crystal Light with Miralax and 10 ounces of magnesium citrate made me feel like a bloated whale. I was stuck in a bathroom, chilled from the cold liquid, and could only tolerate wearing grey flannel sweats. Nevertheless, I drove to my appointment feeling unstressed and singing Pharrell Williams' "Happy" song at the top of my lungs. My pressing question was whether there was Wi-Fi in the clinic so that I could work on email while waiting for the procedure to start.

I’ll spare you the details and simply say that the procedure was a non-event. This was a function of the wonderful staff at Minnesota Gastroenterology as well as the intravenous Versed (anti-anxiety medication) and Fentanyl (short acting narcotic) that eliminated any subliminal worries from my consciousness. I felt even better after finding out that the results were normal and have a 10 year reprieve before needing a repeat screening.

With that milestone behind me (so to speak) I turned my focus to understanding why I had adamantly refused getting this important health screening done. And, more importantly, what influenced my behavior change?

My unwillingness to getting a colonoscopy is no different than an individual who refuses to wear a seatbelt, wear a bicycle helmet, have a BRCA test (when they have high familial risk for breast cancer), prepare an advanced directive, wear a condom, or wear sunscreen.

Behavioral science research has identified a series of potential barriers to healthy behaviors. But, as I went through the list, the typical barriers were not the root cause of my stubbornness.

1) Perceived invulnerability

· Doesn’t apply. I am fully aware that colon cancer is the 4th most common form of cancer, and at age 50 my risk significantly increased.

2) Fear of the condition or pain from the procedure

· I knew the drugs would be effective. Moreover, I’m such a believer of “knowledge is power” that I’ve had personal genetic testing done 3 times.

3) Lack of knowledge

· Hope not. Got my M.D. in 1986.

4) Lack of perceived efficacy/accuracy

· Nope. Married to a GI doctor, and I am probably even a bit biased on efficacy. Colonoscopy has a 95% sensitivity rate.

5) Lack of social support

· Quite the opposite. Thankful for a wonderful family.

6) Social/economic barriers

· We are fully insured and with the Affordable Care Act, colonoscopy is covered 100%.

7) Time

· This would be an excuse. I manage my own schedule.

So what was the barrier?

I realize now that I was afraid of what the procedure symbolized: invasiveness, vulnerability and the losing my (competent) voice during the procedure. It was an iceberg of emotions that had absolutely nothing to do with the technical or clinical aspects of the procedure. Therefore, pummeling me with brochures, prevention reminders, health risk assessment scores, wellness apps and bribing me with financial incentives for lower insurance premiums….was simply a waste of money. I only overcame my “irrational” resistance after looking deeper and uncovering my own insecurities. Once I understood how to protect myself from feeling powerless in other aspects of my life…I was willing to give up control for a 17 minute procedure that might save my life.

My recommendation: If you find yourself being repeatedly unwilling or unable to do what it takes to increase your chance of living a healthier life despite having the facts, social support and financial resources….look beneath the surface. There may be a bigger and more important issue to address.

Learning Not To Pour Beer on Your Picasso

noreply@blogger.com (Archelle Georgiou, MD) — Tue, 27 May 2014 16:08:00 +0000

April 2013: “I have a proposition for you. Can you teach anatomy?” What Dr. Steve Parente, Incoming Associate Dean, was really asking was whether I’d be willing to teach Anatomy and Physiology for Managers at the University of Minnesota Carlson School of Management in Spring 2014. A shift in faculty assignments opened an opportunity to bring in a new professor, and Steve had his pitch well prepared:

“It won’t be a lot of work. Dr. Jeff Hertzberg, the previous professor, will share all his slides."
“It's just once a week for 7 weeks.”
"You're a natural..you do public speaking all the time."
"You know this stuff! This is basic anatomy for MBA students interested in the healthcare field."

May 2014: The students were great. They averaged 79% on the mid-term, group projects were extraordinary, and final grades averaged out to a B+.

The unexpected surprise was how much I learned.

“It won’t be a lot of work.”Wrong. Jeff’s course materials gave me a running start, but I quickly realized that to be credible and fluent with the content meant I had to build my own slides. In addition, since Carlson gives professors flexibility in how to structure their courses, I couldn’t resist the opportunity to change the syllabus, use a new textbook, and broaden the content to cover more organ systems. I spent the better part of each weekend preparing for the next week’s class and gained a true appreciation for the time that educators invest outside the classroom.

“It’s only once a week for 7 weeks.” I should have done the math. The entire semester is simply compressed into a shorter period of time. Keeping 25 students awake throughout a 3-1/2 hour weekly evening class meant that I needed creative ways to keep them engaged. Adam Sandler's Cajun Man skit was the kickoff to teaching the functions of the Digestive System: ingestion, propulsion, digestion, absorption, and defection. (You'll have to watch the clip to get the connection.) For the Urinary System, I resorted to shock value and promised the class they’d be able explain why men don’t ejaculate and urinate at the same time.

Adam Sandler's Cajun Man

“You’re a natural..you do public speaking all the time.” Public speaking, talking at an audience to raise awareness and drive influence, is not teaching. Teaching results in learning---transferring and embedding usable knowledge that can be applied to future experiences. That’s not a skill I gained in medical school or multiple rounds of media training. Thank you Mrs. Chavala. Now I know why the novels I read in 10^thgrade English continue to influence me.

“You know this stuff! This is basic anatomy…” Taking anatomy exams in med school requires sheer memorization. Teaching anatomy requires a true understanding of the body’s structure and function. I had to re-learn (and sometimes learn for the first time) the unique and specialized design of each organ system and then how systems integrate and communicate with each other.

I spent hours re-learning how the kidneys and the brain work together to maintain perfect water balance; how nutrients pass from the small intestine’s microvilli into the blood and then route through the liver’s sinusoidal system to remove toxins; how the heart, lungs, endocrine, immune and nervous systems all instantaneously kick into gear during a moment of physical or emotional stress.

Somewhere in the midst of 352 slides, 60 hours of lecture and countless hours of prep...and twenty-eight years after becoming a physician...I came to the realization that the human body is like a precious piece of art. And, while most of us wouldn’t imagine destroying, abusing or slinging mud at a beautiful painting, we don’t hesitate to abuse our bodies with food, alcohol, sleeplessness, stress, and other harmful behaviors.

Addressing this dichotomy is what got me energized about teaching. While it was subtle, Anatomy and Physiology for Managers transformed into a course that should have been called Art Appreciation Of The Human Body. The course objective shifted from “developing a basic understanding of six important human body systems” to "identifying the beauty of eating, breathing, walking, talking and thinking." My hopeful hypothesis is that by inspiring a long lasting awe for their body as a valuable piece of art, these future device, technology, and pharmaceutical executives might be more likely to make the life choices that support and create their own health.

Consumer engagement is the trillion dollar issue in healthcare. Is art a potential vehicle for driving healthy behavior change?

From Parrillas to Politics: How Argentine Barbecue Influenced My Vote

noreply@blogger.com (Archelle Georgiou, MD) — Mon, 29 Oct 2012 17:56:00 +0000

Parrilla (pronounced pa-REE-ya) is the Spanish word for “grill”, and in South American countries it also refers to the restaurants that prepare their meats over a large charcoal or wood-fired grill. We were recently in Buenos Aires visiting our daughter during her college semester abroad. Within hours of arriving, we were surrounded by the intoxicating whiffs of steak, sausages, and chicken that emanated from four parrillas surrounding our hotel and hundreds of others in the city. Our nightly dilemma was which one to select for dinner. Differences in price, menu selection and atmosphere were trivial. Restaurant hosts, attempting to lure us in, stood on the sidewalks passionately declaring they had “the best steak in Argentina.” Ultimately, our decision came down to a gut feeling about where we’d most enjoy our next delicious carnivorous experience. The verdict was only clear when we loosened our clothing at the end of the meal and received the bill.

This isn’t dissimilar from the dilemma we each face when we cast our vote in the upcoming presidential election. Barack Obama and Mitt Romney both believe they are the “best” person to lead the country. Floods of television ads, mailers, rhetoric, and drama have flooded our senses, appealing to our emotions and trying to capture our support. And, on November 6, most of us will make a decision based on a gut feeling about which man’s leadership will lead the country toward a better future. The impact of the decision we make in eight days won’t be clear until 2016 when we assess the state of the union and, specifically, the nation’s economy.

Over the last ten months, the candidates (and their super PACs) have invested $2 billion dollars in this campaign. However, just one week in Argentina significantly affected my view of the key issues and, ultimately, how I will vote.

On the economy. Athena arrived in Argentina in August and one of the first emails we received said, “Here’s my address…but PLEASE don't send care packages or mail anything except letters. They tax everything!” Since the 1930s, Argentina has had policies that support import substitution—meaning, replacing foreign imports with domestic production. The theoretical benefit is that it increases domestic employment and national independence. However, in 2012, these policies create inefficiency, stall innovation and prevent global trade.

Since February 1, 2012, President Cristina Fernandez de Kirchner imposed policies that requires all foreign trade importers to get government permission before bringing goods into the country since she would like “not a single nail” to be imported into Argentina. Products from books to Barbie dolls have, at times, been denied entry; imported products are extraordinarily expensive. As tourists, we were prepared to enjoy the shopping in Buenos Aires and even took an extra suitcase to fit our anticipated purchases. But, prices were extraordinary, and we came home empty handed. Consider the cumulative loss of revenue across five million tourists a year.

Insight/Consideration: Nations must maintain global competitiveness. In September 2012, the US ranked 7^th on the World Economic Forum’s Global Competitiveness Index. This is two positions lower than in 2011.

Which candidate will use their power and influence to re-establish trust in the business community, address the nation’s fiscal imbalances and successfully break through political deadlock? (These are the cited reasons for the downgrade.)

On the role of government: While we were eating beef and drinking Malbec, our conversations with locals focused on soybeans. Argentines proudly tout their status as the third largest exporter of soybeans in the world, but the government’s new export taxes makes them fearful that they’ll experience a déjà vu.

For many years, Argentina was the third largest exporter of beef in the world. Between 2002 and 2005, cattle production rose 24% and exports doubled—a positive boost to their economy after the 2001 devaluation of the peso. But, in 2006, in an attempt to keep beef prices affordable (and voting consumers happy), then President Nestor Kirchner(Cristina’s husband and predecessor) banned beef exports for six months and then imposed federally mandated price caps. The controls unraveled the industry. Demand decreased by 17%, production shrank, and domestic beef prices increased 70%.

Insight/Consideration: Government control of markets can lead to unintended consequences.

Which candidate will create frameworks that promote free enterprise and unleash the American entrepreneurial spirit while protecting people’s rights and opportunities?

On social welfare: Eva Peron died in 1952, but the “spiritual leader” of the country is ever-present in Buenos Aires. Not a day passed during our stay without Peron’s name being raised by cabbies, guides, and waiters. Opinions are polarized; she is remembered as a savior by the underprivileged and a Robin Hood by the bourgeoisie. All agree, however, that Eva’s fight for women’s suffrage and laborer’s rights were important and necessary social reforms at that point in Argentina’s history.

Cristina revitalized the ideology of the mythical Evita with her focus on social justice and wealth redistribution. However, in 2012, Argentina has different needs than in the 1940s, and her populist platform is seen as a key driver of the nation’s 25% inflation rate. Although Cristina was re-elected in 2011 with 54% of the vote, she now has a 72% disapproval rating regarding her management of the economy.

Insight/Consideration:Countries need different leaders for different times. While abortion, gay/lesbian rights, and same-sex marriage are important social issues, the more pressing social issue is unemployment which leads to poverty, crime, familial instability and poor health status.

Which candidate has the most experience and the best plan to stimulate job growth in America?

So, back to the parrillas. (At some level, life is all about the food!) After eating at 10 restaurants in 6 days (excluding hotel breakfast) “the best steak in Argentina” was at La Lorenza. We walked into this neighborhood parrilla because of the large grill in the front window that gave us full transparency to the food we’d be eating and a menu that went beyond the traditional offering with grilled goat and lamb. While we also enjoyed wonderful meals at El Bistro (Buenos Aires’ best and very sexy restaurant with crystal chandeliers, red roses and white unicorn heads adorning the walls) and at a fast food steak joint in the shopping mall food court, La Lorenza got our vote. They delivered an excellent meal at a moderate price.

Transparency…beyond the traditional (entitlements)… moderate.

Important virtues for a parrilla and politicians.

Create Health,

Archelle

Business Lessons From Auschwitz

noreply@blogger.com (Archelle Georgiou, MD) — Tue, 10 Jul 2012 15:07:00 +0000

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יִתְגַּדַּל וְיִתְקַדַּשׁ שְׁמֵהּ רַבָּא

Yit'gadal v'yit'kadash sh'mei raba…

May His great Name grow exalted and sanctified

This is the beginning of the Mourner’s Kaddish, the Jewish prayer recited to remember and honor the dead. It is the best way I can express the profound sadness I felt for the 6 million Jews and 5 million Gypsies, Serbs, Poles, Jehovah's Witnesses, German resistors, homosexuals, and others who were killed by the Nazis in World War II.

A few weeks ago, our family visited Central Europe which included a visit to Oswiecim or, as the Germans renamed it, Auschwitz. The entrance was exactly as we had imagined from seeing Sophie’s Choice, Schindler’s List, Life Is Beautiful: black iron gates crowned with the ironic motto, Arbeit macht frei ("work makes you free").

And, while Hollywood helped us anticipate seeing the large pile of shoes, the stark grey “showers” and the ovens, seeing the camps on the big screen could not prepare us for 98 foot long display case filled with human hair or the subtle smell of lingering char in the air.

Zoe, our nine year old, persistently asked “How?” and “Why?” Our guide’s answers which explained the Nazi’s highly systematic killing methods made me physically uncomfortable. Maybe this explains why I started intellectualizing my observations through the familiar comfort of a business lens.

For a few moments, I tried to forget (or at least compartmentalize) the abominable intentions of the Germans, and I focused solely on the strategies and processes they used to achieve their goals.

View of Auschwitz 2-Birkenau from watch tower

Design Thinking was incorporated into the architectural planning of the camps. From the top of the infamous watch tower at Auschwitz 2-Birkenau, we could see the extension of the train tracks to the center of the camp that was designed to expedite the "selections" that divided the prisoners into those deemed able to work versus those who were sent to the left and immediately gassed. The barracks were organized symmetrically on both sides of the tracks with the crematoria built in the back of the camp, behind trees, to keep them out of sight and to help muffle the sounds of screaming.

Pile of empty containers of Zyklon B

Rapid Cycle Prototyping was used to determine the optimal amount of Zyklon B that would kill the greatest number of people in the shortest period of time. Through repeated human testing, they vastly “improved” the process…speeding up capacity and decreasing resource consumption.

Innovation and Operating Efficiency was a core focus. In 1940, incoming prisoners were photographed and assigned a camp serial number which was sewn to their prison uniforms. However, to accelerate the process and decrease film developing costs, tattooing was introduced in 1941. At first, a special metal stamp was used to punch the serial number onto the prisoner's chest then ink was rubbed into the bleeding wound. By 1942, however, a new single-needle device was introduced which quickly pierced the outlines of the serial-number digits onto the skin.

The objective of the “Final Solution” was horrific, but when considered in a vacuum, the Nazi’s business strategies, planning, and executional discipline rival that of today’s well-performing companies. Business and trade journals highlight Design Thinking, Rapid Cycle Prototyping, Innovation, and Operational Efficiency as core capabilities essential for sustained market performance. Investors look for these capabilities to predict growth and profitability.

How often do we admire, invest in or support companies that have a stock chart that looks

like this:

or this..

The one on the left is Enron’s stock performance from the mid-1980’s until its peak in August 2000. On the right is the stock chart for Accretive Health Inc (NYSE: AH) from 2010 through March 2012. Accretive’s website says its focus is“ensuring that the financial portion of the patient experience is compassionate, efficient, clear, and achieved without errors or confusion for the patient.” However, in April 2012, they came under fire from Minnesota regulators after using aggressive and illegal bill collecting tactics at Fairview Health Services facilities that included confronting patients in emergency rooms for paying their current bills or outstanding debts.

We all know the fate of Enron. Accretive's stock has declined to by 60% from one year ago. But, while these stocks were on the way up, how many clients and shareholders looked beyond the company's financial performance to ask “How?” or “Why?” or "What is the meaningful impact of this company on people?"

The crimes that occurred at Auschwitz cannot be compared to the dishonorable actions of Enron and Accretive. However, the insights at Auschwitz were a sobering reminder that successful bottom line performance is not a proxy for a noble mission or vision, and stock price does not reflect a company's moral and ethical behavior.

Amein
אָמֵן

Create Health,

Archelle

The Advantages of Being A Skeptic B****

noreply@blogger.com (Archelle Georgiou, MD) — Wed, 18 Apr 2012 20:08:00 +0000

Have you ever:

· Deferred to your accountants when they recommended excluding a deduction from your taxes… only to find out later that it was completely legitimate?

· Trusted your tailor’s judgment when he pinned the hem on a brand new pair of pants... then ended up with slacks too short to wear with your favorite shoes?

· Followed the commands of the automated voice on your GPS device (even when you knew intuitively knew to take another route)… then ended up at the wrong location?

According to the World Values Survey, the US is high on the scale of traditional values. Interpretation: In comparison to other countries, we emphasize religiosity, national pride, marriage, and parent-child ties. We also emphasize absolute standards and obedience.

Bottom line: We defer to authority—regardless of whether the authority figure is real or perceived; ordained or self-proclaimed; professional, technical or virtual.

Maybe this begins to explain those instances when we feel inept and take actions that are against our better judgment even when we have facts, knowledge, intuition or experience that would could lead us, or at least contribute to, a better outcome.

The risk? Blindly following the advice of accountants, tailors, or GPS units can cost you time and/or money. Blindly following the recommendations of a physician can cost you your life.

This is the underlying warning I’ve tried to convey in the 500 Fox segments I’ve done over the last five years. The key message is “Speak Up” as I stress the responsibility of viewers to do their own research, ask questions, consider all their alternatives, demand (not request) specialty referrals, get second opinions---and yes, question the doctor. I find myself reassuring viewers chatting with me on line that speaking up is not disrespectful or bitchy. It’s each person’s responsibility.

The importance of this advice crystallized when I interviewed Ana Gregg.

Ana Gregg and Cardiologist, Dr. Stephen Smalley

Click here to watch the clip.

Or, if you don't have 4-1/2 minutes...here are the Cliff Notes:

Ana is 36 years old, mother of 2 young boys. In November 2010, she had classic symptoms of a heart attack: left crushing chest pain radiating down her arm with nausea and vomiting. Ana took herself to an urgent care center where her EKG showed clear evidence of an acute MI. An ambulance was called to take her to the Emergency Room of a local hospital.

Ana EKG in the ER was still abnormal, and she was admitted for observation. But, the ER doc and the hospitalist were both convinced she simply had gastroesophageal reflux. A cardiologist who saw Ana before she was discharged seemed to merely reinforced the other doctors’ assessment. Ana was sent home with reassurance and reflux medication.

Ana was so relieved to be told her heart was normal that she ignored her intuition that something else was wrong. She'd never had reflux in the past, and, "besides, how can I know more than a doctor who has been to medical school for 8 years and had all that training?"

Nine months later, on August 5, 2011, Ana had another episode of crushing left chest pain. “It’s just reflux,” she thought. She would have ignored it, but she happened to be across the street from Regions Hospital, and since she was so close, she walked herself into the ER—nauseous, sweating, and pale.

Ana had an acute cardiac dissection (tearing of the arterial lining) with blockage of the left anterior descending artery; the right coronary artery was also blocked--with evidence of an old heart injury, one that likely occurred nine months earlier. She had seven stents placed.

Eight months later, Ana feels healthy, is back to work and playing with her boys. She looked radiant as she shared her story on air, but, afterward, her eyes welled with tears as she got contemplative as she rhetorically asked “What if I'd spoken up 9 months earlier? Would I have a better chances of seeing my boys grow up?”

Ana’s clinical condition is relatively rare—spontaneous coronary artery dissection occurs in 0.2% of the population. Unfortunately, her health experience is all too common. Even in our own family of two physicians, we have hesitated to question the experts and then dealt with the consequences of a misdiagnosed fracture, an ectopic pregnancy, a pre-malignant mole, and a severe drug reaction.

Paternalistic, traditional values are woven into the fabric of the American public. We faithfully trust our parents, our pastors, or professors, our politicians, our plumbers, and our physicians. But, they are not our destiny.

As Ronald Reagan said, “trust, but verify.”

Take responsibility. Speak up. Advocate for yourself. No one cares as much as you do about your health, your pants, or your taxes.

Create Health,

Archelle

Healthcare: Survival of The Fittest

noreply@blogger.com (Archelle Georgiou, MD) — Thu, 16 Feb 2012 15:48:00 +0000

According to Levin and Associates, mergers and acquisitions in the healthcare industry totaled over $227 billion, an 11% increase over 2010 and the fourth-largest year of the past decade. Even more interesting, is that the value of healthcare services deals increased 43% while technology decreased 2%. Hospital systems are moving into new communities, integrated health systems are acquiring additional delivery system assets, managed care networks are growing, and specialty care service businesses are expanding their footprint---to be well-positioned for survival in a post-reform world.

This is the type of data we shared with TripleTree's Health Executive Roundtable--the investment bank's "think tank" comprised of a diverse group of health industry executives with backgrounds ranging from banking, medical device, education and life sciences; to food services, technology, human capital management, and compliance.

We asked each Roundtable member: "What are the key trends that will emerge from this consolidation?"

Their independent and unique perspectives are published in:

Viewpoint: A Kaleidoscope of Insights Regarding Growth Opportunities amid Consolidation in the Healthcare Industry.

You can view and download the report here.

In addition, you are invited to participate in a webcast on Wednesday, February 29, 2012 from 12-1 pm CST where we will discuss the highlights and key themes from the report. You can register for the webcast at: https://www2.gotomeeting.com/register/771534410. After registering you will receive a confirmation email with information about joining the event.

As a preview. the following are the highlights and key themes from the report:

Healthcare costs will increase. It's all about supply and demand. Market consolidation sets the stage for increasing healthcare costs as fewer, large, hospital and healthcare systems leverage their size and strength during unit cost contract negotiations with payors.
Contraction of the delivery system = expansion of demand for meaningful innovation to combat the pressures of #1. However, the only "new new things" that will survive are those that solve real problems with a scalable, cost-efficient solutions that integrate with the existing healthcare infrastructure.
B to C solutions require B to B revenue streams. Consumer adoption is critical for demonstrating relevance, but consumers don’t typically fund high growth enterprises.
"Health and Wellness" will transition to "Life and Well-Being." Payers and employers will seek innovations that support life and well-being as the distinction between work, home and health become increasing blurred.
Healthcare gaming will emerge--actually, it will explode. Gaming platforms that integrate entertainment, interaction, and achievement will be a transformational solution for driving consumer engagement and behavior change as well as provider education, training, delivery, research and cost containment.
Electronic health records will evolve into smart health information technology ecosystems. These ecosystems will (finally) enable the coordination of care and drive shared accountability among healthcare providers.
Doctors will be loyal to a single system. (Smart) hospitals and health systems will attract and retain doctors with mobile and wireless software applications that enhance personal income and lifestyle.
The most disruptive solutions are likely to come from outside the traditional healthcare industry. The core assets and capabilities that fuel retail, consumer packaged goods, banking, and telecommunications, for example, can be translated into unique and meaningful healthcare solutions by companies and individuals not trapped in parochial "we've always done it that way" thinking.

A “perfect storm” is brewing where science and technology have no boundaries, and the convergence of reform and unsustainable medical costs are generating opportunities for change. I can't think of a more exciting time to be in healthcare.

I look forward to your feedback via blog post comments, personal email, or during the webcast.

Create Health,

Archelle

Rebuttal to Last Week's Blog, Death of Disease Management (Finally)

noreply@blogger.com (Archelle Georgiou, MD) — Tue, 17 Jan 2012 15:15:00 +0000

Last week's blog, The Death of Disease Management, was well....provocative. It received unexpected broad readership and was reposted on Managed Care Magazine Online.

Here is a fantastic "rebuttal" to my blog by Al Lewis, Executive Director of the Disease Management Purchasing Consortium and someone I consider the "father" of disease management.

In the spirit of collaboration, I am re-posting Al's blog and encourage you to read it. It's this type of constructive dialogue (and banter...which Al is always good for!) that will help identify the opportunities for change that we need to advance health.

Reports of the Death of Disease Management Are Greatly Exaggerated

Submitted by Al Lewis on Sat, 2012-01-14 10:28

There have been unsavory rumors flying around the internet that disease management as practiced today may not be all that effective. I’m not going to reveal who started these rumors but her name rhymes with Archelle Georgiou. This person says disease management is “dead.” Since there are still many disease management departments operating around the country apparently oblivious to their demise (and disease management departments are people too, you know), I suspect this commentator was using the word "dead" figuratively, as in: “The second he forgot the third cabinet department, Rick Perry was dead." (Another example of presumably figurative speech in the death category would be: "After he denounced gays while wearing the Brokeback Mountain jacket, you could stick a fork in him.")

And if the rhymes-with-Archelle commentator intends “dead” as a synonym for “not in very good shape,” she certainly has a point. Not only does she have a point, but I would add more items to her list of reasons for the field's current troubles:
(1) The interval between diagnosis (the point where readiness to change is usually greatest) and successful patient contact can exceed three months;
(2) Predictive modeling “risk scores” that tell you only how sick someone was, dressed up as a “risk score,” not how sick they will be, even though they aren’t already high utilizers;
(3) Some interventions are so expensive that they exceed the cost of the disease;
(4) The physicians are still not involved;
(5) Rather than using actual mathematically sound methodologies to calculate results, many vendors and consultants damage the credibility of the entire endeavor by believing in the Outcomes Fairy.

Fortunately, there are improvements afoot to address all of these issues:
(1) Electronic medical records presage faster claims adjudication, and ICD-10s will mean much more detailed patient information than is possible today. And disease management departments are already coordinating with UM/precertification/discharge planning better than even two years ago. Together, these innovations will match people with programs much faster;
(2) Predictive modeling is increasingly including the lab scores. “Increasingly” meaning that instead of 1% of models having lab data, maybe 3% do. Still, it’s a start. Lab values allow actual prediction, instead of simply drawing a line connecting last year’s high claims to this year’s high risk scores;
(3) The cost of interventions is declining quite rapidly, largely with the advent of mHealth (use of mobile communications devices in health care), which is hugely overrated by venture capitalists as a vehicle for getting rich from, but quite appropriately rated as a way to facilitate contact with members if indeed privacy regulations get rewritten to assume that the only person who answers a cellphone is the owner of that phone, and hence no “opt-in” app is needed;
(4) Some physicians are getting involved because their contractual arrangements and accreditation, such as patient-centered medical homes, are requiring it;
(5) And finally, my own forthcoming book, Why Nobody Believes the Numbers: Separating Fact from Fiction in Population Health Management, will take care of the last item. Imagine the Outcomes Fairy-meets-The Hurt Locker. Credibility will be restored for those vendors whose outcomes are modest but valid. The introduction may be downloaded gratis from www.dismgmt.com .

Is disease management dead? No. It is going through a transition period in which older models are being replaced via “creative destruction” and plain old innovation with newer models. This isn’t too much fun now but ultimately this trial-and-error process should create health-improving interventions that are truly effective in preventing, forestalling and addressing some small but significant portion of the 75% of cost attributable to people with chronic disease.
So I think perhaps these two seemingly conflicting posts are in broad agreement, the only difference being that what I believe is well-founded, evidence-based optimism that the industry can innovate its way out of the current stagnation. On this point, only time will tell. In a few years we should know, to quote the immortal words of that aforementioned great philosopher Rick Perry, whether or not who is right.

Al Lewis is Executive Director of the Disease Management Purchasing Consortium

Originally posted online by Managed Care Magazine

The Death Of Disease Management (Finally)

noreply@blogger.com (Archelle Georgiou, MD) — Thu, 12 Jan 2012 18:13:00 +0000

In 1995, Dr. Michael Rich published an article in the New England Journal of Medicine (NEJM) that fueled the start of an industry. In a randomized, controlled trial, he showed that an investing in proactive disease management (DM) activities could decrease the cost and improve the quality of life for patients with congestive heart failure.

The premise of disease management seemed intuitive:

· Systematically assure that evidence-based medicine is applied.

· Educate and empower patients to practice self-care.

· Intensely manage the sickest 5-10% of the patients driving 80% of the costs.

Healthplans, employers and other payers (and I) jumped on the bandwagon hoping that these programs would be a consumer-friendly silver bullet to escalating health care costs.

Cardiac Solutions, Matria, LifeMasters and American Healthways, among others, became household names. In addition, business opportunities abounded:

· Disease Management Association of America was founded in 1999.

· NCQA developed an DM accreditation program in 2002.

· Data analytics companies developed predictive modeling tools to better identify the highest risk patients.

· Employee benefits consultants promoted the “new new thing” for cost control.

But, behind the scenes, there was a lot of hand-wringing. On the eve of a major Disease Management conference, circa 2004, I remember sitting in the bar of an Orlando hotel having cocktails with DM gurus who who’d nabbed the coveted keynote speaker spots at this major forum. The Medicare Modernization Act of 2003 had just passed, and CMS had a mandate to test the disease management model in Medicare fee-for-service beneficiaries. I was shocked when my industry colleagues admitted that this $20 billion industry would only last as long as it would take for the pilots programs to be completed and CMS to analyze the results.

In the mean time…double-digit healthcare cost inflation fueled employers demand for a wide array of condition-specific programs as a cost reduction strategy. According to Mercer Consulting, in 2010, 73% of employers offered disease management programs even though consistent, reproducible evidence of a positive ROI is still lacking.

It’s been seven long years since that Orlando meeting…and the time has come when will disease management may finally…finally…. fizzle and die.

The CMS demonstration programs started between August 2005 and January 2006 and preliminary results reported in 2008 concluded that "Results to date indicate limited success in achieving Medicare cost savings or reducing acute care utilization."The individual programs, all using nurse-based call centers, ended between December 2006 and August 2008, and the definitive results were published in NEJM in November 2011. In summary:

Only 2 of 15 programs resulted in reduced hospital admissions. None generated net savings.

There were only 14 significant improvements in process-of-care measures out of 40 comparisons.

These modest improvements came at substantial cost to the Medicare program in fees paid to the disease management companies ($400 million), with “no demonstrable savings in Medicare expenditures.”

So, why did this intuitive approach to managing disease fail?

In my opinion, there have been 3 critical missteps in the evolution of this industry:

1) NCQA Accreditation Standards: NCQA’s health plan accreditation standards require that DM programs be population-based—in other words, that ALL individuals with a condition be eligible for participation--not just those at highest risk who are most likely to benefit clinically and financially. Healthplans and vendors complied to achieve the marketing value of the NCQA gold seal of approval. Employers bought into this approach in the spirit of “prevention.” However, this peanut butter approach allocates time and money to individuals who are so low risk that there is little opportunity for clinically meaningful improvement that translates into financial savings.

2) Toys and Trinkets: From glossy brochures to felt puppets to refrigerator magnets, DM companies have differentiated themselves with collateral materials that have sales appeal but have little impact on improving care or decreasing utilization. At the same time, all these all of these items inflate program costs and erode ROI. At the end of the day, DM that does not achieve a net savings is not successful.

3) Over-reliance on Evidence-Based Medicine: Yes, EBM is the holy grail. However, the sole reliance on these standards in disease management interventions does not actually "manage disease” since avoidable costs are frequently due to subtle opportunities and gaps in care that exist as a result of multiple co-morbidities. For example: A patient in a diabetes DM program may also have rheumatoid arthritis. If the patient’s hand/joint pain is not well managed, it is unlikely that she will be able to comply with manually operating a glucometer to check her blood sugars. Unfortunately, the critical thinking required to truly coordinate care is difficult to systematically build into program design....therefore, too often, its absent.

So, if disease management doesn’t work, what does?

This month, hundreds of health care entities will be submitting proposals to CMS to get a piece of the $1 billion funding available through the Health Care Innovation Challenge. As CMS grants between $1 M and $30 M to various projects, let’s hope that they fund initiatives that reflect fresh, not "same old, same old" thinking for improving health and decreasing cost.

Technologies and platforms that are relatively low cost, scalable and seem the most promising are those that leverage:

1) Social networking—Condition-specific communities of patients continue to proliferate and the user-generated content from “people just like me” is having a positive impact on compliance, self-care, and quality of life.

2) Gaming: Health gaming is extending far beyond Wii Fit. Game developers are designing increasing numbers of consumer-oriented applications that address prevention, healthy lifestyles and disease self-management.

3) Remote monitoring: Biometric and ambient activity sensors offer clinicians and caregivers 24/7 insight to a person’s clinical status so that care can be delivered when it’s needed rather than when it’s scheduled.

4) Mobile/wireless health management applications: In addition to consumer focused health management apps, mobile and wireless access to patient medical information accelerates how physicians make critical diagnostic decisions and can prevent delays in care.

5) Environmental solutions: Innovative companies are poised to transform health care with disruptive products and systems that rely on design thinking--solutions that make it easy to be healthy, passively and continuously support better health, and don't rely on individual behavior change.

Proposals are due January 27, 2012. Awards will be announced in March. Results won’t be in for 3 years.

In the mean time, employers looking for immediate health care cost savings can save $2-5 per member per month in fees by terminating their disease management programs.

Disease Management: RIP

Sweat The Small Stuff

noreply@blogger.com (Archelle Georgiou, MD) — Tue, 25 Oct 2011 22:47:00 +0000

For the last 2 months, I've exited the blogosphere....and plunged into the dance studio.

As mentioned in my last post, I am a "celebrity" dancer for the Annual CornerHouse Let's Dance event scheduled for November 12. While the evening of the gala will be an exciting finale to four months of preparation, it's really been the process of getting ready that has been extraordinary. Take a look at this 1-1/2 minute video for a 'behind the scenes' glimpse:


Link: Dancing with Bruce, the planet's most patient dance instructor

The video is a humorous promo for the event. The more important transformation transcends the dancing and comes from "the small stuff" --- brief but important moments that made me pause and translated into meaningful insights:

On technology: We selected a song that was 34 seconds too long. At 9:15 am one morning, while driving to work, I used my cell phone to call a professional production company. By 9:25, David (of David & David Productions) had downloaded the song from iTunes and we were discussing the areas to splice. At 9:45, I got my first cut; by 10 am, I had a 2 min 29 sec version of the song loaded onto my iPod. Thank you David..and Steve Jobs. Technology is truly amazing.

On people: After looking at more than 1000 dresses on line (yes, 1000), my favorite was a lace and crystal extravaganza made by Randall Designs. Custom made for L'il Kim (the rapper) when she danced the Argentine Tango on Dancing With the Stars, the dress is for (re)sale, but the price tag...excessive. As a last resort, I asked Randall Designs if they could help me and explained the charity. To my surprise, they graciously agreed to let me borrow the dress for the night. Generosity is abundant.

On health: By itself, dancing once or twice a week hasn't been rigorous enough to get me in shape. But, the pressure of a performance has suppressed any desire to binge, got me back on the treadmill and motivated me to lift weights every day. The result: I'm a little lighter and a little firmer (for now) with greater appreciation for the power of the accountability that arises from publicly stated goals. Competition is an important element of behavior change.

On purpose: Many of us receive donation solicitations and dutifully write our checks to various charities. However, in this case, complementing the financial support by getting personally engaged has connected me to the cause and touched my heart in a way I didn't expect. Whether you are passionate about breast cancer, a religious institution, a political candidate, human rights, or legal advocacy....immerse yourself. You will get back much more than you give. Philanthropy is more meaningful when you give of yourself..not just your money.

On human rights: During a recent tour of the CornerHouse, my spine shivered when I learned that in the room next door, a young girl was disclosing the details about her sexual abuse. This story repeats itself 3 times a day...every day. Child abuse is real.

And so many more.

So, as hard as it is for me...I will "just ask" if you would support the children served by CornerHouse by voting for your "favorite" dancer. Here is the link. Each vote costs $5. You can buy as many votes as you want using the online link below. I would greatly appreciate it.

Create Health,

Archelle

Dancing With The Boogeyman

noreply@blogger.com (Archelle Georgiou, MD) — Tue, 23 Aug 2011 15:02:00 +0000

A report of child abuse is made every ten seconds and three million cases involving almost 5.5 million children are reported each year. This tragedy occurs at every socioeconomic level, across ethnic and cultural lines, within all religions and at all levels of education.

This issue has never impacted me, my family or anyone close to me, but since childhood, I have been passionate about protecting children from abuse. As early as age ten, I was in Rock Creek Park (in Washington, DC) on a picnic with my family when I saw a mother whipping her young children with a tree branch. I marched up to her and demanded that she stop. As recently as a month ago, while patiently waiting for a table at IHOP, I noticed a mom yanking so hard on her toddler's arm that she was pulling her up from the floor. "Um...excuse me," I said calmly as I kept texting on my phone, "but if you keep doing that you might dislocate her shoulder." She stopped yanking then and angrily tried to defend herself. I stayed within her striking striking distance and secretly hoped that she'd hit me so that I could call the police...and protect an innocent 2 year old.

In this month's Martha Stewart Whole Living Magazine, I was interviewed about child abuse and it's impact on adult medical illnesses. I was familiar with the association between early abuse and conditions such as depression, fibromyalgia, irritable bowel syndrome, and eating disorders, among others. However, it was only because of a smart journalist's leading question that I learned about the epigenetic impact of early abuse. Stated simply, environmental events and exposures impact whether genes are turned on or off.

According to the Center on the Developing Child at Harvard University,

"If young children or pregnant mothers experience toxic stress as a result of serious adversity (such as chronic neglect, abuse or exposure to violence) in the absence of protective relationships, persistent epigenetic changes can result. These modifications have been shown to cause prolonged stress responses....(which can) result in increased risk for physical ailments, such as asthma, hypertension, heart disease, and diabetes."

CornerHouse is a non-profit agency in Minneapolis that works closely with law enforcement, child protection, and the county attorney’s office to advocate on behalf of abused children. Each year, their annual gala, "Lets Dance" is modeled after the show, Dancing with the Stars. Six local celebrities (Minneapolis business executives, community leaders or social figures with key contacts who can help raise visibility and money for the event) are paired with a professional dancer and dance studio who donate 15 lessons. The performance is a fully choreographed, three minute performance with the "winners" being the pair who dance the best and raise the most money.

When I was asked to be one of the local celebrities for their November 12, 2011 event, it seemed like a no-brainer. I care deeply about the cause, have decent rhythm and have always wanted to take dance lessons. I am not afraid to be on a stage, the chance to exercise is always a plus and, of course, I'd get to wear a fabulous outfit. Even before meeting my dance teacher, I decided to do a Latin dance since the music and fast-paced beats were similar to the Greek music I'd grown up with.

Bruce Abas at Four Seasons Dance was selected as my dance teacher and partner. He is a perfect fit since he'd studied Tango in Argentina and Salsa in Puerto Rico and Cuba. At the first lesson, we briefly introduced ourselves to each other, and then Bruce quickly launched into demonstrating the Latin Basic and the Side to Side steps while we both stood in front of the mirror. "Got it! This will be easy," I was thinking to myself.

After thirty minutes, it was time to practice the same steps while dancing together...facing each other. And, that's the last time this experience was easy. It was frightening.

In order to do any ballroom dance properly, it is essential for partners to communicate with direct visual contact, arm resistance and close body contact. In addition, Latin dance requires a sensual movement of the hips in order to make it authentic and beautiful. A basic rule is that the male partner is always in control. And, finally, trust is essential.

Try this with a relative stranger. Try this when your success has been centered around the rules, mores and conservative behaviors of corporate America. Try this when you have led your whole life being "in control." Try this when the skeletons from your past are sending you conflicting messages and fueling a heightened stress response.

Lessons two and three triggered the same fright and anxiety. I contemplated backing out, and one friend suggested that I simply write a large check and withdraw. But, it's my husband who encouraged me to follow through. In fact, not only has he encouraged me to dance well, but to dance with the emotion that it will take to win. Besides honoring my commitment to CornerHouse, it is a personal opportunity to grow.

I have had my 5th lesson and can finally make eye contact with Bruce. I can even do a few turns. The hip thing is still a problem, but improving a little. While Bruce is in control of the dance moves, I am finally feeling in control of my Boogeyman.

Take home message: Don't run away from yours.

I will periodically continue to blog about this experience as we lead up to the November event.

Create Health,
Archelle

It's Just Coffee

noreply@blogger.com (Archelle Georgiou, MD) — Wed, 17 Aug 2011 12:22:00 +0000

There has only been one moment of levity on Wall Street in the last 2 weeks. It was Friday, July 29 when the Smurfs rang the opening bell at the New York Stock Exchange. Smurfette, the one on the left with yellow hair, is my daughter, Arielle. Her fifteen minutes of fame at the Exchange was a few days after being with Katie Perry and Brooke Shields on the "red" (actually, blue) carpet at the movie premiere. On that day, the actresses had on couture clothing and bling while Arielle was dressed as...Papa Smurf.

How does a 21 year old get to hang out with movie stars and then get VIP treatment on the floor of the Exchange? One could simply write it off as a benefit of living in New York City...or being at the right place at the right time...or, my least favorite, being lucky. On the other hand, one could attribute her experience to a willingness to take a calculated risk.

When Arielle agreed to this opportunity, she didn't know what any of the perquisites would be. Being a Smurf doesn't quite meet any of the typical criteria for opportunities that might advance her education--she is an International Relations major and law school bound without any hint of acting/theater aspirations. The only information she had was that she'd be running around New York City during a heat wave wearing a heavy blue outfit and getting paid $100 for each event. Nevertheless, it sounded fun...she had the time...it was safe, and it was legal. (Yes, I am grateful that it met all three criteria.)

It's easy to identify an opportunity when it is presented as a promotion, attached to a salary increase and packaged into a press release with corporate fanfare. But, how do you recognize those subtle moments when a door gently opens...just waiting for you to walk through it? It's not luck. It's a process.

Here are a few tips that have served me well. They combine a little intuition with an intense commitment to developing relationships.

1) Listen to your gut. Don't over-analyze. In mid-2008, Dan Buettner, author of Blue Zones, didn't have the name recognition and fame he has today. But, when he jokingly invited me to participate in a longevity expedition to Greece, I immediately called my husband, and told him I'd be away for 3 weeks. Given my diva approach to vacations, I knew that I'd never have another chance to experience Greece with a rugged explorer. Spontaneous? A little. A calculated risk? Absolutely. The trip sounded adventurous and I had the time. I didn't ask too many questions about safety; since I speak Greek and have a credit card, I figured I could get out of any untoward circumstances. Little did I know that this experience would fundamentally transform my view of health and health care in addition to fueling a myriad of speaking and media opportunities.

Pay attention (!) if you have an initial fleeting thought of "That's really interesting" or "I'd love to do that sometime" or "Wow...that's a once in a lifetime opportunity." Look for ways to take advantage of new experiences instead of ignoring your piqued interest and/or getting paralyzed by over-analyzing barriers.

2) Take the cold call and listen. Mickey Beyer-Clausen, CEO of Mental Workout, found my cell phone number and called to introduce himself. No referral. No e-intro from a mutual colleague. It was tempting to say, "Sorry, I have no time," but instead, I took my own "how to" advice, risked 5 minutes and listened as he explained that his company was reinventing psychology with mobile applications. Within a few minutes, it was clear that he had an innovative and disruptive health care technology. Eight months later, not only have we forged a formal business relationship, but Mickey also introduced me to a company (now a client) with groundbreaking innovation around hospital-acquired infections. (More on that in a future blog.)

We all receive our share of unsolicited calls. Talk to every single one; engage in the conversation for long enough to make an informed decision about the potential synergy with the caller. The calculated risk is miniscule: lose some time versus lose a chance to participate in meaningful change.

3) Carry your business card. Meet for coffee. Don't show up with an agenda. Introductions occur every day...at work, the health club, at dinner parties, in the grocery store aisle. With a few, there will be an immediate connection. Why? Who knows? There isn't enough time or interaction in the 7 second "meet and greet" to figure it out. However, if you simply walk away, you are likely to lose the connection forever. Hand them a business card, get their contact information, send a follow up note and arrange to have coffee. (Note to self: Pay for their coffee.)

Has a colleague, a friend, or a relative proactively offered to introduce to one of his or her contacts? Never, ever turn them down or procrastinate for so long that the opportunity passively vanishes. But, what if the individual is outside of your industry, your educational/professional background, or (gasp) above or below your grade level? What if you can't see an obvious link between what you do and can't think of a business reason to meet with them? Don't pre-judge; don't speculate. There is no risk if you are genuine and don't expect anything in return. Just show up, learn everything about what they do and, if there is time, take a few moments to tell them about yourself.

To many, it may seem like an extraordinary time commitment to meet or talk to virtually every individual who suddenly appears in your world for the mere handful of conversations that might materialize into a valuable or profitable interaction. But, there is more than that. With each conversation, you get smarter and expand your potential as you are introduced to a new thought, a new industry, a new perspective, or a new cause. In the article, How Aha! Really Happens, the authors describe a concept the concept of intelligent memory:

"From the moment you're born, your brain takes things in, breaks them down, and puts them on shelves. As new information comes in, your brain does a search to see how it might fit with other information already stored in your memory. When it finds a match, the previous memories come off the shelf and combine with the new, and the result is a thought. The breaking down and storing process is analysis. The searching and combining is intuition. Both are necessary for all kinds of thought. Even a mathematical calculation requires the intuition part, to recall the symbols and formula previously learned in order to apply them to the problem. When the pieces come off the shelf smoothly, in familiar patterns — such as simple addition you’ve done many times — you don’t even realize it has happened. When lots of different pieces combine into a new pattern, you feel it as a flash of insight, the famous “aha!” moment."

That's a pretty good return-on-investment for the price of a cup of coffee.

Create Health,
Archelle

Chinese Takeout: 3 Impressions I Carried Out of China (and Vietnam)

noreply@blogger.com (Archelle Georgiou, MD) — Wed, 20 Jul 2011 15:02:00 +0000

"So, how was China?"

We recently returned from China and Vietnam and have been asked this question many times by curious friends, family, and colleagues. Recognizing that we live in a world of soundbites and that no one really wants to hear every detail about our fourteen day trip, I've responded by focusing on the experiences and observations that had a lasting impact on how I think. There were three: one is personal, one is political, and one is professional.

Shanghai: Freeways with neon blue underlighting amidst skyscrapers

Personal: While "Made in China" is present on everything from chatchkas to clothing labels to housewares, and although China's thriving economy is a frequent topic in the business world...I simply wasn't expecting to see their ultra-modern infrastructure. I went to China with a visual image that was pre-Mao. Shame on me. Instead, I saw 14 story shopping malls, a Shanghai skyline best described as "New York on steroids," an efficient and clean subway system, and construction cranes on every square block. While analysts predict an economic and building bubble that will deflate soon...there is national confidence that China's 5 Year Plan (for 2011-2015) will address these risks. Take a look at the well-defined, measurable goals regarding their economic targets, innovation, the environment, people's livelihood, social management, and reform. The Plan is translated into action down to the individual citizen level to assure that they achieve their goals. We may not agree with socialist/communist ideals, but step back for a moment and imagine how much progress the US would make if we had a unified plan regarding our nation's advancement.

How was China? A strong world power. Never again will I refer to China as an "emerging economy." They have emerged, and there are a few things that the US can learn from them.

600 people live on floating platforms in Ha Long Bay, Vietnam

Political: In Vietnam, our guide whisked us to Ho Chi Minh's tomb, and proudly announced, "We are a communist country." Well versed in his country's history, Happy (yes, that was really his name) gave described, in depth, how communism liberated the Vietnamese from the French. As usual, we peppered him with as many questions as he would tolerate about life in, what we presumed to be, a classless society. He was understandably cautious in how he represented the government, and his standard response to many questions, such as "How much corruption is there?" was "That is a sensitive question that I cannot answer." Recognizing there are pros and cons to any ideology, we looked forward to hearing about their health care system and how it was designed to offer equitable access to care. We were shocked when he explained that only those who have money can afford health insurance, and only those who have insurance get health care. Everyone else struggles. I was distraught. "What?! How can this be? How can a fundamental need not be provided in a communist country?" His response? "That is a sensitive question that I cannot answer."

How was Vietnam? Physically beautiful but politically contradictory. I have since learned that Vietnam (and China) have a "socialist market economy"--in other words, they have both the political and social disadvantages of communism as well as the economic disadvantages and disparities of capitalism.

Great food, but we just wanted some rice!

Professional: During the annual business planning cycle of US businesses, it is typical for managers to request a budget to hire more staff. In most cases, the proposed employee increase is trimmed, slashed, or completely eliminated with subsequent grumbling about the "impact on service and innovation." Sound familiar?

While we were in China, I paid particular attention to staffing. In a nation with almost unlimited opportunity to hire due to low labor costs, I paid special attention to whether more people resulted in better service. My observations were far from a formal analysis..but, here's what I saw:

Staffing levels were 3-4 times higher than in the US. Example: In a casual US restaurant, there is typically 1 host who greets and seats customers. In China, there were 4:

At the entrance to the restaurant. Responsibility: open door
In front of the hostess stand. Responsibility: ask for number of people in the party
Behind the hostess stand: Responsibility: assign the table
Beside the hostess stand: Responsibility: lead guests to their table

The service was adequate (but not extraordinary) as long as we had ordinary, predictable requests. But, when we strayed from the norm---service collapsed. When we tried to order a plain bowl of rice for Zoe in a restaurant with rice-based dishes, we created a bit of chaos. The waitress called the supervisor who called the manager. After fifteen minutes of huddling, they were unable to serve a plain bowl of rice since it wasn't specifically listed as a menu item. An overflowing chafing dish of plain rice was 20 feet away in the buffet line. We gave up.

This scene, with different details, was repeated multiple times each day. (No, we were not being difficult Americans.) While our daughter lived in Shanghai, she was in the bed/mattress section of a department store and asked where she could find bed pillows. The bed salesman had absolutely no idea...and was unable to help figure it out.

The employees did not seem are complacent, uncaring, or intentionally inflexible. Instead, they just couldn't think or act outside the boundaries of their tiny, narrowly defined scope of responsibility. I realized, for the first time, that excess labor isn't necessarily a solution to better service. Rather, it can drive inefficiency and dilute accountability for the entire consumer experience.

How was China? A culture that fosters order and compliance versus risk-taking. Yes, they can copy couture fashions before they are off the runway, and reproduce the newest Apple device before Steve Jobs is off the stage, but the lack of flexibility and, consequently, little problem solving, translates into a larger national issue for China: lack of innovation. The government, however, has recognized this risk, and the 5 Year Plan includes investments in R&D with a goal to achieve 3.3 patents per 10,000 people.
What was my overarching takeway, or, should I say takeout? Our trip was analogous to a Chinese feast that offers a disparate array of exotic foods that I never imagined eating. Similarly, our trip offered a disparate array of impressions and observations that disrupted some of my long held beliefs. I am still digesting it...though with a little heart burn.

Create Health,
Archelle

The Battle Over Avastin

noreply@blogger.com (Archelle Georgiou, MD) — Fri, 01 Jul 2011 16:04:00 +0000

The use of Avastin for breast cancer was addressed by the U.S. Food and Drug Administration this week. The outcome was devastating for Roche and an emotional one for many women who believe the FDA is subjecting them to a death sentence. As usual, there are a variety of perspectives to take into consideration.

The history: In 2008, Avastin was given preliminary approval by the FDA for the treatment of breast cancer on the condition that the company would do more studies to demonstrate its effectiveness. Many women have been successfully treated with Avastin -- a billion dollar drug for Roche.

But when Roche submitted the required follow-up studies in 2010, the data showed that there was no benefit from the drug for treating breast cancer. Studies did not show significant impact on mortality or improvement in quality of life. In addition, the drug was associated with some significant side effects such as high blood pressure and blood clots.

In December, 2010, an FDA panel voted to withdraw the drug's approval as a treatment for breast cancer. Roche appealed the decision, and earlier this week, an FDA panel hearing the appeal unanimously decided, in a 6-0 vote, to withdraw the drug's indication for breast cancer. The final decision on whether or not Avastin loses the indication is ultimately up to the FDA Commissioner, Dr. Margaret Hamburg.

Hamburg support of the panel's recommendation is critical. At the same time, this will fuel even more emotion and protests among patients. Here's why:

• From the FDA’s side: The FDA issued a provisional approval with the explicit understanding that the final decision would be based on more conclusive studies. If the FDA maintains the drug's approval despite the lack of scientific data, this would likely impact all of their future decisions to offer provisional approvals for potentially life-saving drugs.
• From the patients' side: Women who have benefited from the medication have clearly voiced their opinion that the doctors and patients, not regulators, should decide whether or not to get potentially life-saving treatment.

An important fact to keep in mind is that Avastin will remain on the market because it is FDA-approved for certain types of lung, colon, kidney and brain cancers. Therefore, Avastin will still be available "off label" for treating breast cancer when patients and their doctors believe that this medication is the best option. In those situations, the only real barrier to access is financial since expensive drugs used "off-label" are frequently not a covered benefit, and very few women can afford $80,000 per year out of pocket for Avastin.

Roche is understandably passionate about making this drug available to women, and they will be pursuing additional studies to prove its effectiveness. But, in the mean time, there is a solution that's not been discussed and doesn't involve beating up on insurance companies: For women who decide (despite the data) that they want or need Avastin, Roche could simply decrease the cost.

What do you think?

Create Health,
Archelle

Sources:
FDA begins process to remove breast cancer indication from Avastin label
www.fda.gov/newsevents/newsroom/pressannouncements/ucm237172.htm

A version of this blog was originally posted on EmpowHER.

Mayo (Clinic): The Secret Sauce To Better Care

noreply@blogger.com (Archelle Georgiou, MD) — Wed, 15 Jun 2011 14:06:00 +0000

“In the event that I have a critical illness and am unable to make medical decisions for myself, my health care agent, David Feldshon, should transfer me to Mayo Clinic for health care services as soon as I am stable for transport.”

This is the exact language included in my Health Care Directive. No, I have never been a Mayo patient, don’t have any medical issues and don’t plan on getting sick any time soon. Nevertheless, I simply feel better knowing that if I need critical care, I will be at an institution where I believe I’ll have the best chance of a good outcome.

The aura that surrounds Mayo has mesmerized many. Friends and colleagues who have trekked to the Clinic for their $5000 executive physicals have uniformly reported that after being poked, prodded, and palpated for two days, they felt reassured that they'd had a thorough evaluation. And, of course, there is a continuous stream of royalty and dignitaries who fly their private jets to Rochester to get, what they hope, is the best care in the world.

But, are these beliefs, hopes and perceptions real? Do Mayo doctors really offer better care or does the institution just have a better, and incredibly powerful, brand?

Last month, I got closer to an objective answer. I was invited to give a keynote speech on health, longevity and technology at the Mayo Clinic Alumni International Meeting in Athens, Greece, and I attended two days of the conference. Of the 150 attendees and speakers, I was the only one who was not a Mayo graduate and/or a practicing Mayo doctor. But, as the sole outsider, I had a unique glimpse into their world.

Mayo hosted a black tie dinner in a swanky restaurant on the shores of Vouliagmeni Beach. In the midst of the glorious sunset and a gourmet meal, Dr. Scott Swanson, one of the Scottsdale-based urologists, turned to me and said, “Ok, Archelle…you challenged our conventional thinking earlier today. Challenge us some more. Throw out some tough questions.” I couldn’t resist the invitation to ask: “Do you really believe that Mayo offers better care…or does Mayo just have a great brand. And…why?”

I expected an immediate, and arrogant, “yes, of course we provide better care.” This is the typical response I’d received in the past from large multi-specialty groups who defended their clinical superiority based on the size of their practice, patient volume, number of procedures, and income. Instead, the conversation at the dinner table focused on how Mayo's environment facilitates better care and a better experience for patients. Initially, they pointed to two key elements of their system:

1) Electronic Health Record: Mayo’s EHR was designed and built in-house, and the physicians uniformly agreed that it is organized to be useful for patient management--not simply a vault for medical record documentation. As a result, their EHR is a key enabler of efficient communication between doctors and staff regarding diagnostic workups, treatment plans and follow up visits.

2) Immediate Specialty Consults: There is significant peer pressure among the doctors to be highly accessible. If a doctor has a challenging case and needs a specialist to assess their patient, there is an expectation that colleagues will make themselves immediately available. “Too busy,” “later” and “can’t do it today” are shunned and not part of the vocabulary and relationship that doctors have with each other. As a result, they believe that complex diagnoses that take weeks or months to sort out in other settings can get addressed quickly and efficiently in the Mayo system.

Dr. Swanson was clearly enjoying the conversation but wanted more controversy. He presented a specific patient care issue: “Would you do prostate cancer screening on an 80 year old man?” (FYI, the US Preventive Services Task Force guidelines recommend against PSA screening in men age 75 years of older.) A spirited debate erupted, and I pulled out my notepad:

Medical oncologist: "No, it's unlikely that screening would make a meaningful difference in the patient’s outcome."

Dr. Swanson: “That’s an insurance approach to the patient. What if the man’s parents died at age 95 and there was no other underlying illness? If you found a cancer, you could potentially let him live out those 15 years.”

Medical oncologist: "Agree...but there should be a discussion with the patient in advance of the testing to explain the implications and potential treatment associated with a high PSA result."
Family practitioner (wanting to get in on the debate): "What about a 40-year-old man whose father and two brothers all died of prostate cancer? I screened him and ended up diagnosing a Gleason 2 (early stage) cancer. This guy is likely to be the only male in his family who will survive past the age of 65."

While each of the Mayo doctors started with slightly different clinical approaches, they shared a common philosophy: guidelines are just that--a guide; treatment should be personalized based on the specific needs and circumstances of individual patients. In addition, there was a striking absence of CPT codes, insurance rules, or reimbursement opportunities influencing their judgment. And, in striking contrast to doctors in private practice who tip toe around each other to protect referral patterns, the Mayo docs clearly felt comfortable challenging each other when they disagreed. I suspect that it is this type of collegial banter that results in the thorough and coordinated care plans for Mayo patients.

I probed further and kept firing questions. I shared the story of a friend who had a positive experience at Mayo but had a difficult time getting follow up questions answered over the phone. The internist spoke up: “Most processes work well, but there are still issues we need to address. We need to make sure it’s easy for patients to get their questions answered.” No defensiveness. No rationalizing. No whining about reimbursement rates as the barrier to being responsive to patients.

This was Mayo's secret sauce. They have a culture of “patient-centered care.” The aspiration of many. The achievement of very few.

Last month, Mayo launched its first affiliated practice network (APN) relationship with Altru Health System in Grand Forks, North Dakota. This is a strategy to broaden Mayo’s footprint without building new, owned facilities. Health system who are part of Mayo's APN maintain their independence but have fast track availability for consults and immediate phone access to Mayo specialists. Mayo will share its electronic health record system and clinical protocols—as well as it’s coveted brand.

This is a brilliant strategy but only if Mayo develops a deliberate and effective plan to also export its secret sauce. Will doctors in these more loosely organized health systems be committed to being available and accessible for each other? Will they feel safe to debate? Will they make and take the time to collaborate and coordinate integrated treatment plans? Will they take a multi-disciplinary view toward patient care without protecting their small kingdoms and personal income? Will they learn to care about the patients’ experiences? I don't mean to imply that all other health systems are starting from ground zero, but the Mayo brand implies a solid and consistent patient-centered culture.

The real question is whether establishing a patient-centered culture is even possible in a production-driven, fee for service health care systems. Time will tell.

In the mean time, David, my health care agent, has strict instructions:
Do Not Pass Go. Do Not Get $200. Take me directly to Rochester.

Create Health,
Archelle

To Sell Your Story, You Have To Tell Your Story

noreply@blogger.com (Archelle Georgiou, MD) — Wed, 25 May 2011 07:27:00 +0000

It’s great when the stars align:

The Wireless Life Sciences Alliance Summit was in San Diego.
Michelle King Robson, CEO of EmpowHER (and a dear friend) was a panelist/speaker.
Michelle and Ed Robson's boat is docked in San Diego harbor.

The Robson's graciously invited me to stay with them on their 120 foot yacht instead of staying at the Hyatt. Ummmm...okay. As you might expect, it was amazing. But, I will forego a description of the boat's luxury and the 24/7 attentiveness by their staff because the most memorable part of staying on this beautiful vessel was the time I spent with Ed each morning over a few cups of Starbucks coffee.

A little about Ed Robson: Adopted. Graduate of Colorado College. He joined the Marines and was helicopter pilot but then got a leave of absence to play on the US Olympic Hockey Team. Ed started his career selling real estate then started his own real estate company and then started building homes. Forty-five years later (Ed is a vibrant 80!) he is the owner of Robson Resort Communities, a collection of 7 adult active senior living communities in Arizona and Texas. He also owns 100+ additional companies that control the entire supply chain....from water to carpet for the 40,000 homes he’s built. In other words, he owns seven small cities. Its fair to say... he's had a very successful career.

Ed walks his three dogs at 5:45 am. Since I was on a different time zone and awake before sunrise, I quickly figured out that I could find him on the back deck of the MyChelle by 6 am. I tried to extract as much wisdom as I could from his brain. The topics of our conversations ranged from from health, seniors and fly-fishing to architecture, wealth, and raising children to be accountable. I asked Ed countless questions. He was gracious, humble, and, frankly, tolerant. But, it was his answer to the most probing and personal question that inspired this blog.

"Ed, is there anything about your career that you regret?" He paused, and I expected him to talk about a failed real estate deal or a missed business opportunity. Instead, he said, "I wish I had been a better student and got more of an education."

He explained, "When I was in a room with these business guys from Harvard or Yale...they weren't more intelligent than me, but they got their ideas out better and faster. And, in those high pressure meetings...there isn't alot of time to listen. So, those guys would win."

Ed’s laser-like answer wasn’t referring to education as a way to get more book smart but rather, as a vehicle for learning how to be an effective and influential speaker. And, I started wondering…what is the relationship between education, communication, and success?

No one can argue with the value of higher education. There is ample evidence that it is correlated with a broader array of opportunities and greater income potential. In addition to acquiring raw, core knowledge, the learning process, particularly in post-baccalaureate programs, is designed to teach students how to research, analyze, summarize and weave pertinent facts into a compelling, influential argument. Throughout their curriculum, law students are repeatedly required to present briefs, MBA students share their analysis of company studies, and PhD candidates defend their research. With each experience, they get a little smarter and, simultaneously, their communication skills gets a little sharper.

Looking back on my own experience…Morning rounds at John Hopkins Medical School were like a daily Toastmasters exercise. Chief residents expected a crisp, three minute summary of each patient we had admitted during the previous night on-call. No notes allowed. They relentlessly critiqued our presentation skills as much as our diagnostic skills. After 2 years of clinical rotations and 3000 patient presentations later, I graduated with a proficiency in storytelling. (And an M.D.)

While a rigorous academic environment can help fuel and develop strong verbal skills, we’ve all met plenty of professionals who aren’t effective speakers and, conversely, non-professionals who are quite eloquent. The common denominator is neither education nor natural talent. Rather, it’s about practice AND the realization that the story you tell about yourself, your company, your product, your idea--- is highly influenced by Words That Work: It's Not What You Say, It's What People Hear—the best-seller written by Frank Luntz.

Presidents and politicians are judged heavily on their oratory skills rather than their judgment. During my years at United, there were countless times when our capabilities were superior, but how we delivered our story was weaker…and we lost the deal. Clients can really only assess what they experience…and that is you. Therefore, effectively communicating a compelling story that captures mindshare…also captures wallet share.

In my consulting, I typically work with businesses and their executives who have very cool health care technologies or service offerings with significant potential for growth. But, they have challenges telling their story. They are bright, entrepreneurial, and knee deep in content knowledge and product details. But, they don’t spend enough time (and understand the value of) selecting the right words, architecting messages, identifying anecdotes, mining key data points, developing beautiful slides, practicing, practicing more, and then listening to themselves tell their company's great story.

I scratch my head when a senior executive says “I do better when I am spontaneous” and convinces themselves that they don’t even have to prepare key messages before a presentation. I am amazed when sales teams are unleashed in front of clients without being required to deliver the pitch internally to get some feedback. The most common excuse: It’s intimidating. Really? Is it scarier to speak in front of a client representing a multi-million dollar opportunity versus your boss? If that's really true, then turn on your laptop camera and start videotaping. Play it back, critique yourself, then practice again. And, again. That’s what it takes.

All things being equal, those who practice more and learn to communicate better…win.

Create Health,
Archelle

PS: You can't delegate the practicing to your marketing director. Doesn't work.

“Healthcare” versus “Health Care”: The Value of a Space

noreply@blogger.com (Archelle Georgiou, MD) — Wed, 11 May 2011 12:39:00 +0000

There have been several blogs and articles written on the grammatical appropriateness of “health care” versus “healthcare.” In Michael Millenson's post on The Health Care Blog, he explains that the Associated Press (AP), which dictates journalistic style standards, says the correct usage is “health care.” Two words. Most major journals, newspapers, and media sites follow this convention, but it may not be the end of the debate.

There is an equally accepted convention that says that “health care” is correct when there is reference to a provider’s action, and “healthcare” is used when it is an adjective to modify another noun or verb—healthcare system or healthcare marketing—for example. And, there are many sites that shift, very consistently, between these two approaches depending on the sentence structure.

I can live with 2 different literary conventions … but here is what is keeping me up at night and: literary styles change.

“Airline” used to be “air line” and “website” was formerly “web site.” Similarly, there is pervasive evidence that the “health care” is turning into “healthcare.” In my own cursory review of sites that I respect--WebMD.com, Kaiser Family Foundation, the Institute of Medicine, I found that "health care" and "healthcare" are used interchangeably without grammatical rhyme or reason.

So, why do I care? And, why should you care that the adjective, “healthcare,” is well on its way to becoming a noun or a verb? In fashion, style changes drive revenue. On Twitter, eliminating the space creates capacity for one more character. However, in health care, eliminating the space and turning two words into one, will have a negative impact on people, their well-being, and thereby, worsen an already deteriorating system.

Take a moment to do an experiment:

1) Write the following sentence on a piece of paper:

Healthcare is important.

2) Show the paper to a few different people, and ask them to explain what the sentence is referring to when it says “healthcare.” Listen for the meaning they ascribe to the word "healthcare."

What is the first thing they say? Most likely, they refer to insurance, access, costs, and/or health reform. Do any even refer to the quality of care that they receive from doctors or other care providers? Do they refer to the importance of their own lifestyle behaviors? Probably not. In my experiment en route from Minneapolis to San Diego yesterday, with an n=5, only XX said anything about care, and only as an after thought.

The explanation is pretty straightforward:
Language triggers images.
Images stimulate thoughts.
Thoughts motivate behavior.

The word “healthcare” conjures up images about the system---not doctors or nurses; not medications; not nutritious foods or exercise. As a result, a gradual, seemingly innocent, linguistic transition to ”healthcare” may slowly erase our mental images of wellness and fuel an unconscious passivity among patients and clinicians regarding their personal accountability as individuals and professionals. The result: further deterioration in the nation’s health.

In the middle of writing this post, I realized that I am contributing to this unfortunate, literary transition. The tagline for Georgiou Consulting is “Healthcare…Simply.” I am embarrassed to admit that when I went through a branding process and web site design in 2009, I worried about the font and the colors and didn’t even think about the broader implications of using one word versus two. So, I will change it (Ka-ching!) and, consistently change how I write.

So, what can you do?

Take responsibility for the word(s) that you use in memos, letters, emails, tweets and other content that you author. Hit the space bar between “health” and “care.” Each time you do, you’ll add value to someone’s life by triggering an image … stimulating a thought…and motivating a behavior.... that has the potential to make a positive difference.

Create Health,
Archelle

ACOs: Millions of Web Hits…Dozens of Theories…One Bottom Line

noreply@blogger.com (Archelle Georgiou, MD) — Tue, 19 Apr 2011 17:59:00 +0000

9 million. That’s how many web hits are returned during a Google search for “Accountable Care Organization,” and reflects the countless articles, white papers and opinions that have been published regarding the potential successes and more likely pitfalls of the proposed ACO mandate. As highlighted in TripleTree's recent post, our team is continuously evaluating the business development opportunities being fueled by the demands and requirements of these new provider organizations. Last week, the members of our Healthcare Executive Roundtable recently discussed and debated an element of the ACO equation that is not typically highlighted but is clearly a critical component of ACO success (or failure)…Trust.

In boardrooms around the country, health care executives are focusing on the technical requirements for their future ACO’s clinical and administrative systems. They are pouring over spreadsheets and attempting to understand the data and analytical tools that will be necessary for adequate financial and quality of care reporting. Getting these operational elements “right” is important; however, these business leaders should also focus on designing a culture – and the corresponding behaviors, communication, and incentives that will fuel strong and collaborative relationships between the ACO and its community of providers.

As Ed Brown, CEO of Iowa Clinic puts it, “People are unclear about what the value-based world looks like, and they’re unsettled on what clinical integration really means. And nobody has really made it work.” This lack of clarity around the value-based model will make it challenging for providers to leave the financial security blanket of the traditional fee-for-service payment engine. Moreover, influencing them to modify their approach to patient care for the benefit of the system and the promise of shared savings is a monumental effort. Success by any measure will largely depend on the trust established between providers and the ACO organization itself. ACO’s should prioritize establishing trust with providers in three key areas:

ACO Operations and Management: Providers need to trust that the ACO is well run. Understanding the organizational governance, expertise of the management team and core capabilities (strategic assets) will help generate confidence that the ACO is well-positioned to generate enough shared savings to make participation worthwhile. In addition, it is critical that the ACO measure and report management performance metrics that demonstrate its accountability to the providers.
Compensation Incentives: Providers need to trust that they are getting their fair distribution of shared savings. Clinical algorithms defining quality and outcomes must be evidence-based; and the financial tools and risk-adjustment methodologies used to distribute payment must be easy to understand. Above all, the organization’s compensation schemes must be highly transparent and accessible so that providers can validate that they are being treated as an equally valued business partner in the organization.
Confidence in Provider Team: Providers need to trust their ACO provider colleagues. If the right incentives are in place to bring members within the organization together, providers will need to trust that their peers will also be active participants working toward fully coordinated care within the ACO. Under an accountabilities and outcomes-based model, it will be important that providers view their care responsibilities as extending beyond the encounter. Active provider participants should be practicing first-class follow-up care, improving patient satisfaction, and reducing re-admission rates which will achieve collective rewards.

The inclusion of ACOs as a provision of the Patient Protection and Affordability Act is a strategy to realign delivery systems in the US so that they provide high quality, coordinated care. The bottom line for achievement might simply boil down to whether providers can engage in meaningful and integrated relationships with the ACO and with each other. Since relationships are based on trust—predictability, integrity, and reciprocity–it is imperative that ACOs make trust a deliberate priority.

This post was co-authored by Archelle Georgiou and Emma Daugherty, Senior Analyst at TripleTree and originally published on the firms blog site, Uncommon Clarity.

Create Health (not just wealth)
Archelle

Bill McGuire on Wireless Health and Technology

noreply@blogger.com (Archelle Georgiou, MD) — Thu, 07 Apr 2011 17:26:00 +0000

The following article was originally posted in mobihealthnews by Brian Dolan.

McGuire: The Land Grab is Misguided

The former chairman and CEO of United Health Group Dr. Bill McGuire recently discussed the opportunity for wireless health (or technology enabled healthcare or whatever you want to call it), wasteful spending on EMRs, the need for interactivity among healthcare technology applications, opera, education and much much more. Dr. McGuire is the Vice Chairman of TripleTree Holding Company and is delivering one of the keynotes at the upcoming Wireless-Life Sciences Alliance Convergence Summit in San Diego next month. TripleTree is an investment bank and one of the founding members of the WLSA and the summit.

Read on for an edited version of our recent conversation with Dr. Bill McGuire.

How do you characterize the opportunity for wireless health? Could you also provide us with some sense of the current investment climate — a lot of activity? A lot of interest but not a lot of activity?

I like to position it as: How can we build products, services, and systems that facilitate the eventual appropriate health and wellbeing for the people in this country and elsewhere. In pursuit of that and in consideration of all that has been done — both good and bad — and all that is yet to be done, which is significant and formidable, I think the whole area of technology enabled healthcare or mHealth or any term you’d like to apply, offers significant opportunity to meet that end. It still remains to be seen obviously what the most appropriate areas and most beneficial areas will be to accomplishing that. When it comes to investments, of course, there will be a lot of investments in things that don’t make any difference or are not contributory to the kind of outcomes I am describing.

What kind of things?

If you look at what has happened in last several years particularly with reform: These huge expenditures that have been directed at technology applications in healthcare. I’m afraid we will see that we have spent an enormous amount of money for marginal or no gain. It’s very indiscriminate. That’s classic healthcare, though and classic investing: ‘Let’s just throw money at things.’
You have the whole idea of applications on cell phones for example. Embedded among [the thousands] of health apps out there are probably a few that will make a difference in the lives of some people. Those apps should theoretically lower costs and improve outcomes, but most of these apps exist because we happen to like apps, it’s a nice story, so we chase them. Discerning what is ultimately going to make a difference and result in the kind of outcomes we are looking for, which is differentiated from just investing money, is the critical issue. The smart investors, smart developers, smart policy makers and so on will benefit from that. The land grab that is going on right now — just throwing money at it — is a little bit misguided.
Another issue is the lack of interactivity among these technology applications. The fragmentation and silos continue. Rather than determining how to piece a number of necessary components together, we have a lot of independent efforts out there to chase after something. We ask for electronic medical records (EMRs) but we don’t necessarily put out standards of performance and interactivity between them. So when someone comes along and asks to gather data or information we know that we can’t get it from each and everyone of them.

So EMR efforts are misguided?

The amount of money that is being thrown at this stuff relative to the value that it is going to return to us is ridiculous and it will not prove to offer up the kind of end gains that we are touting. Those are health outcomes gains and financial gains in terms of lowering costs. I see nothing that suggests this is going to dramatically improve outcomes, improve access to care for people who had heretofore not had access to care and certainly nothing that suggests that it is going to lower the costs of healthcare in America. People are rushing to do various EMRs simply because the government says we will pay you to install it. If you talk to people who try to extract data from various EMRs they would tell you that there is no consistency in the expectation to do it from many different systems and yet we are spending billions of dollars on this.

Let’s switch gears back to wireless health. Are any companies on the right path? If you aren’t comfortable naming companies, what are some specific use cases that you think are promising?

I will be necessarily cautious about the specifics because I don’t want to come across as endorsing or refuting things that I know relatively little about specifically. Let’s start with a concept. What I think we are talking about in some way parallels what we are seeing from efforts in education. As we confront challenges around resource availability and the spacial relationship between the users (the someone in need) and the resource. The ability to take content out to individuals — which is what mHealth or various mobile technologies have done — becomes a substitution for asking those people to go to the content source in a different way.
It’s sort of like: If the cost of gas goes up and bus costs go up, how do we really expect kids to learn about the arts when they used to get on a bus and go on a field trip to a museum? Museums are beginning to take their content to the students where they live. The Metropolitan Opera says we can’t expect everyone to come to the Met, but opera is an important cultural element for society. So they started filming it and showing it at theaters around the country, which has been wildly successful. In these cases we are looking for ways to bring content out to touch people when we can’t in essence do it physically.
In healthcare the same principle exists. People who live in remote sites do not have access to care — primary care to say nothing of secondary or specialized care. How do we help them manage their health and wellness and help deliver services that might be beneficial to acute but relatively everyday problems. That is the kind of application opportunity that the technology provides. Whether that includes telehealth, applications, gaming… that’s the huge opportunity.

Any closing thoughts?

I think healthcare might be unique in that it is a space where technological advance has not positively influenced efficiency or cost reduction. Just across the aboard it has not happened. Costs keep going up year after year after year. Why is that? The discussion we hope to have at the WLSA Summit is around how the companies presenting are in fact going to accomplish the needs of both enhancing efficiencies and lowering costs while achieving improved health outcomes for people. I expect it will be a lively discussion about disruption and how mobile will play into that.

An Apple A Day....Drives Growth

noreply@blogger.com (Archelle Georgiou, MD) — Mon, 28 Mar 2011 17:04:00 +0000

At 9:55 am on a Wednesday morning. I was 15 miles from home and making good time getting to my 10:30 meeting until I realized that I’d left the power cord for my Mac computer at home. There was no way I’d have enough battery power to get through my presentation. So, I had a choice: turn around, go home and be late or run by the mall and buy a new power cord at the Apple store. Since the mall was only ¼ mile away, I could arrive just as the store opened and likely be the first customer. The decision was easy.

As expected, the parking lot had a scant number of cars and I got a plum spot by the entrance. Racing past several stores en route to my destination, I noticed employees in the sporting goods store dribbling basketballs waiting for their first customers. Gap associates were folding and re-folding jeans while Sephora employees were sampling products and primping in the mirror. The mall was empty.

And, then I got to the Apple store…it was packed. No, this wasn’t the day the iPad2 was being released although the store had already received 200 calls since 8 am from people wanting to know if it was available. What were all those people doing there? Buying Apple products; playing with Apple products, taking classes on how to use Apple products, and getting expert help from the Apple whiz kids at the Genius Bar.

After witnessing this scene, it was no surprise that Apple was in the #1 spot on Fortune’s List of Most Admired Companies in America—again--for the 4^th year in a row. Apple’s wildly successful performance is not new news to any of you; the high level themes are innovation, product, and brand. We’ve read about them many times. But, how can CEO and leaders of companies translate these themes into their business? That’s the diplomatic way to tee up this blog. The real question is: What can health care companies do to be more like Apple?

1. Fit in: In 2008, Apple leaped into the #1 spot in Fortune’s rankings (from #7 in 2007.) Steve Jobs himself said, “Apple products work, and if you buy more than one, they work better.” In other words: integration.

Yes, Apple has a fully integrated platform. But, Apple wouldn’t be as successful without the relationship and integration with Microsoft products. Early on, the company recognized they needed to fit into the prevailing system.

The number of new health care developments that are being generated are dizzying: billing programs to accelerate payment of patients’ copayments; software to maximize performance in pay for performance initiatives, IVR systems that increase patient engagement, incentive programs to enhance compliance with needed behavioral changes. The founders/developers are passionate that their cutting edge innovation will increase “quality and decrease cost.” However, too many of these great ideas aren’t designed to fit into the operational complexities of a hospital, doctor’s office, health system, or payor. And, despite the promise of more revenue and profitability, decision-makers can’t bear to layer any more chaos to an already chaotic system.

True systems integration may be prohibitively expensive for start-up or early stage companies, but at a minimum, be prepared to offer a feasible operational/process solution that achieves integration. How? Roll up your sleeves and invest time in learning how the system is wired: the back office operations in a doctor’s office, the politics of hospital revenue management, the benefits, claim and administration realities of insurance.

2. Sell solutions..not technology. Anyone who’s walked into an Apple store knows that the question the associates ask is: “What do you need to accomplish on your computer?” Fast Company magazine published an article about how Apple employees are hired and trained after one of their contributors worked undercover. The company has a 3-step selling process:

· Position: Understand the customer’s needs.

· Permission: Get permission to ask questions.

· Probe: Keep digging to ascertain which products would be best.

Avoid the temptation to sell your box, your widget, or your innovation. Focus on the customer, the problem they need to solve, and how you can help them accomplish that. Oh…and don’t forget to be intellectually honest. Don’t oversell. Don’t let them buy something they don’t need. In the end, you will sell more and have a loyal client. Bottom line, Jobs says, “When employees become sharers of information, instead of sellers of products, customers respond.”

3. Have a problem? Fix it. Now. In June 2010, sales of the iPhone 4 were so successful that it overwhelmed AT&T’s network capabilities resulting in dropped calls, error messages, and, as a result, negative national media attention. Heads must have rolled at 1 Infinite Loop in Cupertino, but there was relatively little public response from Apple. The immediate issue was quietly resolved and then—WHAM!—in January 2011 Apple unraveled its exclusive relationship with AT&T and announced that service for the iPhone 4 would also be available through Verizon.

How often have you seen heath care companies, particularly the larger ones, try to rationalize away their errors and waste time defending themselves? Claim delays, reimbursement underpayments, customer service issues, regulatory violations, security breeches. Intentional errors? No. Defensive cover-ups? Yes.

We are all at risk for making mistakes. Find them. Acknowledge them. Fix them. Like Apple, pay “meticulous attention to perfection.” Do it with stealth and speed.

Recommendations # 1-3 may be easier said than done. Number 4, however, is simple. It just takes ego strength.

4. Be Steve Jobs: Jobs is the face of Apple. He is the brains behind it’s success. But it wasn’t always that way. Jobs was ousted as the CEO in 1985 when revenues plummeted. While Apple started its turn around when he returned in 1997, the company’s success didn’t sky rocket until about 2006. So, what changed? Jobs. Take a look at 60 seconds of each of these videos:

Circa 1996: Interview. (Watch from :49 to 1:49 to skip introduction)

MacWorld 1997

MacWorld 2006

How many times did Jobs say “I” or “me” in 60 seconds?

In 1996, prior to his return to the company: 13 times

In 1997, within weeks of returning: 5 times

In 2006, 2 times

Don't EVER put “I” or “me” in a memo or a press release. Avoid these pronouns in your presentations. It’s not about you. Although you may be the face of the brand, the founder, the funder, and the brains, your messages should center around the company, the team, and how you add value to your customers.

All that from a $80 power cord.

Create Health,
Archelle

Got Ethics?

noreply@blogger.com (Archelle Georgiou, MD) — Thu, 03 Mar 2011 15:14:00 +0000

This week's Sunday New York Times had its usual array of breaking national and international news on the front page, but my loudest "Oh No!" came when I turned to page 14 of the Magazine. Randy Cohen, author of The Ethicist, announced that he is retiring his column. For those of you who are not familiar, Cohen's weekly column typically posed two moral/ethical dilemmas followed by his expert analysis and perspective.

This column has been part of our family's Sunday morning ritual since it started being published 12 years ago. Bagels, lox, coffee...and... The Ethicist column. We all knew the routine:

Archelle reads the dilemma. Twice.
Each daughter, youngest to oldest, must take a definitive position and defend it with clear rationale (yes, even Zoe is included in the lineup)
David, then Archelle, declare their positions. (I always go last since I seem to have the strongest opinion and don't want to influence everyone else.)
Family debate...aka...we argue.
Once we're exhausted or reach an impasse, we read Cohen's expert opinion.

This discussion, every Sunday, week after week, was valuable for teaching the girls a process for deciding between right and wrong. The everyday scenarios that Cohen presented were a non-threatening way to proactively work through many of the seductive temptations that they would inevitably face later in their lives.

From December 2002: Is it okay to Google some one you've started dating to check up on them? SN, New York

In 2002, this was a dilemma. In 2011, this seems like a no-brainer.

From May 2004: I am an American posted to Vietnam, where pirated movies on DVD are cheap and ubiquitous, and legitimate copies are nearly nonexistent. Would it be ethical to purchase pirated DVD's if I also join a monthly unlimited-rental service like Netflix? Ben Moeling, Hanoi, Vietnam

Arielle found herself with this exact dilemma as she spends the year in China.

From September 2007: A friend and I will soon take the LSAT. His father, a psychiatrist, gave him Adderall to help him take the test. I asked if he could share some with me, and he said that would be unethical. Is it? Isn’t his dad’s giving him the Adderall unethical? — Name Withheld, Austin, Tex.

The sharing of Adderall on college campuses is rampant.

The lifelong impact of this column became evident in 2005 when Athena was preparing for her Bat Mitzvah and matter of factly announced to us and the Rabbi that she wasn't sure whether she believed in God. Since God and religion are merely a construct for moral/ethical decision-making, we were unconcerned about whether she believed in "God" but were very concerned that she develops a solid framework for distinguishing right from wrong.

Cohen's ethics column was a non-threatening, familiar vehicle for helping Athena navigate through the process of maturing her moral framework. After 10 months, Athena developed her own set of "ethical decision guidelines" that she proudly shared in her Bat Mitzvah speech with our 130 guests: When faced with a dilemma, avoid decisions/actions that:

are against the law
don't give you a good gut feeling
you wouldn't be proud to tell your mom
you wouldn't want on the front page of the Wall Street Journal

Making ethical decisions is learned, not innate. It’s a skill, not a talent. It takes practice and improves with feedback, debate, and, most importantly, self-reflection. It requires that you look at your own actions and honestly assess your intentions.

Is it ethical to sign an employment non-compete without really intending to honor it since its unlikely to be enforceable anyway?

Is it ethical to use ICD-9 codes that are not accurate but that assure a patient's medical services will be reimbursed?

Is it ethical to accept a Senior Discount when a hotel clerk mistakenly assumes you are over 65?

Is it ethical to have dinner with a friend when on a business trip and then submit the entire restaurant bill as a business expense?

What decisions would you make in these scenarios? Some may seem so innocent…but are they?

Cohen may be retiring his column but his dilemmas are very alive on the New York Times website. Read them. Debate them. Help your kids mature their moral maturity and continue to refine your own. We all need probably need some help in this arena. It’s a process that never ends.

Create Health,
Archelle

5 Ways To Boost Patient Self-Management of Care

noreply@blogger.com (Archelle Georgiou, MD) — Wed, 23 Feb 2011 22:14:00 +0000

Most clinicians agree that if patients took more personal responsibility for their health, we'd have a healthier society and lower costs. But, what is the responsibility of clinicians to promote self-care? And, do we promote and encourage it...or do we subliminally create barriers and obstacles for patients? Do we really want them to be empowered...or not?

What will it take to help people help themselves when it comes to their health? This will be the theme of an upcoming keynote presentation I am doing at the Dorland Health's Care Coordination Summit in Las Vegas on March 8, 2011. As usual, I will be pushing the envelope and challenging the audience to re-define the definition of "care"--what it is, where it is delivered, and who delivers it.

As a preview to the event, the following article was published by Dorland Health....

5 Ways To Boost Patient Self-Management of Care
By Richard Scott
February 15, 2011

With the emergence of patient-centered care comes the express need for patients to move into an active role and take ownership of their care – an increasingly crucial characteristic to success. Yet propelling patients into this position of empowerment can be a tall task. What are the best ways to effect positive self-change in individuals?

We posed the question to healthcare consultant Dr. Archelle Georgiou, founder of Georgiou Consulting who will deliver a presentation titled Help People Help Themselves at the Care Coordination Summit on March 8 in Las Vegas. Dr. Georgiou offered the following tips to thrust patients into greater control of their health and healthcare.

Look past the condition. If this list of advice can be summarily divided into two parts – one oriented to how the healthcare practitioner approaches the patient and the other focused on a patient’s own recognition of care ownership – this first point falls into the former category. “The starting point is for the clinician to recognize that you’re dealing with the wholeness of the person and not just the condition,” says Georgiou.

While clinical skill is ever-important, the initial – and continuing – approach to how a physician or other member of the treatment team views a patient perhaps has more to do with good outcomes than clinical skill alone by engaging the patient in their own care from the outset. Only positive things will come out of that approach.

Look past clinical skill alone. Expanding on the above area, it is important to further engagement with the patient’s complete mind-body dynamic. This means more than relying on top-rated medication or surgical interventions or other evidence-based approaches. It’s key to focus on “marrying that with some things we forget to incorporate into a treatment plan, like mind-body medicine, relaxation techniques, stress [management] techniques,” says Georgiou. “It’s one thing to give a pill for anxiety. And it’s another to engage someone and empower them to do meditation-based stress reduction.”

Bolster communication. A two-part strategy, effective communication involves open discourse between both the treating team members and the team and the patient. “We have a culture that in some ways has encouraged patients to be passive about their own health,” says Georgiou. “Part of it is the communication that clinicians expect and give permission to patients to take charge of their own health.”

Expand your knowledge base. As patients feel more comfortable taking charge of their health, it is incumbent on them to become aware of their general health status and their treatment plan. In owning their treatment, patients can create personal health records or be knowledgeable about their office-based electronic medical records (if they exist). Of course, in many cases a clinician’s overall approach to how they deliver care (see the first two points) will go a long way toward deciding how engaged a patient will be.

Open up new lines of knowledge acquisition. The immediacy of information-sharing today means that there are many avenues patients can use to acquire information about their illness or treatment plan. According to Georgiou, social networks – online medical sites and discussion forums, for instance – are a vastly underused resource. “There’s a whole other sphere to where people can receive care, advice and support that clinicians typically don’t tap into,” she says.

With the care landscape changing, the most advanced clinicians and their teams will need to adapt to new ways of delivering medicine – not simply to keep pace but to remain ahead of the game.

Yes, Size Matters

noreply@blogger.com (Archelle Georgiou, MD) — Mon, 14 Feb 2011 17:01:00 +0000

The President quit smoking. Yup, it's true. The First Lady said so during a press conference last Tuesday. Later in the day, Robert Gibbs, the Press Secretary, confirmed that the President has worked hard to kick the habit.

Well, only the Secret Service knows for sure whether or not the President is still sneaking a few puffs. But, regardless, I admire his accountability to himself, his family and to the public. Obama has 'fessed up to his vice. “This is not something that he’s proud of – he knows that it’s not good for him,” Gibbs told reporters. Obama hasn't tried to rationalize his behavior or made excuses. And, he hasn't implied that simply cutting back is good enough. He has plainly said that smoking isn't good for him...or for anyone else.

Compare that to Surgeon General Dr. Regina Benjamin. Lets call it like it is...she's fat. And, so are 63% of Americans. But, the real question is: Is she accountable to herself and, more importantly, to the public? Is she helping address the obesity epidemic...or is she fueling it?

Having a svelte figure is not, and should not, be a prerequisite to being "America's doctor." Many who have defended the Surgeon General argue that her job is to make health care and policy decisions for the country -- "not to look hot in a pair of skinny jeans." Good point, great sound bite, but clearly a defensive stance. No one expects her to be thin--just realistic and evidence-based about her current weight.

Experts estimate that Benjamin is at least 40 pounds overweight and wears a size 18. Women in this size range report a BMI between 32-34, and using standard American size charts, her waist measurement is estimated at 34.5 inches. She is not a little overweight or in a gray zone. Benjamin squarely falls into the obese category and likely has an abdominal girth that is dangerously close to, if not over, a critical threshold. (FYI...a waist size greater than 35 inches in women and 40 inches for men is considered high risk.)

There is no question that she needs to lose weight. However, when asked about her weight issues in interviews, she rationalizes by focusing on her treadmill endurance and her goal of climbing Mount Kilimanjaro. "The goal isn't to lose weight," Benjamin frequently says. "It's to be healthy and enjoy it."


Same skeleton...with and without excess fat.

Take a look at this picture of a body with and without excessive fat. It's painful just looking at it. And, Benjamin doesn't have a weight loss goal? Really? Not even 5-10% of her body weight? What kind of a message is this? What if Obama said that the goal was not to stop smoking but to be healthy? The subliminal message: Its okay to be ~~overweight,~~ oops, obese.

Just to be clear: We shouldn't judge her on whether or not she actually loses weight. The reality is that Benjamin is unlikely to ever achieve a normal BMI just like Obama is likely to "fall off the wagon" within 6-12 months, But, she should walk the talk and face the facts. No excuses. No rationalizing.

Too personal? Not anyone's business? Am I being too harsh? Clearly an opinion some of you may have right now. Okay...regardless of whether she conquers her own weight problem or talks about, she should at least be straightforward with the the public about the health risks associated with obesity.

During Benjamin's confirmation hearings, she said, "being healthy and being fit is not about a dress size. It's about how fit you are at that moment in time." And, in a January 7, 2011 interview in the NYT Magazine, Benjamin said, "My thought is that people should be healthy and be fit at whatever size they are."

Translation for the American public: "It okay to be fat. The Surgeon General said so."

Benjamin's position is supported by data that shows that cardiorespiratory fitness (defined as exercise capacity) is a strong and independent predictor of cardiovascular disease mortality and may mitigate the increased risk of death associated with obesity. In other words, she is promoting the perspective that overweight people who are "fit" may be healthier than those who are thin but sedentary.

Don't get too excited and start eating more Twinkies. This unbalanced view ignores other well-documented studies showing that weight, and particularly abdominal girth, is an independent risk factor for cardiovascular disease. In addition, do I need to remind you that excess weight is associated with a multitude of other conditions including sleep apnea, infertility, arthritis, depression anxiety, and certain cancers? Less commonly known is that obesity can lead to non-alcoholic fatty liver disease--an asymptomatic condition, that can lead to liver fibrosis or cirrhosis. In children, obesity contributes to poor academic performance, bullying and low self-esteem. The list goes on and on.

So, while getting fit is associated with reducing some health risks, failing to tackle the fat problem is linked to many more.

No, you can't be obese and healthy just like you can't be a smoker and be healthy. The Surgeon General has a responsibility to educate Americans based on evidence-based medicine rather than politically correct messages. And, while every public figure deserves their privacy, she should take a lesson from her boss and stop dodging the issue.

Dr. Benjamin, your "prescription" to Americans is delivering a dangerous message.
America..size matters.

Create Health,
Archelle

Have Your Cake and Live It Too

noreply@blogger.com (Archelle Georgiou, MD) — Tue, 11 Jan 2011 22:06:00 +0000

Ever have a deconstructed cupcake? It was our favorite dessert in QSine, the specialty restaurant aboard our cruise on the Celebrity Eclipse. Plain cupcakes were served with chocolate, vanilla, and caramel icing along with four types of sprinkles. While we all had the same ingredients, we each created our own (almost) perfect concoction.

And, during a long and relaxing sea day, I started reading “The 5 People You Meet in Heaven,” Mitch Albom’s fictional story about Eddie, an amusement park maintenance man who dies and goes to heaven. When Eddie arrives in the afterlife, he encounters five strangers, but then he realizes how each one of them had significantly influenced his life on earth as they taught him about sacrifice, forgiveness, love, and interconnectedness.

Who knows what happens when we transcend from this existence to the next. But, why wait for heaven? There are individuals who have stepped into your life and forever shaped who you are and how you think. They are the heavenly people you have met on earth.

Rich

Prom (1979)

At 16, I left home for the first time to attend an 8-week summer camp. During the day, I was part of a small group of students selected to work in a biological warfare laboratory in Fort Detrick, Maryland. At night, we integrated with a larger group of kids enjoying traditional summer camp activities. Too shy to participate, I sat by myself writing letters to my parents. Tired of coaxing me to get involved, all the counselors decided to leave me alone---- except Rich who thought I needed some individual attention. During his time off, he took me swimming and running and taught me to dance—all firsts for me and the first time I realized that love exists. While Rich and I may have had a different future had our lives intersected at another time, he is still my dear friend 33 years later.

Stephen

Dr. Kopits with his Little People

My first surgery rotation in med school was with Dr. Stephen Kopits, a pediatric orthopedic surgeon specializing in the treatment of dwarfs. Voted “Baltimore’s Best Doctor” I was most excited about scrubbing in with him during his famous 12-hour surgeries where he untwisted, de-coiled and re-built the skeletons of his very small patients. But, it wasn’t his technical excellence in the operating room that made an indelible mark on my career. It was the relationship he had with his patients.

Most of his “little people,” as they prefer to be called, ranged in height from 24 to 36 inches. At 6’2”, Kopits towered over them, even while sitting in a chair. So, in clinic, he’d sit on the floor, legs crossed Indian style, and made direct eye contact with his patients as he spent hours answering questions, drying their tears, and reassuring them that they could live a full and productive life. “Archondoula, always remember” he said in his thick Hungarian accent, “you have to love your patients.” I never saw Dr. Kopits after my rotation but when I learned that he died of a brain tumor in 2002, I sobbed. He taught me what it really means to be physician.

Jeannine

Jeannine holding one of her many awards

For the last 14 years, Jeannine has been a boss, a colleague, a friend, and a boss again—and, through it all….a coach. As a senior executive in UnitedHealth Group, she’s was in the position to lobby for opportunities on my behalf and helped advance my career. But, more importantly, she continually gave me constructive feedback. She expected data when I took a strong stand on issues and she demanded facts when I whined. She has made me aware of passive-aggressive body-language, counselled me on event-appropriate clothing, and helped me soften some edges –all with love and objectivity and without fear of consequence. Jeannine taught me how to demand accountability from myself and to inspire it in others.

David

David, is the man I married and continue to love dearly. Among his many qualities, the true gift he’s given me is his encouragement to take calculated risks and pursue my dreams. He hasn’t painted me into a traditional role as a wife, a mother, or a doctor. Even when he has pushed too hard…it’s been because he believes that I have the potential to reach a bit farther. David believed in me before I believed in myself.

There are others. Without them, I may have never recognized that I didn’t have to be “one of the boys” to be a successful woman in corporate America. I may have never figured out how to have happy, well-adjusted kids while being a working mother. And, I may have never learned that true friendship requires brutal honesty.

Love, compassion, self-confidence, accountability, sexuality, balance, friendship.

This is my story. But, how did you get there? The themes are universal---but the details matter and are uniquely yours.

Take the time to plot your own emotional growth on a graph. Who are the people responsible for the inflection points? What were the defining moments? We all learn and grow at different times, from different people, under different circumstances.

Just like the cupcake, reconstructing your life--piece by piece--helps you appreciate the whole. And, one last thing...it’s also an opportunity to identify what might be missing. In the future, I think I’ll order cream cheese frosting….along with a heaping tablespoon of patience.

Create Health,

Archelle

Heel (Heal) Like A Dog

noreply@blogger.com (Archelle Georgiou, MD) — Mon, 27 Dec 2010 19:51:00 +0000

Have you ever wondered what dictates the pace of the healing process?

Why do some of people recover from a cold in a day and in others, it lingers for 1-2 weeks?

Why do some college students with mononucleosis lose a semester of college due to extreme fatigue but others just need a little extra sleep for a few weeks?

Why do some adults just take one day off from work to get their wisdom teeth extracted and others are home, on narcotics, for a week?

Yes, level of severity, comorbidities, and complications drive variation, but is the "each person is different" rationale completely about the differences in cellular physiology?

Exactly 2 weeks ago, Isabella, our 13 pound dog, a shitzu-bijon mix and a bit of a diva, was spayed. In human medical terms, she had a total abdominal hysterectomy--1-1/2 inch incision, anesthesia, and removal of her ovaries and uterus. When I picked her up from the vet, she was subdued, and as he handed her over, his post-op instructions were "Follow her lead, she'll tell you how she's feeling." Within 24 hours, she was eating and drinking with normal bowel and bladder function. She didn't appear to need any pain medication; in fact, our bigger challenge was trying to protect her stitches and keeping her from running laps around our kitchen counter.

As I watched her recovery, I was amazed. If she were human, she'd be in the hospital for 2 days, on narcotics for 2 weeks, and unable to drive for 4 weeks. And, regardless of the actual healing process, the "standard of care" would be for her ob-gyn to authorize 6 weeks of disability...whether she needed it...or not.

"Why the stark difference?"

There are many possible reasons. Clearly, dogs have a different biology than women. Their abdominal wall muscles are thinner and they don't experience the same hormonal shifts post-operatively. In addition, they are generally more physically fit which accelerates the healing process as well. And, age is undoubtedly a factor. Dogs are spayed when they are young whereas women generally have this surgery after age forty.

Nevertheless, Isabella's recovery was 20 times faster than the average woman's recovery. And, even if I take into account that 1 dog year = 7 people years....the recovery was still 3 times faster. Why? Are there other considerations?

The following offer some thought-provoking rhetorical questions.

Do women need the emotional healing time to deal with the loss of their reproductive ability and a fear of a loss of sexuality?

Do they need to protect themselves from the demands of work and home? One of the most popular articles on HysterSisters, a social networking/support site for women pre- and post-op, focuses on what NOT to do after a hysterectomy. The bullet point list reads like a strategic military plan for protecting oneself from colleagues and family.

Do people have a hard time asking for, and affording, a mental health break? How often do the final few weeks of prescribed disability offer a valid reason to be off work, receive a paycheck, and de-stress?

You may be wondering...why does this matter? Why dissect how much of the needed healing time is influenced by biology and how much by our brain? Because the care process is different.

Unfortunately, we have a medical system and a culture that understands wound healing but doesn't know how to support emotional healing. As a result, many women simply stay in a traditional "sick role" for longer than necessary...with the hope of getting their needs met.

The advice women give to each other in HysterSisters is "Don't act too good too soon. Even if you feel good, try to look lousy and weak. When you act better you automatically lose everyone's help and sympathy. Make it last because even though you feel better you still need the help..."

While adequate rest, activity limitations, antibiotics and pain medication support wound healing, they do not address how to cope with mourning, addressing fears, and managing stress. Dogs seem to escape these issues, but women don't. With 600,000 hysterectomies performed each year, think about how many womens' quality of life and productivity would be improved if they could stop being "sick" and get support they need for the emotional aspects of the healing process.

Create Health,
Archelle

PS: About 1 hour after I posted this blog, I got some constructive feedback that I could have been more "to the point." So, here is what I was trying to say:

There are various dimensions to the healing process: physical and emotional. But, the "system" and our culture only acknowledges one: being physically sick. So, what do we do? We stay "sick" for longer in hopes of being able to figure out the other one. But...is that effective? Or does it prolong the recovery process because meds, etc etc do not address the real needs?