Live event: Can rethinking the healthcare workforce help drive down medical costs?

There’s no shortage of news, or worry, about the coming scarcity of healthcare workers. But is there really a problem? What if we’ve got enough hands, but just need to align tasks better?

shutterstock_172496525According to a study from the Annals of Family Medicine, one doctor can reasonably help 983 patients in a year working solo. As part of a team and delegating some tasks to others, that same doctor could potentially reach 1, 947 patients.

As Ed Salsberg, a research professor at the George Washington University Center for Health Workforce Research and Policy, said:

How we use workers also directly impacts costs, efficiency and quality. If we only allow highly educated practitioners to provide certain services…we are likely to drive up costs and may limit access. If we allow a lesser-educated caregiver to provide services, it may be beyond their skills and training. So how do we know who is qualified to provide what services?

What needs to happen on all fronts to make that work? How can we handle rural and under served areas? Who should play bigger roles: Nurses, pharmacists, technicians? What would that mean for costs? What are our future healthcare needs, and how can we meet them?

Join a TEDMED Great Challenges live event this Tuesday, May 20 at noon ET with Salsberg and others on the forefront of rethinking the healthcare workforce. Kick off the conversation today by tweeting your questions and comments to #GreatChallenges and we’ll discuss them on air.

Disordered: What causes kids to lose control over eating?

An 11-year-old boy – let’s call him Enrico – had a tough day at school. He’d done poorly on a math test – again – and some boys picked on him during gym because he’d missed an important free throw. Enrico walked home from the bus, let himself into the house and grabbed an unopened extra-large package of chips. He took one, then another; he ended up methodically eating the entire package, even though he’d even felt a little sick half way through. He simply couldn’t stop himself. It wasn’t the first time it had happened; in fact, it had gone on long enough that Enrico had started to become overweight.

shutterstock_39643708A hypothetical story, but not an unusual one. Loss of control (LOC) eating is the most common disordered eating behavior in overweight kids, even pre-adolescents. A mental disorder that causes people to lose control of the amount or type of food they ingest, binge eating is also the most common eating disorder in the United States. Up to half of adults who seek weight loss treatment may suffer from it – and those who do often report that they began having weight problems at a younger age. In some cases, binge eating promotes excess weight gain and obesity.

Marian Tanofsky-Kraff, an Associate Professor at the Uniformed Services University of the Health Sciences, says many of the issues that predict obesity are also linked to eating disorders. It’s an evolving field; binge eating was only last year classified as a disorder by the American Psychiatric Association. Like the obesity epidemic itself, the causes of binge eating in kids are varied and complex, from anxiety to environmental triggers.

“Our obesogenic environment promotes loss of control. When we were in school, there weren’t birthday cupcakes every day of the month. We weren’t surrounded by junk food. I’ll hear about kids in a Saturday morning dance class whose moms make a list of who’s bringing brownies for the next class,” she says.

Eating disorders in children have been associated with depression and anxiety, yet younger kids have a harder time pinpointing emotions or realizing triggers, Tanofsky-Kraff says. She conducts interpersonal therapy with children to help them express their experiences, as it’s often upon reflection that they realize the trigger of an unhappy experience like Enrico’s.

Primary care clinicians could help, too, by asking about eating patterns rather than just noting height and weight, which could help pinpoint LOC eating.

“We can focus on that excessive intake instead of saying, well, just jog an extra mile and eat healthier, which is quite difficult to do. We don’t live in a society that promotes moderation. We live in a society of extremes,” Tanofsky-Kraff says.

Super Heroes: Role Models Help Keep Kids on Track

The best places to begin to teach moderation and healthy eating are in homes and schools, says Lynn James, a Senior Extension Educator at Penn State Extension in Sunbury, PA.

“Children are not going to make good connections or changes if they don’t see the adults around them walking the walk themselves. If healthy food’s not in the home, there’s no chance they’re going to eat it at home,” she says.

The Extension, part of Penn State’s College of Agricultural Sciences, runs many group education programs, including Family Fitness, in which parents attend classes on how to make healthy food choices right along with their kids. Another called Cook Smart, Eat Smart teaches basic food prep and planning to young adults and parents of teens, and Nutrition Links helps low-income families eat well on a budget.

Proud2BMe is a youth outreach project of the National Eating Disorders Association (NEDA) that tackles another big influence on what kids see and hear: the media. Claire Mesko, who runs the project, says that uphill battle is only compounded by social media, which means kids can be bombarded virtually 24/7 by airbrushed images that convey the ideal that only a certain kind of face and body is attractive and only perfection will do. Boys hear about extreme workouts and bulking up.

“There are lot of mixed messages about food body weight and health, and its very difficult to intuitively know how to eat healthfully. Phrases like ‘sinfully delicious’ promote the idea that there are good and bad foods and things to avoid, and that if we indulge we are slipping up,” she says.

Proud2BMe counters with stories and webinars explaining just how images and messages are manipulated, and provides a forum for a lively online community of bloggers and boards where kids can share thoughts or stories of their own struggles with disordered eating. NEDA is also working on public policy to expand mental health coverage for eating disorders.

“We have several states now that have made eating disorders information mandatory for parents, and we would like them to conduct eating disorder screenings right along with BMI tests,” Mesko says.

Join a Great Challenges Google + Hangout Tuesday, May 6 at 12pm ET to talk about disordered eating in children and ways to help keep them healthy through empowerment and effective role modeling.

Better outcomes for engaged patients may start with an empathic doctor

An engaged patient, one who is knowledgeable about his condition and feels confident in his skills to help manage his own care, may in turn contribute to improved outcomes and reduced costs for himself and for the system.  There are even ways to measure their ability to take a stake, including the Patient Activation Measure (PAM).

On last Tuesday’s Great Challenges Hangout, we gathered a team of thought leaders to explore PAM and how well it measured patient engagement. Of course, getting patients to take a more active role is a two-way street; well-managed care involves solid clinician-patient collaboration.

What, then, can providers do to make this happen, and who tracks how well they do it?  We’re not talking about best-doctor magazines or web site rankings, but an across-the-board measure of how doctors succeed in relating to patients – a “doctor activation measure,” as one of our Community Members called it in his tweet.

As it turns out, there’s no universally used rating for clinician engagement. But there is one trait that has, in study after study, shown to positively affect patient engagement and outcome: empathy.

Clinician empathy leads to greater patient satisfaction, increased compliance and better outcomes. It boosts job satisfaction for providers.  It may be particularly helpful in cases of chronic illness; In one study, patients with diabetes had measurably better outcomes when their doctors scored higher on the Jefferson Scale of Empathy, a tool that measures patients’ perceptions of physician caring. A recent systemic review and meta-analysis concluded that the patient-physician relationship had a small but measurable effect on patient health outcomes.

Yet with so many patients seen in limited time increments, and the increasing specialization of medicine, how can doctors get – and remain – empathetic?

Here’s the neat part:  They can be taught. Researchers as Massachusetts General Hospital gave residents three 60-minute empathy training modules. The courses explained the neurobiology of empathy, showing physiological responses to dismissive comments. Based on another scale, the Consultation and Relational Empathy (CARE) measure, the group with training showed higher scores than those without.

Understanding how our brains process and respond to verbal and physical cues is key to shaping behavior, says Helen Riess, a psychiatrist who developed the modules and led the study. As grounded in science as clinicians are, they can forget their autonomic nervous systems may lead them to act in ways they don’t intend.

That doesn’t mean a physician needs to or should feel deeply emotional about a patient’s outcome. More important is an awareness of how actions might be perceived.

“Empathy has cognitive, emotional, behavioral and moral components. Sometimes we really feel for another person; another time we cognitively understand what they’re going through, but we may not feel it because we’re tired. That still leaves us a choice to behave in a more empathic and caring way,” Riess says.

Empathy among med students tends to erode in the third year.  Perhaps this is where intervention can begin; as this blog has reported, some schools, including Harvard Medical, are exploring ways for doctors to learn to see patients holistically, including a curriculum called the Longitudinal Integrated Clerkship in which students follow a patient’s case from beginning to conclusion.

In the end, showing empathy can start with measures as sitting down to listen to a patient and making eye contact.

“If you can learn empathic behaviors and be respectful and kind, that’s really what the patient is going to remember at the end of the day,” Riess says.



Live Online G+ Hangout: In search of the “activated” patient

In 2004, researchers from the University of Oregon developed a scale called the Patient Activation Measure (PAM) to determine how likely patients were to know about and to confidently take a role in their own care. Since then, research has suggested that “activated” patients are less likely to have an ER visit, be obese or to smoke, among other health measures, and more likely to save providers money. A number of healthcare systems are already using PAM and seeing positive results. Interesting, but with some 50percent of patients even failing to take prescribed medications properly, current engagement methods would seem to face an uphill battle.

Patient-activation-PAMA Live Online Event: Tuesday, April 22 @ 12:00 pm EST
Making the Grade: Examining the Case for Patient Activation Measures

Are there other ways to measure and guide adherence planning? What are the benefits and the drawbacks of measuring patient skills? How can patients improve scores? Kick off the conversation today by tweeting your questions and comments to #GreatChallenges and we’ll discuss them on air.

Join our group of special guests for a Google+ Hangout on the pros and cons of patient engagement measures – RSVP today.

Next Up: Monday, May 6 at 12:00 pm EST – Childhood Obesity: How do we empower the child?

The positives of HIV testing: A tale of two cultures

Last week, we hosted a live online discussion about essential community building blocks for breaking the links between poverty and poor health outcomes. And the need to think creatively is perhaps strongest in local HIV/AIDS prevention initiatives. Cultural pressures, health myths, and access issues can hamper engagement and progress and yet, two campaigns are making strides.

The Many “Reasons” to Get Checked

Putting a positive spin on HIV testing for young men at high risk for the disease may be a daunting task, but culturally poignant messages may go a long way towards selling the value of getting checked.

Manuel Rodriguez manages the “Reasons” program for the non-profit development strategy organization FHI 360.  Reasons is a messaging campaign that aims to get Latino men who have sex with men to undergo testing for the HIV virus.  It comprises social media outreach, print, t.v. and online advertisements, and presence at gay pride events, and currently focuses on cities with many members of the target population, including Miami, Los Angeles and New York.


“We all have a reason for getting HIV tested,” the ads say, including words like love, life, family and pride.

Rodriguez says Reasons aims to touch on the strong sense of community in the Latino culture, which holds whether one is a first-generation immigrant or has lived in the U.S. for decades (Rodriguez was born in Caracas,Venezuela.).

“We incorporate family and friends, and the importance of protecting your partner. Mom is a very big figure in Latino culture, so some of the messages are, ‘I’ll do it for my mom to make sure I’m going to be there for her,” Rodriguez says.

Another hallmark of the effort is its positive, not punishing, slant.

“We see this as a new way to communicate because it comes from a positive and empowerment framework, instead of, ‘You must do this, because you do that.’ It’s more of a value-driven proposal.  ‘You can control it.  You can prevent it.’

“As a person, your value as a member of a family and your community is health. To be there for them is to take control of your health,” he says.

Rodriguez says impact of the year-old program is measured so far in the millions of online website views and by a big bump in social media interactions since the program launched. The program has conducted strategic online listening activities to fine-tune campaign messages. Some findings include that some Latino gay and bisexual men see testing as the right thing to do, and they go as far as to share Instagrams of their test results as a badge of honor — negative results, because a positive test result still carries a stigma in Latino culture; one that Rodriguez has worked to mitigate throughout his career in public health communication.

Though Reasons has a defined target audience, Rodriguez says that its themes may turn out to be not so specific after all:

“We think at the end of all these Pride events and local mobilization, we’re going to have a story to tell. And we’re going to find out that these will be universal themes that unite us all.”

Taking Pride in Resilience

Another FHI360-managed program, Testing Makes You Stronger, is aimed at African-American men with male partners. According to Cornelius Baker, Acting Director of the HIV/AIDS Unit, Testing reflects a common ethos in the black community of ‘that which doesn’t kill you, makes you stronger.’

“It’s the messages one gets by growing up in an African American family; that of resilience, that you can survive through tough things,” Baker says. “It’s also very much that sense of pride, of having a respect of agency for the community.  People want to live well; they want to survive.  What we have to do is create an environment of support for that, and give people the tools to be able to benefit themselves,” he says.

Baker says his organization gathered input from community leaders, advocates and the Testing target audience — more than 400 black men in five cities — before embarking on the campaign.  There is also a campaign for African-American women, Take Charge: Take the Test.

Both programs are funded by the Centers of Disease Control and Prevention, which also lends its scientific and technical expertise to governments and agencies worldwide to help stop the spread of HIV.  (For more on how global health strategies are applied locally, join TEDMED’s special World Health Day Google Hangout on April 7.)

BUSTED: What are the top five preventive health myths?

You can get the flu – or worse — from a vaccine. Only old folks get strokes and heart attacks. Calories in, calories out. X-rays cause cancer. Sleep eight hours a night and drink eight glasses of water a day. Skip the sunscreen on a cloudy day. Take a multivitamin every day, just to be on the safe side. An apple a day keeps the doctor away. Exercise more to lose weight.