Tell Us: What’s Your Medical Metaphor?

Do you have a barking cough or butterflies in your stomach? Are you waging a war against an army of bacteria? Perhaps you are approaching life with chronic disease as a marathon, not a sprint – with bumps in the road on your journey to health.

Whatever your health condition, TEDMED 2014 speaker and physician storyteller Abraham Verghese believes that medical metaphor is key to better understanding what’s happening in your body. Studies show that when physicians use metaphor, patients are more satisfied with their communication. In his TEDMED talk, Abraham encourages patients and healthcare providers alike to invent metaphors to help bridge a widening communication gap.

“It’s a peculiar atrophy of the imagination at a time when our scientific imagination knows no bounds. I think our right brains are churning, wanting to label and make colorful and to connect, but the imagined constraints of science and data have introduced a peculiar self-consciousness.” — Abraham Verghese

Now, it’s your turn. In his blog post, Abraham invites you to create more eponyms, more metaphors, and more colorful ways of capturing this incredible time we live in. So we invite you to tell us your favorite medical metaphor – or create one of your own – tagging it with #mymedicalmetaphor via Twitter. Or, if your metaphor goes beyond the boundaries of 140 characters, try tagging it on Facebook or any other platform you use.

Next week, Abraham will choose his three favorites. If your metaphor is selected, we’ll send you a copy of Abraham’s book, Cutting for Stone.

Go on – flex that right brain. Good luck!

Announcing TEDMED 2015

We’re thrilled to share some exciting news with you: the venue, dates and theme for TEDMED 2015.

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This year’s event will focus on Break<ing>Through the status quo and celebrating the typical, the atypical and the spaces in between as we come together to shape a healthier world.

The mythology of a “breakthrough” tells the story of a lone genius and one magical, “aha” moment. But, let’s not mistake a good story for the truth. In reality, we all have breakthrough potential and the least likely way to unlock that potential is to toil away in social or intellectual solitude. Instead, we break through in new combinations and we collect the building blocks of our future breakthroughs every day, in every new interaction, in every new insight, one improvement at a time.

This year we’ll explore…

  • breaking through the silos that prevent different disciplines from sharing problems and insights;

  • breaking through glass ceilings and closed doors that hold back some women and minorities from entering medical research;

  • breaking through national and cultural boundaries;

And, breaking through old assumptions to explore new science and new visions of what’s possible – in ourselves, in our work and in the world at large.

We invite you to join us and secure your spot at TEDMED 2015 today.

Our home in 2015: Palm Springs, California, November 18-20

The venue this year in sunny Palm Springs, California inspires a new vibe that we hope you are as excited about as we are. A more collaborative setting and design will help speakers, delegates and innovators come together and explore the important topics and themes the stage program brings forward in a more connected way than ever before.

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Of course, our gathering will include the brilliant talks you’ve come to know from some of the most inspiring change-makers both inside and outside of health and medicine, as well as stunning artistic performances and transformative innovators. Our recently formed Editorial Advisory Board – made up of rock star movers and shakers hailing from health and medicine as well as the worlds of business and technology, foundations and academia, philanthropy and design, and journalism and communications – is hard at work helping us shape a diverse and inspiring stage program.

Connecting across the world: TEDMED Live

As always, a vital part of our mission is to ensure that all stage content is accessible to the broadest community possible. Through TEDMED Live our content is free for teaching hospitals, medical schools, non-profits and government agencies around the world, building on last year’s participation of 200,000 remote participants in 140+ countries.

We invite you to join us in Palm Springs this November – visit www.tedmed.com for more information, or click here today.

Measuring the Value of Patient-Centered Care: Last Week’s Hangout Participants Address Unanswered Questions

Is it possible to measure the value of patient-centered care? Last week, as part of TEDMED’s Great Challenges Program, a multi-disciplinary group of experts moderated by Boston NPR Health Care Reporter Martha Bebinger, discussed the rise of patient-centered care, explored how we can standardize its measurement to encourage evidence-based policy changes, and touched on what those potential policy changes might look like.

If you weren’t able to join us, check out the recast here:

Thanks again for taking to social media to submit your questions and comments! We had such wonderful questions that an hour left us short on time to address them all. So, we asked a few of our panelists, Steven Horowitz, Alyssa Wostrel and Alex Drane, to offer their perspectives on several remaining questions. Read on for their thoughts:

What are the pros and/or cons of relying on patient or healthcare provider self-reporting of patient-centered care?

Steven: The patient’s assessment of pain and suffering is the gold standard for this measurement. This may be influenced by behavioral problems, addiction or mental illness. How many patients have these problems may vary significantly from community to community, thus survey results may be difficult to compare between geographical regions. In terms of the healthcare provider assessing his or her own performance, I’m reminded of one comedian’s line: “85% of car drivers consider themselves above average.” Many surveys show discordance between what healthcare providers consider important and what patients and families consider important. That does not mean the opinion of the healthcare provider is not helpful. However, the experience of the patient essentially defines the concept of patient-centered care.

If we encourage heavy focus on data (such as survey results), should we be concerned that it may take the attention off of actual patient care? Is there a chance that meeting the specific numbers might not equate to care that is focused on the patient?

Steven: Good question! Surveys and other assessment tools are critically important to generate the data we need for continuous quality improvement. This data keeps us on target for addressing the needs of the patients, however, when these results are blindly tied to pay and promotions there is great potential healthcare providers may inordinately focus on survey results to the exclusion of other important considerations.

Alex: It depends on what you are surveying! Historically, the industry has focused on measuring things that are clinical in nature – these are important indicators of overall health, but may themselves be just markers of other issues. For example, maybe my blood pressure is high because I hate my boss and dealing with him makes my heart race. You can tell me to work on managing my blood pressure or eating better, but if you don’t know why those things are happening, you’re squeezing a water balloon. If, on the other hand, you were asking me about my workplace stress and I told you it was high, then you could provide me with some resources to help, and we could begin to track how well they were working against, let’s say, a goal of a 30% improvement. If workplace stress is what’s making me unhealthy, then reducing my workplace stress by 30% would equate to care that is very much focused on me. We all know the old adage “you can’t manage what you can’t measure” – we need to measure the things that matter so we can manage them. 

If we achieve a standardized measurement system for patient-centered care, do you see a place for rewarding healthcare providers who consistently deliver this type of care? If so, how might that work?

Steven: Healthcare providers, or better, teams of healthcare providers, should be rewarded for consistently outstanding results in patient-centered care. The difficulty remains, however, that high achievers may represent healthcare providers adept at gaming the system or, more hopefully, healthcare providers who have created an outstanding culture of patient-centered care that any assessment would identify. 

What steps can patients take to ensure the care they receive is tailored to them?

Steven: Patients need to ask critical questions, speak to current patients if they are allowed to, review standard healthcare and physician grading systems to identify flaws, and most importantly, avail themselves of the many electronic resources available about how to become a successful and informed patient.

Alex: This is one of the easiest, and hardest, questions in all of health care. The concept of what we can do is enormously straightforward: become empowered, get informed, stand up for what we care about, demand care that is commensurate with our values and beliefs. But oh boy, that can be hard to do. I’m the queen of walking into a doctor’s office ready to demand this and that – only to slouch out, tail between my legs, with none of my original goals shared, acknowledged, let alone addressed. Whose fault is that? On some level, it’s mine. Slowly, with time, with sharing enabled by new technologies, with shifting demographics and new “norms,” we will rise up and demand to be equal participants in our own care – and we will be happier, healthier, and all the more productive (providers, too!). A great low-hanging fruit as we transition from one end of the spectrum to the other is to become an advocate for someone else’s health – bit by bit, if we all commit to do this for each other, we’ll help speed the arrival of a new normal where collaborative, empathetic, holistic care is rarely the exception.

Some argue that medical care is meant to cure – not to cater to patients. What would you say to those who purport that sometimes, the patient isn’t right and needs to be sternly told what to do? 

Steven: In conversations with patients I try to be as supportive and understanding of their concerns as possible, but I’m very clear about my own interpretation of the literature and what I think is in the best interest of the patient. At times I will tell a patient that we are dealing with two separate issues that are interrelated: the healthcare condition that needs treatment and the the underlying fear that may cause denial. It’s at these moments when I express my concern that the emotional component may interfere with the patient choosing the best medical option.

Alyssa: This question suggests a controlling and patronizing role may be successful and necessary in reaching the “cure.” One of the key problems with this approach is that it denies the patient involvement in and accountability for their own health and well-being.

Alex: We’ve all read the literature showing the more collaborative and shared the decision-making is, the better the outcomes. There is also increasing evidence that outcomes in situations where a provider shows empathy trump those where they do not. The days of old-fashioned paternalistic care are coming to an end…all hail the new day!  Look at the extraordinary success of efforts like “Open Notes” at Beth Israel – “Nothing about me without me.” Now – is it true that there might be some souls who, when asked, request an extremely militaristic approach to care delivery? Sure! But then it would be their choice.

What is the best solution for keeping patients engaged and involved? 

Steven: It is important to be respectful and empathic and meet the patient where he or she is now. Encouragement and praise for the patient starting to take responsibility for understanding their condition and becoming proactive is often a turning point in their care.

Alex: If I’m pretty sure my husband is cheating on me and I just got fired…do I really have the capacity to focus on my diabetes? We need to expand the definition of health to include life – because when life goes wrong, health goes wrong. Not only do life challenges sap our capacity to care for ourselves in traditional ways (eating well, taking our meds, exercising, sleeping, taking care of our preventive screenings…) – they actually make us sick as well. Solve the problems real people want solved, redefine “vital signs” to include what is most vital. Meet us in the messy realities of our lives, where we live, work, and play (or pray!) – and not only will we engage, we’ll finally be enabled to make real change to our health. I recently had the great fortune to work with RWJF on their Pioneering Ideas effort, and through that was introduced to the work of Sendhil Mullainathan out of Harvard. Sendhil talks about the difference between something being important and something being urgent. Going to the gym is important – making sure your marriage isn’t collapsing is urgent. Given his additional assertion that time and attention are scarce commodities – how do we incorporate the reality of “attentional real estate” in our attempts to foundationally impact health?  He’s building some super sexy tools to help – so listen here when you get a chance: RWJF’s Pioneering Ideas podcast.

How do we involve patients in crafting policy changes for patient-centered care?

Alyssa: Including patients on hospital and community health center boards and committees to hear their feedback and to involve them in finding and implementing solutions has gotten excellent results.

Dr. Selby observed that measuring patient experience is difficult to do via objective measures (which I think is true). Yet clinicians often show reluctance to embrace subjective assessments. What can be done to change this culture? 

Steven: This is also an excellent question! There are several ways this can change. One is the continued tying together of surveys with critical outcomes. This may include freedom from suffering, duration of illness, complications of treatment and longevity. The ones that I feel strongly about, for which we have barely put a toe in the water, include objective laboratory assessments of inflammatory markers and gene expression. Although “hard” measurements, they may be influenced by “soft” intervention such as meditation, empathy, exercise, diet and sleep.

Introducing the 2015 TEDMED Editorial Advisory Board

We’re excited to share something new to TEDMED!

In preparation for TEDMED 2015 and the selection of 60+ speakers and performers, we’re honored to introduce TEDMED’s Editorial Advisory Board.

Board members will offer their expertise, insights and wisdom to assist in the shaping of our stage program themes, topics, speakers and performers while also advising on TEDMED’s overall editorial strategy. Vetting by the Board will help ensure that TEDMED speakers and stage program topics continue to meet the highest standards of scientific relevance and rigor.

To form this Board, we drew upon our remarkable TEDMED community, gathering 20 highly creative, accomplished, diverse and innovative movers and shakers. Each member embodies a spirit of generosity, depth of knowledge and breadth of experience that will contribute immeasurably to the quality and impact of this year’s stage program.

Inclusiveness is a big part of TEDMED’s DNA. That’s why our Board is made up of representatives from across health and medicine as well as the worlds of business and technology, foundations and academia, philanthropy and design, and journalism and communications. This diversity allows us to approach proposed topics and themes through multiple lenses.

We’re delighted to welcome the members of the TEDMED Editorial Advisory Board and we thank them for their collaboration:

Pam Belluck is a health and science writer for The New York Times. She covers a range of subjects, but tends to focus on the most controversial and complex topics related to the brain, behavior, and reproductive health. An award-winning journalist, Belluck has been the recipient of a Knight fellowship, a Fulbright and the Best American Science Writing.

Carlos Bustamante, PhD, is a Stanford professor, population geneticist and MacArthur “Genius” Fellow who analyzes genome-wide patterns of variation within and between species to address fundamental questions in biology, anthropology and medicine. Bustamante was Stanford’s inaugural co-host at TEDMED 2014 and has also been featured on TEDMED’s Great Challenges Program.

Christopher Elias, MD, MPH, is the President of the Bill and Melinda Gates Foundation’s Global Development Program, where he leads efforts in integrated and innovative delivery, finding creative new ways to ensure that solutions and products get into the hands of people in developing countries who need them most.

Harvey Fineberg, MD, PhD, is the President of the Gordon and Betty Moore Foundation and the Presidential Chair of UCSF. He previously served two consecutive terms as president of the Institute of Medicine. Harvey studies medical decision-making, asking important questions about how new medical technologies are rolled out and how we cope with new illnesses and threats of epidemics. He spoke at TEDMED 2013.

Adam Gazzaley, MD, PhD, is a Professor of Neurology, Physiology and Psychiatry at UCSF and the Founding Director of the Neuroscience Imaging Center. Adam was UCSF’s inaugural co-host at TEDMED 2014.

Carleen Hawn is the Founder and CEO HealthSpottr. Prior to founding Healthspottr, Carleen was an associate editor with Forbes and senior writer and west coast bureau chief for Fast Company magazine.

Peter Hopkins is the Cofounder and President of Big Think, a cutting-edge online knowledge company that makes people and companies faster and smarter through efficient e-learning from world renowned experts. Peter also spearheaded the creation – and currently serves as the Principal – of Floating University, a joint venture with the Jack Parker Corporation that aims to foster content innovation in higher education.

Jeff Karp, PhD, is an Associate Professor at Brigham and Women’s Hospital and Harvard Medical School. His research focuses on stem cell engineering, biomaterials and medical devices inspired by nature. He shared his work at TEDMED 2014.

Mohit Kaushal, MD, MBA, is an Associate Professor at Stanford University and a visiting scholar at the Brookings Institution. He is also a partner at Aberdare, a venture capital firm focused on transformational healthcare opportunities. Mohit has also served on TEDMED’s Hive curatorial board.

Sandeep “Sunny” Kishore, MD, PhD, is an Internal Medicine Resident at Yale University. He’s been a founder of a global health organization, a Delegate to the UN General Assembly, a Fellow at MIT Dalai Lama Center for Ethics & Transformative Values, a Soros Fellow and the first Lancet awardee for community service. Sunny was a TEDMED 2012 speaker and also co-hosted the TEDMED 2014 DC stage.

Rupa Marya, MD, is a hospitalist and an Assistant Professor of Internal Medicine at UCSF. She is also the lead singer, composer and musical director of Rupa & the April Fishes, a band that seeks to celebrate beauty in pluralism and reinvigorate appreciation for living music with their diverse, global sounds. Rupa & the April Fishes performed at TEDMED 2014.

Vivek Murthy, MD, MBA, is the U.S. Surgeon General. Prior to his confirmation, he was a physician at Brigham and Women’s Hospital in Boston, and a Hospitalist Attending Physician and Instructor in Medicine at Harvard Medical School. He is also the President and cofounder of Doctors for America.

Betsy Nabel, MD, is the President of Brigham and Women’s Hospital, a practicing cardiologist, a biomedical researcher, a patient advocate, a Professor of Medicine at Harvard Medical School, and the first Chief Medical Advisor of the NFL. She was previously the Director of the National Heart, Lung, and Blood Institute. She spoke at TEDMED 2014.

Ivan Oransky, MD, is the Vice President and Global Editorial Director of MedPage Today. Previously, Ivan was Executive Editor of Reuters Health, Managing Editor of Scientific American and Deputy Editor of The Scientist. Ivan is Vice President of the Association of Health Care Journalists, and serves on its Board of Directors. Ivan spoke at TEDMED 2012.

Manu Prakash, PhD, is an Assistant Professor of Bioengineering at Stanford University.Manu serves as a core member of graduate program in Biophysics and an affiliate of Woods Institute of the Environment at Stanford University. In 2014, Manu was nominated as MIT Tech Review TR35 and Popular Science Brilliant 10.

Carla Pugh, MD, PhD, is a Surgeon and the Director of the Health Clinical Simulation Program at the University of Wisconsin. Her work focuses on fine-tuning students’ haptic skills as a standardized part of clinical education and daily practice. She spoke at TEDMED 2014.

John Qualter is the co-founder and Chief Creative Officer of BioDigital Systems, where he leads digital content creation and consulting for clients in the device, pharmaceutical and communications industries. John is a pioneer in the field of biomedical visualization, promoting the implementation of high-end 3D media in the healthcare industry. He spoke at TEDMED 2012.

Teeb Al-Samarrai, MD, is a physician, writer and epidemiologist with a diverse background in neuroscience, anthropology, and domestic and international public health. She previously served as a CDC Epidemic Intelligence Service Officer assigned to the New York City Department of Health and Mental Hygiene and currently serves as Deputy Health Officer & Tuberculosis Controller with the Santa Clara County Public Health Department in California, focusing on immigrant and refugee health.

Nina Tandon, PhD, MBA, is the CEO and Co-Founder of EpiBone, the world’s first company to grow living human bones for skeletal reconstruction. She is also an Adjunct Professor of Electrical Engineering at Cooper Union. Named one of the 100 Most Creative People in Business by Fast Company in 2012, Nina was a TEDMED 2014 speaker and is a Senior TED Fellow.

Abraham Verghese, MD, MACP, is a physician,Professor and Vice Chair for the Theory and Practice of Medicine at Stanford University’s School of Medicine and the author of the novel Cutting for Stone. In the modern era of medicine, where patients can seem to be mere data points, Abraham believes in the value and ritual of the physical exam, and in the power of informed observation. He spoke at TEDMED 2014.