Sunday, May 17, 2015


Tonight two public health and health policy forces are conspiring to make me want to sit down and type a blog post:  public health school graduations and the current political environment.

It's that time of year when many public health students are graduating.  With MPHs, PhDs, DrPHs, and various other initials after their names.  Some of these are veteran professionals who have just completed degrees, while others are brand new graduates.

These graduates have one thing in common:  they have all chosen a very, very challenging time to be public health professionals!  Especially those graduating in my home state.  I'll keep my mouth shut on this other than to say that the legislative environment is rather unfavorable to public health at the moment.  Other states also have challenges in terms of budgets, legislation, non-Medicaid expansion, etc.  The ACA, as exciting as it is, also presents new and ongoing complications for  public health professionals.

The public health graduates have another thing in common:  they'll all be fixing.  Fixing people and communities that are cracking, have hairline fractures, or  are completely broken.   Fixing processes and procedures.  Fixing ill-thought out legislative bills and laws through advocacy.  Fixing our health system.  Examples of how public health professionals fix things:   performing restaurant inspections to make sure food is prepared safely--and facilitating changes when it's now.   Giving immunizations to people of all ages who have no other affordable access..  Implementing obesity and diabetes prevention programs in communities where such programs don't exist.  Streamlining ACA insurance procedures to make them more user-friendly,  

Paul Farmer wrote a book To Repair the World, which contains transcripts of his wonderful commencement speeches from medical schools, public health schools, etc.  I completely love the title...because that's what public health is all about.  Repairing.  Fixing.  Strengthening.  Rebuilding.
Public health professionals are well-trained to do fix. They have the nuts and bolts--basic public health knowledge, the wrench--for arm-twisting, the duct tape--for quickly patching up crises, the measuring tools--for data and evaluation, and perhaps most importantly, the hammer for hammering consistently with a strong, powerful advocacy voice.

And there is plenty for public health professionals to fix in our system!

Monday, April 20, 2015

Talk vs. Walk

I haven't blogged for a while, partially because I have been busy, and partially due to "blogger's block."  There were a few ideas going through my head of things to write about, that for various reasons got discarded.  National Public Health Week?  Nope, everyone and their brother was writing about it.  The Medicare doc fix (MACRA)?  Nope, because others did a much better job than I ever could at spelling out the far-reaching details of this new bill-turned-law.  Politics and health policy happenings in my own state?  Nope, too hard to be even remotely tactful, and better to keep my mouth shut on that for now.    

The topic that has bubbled in the back of my mind for the past few weeks, though, made the blogging cut.  Here goes.

I like to talk. Just ask my brothers.  What do I like to talk most about?  Medicine, public health, health policy, and anything related.  I can go on about these subjects for a long time, as anyone who knows me knows  all too well.

Lately, though, I'm kind of fed up with some of the talking that goes on in and about public health and health policy.  Why?  Because it doesn't lead to action, to tangible changes that make a difference for real people.  Sometimes it seems like talking for the sake of talking (or, worse, meeting for the sake of meeting).  This bothers me.

Don't get me wrong.  I strongly believe that dialogue and conversation, brainstorming and planning and advocating out loud are important in public health and health policy.  They are central and critical...when the end goal involves action.  Action can mean many things...legislative advocacy, program implementation, creation of new materials, planning conferences, etc.  But talking without an end goal involving real change?  "Talking the talk" without planning on "walking the walk" toward honest-to-goodness change that will make a difference for people?

My National Public Health Week promise to myself is that when I am with others "talking the talk,"  I will try as hard as I can to make sure we also "walk the walk."  That we focus on an end goal of real change, and the action steps needed to achieve it.  Because public health and health policy are not just about "talking the talk".  They're about "walking the walk" toward real real changes that will improve health.  

Monday, March 30, 2015

Looking Back, Looking Forward...

Next week is National Public Health Week (NPHW).  In previous years of blogging, I've made a point of writing a post each day.  For a variety of reasons, that will not be happening this year...but at least this one NPHW post will.

I like to make lists.  Grocery lists, Christmas lists...and public health lists.  Since "officially" becoming part of public health over ten years ago when I graduated with my MPH, these are a few of the things I've seen:

1.  The passage of the ACA, and the subsequent Supreme Court decision to uphold it.  Definitely the most far-reaching public health happening, and hands down the coolest policy thing I have seen.

2.   SARS, Ebola, H1N1, regular influenza, etc.  Signs that our world is indeed global and that these diseases know no boundaries...and testaments to the intelligence and skill of the public health professionals who handle these epidemics, some of whom are friends and colleagues.

3.  The recent Disneyland measles epidemic, a sharp reminder that immunizations are
a public health triumph....and that more people should get them.

4.    Too many uninsured people (i.e. undocumented immigrants) who have difficulty accessing and paying for care...proof positive that public health still needs to protect and serve vulnerable populations.

5.  Some passionate, effective, powerful public health advocates, who are committed to speaking up and making a differnece.

And no public health list would be complete without includingthings that I hope to see in the future:

1.  The ACA solid and strong, with a King v. Burwell decision that upholds it as is, and without any Congressional repeals or actions to weaken the law.

2.  Fewer vaccine-preventable diseases, and more people who are fully immunized.  My public health friends and colleagues who do epidemics have plenty of material for their knowledge and skills without Measles, etc that could largely be avoided..

3.  More public health professionals who have been trained to advocate, who feel that moral imperative to speak up,  who make advocacy part of their personal and professional lives.

4.  Health care and coverage that are affordable and accessible for all people in our country...wherever they were born, whatever their age, whatever their needs.

5.  More people whose right to health--a right codified in international law--is fulfilled.  People who have access to clean water and safe food, people who earn enough money to stay out of poverty, people who are safe from war and violence, people who can get quality health care when needed.

Happy National Public Health Week!

Sunday, March 22, 2015

The Computer in the Room...

Recently, I was a patient.  Like many patients, I was in an exam room with...a computer. Which was meant for physicians and staff to access Electronic Medical Records (EMRs).  On one hand, I was glad that the EMR provided the history I didn't know well, and that the doctor could access it quickly.  On the other hand, I felt like the computer screen received as much, if not more, attention than I did as the actual patient in the room.

In a previous life when I interpreted, I worked with a bunch of health care providers, who had different ways of handling the computer-in-the-room.  Some managed to keep their attention on the patient while seemingly effortlessly also glancing at and typing on the computer from time to time.  Others were generally glued to the screen.  It varied.

In light of my recent patient EMR experience, I absolutely love the quote that has been floating around the Internet (Medscape article and various Tweets), courtesy of Abraham Verghese, a fantastic doctor-author.  Dr. Verghese spoke at the recent American College of Cardiology conference, and reportedly said "The EMR has nothing to do with your heart, or your patient's heart." 

Wow.  Just wow.  I happen to think this powerful quote should be framed and posted in highly visible locations (i.e. physician/staff lunchroom walls) in almost every clinic, hospital, health center, medical school, nursing school, etc.  As a reminder that the EMR is not the be all-end all of patient care.  As a reminder that the patient and provider are at the center of the health care equation, not the EMR.  
A great New York Times article began with a funny story, about a hospital's print ad, in a journal, to recruit physicians, which stated "no EMR."  This is meant to be a selling point for the hospital.  After I finished laughing, I started thinking more seriously.  Yes, I can probably think of some physicians who would prefer to practice in the world of paper, not EMRs, at a place like this hospital.   And some patients might as well.  Would I go back to pure paper as a patient?  No. The EMR does have being a great memory that reminds my doctors with alerts when it's time for certain exams and tests.  Along with this EMR, though, I want...doctors who look into my eyes rather than just looking at the monitor, doctors who listen closely to what I say rather than just scanning their notes in the EMR from previous visits, doctors who pay more attention to the patient than to the comnputer in the room.  Doctor who follow Abraham Verghese's wise advice.  

Wednesday, March 11, 2015

Eating Some Humble Pie...

Lately I have been immersed in a whole new world.  One with unfamiliar concepts and people and processes and procedures, and its own jargon.

It has been challenging, to say the least.  As a result of my recent foray into this new world, I now understand better what some patients and families I've worked with over the years have experienced as they've interacted with the health care system.

And I have to eat some humble pie.

In the past, I worked with parents who seemingly didn't realize that they shouldn't give their overweight toddler soda to drink.  They thought as long as it was caffeine-free, it was OK. I've met patients who had no clue what a Pap smear was meant to screen for, and who didn't understand the underlying anatomy. And many more such stories.  It happens in poor families and rich families, in English speaking and Spanish speaking--although there are definite disparities in health literacy depending on socioeconomic status.  As I've worked with patients and families, interpreting and educating, I've learned the importance of simple terms, easy-to-read written materials, pictures and visual demonstrations.  Thanks to my public health education and training, I'm pretty knowledgeable about health literacy  Yet sometimes, there has been this quiet-yet-very-shocked voice in the back of my head, asking the question "how can these people not know that?!?  How can they not know the basics of their bodies or the importance of that test?  How can they not know that they have to take their meds every day?"

I grew up in the world of medicine.  Terms like "hemoglobin," "hypertension," "antihistamine," and "antibiotic resistance" are part of my first language. The terms and concepts of medicine, and later of public health and health policy, have become such a part of my world that it's hard sometimes to remember that others weren't born and raised in medical worlds. Which is why that quiet, shocked voice sometimes echoes in my head.

Now that I've experienced what it's like to be immersed in a whole new world, where I know much, much less than some others in it, I know how people feel who are unfamiliar with medicine and find themselves immersed--whether for routine care or for crises--in the health care system. Apparently I need to eat some humble pie to quiet that little voice that pops up sometimes.  Ice cream--real, not fake--to sweeten that pie, please.