Navigating Healthcare – Patient Safety and Personal Healthcare Management

Treating Mental Health

Posted in Uncategorized by drnic on July 6, 2017

Don’t judge my path if you haven’t walked my journey

Mental Labels

Just the term “Mental” induces reactions and responses from every corner of our society, and mostly they are not positive. Perhaps part of the problem can be attributed to the broad and different definitions applied to the term that includes its use as an adjective relating to the mind or disorders of the mind but it also has an informal us as “insane” or “crazy”

It’s no wonder that when we refer to someone as having “Mental problems” or a “Mental Condition” – so perhaps we need to change the terminology to start addressing “Mental” health as part of our overall health. The precision of language and terminology is important but we have a tendency that appears to be increasingly misused, or perhaps it just appears that was because it is magnified by social media and the 24/7/365 news cycle. For example, the term “Depression” is a clinical diagnosis that has some very specific symptoms and durations but the term is used excessively in place of sadness, misery, or sorrow. SO for this article, I will refer to “Diseases of the Brain” rather than “Mental Disorders”


Part of Physical Health

A recent article by John Campo, MD, Professor, and chair of the Department of Psychiatry at Ohio State University pointed out the mismatch between the prevalence and impact of diseases of the brain and the lack of legitimacy as a “real disease

The treatment of mental illness has long been held back by the sense that disorders of emotion, thinking, and behavior somehow lack legitimacy and instead reflect individual weakness or poor life choices

Some of this likely stems from our lack fo understanding relative to brain disorders evidenced in history by the way we viewed and “treated” anyone deemed to be unusual or different. These attitudes date back to at leat the 13th Century and “St. Mary of Bethlehem” in London built in 1247 and used as an institution for the insane. It was colloquially referred to as “Bedlam” hospital (yes that is where the term “Bedlam” came from) that featured horrific treatments from “rotational Therapy”

Imagine being stuck on the Mad Hatters Tea Cup ride at high speed for hours


And extended to beatings, bloodletting, and starvation! This sordid history is covered by the Museum of Healthcare Blog. This attitude extended into my medical school training where we were dispatched to Friern Hospital (formerly Colney Hatch Lunatic Asylum) that at its peak was home to some 2,500 patients with disorders of the brain. My clinical experience there included a harrowing personal experience that still shapes my behavior to this day.


Long corridors with Wards radiating out


Moving to Whole Care


The disconnect between the specialty of Psychiatry and the rest of medicine is rooted in our inability to observe and explain the workings of the brain. Even some of our treatments work but we struggle to understand why or how. This manifests in the challenge of honest acceptance of having a disease of the brain and being able to find help to treat that condition. For most people, our exposure to this world is limited to the Hollywood lens, like “Awakenings” starring Robin Williams and Robert de Niro



It is sad to note that Robin Williams suffered a sometimes public struggle with a brain disorder and ultimately committed suicide secondary to his suffering of Lewy Body Dementia

Based on the true story and book “Awakenings” written by Oliver Sachs – the British Neurologist, naturalist, and author who died back in 2015. He was a prolific writer who wrote with such eloquence and mastery of language you can lose yourself in his books.

Papa would tell me,
‘is not a science,
but the intuitive art
of wooing Nature.’

The Art of Healing – W.H. Auden


Science is Helping

The good news is that technology and science are helping as we unlock some of the mysteries of the brain’s function and the diseases that impact function. In fact, in many instances, we are discovering that the brain plays a much larger role in many diseases and we ignore this at our peril. We continue to unlock the chemical and physiological functions in the brain and as the science advances so too does the integration of the specialty psychiatry under the same roof as the rest of medicine.

There are now a number of initiatives working to expand our understanding, coordinate research, results, and findings that included the 2013 announcement by President Obama for the “BRAIN Initiative” (Brain Research through Advancing Innovative Neurotechnologies) that is homed at the National Institute of Health (NIH) and complemented by the The Human Brain Project from the European Union. The initiatives are not without problems and uncertainty of funding continues to challenge progress but understanding, science, and data remain a central requirement to progress.

There are some areas of progress from industry and Arshya Vahabzadeh, MD, the Chief Medical Officer at Brainpower has been championing Virtual Reality and Augmented Reality as a tool to help the growing population of Autism patients handle the complex world of emotions and human interactions. As he highlighted Virtual and Augmented Reality was a hot topic at the recent American Psychiatric Association Meeting


And was featured in this Medscape article: Virtual Reality a Game Changer for Psychiatry (Medscape)


Incremental Improvements in Brain Disorders

As Dr. Campo pointed out

Better understanding of the human brain and the biological nature of the mind will help, but it won’t be enough. How we think about mental health matters. When mental health is ultimately recognized as essential to physical health, not an extraneous element of it, then we will have access to true, complete, modern medicine

Changing the narrative and words may seem trivial but for any change to take place we need education and awareness that removes the stigma and fear associated with disorders of the brain and deliver the same compassion and care that patients with cancer or heart disease receive.

So my thoughts for some incremental improvements you can make addressing disorders of the brain

  • Words Matter – it’s not “Mental Health/Disorder” – it is Disease or Disorder of the Brain
  • Ask, listen and most importantly digest and be there as we interact with others – read Maneesh Juneja  blog – Being Human
  • From a clinical perspective – the clinical history and the detail of the Presenting Complaint and History of Present Illness remain the mainstay of diagnosis and understanding
  • Read or listen to Oliver Sach’s – you can find his books – or watch his TED Talk, or hear him on Science Friday or NPR or read one of his articles


What small change have you seen that makes a difference in the support of people with disorders of the brain. What one thing could we do that would have a big impact in this area?

You can also follow me here on medium, on twitter, or on facebook




MasterChef in Healthcare: Integrating Social Media

Posted in #hcsm, #mHealth, Healthcare Technology, HealthIT, HIT, HITsm by drnic on April 15, 2015

Social Media is rapidly becoming an integral part of our lives. Despite the pervasive nature of the communication channel healthcare remains a technology laggard. This presentation from HIMSS15 Wednesday Apr 15) will offer insights to help understand why healthcare professionals should join the community, participate in the discussion and how can do so successfully.


I presented this topic at HIMSS15 on Wednesday Apr 15 – you can find the listing here. As promised I am posting a summary of the points as well as a link to the Slideshare for that presentation

You can find the presentation on my slideshare (nvt) here

Master chef in healthcare- integrating social media – @DrNic1 from Nick van Terheyden




Technology is all pervasive in our lives and Social media is everywhere – in fact in a recent survey of 3,000 people conducted in the US, UK and Germany to help counter the limited time with their physicians, patients are seeking information and embracing technology outside of the doctor’s office to come to appointments prepared. Approximately 80 percent of patients feel engaged in their own health:

  • 68 percent of patients bring a list of questions to each doctor’s consult;
  • 39 percent have checked WebMD or another online source in advance; and
  • 20 percent bring personal health data from outside monitors.



You can see some 87%o f US adults are online in this Pew internet research so if you are not on board you are missing a huge opportunity but more importantly your patients are forming an opinion about you before they meet you




 What is Social Media

  • It’s a conversation, not a lecture
  • It’s an extension of everyday interactionCollaboration
  • It’s group driven, not top-down
  • It’s messy, disorganized & hard to control
  • It’s a tool, not an end-point
  • But most of all…



If you have not already – go to twitter and sign up for an account

What to Tweet

  • What you have read that you want to share with others
  • When and where you are speaking
  • Something you post on your blog
  • A link to a Web site that you find interesting
  • Listen to conversations happening online using keywords (hashtags, lists and searches) – learn from your colleagues, friends and patients
  • Befriend people – and then earn their trust by solve problems, answering queries, helping and providing useful information
  • Share information, valuable content with them
  • Questions and Requests for information and help – crowdsourcing answers
  • At a minimum – Lurk, Listen and Learn

There are many HashTags to follow and starting by assign friends and colleagues what they follow is a a good start but then get involved – join an online chat and community and take a look at the listing of healthcare hash tags from symplur. Listed below are a few of the healthcare hash tags I follow:

#hcsm (h/c social media)
#HCLDR (healthcare leaders)
#HITsm (health IT social media)#MedEd (medical education)
#eolchat (end of life/elder chat)
#BCSM (breast-cancer social media)
#LCSM (lung-cancer social media)
#BTSM (brain tumor social media)
#S4PM (Society for participatory medicine)

But I received a aggregated list when I polled my followed that included all these:


#POWHIT – People & Organizations improving Workflow w/HIT


#JACR 4th Thurs 12pm EST
#LCSM Every other Thurs 8pm EST
#BCSM Mon 9pm ET
#HCLDR Tues 8:30pm EST
#MedEd Thurs 9pm EST


@twubs @hashtracking or @tweetreachapp


My thanks to all my twitter friends who contributed

@HealthcareWen @HIMSS @lsaldanamd @sjdmd @HealthcareWen @DrJosephKim @dirkstanley @dlschermd @Docweighsin @RossMartin @CraigJoseph @RobertWahMD @ishakir @SteltsMD @JenniferJoeMD @StevenChanMD @CIBR_News @Jim_Rawson_MD @aussiclydesdale @ACRselect @AdamFuhriman @Gregmogel @ruthcarlosmd @techguy @MandiBPro @HITshrink @ahier @RandaPerkinsMD @motorcycle_guy @wareflo @susannahfox @Lygeia @ePatientDave @CMichaelGibson @Colin_Hung @annelizhannan @MelSmithJones @Paul_Sonnier @JennDennard @HIStalk @JohnNosta @2healthguru @lsaldanamd @lisagualtieri @EricTopol @ShahidNShah @DanMunro @Daniel_Kraft


Put yourself somewhere on the Social Media Adoption Curve



Add LinkedIn and Facebook – they offer a different channel and voice – Facebook tends to be more social and LinkedIn tends to be more professional/business orientated

There are some good examples already out there

The Mayo Clinic has several properties and their own published guide book to social media and the University of Maryland Medical Center that has blended many channels

What Not to Do

The JAMA 2012 report Online posting of unprofessional content by medical students highlighted a high proportion of violations and problems and there are plenty of examples of people who failed use basic common sense – I personally like the 12 word Simple Social Media Policy from the Mayo

Don’t Lie
Don’t Pry
Don’t Cheat
Can’t Delete
Don’t Steal
Don’t Reveal



  • Social Media for Physicians is a Game Changer
  • Social media, when effective, will establish a physician’s brand and connect him/her with those in need of their services
  • With increased deductibles, more consumers will “shop” using social media sites.
  • Social Media will Expand the Physician’s Role with Patients
  • Social media is shaping patient encounters with physicians and that impact is expected to increase significantly
  • Extending the patient experience will foster existing patient relationships and improve patient outcomes, especially for long-term chronic conditions.


Where are you on the social media ladder and are you going to climb higher?




MasterChef in Healthcare: Integrating Social Media was originally published on Dr Nick – The Incrementalist

The NHS at 70

Healthcare, NHS

The crown jewels of British society

The NHS was the crown jewels of British society providing healthcare to every member of society no matter who they were, where they came from and what personal resources they had. It was the great leveler of society creating a single standard of care and service that was accessible to rich, poor and disenfranchised and it was well loved.
To me personally, it was my guide and educator – I was lucky to attend one of the great London medical schools – The Royal Free Hospital School of Medicine. The “Free” hospital created to treat all comers and the original medical school (The London School of Medicine for Women) for women created in an era when women were not admitted to British Medical schools

That hospital and the NHS provided me with a first-class medical school education, access to groundbreaking research that included the early work and discoveries around HIV/AIDS, Hemophilia, Liver disorders and beyond.
The staff in every department were friends, colleagues and members of a community that were family and all pulled in the same direction – that of the patient. I spent time working in different areas during my time, staffing the manual telephone switchboard, helping the porters and security staff, nurses, technologists, and maintenance and quickly realized the well-oiled NHS machine demanded a family of committed people to make it work and deliver outstanding care each and every day.

What Could We Do Better

As we know today, and probably knew 70 years ago and before, healthcare is as much about our environment and resources as it is about medical treatments, technology, and innovation. We know that 60-80% of health is attributable to lifestyle but fail to take account of this in the NHS and in the majority of health systems from around the world.


We need a WellCare system not Healthcare


The system spends large sums of money providing medications to the population but fails to take account of the most basic needs of the population and acknowledge that food is also a drug. What we put into our bodies contributes to our health and well-being. Failing to acknowledge and manage these elements of health with sleep as the foundation and exercise and nutrition built on top has created a system that treats the failing of these issues at great financial and personal patient cost. Investing in the prevention would create a WellCare system and not the Healthcare System that the NHS is.

Manage and Allocate the Limited Resources with Transparency

It’s an unpleasant fact that few want to address or even acknowledge but the reality of treating people is that in this day and age of innovation, scientific progress and developments we could spend every last penny on treating patients. There is an unlimited supply of possible treatments and a never-ending procession of people needing those treatments. But not all treatments are created equally – some don’t work, some are harmful and in the cases of those that do work there is the wide disparity in the effectiveness and cost. Any healthcare system needs a means of assessing the effectiveness of treatments that includes the financial and resource cost linked to the improvements. The problem with a “free” (the NHS is not free – it is simply free at the point of care, paid for through taxation of the individuals) is the inducement of un-economic behavior by individuals looking for every last treatment option no matter the cost or effectiveness. That path is unsustainable and breaks the system and ultimately harms patients.

Enable Informed Decision Making for Everyone

Doctors Die Differently and do so because they understand the economic and personal tradeoffs between treatments and quality of life. In the data presented by the Johns Hopkins Study of a Lifetime we see a big discrepancy in treatment choices between doctors and everyone else. We make our choices in the context of the knowledge of effectiveness weighed against the personal cost of treatments and quality of life impact. An open an honest assessment of treatment that is clinically effective would level the disparity in treatment choices selected by patients. As a society, we struggle to discuss end of life but it is a reality that everyone faces and we must find ways to educate and support people through all aspects of life and death.

Technology and innovation is essential to the future of the NHS

The future of a scalable meritocratic system accessible to all that does not bankrupt society will be dependent on technology and innovation. Humans remain the core constituents of any compassionate caring system and technology is a supporting player. But as Michael Dell put it:

Technology has always been about enabling human potential

Michael Dell, Dell
Technology has always been about Enabling Human Potential

Technology does not replace the human beings or interaction but rather augments it in ways that extend our capabilities and improves the accessibility and economics.

It is an impossible task for humans to process the amount of data currently being generated about our patients, the knowledge derived from research and advances in science and put it into the context of treatments at the point of care when it is needed most.

We have expanded beyond the human brains capacity to absorb, process and apply the knowledge and must rely on technology to augment the brains abilities and place information into the context of the individual patient and the care choices available.

Selecting the innovations that deliver the most value

Innovation impacts each and every area of the NHS and will continue to do so but the challenge will be to select the innovations that deliver the most value to the largest number of people based on scientific peer reviews.

Innovation is not confined to the clinical treatment but extends to every element of the NHS system and the delivery of wellness care. It is changing the design of facilities to include features that improve care and outcomes – for example by adding natural light and open spaces.

Innovation is allowing patients the option to access their care team at any time and from any location – for example bringing the care team to the patient as we used to do with home visits but now using technology to extend the reach and scalability.

Innovation is building rooms and beds that can be efficiently and effectively cleaned between visits while maintaining comfort and welcoming surroundings. It is using available data to predict potential health issues before they occur and reaching out to patients helping to guide them to better healthier choices and wellness. Innovation is allowing parents to stay with their child in the hospital when they are sick and in need of care in comfortable and caring surroundings.

Innovation is offering dignity and compassion to those facing death and offering realistic options for no treatment and hospice care.

What can Britain and the NHS learn from the rest of the world?

Over 700 years ago, China had village doctors who were paid by the villagers when they were well but received no money when the patients were sick. This is the principle of wellness over sickness care. In Norway, they have a wide and uniform implementation of a digital health record that is accessible to everyone that needs it including the patient – tied together with a unique patient identifier designed for that purpose. One Citizen, one record.

The European Union allows citizens to cross borders and different health systems but to receive urgent care while traveling and administers the cross-country charges, managing fees and removing the patient from worrying about payments while they are sick and abroad.

Look also to Africa and the innovation that takes place on a continent with access to far fewer resources and technology to see what’s possible with the existing technology. Small incremental steps in using technology to boost healthcare services such as text messaging have been wildly successful and yet remain simple, easy to implement and understand and accessible through all social groups in society.

In Rwanda, they have integrated drone delivery for hard-to-reach locations, offering lifesaving support that was previously almost impossible. Expect to see more of this and bi-directional capabilities for resources, tests, and samples as well as lifesaving treatments.

Finally, in Korea, they have a culture of celebrating aging and the elderly that includes dignity in end of life and the inclusion of everyone in the family and their health. Korean culture sees the 60th and 70th birthday as a big family affair and the inclusion and the universal expectation that roles reverse once parents age, and that it is an adult child’s honorable duty to care for his or her parents’ health.”

A version of this appeared previously here

The NHS at 70 was originally published on Dr Nick – The Incrementalist

Should You be Taking a Statin

Statin, Cholesterol, Heart
Are statins the wonder drug for your Heart Health


The answer to that question is complex and individual and before thinking about that you should have a basic understanding of cholesterol in your body. You can learn about this from my video and blog post


In the previous episode, I talked about Cholesterol in your body. This week as a follow up I’m talking about Statins, a group of drugs that lower the level of cholesterol in the body. They work by acting on the liver’s mechanism for producing cholesterol inhibiting the enzyme Hydroxy-methylglutaryl-coenzyme A reductase (HMG-CoA reductase).

The Human Circulatory System

We know that cholesterol is closely linked to atherosclerosis – the formation of plaques that build up on the walls of our arteries and contain cholesterol and that these plaques can rupture or break off and cause blockages that cause cardiovascular disease that ranges from the mild decrease in blood flow to our limbs to the severe effects that throw blood clots into our brains and heart causing strokes or heart attacks. But as we learned last time – cholesterol is not all bad – it is an essential part of our body systems making up parts of cell membranes and integral to several signaling molecules.

Statins are also known to have additional effects beyond the simple reduction in cholesterol levels and production in our body and several studies have shown that these drugs also reduce inflammation in the cell walls which is not connected to the cholesterol-lowing effect. In fact, this effect occurs rapidly and is seen as soon as 2 weeks after starting statin therapy

Statins Drugs

Medication choices

There are multiple Statins around the oldest and best known is Atorvastatin (widely known by its brand name Lipitor) with its breakout general usage in 1996. The good news is this drug is off patent and there are plenty of low-cost generic options available and there is lots of safety data gathered given it has been in widespread use for over 20 years.

But Statins are not side-effect free and some find themselves suffering from constipation, diarrhea, and fatigue and in some 5-10% of people muscle cramps that can make the drug intolerable. This can be mitigated with some of the newer variant drugs that can help mitigate or even completely reduce the muscle cramps and other side effects. There is a rare and significant effect of causing diabetes in a small percentage of patient’s which is an important factor to consider when considering if Statins are right for you.

New Research on Statin Therapy

There has been lots of research and trials and the most recent I mentioned in the video the HOPE-3 trial which had a multifactorial design – meaning multiple variations on treatment therapies were tested in different populations.

They had a diverse group of patients divided up into multiple groups in a 2×2 factorial design that had groups being treated with a statin, an Angiotensin-converting enzyme (ACE) inhibitor for blood pressure and a diuretic hydrochlorothiazide also for blood pressure (BP). They had 12,000 people with a follow up to 5 years and they maintained good adherence for drugs of around 75%.
Overall, the anti-hypertensives did not reduce the risk of cardiovascular events at all – but there were differences depending on whether or not you had hypertension when you entered the trial. Interestingly the combined statin with an antihypertensive treatment was no better than a statin alone. And the data offered a clear benefit for Statins for those at intermediate risk of cardiovascular disease.

The details of this are nicely summarized here and the article includes links to the 3 published studies that were published from the data. One of the specific questions answered by this study is on that one cardiologist friend of mine and I have discussed before – should Statins be placed in the drinking water like fluoride. Given the cost and the side effects associated with statins, the answer is no for economic reasons as well as increased risk of side effects.

In the intervening time since I recorded this video another paper was published:
Finding the Balance Between Benefits and Harms When Using Statins for Primary Prevention of Cardiovascular Disease: A Modeling Study, and a new set of guidelines from the American College of Cardiology (ACA)/American Heart Association (AHA) on the management of cholesterol in the blood: 2018 ACC/AHA Multi society Guideline on the Management of Blood Cholesterol

Which emphasizes a heart-healthy lifestyle but then details some very specific “high-intensity” statins to focus on specific cholesterol levels in people who are at high risk or with proven clinical cardiovascular disease (they reference ASCVD or atherosclerotic cardiovascular disease) alongside detailed clinical guidelines for stating therapy based on specific risk and disease assessments in individuals. There are too many variations to make any generalization beyond what I stated in the video – start with the incremental step of knowing your numbers and the details of your family history and medical history as contributing factors to your risk assessment to take with you and discuss with your doctor to decide what’s right for you

Once you have your numbers you should calculate your 10-year risk of heart disease or stroke using the Atherosclerotic Cardiovascular Disease (ASCVD) algorithm published in 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. This is available from several sources including this from MDCalc or this one which includes a spreadsheet you can download to plug in your values as well.
To include the new updated guidelines from 2017 and the ASCVD Risk Estimator Plus tool (background available here) you can download the app with updated guidelines from 2017 for Apple iOS but Android is a little more challenging with a generalized cardiology app which does not get as good reviews.

Ultimately the decision is a very personal one and is driven by data and supported by clinical evidence. There are no quick global answers, but it is an important decision for everyone to consider, especially if you have any contributing factors in your family history, past medical history or are suffering from any aspects of cardiovascular disease.

Listen in to hear the details Statin Therapy and if its right for you

Incremental steps – Deciding on a Statin

  • Measure your Blood Cholesterol
    Gather the details of your medical history
    Use the ASCVD calculator to give you a guide based on the clinical research
    Bring everything to your doctor and discuss the evidence data and make a personalized decision together


The evidence is clear for those in the groups that have treatment with a statin recommended that the benefits outweigh the risks and side effects.

Should You be Taking a Statin was originally published on Dr Nick – The Incrementalist

Your Body and Cholesterol

This week I’m talking about Cholesterol. What it is, where does it come from (hint your diet is only a small part) and what does your body use it for

Fatty Foods – Are they as bad as we think?


It’s interesting that when you search for cholesterol the recurring image is of Eggs which have been closely linked with Cholesterol and to some degree part of a simplistic link that associates food that contain cholesterol with cholesterol levels in our body but it’s not that simple.


The word Cholesterol comes from the Greek Chole for bile and sterus for solid and adds an “ol” at the end for hydroxyl functional group or alcohol bond on the molecule. It is a lipid molecule and is found in cell membranes and in signaling molecules like our the hormones Progesterone, Estrogen and Testosterone. Suffice to say our body needs it so the idea you get rid of all your cholesterol to be healthy won’t work.

So what does it mean for your health, how much should you eat and what are all these HDL, LDL and VLDL measures your blood test and what do they mean for you? Listen in to find out the details of the cholesterol measurement and what they mean to you and what Incremental Steps you should be taking regarding cholesterol in your diet an for your health.

Can I ask a favor – if you like the video, please subscribe to my channel, and if you don’t leave me your feedback/thoughts on how I can improve things?
Read more from Dr Nick at

Your Body and Cholesterol was originally published on Dr Nick – The Incrementalist

Using Advanced Trauma Life Support Methodology in Population Health

 Preventative Health for Everyone



This week I am talking Joshua Scalar, MD, MPH, Chief Medical Officer for BioIQ where they are working to seamlessly connect people to preventative health testing by removing the friction from the system and allowing as many people as possible to access essential, cost-effective life saving preventative testing services.

Josh had an interesting path to his current role – find out how a Saxophone playing band member became a passionate advocate for patient engagement and widespread and easy access to preventative services

Hear how Advanced Trauma Life Support (ATLS) insights offer a model and guide for the triage and delivery of preventative care that should address a problem that by some estimates has only 8% of people accessing fully validated life-saving preventative care opportunities in the United States

Like many of my other guests, Josh made the point that one of the clear incremental steps to getting patients and consumers to access preventative services is

Making the right choice the easiest choice

Hear how he and his team have addressed a basic problem of colonoscopy screening that is an effective and well-tested method of picking up and preventing untimely death from colon cancer but is still poorly adopted. As he points out – colon cancer killed 50,000 people in 2017 – that’s more than the opiod epidemic did but it continues to lack the focus and attention warranted.

Listen in below to find out how this can be applied to Diabetic Retinopathy – preventing blindness that is a high risk for Diabetic patients

Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next two weeks at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.

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Listen along on HealthcareNowRadio or on SoundCloud

Using Advanced Trauma Life Support Methodology in Population Health was originally published on Dr Nick – The Incrementalist

Why Healthcare Needs More Women Leaders

Posted in DigitalHealth, Healthcare Technology, Incremental, Innovation, Inspiration, Technology by drnic on November 19, 2018

Women as the Key Healthcare Decision Makers

Venture Capital

This week I am talking Lisa Suennen, (@VentureValkyrie) Managing Partner of Venture Valkyrie, LLC, an advisory firm that works with healthcare and other companies on investment and innovation strategies and host of the Tech Tonics Podcast. Lisa is a twenty year veteran of healthcare investment, healthcare technology and venture funding and a history with behavioral health company that was treating 35 Million people.

This interview arose from on twitter discussion

featuring #ThisWomanRocks that I nominated Lisa and several others for and I asked them to join me on my show to share their experiences and thoughts on how we change the poor representation of women. In the Venture capital world when Lisa joined the statistics were dismal – only 8% of Venture Capitalists were women – 20 years later, its still about the same!

This despite the fact that gender diverse companies show better financial performance – so its not just good to do its the best for the bottom line too. As Lisa highlighted, Kevin O’Leary (aka as M.r Wonderful on Shark Tank) has highlighted the fact that in all the companies he is involved in – the ones with gender equity and women backed are far more successful on multiple measures.

So why are we still seeing dismal representation for women and what incremental steps can we take to improve this – listen in to hear what Lisa has to say and why in healthcare especially this should be a prime directive (hint – think about who makes the majority of healthcare decisions for any family)

As we discussed, the way to get more women onto the stage and engaged is to be part of the solution and there is no better way than signing up with CSweetner, a not-for profit organization dedicated to helping women benefit from mentorship to become the best leaders they can be and offering a speaker bureau for conferences to find women speakers

Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next two weeks at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.

Listen along on HealthcareNowRadio or on SoundCloud

Why Healthcare Needs More Women Leaders was originally published on Dr Nick – The Incrementalist

Alcohol – What’s a Healthy Amount

Posted in behavior, education, Incremental, Mens Health, Personal Health, Whisky by drnic on November 13, 2018

Media Coverage of Alcohol

This week I’m talking about Alcohol consumption and the recent study published in the Lancet:

Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Which generated a slew of coverage in the media with headlines like this:

Drinking Health
NPR Coverage: No Amount of Alcohol is Good for You Media


Yikes! Those of you that know me will understand how distressing that is for this Whisky Librarian. Taking a look at the details behind the study things are maybe not as dire as they first seem

Is that really the case and what might it mean for you and your health?

The study was a Meta-Analysis and things aren’t always quite that simple and while the underlying facts are that harm increases with each additional drink, the additional risk of having one drink (unit of alcohol) per day revealed in this study is not as large as the headlines seem to suggest and that means for your decision on alcohol consumption you should take account of the details before you start panicking about enjoying a drink every so often.

For clarity – I am probably biased given I am well known as a Whisky Librarian and enjoying a wee dram of whisky every so often but I’ve tried to present the data and allow you to make your own decisions

Listen in to find out the details of the study and what they mean to you and what Incremental Steps you should be taking regarding alcohol consumption and your health

Can I ask a favor – if you like the video, please subscribe to my channel, and if you don’t leave me your feedback/thoughts on how I can improve things?


Alcohol – What’s a Healthy Amount was originally published on Dr Nick – The Incrementalist

Making it Easier to do the Right Thing

Behavioral Health for Positive Impact


This week I am talking to Matt Wallaert (@mattwallaert), Chief Behavioral Officer at Clover Health. I have listened to Matt on a few occasions, most recently at the FitBit Captivate event in Chicago so I was excited to get to talk to him one on one.

Matt plays an unusual and atypical role in Clover Health – he is their Chief Behavioral Officer, a title and role that is not commonly found. He is a Social Psychologist who focuses on Judgement and Decision Making and is most well known for applying behavioral science to practical problems.

We explore behavioral health influences and how we can create interventions that will have a positive impact. How do we create incremental steps and test these and then roll out of programs to have a positive impact on health? He wanted to have an impact and wanted to make things better for people and over the course of his career has managed to do so in many places but is now focused on healthcare and specifically personal health. There’s a recurring theme in many of my INcremental interviews and I heard it again from Matt:

Assume you are going to fail

As Matt puts it – “don’t set up a durable process – for example, if you are doing a mailing do that yourself vs getting your marketing department to create the mailing”. Then head out to the next step – a Test. It is not hard to find behavioral changes that work – but that’s not the only requirement as the change has to work well enough and are scalable enough that you really want to roll them out widely.

Incremental Step to Behavioral Health

It’s not just finding good behavioral changes but rather things that are worthwhile and scalable

“If behavior is your outcome and science is your method – then you are a behavioral scientist”

As Matt says we have to make it easier to do the right thing and not blame individual choices and health behaviors when we make poor health, decisions. Listen in to find out why there are significant cultural differences in flu vaccination take up rates and what incremental steps can be taken to improve on that and hear why it is important not to blame people for poor health behaviors. Learn how they are behaving like Netflix or Pandora that can can match you to the right videos or music we should be able to match you to the right doctor


Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next two weeks at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.

Listen along on HealthcareNowRadio or on SoundCloud

Making it Easier to do the Right Thing was originally published on Dr Nick – The Incrementalist

Is Intermittent Fasting Right for You?

Does Intermittent Fasting Work?

Eat Stop Eat

This week we I’m covering the world of Intermittent Fasting. What’s that you ask – in its simplest form

Eat – Stop – Eat

In other words, challenging your body with no intake of calories for a variable amount of time. In my case I fast for about 36 hours with my last meal in the evening of day 1, I eat nothing on day 2 but do drink plenty of water and allow myself coffee and tea but without any milk (or sugar) and my next meal is breakfast on day 3

But there are plenty of variations on this that range from the 5:2 program that has you eating 5 days and fasting 2 days but non-consecutively and in some cases allowing for a small number of calories (500-100) or the 18 hour fast where you only eat food between the hours of 12 and 6 pm and fast the remainder of the time through to some who fast for more than a day.

Listen in to the video to find out what are the good things about intermittent fasting and what are the downsides and what the various types of intermittent fasting methods are and how you might take an incremental step and try them out.


If you are interested in finding out more I have linked to some additional papers and articles to give you some more reading

Links to Studies on Intermittent Fasting

Harvard study shows how intermittent fasting and manipulating mitochondrial networks may increase lifespan
Intermittent fasting promotes adipose thermogenesis and metabolic homeostasis via VEGF-mediated alternative activation of macrophage in Mice
Is fasting the fountain of youth?
Study Fasting for 72 Hours can Regenerate the Entire Immune System of Humans!

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Is Intermittent Fasting Right for You? was originally published on Dr Nick – The Incrementalist

The Healthcare Huddle

 Delivering the Care Patients Want


This week I am talking to Dr. Jay Mathur, Associate Regional Medical Director for Caremore Health Systems in Connecticut. A program that started 25 years ago in California and has now expanded to multiple states and has been in Connecticut for a little over a year. This is the medicine that we went to medical school to practice, the opportunity to deliver the care that patients and families want.

We know that the poor typically live alone and quite often socially isolated and their zip codes play a part in their health status but sometimes it can be their shopping experience and availability of food not just their zip code that is a key determinant of health. We talked about some of this in my interview with Dr. Won Chun from Carrot Health

Team Sport
The Healthcare Huddle

Listen in to hear how they select the hardest patients with the most complex diseases and chronic conditions as and learn the key elements in their success that are tied to the early morning huddle where everyone shares the upcoming day, tasks and resource allocation getting everyone on the same page. All I could think of was the scene from The Replacements and Shane Falco’s huddle:

Huddle Fight

They have a range of team members with their Clinical Partners as the glue that keeps everything together and others on the team including Social Workers, Psychiatrists, Case Managers and physicians playing a supporting role to each other

Glory Lasts forever

From a patient standpoint, it all starts with a detailed assessment and importantly introducing all the team members to the patient using a range of technology tools to facilitate and improve efficiency

Their Incremental steps to improvement include the huddle but listen in to hear what other incremental steps you may be missing that has added significantly to their team-based approach, coordination and success

Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next two weeks at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.

Listen along on HealthcareNowRadio or on SoundCloud

The Healthcare Huddle was originally published on Dr Nick – The Incrementalist

How Good is BMI as a Health Indicator?

How do You Measure your Healthiness?

A recent conversation with my brother about Body Mass Index or BMI got me thinking about this data point and how we use it. Many of you are probably familiar with the value – it shows up on your weighing scales right after displaying your weight

Obesity BMI
Digital Weighing Scale

And if your scales don’t offer it you can always calculate your BMI with a multitude of online calculators (simply put weight divided height)

But there are some challenges with this simplistic value – not least of all the Obesity Paradox – the counterintuitive notion that obesity may be associated with longer survival.

Muscle Mass

A recent study published in PLOS One: Muscle mass, BMI, and mortality among adults in the United States: A population-based cohort study that delves into this deeper and offers some explanation of this counterintuitive notion that having a high BMI can be associated with longer survival. The results offered a clearer picture into our bodies and the relationship between these measures and our health status and long-term survival. There was lots to digest but this chart captured an essential point

Risk of Mortality BMI and Muscle Mass

The Blue line represents people with “Preserved Muscle Mass” – in other words, those that have more muscle vs less. The Red Line for people who have lower muscle mass. I’m simplifying a complex detailed study a little but essentially but here goes

TL;dr: Healthier longer survival for people who sit in the middle range of BMI and have more muscle mass. For those with high or low BMI muscle mass has a positive impact on improving long-term survival

Listen in to find out the importance of Muscle Mass and what Incremental Steps you should be taking to improve your health


Can I ask a favor – if you like the video, please subscribe to my channel, and if you don’t leave me your feedback/thoughts on how I can improve things?

How Good is BMI as a Health Indicator? was originally published on Dr Nick – The Incrementalist