Navigating Healthcare – Patient Safety and Personal Healthcare Management

22 Pushups

Posted in Compassion, Empathy, Suicide by drnic on August 21, 2016

Honoring those Who Serve (Updated Friday September 9, 2016)


So what’s the 22 Pushups challenge all about? It came from the Honor Courage Commitment organization who’s mission is to create elite veterans through education, mentorship, and community service. They started the #22Kill movement back in 2013 when they learned that a staggering 22 veterans are killed by suicide every day. There is some controversy over this statistic, the original source from a 2012 study and the detailed analysis but there is a higher rate of suicide amongst those who serve and even with controversy it should remain a priority – by any measure, this is a devastating epidemic of staggering proportions

It all started with my good friend and Royal Free Hospital School of Medicine Alumni Sue Roche as she took on the challenge and tagged friends – it inspired me and I followed along daily, adding my own set of 22 pushups to Sue’s each day. After a few days I was tagged and as they say the rest is history – as of writing I am on my 4th official day of 22 with some interesting opportunities to complete the challenge coming up in my travels.

As of today Friday September 9, 2016 I have completed my journey and you can find all 25 videos posted at the bottom of my 22 pushups that were done in: various places around the world including Los Angeles, Phoenix, Maryland, Virginia, Frankfurt Germany, Bangalore, Chennai, Delhi in India.

If you discount my inability to count and keep track of days and assume I did the correct number of 22 days with 22 Pushups
In the 11 days I have been doing this in raw numbers:
In the US (Ranked 50) ~2,590 people committed suicide of which ~484 were veterans
In India (Ranked 11) ~8,136 people committed suicide
In Australia (Ranked 63) ~174 people committed suicide
In the UK (Ranked 105) ~364 people committed suicide
In Ireland (Ranked 59) ~28 people committed suicide
All based on best estimates for most recent data – rankings based on suicide rate per head of population)
In the US for all causes of death suicide is ranked 10th above septicemia, chronic liver disease and hypertension

As of today the counter is at 15.2 Million pushups – and I know the awareness has increased and I am grateful to each and everyone that has participated, contributed and got involved continuing to keep the focus and inspire me to complete my small part in this important project that includes a donation today in my father’s name: A World War 2 veteran who fought in the Dutch resistance and escaped occupied Europe and shipped out to Camp Le Jeune where he trained to become a Royal Dutch Marine. He suffered undiagnosed PTSD that manifested itself when he was undergoing surgery and anesthesia

What do you have to do – the detailed instructions are here – record a video of you doing push-ups – it does not have to be 22 – every push up counts and they are being grabbed automatically to update the counter:


But you have to tag your post with

#22pressups for #22Kill

The number preceding the “press-ups” can be whatever you make it for the number – if you can get some other participants to complete the press ups at the same time you can multiply up. Then post it on Facebook, Twitter, Youtube or instagram and


Can you Hear me Now

Here’s the video from their YouTube channel featuring many contributing and many lost


How do you support them beyond raising the awareness and completing the challenge

  • Hire a Veteran
  • Volunteer
  • Become and Advocate, or
  • Donate



I was nominated by Sue Roche and my nominations were as follows:

  1. Paulo Machado
  2. Mandi Bishop Meyers
  3. Arshya Vahabzadeh
  4. James Vincent
  5. Tom Vincent
  6. Karen Branz
  7. Curt Aubley
  8. ZDoggMD
  9. Michael Osborne
  10. Frederik Brabant
  11. Therese McGonagle
  12. Jen Vincent
  13. Dewinder Bhachu
  14. Ravi Kumar
  15. Molly Merluzzi
  16. Bob Blount
  17. Howard Luks
  18. Brad Justus
  19. Justin Kuritz
  20. Dirk Stanley
  21. Jeff Ryan
  22. Sean Casey


22 Pushups was originally published on DrNic1

Tagged with: , ,

5 bright planets visible this month – Me

Posted in Uncategorized by drnic on August 20, 2016

5 bright planets visible this month – Mercury, Venus, Mars, Saturn & Jupiter #space

Joining the MedicAlert Board


I am excited to be elected to the MedicAlert Board joining Jessica Federer, head of digital development at Bayer. As Barton Tretheway, CAE, chair of the MedicAlert Foundation Board pointed out

Their collective experience aligns with our priorities and will be immeasurable to us as we look to leverage the power of new technology to expand the mission of MedicAlert Foundation, which is designed to help save lives

Which succinctly captures my feelings around this additional role. I personally experienced the value of the MedicAlert solution, brand and promise when I practiced as an Emergency Room physician in the United Kingdom. It was part of the standard procedure for any patient who arrived unconscious or confused to look for the signature bracelet

Traditional Medical Alert Bracelet


With its iconic Caduceus (similar but different to the Rod of Asclepius) which was the traditional sign of the God Hermes and became established as the symbol of medicine in the United States in the late  19th Century.

History of MedicAlert

The Original MedicalAlert User – Linda Collins

The history of MedicAlert dates back to the Early 1950’s developed by parents of Linda Collins who had an who had an anaphylactic reaction to tetanus anti toxin (which in her instance she only received a small scratch test as was the practice in 1953) and had a severe reaction. She survive but her parents Dr Marion Collins and his wife Chrissie realized that she was at risk and made a paper bracelet and note that was attached to her coat detailing her severe allergy.






In fact the original MedicAlert Bracelet is now in the permanent collection of the Smithsonian Institution in Washington, D.C. Today

The Original Bracelet stored in the Smithsonian in Washington DC
The Original Bracelet stored in the Smithsonian in Washington DC

From these modest beginnings things have developed with early recognition by “Peace Officers”. The California Peace Officers magazine even ran an article back in January 1957 highlighting the MedicAlert bracelet to their members. In the era before mobile phones and always on communication it was a reliable way of identifying individuals and providing immediate access to a 24- hour phone line linked to critical and life saving information for that individual. This function continues today with a live 24/7 Emergency Response Service

I worked on one of these switchboards as a Medical Student many years ago



with full health and personal information including your personal health record and emergency contacts information and available in other countries including Australia, the UK, Canada and South Africa to mention a few through affiliates and partnered with many groups including AAFP, Alzheimer’s Association, ACEP, Autism Association, Philips LifeLine, National Alliance of Mental Illness, Food Allergy Initiative – to mention but a few

The age of computing brought new innovations and the ability to more readily store and retrieve more information for members and track and follow membership and presidential recognition dating back as far as April 9-16, 1978 when then President Jimmy Carter commemorated the occasion of MedicAlert and their contribution to Medic Alert week in April. Even Hollywood got in on the act with appearances of the MedicAlert in everything from the Today Show and Good Morning America to CHiPs

and Columbo

Peter Falk in Columbo


Moving into the Digital Age

The organization is moving into the digital age with solutions around stored medical records, moving to digital mobile formats and storage solutions and even exploring the potential for RFID enabled solutions and in partnership with the American Medical Association has a joint venture on advanced directives.

Back in 1956 Dr Marion Collins commented that

“I think I can save more lives with MedicAlert that I’ll ever save with my scalpel”

Which is much like my own perception of medicine and the opportunity of Digital Health that I saw 30 years ago and continues to be the case. It’s this combination of a storied brand and concept from MedicAlert as a foundation and the opportunity to update for the new Digital world we live in that presents such an exciting opportunity. We are facing a Silver Tsunami of people who struggle to age in their homes and technology and solutions that help them do so, safely and with the support of their relatives and the health system will be in high demand.

I’m looking forward to working with my fellow board members and the MedicAlert team to continue the tradition and build on the brand with a Digital update and twist







Joining the MedicAlert Board was originally published on Dr Nick van Terheyden, MD

Tagged with:

Evolution of the #EMR and the challenge

Posted in Uncategorized by drnic on August 16, 2016

Evolution of the #EMR and the challenge of caring for complexity #safety #HCIT

Outrageous experiences of inhumane treat

Posted in Uncategorized by drnic on August 15, 2016

Outrageous experiences of inhumane treatment documented by the ever +ve #UnicornJess – are you angry now?

Come vote #SXSW PanelPicker Heal Thyself

Posted in Uncategorized by drnic on August 13, 2016

Come vote #SXSW PanelPicker Heal Thyself! How Tech Improves Health & Self-Care #mHealth

Channeling Churchill to deal with innovation, impatience and chaos in healthcare

Posted in Healthcare Technology by drnic on August 9, 2016

Channeling Churchill to deal with innovation, impatience and chaos in healthcare

Photo Courtesy of UniSci24
Photo Courtesy of UniSci24

To say that healthcare is changing is to understate the situation dramatically. The combination of new technology and a demand by payers and consumers for more value for their money has created an environment rich in both innovation and impatience. You may think you are moving swiftly, but no matter how quickly your organization is adapting, both payers and consumers are tapping their collective feet and wondering why it’s taking you so long to get with the program.

Consumers now expect digital access to everything 24x7x365. The online world has taught us that this is not only possible, but even routine – everywhere but healthcare. So their impatience with our slowness is understandable. They can search at 3 a.m. for answers to health questions that we as healthcare providers haven’t given them. Given that many of the answers they find on the internet may be dangerously wrong, it’s time we did a better job answering their questions, even at 3 a.m.

Payers, too, are impatient for change. They want value-based contracting and want to reward results, not volume of procedures done.

Technology is behind much of this, because appropriate use of technology can speed up the process of everything we do. Beyond speed of connection, though, technology will change, at a very basic level, the way we deliver healthcare.

In speaking of a fundamental change in healthcare, I’m thinking particularly of analytics and the progress toward what I call “augmented intelligence.” While artificial intelligence has a long road to travel to match the thinking abilities of the human brain, technology can now augment our capabilities. Technology can take over the tedious task of searching for data and looking for patterns, giving us an invaluable assistant. No human is capable of reviewing clinical data and images from thousands, even millions, of patients to find the knowledge hidden in those terabytes. But a computer with the right software can do it quickly and efficiently, giving caregivers access to new knowledge.

Finding the zebras among the horses

Computers can also profoundly improve decision support systems, broadening the thinking of physicians. If you ever read the New York Times column, Think Like a Physician, you will understand just how useful this could be. In that column, the author presents a diagnostic challenge that has stumped many physicians before being resolved. Often, it takes months and many different physicians before an accurate diagnosis is made.

In training, we learn that when you hear hoof beats, think horses, not zebras. In other words, think of the common things first. But now and again, those hoof beats turn out to be zebras, and we often miss the subtle differences that tell us that zebras are lurking over the horizon, not horses. We keep looking for horses while the zebras roam freely around our feet. Conversely, we may think we see a zebra when it’s just a pony with odd coloring. This happens in part because we are searching in the dark, and it’s hard to tell a horse from a zebra with the lights off. An augmented intelligence system could help sort through a patient’s complex set of symptoms and clinical findings to offer up a broader range of ranked possibilities and recommendations for testing that could pinpoint the diagnosis. It could flip the light switch and make it easier for us to see whether it’s a herd of zebras or a herd of horses making all that noise.

A new kind of medical progress: R2D2 (or possibly C3PO) will see you now

Vinod Khosla, co-founder of Sun Microsystems, has said, “In the next 10 years, data science and software will do more for medicine than all of the biological sciences together.” He has also noted, “By 2025, 80 percent of the functions doctors do will be done much better and much more cheaply by machines and machine learned algorithms.”

But, even if he is right, that doesn’t mean that doctors won’t be needed. On the contrary, it will allow physicians to bypass the really boring part of their jobs and do that 20 percent of functions that require a thinking, feeling human being to accomplish. It will also extend our resources dramatically, which is important, because the US Department to Health and Human Services predicts that by 2020 we will need 20,400 more physicians, just in the U.S., than will be available.

And it’s not just the supply of doctors that will see a shortfall. Globally, the World Health Organization says that 15% of the need for doctors and nurses isn’t being met. Moreover, in Africa, that shortfall is dramatically worse. The continent has about 24% of the world’s disease burden but has only 2% of the global health resources. The unequal distribution of medical expertise is a serious problem that technology can help solve, with telehealth solutions and cheap, portable diagnostic testing solutions.

And it’s not just the role of physicians that will change

Profound as the changes are that will be coming to medical professionals, healthcare executives are facing an even more profound change in the way they will perform their work. The move from fee-for-service and opaque claims and billings systems toward value-based care and transparent pricing is happening rapidly, and it will require a complete overhaul of the thinking and strategizing of most healthcare executive teams.

Everything you thought you knew about how to make your organization financially successful will change. Profit centers like radiology and diagnostic imaging will become cost centers; the more high-end expensive care you give, which once supported all the more mundane services you provide, the lower your profits will be. Instead of filling beds, your job will be to keep them empty.

It’s a big challenge, but the same kind of augmented intelligence systems that will help physicians keep patients healthy can help you keep your organization healthy. Analytics can help you identify and stratify risk, so that you can contract with payers at rates that won’t kill your bottom line. And it can help you identify gaps in care that could lead to the need for expensive treatments and procedures.

Technology can also help you keep patients healthy. Telehealth and remote monitoring are making significant improvements in chronic disease outcomes.

To face the challenge, be like Churchill

The cultural change required by all this progress will likely create anxiety and chaos within your organization. But it doesn’t have to do so. If the CEO and executive teams stay calm and focused, the people they lead will be less anxious and more able to think creatively.

Remember London in 1940? Bombs were falling nightly from Nazi warplanes, and the city was literally on fire. Hitler believed that by bombing population centers, he could sow panic among the people and make invasion possible. But the people of London didn’t panic. Their leader, Winston Churchill, personified the advice to “Keep calm and carry on.” That firm hand at the wheel of the nation gave the people of London and of the entire country a model to follow. Rather than chaos, the Nazi attacks created incredible resourcefulness that resulted in remarkable innovation that helped win the war.

So when the task of facing the upheaval in healthcare seems too much, channel the spirit of Churchill and keep calm and carry on.

You also might want to get your physician to prescribe for you what Otto C. Pickhardt, MD, prescribed for Churchill in 1932, when he was recovering from being hit by a car on Fifth Avenue in New York: “alcoholic spirits especially at meal times. The quantity is naturally indefinite but the minimum requirements would be 250 cubic centimeters.” For my non-scientific American readers, that’s about 8.4 ounces or about 10 shots!


I’d moderate that dose a bit, but I’d go with Churchill’s choice of medicine, whiskey. Sometimes chaos and challenge require you to sit back, take a deep breath and get some perspective. I find that a good single malt Scottish whiskey gives me a broader view of the world and my place in it. And I find that my thinking can become quite innovative after a couple of ounces.

The original appeared on HealthBlawg’s Festschrift Tenth Blogiversary here

Channeling Churchill to deal with innovation, impatience and chaos in healthcare was originally published on Dr Nick van Terheyden, MD

Study Finds no Link Between #Vaccination

Posted in Uncategorized by drnic on August 9, 2016

Study Finds no Link Between #Vaccinations $ #Autism – funded by antivax group safeminds #irony #science