Navigating Healthcare – Patient Safety and Personal Healthcare Management

Is Intermittent Fasting Right for You?

Does Intermittent Fasting Work?

Fasting
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

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The Healthcare Huddle

 Delivering the Care Patients Want

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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

Health
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

 

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

Future Failure Guaranteed in Healthcare

 Medical School Candidate Selection

MedEd Books Education books
Are we are selecting the wrong candidates for medical school and not teaching them the skills they really need to be good doctors?

I’m a doctor first – anytime anyone asks me what I do the first words out of my mouth are “I’m a Doctor”, followed by a follow-up explanation of my role today outside of day to day clinical medicine and the laying on of hands-on patients.

Many years ago I decided to give up my daily medical practice and it was a difficult decision. While I loved taking care of patients, I’d been beaten up in a system that pushed me to my limits and I did not like what I felt and saw in myself as I existed in a sleep-deprived haze courtesy of a 152-hour working week aka a 1 in 2.

I believed that the healthcare system was creating barriers for doing what patients really needed. And too much of my time was taken up with things that didn’t really matter. By moving into the world of technology and focusing on medical technology development, I hoped to create new tools that would improve our ability to help patients in the ways that they wanted to be helped.

My emotions about this move were conflicted, and I sought out a colleague who had been a mentor to me and shared my decision and mixed emotions about that decision. His response bewildered me.

“That’s terrible,” he said. “You never should have been allowed into medical school.”

From his point of view, the fact that a doctor was leaving the profession was not a sign that anything about the healthcare system needed to change. It just meant that the selection process for medical students was wrong and I was a flawed candidate that never should have been allowed to study medicine.

That unwillingness to examine the status quo is not uncommon in the world of medicine, especially when it comes to medical education. The current curriculum has changed very little over the past century. While science has been updated, the basic structure of medical education hasn’t changed. The daily practice of medicine, however, has changed. And it has changed a lot. Medical education isn’t preparing new doctors for the challenges they will face, and many of the skills they will need are never addressed during the four years of medical school.

But there is an even bigger problem with the medical education system: acceptance into medical school isn’t based on characteristics that are important in medical practice. We have become very focused on academic perfection and MCAT scores, with little consideration for the personality traits that lead to highly effective and compassionate physicians. We get lucky with many people, who have the academic performance and the needed personality traits, but we also train people who are not inherently suited to the practice of medicine or who have what compassion they had entering the system crushed out of them with debilitating academic testing with multiple choice questions systems. And we exacerbate the problem with a system that encourages isolation with a monstrous amount of academic study and rote learning. To excel or even survive the rigors of the system you diminish social interactions and limit them to others who are stuck in the same academic sinkhole.

We are failing to train medical students in the skills and thinking habits that make good doctors.

Recruit for compassion and intelligence, not academic perfection

The first step in getting this right is recruiting students who have more than academic skills. Perfection in academic performance is often accompanied by self-involvement verging on narcissism. To attain perfect grades in college, you have to have enormous discipline as well as intellectual ability. You also have to sacrifice time spent in other endeavors – experiences that might broaden your worldview and increase your sense of compassion. This intense focus on your own goals can create a sense that you are more important than others.

MedEd MedicalStudentID

I watch this first hand with my daughter, who makes me proud on a daily basis with her dedication and focus towards her goal – which she has had since the tender age of 5 – of getting into medical school and qualifying as a doctor. But every step towards medical school moves her inexorably away from the compassion and caring she has demonstrated on her journey thus far. Like her peers, she fears that if she doesn’t keep an intense focus on academics she will fail in her study of medicine. I know I want her as my physician but wonder if the obstacle course she must complete will change her beyond recognition.

Medical Education

 

Teach medical students skills, not just facts

Medical education is like drinking from a scientific fire hose. Few students retain more than about 50% of that data, and we neglect other skills that are more important. Doctors can instantly look up any medical fact they need so this attempted brain download of scientific detail isn’t necessary.

What isn’t taught is how to think about health, illness, and people. Medical students should be learning root-cause analysis and the ability to connect disparate pieces of data and understand the meaning. They need to learn data search skills, listening skills, problem-solving and how to be a continuous learner. They need to flex their compassion and objectivity muscles and learn the patience that will help them understand people who are different from themselves. And they need to learn leadership and how to work with others as in a team and as a team leader. These are the skills that are hard to acquire but are crucial to accurate diagnoses, more effective treatment decisions and effective management of chronic diseases.

The change is beginning

Medical schools are starting to respond to the need. In 2013, the American Medical Association gave $11 million in grants to medical schools that are developing flexible, competency-based pathways. They are making changes that will narrow the gap between how physicians are trained and how medicine is practiced. As of 2015, grants have been given to 32 medical schools, each with an innovative approach intended to prepare students for the real world of medical care. None of these programs are focused on the science of medicine, but rather the thinking, leadership and management skills needed to effectively use the science of medicine.

This is a great start, but there are 141 accredited medical schools in the U.S., and nearly 2,500 worldwide, many still using a curriculum developed more than a century ago. I hope the leaders of these schools are paying close attention to the innovations being tested under the AMA program. We all need them to do a better job of recruiting and training medical students who have the right stuff for the medical environment of this century, not the last.

Some Early Progress

The Dell UT Medical School which was funded in part with support from the Michael and Susan Dell Foundation and by a vote from local residents to increase their personal taxes to fund the development and ongoing management of this facility. They are trying a new funding model that gets rid of the conflict of interest that hamstrings many medical schools that are dependent on fee-for-service hospitals for revenue. The financial model will emphasize outcomes and cost-effective care overpayment for individual procedures and the medical school is taking a different approach to education while still encumbered by the need to meet the regulatory requirements to satisfy the medical education definitions and allow their students to compete on the current playing field for medical education the United States Medical Licensing System (USMLE) testing system

What do we need in Healthcare

More accurate diagnosis early in the disease process (12 million people annually are misdiagnosed, and about a quarter of those errors are life-threatening)

MedEd Costs

86% of healthcare spending in the U.S. was used to treat patients with one or more chronic conditions, and most of that goes for treating complications due to poor management.

Clinicians are under increasing stress and committing suicide at extraordinary rates (A systematic literature review of physician suicide shows that the suicide rate among physicians is 28 to 40 per 100,000, more than double that in the general population)

Incremental Steps to Improving Medical Education

  1. Let’s start by acknowledging the current system and trajectory is not matched to the requirements of our future doctors
  2. Find one element of the curriculum suited to a different method of teaching and change the approach. Match this with an approach to changing the testing methodology to match this more closely
  3. Enlist support to bring about change with the examining board, the clinical teachers and mentors and recently graduated doctors who can all provide relevant insights on the deficiencies of training in preparing for a medical career and what can and needs to be changed

 

Do you think I’m wrong – is our system well suited to the current requirements and just in need of some minor tuning? If I am right – what changes can we work on immediately to change the course and direction for the students now to bring about lasting improvements?

 

Future Failure Guaranteed in Healthcare was originally published on Dr Nick – The Incrementalist

Change Behavior, Change the World

Change Behavior, Change the World

The Incrementalist Graphic Adam Pelligrini

This week I am talking to Adam Pelligrini,(@adampelligrini) the General Manager and SVP for Fitbit Health Solutions. Adam has had a long career in the Digital Health coming from the Digital Health group for Walgreens Boots Alliance where he built a range of digital and mHealth platforms. He recently ran and hosted the highly successful FitBit Captivate conference where over 300 employers, health systems and health organizations from around the country gathered in Chicago to hear about the latest innovation in wearable personalized health technology. You can read more about it here.

The new digital space and innovations in wearables are an exploding and Adam shares his insights into what it takes to be successful in the wearable space. FitBit’s focus is on an open platform and incorporating behavioral change into the DNA of the company and these solutions have been instrumental in getting 6.8 Million people participating in population health programs with their devices!

Connecting Data Wearables

They found Incremental steps to getting people engaged in the United Healthcare Motion Program which was founded on the principle of connecting people to their data and making it simple. Their program was focused on simple small steps of  “FIT – Frequency, Intensity and Tenacity” that were tied to rewards back to the individual

 

 

Listen in to find out how they managed to record 6.5 Billion nights of sleep and added 2.9 Million participants to a new female health tracking feature with just native word of mouth!


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

Change Behavior, Change the World was originally published on Dr Nick – The Incrementalist

Consumer Level Insights to Healthcare

Posted in bigdata, HealthIT, Incremental, Innovation, obesity, Population Health, SDoH by drnic on October 2, 2018

How Much you Travel Can Predict Your Health-Related Behavior

The Incrementalist Graphic Won Chung

This weeks interview was an opportunity to catch up with Dr Won Chung – an Emergency Room doctor and co-founder of Carrot Health – a company focusing on bringing consumer level insights, data and analysis to medicine

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His clinical career has been centered on the Emergency Room which as he describes is primarily focused on treating Accidents and Emergencies but as he has discovered where an awful lot of what happens in the Emergency room is not impacting the long term health of patients. We know that our personal behavior and the social determinants of health (SDoH) (such as gender, marriage and other consumer attributes) are not only important to health but actually are the major components of differential health outcomes and by most estimates contribute 60-80%. I make this point frequently in my presentations:

In a recurring theme on the show – the incremental insight that got him here happened when he was attending business school where he met his co-founder Kurt Waltenbaugh where they were discussing the data missing to manage patients better. As he puts it

if I knew details of what you were buying in the supermarket I could predict you HB1Ac before you even enter my clinical office

Once again – the adjacent possible discussion was the foundation for the company as they realized together that they could gather the missing data from other sources especially retail and help answer those questions.

Listen in to hear our discussion on their insights into Diabetes – a chronic disease affecting 10% of the population (that’s 30 Million people in the US) and a whole lot more that are are pre-diabetic. Hear about the two groups of patients and the correlation between the how much you travel and the success or failure of your diabetes management. Hear how pet ownership and your civic responsibility are also linked and find out which car you drive is linked to your success in managing diabetes. We talk about marriage and its effects on health offering some new and more granular insights into the benefits of marriage – the results will surprise you

You can read more about this insight here


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

Consumer Level Insights to Healthcare was originally published on Dr Nick – The Incrementalist