Monday, February 13, 2017

Finding Dr. Right

(Sneaking in a post or two today before another lengthy hiatus)                  

When good ankles meet bad mosquitoes.  
My ankle doesn’t hurt today.  I even ran on it—not very long but who’s counting—and it didn’t hurt.  That’s how ankles should be but my left ankle (lankle) has hurt off and on since last May.  I tried to rest it and did exercises the Internet suggested to build strength.  Yet there were increasingly more nights when I’d wake up to feel it throbbing.  Finally, after seven months—that’s six months after the Internet said I should see a doctor—I saw a doctor.  She examined it, suggested exercises different from what I’d been doing, and lankle has been improving ever since. 

I felt dumb that lankle languished for so long when its fixes were so simple.  But I dragged my feet to see a doctor because I didn't have one set up.  I moved to Indianapolis last October and began the process of building a social world from scratch.  By my first weekend, I had a go-to bakery.  Finding a doctor, like finding friends and a soulmate, was much harder.  

As a health services researcher, I know the importance of having a ‘usual source of care’—a doctor I know who I can go to when things go wrong.  I have even uttered those words in a radio interview*.  Yet I actually hadn’t had a go-to doctor in almost ten years.  Just as millennials** are forgoing relationships for hookups, I didn’t see a need for a primary care physician so long as I kept up with my preventive care like vaccines and screenings.  Finding a doctor seemed like too much work; I just used student health services as needed.  But I was no longer a student (finally).  And with all my friends getting married and starting families, it was time to settle down with a doctor.

I was lucky not to start completely blind.  In fact, how to help patients find doctors was a conversation I’d had many times with my mentor Albert at Hopkins.  I knew the best first step was to first ask around.  Still, the whole process felt daunting and a little embarrassing.  Just as I often felt like the only single person in Indianapolis, it felt like everyone else already had their doctors.  It didn't help that I knew very few people in Indianapolis.  A colleague suggested I try a different type of word of mouth— the Indianapolis Monthly’s “Top Doctors List.”  The magazine rankings opened up a broader pool for me and lent some degree of validity.  Unfortunately, top doctors tended to be very popular and most were not taking new patients. 

Exasperated, I tried my insurance company's “Find a Doctor” tool.  It allowed me to filter my search by physicians taking on new patients.  Like OKCupid, it was free and online.  It was also clunky and overwhelmed me with too many options.  I wasn’t sure how to distinguish one name from another.  Finally, I realized I needed to set parameters to make the search sane.  Your parameters may be different than mine.  Asking around helped me establish what was important: distance, physician sex, age, and communication style.  I wanted clinics closest to either my apartment or office to make going to the doctor as easy as possible.  As a researcher, having a younger doctor was important because research suggests that younger, female doctors tend to be more up to date on evidence practice guidelines.  I also wanted a doctor who was comfortable with electronic communication (being a millennial and all).  Finally, a younger doctor meant someone I could possible "grow old with" and not leave me for retirement in a few years.

Of course, through all this, I also googled.  It was hard to find any meaningful information through googling.  I knew from prior research that very few physicians have reviews, and that reviews tell incomplete pictures, yet they were still my best estimates of what other patients think of these doctors and I wanted a nice one.  Despite all of this research, a large part of the experience still came down to luck and time.  I controlled what I could, but ultimately needed to take the plunge to actually see my doctor.  It wasn't always fun but in the end, finding Dr. Right was a decision and a gamble-- one that paid off and took away my pain.  Now that I’ve done this once with relative success, I won’t wait as long to see a doctor next time.

If you're ever in need, resources to consider when you look for a doctor:
  • Friends and family
  • Other trusted source
  • Yelp and other review sites, but only to a point. Know that most physicians don’t have many reviews and reviewers are very subjective. I like sites with text reviews, like Yelp and Vitals, over ones that are just stars, because they tell you how people came to their conclusions.Know what you need/want:            
Know what you want.  Consider asking:
  • Do you want an older or younger doctor? What matters to you?
  • How easy is it to see this doctor? Is that something that you care about? Do you prefer a large or small practice?
  • How do you want the doctor to communicate with you? How does this doctor respond to your questions?
*This was a humble brag.  Sometimes I worry I’m too subtle about my achievements.
**By some generous definitions, I count as a millennial.  Really.  I do.  

Monday, November 10, 2014

When We Tweet About Health

A few weeks ago, I discovered that not one, but two colleagues in my PhD program— people I previously held in high esteem, had no idea who Amal Alamuddin Clooney was.  I did not think it was possible to not know.  But, like many things in life, whether or not you know who Amal Alamuddin Clooney is and every outfit she wore over her wedding weekend in Venice depends greatly on where you get your information (for Dan and Ilene, that would be the smooth underside of a rock). 
Where we get our health information is not just a matter of self-improvement, but one of public health.  One only needs to look at the current Ebola outbreak to see the importance of accurate and trustworthy sources of information.  As more and more of our conversations and news-seeking occur online, it’s important to understand who is talking about health online and what they’re saying.  With that in mind, I teamed up with a few colleagues* to examine health conversations occurring on Twitter.  Our results were published last month (synergy!).  We especially wanted to know the types of things people tweeted about (like whether it was evidence-based, personal, or commercial), and whether different types of users (like doctors versus patients) tweeted about different things.
Word cloud of health-related tweets in our analysis (Lee 2014).
Yes, Readers, qualitative research is every bit as sexy as it sounds.  We systematically gathered a pile of tweets and categorized each one.  We found a diverse array of health-related user groups posting about a wide range of health topics.  For example, while organizations and businesses use Twitter to promote their services and products, patient advocates are using this tool to share their personal experiences with health.  Most health tweets were claims that users would expect to be supported by some level of medical evidence or shared news, though whether these claims were actually scientifically valid was not examined. 
While our study may not save lives "millions at a time", it is among the first to capture, in depth and breadth, what users are tweeting about health.  It points to the diverse activity on Twitter and the need for helping users, especially patients, make sense of the health tweets out there, by medical professionals, you, me, and even Amal Alamuddin Clooney**.  Knowing about our information sources enables us to know what to do with their information. 


*Colleague is too inadequate a term.  I worked with four wonderful mentors who generously welcomed me and patiently guided me through the whole process. 

**Not actually on Twitter (but I am!  Follow: @superlegitJoy)

Monday, August 11, 2014

Implications Done Right

Clean water source. Hygiene. Ebola containment.  These public health priorities and crises often seem like issues that only matter for developing countries.  Indeed, the CDC and other authorities have issued ample assurances that given the quality of our healthcare system and our very different cultural practices, the risk of an ebola outbreak in the US is very low.  That doesn't mean that we've learned our lessons.

As Aaron E. Carroll of the New York Times points out in an excellent article, Guinea worms (and ebola) aside, we are still battling issues of clean water, hygiene, and quarantine in the US.  And we pay for not learning such lessons with illnesses, deaths, and high costs.  As he writes:

The Centers for Disease Control and Prevention estimates that 48 million Americans become ill from food-borne illnesses each year. More than 125,000 hospitalizations are caused by food-borne illness, and about 3,000 deaths. Many, if not most, of these illnesses could be prevented if people properly stored, cleaned, cooked and refrigerated their food correctly. 
Between 1976 and 2007, deaths from influenza ranged from 3,000 to 49,000 a year. The vast majority of deaths from influenza occur in people who are 65 years of age or older. Proper hygiene and staying home during the infectious stage of the illness are still mainstays of flu care. But we also have a vaccine for this illness. Too few people get it. It’s estimated that two years ago, if we had just gotten the influenza vaccination rate up to 70 percent, up from the 45 percent we achieved, we could have prevented an additional 4.4 million illnesses and 30,000 hospitalizations.

Carroll connects global health crises with your health and deftly demonstrates the importance of persuasive communication as well as practicing what we preach.  We know what the answers are and we need to be compelled into putting them into practice.  Lives and dollars are at stake.

Thursday, July 3, 2014

That Movie Magic

In the late 1980s, the term “designated driver” began popping up all over pop culture.  The bar in Cheers had a poster and on L.A. Law, Harry Hamlin asked a bartender to call his designated driver.  This was the work of Dr. Jay Winsten of the Harvard Alcohol Project.  Using movie magic for good, he asked Hollywood studios and TV networks to spread the word on designated drivers.  The point wasn’t to change behavior over night but to bring the idea into public consciousness and shape social norms. 

As someone who grew up in the 1980s, I can attest to the success of the campaign.  What was new back then is now a given among my friends today.  As someone who has never owned a car (or a suit— despite my age, I’m barely a grown up), I have ridden shotgun countless times while generous friends drove.  Consequently, I’ve gotten to observe the driving patterns of many conscientious, risk-averse, public-health minded friends— who always buckle up, would never drive drunk, and would otherwise never put our lives at risk.  That is, except for one thing: futzing with the damn smartphone (aka “distracted driving). 


We’ve read the risks.  Signed Oprah’s pledge like Sandra Bullock.  And cried through super sad PSAs.  Yet we stubbornly assume that we are safer, smarter, and luckier drivers than others and whip out phones to send messages, find that one song, and check Facebook when we think traffic is slow. Many states are enacting distracted driving laws to deter phone use, though the policies haven’t stopped many of us.  We need Winsten's movie magic to change social norms.  He is working on replicating his campaign with distracted driving.  Until it becomes widespread though, I offer 3 personal tips to reduce distracted driving:
  •  “Look, Ma, No Hands!”  Bossing someone around is more fun anyway.  Take advantage of bluetooth technology (or even Siri) to make calls and navigate via verbal cues rather than fumble with the phone.
  •  Cede/Commandeer Control.  As a driver, let whoever rides shotty co-pilot.  As a rider, I offer my phone and navigation skillz so the driver can focus on well, driving. 
  •  I Don’t Want To Die Today. As a rider, when I feel particularly uncomfortable with how much a driver is looking down on the phone, I shout “Eyes on the prize!” or other variants.  It’s usually funny enough that I don’t get kicked out immediately, yet alerts the driver to the issue.
Unlike Winsten’s campaign, my suggestions are not quite public health. They are one-on-one interventions whose successes I have personally witnessed.  But until policy initiatives catch up, I hope you’ll give these a try.

Sunday, May 18, 2014

Talking Sh*t About Safety... Done Right

My apologies- this blog is overdue for a resurrection.  My best explanation for this seven-month-and-counting break is that I'm not very good at preparing a dissertation proposal and maintaining a blog at the same time.  It's lame but true.  I promise we'll mount a comeback soon and in the meantime, let me share this with you: absurd, observation comedy about injury prevention, preventive medicine, and medical research.  It's everything I love, it's everything I know you'll love, and more.

Monday, October 14, 2013

Safety Done Pretty Well



(Special thanks to Sarah Riddle for bringing this to my attention.)

Like many in Boston, when I lived in that fair city, I had a love/hate relationship with the public transit system-- the Massachusetts Bay Transit Authority, or MBTA.  The heat lamps by the Silver Line bus shelters?  A nice touch.  The fact that Green Line doors get stuck and passengers are asked to move to the left side of the train to offset the weight?  Absurd in 2013.  So I was heartened to see this solid effort from the MBTA on transit safety and "distracted riding."  I love it when Boston displays Good Public Health.

Admittedly, the dancing is pretty awful.  The song could be better.  And I'm not certain what exactly the safety bounce entails.  This is no Dumb Ways to Die.  But the video raises the issue of rider safety and invites the public in with a goofy song.  And given Boston's high transit ridership (5th in the country), I liked that the video incorporated 3 languages and at least tried to incorporate faces reflective of Boston's demographics.

If you're taking notes, MBTA.  Here are some other videos to work on: accessibility, noise pollution (cough, Boylston Street station), and sanitation.

Monday, September 30, 2013

ObamaCare Done Right



The Affordable Care Act made funny, clear, and Olivia-Pope-y.  This is how you explain things.