Nurses’ week profile from OptumCare Clinician Insights

This past month the great people I work with at client Optum, interviewing subject matter experts and writing content for their Clinician Insights website, gave a great push to acknowledge nurses’ week. Together we went from concept to published article in under a month. Considering that the process is for a corporate client with markets blanketing the entire United States, this is feat to be proud of!

Please check out the results: a profile of the career Registered Nurse Debra Lietz, working in a WellMed clinic in Texas Hill Country. Talking with her about her work made me half want to be her and half want to be her patient. What a proud tradition, this nursing thing. Happy nurses’ week!

Debra Lietz: Nurse profile on OptumCare Clinican Insights

How to turn that blog into your content marketing strategy! (Melissa liveblogging from AMWA)

Some people will sign up for an aspirational marathon, hoping that this act will give them the discipline they need to get out and train so they don’t die (of humiliation of rhabdomyolisis) on race day.

I have a habit of signing up for public speaking gigs that are a bit over my head, hoping that I will have the discipline to cultivate an expertise and create a presentation solid enough that I don’t die of being stoned to death by my colleagues as an impostor.

Today is race day, people!

I am currently presenting on blogging as a content marketing strategy for medical writers at the American Medical Writers Association Mid-Atlantic Conference. Here is my AMWA blog presentation. This is intended to be part instructional manual but mostly a conversation vehicle, so if you are using it for learning and feel there is a gap, send me an email and I will be delighted to fill you in!

Wish me luck and to remember all my passwords, people.

Surgery: what are you consenting to?

In the hospital recovery room, receiving patients from the OR goes like this: sometimes you have the chance to review their medical record between the time you are assigned and when they arrive. Sometimes (like when they are coming through the doors and someone calls your name), you don’t. A body shaped lump of warm white blankets wheels up in front of you. A few inches of face may be visible between linens and blue surgical cap may be visible. Make sure they’re breathing, O2 is good, responsive.

Report is given on the go, so you’ll only learn about what the surgery was, and how it went. Any health conditions directly related to the surgery. Age, sex, and allergies and you’re on your own.

The mystery burrito of hospital blankets starts to stir,  Holler, “You’re all done Mr. Smith, you did great!” The person on the other side of the anesthesia starts to reveal themselves.

I’m a nurse ’cause I love people surprises. Post-colonoscopy sass-mouthed grandmothers. Sweet big bubbas with gallstones who can’t stop giving sugar to the wife. Toddlers that wail and leak fat tears on the shoulders of their parents, sounding like an ambulance getting farther away as they head out to return to familiar cribs.

Truly, there is only one patient that I hate to see. And it’s the system of more care, not the actual patient that drives me nuts. The healthy 90-year-old hip replacement. Not because I don’t believe there are robust 90 year olds who, with new hips, could maintain their activities in much less pain.

Rather, I have seen too many come in great health but for the hip. And after surgery and anesthesia, kick up an atrial fibrillation/SVT that will land them in the ICU short term and sentence them to powerful medication for life, more surgical intervention, and put them at risk for death in at least 4 ways. We’ve fixed your mobility issue and given you a lethal arrhythmia. Being elderly is a risk factor, even when you come in healthy.

First, the problem: health economists are working their butts of to explain why we pay so much and get so little improvement in overall health measures in America. Austin Frakt, in his NYT article elaborates the argument of it’s the prices, stupid. We pay more per service because our country does not price control and regulate as aggressively as other top-of-the-heap nations. But then in through the comments section comes the argument by a data wonk with a blog who says that our prices are in line with the inflation and wealth, and it is the quantity, stupid, of care that’s out of control.

In this academic fight it’s safe to bet there is truth in both arguments. As a patient I don’t think $800 is a reasonable price for a urine dipstick test. As a bedside caregiver, the number of unnecessary and unhelpful procedures I’ve witnessed make me an unhappy nurse, patient advocate, and taxpayer.

The article that came out through Kaiser Health News this week investigates how an 87 year old patient with a DNR and no desire for a shock to the heart ended up with a internal defibrillator (to the tune of $60,000 Medicare dollars). As a cosigner on surgical consent forms, I totally get how it happened. Patients are able to say the words that describe their procedure (“fix my heart beat”) but often have not been educated in global implications. Outside of surgical site infections they may not know what they’re potentially signing up for.

I’ve excerpted my favorite parts of the article, but it’s gold all the way through. This is a corner of health care we must address to lower costs and improve the lives of our patients.

Nearly 1 in 3 Medicare patients undergo an operation in their final year of life.

Educational toolkit for joint replacement, sounds like a plan:
After Kaiser Permanente Washington introduced the tools relating to joint replacement, the number of patients choosing to have hip replacement surgery fell 26 percent, while knee replacements declined 38 percent, according to a study in Health Affairs. (Kaiser Permanente is not affiliated with Kaiser Health News, which is an editorially independent program of the Kaiser Family Foundation.)

Stories are more engaging teaching tools than statistics. Plug: I am for hire to research and write the stories needed to do better patient education:
In a paper published last year in JAMA Surgery and the Journal of Pain and Symptom Management, Schwarze, Kruser and colleagues suggested creating narratives to illustrate surgical risks, rather than relying on statistics.

Instead of telling patients that surgery carries a 20 percent risk of stroke, for example, doctors should lay out the best, worst and most likely outcomes.

Source: Never Too Late To Operate? Surgery Near End Of Life Is Common, Costly | Kaiser Health News

Fun with writing: OptumCare Clinician Insights

Some years ago I was catching up with an old friend who has a prominent position at a managed care company. Intimating that I might want her to help me get a new job, she offered “sure, if you’re okay with coming to the dark side.” My answer? There is no dark side. In health care, every side has shown me good actors and bad. Pharma cures cancer, pharma robs us blind. Managed care denies our claims, managed care is the only thing holding the health system responsible for best practices. Nurses and doctors are angels, nurses and doctors are HOLDING ME PRISONER! (That last one is a direct patient quote).

Here’s the lesson: there are a lot of people spending their waking hours trying to make health care better and more accessible. Far more than the opposite. Since August I’ve been interviewing medical directors and working with people at OptumCare to develop a site called Clinician Insights where some of the best ideas under their large and growing umbrella can be shared. It’s been an absolute pleasure. Eye-opening and heartening to hear about the amount of good, science based, proven effective hard work these doctors and their teams undertake to improve the health care world for their patients.

In partnership with OptumCare providers, this resource library was designed to share insights, best practices, research and much more. The site went live in January and is in the building up phase. I’m proud to get to pick the brains of these leaders and write the articles that share their work.

Source: OptumCare Clinician Insights

Five painless ways to network and market your business (even if you’re a certified introvert)

Writers and scientists are not known for their outgoing natures. Personally, I have been criticized for my habit of bringing books to parties. Having these characteristics, I find the self-employed person’s mandate to “SELL YOURSELF!” a challenge. Fortunately, in the business of writing most work is found through networking, and with a small amount of effort even the book-carrying partygoers among us can build strong networks and grow stable, successful businesses.

When I’m closing out my writing day and I’ve yet to attempt any marketing or networking tasks, I look to achieve at least one of five small daily goals. Ultimately, these efforts are bite-sized enough for me to stomach even on my most introverted of days, and as weeks turn into months they add up to a respectable online presence and foundational marketing tool for a growing company:

  • Reach out to a pro in your field. This is easier than it sounds. A simple LinkedIn search with keyword specific to your field, you’ll likely find someone doing similar work who is farther along in the development of their business. In my experience people are remarkably helpful when asked a concrete question in a gracious manner.
  • Write a thank you note to a client or mentor. Some nice stationary is a treat to have, and handwritten words will make you memorable.
  • Post an article: either on a personal blog that posts to social media channels or LinkedIn, this will make you more visible to connections. Certainly there are days when you don’t have the juice to come up with original material. But, as we all are constantly reading in our research, keep future posts in mind and bookmark a timely or interesting article that your followers might appreciate. Add you 100-word personal take and re-post. You’ve added personal content and done the favor of passing on a piece of interest.
  • Make a new connection: Once you’ve got a presentable LinkedIn profile, the sky is the limit on who you can connect with—as long as, as “The Mighty Marketer” Lori de Milto advises, you personalize your LinkedIn connection requests. I have connected with professional heroes by adding in a true and complimentary detail such as “I read your book in nursing school. You describe bedside nurse life so well. I made my husband read it so he understands me after a hard shift. Thank you.”
  • Comment on the work of others: You’ve probably read the work of a peer in your daily research or perusing of the internet. If you have an opinion, or even better a reference to another article that adds to the discourse, jump in the pool and leave a comment.

One of these a day and you’ll be well on your way to a robust network gleaning insights into the health and medical writing business and finding new clients.

Writing as patient care

I remember a rough day, one of my last days in the hospital. I had a patient immobilized from the waist down and fresh out of surgery who could. Not. Stop. Peeing. In her amnesiac withdrawal from anesthesia, she was rapidly cycling through refusing to use a bedpan and demanding a bedpan. It was madness. An hour of back-wrenching linen changes and getting yelled at.

I can not tell you now how much I miss even those days. As a complete digression, I am made crazy by the challenges faced by nurses (and all clinicians) on the hospital floor, how it is everything but the patients that drives us mad. How many of us are forced to choose between the career we worked to hard for, our calling, and our own health and family. The American Journal of Nursing addresses the concern.

But hospital or no, I observe and I care and I’ll never not be a nurse.

Today I spent a minute in the Sylvia Plath exhibit at the National Portrait Gallery. Visiting with my son for a family event I just happened to pass the small room of framed letters and photos. I dragged him in, promised a treat if he’d chill for just 5 minutes, and let him tap sounds out of the installation of bell jars while I read.

In her letter, pinned just below a smiling photograph of Plath taken 6 months prior with her two very young children, I saw the lines that made it clear why a week from that day she would be dead by suicide.

She was getting over a terrible flu. After much distress, she had left her husband with babies in tow. Fled the comfort of their country home to a flat in London. It was the first week of godforsaken February. The longest, darkest, depressionest month.

February 4, 1963
“Everything has blown and bubbled and warped and split—accentuated by the light and heat suddenly going off for hours at unannounced intervals, frozen pipes, people getting drinking water in buckets and such stuff–that I am in a limbo between the old world and the very uncertain and rather grim new.”

So here is where writing can be patient care. Always be assessing, always be educating. You can do it with a dead mid-century poet if it makes a piece of writing.

Plath is in a volatile state, the responsibilities of motherhood on her shoulders, just separated from the comfort and support of friends and familiar places. The pipe freezing signals her loss of control. Her limbo between old and uncertain and grim? An expression of hopelessness.

It’s no revelation that Sylvia Plath was depressed a few days before her suicide. But by seeing her as not an hysterical artist inclined to shuffle off this mortal coil at a moment’s notice, and instead as a person, mother, a sufferer of a common condition, she is a

I recognize her words as if they were my own read back to me. Because they were my own, not long ago. The remark “I long to have somebody really play with and love the babies…They are so beautiful and dear and will in effect have no father.” This kind of loneliness, where you seek for someone to share love for your precious child, is crushing. And in the worst of depression: losing the ability to play with you babies, lacking energy, lacking interest. Having failed to mother, life’s most important task, why keep fighting? For me, someone noticed. And they got me help.

Hearing words like those of Sylvia Plath in her last days come from the mouths of friends and family should spur action. Recognize a mental health crisis. Help us take care of each other better. Be there at the bedside.

And as a writer, considering anyone who reads this my beloved patient, now you know. I’ve told a story that educates you. Listen for that tenor of in the speech of the people you care about. And to recognize it in yourself. Like a good nurse, assess, then act.

Also, why isn’t February Mental Health Awareness month? It is rough out there, folks. Take care of each other.

Site changes and how a freelancer lives!

Note: I did do a conference call. It’s not all Jenga and mac and cheese.

How The Shutdown Might Affect Your Health | Kaiser Health News

IN SHORT: CDC is the hub for all infectious disease activity in the United States. Every positive flu test goes to those great women and gents, and they generate the data to color the maps that inform the public and help health departments and hospitals and pharmaceutical companies shift around the resources needed to care for sick people in hard-hit areas. THAT SERVICE HAS BEEN SUSPENDED.

Not to mention god forbid a batch of spinach has salmonella smeared on it or the drinking water in some former steel town is poison. CDC epidemiologists are the people that turn random cases into public health guidance.

Reliable governance is priceless, for individual and population health and the well being of business and commerce. I’m voting for consistency.

Source: How The Shutdown Might Affect Your Health | Kaiser Health News

Why It’s Still Worth Getting a Flu Shot – The New York Times

If I wrote the book on public health I would insist on a subtitle. Here’s how it would read:

Public Health: IT’S NOT ABOUT YOU

I’m punting to the expertise of Aaron Carroll and his timely Upshot article this week. I myself, a yearly getter of the flu shot, have the flu. AND I WOULD GET THAT FLU SHOT AGAIN. Because, of course, it is not about me. And sure the flu I have is possibly less virulent than it could have been and I haven’t needed to tap the resources of any health care facility so my only cost has been reduced personal productivity (I’ve met writing deadlines but my apartment is disgusting and hair is dry shampoo). But even assuming that my flu shot did nothing to make my personal experience of flu season better, I’d still get one.

First, a statistical concept used to evaluate the efficacy of an intervention or treatment: N.N.T. or number needed to treat. Surgery is the easiest example to cite to explain it. In an appendectomy, N.N.T. is always 1. One surgery, 1 removed appendix. Unless something really weird is going on.

If everyone that got the flu shot was guaranteed to not contract the flu, then flu shot N.N.T. would be 1. One shot equals one protected patient. But the flu shot was never planned as a N.N.T.=1 type of disease prevention. The flu is too wily, too quick to mutate. Flu shots are here to reduce the disease burden in our overall population. Less infections mean less contagion, lower overall cases mean demand on public health resources is manageable, people that do get sick have better access to the care they need, and ultimately less morbidity and mortality (illness and death) result.

According to Dr. Carroll’s article, this year the flu shot’s N.N.T. is 77. For every 77 people that get the flu shot, 1 will avoid what would have been an flu infection. Considering the cost of the flu vaccine (literally zero dollars if you have any sort of insurance which legally ethically and morally you should but that is another conversation) is five minutes at CVS plus mild soreness for a day…I like to imagine my group of 77 responsible flu shot getting citizens saved a baby this flu season. Maybe that 2 week old baby I saw at the thrift store last month and wanted to scream “FOR ALL THAT IS GOOD AND HOLY GET THAT CHILD OUT OF THIS HUMAN VIRUS SOUP.”

So there’s the lesson for the day. But read The Upshot, Dr. Carroll tells it in true doctor-professor speak, and continues to explain the important role of cost/benefit in the vaccine:

Let’s say that this year’s flu vaccine is even worse than we think. Maybe the absolute risk reduction will be as low as 1 percentage point, making the N.N.T. 100. That’s still not that bad. Even at an N.N.T. of 100, for every 100 people who get a flu shot, one fewer will get the flu. That’s a pretty low N.N.T. compared with many other treatments that health experts recommend every day.

Stories patients tell

I’ve been writing full-time for three months now. Being off the hospital floor has done wonders for my aching back, my parenting, my complexion…and I won’t lie I’m not sorry about missing a horrendous flu season. But I miss patient care. Taking care of strangers was a privilege. And the antidote for the morning news. Bigoted, hateful things lose power after a half dozen conversations with the typical rainbow cast of normal humans at your local public hospital.

I miss it today. Here’s a post I found in languishing in my drafts folder. An attempt to capture what I loved about patient care.

My reasons for being a nurse are selfish. I love stories. Taking care of humans for a living was my passport into every socioeconomic, ethnic, racial, psychological, pharmacological kind of humanity. The wildest thing is that everyone thinks their story is the normal one.

A patient might present with humor. Maybe stoicism. Open tenderness for their spouse. They give me stories that show how brave, how smart, how kind, how resilient they are. Or they may present with impaired coping: venom between parents and children. Complete submission to despair. The desire to mete out as much pain as they have been given.

The way people handle crisis of health: physical pain, just plain bad news, never ceases to amaze. An appetite for what people have to say for themselves is what makes me love being a nurse. And hate it.

Sometimes the stories are whispered. Yelled. Told in profane or racist or sexually suggestive language. Sometimes the story is just a kiss between people who have long since celebrated their 30th anniversary. Divorced spouses who sit him beside her as she’s dying. An elderly woman whose power of attorney is a neighbor that takes three days to locate and another to drop by and sign a DNR. A grandpa whose eighteen grandchildren from six different states come stream in. His hypertension abates when they stand around sharing details of their days. Another patient who becomes hypertensive when her mother is in the room.

People sing hymns. People fight with the priest. A retired four-star general occupies the room next to a man living in government housing. Everyone engulfed by their own narrative, healing or getting sicker, thinking they are the normal one. Feeling like this is the first time anything so scary or tragic or miraculous has ever come to pass.

It’s little me, the nurse, that gets to know all these stories. I still pass like a specter through them, over the borders of these private worlds, from room to room.