Saturday, March 28, 2009

Men Less Powerful in the Boardroom and Bedroom?

Tune up your violins and bring on the ratchet rhapsody. Recessions not only hit the bank account; they affect martial and domestic relationships too!

I recently read an article in the New York Times that reported more men are losing their jobs than women; over 80% of job losses due to economic recession are affecting men.

For the first time in American history, women may soon surpass men when it comes to payroll. That is big news! Reasons for this may be that the jobs being lost are in the hardest hit areas like construction, held primarily by men. Women tend to hold jobs in more recession secure areas such as health care. One drawback is that women’s salaries have traditionally been seen as supplemental income. Women still only make 80 cents on the dollar compared to men, and often hold less financially rewarded jobs with little or no benefits.

Traditional gender roles are in for some fast moving and turbulent changes! We’ve come a long way from the era when homemaker Mom made dinner in the kitchen every night while breadwinner Dad relaxed over a martini, but there are more changes on the horizon. The division of domestic labor will swing more toward men picking up the slack as disposable income used for take-out and housekeeping services dry up. It stands to reason that marital relationships are bound for significant changes as well.

How we go about embracing these changes will play a major part in our long-term happiness. This shift will translate into the household and even into the bedroom. Men may struggle with feeling displaced or inadequate and may have a hard time coping. Women may struggle with the fear and pressure of survival on only one income. How do you support each other through these trying times?

Men, who are traditionally less likely to seek behavioral health services, will be in need of new forms of support to help deal with these changes. See how some brave men are tackling this head on in a brief CNN Video.

How is the recession and changing roles affecting you and your relationship? Comments and discussion are always welcome.

Wednesday, March 25, 2009

What Will it Take for "Online Health" to Work?

"Internet 2.0" emphasizes social networking over simply downloading and reading "content". The world of Twitter, blogging, facebook, e mail, and text messaging is revolutioning our society and rapidly becoming a major force in the way we work and play. It remains to be seen, however, how it will impact health care. There are many, many issues that are no where near resolution.

Although, at eDoc, we have been involved in online health for over a decade, we still run up against innumerable barriers and resistance factors that prevent this modality from truly becoming mainstream.

In order for this to occur, I believe the following needs to happen:

1. The team providing the service must be of high quality. This is difficult to determine in the best of circumstances and almost impossible in the often murky, even sleazy, world of internet
2.0. Until there is a better system for this, the user must be careful to scrutinize the credentials of the professionals involved and understand the business model behind the product. Check to make sure that the physicians are board certified. Beware of industry supported sites that are, essentially, using their web site to sell another product and "giving away" medical content or advice. If possible, find someone else who has used the service and ask whether the service is reputable. If you decide to try the service, dip your foot in the water and assess the quality of what you get back. If you like what you get, try again. If not, run in the other direction!

2. There has to be a widely available method for professional reimbursement. At eDoc, we developed a business model in which sponsoring corporations purchase the service on behalf of their employees or members. Most insurance companies do not cover on line visits with a physician but this is likely to be the case in the future; and, until that occurs, most docs won't or can't afford to, get on line to provide feedback or information to their patients.

3. Better tools are needeed. Although there are a lot of good web sites with good medical content, web tools are just starting to be designed to take advantage of the Web 2.0 world. Good, user-friendly, secure patient and provider portals will need to be connected to eprescribing hubs, will need to readily switch to search for internet sites to attach, will need to accept and view video footage, will need capability to connect through digital cameras for real time viewing and communication, and need easy to use, menu driven drop downs that guide the patient and provider through an online encounter.

For now, eDoc has a high quality team that uses a free form communication model and offers medical, dental, pharmaceutical and mental health professional advice. We are watching with eager anticipation to see what the future brings and, hopefully, we can stay ahead of the curve and continue to offer the highest quality online heath professional experience.

Your comments and dissenting opinions are welcome...

Tuesday, March 10, 2009

Helping Patients Partner with Docs for Better Health

Don't get me wrong, I'm 100% for patients taking responsibility for their own health care and helping them do it. There is a lot being written nowadays about patient empowerment, patient's using the internet to do their own health care research, and promotions for systems like ours which encourage on line communication with medical professionals.

I've recently been talking with patient advocates who rightly articulate the failiings of the medical system in helping patients better manage their own health. And, to be sure, there are forces at work that make it difficult for the patient who wants to be more active, ask questions, and "be in charge" of their own health care.

But there is another side to the story. As a physician in practice for many years, there just simply aren't many patients yet who know what this picture looks like, and many others who simply don't want to, or are unable to, do it.

Realistically, in order to "take charge" of one's own health, one needs to be educated, internet savvy, have good communication skills and a high level of focus and determination. That defines about 5% or less of my patient population. The others seem either to desire or require a more paternalistic caregiving approach. But, maybe its just a blind spot in me!

Clearly, we can continue to advocate for this, and can work to make it easier for more patients to do it. But, in the meantime, patient empowerment and self management will continue to be a movement that tiptoes around the fringes of medicine.

Among other things, we need a national network of physicians who are able to communicate online with their patients and be reimbursed for that so that the patient can do some of their own research and check back for guidance and direction from time to time without having to wade through the morass of office visits each time they need to discuss or verify a medical issue with their doctor.

Your comments and dissenting opinions are always welcome.

Friday, March 6, 2009

Choice of Diet Does Matter

A recent article in the Journal of the American Medical Association (JAMA) reported that all diets that reduce calories work equally well. Of course that is true. Reduce calories, lose weight. The article suggested that it does not really matter whether you choose to lower your carbohydrates, your fat or whatever, just so you reduce your calories consistently over time. Like most large studies of weight loss, the overall results are disappointing in that most people do not stay with weight loss diets and the average weight loss is modest. That is because the people not staying with their diets dilute out those who lose a lot of weight.

What these studies miss is what your experience is with different diet approaches. How do thay affect your overall health? In my previous Blogs here, I have emphasized the importance of reducing simple carbohydrates, like sodas and sweets, since they drive hunger. It is very hard, probably impossible, to stay on a diet program if you are always hungry. Good protein sources, whether from dairy, lean meats, fish, nuts and vegetables, suppress hunger by causing your blood sugar to rise more slowly and remain more steady throughout the day. The rise and fall in blood sugar impacts your hunger. Finally, saturated fats are not good for your health and should be avoided in any healthy diet.

So, what you eat does matter. Your choice of foods will impact your hunger and affect how many calories you are likely to eat in a day. Your food choices affect more than your weight, but also your cholesterol and other risk factors for heart disease. When choosing a diet program for weight loss, make a healthy choice and choose a program that you can stay on for life. Afterall, weight control is a lifelong pursuit. You can vary your protein sources depending on your food preferences, and focus on healthy fats like vegetable oils and avoid the unhealthy satureated fats from things like hamburgers and french fries. Choose a diet program that works for you throughout the day and results in your not eating any more calories than you want to either to lose weight or maintain a healthy weight.

And remember, be physically active to burn those calories so you are more likely to lose unwanted weight.