Sunday, June 9, 2013

What is a Vacation Anyway?

What is your idea of a vacation? 

Most consider it to be a week or two (or more) of kicking back in the pool or on the beach.  My wife, Connie, and I returned today from a week in our house in Fayetteville, AR.  Our idea of a relaxing week away from the grind of everyday life may strike you a bit differently than the traditional vacation.  We enjoy our own version of a week of fitness "boot camp".  Well, it may not be THAT intense, but it certainly is active.  We wake up early, eat breakfast and walk for 2 1/2 hours, with our Golden Doodle "Dolly" in tow.  This usually includes a cinnamon roll break at the Little Bread Company, one of the coolest little places you have ever seen and, currently, rated the # 1 eating establishment in Fayetteville.  It is essentially a hippie joint where the employees all seem happy and the ambience of the place puts you in a great mood.  On our way back to our house, Dolly terrorizes 3 or 4 squirrels in the center of the U of A campus. 

Before lunch, we load a yoga video for 20 to 30 minutes before replenishing for the afternoon.  These are devoted to biking on our tandem.  Fayetteville, courtesy of the Waltons, is almost finished with a dedicated walking/biking path from Fayetteville to Bella Vista, AR, a distance of about 35 miles. It is called the Razorback Greenway. Since it not yet quite finished, we spent most days doing about a 25 mile loop from Lake Fayetteville to south of town but, one of the days, we drove to Spingdale to take in the northernmost aspect of the Greenway through Bentonville and the Crystal Bridges grounds to Bella Vista, AR and back.

As a side note, we were there during the annual Wal Mart associate/shareholder meetings and the scene is interesting, to say the least.  There are Wal Mart workers from all over the world there, hosted in student dorms and transported around campus by golf carts and buses.  While I was in Sam's buying a TV, one came up and asked me if I needed help (I did).  I asked him a question he couldn't answer and then I realized he was a Wal Mart associate visiting from South Africa.  The event was hosted by Hugh Jackman and featured concerts by Elton John and Jennifer Hudson.  Interesting company, Wal Mart!

About mid week, we decided it was time to take in Crystal Bridges in Bentonville, founded by Sam Walton's daughter, Alice, and regarded as one of the premier art collections in the world.  To say it is impressive would be a gross understatement.  We are not aficianados but it was very nice and well worth the afternoon we spent seeing it.

Evenings were time to dine out and Fayetteville has diverse, excellent cuisine from Taste of Thai (our favorite) to Celi's Mexican and, the last night Theo's with great salads, wine and Filet Mignon.  We had early dinners, so we would have time for wine and music (courtesy of Pandora) on our deck at home.  A little TV, then to bed and do it again tomorrow.

We came back a little tired and sore, but very relaxed, refreshed and ready to resume "normal life" tommorow. 

Does that sound like a vacation to you?  It certainly does to us!

Sunday, June 2, 2013

The Scope of Participatory Medicine--Does it really include Everyone?

Several of my colleagues recently joined me in writing a new chapter to add the White Paper: "E-Patients.  Can they help us heal Health Care?.  This chapter was recently published in the on line Journal of Participatory Medicine, titled "A Model for the Future of Health Care".  The paper describes a health care system where patients and providers participate as partners, with patients largely in control of their own health.  The authors encourage you to open the link, read the paper and add your comments  at the end of the paper.  We would benefit from your feedback!

I asked several friends and colleagues to read and comment on the paper and the responses I got were interesting and a little unexpected.  To summarize, they said:  "This is all well and good, but some patients, even educated ones, just aren't interested in the "participatory" model".  Their point was that many patients trust their providers and don't have the energy or motivation to do on line research, prepare questions for the office visit, or even track their own lab results.  They just want to visit their doctor periodically and hear their recommendations and follow them!

The other feedback theme was that there are still many patients who don't have the health literacy or the technological wherewithal to function as participatory partners in their health.  These are the disabled, poor and disenfranchised.  They don't have smart phones, data plans, lap top computers, ipads or wireless internet access.  Many of them hardly know how to read, much less understand the often complex health discussions found online.

So, in spite of an engaged, activated, increasingly empowered cadre of e-patients out there, those of us in the Participatory Medicine movement have a big problem we need to address:  What do we do about the able but unmotivated, uninterested group and how do we addressthe poor and disenfranchised?

Your thoughts, comments, and expressed opinions are greatly appreciated!