By Rebecca Camp. AUSTIN, TX– Today’s SXSH conference (South By Social Health) saw many successful, multi-disciplinary approaches to weaving together new media and health care. I was bothered, however, by a theme that’s becoming increasingly common in the health care conversation: patients treated as consumers.

When a company follows capitalistic principles, the goal is to increase value by offering better services at a lower price. The company strives to improve their bottom line by offering more value than their competitor, in an effort to put their competitor out of business. Offering good customer service complements this strategy. In industries other than health care, the result is a benefit to the consumer: quality products and service at a lower price. Southwest Airlines, for example, employs a very effective social media presence. They respond to complaints tweeted by customers, which is has garnered the company praise in addition to a loyal customer base. But does this consumer-centered strategy translate to health care?

Mayo Clinic is held as a model for value in health care, but attributing their success to “consumerism” is off-base. The new media strategies being presented by health care institutions at SXSH essentially boiled down to damage control by tending to disgruntled Twitterers, and analysis of the types of complaints being registered. Though claiming to be influenced by social media mavens at Mayo’s Rochester flagship, the strategy is misguided and far removed. Mayo Clinic works because of a philosophy of care that puts the needs of the patients first—which does not equate to reactionary PR moves on social media sites. Absolutely nothing about their strategy distinguished it from other industries—and in the context of health care, replicating the strategy of Southwest Air and its ilk borders on insulting. Mayo Clinic avoids the noisy Twittersphere when addressing something as important as patient care; when a complaint is registered, that’s what their specialized center for patient service is for. Their Sharing Mayo Clinic blog allows a community of patients, staff, and families to form, which anticipates service problems before they even occur. This is the absolute obligation of companies in charge of delivering health care to a society.

My issue is also a philosophical one.

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Disruptive Women welcomes Personal Trainer Morris White as our February 2010 Man of the Month.

A personal trainer for 22 years, Morris White has both men and women – and even children as young as 12 – as clients. He helps them with basic fitness, sport-specific fitness and self defense. He also trains people with special needs, including those with disabilities and eating disorders, and those recovering from a stroke and heart attack.

In his own life, he is a power lifter and a practitioner of Kung Fu, Yoga, desert hiking and survival quests and sustainable healthy living. He is currently working on a fitness community site.

I can vouch for his impact. I’m now in my third year with him, with regular work outs at 6 AM. The benefits have been worth every trek to the gym in those before-dawn hours.

Morris, I’m pleased to have the chance to talk about fitness with you. It’s an important topic, but rarely addressed in this blogspace. How did you get started training?

There were three very influential men in my young life. It was the 1970’s. My Father was a pharmacist and successful businessman who took me to monthly Toast Masters meetings and had me working in the pharmacy on weekends. He taught me the importance of physical poise and presence. One of his business partners was a Physical Therapist who mentored me in anatomy and exercise, from him I learned about anatomy and body mechanics At about that same time, I was introduced to Kung Fu by my best friend’s Father who was a Master of the art.  Kung Fu combined all the earlier lessons and helped me to develop my personal philosophy on holistic personal training.

Those were the years of my greatest lessons.

I attended Temple University but my advisors could not grasp what I wanted to become and what I wanted to do with my life. The usual response was, “So, you want to teach phys ed?” No.

From there to the gymnasiums I went, working under different titles until personal training evolved and became popular.

 What about fitness and training makes it your passion? 22 years seems a long time.

Seeing my mother die at young age and my father debilitated primarily by an unhealthy lifestyle, has made me even more intent to give meaning to my existence by living and enjoying life to its fullest and helping others to do the same through fitness.  The bonus is that by helping others achieve their personal goals, I get to meet great people that, in turn, enrich my life through their collective experiences and wisdom.

How do you approach training?

My philosophy of training is:

• Safety first. You should never be harmed or injured in the course of training.

• Strict, proper form. The best form produces the best, most efficient results.

• Keep moving. A body in motion tends to stay in motion.

Follow those rules and you’ll keep at it, making progress. You’ll avoid injuries and won’t suffer any set-backs in your workouts. You’ll also see results and be able to have an increasingly better quality of life. Even if you’re already fit, you’ll see improvements.  As I like to say to my clients, “one foot in front of the other and you’ll get where you’re going,”

Oh, and one more thing, never imitate what you see others doing in the gym.  So many people do their exercises incorrectly. Others may do an exercise properly but their routine may not fit your desired goals.  Always consult a professional about a new exercise or routine.

Do you have any dramatic examples of client improvements?

I could tell lots of stories of women who come to prepare for their weddings. They’re motivated for sure. Believe it or not, they’ve bought dresses three sizes too small and now need to fit into them. Plus, the regular workouts really help them with the wedding-planning stress.

But the one client and story that really inspired me was a 280 lb sedentary banker who lost the weight and became a marathon runner.

As he became physical healthier, his self-confidence and self-esteem also improved.  This newfound self-respect gave him the strength to not only run a marathon but to walk right out of a less-than-supportive, troubled relationship and climb the corporate ladder to a promotion.

(Laughing) Of course, I cost him lots of money – he kept having to replace his wardrobe as his body changed.

Have you ever seen anyone who did not see an improvement in working out with a trainer?

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Probably the thousands of nurses who have been following this case were encouraged to read the press report of its outcome:

“Texas jury finds nurse not guilty for reporting a physician for unsafe practices.

It took the jury less than an hour on February 11, 2010, to return a not guilty verdict for the nurse, Anne Mitchell, of felony charges of “misuse of official information,” for reporting a physician to the Texas Medical Board for what she believed was unsafe patient care.

Since news of the criminal indictment – and Mitchell’s being fired from her job – first spread through the nursing community, nurses across the country have followed developments. Labeling the criminal indictments “outrageous,” an outpouring of support – and financial contributions to the Texas Nurses Association Legal Defense Fund – has continued.

According to a New York Times article on February 9, the prosecutors claimed that Mitchell intended to damage the physician’s reputation when she reported him to the Texas Medical Board, which licenses and disciplines doctors. Mitchell explained that she felt an obligation to protect patients from what she saw as a pattern of improper prescribing and surgical procedures – including a failed skin graft that was performed in the emergency room, without surgical privileges.

Conflicts of interest seemed to be part of this case with allegations that this case was, in part, a result of the local sheriff being good friends with, and a former patient of the physician, and bending the rules to protect his reputation.

A number of nurses who had previous worked at the same Winkle County Rural Health Clinic testified in court that they left the clinic because of their concern about the care provided by the same physician that had never been addressed. The case is no less perplexing as to why Mitchell was even indicted – all witnesses (even the state’s) have agreed nurses have a duty to report unsafe care.

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Immediately after the snow stopped falling in Washington DC this week, another news story took DC by storm–the resignation of Billy Tauzin, effective June 30th.

Mr. Tauzin’s departure comes at a critical time for those involved with health reform efforts, not to mention PHRMA’s own thick portfolio of issues that include patents and trade, the economy, taxes (think offshore), and shrivelling pipelines, just to name a few.

The job pays well, but the applicant will surely inherit a daunting to-do list.

Job Qualifications

It’s a given that she would have impeccable bipartisan connections at the highest levels of government (both here and abroad); a robust rolodex full of private sector titans and Wall Street mavericks; a keen understanding of marketplace complexities (both here and abroad); superior people skills (it can be a b*tch managing those board room egos); not to mention a thorough grasp of and respect for the unique political and policy complexities that define health, health care, and innovation.

But that won’t  be enough.  I would love to see the next CEO take some bold action and harness the power of e-patients:  increasingly, patients (e-patients and their e-caregivers) are hungry to engage in participatory, user-generated health care, often referred to as Health 2.0.  Kaiser’s Dr. Ted Eytan explains it this way, “enabled by information, software and community that we collect or create, we the patients can be effective partners in our own health care and we the people can participate in reshaping the health system itself.”[1]

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I’ve grown weary of the public continuing to rate nurses as the most trusted profession (annual Gallup polls every year of this decade except 2001 when fire fighters understandably led the ratings), only to have leaders in health care agree but ignore us.

The Robert Wood Johnson Foundation released a Gallup poll that surveyed over 1500 opinion leaders in health care, including government officials, health care and insurance executives, and university faculty.

The survey found that:

• Doctors (54%) and nurses (42%) are the information sources about health and healthcare in whom opinion leaders have a great deal of confidence.
• Government (75%) and health insurance executives (56%) are viewed as most likely to exert a great deal of influence on health reform, compared to only 37% for doctors and 14% for nurses.
• 51% say nurses have a great deal of influence in reducing medical errors and improving patient safety
• 18% say nurses exert a great deal of influence on increasing access to care, including primary care.
• 39% say nurses will not have much influence on reforming health care over the next 5 to 10 years, compared with 10% of MDs.

Nothing new here to most nurses. We continue to have to be vigilant about whether nurses are included at decision-making and advisory tables, as speakers at national and regional conferences on quality and safety in health care, and on boards of health-related organizations. The next time you’re in a meeting on health care, look around the table and ask whether nurses are included — and not just a token RN. If they aren’t, ask why not and call for RNs to be appointed. Organizations and the nation are missing out if we don’t all change our expectations about who is at the table.

Healthcare (insurance) reform has passed in the Senate and final negotiations are happening before it moves on to the President’s desk for signature. While the legislation is not perfect – in fact some would say far from perfect – it is a piece of legislation that is very much in keeping with our American philosophy, our constant pursuit of progress and change.

As the late Senator Kennedy’s career on Capitol Hill demonstrated, change is usually incremental, usually negotiated and usually compromised. But at the end of the day, change usually amounts to progress.

I see tremendous progress, too, as I look back on a decade’s worth of work to promote access to affordable quality health care using nurse practitioners in the role as primary care providers, thereby alleviating the burden on a strained primary care system.

We’ve come a long way regionally and nationally. The fact that we as a country are always striving to improve our path is what most invigorates me as a relatively new American. Our pursuit of progress is never ending, but it is what sets us apart from most countries in the world. We know our work is never done. As we enter a new year and decade, we always should remember that what makes us different from most people and countries in the world is that we have the freedom to purse progress and make change.

This health insurance reform bill is not the end all or be all, but it will help make affordable health insurance available to more than 30 million Americans who have been without it. Furthermore, the legislation contains many provisions for others who fall through the cracks and will need additional care and support.

That’s progress for individuals, families and America, as Walt Disney would have said. And not until you take a ride on the Magic Kingdom’s The Wheel of Progress will you truly appreciate how important it can be to take even a small step in the right direction.

Happy New Year! And a toast to a New Decade and our new Pursuits of Progress for individuals, families, and our country.

As this first full term at the Johns Hopkins Bloomberg School of Public Health has unraveled, I see how much they were prepping us during summer term.  My days have been filled with work, outside activity, caffeine, and a test of how long I can go without sleep and still be productive—similar to what I imagine the days are like for most of the Disruptive Women in Healthcare!  Classes this term included biostatistics, evolution of infectious diseases, program planning for health behavior change, health policy I, and public health economics seminar.  I chose the more rigorous biostatistics course (and will take others throughout the year) in an effort to become more quantitative and enhance my ability to analyze and conduct cost-effectiveness studies and economic evaluations in particular.  The course has its challenges, and there are certainly days when I wonder if I should have taken the other class, fondly known as “baby stats” to fulfill the requirement.  Health policy I: the social and economic determinants of health has been my favorite class, because not only have I learned about what the name of the course suggests (and health disparities is of great interest to me) but also how to develop a conceptual framework for a health policy problem and how to write testimony in an effort to get such an issue on a policymaker’s agenda.

In between classes, I have busied myself with all that the MPH program has to offer outside the classroom, as there is no shortage of activity competing for students’ every “free” moment.  For instance, I am part of a monthly health disparities journal club and am working with a professor on a book about Taiwan’s national health insurance system.  I am also now VP of Communications for Students Promoting HEalthcare REform (SPHERE), an organization spanning the school of public health and school of medicine whose goals are to assure that every person in the United States has the right to affordable, high-quality healthcare and to educate the Hopkins community.  So far the organization has had one event this year in which we heard from a panel that included representatives from Kaiser Family Foundation/The Commonwealth Fund, Johns Hopkins faculty, and local news radio, on the state of play in health reform.  We will be having other health reform educational events throughout the year and one major advocacy event in the spring.  As VP of Communications, I will be promoting events at the school, updating and enhancing our website, and possibly forming partnerships with other similar, local student groups.

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As an insurance broker in the metro Washington DC area, I have been in the trenches of selling, and advocating for our customers for their small group health insurance, disability programs and life insurance plans for over 17 years.

Needless to say, it has been maddening in the last five years to watch rates rise and our customers get increasingly frustrated with the system. I spend my days arguing with insurance companies about what they will cover and what they won’t — and I’m consistently amazed that these large firms often don’t have a handle on the benefits they provide in their policies. To say the right hand doesn’t know what the left is doing is a dramatic understatement.

I am one of the first to admit that something needs to be done. Last fall I hosted the DC Health Summit and brought together some of the country’s top health insurance executives, doctors, politicians, hospital administrators and business people into one room to discuss what might be done to fix the system.

An Obama spokesperson was one of our speakers — and today I continue to stand behind the president’s goal to accomplish health care reform, and do it as soon as possible.

As the debate has unfolded, however, it has been suggested that health insurance brokers be eliminated from the mix. Obviously, this potential threat is unnerving, but if you consider the possibility on a more global level — it simply doesn’t make sense.

Here’s why: If we have a government option in health care reform, over a short period of time, it will likely crowd out the private sector. If private health plans are squeezed out of the market, it follows that insurance agents will be as well, and that would be a major loss — not just for my firm, but also for every American who currently relies on their broker to explain their benefits and advocate for them when there is a problem.

I believe it is critical that the broker not be categorized as an administrative cost — especially as those costs are the biggest target in the reform packages. We also want to make sure Congress doesn’t do anything that removes us from the system, or removes the value that we know we add for the customer.

So let’s consider the doomsday scenario for brokers.

If the current threat comes to fruition and brokers like myself are put out of business, I’m certain there will be a consumer advocate of some sort under any new model that is adopted. Like with many government-run programs, will these be poorly trained people be truly knowledgeable about how the system works? Will they be advocates for their customers? Will they have the time, resources, or incentive to spend five hours on the phone in a day — as I often do — arguing for a patient’s health insurance rights?

Not likely. Indeed, odds are good that we’ll end up with internet-based FAQ pages filled with complex explanations. I can foresee the day when trying to understand your health insurance benefits will resemble trying to understand how to do your taxes. Will we look back on these days as the good times for our health insurance benefits?

Needless to say, I believe strongly that brokers are an important part of the health care system. I hope to have the privilege to continue to do my job for many years to come.

Those who have spent their careers in the trenches of healthcare and are now reading the uncertain headlines in the news each day and fearing for the future of healthcare, fear not! There are fresh crops of enthusiastic students, eager to make a difference and keep the ball rolling in the quest to improve healthcare, sprouting up in graduate programs starting across the nation this summer.

Having started the Johns Hopkins Masters of Public Health (JHSPH) program in July, it has been a thrilling month and will no doubt be a fast year with many choices to make for classes, volunteer opportunities, and research projects. The plethora of options was described by one former student as “going to the grocery store when you’re hungry.” Not to mention, each student shopping in the “grocery store” is a Type A overachiever with diverse interests and remarkable accomplishments under their belts. It is no exaggeration that it is difficult to get a seat in the first few rows of the lecture halls—it is just that kind of crowd.

Each day has been a new adventure with exciting speakers further energizing us and spurring new thoughts and ideas, laying the groundwork for our future studies this year. Countless fliers for seminars to attend cover the bulletin boards week after week, and we each have several hundred courses for credit from which to choose during our 11-month program.

As the summer session comes to a close and I find myself in the throes of final exams, I not only have learned the principles of epidemiology and environmental health but also have taken away several overarching lessons with widespread implications:

• Change is possible, even if the odds are against you. Dr. D.A. Henderson, former Dean at JHSPH, spoke to our class about the global campaign he led to eradicate smallpox in the 1960s when no infectious disease had ever been eliminated on such a large scale.
• Even if wide scale change is not immediately plausible, something—no matter how small—can still be done. For instance, Howard County, Maryland took it upon itself to help its own uninsured residents by launching the Healthy Howard Access Plan to provide basic health services to those unable to obtain or afford health insurance.
• The American people can successfully unite to affect healthcare change. Polio: An American Story (required reading for incoming MPH-ers) by David Oshinsky, a Pulitzer Prize-winning historian, depicts the true story of Americans coming together despite socioeconomic class or political party to find a vaccine for polio.

Needless to say, with just one term under my belt, the JHSPH motto “protecting health, saving lives—millions at a time” doesn’t seem such a far-reaching feat after all. This thinking that is shared with my classmates is proof that midterms and finals have not tarnished our raring-to-go attitudes or deflated our ideas and dreams about improving the health and lives of many. And hopefully knowing this will help some of my more seasoned colleagues out there rest assured and sleep a little easier.

EAST COAST.  In and around the DC Beltway, there is a tremendous amount of excitement when it comes to Health Information Technology (HIT).  Lots of mainstream IT vendors, trade associations and HIT gurus are licking their chops.  Policy wonks, legislative aides and administration appointees have been diligently debating the thorny issues of the day: privacy, security, standards, and meaningful use.

WEST COAST.  In and around Silicon Valley, there is a tremendous amount of excitement when it comes to Health Information Technology (HIT). Lots of software engineers, health 2.o entrepreneurs, and venture capitalists are licking their chops.  IT experts,  computer intelligensia, and bleeding edge developers have been diligently innovating the thorny issues of the day: privacy, security, standards, and meaningful use.

East meets West.

Policymakers and legislators are talking about the promise of increased efficiencies and cost savings. And meaningful use.  HIT innovators are talking about the right to personal health data and personal health records.  And meaningful use.

Lots of people are talking about meaningful use.  Here’s what the Department of Health and Human Services’ Office of the National Coordinator’s website has to say about it:

The American Recovery and Reinvestment Act authorizes the Centers for Medicare & Medicaid Services (CMS) to provide a reimbursement incentive for physician and hospital providers who are successful in becoming “meaningful users” of an electronic health record (EHR).  These incentive payments begin in 2011 and gradually phase down. Starting in 2015, providers are expected to have adopted and be actively utilizing an EHR in compliance with the “meaningful use” definition or they will be subject to financial penalties under Medicare.

The focus on meaningful use is a recognition that better health care does not come solely from the adoption of technology itself, but through the exchange and use of health information to best inform clinical decisions at the point of care.

Informed clinical decision making must include the patient.

But who’s talking about meaningful use for today’s patients, the future HIT generation?

What we have here is a teachable moment:  If we are really serious about meaningful use, it must be meaningful for the patient.  Not just for health providers.

• How do we make sure the public (patient and caregivers) are well informed?
• What, if any, consumer protections may be necessary (ie, a misdiagnosis is inadvertently entered in an electronic health record–who, how does that correction get made–everywhere in cyberspace?)
• How do we insure that all people–the disabled, those who don’t speak English–will be able to meaningfully use HIT?

My suggestion:  As we make the transition from paper to electronic records let’s have the National Coordinator, working with patient, consumer, and provider groups develop a HIT LIST–a plain English (with translations as needed) document explaining what electronic records are, why they are meaningful/useful to patients, along with a consumer check list of questions patients should ask. If I were putting this together, I would also include where to go for help (both online and offline).

Ideally, patients need to receive this HIT LIST before they are sick.

Heart disease is the number one killer of women. The problem is, women have different symptoms then men — so they often don’t realize they’re having a heart attack. The Queen of Hearts Foundation is co-hosting a women’s wellness seminar in Atlanta June 2 and 3 at the Crowne Plaza Hotel Atlanta Perimeter At Ravinia – (Address is: 4355 Ashford Dunwoody Rd NE, Atlanta – (888) 444-0401)

If you’re in Atlanta, the cost is only $10 — and it could save your life.

Queen of Hearts co-founders, Katy Atterbery and Carmen Perez, talked to Disruptive Women’s Wendy Grossman.

DW: Did you know each other before you started the foundation?

KA: We met while volunteering on a project regarding women and heart here in Atlanta in 2004. We formed the foundation in May 2005, and got our 501C3 status in July 2008. Carmen is the daughter of a man who has had open-heart surgery. And I, of course, am a multiple heart attack survivor.

DW: I read that you had several heart attacks in a week.

K.A.: I had three heart attacks in a five-day period.

DW: And you didn’t know you were having a heart attack?

K.A.: I had no idea. I had symptoms for six to eight months and ignored them. I was busy doing other things. I had a burning sensation in the pit of my stomach, a pain in the side of my neck, and a pain in the shoulder blade. Women symptomize differently than men (visit qohf.org and click on symptoms).

I never had a pain in my chest; I never had a numb left arm. I felt lousy, my skin tone was gray, I saw dots in front of my eyes. When I had the first heart attack, on Nov. 13, 1997 (a week after my 54th birthday) I was misdiagnosed as having an anxiety attack in the ER and they sent me home.

DW: Wow.

KA: I drove myself — which was a really stupid thing to do — but I didn’t know what was wrong. The second heart attack I had while co-chairing a fundraiser at my son’s school that Sunday night (Nov. 16.)

I wouldn’t let my husband take me back to the hospital because they told me nothing was wrong. I saw my internist that Monday who told me that I was over 50 and probably had acid reflux. He gave me a prescription for an upper GI series and said he’d call in a couple days. That night, I suffered a major myocardial infarction — which is a heart attack. I was throwing up and in excruciating pain.

My husband carried me back to the ER. Our son, Christopher, was a senior in high school and he had the flu. He was sick in bed and my husband — who traveled for business every week, by God’s gift was home that Monday. If he hadn’t been home, my son would have come upstairs that morning and found me dead. Because I never would have got to a phone, and he never would have heard a cry for help.

At the hospital, I lost consciousness and lay for over four hours with them insisting it was my gallbladder, before they called a cardiologist.

It wasn’t until the cardiologist did the cardiac blood enzyme test they knew I had a heart attack. (That is a blood test that detects the presents of certain enzymes your heart produces when under attack.) I was unconscious. They did a heart catheterization and a angioplasty and put a stent in my lower and anterior descending artery. The interesting thing is, 11 years ago when this happened, stents were brand new. So I have a surgical steel coil that is now embedded in the wall of my artery. (more…)

The following guest post is written by Melinna Giannini, President, CEO, and Founder of ABC Coding Solutions (formerly Alternative Link), who has worked in the health insurance industry since the 1980s. She is one of the nation’s leading experts on contracting, billing, and practice management for nursing and other forms of integrative healthcare. Melinna designed ABC codes to fill gaps in national code sets used for managing healthcare reimbursement and outcomes analysis.

The U.S. healthcare system can no longer rely on medicine as its primary form of healthcare. Our U.S. medical schools cannot increase the physician workforce fast enough to keep pace with population growth and the needs of baby boomers.

The physician workforce decreased from 772,000 doctors to 633,000 doctors since 2000. Significantly, the U.S. population grew by 50 million people since 2000. Care shortages, dramatic cost escalations and more people without insurance require immediate action.

Our nation can immediately increase care and reduce costs by maximizing direct patient access to the 2+ million healthcare professionals who are authorized and available to manage non-acute patient care. Rather than routing patients to physicians for non-acute care, we can route them to non-physicians who are legally authorized to manage care without oversight. This minor change in policy will free physicians to better manage acute care, provide patients with timely care and reduce physician oversight charges.

To make this change in our healthcare delivery model, certain government healthcare policies must be modified. For example, Medicare should eliminate its policy of disallowing direct reimbursement to advance practice nurses.

Non-physicians also need an infrastructure to bill public and private insurers for their services in order to:

• Reduce paperwork burdens and costs for both parties
• Increase the accuracy and speed of communications
• Protect providers and payers from fraudulent billing practices
• Identify effective options to more expensive medical care
• Help create more effective federal and state healthcare policies

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What’s not to like about the idea of Sanjay Gupta being the next Surgeon General of the United States?

It may be viewed as a brilliant move since Gupta is widely known because of his work on CNN and well known among journalists. It could be a great way to get media to pay attention to your message when you’re in a position that may be considered by some to be largely ceremonial.

But that should not be the case. Certainly, C. Everett Koop learned how to use the position as a platform to advance important public health initiatives, such as quitting smoking. The surgeon general heads up the large Public Health Service that does important work on things like disaster preparedness and response, disease control and prevention, mental health, and even international health. Gupta is a neurosurgeon. The Public Health Services Act specifies that the Surgeon General be experienced in public health.

Of course, his role with CNN has equipped him—out of necessity—to focus more on public health matters. But why would President-elect Obama not select one of the many highly qualified public health professionals? For example, Thomas Frieden is the bold commissioner of health for New York City. He’s been brilliant on issues such as diabetes, changing what people know about healthy versus unhealthy foods, banning transfats from restaurants, and more. He knows the breadth of public health, what works and what doesn’t in this field, and is a pretty good spokesperson. I’ve interviewed him on a radio program I produce in New York City and he was excellent in discussing the priority issues for promoting the health of New Yorkers. (Note: He has not told me that he wants the position.)

I also don’t believe that the position has to be filled by a physician. For example, Kristine Gebbie is a nurse who is the former commissioner of health for Washington State and Oregon. (Note: She has not told me that she wants the position.) And other non-nurses with public health experience should be considered.

Regardless, it will be interesting to see what unfolds. Koop’s appointment was not supported by the American Public Health Association because he was a pediatric surgeon, not a public health expert. But by most counts, Koop’s performance as Surgeon General earned him kudos for taking on some controversial issues. Perhaps the lack of unanimous support from the public health community spurred him to rise to the occasion.

Maybe Gupta will do likewise.

In the spirit of President Elect Obama’s/HHS Secretary Designee Tom Daschle’s efforts to mobilize a grassroots “get out the health” series of house parties, I am re-posting my first Disruptive Women post:

My Top 10 Priorities for the Next HHS Secretary (NOTE: this was written prior to the selection of Tom Daschle–not surprisingly, I was holding out hope for a woman–no offense to Mr. Daschle):

The next Secretary of the US Department of Health and Human Services (DHHS) will have a plate that is not only full, but is overflowing. While all the political rhetoric is focused around access—health insurance for all—there are a number of other critical areas that need immediate attention as well.

Clearly there are many more than 10 priority areas. However, if I just so happened to find myself sitting across from the next Secretary of HHS, I would remind her (just indulge me on that) that she is the Secretary of Health AND Human Services—that for her to make a dent on the health side of things, she must take into account whether people have: the support systems they need, heat, a home, transportation, enough to eat.

Here is my list of the top 10 priorities, in no particular order:

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I was recently called an “audist” by a sign language interpreter on my staff, and believe me, it was not a compliment. Audism is a term used to describe attitudes and actions by people in the hearing world that oppress those who are Deaf. Audism, like racism…judges, labels and limits…The belief is that hearing people feel they are superior to Deaf because they can hear. It might be because I am Jewish but words that end in ISM such as anti-Semitism, racism, sexism and now AUDISM are words that are powerfully repugnant to me.

I told the interpreter that I wanted to share a story with her. A long time ago I had an assistant who I was very fond of, and she, me. One day an elderly Jewish lady, whom I’ll call Mrs. Goldstein, had an appoinment to purchase hearing aids. When she left without purchasing them, Katie, my assistant, asked “did Mrs. Goldstein try to Jew you down on the price?” What was so upsetting to me was that she had absolutely no idea that what she was saying was offensive, bigoted, insulting and just plain ignorant. I explained that to Katie and vowed to myself that I would help teach her the truth…it is the only way to combat prejudice.

I asked my staff person to help me in the same way. I am not an audist…but I may occasionally say things that might make it seem, out of ignorance that I am. Rather than make derogatory comments I asked her to take the time to educate me. I am very open to listening and learning.