Anna Gawlinski

The following is a guest post by: Anna Gawlinski, RN, DNSc, FAAN, Director, Research and Evidence-Based Practice and Adjunct Professor at Ronald Reagan UCLA Medical Center and UCLA School of Nursing and Elizabeth Henneman, PhD, RN, Assistant Professor at The School of Nursing at the University of Massachusetts-Amherst.

It’s easy to criticize the current state of our health care system. All over the place, even outside of Washington DC, people are talking left and right (politically, that is) when they should be talking right and wrong (care, that is). But, one important talking point that’s almost always left out of the equation is our role, the role of the nurse. Or more specifically, the critical care nurse whose job it is to save you or your family members’ lives if hospitalized in the intensive care unit (ICU).

With its latest effort to reduce medical errors through the National Patient Safety Initiative, the government is putting dollars behind this effort. Hospital ICUs not only house a hospital’s sickest patients, but they also account for up to 30 percent of a hospital’s costs. As many as 1 in 5 patients die in the ICU and this is partially attributed to the severity of medical conditions and the high rate of health care-associated infections (HAIs). However, we all know that medical errors also play a huge role.

Medical errors occur in the ICU. In the past, many have been of the mindset that they are inevitable. However, our study recently published in the American Journal of Critical Care illustrates that nurses can play a significant role in reducing medical errors. (more…)

Addressing the inevitability of nurses caring for older adults with mental health and substance abuse issues, the American Academy of Nursing’s Geropsychiatric Nursing Collaborative (GPNC) released a new short video: “Discover Mental Health: The Forgotten Piece in Elder Care.”

The video conveys that while not every student will become a geropsychiatric nurse, almost all nurses at some point in their careers will care for older adults with mental health issues. Therefore, nurses will need the requisite knowledge, skills and compassion to improve the quality of life for this most challenging, rewarding and neglected population.

View the video. Note that this video can be used as a standalone resource or segments can easily be excerpted for specific uses. It is available for free download on the Portal of Geriatric Online Education: POGOe, Product #20893   (You must have an account to access the video for download, but registration is free.)

Please share with your colleagues. GPNC would love to hear who is using it in what venues and any responses about its utility and value. Send comments to Pamela Dudzik at pdudzik@aannet.org.

The following is a guest post by Sandra Phillips Sperry and Caryl Mahoney. Sandra Phillips Sperry, MPA, APC, RN, CMC, FACHE is the Principal & EVP of Management Transitions a health care transition management firm and Founder & CEO of Connect2Care America, LLC an internet based health care advocacy service established in 2010. She is a senior healthcare executive with over 20 years of diverse experiences in hospital operations, financial management, clinical integration, business development, and hospital facilities planning and design. Caryl Mahoney has extensive executive experience in Human Resources, Organizational Development, Strategic Planning, Employee Relations, Coaching and Communications.Caryl’s experience includes healthcare management as a senior executive, consultant to Fortune 100 corporation and the intelligence community of the federal government.

By Sandra Phillips Sperry and Caryl Mahoney. An unavoidable fact of business life is that the workplace is fraught with the potential for conflict. High performing organizations and effective teams must attend to not just the work that gets done, but how it gets done.  Unfortunately, intimidating and bullying behaviors have always been an unwelcome part of the healthcare workplace.  Unresolved, these toxic behaviors can lead to debilitating consequences such as lowered morale and productivity and loss of quality staff.  These toxic behaviors effect performance and are evidenced among peers, patients towards staff, staff towards patients, and throughout the matrix of the organization.  Toxic behavior or personalities can be defined as exhibiting counterproductive work behaviors that demoralize and incapacitate individuals, teams, and organizations.  These behaviors reflect a disconnect between stated organizational values and performance.  The behaviors are often tolerated because an individual is viewed as talented, in a position of power, a significant contributor to the bottom line, a “driver” of other’s performance or simply affected by situational stress.  There is significant evidence that toxic behaviors are no longer just an irritant to can be put up with but are serious disruptions that contribute to decreased productivity, safety and increased cost.  The nature and form of bullying is often unclear in the workplace.  Overt bullying behavior is more easily recognized in a schoolyard, but can be masked or more subtle in the workplace.  Dealing with bullying in the workplace is a compelling reason for the broadening of organizational goals and culture.  Developing individual and group awareness can result in positive organizational outcomes and wise personal and professional relationships.

The Institute for Safe Medical Practices (ISMP, 2010) survey findings found that 49% of health care professionals felt that intimidating behaviors had altered their ability to manage medication orders.  The Joint Commission for the Accreditation of Hospitals (JCAH) found that 70% of sentinel events were directly correlated with poor communications that are the result of negative, toxic behavior and bullying in the environment.  Findings were of such significance that standards for the management of bullying and toxic behavior were established (JCAH, 2009).  Another example is the work of Kusy and Holloway (2009) who found that 64% of individuals surveyed from a range of industries responded that they were currently working within a toxic situation or with a toxic individual.   Unprecedented interest in workplace bullying in the U.S. and globally has arisen out of the recognition that bullying, intimidation and other toxic behaviors have severe consequences and are on the rise first in our families, then in the education system, and finally in the workplace. (more…)

The following is a guest post by Elizabeth Madigan, PhD, RN, FAAN who is a professor of nursing at the Frances Payne Bolton School of Nursing, Case Western Reserve University in Cleveland, Ohio. She has been an RN for more than 30 years and has spent the last 14 years as a researcher focused on quality and safety in health care, primarily home health care.

By Elizabeth Madigan. There really is no low hanging fruit in safe health care. The “hurray for checklists in health care” mantra that has been recently promoted in the popular media, misses a couple key points—it’s not the checklist that improves the outcomes—it’s the change in the organizational culture and where that cultural change happens. Anyone who has worked in quality improvement or performance improvement long enough knows the familiar story of a blip of improvement in patient outcomes following one simple intervention that is not maintained and often falls to worse when QI and PI attention moves to another problem. Persistent changes come about through changes in organizational beliefs and operations. The Institute for Healthcare Improvement has identified the importance of the engagement of key leadership in bringing about organizational change, but it also requires the frontline workers, regardless of the health care setting, who do the heavy lifting in making changes in day-to-day work practices. The implication of the popular media is that if the health care industry would adapt the same successful and (oh by the way) very simple approaches (the checklists) from aviation or nuclear power, we would see big and persistent improvements in patient safety. Here’s the rub: on the other end of that checklist is a person, not an airplane or a nuclear plant. And people, particularly people seeking health care, are complicated in ways that airplanes and nuclear plants are not and deserve a provider who recognizes their unique perspectives, needs, backgrounds and current status. The other part of the story from both the aviation and nuclear power industries is that the successes associated with the checklists resulted from changes in the organization as well. For example, in the aviation industry, co-pilots were encouraged to and actually empowered to question the pilots about safety issues. Can using checklists help improve health care quality and safety? Should checklists be integrated in some parts of health care? Absolutely on both counts. Are checklists low hanging fruit that the health care industry has chosen to ignore because health care providers are (pick one) greedy, not caring, resistant to change or not smart enough to recognize? Not a chance. All of health care is under increased scrutiny for quality and safety outcomes; implying that the industry and all the research to date has missed the simple “silver bullet” solutions is not helping and is actually counter-productive to addressing the complex issues here.

By Jane Sarasohn-Kahn. In February 2011, 1 in 10 jobs in the U.S. is in health care employment; nearly 14 million people in the U.S. work in health care employment, with health care representing 10.7% of all jobs in America. The growth rate of health care jobs rose 1.2 percentage points since the recession kicked in late 2007. Since the start of the recession, health employment grew 6.3%; the number of non-health jobs fell by 6.8%. The chart starkly illustrates this story (click the chart to enlarge for easier reading).

Altarum Institute has crunched the health job numbers from the Bureau of Labor Statistics (BLS) and published their analysis in Health Sector Economic Indicators, published February 9, 2011. Altarum’s top-line: health care employment has reached an “all-time high” in the U.S.

Outpatient care settings accounted for the fastest-growth in jobs with a 12-month rate of increase of 5.3%. The hospital segment grew the slowest, at a mere 0.7% — basically flat-lining (though still representing, by far, the largest segment in terms of jobs). Home health jobs grew by 4.3%.

Health Populi’s Hot Points:  It is impossible to separate the U.S. health microeconomy from the nation’s macroeconomy. With only 39,000 new jobs added to the U.S. economy in January 2011, we economists look for bright signs wherever we can find them. One-third of this increase in total new employment was in health care.

The number of jobs in the health sector will continue to grow. This will continue to be the case for the next decade, at least. Among many drivers for health job growth, two are at the top of the list in 2011: health information technology and the aging of the population. There will be intense demand for workers skilled in health information technology, based on the adoption of electronic health records by providers (both doctors and hospitals), along with growing digitization of all health information generated by digital imaging, point-of-care diagnostics, smart infusion pumps, and other medical devices. Dr. Blackford Middleton of Partners HealthCare projects a need for an additional 40,000 to 160,000 workers in health IT in the coming years.

As for aging, the chart shows already-growing demand for more home care workers. Boomers won’t age quietly into that good night, wishing to avoid institutional care in nursing homes. So home care work will be re-defined back in the person’s home — requiring even more digitally savvy workers to re-imagine and re-design what home care is. This will mean more jobs for new kinds of design and ideation, applying the disciplines of anthropology and sociology, and of course, more IT developers who can marry, say, miniature accelerometers to milk bottles and sensors to scales.

How we define health care jobs today will morph into a new definition for jobs in health tomorrow.

Originally posted on Health Populi on February 10th.

By Jane Sarasohn-Kahn. While 8 in 10 U.S. adults want a physician to have primary responsibility for the diagnosis and management of their health care, many people are not sure who’s a medical doctor. Surprisingly numbers of health consumers don’t think that orthopaedic surgeons, family practitioners, dermatologists, psychiatrists, and ophthalmologists are MDs.

The American Medical Association‘s survey, Truth in Advertising, published in January 2011, follows up the AMA’s 2008 survey which had similar results.  Data based on consumers answering the question, “Is this person a medical doctor,” are organized in the chart.

90% of people say that a physician’s additional years of medical education and training are ‘vital’ to optimal patient care. At the same time, only 51% of people say it’s easy to identify who is a licensed medical doctor and who is not by reading what services they offer, their title and other licensing credentials in ads and marketing materials.

In a related story, my colleague and friend Michael Millenson wrote in Kaiser Health News today about “Fixing the Failure at Physician Compare.” Physician Compare is the Centers for Medicare and Medicaid Service’s (CMS’s) portal meant to assist the health citizens (whether enrolled in Medicare or not) in finding doctors in their local communities. Millenson writes,

“In reality, the site is confusing and unfriendly to consumers, painfully slow and, worst of all, factually unreliable. Put bluntly, the agency, whose leader famously called himself a ‘patient-centered … extremist’ in a 2009 Health Affairs article, has produced a consumer tool that practically shouts, ‘We couldn’t care less whether any consumer ever uses this.’”

The AMA survey was conducted in November 2010 among 850 adults.

Health Populi’s Hot Points: The AMA poll and Millenson’s analysis point to the desperate need for greater health literacy, transparency and useful, usable tools for health citizens for becoming more engaged and empowered in their health and health care choices. Most health citizens don’t aspire to be couch potatoes when it comes to tapping into health information: in fact a majority of U.S. adults who have a primary care doctor would like more comprehensive information about their doctors online, learned in a survey conducted in November 2010.

AHRQ is soliciting comments for the Agency’s project, Understanding Development Methods from Other Industries to Improve the Design of Consumer Health IT.  This project will focus on consumer health information search and storage, and health monitoring. Health Populi readers involved in consumer-facing health IT innovation and design should tap into this site and get involved. As the Physician Compare early experiences point out, AHRQ — which is a ‘sister’ organization to CMS under the umbrella of the Department of Health and Human Services — can benefit from your input.

Originally posted by Jane Sarasohn-Kahn on January 27th on Health Populi.

By Tine Hansen-Turton.  In the face of an acute primary care physician shortage, and the steady reduction in the number of physicians who are willing to accept Medicaid and Medicare, it is unclear whether our existing primary care system will be able to meet the needs of the 30 + million Americans who shortly will become insured as a result of national health reform.

Health care delivery is strained under tremendous pressure from the demands of chronic health issues, downward trends in third party payments, and while insurance coverage will address some of these issues, many of these problems may persist even when near universal insurance coverage is achieved in the United States. So what else needs to happen to make health care reform a success? 

In recent years, a series of “disruptive innovations,” (as coined by Harvard Business Professor, Clayton Christensen, PhD), in the health care sector have capitalized on non-physician providers, such as nurse practitioners. Their ability to provide high-quality primary and preventive care in retail-based settings such as Convenient Care Clinics (also known as retail-based clinics) and in community-settings, such as Nurse-Managed Health Clinics has been well documented.

Research by RAND Corporation and publications in Health Affairs, the Institute of Medicine and Robert Wood Johnson Foundation’s Future of Nursing report and peer-reviewed journals have documented that retail-based clinics and Nurse-Managed Health Clinics provide safe, accessible, affordable care to millions of Americans without threatening continuity of care.   Nurse practitioners practicing in these independent settings already touch 20 + million or more people annually. Consumers gravitate to both models because they are accessible, affordable, provide quality care but most importantly, they are convenient in their locations, hours and ease of use.  For health care reform to be successful, we need to embrace these and many other disruptive innovations.

Disruptive innovation does not happen overnight or without a strategy – rather, innovation is built on a series of innovations that happen over time; time needed to grow and mature outside the limelight.  Neither the convenient care clinics nor Nurse-Managed Health Clinics would exist without the nurse practitioner in the primary care service seat. 

The nurse practitioner workforce, 150,000 strong today, with an annual growth rate of 5,500, was first established in the late 1960s as a response to a physician shortage and a belief that nursing could play a critical role in primary care.  It grew slowly over a 30 year period.  Like Thomas the Little Tank Engine, it stayed focused and gained steam as the number of providers grew. 

First, nurse practitioners proved their worth by silently filling the health care needs of underserved populations in rural and urban settings. Over time, and thanks to national and state legislative and regulatory reforms that have taken place over decades, including those recently led by governors in Pennsylvania and Massachusetts, nurse practitioners gained public support, were defined in law as primary care providers, and now are legally authorized to prescribe medications and provide care that is a comparable in scope to that of a primary care physician in all 50 states. Today, they are known by most Americans and have become a household name and provider of choice.

* This post is part of the Disruptive Women series on innovation.

Debra Lappin

The following is a guest post by the President of the Council for American Medical Innovation, Debra Lappin.

By Debra R. Lappin. A recent survey of 6,000 people across six countries found that a majority believe that the United States will lose its billing as the most innovative country in less than 10 years.  Aside from the competitive and reputational repercussions of such a drop, losing ground in innovation, especially medical innovation, means significantly less hope to discover cures, invent devices, and fundamentally bend the cost curve for health care, thus having a positive impact on the nation’s deficit.

America’s medical innovation enterprise will lead our nation out of the current economic recession. It provides excellent jobs in the public and private sectors, and improves health for all Americans. Medical innovation industries continue to be an important source of high-wage jobs, and while other sectors have been negatively impacted by the recession, medical innovation sectors have fared better and appear to be rebounding more quickly than other sectors from the economic downturn.  Health care and biomedical fields are expected to generate more new jobs than most other industries between 2008 and 2018.

From a health perspective, a single discovery in the world of chronic diseases resulting from investment in medical innovation today has the potential to save billions – if not trillions – of dollars tomorrow. This is what I call the new ROI, or return on innovation. And it is something I am advocating for through my role as president of the Council for American Medical Innovation (CAMI).

This past summer, CAMI commissioned a study by Battelle that offered a road map on what the U.S. needs to do to retain its leadership position in medical innovation. In particular, continued American leadership in medical innovation will require strong presidential vision, new public-private partnerships to promote medical innovation, a better investment climate, a smarter regulatory infrastructure and a stronger educational system.

Let me focus on two of those areas that where I believe we have the best opportunity to enact change in the near term. (more…)

You’re Invited

10 Years after Legislation was Enacted,

How Safe are Health Care Professionals from Sharps?

THURSDAY, November 4th, 2010

9:00 – 10:30 a.m. (Continental Breakfast Served)

The American Nurses Association (ANA) will host a critical discussion on the Needlestick Safety and Prevention Act, 10 years after it was enacted. The new ANA President Karen Daley, PhD, MPH, RN, FAAN who was instrumental in the Act’s passage will be a featured speaker. Panelists will discuss where we need to go from here in order to further improve needlestick safety.  According to the Centers for Disease Control and Prevention (CDC), more than 1,000 needlesticks and other sharp object injuries occur each day in health care settings and many others go unreported.

SPEAKERS:

• Karen Daley, PhD, MPH, RN, FAAN, President, American Nurses Association
• Jordan Barab, Deputy Assistant Secretary of Labor for Occupational Safety and Health
• Mary Ogg, MSN, RN, CNOR, PeriOperative Nursing Specialist, Association of PeriOperative Registered Nurses
• AnnMarie Papa, MSN, RN, CEN, NE-BC, FAEN, Board Member, Emergency Nurses Association
• Annie Lewis O’Connor, NP, MPH, PhD, Emergency Department Nurse 
• Susan A. Dolan, MS, RN, CIC, Chair, Public Policy Committee, Association for Professionals in Infection Control and Epidemiology, Inc.
• Angela Laramie, MPH, Project Coordinator, Massachusetts Sharps Injury Surveillance Program, Massachusetts Department of Public Health
• Marla J. Weston, PhD, RN, Chief Executive Officer, American Nurses Association (moderator)

WHEN:          Thursday, November 4, 2010 – 9:00 to 10:30 a.m. (Continental breakfast will be served)

WHERE:        National Press Club – Fourth Estate Room

 TO RSVP:      Contact Hope Ditto at 202-263-2900 or hditto@amplifypublicaffairs.net

This educational project was developed exclusively by the American Nurses Association for the purpose of providing objective information regarding needlestick safety and prevention. Financial support was provided in part by BD (Becton, Dickinson and Company).

By Diana J. Mason. The Institute of Medicine’s (IOM) report on the Future of Nursing released on October 5^th at the National Press Club was developed by an interdisciplinary committee after public hearings around the country and an exhaustive review of the literature on various related themes, such as the evidence on the outcomes of nursing care. Physicians Harvey Fineberg (President of the IOM) and Risa Lavizzo-Mourey (President of the Robert Wood Johnson Foundation) spoke to the importance of the report for improving health and health care in the United States. Risa specifically pointed out that the report was not so much about nursing as it was about how to transform health care. Additionally, committee member and physician Jack Rowe (former head of Aetna) spoke eloquently to the importance of ending interprofessional turf battles by focusing on what patients need.

Organized medicine continues to be stuck on protecting its view of its turf. In a statement issued after the IOM report was released, the American Medical Association (AMA) claimed that only physicians can lead health care teams because they are more educated than nurses. They claim it’s a matter of quality and safety, but they are ignoring the evidence to the contrary that is laid out in the IOM report. To better understand the origins of this turf battle, read Chapter 3 of the IOM report and look at the work of legal scholar Barbara Safriet.

What the AMA doesn’t seem to understand is that the future of health care requires skills that other health care providers have. Especially in primary care, clinicians need to emphasize health promotion, chronic care management, and care coordination. Physicians are highly trained diagnosticians of disease and surgeons, but this is a narrow skill set for primary care. The ideal is to have primary care physicians who can provide that expertise when needed but be on teams that may be headed by them, nurse practitioners, nurse midwives, social workers, or others. For example, for people with chronic mental illness who have developed important relationships with mental health practices, the social worker may be the best person to head the team.

Nurse-managed health centers have demonstrated that nurses can lead primary care centers that are health or medical homes using interprofessional teams that include physicians. We know that nurse practitioners can do 90% of what primary care physicians do with comparable outcomes, plus the health promotion and care coordination.

If we all can keep our eye on the real aim defined by Jack Rowe—focusing on what people need to promote health—the approaches to health care will become clear. Here’s hoping that the AMA achieves an understanding of this essential point soon.

By Gwen Mayes. It was 1998 and I was new in town.   By town, I mean a Midwest city on a big river with well over two million residents and two academic medical centers.  Having been diagnosed with a rare heart disorder many years before, finding a good cardiologist in town was one of my first priorities. 

I checked my health plan, researched the local paper, called the university medical centers and settled on a highly regarded, mid-50s, white-haired cardiologist in private practice with an affiliation at one of the medical centers in the area. 

Our relationship lasted six months.  Well, maybe one year, but that would be a stretch.

As a former physician assistant, I handled the paperwork and repetitive tests that come with seeing a new doctor without concern.  But the first few months of my move I was miserable and an emotional wreck.  My mother died four days after I moved; her mother the next month.  The job I was hired to do was canceled and I missed passing the bar exam by one point.  I was exhausted and trembling at night from the weight of all the changes and uncertainty in my life. 

When the palpitations started, I knew the stress was too much.

“I think I’m depressed,” I said with a lump in my throat to the Midwest cardiologist a bit shocked that I could utter the word.  It was our third visit.  I went on.  “I’m not sleeping well, all I do is cry, and I’m just a bundle of nerves.”    

Without looking up from the note he was scribbling in my chart he said, “Have you thought about looking for help on the internet?”

It was all I could do to sit upright on the examining table.  I was shocked and disappointed that this was his best suggestion.

 “The internet?” I thought to myself.  “Who is going to hold my hand or hug me on the Internet?”

At that moment I realized I needed a different doctor.  I walked out of his office and never returned.

What I had overlooked was the importance of finding a doctor I meshed with personally.  Not just one who had a prominent title, several clinical trials to his name, and a prestigious academic center standing behind him, but one that could simply look me in the eyes and tell that something wasn’t right.  Someone with empathy and a gentle touch.  Someone I could build a relationship with.

The doctor-patient relationship is delicate; for patients living with chronic conditions or illnesses it means balancing personal rapport with clinical knowledge.  Sometimes all you want are the facts from your doctor.  But sometimes, you want a hug and some encouragement and the personal connection is as healing as any pill.   Keep looking until you find the best of both.

By Phyllis Kritek. As a registered nurse, I feel great pride in my profession. The list of reasons is long. One factor enjoys external validation, nurses have topped Gallup’s Honesty and Ethics ranking of different occupational groups every year but one since they were added in 1999. The exception is 2001, when firefighters were included on the list on a one-time basis, shortly after the September 11th terrorist attacks. I consider it an understandable outlier.  Apparently citizens think we are ethical and honest.

This amazing achievement is no accident. The ethos of nursing, since Nightingale, has gone well beyond the familiar “Do No Harm”. Ours has been an ethos of patient advocacy. We teach and enforce it with the same intensity of focus we give to medication administration. I think of it as a hybrid ethos, merging the principle-based ethics of Lawrence Kohlberg (read masculine) with the relationship-based ethics of Carol Gilligan (read feminine). Early on, as we became increasingly adept at articulating our “Code of Ethics”, the Hastings Center fretted with our fixation on patient advocacy.  We insisted and persisted. I am proud of that.

This persistence about patient advocacy shapes the daily lives of practicing nurses. It is achieved in health care settings where hierarchic structures are designed to protect the hegemonic power of physicians and health care administrators. It is perpetuated in civic discourse. It is rarely visible, often only made public in whistleblower lawsuits where a nurse was fired for being a patient advocate, i.e., challenging a practice or person that puts the patient at risk.  It is complex work, behind the scenes, often made exceedingly difficult and even career threatening.

When I was a very young nurse, a nurse leader advised me as follows: “If you haven’t been fired by the time you reach the age of 30, you probably have been co-opted”.  At the time I found this advice disturbing. Over time, through a number of experiences that pivoted on professional integrity and the cost of protecting it, I have learned the wisdom of her message. I agree with her. (more…)

Disruptive Women Archelle Georgiou was interviewed for the blog below, originally posted on August 21st on Big Think.  In order to be a patient advocate you need to be well informed of the issues, this post reminds us of that:

You may want to think twice before your next visit to the doctor’s office. According to Dr. Barbara Starfield’s now-famous study, iatrogenic deaths (those resulting from treatment by physicians or surgeons) are the third leading cause of mortality in the United States, resulting in the loss of 225,000 lives per year. Of that total, nosocomial (hospital-acquired) infections kill 80,000, physician errors claim 27,000, and unnecessary surgery results in 12,000 deaths.  

But iatrogenic errors aren’t the only reason people should avoid hospitals, says physician and health care administrator Archelle Georgiou. She tells Big Think that relying on doctors may actually shorten your lifespan. Georgiou bases this idea on her studies of the earth’s so-called “blue zones,” isolated communities around the world whose inhabitants live longer and healthier lives than the greater populace.

In the Greek blue zone, the island of Ikaria, inhabitants are more than 4 times more likely to live to age 90 than Americans are—yet there is virtually no health care infrastructure. Georgiou tells us: “There are no hospitals or major surgery capabilities…. People needing emergency care are transported by helicopter to Samos (a neighboring island), and all elective surgery is done in Athens.”

A procedure like an arthroscopy or a hysterectomy that would take 3-5 days in the U.S. consumes 3-5 weeks for Ikarians, who must relocate to Athens for the procedure and convalescence. Therefore, “their threshold for elective surgery is significantly higher than ours,” Georgiou says. The result is that people depend on themselves rather than doctors for non-life threatening ailments. And, knowing that health care is so inconvenient, Ikarians take greater care not to get sick—they eat a healthy diet rich in vegetables and exercise daily.

Our greater access to health care (discounting, of course, the millions of uninsured Americans) might make us more likely to live unhealthfully. “U.S. culture is steeped with a ‘find it and fix it’ mentality,” Georgiou tells us. Rather than try to prevent illnesses, we rely on our doctor’s ability to fix what ails us. And the result is that “we spend significantly more on health care than any other nation but without the benefit of improved outcomes or longevity.” In the U.S., our life expectancy is only 78, yet we spend 2.5 times more money per capita than Japan, the country with the highest life expectancy (82.6 years). One-half to one-third of the $2.2 trillion per year America spends on health care is simply unnecessary, says former AMA chairman Raymond Scalettar. (more…)

By Robin Strongin. Over the next several weeks Disruptive Women will be blogging about the various aspects of patient advocacy.  Then in September, we will disseminate an e-Book on the topic.  To get ready for this series, I invite your input; think about what patient advocacy means to you and share your stories with us. Please comment on this post to let us know what you think about the topic– its level of importance in health care and any questions you may have or experiences you are comfortable sharing.I hope you will join us in this very important dialogue.

Did you miss Disruptive Women bloggers Indu Subaiya, Jane Sarasohn-Kahn, Trisha Torrey, and Regina Holliday this week on the Real Women on Health! Radio series? Or did you hear them, but want to listen again? If so, you can listen to the podcasts now available.