canada reads 2010

Last year, I challenged myself to read all the books selected for Canada Reads 2009. There was only one that I didn't finish (Mercy Among The Children by David Adams Richards) but that was because it was just too relentlessly depressing for me. I had to call it at page 64.

The book that won, The Book Of Negroes (published as Someone Knows My Name in most other countries) by Lawrence Hill had been my favourite read of 2008, so I was happy to see it selected as the winner. I also really enjoyed both runners up - The Outlander by Gil Adamson and and Fruit: A Novel About A Boy And His Nipples by Brian Francis.

It was so interesting to listen to the debate. I had been sure that The Outlander would come second and was surprised when it was beaten by Fruit, which I had read very quickly.

But you know what? A year later, Fruit has stayed with me. It was funny, yes, but also poignant and powerful in a way that I didn't realize as I read it. A year later, and I can still recall all the characters and events very vividly.

This year there are again five books to read. I've already read one of them (Fall On Your Knees by Ann-Marie MacDonald, which was brutal but I loved it) and I'm about half way through Nikolski by Nicholas Dickner (I'm reading it in the original French, as I did with last year's La grosse femme d'à coté est enceinte, by Michel Tremblay and published in English as The Fat Woman Next Door Is Pregnant).

Last year, I came across a Canada Reads challenge hosted by Melanie and Alexis of Roughing It In The Books. It was fun and I've signed up again this year. To participate, send an email to melanie AT roughingitinthebooks DOT com. All are welcome. Last year, I won a prize (thanks to Melanie's daughter for drawing my name out of a hat. She chewed on it a little first. It was sweet).

To do the Roughing It In The Books challenge, all books must be read by March 6. Canada Reads will take place from March 8-12 on CBC radio. If you live outside the listening area, you can download the podcasts or catch it all online.

Shall we read some books together?

The Books:

Fall On Your Knees by Ann-Marie MacDonald, defended by Perdita Felicien

The Jade Peony by Wayson Choy, defended by Samantha Nutt

Generation X by Douglas Coupland, defended by Roland Pemberton

Good to a Fault by Marina Endicott, defended by Simi Sara

Nikolski by Nicholas Dickner, defended by Michel Vézina

The Disease Management Care Blog's 1/3-1/3-1/3 Rule of Physician Engagement

The Disease Management Care Blog has a television cable function called "video on demand." Its push-of-a-button weekly offerings have been more than an occasional source of friction between the DMCB and the spouse. A recent addition has been the latest Star Trek movie. It's excellent plot features the usual combination of Kirk's plucky derring-do, Spock's ironic logic and McCoy's emotional martyrdom, this time pitted against the nefarious and vengeful Romulan Captain Nero. Thankfully, unlike the 'Zombieland' movie option, the DMCB spouse has not exercised her viewing veto power.

Speaking of Star Trek, the DMCB is reminded about physicians. Whether you're a Medical Director for a health insurer, a VP for Medical Affairs at a hospital, the operating room Charge Nurse or the Chief Resident responsible for setting up the physician call schedule, the Kirk-Spock-McCoy triad is a useful lens when it comes to thinking about physician behavior:

Spock-Doctor: Ever the eminent scientist, this evidence-driven logician will accept the merits of a transparently contrived and evidence-based intervention that is reasonable and serves patient needs. When approached by disease management (DM) nurses, asked to change how discharge summaries are dictated, confronted by a change in surgical trays or asked to take call next Saturday, they'll pause, ponder and then say 'OK.'

Kirk-Doctor: Armed with a uncanny degree of intelligence, these physician leaders can reconcile multiple options and find the best if unexpected choice for their patients and their clinical practice. They're unlikely to take the DM nurses' word for it and expect proof that their approach actually works. The discharge summaries will not only be done, they'll probably be shorter, they didn't use all the items on the surgical tray anyway and taking call on Saturday means they won't have to host the mother-in-law for dinner.

McCoy-Doctor: Dammit Jim, they're continuously reminding everyone they're doctors and are not above exercising maximum passive aggressiveness to get their way. Highly unlikely to be convinced that any departure from the norm has any merit, they're not going to cooperate with DM nurses, getting discharge summaries done sooner, changing surgical trays or taking call next Saturday. Unless, of course, they want to.

What does this mean for population-based care management? Spock-Doctors, with little fanfare, will generally accept the merits of patient coaching, cooperate with the nurses, and respond to clinical prompts. Kirk-Doctors need to be convinced and may or may not respond, at least in the usual way or the same way on each patient. McCoy-Doctors will drive the DM nurses crazy even if a general lack of cooperation means they're only involved in a small percentage of the patients.

The DMCB thinks 1/3 of any population of docs are Spock, 1/3 are Kirk and 1/3 are McCoy. Launch a DM program, and 1/3 of the physicians will readily cooperate and be a significant source of patients. The McCoy physicians will generally not buy in without significant effort. It is the Kirk doctors that will be the difference between high and low patient enrollment numbers. They are the key to success or failure. They are the path to a competitive advantage

Succesful care management programs and their nurse-coaches gratefully accept the Spocks, move past the McCoys and focus on the Kirks. The latter are the real key to increased recruitment and achieving high outcomes.

Last but not least, the DMCB predicts that when the patient centered medical home gains traction, the dynamic in the Accountable Care Organizations or the insurance networks will be exactly the same.

Image from Wikipedia

inspired

Last week, a comment was left on my blog that really moved me. It linked to BrCa: Blog on Risk, Cancer and Anxiety (it's an excellent resource if you are interested in learing more about genetic testing and the genes that carry breast cancer).

It seems that the 29 year old woman who writes the blog has been reading mine for a long time. Last week was the first time that she left a comment and it was to tell me about a post she'd written about my blog, called Blogs that inspire me: Not Just About Cancer.

I was so touched by this post. And so pleased to learn that some of my writing has been helpful to others looking for answers.

I write to fill my own needs, of course but it does motivate me to keep going when I learn that I have been striking a chord with others.

The Latest Cavalcade of Risk is Up!

The latest Cavalcade of Risk, dubbed the The New Year Edition is available for your reading pleasure over at Louise Norris' Colorado Health Insurance Insider. This is a compendium of recent and unique blog postings on the topic insurance, business and financial risk. This well written summary will take minutes to peruse and offers up lots of new links and insights. Enjoy!

More On "Should Health Reform Legislation Allow Insurers to Incent Wellness Programs With Carrots and Sticks Made of Cash?"

The Disease Management Care Blog announces that there's an important update to this original January 10 posting on financial incentives and worksite health promotion programs. The authors of the New England Journal article that was referenced have some important comments that should not be missed.

The Politics of Mammography and What It Tells Us About Population-Based Care Management and the Importance of Patient Empowerment

According to the Wall Street Journal, it is likely that the final version of Congress' health reform legislation will disown the mammography guidelines of its United States Preventitive Services Task Force's (USPSTF) recommendations against routine screening for women aged 40-49 years. Rather than stick with the published science that has failed to conclusively show that mammograms reduce death rates from breast cancer, Congress has apparently taken HHS Secretary Sebelius' perspective into account: it's up to insurers to cover women who 'talk to your doctor about your individual history, ask questions, and make the decision that is right for you.'

'Bravo!' says the applauding Disease Management Care Blog.

'What!?' you ask? [Zounds!] This is the same DMCB that typically links more peer-reviewed literature in single posting than most blogs offer in a year? [Sputter!] The evidence-based DMCB that is distrustful of anedcotes, likes to read the original studies and even then, demands methodological transparency and statistical rigor? [Gasp!] The DMCB is okay with Congress jettisoning traditional effectiveness research and letting lay people [Egads!] decide for themselves?

Not only does the DMCB think that is a good idea, but so does the entire disease management industry. In fact, helping patients talk to their doctors and decide for themselves has been a bedrock principle of population-based care coaching for more than ten years. At one level, advocates of disease management argue that patient engagement is far more likely to result in compliance with phyisican recommendations. At a deeper level, empowering patients will result in some persons making a 'wrong choice,' but, in aggregate, lead far more to getting it right. In fact, there's really no such thing as a 'wrong choice' in rigorous care management, because at its core, it assures each patient can decide what to do based on his or her own values and a uniquely personal assessment of the advantages and disadvantages of the proposed testing or treatment. Radical you say? It can be, but this has been around for quite some time.

The DMCB heartily welcomes Ms. Sebelius and a majority of Congress to our fold. Hopefully, they won't stop there, and allow the same approach across all ages and genders in other conditions, such as (for example) cardiovascular disease, depression, prostate cancer screening, and asthma.

the world needs a little more silliness

Formspring is a nifty new site that allows folks to ask each other questions. I'm still figuring it out but it seems like harmless fun.

Go ahead, ask me anything: http://formspring.me/lauriek

I don't promise to answer every question but I will answer the ones that intrigue me.

Have you tried out Formspring? What do you think?

(Oh, and in case you're wondering, this post was not prompted by any contact from Formspring. I just read about it a few times and my curiosity was peaked enough to try it out).