I'm impressed by how much we struggle with seemingly simple health decisions when faced with sorting through too much information. Buying sunscreen: It's a simple task, right? Most of us do it every year about this time. And among actions we can take to reduce our risk of cancer in general and skin cancer specifically, this choice is fairly important. So my colleague was surprised to hear this snippet of conversation as she contemplated ...

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Media-fueled flip-flops and research breakthroughs on lifestyle and health behaviors are wearing down my usual patience with the provisional nature of science. Even simple dietary recommendations like ...

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I know the ropes at the VA ... I'll pick up the phone in a heartbeat and call my senator and get what I need right away. A lot of guys aren't like that. –Max Gruzen, PTSD patient, Vietnam veteran from the New York Times So this is what it means to be an "engaged" patient in the VA system today. You have to know a senator who will intervene on your ...

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"All patients are alike. This one complains about the same things that the last one did." "Every patient is unique. We can never find a way to make each one of them happy." Remember that 1980s public health paradox: Do you focus on intensive interventions that might produce significant improvements in outcomes for a defined, high-risk group or do you direct energy to system-level changes that may achieve more modest outcomes ...

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Remember in second grade when you realized that you could say the word "giraffe" 25 times and it would lose its meaning, shed the image of that gawky creature and turn into a little pile of meaningless sound? You know, when you had your first insight into the wonders of language? I was reminded of this experience when, at a conference about patient engagement in health care, the word "dignity" was ...

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I heard this on the radio recently: Mom takes her new baby to the emergency department on a weekend because she thinks her daughter might have a urinary tract infection. She's right, but regulations say the baby has to stay in the hospital for two days to ensure the infection clears. Afterwards, the mom is surprised by and concerned about a $7,000 hospital bill for the baby's care. The reporter says ...

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There's a pesky cognitive bias that creates a honking big barrier to patients and families making the most of the health advice and services available to us. It's the tendency of experts to overestimate the knowledge of others. One consequence of expertise -- or even just easy familiarity with a topic or institution or practice -- is the inability to remember not knowing what you now know. Think back to your ...

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It looks like an airport lounge without the rolling suitcases. There are about 20 of us cancer survivor-types fiddling with our phones or reading the newspaper. A few of us are sipping delicious contrast fluid in preparation for a scan, but most of us are waiting to meet with our oncologists for follow-up or monitoring visits. All of us are between the ages of 20 and 70 and all of ...

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Do I value the privacy of my health information? What do you mean? That if I email my doctor about an embarrassing symptom, only my doctor will read it? That only my doctor, my nurse and I have access to the information in my electronic medical record, including notes on our confidential conversations, prescriptions and test results? That my local drug store doesn't sell information about me to pharmaceutical companies? That ...

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Twitter -- its functions, benefits, risks and limitations -- has figured prominently in the heated discussion about Emma and Bill Keller's respective editorials in The Guardian (since deleted, though the archived version is still available) and the New York Times about the Twitter feed of Lisa Bonchek Adams. I have followed Lisa for a long time and greatly admire her thoughtful, highly personal tweets about the ups and downs of ...

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Overheard in the gym: "Yeah, but I heard that ____ can be dangerous." "Oh, they wouldn't let us buy it if it was." Lately, the public's faith in the safety of prescription and over-the-counter drugs has been making me uneasy. Advances in drug development mean that many of us truly can live better lives through their wise use. But are we adequately guided and protected by a) regulators, b) our clinicians, c) a ...

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What can we learn from an experiment conducted on a single person? That is, when the subject population (N) is a single person, aka N=1? How and how much do such findings contribute to knowledge about the experimental intervention? How relevant are results to other patients or populations or diseases? In assessing what is known about a phenomenon, how are these findings treated in comparison to studies with 30 or ...

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You may have noticed an uptick in messages from your health plan or clinician notifying you that "You are the captain of your health care team." I have seen them here and here and here and here, for example. My response to this message? Bad metaphor: I am not the captain of my health care team. I may -- on some days -- consider myself a member of that team, should I actually ...

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Current efforts of clinicians, hospitals and researchers to make health care more "patient-centered" include inviting some of us to advise on research priorities, care organization and delivery under the assumption that, as patients, we understand what patient-centered outcomes and care are. These invitations and our acceptance of them often result in confusion and disappointment for everyone, regardless of good intentions. What do patients know about the inner workings of ...

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glass-faces Remember the figure-ground drawing from psychology 101 that demonstrates (ahem) "how edge assignment designates perceptual groupings?" I always just thought it was cool how you could look at the picture of a vase and blink and -- whoa, Nellie -- now you saw two people face-to-face. I'm concerned that the frantic drive toward evidence-based medicine as a strategy for quality improvement and ...

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Outsourcing work to cheaper workers is a common strategy of corporations. It has largely escaped the public's notice, however, that much of this new labor force isn't located in Southeast Asia, but is rather found here in the U.S. and is virtually free. It is we, using our laptops and smartphones to perform tasks once carried out by knowledgeable salespeople and service representatives. This was particularly salient to me this week: ...

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Recently, both my husband and I came away from a conversation with my doctor positive that we understood my new weight gain plan. Funny thing: Each of us recalled a different plan. I am always struck by how our memories of the words spoken by my doctor can be so dissimilar. No, not all of them, but enough of them to be wary of going to any appointment without a ...

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One of my doctors always asks if he can examine me before he starts. He identifies each body part he is going to touch as a question. I feel like I can always say, "No ear exam today, thank you." Or alternately, "I've been having a little pain in my left ear. Can you check it?" Tiny point. Subtle. But by merely asking me, my doctor signals that I am not ...

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"Health care costs are sky-rocketing!" "The percentage of the U.S. GDP devoted to heath care costs is the highest in the world." "The cost of Medicare is unsustainable." For most of us, the cost of health care (i.e., the dollars required by the system to produce and deliver care) isn't what brings us the most anxiety. It's when we're patients or helping a loved one find care that so many of us are deeply ...

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Have you noticed that most sick characters on TV shows look pretty good and are coherent -- often feisty -- even when they are in the hospital? Have you caught the number of ads for drugs and health plans showing happy, vigorous people that dominate the major consumer health websites and are common on TV? Have you noted that websites of disease voluntary organizations (lungcancerCrohn's diseasearthritis) tend to show healthy people participating in "fun runs" or ...

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