How to Fail at Building a Relationship with a Patient, or, This is How Professional Fitness Cheerleaders Discourage People

June 1st, 2011 by admin

With the current car-free situation, I have been walking at least 2.5 extra miles each day, often more. This is objectively good for me – as long as I avoid cars that don’t bother to stop for pedestrians and too much sun. It’s a positive thing.

Based on my recent experience with folks whose job it is to motivate people to be healthier, I should just be worried and OMG and am practically about to drop dead. Because my blood pressure was 120/70.

No, really. It was a weight and blood pressure check thing, and I was curious about whether the walking had changed my weight any. I should have known better. I already know what ZOMG-GONNA-DROP-DEAD! BMI category I’m in. So this lady looks at my weight, and immediately asks, before the blood pressure cuff even went on, “Do you have any problems with hypertension?” You know, ’cause I’m fat.

I told her no. She took my blood pressure, which was respectable. Especially after this lady’s attitude. Did she ask me if I’d taken any cold medicine or other drugs, like birth control? If I’d had a high sodium meal? If I was a smoker? Did she take a second measurement? Nope. She just told me repeatedly that the top number, 120, was “right on the line.” That’s right on the line of the lowest value of possible “prehypertension,” by the way.

It’s true that the current guidelines now suggest that the top number should be “less than 120.” With a second measurement, mine might have been lower or higher. I’ll be happy to get it measured every so often to make sure it’s still in a decent range, and not higher. But having someone – who is not my care provider, who does not even bother to ask relevant questions – tell me *three separate times* that my blood pressure is “right on the line?” There was no discussion of the bigger picture of my health, just a subtext of “overweight, so let me be smug while looking for something else problematic I should be finding.”

That makes me think that somebody just doesn’t know what to do with somebody who is higher than normal weight yet not explicitly way hypertensive and ZOMG BOUT TO DIE! And it makes me question whether the folks doing the measurements have my actual health in mind or might be fat-phobic a-holes who need to find something, anything, to be judgey about if a person is not a BMI-chart-normal-weight. That’s not exactly a charitable reading, but I can’t properly convey to you the “looked at my weight on a card, and then thought they knew everything there was to know about me” exhibited in this brief interaction. In just a short minute, instead of forming a partnership in which my blood pressure could have been calmly monitored for more information, a hostile relationship was created in which I assume the measurer and her cohort are more interested in stereotypes than health.

Not much good for patient engagement, that.

Filed under: Heart Health

Posted in blood pressure, Health, heart health, patient engagement | Comments Off

2011 Tennessee Women’s Health Report Card Highlights, and a Call to Action

May 11th, 2011 by admin

2011 Tennessee Women's Health Report CardToday marked the release of the 2011 Tennessee Women’s Health Report Card, a publication which provides a snapshot of the health status of women in our state, and the disparities they experience. It’s a handy resource for anyone interested in making a case – or understanding the need – for improved health services and community programs, and includes statistics that clearly illustrate some of the challenges we face.

Among them:

  • 18.4% of us – or almost 1 in 5 – smoked while we were pregnant. The rate is highest (21.4%) among white women, and lower among African American (10.3%) and Hispanic (2.4%) women.
  • African American women experience tremendous disparities in their infant mortality rate, with 16 infant deaths per 1,000 live births, compared to 6 for white women and 6.6 for Hispanic women.
  • About a third of us have high blood pressure, high cholesterol, are obese, and do not “engage in leisure time activity,” or exercise.
  • 16.9% of us live below the poverty line, with disparities here as well – 13.9% of white women, 28.2% of African American women, and 42.1% of Hispanic women meet this depressing criteria.

I would encourage to take a look at the full report [PDF], especially if you are interested in working to improve the health of women and Tennesseans. Just browsing the statistics on reproductive health, sexually transmitted infections, causes of death, risky behaviors, preventive health practices (like cancer screening), and barriers to health care is sure to give you ideas for possible actions to take in your family, neighborhood, county, and state.

This year, I had the privilege of attending the release event for the report at the downtown branch of the Nashville Public Library, and so got to hear some really smart and engaged folks speak about the report and its implications for our communities. Action, or what we do in response to this report, was a major theme.

First up, Dr. Katherine Hartmann of Vanderbilt made a clear call to action, stating that this must be the year we look at this report and say, this is not just public health data, it’s us and our families, and represents many challenges that we must address.

Next, Dr. Jeffrey Balser of Vanderbilt, noted the responsibility of large employers in contributing to the health of their employees and, by extension, the community. He challenged people in places of authority to do active and visible things to improve the health of those around them.

Third up, Dr. Charles Mouton of Meharry Medical College observed that some of his peers have grown weary of hearing about health diaparities and how we have failed to fully addreas them. He then challenged us all to work to eliminate them, calling it our duty to the women this report card represents to eliminate those disparities. He asked the audience to look at the report card as a roadmap for where we have not done well, and where we can and should work to improve health care and access to care for all Tennesseans.

Next, Dr. Stephaine Hale Walker of Vanderbilt began with a review of the good and bad grades on the report card, noting the good news that deaths from diabetes continue to decline, more than 80% of women over 50 had a mammogram in the last two years, and deaths from colorectal cancer are at a low. She also noted that stroke and heart disease rates are very slowly showing trends toward improvement.

The bad news, as we’ve touched on, is that disparities continue for many health issues, such as our African American women being at a much higher risk of having a very low birthweight infant, having an infant die before its first birthday, dying from cervical or breast cancer, or having a sexually transmitted infection. Likewise, social barriers such as poverty, unemployment, and lack of healthcare coverage continue to challenge us.

From there, Dr. Hale Walker moved to an inspiring discussion of the need to ask ourselves “now what?” We can’t just talk about these problems, she said, we need to ask what we can do to be part of the solution, form collaborations, and act to make change.

As an example of her own committment to acting for change, Dr. Hale Walker spoke about the Full Circle organization which works to connect people with the great organizations in Nashville offering free and sliding scale healthcare resources. She also is married to Bishop Joseph Walker of prominent Mount Zion Baptist Church, where the church has implemented the ChurchFit program to provide access to fitness classes to the member community, and health education programs on a variety of topics, partially inspired by the statistics in the 2009 edition of the report card. I had the opportunity to speak to one of Mount Zion’s congregants at the reception after the report release, and found her attitude, story, and words inspiring and motivating as well. Stories shared by other women in conjunction with the report are available on this page.

Finally, Commisioner Susan Cooper of the Tennessee Department of Health spoke, calling for us to be smarter about how we spend our resources, and to focus them in areas of highest risk. She reminded us that significant improvements are not going to happen overnight or on their own, and require time and dedicated action. She highlighted state programs acting to make a difference, like the tobacco Quit Line, and Get Fit Tennessee, the website of which includes a free healthy cookbook I need to check out.

Cooper asked us to think about small personal changes we can make, but to also think about policy. Her vision of policy extends beyond whatever the legislature is or isn’t doing – we are asked to think about how university, urban design, and other policies affect the health of our community, and to ask for these policies to be formed in ways that promote our health.

All of this is a very long-winded way of saying – I left today’s report card launch inspired, and hope seeing the disparities and room for major improvement of the full report inspires you, too.

*Disclosure: Vanderbilt is my larger place of work, and people I’ve worked with worked on this report.

Filed under: Birth, Cancer, Events & Observances, Heart Health, Infectious Diseases, Mental Health, Pregnancy, Women’s Health

Posted in Birth, Cancer, Events & Observances, heart health, Infectious Diseases, Pregnancy, Tennessee, Women's Health | Comments Off

Sunday News Round-Up, Sunny Day Edition

April 4th, 2011 by admin

The New England Journal of Medicine published a freely available Clinical Practice article, “Care of Transsexual Persons.” It covers hormones, surgery, and adolescents. Note that it does use the problematic gender identity “disorder” language as included in the DSM and it also promotes the standard psychological counseling hoops that transgender persons must jump through prior to obtaining treatment – Julia Serano‘s “Whipping Girl” provides a good primer on why those hoops can be problematic. It might be worth checking out what kinds of materials health care providers are seeing regarding these topics, including how they’re problematic.

Relatedly, there’s a possibility that “gender identity disorder” will be renamed “gender incongruence” in the DSM-V.

Laura Chapin at a US News politics blog asks why anti-choice extremism is so commonplace and continuous threats against providers are considered acceptable:

It’s the acceptance of a level of hatred directed at women, especially poor women, seeking reproductive healthcare and abortions. And it’s the acceptance of threats and violence directed at the doctors, staff, and healthcare workers trying to provide it to them.

The Boston Globe has a very brief story illustrating the problem of giving obesity too much focus and attention when diagnosing a patient.

In The Crocodile Tears of Anti-Choice Billboarders, Gaylon Alcarez outlines the failures and disingenuousness of anti-choice billboards targeting Black women. Just read it.

Relatedly, NARAL and SisterSong have partnered to fight such billboards in Texas.

The CDC notes April as STD Awareness Month (can we get that changed to STI?), including some resources for providers and for finding testing.

Studies presented at meetings always have the caveat that they need to be peer-reviewed and have the methods and data published in order for the public to fully review and understand them. However, I wanted to note this recent news item:

New Orleans residents were found to have three times the rate of heart attacks four years after the devastation of Hurricane Katrina than before the storm and levee break that flooded the city, according to a study presented at a major heart meeting on Sunday.

I’ll be interested to see the paper when published; the news item focuses on psychiatric illness, stress, and employment, but I wonder how much people with more financial resources leaving the area and access to care generally play a role.

Via TransTalk, U.S. Department of Health and Human Services Recommended Actions to Improve the Health and Well-Being of Lesbian, Gay, Bisexual, and Transgender Communities, which includes a summary of actions taken and recommendations for future actions. What do you think? Will this make a difference? Have they focused the right way?

The Institute of Medicine released a new report, The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. It’s freely available if you read the PDF online; I haven’t read it yet, so I can’t vouch for how truly inclusive or useful it is.

Note to self: don’t ever move to the Dakotas. Most recently, North Dakota approved abstinence-only sex education.

A worthy rant from tigtog at Hoyden: Don’t mistake expressing contempt for taking offense.

Via Siobhan (who I’ll get to see at a health literacy conference in May – yay!) at BHIC, HHS Launches New Consumer-Focused Immunization Website. The new site is vaccines.gov.

Shameless Self-Promotion: at work, we’re posting staff profiles to our Facebook page leading up to an open house event; here’s mine. I’d appreciate if any personal comments were left here or on my own Facebook page instead of there.

Unrelated to health, except for the insurance aspect: an employer of 500+ people in my hometown is closing. The employees (largely hourly, relatively low wage) of this furniture factory were called together and basically told that – in addition to the upcoming closing – their health insurance was ending effective immediately. If that doesn’t illustrate a major problem with employer-based insurance, I don’t know what does. The county already has an unemployment rate over 10% so I expect those folks will have a hard time finding work; the company had been in town for more than 70 years.

Filed under: Abortion, Abuse, Rape, & Safety, Access, Rights, & Choice, Events & Observances, Heart Health, Infectious Diseases, Laws, Legislation, & Courts, Libraryland, News Round-Ups, Sex & Sex Education, Shameless Self-Promotion, Web Resources

Posted in Abortion, Abuse, Rape, & Safety, Access, Rights, & Choice, Events & Observances, heart health, Infectious Diseases, Laws, Legislation, & Courts, LGBT, Libraryland, News Round-Ups, Obesity, Sex & Sex Education, STIs, transgender, Vaccines, Web Resources, women of color | Comments Off

February Is Heart Month!

February 4th, 2011 by admin

To kick off our month-long focus on heart health here at Women’s Health, contributor Dr. Keri Peterson appeared as a guest on the Today Show this morning discussing heart disease. Check it out! Your heart REALLY wants you to!

And while you’re at it, check out these tips to keeping your ticker in shape:
Are You Stressing Out Your Heart?
Heart Healthy Recipes
5 Steps to A Healthy Heart

read more

Posted in Conditions, Health, heart health | Comments Off