Diets and the dangers of asking Dr Google

It’s 5 days now of being on a liquid diet, and as a true Melburnian I love my food – we are blessed in this city to have lots of great fresh food markets readily accessible and I am/was a frequent visitor to Queen victoria markets on my trusty Amsterdam bike with big baskets to carry all my lovely yummy loot home. All Australians should count themselves very lucky in teh food situation – I was in Norway a few years back and was quite surprised at the lack of variety and lack of fresh food available, many countries work this way and it’s simply a pipe dream to think of going to the supermarket and picking up whatever you like. I’ve had a few friends from Europe come over and just be astonished by the range of fruit and vegetables and particularly now we have a stronger influence and availability of asian vegetables.

If you’re a bit of a foodie too you can probably understand my disappointment and yes I’ll admit fear regarding how long my current menu will last. It can’t be that bad you say, and surely you can’t be that hungry? True on both questions but flavour and taste are something in your brain not your gut, and thankfully my brain seems to be doing just fine (insert random joke regarding my normal state of mind here…).

My menu consists of the following – at about 8am breakfast arrives, it consists of a cup of hot water with the option of a tea bag or sachet of instant coffee, an orange juice and cup of milk. After experiencing what coughing is like with stitches right up your belly I avoid the milk as diary makes you form mucous and often cough – I’m not sure why they give this to people it doesn’t make sense to me. The orange juice is really acidic and very very sweet and when you have nothing in your gut except panadol, tramadol or oxycontin it burns and causes heartburn so i generally avoid that to. Leaving me with the option of tea or coffee which I alternate each day, just to spice things up a bit.

We then move onto lunch which is a small bowl of “vitamised soup” no idea what the heck that means but it’s usually just strained tomato soup, or one day I had a really nice sort of leek and chicken thing or thats what it tastes like – it was sort of whitish in colour. there are other options on the tray – a low fat, gluten free custard which tastes hideous and again sooo much sugar, jelly and a juice of some variety – not fresh people it’s one of those in a round plastic container jobbies that really suxs to open and you generally spill it all over yourself in the process.

And guess what…. dinner is exactly the same as lunch.

after 5 days of this…. it’s getting a little tiring.

So I did what a large proportion of us do when we have a medical question and asked Dr Google.  It’s amazing how many people ask Google health questions and in fact that data has proven useful for a range of government health initiatives – Google can predict flu and other disease outbreaks faster than the government (US) and has now partnered with them to provide these search results in clusters to help reduce spread of disease – thats a pretty cool use of technology in my books.

However the fact that any old schmuck – me included, can post up content onto the interweb means you can thousands of results and it’s hard to know who to trust.
Take me for example I wanted to search for Diet after bowel resection, over 10,000 results and mainly from the states and mainly people leaving their stories. Now I’m a big fan of the social media revolution and the interactivity of todays websites – enabling people to have a voice and share their opinions and stories is great.

10,000 results all saying different things... helpful? no maybe not

It’s not a new thing though talk back radio has been around for years, and I must say that some of the comments on teh health blogs remind me of those rather set in their ways older talk back radio callers who harp on about a specific subject.

But was it useful? no, not really. it was all so contradictory – eat vegetables dont’ eat vegetables, stay away from orange juice, I am never allowed to eat cheese again( my heart did a little skip reading this one, I am a MAJOR cheese fan and life will be a little less rosy if I’m not allowed to indulge in a Delice de Bourgogne or Yarra Valley Persian Fetta… oh yummmmm… sorry as i wipe the dribble from my laptop.

So I asked my surgeon – oh dont’ worry you’ll be able to eat anything.

awesome news, but when? how long will I be on the liquid diet, what do I start eating after that? whats the best type of food to help my body heal? how can I actively take part in my recovery by choosing the right food to nourish and support my bowel healing? Will eating laxative inducing foods like prune juice be a good thing or a bad thing?

I think sometimes people think patients are stupid, and often we dont’ do much to alleviate this myth – there is an aura around surgeons that they know best, that they are gods and that anything they say must be gospel. But I think us patients are smarter than that and I think we need to start asking for more, why isn’t there a dietician here to help me, why isnt’ there a pack for me to read – preferably online through my personal tv screen monitor thing in my room, to learn about different foods and their affect on my bowel be.

Provide me with the information to empower me to make decisions and manage my recovery.

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fart watch steps up a gear…

Day 6 in hospital and I woke up this morning feeling pretty ordinary, guts hurt, head aches, hips and back hurt from not being able to move in bed… just generally feel a bit bleurgh.

I never thought I’d be excited to tell somebody about my flatulence but have bowel surgery and indeed fart watch becomes a very exciting part of your day, that expectant look from the nurse as she pops her head round the curtain and you start to feel a bit dissapointed that no trumping going on here love.

Now I know it’s not ladylike but there is actually something quite nice about the morning fart, you’ve slept all night and some gas has built up and in the morning you let it out and it sort of feels like your starting your day.

When you can’t “pass wind” you know about it, trust me. My guts have been gurgling like nobody’s business and my belly is starting to look like one of those Budhha statues – very rotund… the gas has nowhere to go and it hurts, particularly when it’s trapped in swollen gut.

Lucky for me I was very excited to tell the nurse yesterday that I had in fact achieved that great milestone and parped one out – horraahh!! I was expecting something quite musical a trumpeting sound to herald the next page in my recovery journey, but no, a meek little one but still – it means that air is passing through the pipes and that, is a very good thing.

Hold your horses though… I wasn’t able to bask in my flatulence glory for long as I was immediately then asked the next question in the journey… yes it’s all about the  “end result”. We’ve now stepped up a gear and moved to what I like to call Poowatch….

It’s funny how people have such an aversion to talking about bowel movement’s, fair enough they are waste material and not really that pleasant but it’s been funny watching and listening to the nurses refer to it.

“have you been for a number 2 dear?” “have you made a bowel motion yet?, have your bowels moved? any waste to report?”

and my favourite from my lovely Gynae surgeon – “basically you can’t leave here till you take a shit.” – you can see why I like this guy 🙂

So I sit and wait in my little room, going for walks as often as my painkillers and pain tolerance will allow me too and wait… for that magic moment…

Stay tuned for the next thrilling episode of…. Poo watch!

Poo watch

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If it can’t be measured, it can’t be managed

The digital nirvana talks about measurement as a key to successful projects and making sure you integrate this vital philosophy into your development to ensure you can measure what you built and therefore can manage its future.

So how do we measure the success of ehealth? counting the amount of people who turn up – e.g sign up to a PCEHR will give a good indication of how your consumer marketing activities went but how do you truly measure success that will bring long term financial benefits to our health delivery system?

I’ve never been a particularly big fan of the online model of page impressions – as so many people will go to a page and not even see the ad but this will be counted as one set of “eyeballs” or even going so far as to look at who clicked on your ad, often as is the case with sites like yahoo and others who use popups and slide out adverts you click on things by mistake as it suddenly took over your page and you’ll then press back or close the window – does that get added to the measurement? no i don’t think so. That’s I think why I liked some of the mobile advertising models better, pay per action being added to the end of the continuum. So if someone interacts with your brand through an advertisement – that can be

  • step 1  – passive from having it something they view only – goal being increase brand or product awareness
  • Step 2 – stimulate trial by having a user click on an ad, respond to an sms call out, scan a mobile code, call a number or even go to the store
  • Step 3 – activate sale get the user to commit to something, sign up for a free trial, download a ringtone sample of the new album etc
  • Step 4 – give them the tools to become a brand advocate and create viral marketing possibilities by incentivizing them to tell their friends and in effect start the cycle agin with their own network

Ok that may seem like I went on a weird tangent there but I think we need to have some of that thinking in how we measure ehealth success.

Being in hospital now I  am convinced more than ever it’s about workforce efficiencies. the amount of time wasted by precious resources having to search for things or repeat activities or information that has already been performed/collected. that is where I believe you get the triple whammy or trifecta result; happier workforce as not as stressed running around led by machines beeping at them, rather than supporting them in their jobs. happier patient as more face time spent on care versus admin and things happen more quickly, Last bit by no means least happy financial situation as cost of care per patient is reduced and activities per resource improve.

This gives you the various levers of measurement to be able to create driver models to manage your success, by measuring those areas and understanding what drives the uptake you can create work plans to drive results and lead to the end result of improved efficiencies.

step 1 is going to have to be to get the systems to speak the same language in order to send or share across applications and repositories of data and have the right meaning so that system 1 calls it the same thing as system 2. Be that a nurse writing a temperature down on a paper record at the end of the bed to the electronic in your ear thingy( I know so technical!!) sending the temperature data to an electronic record via bluetooth or when it’s back in its hub.

I’d be interested to know what the KPI’s the government has set out for the ROI on their $1billion dollar investment in ehealth are – what are they measuring as success? As a taxpayer I want it to be leading to a reduced healthcare bill for all Australians(and those pesky kiwi’s who live here and pay taxes too)

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where is my surgeon?

when you’re in hospital a lot of your day is spent waiting. for your next dose of painkillers, for your daily shower, for someone to answer the buzzer to help you to the toilet, and my favourite of all the daily 5minutes with the surgeon.


You never really know when he’ll pop by as he consults at a number of clinics, does surgery and I think he might even teach as well – a very busy man.
Wouldn’t it be good if there was a tracker or something on his mobile that alerted when he was out of surgery or heading up to the ward so that the patients could be ready to see him, information and obs prepared? a lot of his time is wasted as well as sometimes the patients went for a walk or had their shower or haven’t had their obs (temp, blood pressure, etc) done.
I’m not saying we should ask the surgeons to have to check in or check out of places. I read a scary report about how log doctors spend actually logging in and out of systems everyday – what a waste of such valuable resource!! lets aim for invisible technology people!
Maybe a readable card that they wear around their neck or in their wallet that has a RFID signal or reader that can send a message to the key people – i.e secretary at his clinic and head nurse on duty of the wards he has patients in.
Maybe even if he has an iPad or some sort of table it could push him the key summary data of that patient since his last visit – so they know what they need to concentrate on.
Just a thought…

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broadband connection is useless!

been trying to upload a video – only 1 minute taken on iphone so about 100mb, and it’s just too slow, can’t do it. Very frustrating I wanted to walk you through the screen in my room that has some health info on it, a fingerprint scanner as ID recognition and a few other things, but really falls short of the mark, it’s like they had all the ingredients to make a beautiful meal but ended up with bland soup.
I really do believe if we look at a typical change agenda that you might do in business consultancy or analysis – you say what is the lay of the land today and what do we want it to be tomorrow. Then cut that by the stakeholder groups – e.g patients, GP, Nurse, Hospitals, educators – and then talk to them about how we move from a to b. come together to look and see where the synergies are and most importantly the priorities.
It’s no use consumers getting excited about being able to sing up for a personal health record in June 2012 only to find it actually doesn’t benefit them that much, it’s a barcode on the end of their existing prescription that doesn’t save them anytime or make it more convenient to fill out a script – I know ti’s a first step yadda yadda.
I believe if we want to share and access information we need to make sure we are talking the same language – clinical terminology to me is step 1.
Incentivizing software vendors to open up API’s or enable data to be searched and retrieved or sent through to other applications – how we do this in the competitive software vendor market will be interesting.
Will medical director let a GP clinic using a rival software search through their system to access patient data after consent has been given? I guess this goes back to that big old question – who owns the patient health data?
We need to respect and maintain a competitive revenue generating environment for vendors in the health space, it is and will continue to be a major industry supporting jobs, innovation and potential overseas investment – we need to remember that. It’s funny how GP’s – or at least most of the ones I’ve met talk about getting compensated to put a patient on a pcehr, or a medicare rebate or government funding before they will participate in the ehealth conversation – yet software vendors and industry meet regularly “off the clock” to discuss ways to work together they just haven’t been given the framework and governance of how to do so.
Saying that I know there are some very good GP’s and specialists out there as well who live and breath eHealth and how to get Australia to this new world we all are talking about.
If it really is about being patient centric – we need to think like a consumer – not a doctor or vendor protecting their IP.
I want to go to a GP, specialist, hospital admission, hospital a&E and have them be able to access a topline summary of all my current medicines, allergies, surgeries I’ve had. I want the systems to be able to talk to each other so if a doctor in Queensland wants to search through all my blood tests I had over the 5 years I lived in Victoria to see how my iron levels were can easily do so – not have to request a PDF file and print them out and read through them all. In actual fact I the patient would quite like to access that information to see a graph of my iron levels and then I could perhaps choose to put big life events in there two – being made redundant, surgery, major diet or lifestyle changes – to see how those “non medical” things tie into it.
I don’t want to every 3 months think – oh bugger where did I put the repeat prescription thingy? I’d like to be able go to the pharmacist wave my medicare card or health identifier I dont’ care whatever card I always have – and get an up to date script.
I want to be able to email my GP to get a script repeated, most script repeats do not actually need a GP to do anything. so why can’t they just read through these at the end of the day and click an approve button – my gut feeling is it’s something to do with rebates from the government that you get more if you see someone… surely thats a scary system to be living in if thats the case?
I want to turn up to clinic and sit in a chair that does my obs for me by a student or junior nurse so that when I go see the specialist or GP they have what they need already and can just administer the care, hopefully meaning it’s not a 2hour wait to the see the surgeon as per usual.
Make my life easier, put in infrastructure and systems to save me time and maximise resource within the health system to save my tax dollar.
It’s not that hard really 🙂

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will social media move the specialists fee’s and performance into the open?

It’s 4am, in theory I should be asleep but I’m not I”m in bed feeling pretty crappy and i can’t sleep. The wound has been really sore this evening, everywhere I move it pinches or pulls on top of the dull ache. Luckily i have a PCA morphine drip but any thoughts of feeling like I was on drugs are not true at all, it just takes the pain away for a bit, and helps me sleep.

If anyone out there has anything to do with hospital beds, could you please invent something so the pillow is attached somehow to the top of the bed, when your bed reclines and you sit it up to breath easier as a lot of people in recovery do, it’s a right pain when the pillow always slips down.

So I”m still not sure how much I will be out of pocket for this surgery, and in fact I’m still not really sure about much – how long will I be in here for, what can I expect, when will i start eating food, what sort of food, how long will the bleeding last – etc etc.

THe nifty little screen over my bed has some health info but to be honest not much – it has an internet connection to so I”m quite surprised they didn’t take the small effort to link up the various societies like diabetes Australia, bowel cancer etc to have accredited information on there. Or you know what? let people ask questions and if you don’t have the answer that gives you a really powerful survey tool to understand what patients are worried about. don’t be scared to let patients get involved in their own care.

Many industries have been revolutionized by the internet and in particular the web2.0 way of doing things of commenting and sharing with others and moving to a “power of the crowd” mentality. It would be nice for this to happen to happen to surgeons and specialists. So you can go to a department of health website and say I am having this surgery and they give you a guide – I guess you could say like a what to expect when you’re expecting..  but for “XX” surgery.

you can see what the average medicare costs cover what your area hospitals charge and the types of surgeons in your area and read comments from patients and others from them – I guess a combination of domain.com.au with real estate prices and information and searchable functions married with restaurant reviews on something like eatability.

Right I think I’ll try and get some sleep now, it’s not the worst pain I’ve ever had thats for sure but it’s really uncomfortable and each time you move or get gas it feels like you got stabbed… ouchie.

 

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post surgery

I awoke to a fuzzy world of bright lights and those soothing, pitched loud nurse voices – “can you hear me dear” as i began to get back to the land of the living. 4 hours of surgery removal of a bunch of endometriosis and a resection of 8cm of bowel… No wonder I feel like I got hit by a truck.

I have tubes coming out of pretty much every orifice and feel rather ordinary to say the least, but I know that it will hopefully lead to a better pain free life once I heal so thats the thing to cling onto at present.

I get wheeled to my room where my mother and partner are waiting, they were getting quite anxious as nobody had told them what was happening, I was quite surprised they didn’t call or text Matt and tell him she’s out of surgery – he is down as my contact. I would have been flippen out if the shoe was on the other foot, it is such a frustrating thing to wait for a loved one in surgery, you feel really helpless i mean what can you really do but wait?

Maybe one day they will do the things like runners where people get a geotag when they go into surgery and loved ones are securely allowed to access it to see if still in surgery or in recovery, or maybe it automatically alerts when it bypasses the doors of the OR or post op recovery room – saving precious theatre nurse time from yet more admin.

I am excited to see I have a room to myself with a big window, looking out to a nother building but it’s still nice to be able to see the sky. I have a whole bunch of machines in here.

A touch TV screen which I can pay to watch tv – well actually only some tv – booo only sports, where is discovery and Arena? thats a bit cheeky to say $14 a day for access to all cable tv channels when it’s not really at all. Well they do have free wireless in the room thats good news.

touch screen based questions for nurse to ask patient

 

 

The touch screen also acts as a system for teh nurses to capture patient obs – although by the looks of it only question based stuff like – has the patient passed wind, what is the pain from 1-5 etc. The Obs are still taken every 2 hours and it’s not really possible to sleep through.

 

 

Check drip to see how empty bag is, it beeps madly when it’s empty. Check morphine drip in PCA – this again beeps madly. Check drainage tube from the wound, check catheter and empty of needed – this doesn’t beep but feels rather uncomfortable if nobody empties it for a while, same goes with other tube… lets just call it the other tube. And finally oxygen mask checked – blood pressure taken and pulse oximeter.

I am positive there are better ways technology can improve that process, I get that blood pressure needs to be taken but is there a way it can be done automatically or wear a pulse monitor and if the pulse goes down or up then trigger need for BP?

To be honest I think the most useful tool in here, apart from my pain meds as I would be in agony without them! is the whiteboard where the different nurses and care staff – physio etc leave notes for each other.

Beeep!!!

 

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