Health Hats, the Podcast

By Danny van Leeuwen, Health Hats

Learning with people on the journey toward best health.... more

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June 26, 2022 Family, a Magic Lever of Best Health. 3 Danny van Leeuwen’s
Introducing 3 generations of Danny van Leeuwen's. Inclusive, blood, intentional family lore. Spiritual health can come from family. From the Holocaust to today.
Blog subscribers: Listen to the podcast here. Scroll down through show notes to read the post.
Subscribe to Health Hats, the Podcast, on your favorite podcast player
Please support my blog and podcast.
CONTRIBUTE HERE
Episode Notes
Prefer to read, experience impaired hearing or deafness?
Find FULL TRANSCRIPT at the end of the other show notes or download the printable transcript here
Contents with Time-Stamped Headings
to listen where you want to listen or read where you want to read (heading. time on podcast xx:xx. page # on the transcript)

Proem.. 2
Catching up 02:29. 2
We’re all three well partnered 03:22. 2
Forgetfulness runs in the family 04:27. 3
The meaning of our name 05:07. 3
Music in our lives 07:08. 4
Uncle Danny’s feeling it 09:22. 4
The team: care coordination and family 10:21. 5
Sleep 13:04. 5
The life of Danny III 14:06. 6
Joey van Leeuwen 15:16. 6
Visiting Morocco 18:06. 7
Danny III’s health 20:32. 8
Travel and language 22:47. 8
More about Morocco 23:34. 9
Uncle Danny, tell us a story 24:30. 9
Opa returning from the concentration camp 26:00. 10
Israel and the Kibbutz 27:28. 10
Screwed up paperwork 29:26. 11
First meeting my Uncle Danny 30:48. 11
My dad, Ruben van Leeuwen 31:47. 12
Uncle Danny’s first wedding 32:34. 12
Danny III’s calming voice 33:24. 12
Uncle Danny’s 90th Party 34:40. 13
Concentration camp, faith, draft counseling 35:13. 13
We’re van Leeuwen’s 39:40. 14
Uncle Danny in Jerusalem 42:19. 15
Reflection 45:03. 15
Please comment and ask questions
at the comment section at the bottom of the show notes
on LinkedIn
via email
DM on Instagram or Twitter to @healthhats
Credits
Music by permission from Joey van Leeuwen, Drummer, Composer, Arranger
Web and Social Media Coach Kayla Nelson @lifeoflesion
The views and opinions presented in this podcast and publication are solely the responsibility of the author, Danny van Leeuwen, and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute® (PCORI®), its Board of Governors or Methodology Committee.
Sponsored by Abridge
Inspired by and grateful to Henri B, Evaline, Nathan, Kato, Leon, Ruben, Daniel, Lea van Leeuwen

Links
Crescendo Baby Music on a Facebook page
Danny III on SoundCloud,
Fireship first recorded by (the Weavers)
Peter Paul and Moses playing Ring Around the Roses.
September Song.
City of Chefchaouen
Rabat
kibbutz
Unilever
Kathy’s Consulting
Related podcasts
About the Show
Welcome to Health Hats, learning on the journey toward best health. I am Danny van Leeuwen, a two-legged, old, cisgender, white man with privilege, living in a food oasis, who can afford many hats and knows a little about a lot of healthcare and a lot about very little. Most people wear hats one at a time, but I wear them all at once. I'm the Rosetta Stone of Healthcare. We will listen and learn about what it takes to adjust to life's realities in the awesome circus of healthcare. Let's make some sense of all this.
To subscribe go to https://health-hats.com/
Creative Commons Licensing
The material found on this website created by me is Open Source and licensed under Creative Commons Attribution. Anyone may use the material (written, audio, or video) freely at no charge. Please cite the source as: ‘From Danny van Leeuwen, Health Hats. (including the link to my website). I welcome edits and improvements. Please let me know. [email protected]. The material on this site created by others is theirs and use follows their guidelines.
The Show
Proem
I talked about the magic levers of best health in my first blog posts in 2012 – ten years and 535 posts and episodes ago—pretty mundane stuff – hydration, rest, diet, exercise, and team. The most important team – you and yours, family, however you define that. I am a van Leeuwen. That’s my blood and relations family. We are a kooky, solid, kid-oriented, widely dispersed, mostly get along sometimes, clan. I’m proud to be a van Leeuwen. I take the opportunity to introduce some of my family – the three Dans. My Uncle Danny just turned 90. The youngest of six, the patriarch, lives in Utica, NY, with his wife, Beth. He’s had four heart bypasses, and until a few years ago, he played basketball every week and, recently, pickleball. Covid set him back. Strength of spirit is a van Leeuwen trait. I, Cousin Danny, almost 70, live in Arlington, MA, with my wife, Ann. You know me already. My cousin David’s son, Danny III, 26, lives in Morocco with his partner, Leslie, and teaches music. Three generations of Dans.
Danny Health Hats: All right. So here we are. The three Dans, Danny. We’ve got an old fart, a middle fart, and a young fart.
Danny III: Yes, and a cat.
Danny Health Hats: Uncle Danny, how are you feeling?
Uncle Danny: Slowly getting there. I regressed. I got better. I was playing pickleball, then regressed, and I can't go very far. I could do it like a six-minute walk, and I get out of breath.
Danny Health Hats: Okay. And you have the bleeding?
Uncle Danny: Oh, my nose bleeds. I don't know. I got all kinds of; I can go from head to toe and something wrong with almost every part of my body. Ugh.
Danny Health Hats: Are you thoroughly discouraged?
Uncle Danny: Sometimes I am, yeah. But no, then something gets better.
We’re all three well partnered
Danny Health Hats: And you're still married.
Uncle Danny: I'm still married, and I don't know what I would do without my wife.
Danny Health Hats: I understand that. And Dan, you're still with your partner?
Danny III: Yeah. She's over there in the other room. I promise she's real
Danny Health Hats: How long have you been together?
Danny III: Since May of 2020.
Danny Health Hats: Wow. Close to two years. Uncle Danny, how long have you been together?
Uncle Danny: 34 years
Danny Health Hats: I’ve got you guys beat – 46 years. That's ridiculous, isn't it?
Uncle Danny: You only had to do it once.
Danny Health Hats: I lucked out on the first round.
Uncle Danny: I lucked out twice.
Forgetfulness runs in the family
Danny Health Hats: I want to recognize that we spoke a couple of weeks ago, and I forgot to record the chat. Nobody was surprised.
Uncle Danny: There’s a lot of stories about your grandfather forgetting.
Danny Health Hats: Yeah. So, tell one.
Uncle Danny: I understand that he had an audience with the queen (of Netherlands), and his zipper was open.
The meaning of our name
Danny Health Hats: We decided last time that Daniel meant The Judge, something like that.
Danny III: God's Judge
Uncle Danny: Dan is judge, and el is God.
Danny Health Hats: Is that judging God or judged by God?
Uncle Danny: Not a judge of God. Not meaning that you're judging God, but you're one of God's judges.
Danny III: I didn’t know that.
Some say Daniel means God is my judge, others God’s judge. Daniel was a Hebrew prophet whose story is told in the Book of Daniel in the Old Testament. He lived during the Jewish captivity in Babylon, where he served in the king's court, rising to prominence by interpreting the king's dreams. Our Uncle Leon van Leeuwen was an interpreter of dreams. He hosted a dream group in Manhattan for more than 30 years. People would tell their dream, and they’d go around the room, if this were my dream, it would mean…
Danny Health Hats: What did we decide van Leeuwen meant? We decided it meant the lion or something mundane.
Danny III: Tombstone.
Uncle Danny: Yeah. Tombstone. That's what I remember.
Danny Health Hats: We decided to go for the lion Daniel of the Lion. It's more poetic.
Music in our lives
Danny Health Hats: What can I tell you guys about? I've been playing a lot of music. I had a rehearsal last night. We haven't played in four months because of the weather, and some people didn't want to play indoors, but we got together a couple of nights ago. My bandmates thought it showed I'd been rehearsing and that I was much better. I couldn't tell, but they could, so that was nice.
Danny III: That's all that matters.
Danny Health Hats: How about you, Cousin Danny? How's your music going?
Danny III: I've been practicing a lot, too. I've been practicing flamenco techniques and some electric guitar stuff for my students. I have to learn a lot of new songs because the kids want to learn things I've never played before. All I learned how to do was entertain myself with the guitar, which only goes so far. So, I've enjoyed that. I don't play a lot of Moroccan music. I'm familiar with some of one of the basic rhythms, but that's about it. We do a couple of songs in Moroccan Arabic, but they're not very Moroccan in how they're made up musically.
Danny Health Hats: And who's we?
Danny III: We is my organization group thing that I'm a part of - Crescendo. I think it's Crescendo Baby Music. They go to different schools and hold classes and stuff for babies, sometimes with their parents or other family members. Teach kids basic elements of music and rhythm and expose them to stuff like that.
Danny Health Hats: Is any of your music on YouTube or anything like that?
Danny III: I have some old songs on SoundCloud, and maybe there's some stuff on YouTube. And with me with the work that I do. I know we have a YouTube. We have a Facebook page and probably some of the base Facebook videos. And we're going to have a concert next weekend. So, I'll probably be in that video for that.
Uncle Danny’s feeling it
Danny Health Hats: Uncle Danny, what do you want to tell whoever might be watching or listening to this?
Uncle Danny: I miss them all....
...more
47min
June 12, 2022 Collaborative Notes, Engaged Partners, Fewer Errors
Patients, care partners & clinicians can reduce record errors with collaborative notes. Dr. Peter Elias shares his note-writing with collaborative partners.
Blog subscribers: Listen to the podcast here. Scroll down through show notes to read the post.
Subscribe to Health Hats, the Podcast, on your favorite podcast player
Please support my blog and podcast.
CONTRIBUTE HERE
Episode Notes
Prefer to read, experience impaired hearing or deafness?
Find FULL TRANSCRIPT at the end of the other show notes or download the printable transcript here
Contents with Time-Stamped Headings
to listen where you want to listen or read where you want to read (heading. time on podcast xx:xx. page # on the transcript)
Proem.. 1
Introducing Peter Elias 01:41. 2
Medical documentation over the years 02:42. 2
Records go from paper to electronic 05:55. 3
Copies of doctors’ notes to patients, sometimes 7:16. 3
Always 10:28. 4
Patients feel reassured 11:21. 4
Care planning and collaborative notes 12:20. 4
Challenging conversations 12:46. 4
Families, records, getting it right 14:00. 5
Using a scribe to assist with documentation 15:16. 5
Misdiagnosis and long-standing error 16:24. 5
Preserving data, accurate data, workarounds 18:02. 6
Insurance companies 20:24. 6
Open Notes, relationships with clinicians 21:27. 6
Not at your best at the doctor’s office 22:13. 6
Getting the most out of it 24:10. 7
Coaching other docs 25:04. 7
Emerging issues 26:40. 8
For other clinicians 27:36. 8
Reflection 29:12. 9
Please comment and ask questions
at the comment section at the bottom of the show notes
on LinkedIn
via email
DM on Instagram or Twitter to @healthhats
Credits
Music by permission from Joey van Leeuwen, Drummer, Composer, Arranger
Web and Social Media Coach Kayla Nelson @lifeoflesion
The views and opinions presented in this podcast and publication are solely the responsibility of the author, Danny van Leeuwen, and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute® (PCORI®), its Board of Governors or Methodology Committee.
Sponsored by Abridge
Inspired by and grateful to Liz Salmi, Tom Delbanco, Danny Sands, Janice Tufte, Alexis Snyder, Jan Oldenburg, Virginia Lorenzi
Links
Society for Participatory Medicine
How accurate is the medical record? A comparison of the physician’s note with a concealed audio recording in unannounced standardized patient encounters in the Journal of Informatics in Health and Biomedicine
How to Correct Errors in Your Medical Records
Correcting Errors In the Electronic Medical Record
Impact of Electronic Health Record Systems on Information Integrity: Quality and Safety Implications
Beat cancer? Your Medicare Advantage plan might still be billing for it.
Related podcasts
https://health-hats.com/pod168/
https://health-hats.com/opennotes-a-gold-mine-of-community-organizing/
https://health-hats.com/misdiagnosis-how-can-patients-help-doctors/
About the Show
Welcome to Health Hats, learning on the journey toward best health. I am Danny van Leeuwen, a two-legged, old, cisgender, white man with privilege, living in a food oasis, who can afford many hats and knows a little about a lot of healthcare and a lot about very little. Most people wear hats one at a time, but I wear them all at once. I'm the Rosetta Stone of Healthcare. We will listen and learn about what it takes to adjust to life's realities in the awesome circus of healthcare. Let's make some sense of all this.
To subscribe go to https://health-hats.com/
Creative Commons Licensing
The material found on this website created by me is Open Source and licensed under Creative Commons Attribution. Anyone may use the material (written, audio, or video) freely at no charge. Please cite the source as: ‘From Danny van Leeuwen, Health Hats. (including the link to my website). I welcome edits and improvements. Please let me know. [email protected]. The material on this site created by others is theirs and use follows their guidelines.
The Show
Proem
Expecting an error-free medical record seems unreasonable - too many opportunities, too many forces, too many players, too many perspectives. Not having error prevention and correction hardwired into our workflow and documentation processes also seem unreasonable. Last week we spoke with Virginia Lorenzi about technical solutions to correcting errors in medical documentation. Virginia talked about information system solutions to aid human problems and solutions and understanding the different types of errors. This week I read an article in the Washington Post about mining records for outdated data to enhance billing. Another level of error.
As with any concern, the more you discover, the less you know. I do know that the endpoint is best health. Going upstream – best health includes community and personal habits, which comprise care, treatment, and policy decisions. Upstream from that is analysis and interpretation of data and at the source is data itself, the more accurate, the better. Or moving back downstream – accurate, relevant, accessible data with analysis and interpretation of that data, finally, informing action for best health.
Introducing Peter Elias
Today, Peter Elias, a family practice doc, joins us to discuss his documentation journey. Peter is retired from active primary care after 38 years as a family physician in Maine. We met at the Society for Participatory Medicine, working on several projects together.
Medical documentation over the years
Health Hats: Yeah. Peter, what I wanted to talk to you about is three things. I wanted an all related to documentation errors in the EHR. The risk of errors, preventing and fixing errors for patients and clinicians. So that's huge, and I'm not looking to be comprehensive. More to think about just talking with you about your take on those and how you manage those in your experience as a physician. So, start anywhere.
Peter Elias: I'm part of the cohort that did my medical document on paper for a long time and then switched to digital. And medical areas are very different in those two circumstances. I don't think many people are doing it on paper purely anymore. I won't talk much about that unless it comes up personally. The computers are trade-offs. The digital records provide certain scaling and efficiency at the cost of flexibility and individuality. So, in the paper world, you can write down pretty much any word you want for a diagnosis or symptom. And in the digital world, we're often stuck picking a checkbox or a number from a predetermined list. So, the system is based on some artificial, external constraints that a background error it's it would be as if you were told to go grocery shopping and give it a list of fruits that only had four fruits on it. And if you wanted one of those four fruits, you were all set, but if you wanted a fruit that wasn't on the list, you were stuck. So that's one part. Another part is that the documentation has been done over time, mainly after the visit.
Health Hats: Okay. So, I see my doctor. We do what we do. And then, at the end of the day, they're documenting.
Peter Elias: Yes. Okay. And for several years in the old paper world, I would take a pile of charts home at the end of the day with my little handheld Dictaphone, lock myself in a small room, and sit down with the charts and some I took and dictate notes. Then somebody would transcribe and put them; very few systems ask the clinician to review the transcription. So, I dictated mistakes, and the transcriptionist misunderstood what I said, and it got pasted into the chart, and it didn't show up again until it was a problem.
Records go from paper to electronic
Nobody I knew was counting or paying attention. It changed a little bit when documentation became part of the reimbursement system. But I am old. So, when I started, we decided what we charged and whether the patient or the insurance company paid or they didn't. And nobody ever looked at their chart to see, and with the electronic record, The documentation is a huge factor in reimbursement. And so that number one that's pressure, if you don't use the right terms, the reimbursement goes down. So obviously, there's some pressure to use the most remunerative terms that you can imagine, or to check three boxes, because you mentioned one of those three things, not because you dealt with it. There is that pressure. I liked to consider myself immune to that pressure, but I'm human. So, I doubt that I was as immune as I pretended. For me, a transformative thing happened two-thirds of the way through my practicing era. It changed the way I approached documentation. It was named primarily at error. But it had a huge impact on accuracy and errors.
Copies of doctors’ notes to patients, sometimes
Should I describe that? I saw a couple for a relatively long visit about a new complicated diagnosis. It was going to require that they get specialty care in a couple of different places besides my primary care. And we made a plan. They were young artists, an engaged couple. And at the end of the visit, I reminded them that our medical record system in this country is fractured and not very responsive. And if they needed it to steward their information, I told them to ask for a copy of every test, every x-ray, and every note or letter. And organize it in a binder and bring it to all their visits because that was the only way they would be sure each person saw what the last person did on the way out. My patient's wife smiled at me and nailed me to the wall. She said, how do we get a copy of your note? And until that day, I had never given a patient a copy of their note that I could recall. So that night, when I was making their note At a somewhat different mindset. I was doing the note,...
...more
31min
June 05, 2022 Garbage In Electronic Data is Faster Garbage
How can medical document errors become easy to fix, everywhere the error lives, & fit in the workflow? Virginia Lorenzi and HL7's Patient Empowerment Workgroup.
Blog subscribers: Listen to the podcast here. Scroll down through show notes to read the post.
Subscribe to Health Hats, the Podcast, on your favorite podcast player
Please support my blog and podcast.
CONTRIBUTE HERE
Episode Notes
Prefer to read, experience impaired hearing or deafness?
Find FULL TRANSCRIPT at the end of the other show notes or download the printable transcript here
Contents with Time-Stamped Headings
to listen where you want to listen or read where you want to read (heading. time on podcast xx:xx. page # on the transcript)
Proem.. 1
Introducing Virginia Lorenzi 03:31. 2
HL7's Patient Empowerment Workgroup 04:56. 2
An intelligent customer understands some of the technical 05:45. 2
Requests for corrections – a sign of engagement 07:12. 3
Fixing errors - from the fifties 08:01. 3
Patient satisfaction and errors 09:30. 4
Release more information, find more errors, feel worse 10:07. 4
Burden on clinicians, burden on patients 11:42. 4
What if you could push a button and start and track the correction process 12:12. 4
Connectathons – a meeting of the minds in a sandbox 13:17. 5
Making decisions about data standards 15:32. 5
Eureka, we have standards. Now, who’s going to use them? How easy can we make it? 18:41. 6
An error is not an error, is not an error 21:11. 7
Ink on paper 24:07. 7
HIPAA-federal rules about requirements to correct errors 26:38. 8
Misdiagnosis – Out damn spot! 28:54. 9
Impact of errors 32:07. 10
Motivation to fix errors 33:50. 10
Reflection 38:44 12
Please comment and ask questions
at the comment section at the bottom of the show notes
on LinkedIn
via email
DM on Instagram or Twitter to @healthhats
Credits
Music by permission from Joey van Leeuwen, Drummer, Composer, Arranger
Cohelo as originally played by Mandrill, here played by Lechuga Fresca Latin Band, Danny van Leeuwen soloing on Baritone Sax
Web and Social Media Coach Kayla Nelson @lifeoflesion
The views and opinions presented in this podcast and publication are solely the responsibility of the author, Danny van Leeuwen, and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute® (PCORI®), its Board of Governors or Methodology Committee.
Sponsored by Abridge
Inspired by and grateful to Liz Salmi, Tom Delbanco, Peter Elias, Grace Cordovana, Dave DeBronkart, Debi Willis, Laura Marcial, Bryn Rhodes
Links
How accurate is the medical record? A comparison of the physician’s note with a concealed audio recording in unannounced standardized patient encounters in the Journal of Informatics in Health and Biomedicine
the Patient Empowerment Workgroup
HIPAA, you have a right to get your record fixed
HIPAA rule says that if a record is amended or if a record amendment
the 21st Century Cures Act.
the Patient Requests for Corrections FHIR Implementation Guide
United States Core Data Set for Interoperability.
How to Correct Errors in Your Medical Records
Correcting Errors In the Electronic Medical Record
Impact of Electronic Health Record Systems on Information Integrity: Quality and Safety Implications
IHE Connectathon: A Unique Testing Opportunity
Late addition: Beat cancer? Your Medicare Advantage plan might still be billing for it.
Related podcasts
https://health-hats.com/pod158/
https://health-hats.com/opennotes-a-gold-mine-of-community-organizing/
https://health-hats.com/misdiagnosis-how-can-patients-help-doctors/
About the Show
Welcome to Health Hats, learning on the journey toward best health. I am Danny van Leeuwen, a two-legged, old, cisgender, white man with privilege, living in a food oasis, who can afford many hats and knows a little about a lot of healthcare and a lot about very little. Most people wear hats one at a time, but I wear them all at once. I'm the Rosetta Stone of Healthcare. We will listen and learn about what it takes to adjust to life's realities in the awesome circus of healthcare. Let's make some sense of all this.
To subscribe go to https://health-hats.com/
Creative Commons Licensing
The material found on this website created by me is Open Source and licensed under Creative Commons Attribution. Anyone may use the material (written, audio, or video) freely at no charge. Please cite the source as: ‘From Danny van Leeuwen, Health Hats. (including the link to my website). I welcome edits and improvements. Please let me know. [email protected]. The material on this site created by others is theirs and use follows their guidelines.
The Show
Proem
My father died when he was 45 of his second heart attack. I have multiple sclerosis. These don’t seem connected. Heart disease is hereditary, but MS isn’t. For me, heart disease and MS still connect. They connect because when I got diagnosed with MS, the neurologist said I’d had had MS for 25 years. I would have repeated episodes of falling, fainting, and being unable to get out of a tub. Because of my family history, I’d get a cardiac workup. The result would always be negative - twice or three times a year for 25 years. Spell, cardiac testing, results negative. I cannot get the incorrect diagnosis code of heart disease out of my many medical records. I really have MS.
Another story: I have a friend who is 5’3’, 5’4”, and weighs 137 pounds. Somebody typed in her record that she weighed 317 pounds. The weight was easy to fix the next time she went in she could not get the obesity diagnosis code off her problem list. While mine is annoying, you can imagine hers has severe implications with dosages and everything.
My obsession with documentation errors throughout my career accelerated with the start of electronic health records and supercharged with OpenNotes and increased reading of our own records.
Calculating an error rate is quite tricky. A 2020 study in the Journal of Informatics in Health and Biomedicine compared 105 secretly collected audio recordings of visits with unannounced standardized patients among 36 clinicians. There were 636 documentation errors, including 181 charted findings that did not take place and 455 findings that were not charted. Ninety percent of notes contained at least one error. Yikes.
Introducing Virginia Lorenzi
My guest is Virginia Lorenzi, the Senior Technical Architect at New York-Presbyterian Hospital and an HL7 Standards Developer. HL7 is a not-for-profit standards development organization that aids in exchanging information across electronic health record platforms (medical records and health apps). These standards for data exchange are required for clinical practice and evaluating the quality of health services. Errors in electronic health information make for faster mistakes. Not good. Virginia also talks about FHIR (Fast Health Interoperability Resources). FHIR part of HL7. Don’t worry if they feel Greek to you. Just know they are data standards within a standards organization. Our conversation combines common sense with the technical. I will break in when the gap seems too broad. You might want to skip a section and forgo the details.
HL7's Patient Empowerment Workgroup
Health Hats: Okay. So why don't you tell me what you're working on with FHIR and errors?
Virginia Lorenzi: So, in Health Level Seven (HL7), the standards organization that develops FHIR, we created a work group in 2019 called the Patient Empowerment Workgroup. The focus of this work group is to amplify the voice of the patient within all HL7's work. I realize that time is a problem, and we're trying to figure out how to include people most helpfully. And when we started this work group and it was founded by Debi Willis, who's the other person I'm talking about, Dave DeBronkart, ePatient Dave, and myself. The members, many of them, are very much patient advocate voices. So, it's a fairly special group within HL7, in my opinion. You're welcome to join if you'd like. We'd love to have you.
An intelligent customer understands some of the technical
Virginia Lorenzi: What you brought up before is that sometimes you have to understand the technical to be a smart customer and know an advocate for what you want. And I am a teacher as well, and I teach my students that one of the important goals for my clinicians is to know how to be savvy customers and ask what they need, not be snowed by the techies. Also, understand why it's hard to do. So that, and then you could be a savvy customer and get what you need.
So, in the workgroup, there are many things that a patient is interested in. And patients are direct customers of FHIR interfaces because data is now being freed from EHR and going through these personal health records. We couldn't do everything. So, we did a kind of prioritization exercise. Several things bubbled to the top: consent and care plans and any kind of patient contributed information: anything that the patient is contributing and corrections, which is one of those contributing data. And corrections were a hot topic, a very big, hot topic of the group. So, we ended up with three projects, and then we watched everything else. Our three projects are patient requests for corrections, the patient contributed data, just trying to understand the whole field and who was helping to run that as Jan. I know you're friends with friends at Jan Oldenburg. A wonderful person is running our advanced directives projects. How do you get your advanced directives where you need them, even if you can't communicate them or someone else can't communicate them electronically?
Requests for corrections – a sign of engagement
Virginia Lorenzi: That's another project we have, Debbie Willis and I are the project leads of the patient requests for corrections project....
...more
41min
May 22, 2022 Burnout, Healthy Habits, American College of Lifestyle Medicine
An epidemic of burnout among health workers. Learn about the American College of Lifestyle Medicine's solutions 6 pillars and 3 teaching axioms from Dr. Robyn Tiger.
Blog subscribers: Listen to the podcast here. Scroll down through show notes to read the post.
Subscribe to Health Hats, the Podcast, on your favorite podcast player
Please support my blog and podcast.
CONTRIBUTE HERE
Episode Notes
Prefer to read, experience impaired hearing or deafness?
Find FULL TRANSCRIPT at the end of the other show notes or download the printable transcript here
Contents with Time-Stamped Headings
to listen where you want to listen or read where you want to read (heading. time on podcast xx:xx. page # on the transcript)
Proem.. 1
Introducing Dr. Robyn Tiger 01:05. 1
A complex case physical, mental, spiritual 02:56. 2
The practice of Lifestyle Medicine 06:09. 2
Eureka 09:00. 3
Manage manageable stress 09:50. 3
Forming good habits 12:19. 4
Should, why, how 14:33. 4
Burnout among family caregivers 16:40. 5
Accessing Lifestyle Medicine 18:52. 5
Getting to how 22:21. 6
Burnout – personal and system issues 23:46. 6
Global celebration 24:18. 7
Reflection 26:28 7
Please comment and ask questions
at the comment section at the bottom of the show notes
on LinkedIn
via email
DM on Instagram or Twitter to @healthhats
Credits
Music by permission from Joey van Leeuwen, Drummer, Composer, Arranger
Web and Social Media Coach Kayla Nelson @lifeoflesion
The views and opinions presented in this podcast and publication are solely the responsibility of the author, Danny van Leeuwen, and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute® (PCORI®), its Board of Governors or Methodology Committee.
Sponsored by Abridge
Inspired by and grateful to Geri Lynn Baumblatt, Mary Anne Sterling, Lisa van Leeuwen, Mark Heyward Johnson, Smitty Heavner, Chris Friese, Jane Sarasohn-Kahn
Links
American College of Lifestyle Medicine
stressfreemd.net to reach Dr. Robyn Tiger
Lifestyle Medicine Week
annual lifestyle medicine conference in Orlando
NAM Clinician Well-Being Collaborative National Plan for health workforce well-being,
Health Populi As Americans Start to Return-to-Work in the Summer of COVID, Mental Health is a Top Concern Among Employers
The ramifications of health care worker burnout
Related podcasts
https://health-hats.com/help-the-helpers-care-for-healthcare-workers-now/
https://health-hats.com/help_the_helpers_in_crisis/
https://health-hats.com/difference_collaborative/
About the Show
Welcome to Health Hats, learning on the journey toward best health. I am Danny van Leeuwen, a two-legged, old, cisgender, white man with privilege, living in a food oasis, who can afford many hats and knows a little about a lot of healthcare and a lot about very little. Most people wear hats one at a time, but I wear them all at once. I'm the Rosetta Stone of Healthcare. We will listen and learn about what it takes to adjust to life's realities in the awesome circus of healthcare. Let's make some sense of all this.
To subscribe go to https://health-hats.com/
Creative Commons Licensing
The material found on this website created by me is Open Source and licensed under Creative Commons Attribution. Anyone may use the material (written, audio, or video) freely at no charge. Please cite the source as: ‘From Danny van Leeuwen, Health Hats. (including the link to my website). I welcome edits and improvements. Please let me know. [email protected]. The material on this site created by others is theirs and use follows their guidelines.
The Show
Proem
On the second day of my first management gig as nurse manager of an ICU, I noticed that staff nurses seldom took breaks (bathroom or meal). Surprised that this would be the reason for my first impromptu staff meeting, I was astounded to learn about the resulting high incidence of bladder infections. “We are smart people. We can figure out how to design workflow, so everyone gets breaks.” So, 1987, my first awareness of burnout. No breaks, ill health, and stress all lead to burnout. Today, in COVID-world, the epidemic of burnout among healthcare workers appears in high relief. Not new, but in the headlines.
Introducing Dr. Robyn Tiger
I met today’s guest, Dr. Robyn Tiger, through Kelly Freeman and Alex Branch at the American College of Lifestyle Medicine. I met Kelly because of my interest in the science of healthy habit formation and the reduction of burnout among clinicians and family caregivers. Robyn Tiger, MD, is on a mission to empower physicians with self-care tools backed by science and research. With physician burnout on the rise, Robyn knows firsthand what it’s like to love your job while coping with stress, anxiety, imbalance, and even illness. Robyn, Dr. Tiger, is the lead faculty and subject matter expert in stress management for the American College of Lifestyle Medicine. Robyn is currently editing and creating the new board review materials for the 2023 certification exam.
We started our conversation by learning about Robyn’s journey to Lifestyle Medicine.
A complex case physical, mental, spiritual
Robyn Tiger: My medical profession is diagnostic radiology. I'm a board-certified fellowship-trained diagnostic radiologist and went into medicine starry-eyed like most of us healthcare professionals. I still think it's an amazing field to be in. But about ten years in, I became known as a complex case. I know you're a healthcare professional as well. We know that being complex cases isn't something we want to be ourselves. We love to figure them out cause our brains love to figure them out. But I had many things going on that no one could understand, and they seemed very disconnected. There were symptoms such as migraine headaches with intractable vomiting. I had vertigo and, tinnitus, bleeding gums, and reflux. My whole body hurt. I couldn't move. I describe it as a feeling like the Tin Man from the Wizard of Oz. Just ugh, I just couldn't move. And I had a very scary symptom, which was intermittent paresthesia. So, for the non-healthcare professionals listening, that's numbness and pain that would occur intermittently in my hands, feet, and the left side of my back. And that would happen when I'm driving my car, and I can't feel the steering wheel, or I would be cutting up vegetables for salad, and I lose the sensation of the knife, or I would be doing a breast biopsy, and I couldn't feel the biopsy gun in my hand.
So that's all the physical stuff that was going on. And then, of course, there was the stress, the anxiety, the lack of sleep, the exhaustion, and all the mental stuff happening in my brain, which got dark and scary. It made me wonder if I even wanted to be here anymore. So that's my complex case in a package. And I saw lots of docs, and they gave me lots of pills. We say pill for an ill, right? I had a pill for every symptom. Every doctor I went to gave me a pill and lots of imaging studies because I'm a radiologist.
Everything was negative, and I wasn't getting better. I was seeing a psychologist. I was working on my mental health. That wasn't getting any better either. And at this time, Danny, I had three physician colleagues who had died from suicide, and nobody was talking about this stuff. I thought I was all alone, and I was really scared. And I said, oh my gosh, I've got this amazing husband. I've got these great little kids, and I am heading down the path of my colleagues. What am I going to do? These pills aren't working. The therapist isn't helping; I'm just circling the drain. And it was then that I just decided I needed to try and figure out what was going on for myself. And that was what I did. I started to look outside Western medicine, which was when I began to recognize what was going on with me.
The practice of Lifestyle Medicine
Health Hats: Okay. So, before this, I had not heard of Lifestyle Medicine. I'm a user of chiropractic, acupuncture, and massage. They're part of all part of my practice, stress reduction. But never as coherent. That's not the right word. Do you know what I mean? All together in a practice, in a field. Is it relatively new?
Robyn Tiger: No, it was relatively new. Yes, as an actual organization, it started in 2004. Interest in Lifestyle Medicine started way before that. And when I found them, I found my people like, wow, these people get me. I'm doing everything that they're recommending. Going back to my story, when I realized what was going on and I could help myself, it was my ability to relieve all the symptoms I described to you. I was relieving my stress. And we can talk about that in a bit, but that is one of the six pillars of lifestyle medicine. The other five pillars, the focus, the other six pillars, one of which is stress management or nutrition, which is a whole food plant-based diet getting restorative sleep. Fitness. Having wonderful, supportive relationships and abstaining from damaging substances as much as possible, over-drinking tobacco, drugs, things like that. And so, to go backward in my life to answer your earlier question.
Eureka
I'm going to take you back to anatomy lab in first-year medical school. Okay. So here I am over my cadaver, and I felt a sharp pain in my finger. And I looked down, and my glove was sliced open, and there was a scratch on my skin, and I realized that the plaque had cut my glove in the aorta of my cadaver. Wow. I don't like it, what is that? What the heck am I looking at it? What's going on here? And I came to understand that it was an atherosclerotic plaque formed by what we put in our bodies. Most of the time, people sometimes have familiar diseases, but most of the time, plaque buildup is caused by what we put in our mouth and the stress that causes all these increased fats and sug
...more
30min
May 15, 2022 From Here to There: Accessibility on the Camino de Santiago
Managing rural and urban travel with my set of abilities. Roots, dips, inclines, Roman roads, elevators. falls. We did 170 miles (I did 70). A hoot and a half.
Blog subscribers: Listen to the podcast here. Scroll down through show notes to read the post.
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Please support my blog and podcast.
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Episode Notes
Prefer to read, experience impaired hearing or deafness?
Find FULL TRANSCRIPT at the end of the other show notes or download the printable transcript here
Contents with Time-Stamped Headings
to listen where you want to listen or read where you want to read (heading. time on podcast xx:xx. page # on the transcript)

Please comment and ask questions
at the comment section at the bottom of the show notes
on LinkedIn
via email
DM on Instagram or Twitter to @healthhats
Credits
Music by permission from Joey van Leeuwen, Drummer, Composer, Arranger
Web and Social Media Coach Kayla Nelson @lifeoflesion
The views and opinions presented in this podcast and publication are solely my responsibility and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute® (PCORI®), its Board of Governors or Methodology Committee. Danny van Leeuwen (Health Hats)
Sponsored by Abridge
Inspired by and grateful to Linda and Mike DeRosa, Kate Higgins, Mary Lawler, Ann Boland, Ed Lomotan, Kara Ayers, Carole Blueweiss, David Bourne, Simon van Leeuwen, Portugal Green Walks, Progressivecare, LDA
Links
Portugal Green Walks
The Camino de Santiago for People with Disabilities
Walk the Camino. Customers with Disabilities
Accessible Camino

Related podcasts
https://health-hats.com/pod165/
https://health-hats.com/pod164/
https://health-hats.com/pod162/
About the Show
Welcome to Health Hats, learning on the journey toward best health. I am Danny van Leeuwen, a two-legged, old, cisgender, white man with privilege, living in a food oasis, who can afford many hats and knows a little about a lot of healthcare and a lot about very little. Most people wear hats one at a time, but I wear them all at once. I'm the Rosetta Stone of Healthcare. We will listen and learn about what it takes to adjust to life's realities in the awesome circus of healthcare. Let's make some sense of all this.
To subscribe go to https://health-hats.com/
Creative Commons Licensing
The material found on this website created by me is Open Source and licensed under Creative Commons Attribution. Anyone may use the material (written, audio, or video) freely at no charge. Please cite the source as: ‘From Danny van Leeuwen, Health Hats. (including the link to my website). I welcome edits and improvements. Please let me know. [email protected]. The material on this site created by others is theirs and use follows their guidelines.
The Show
I’m back. What an adventure along the coast of Portugal and Spain to Santiago de Compostela. I have hours of material that I will produce over the next few months. Today, a very brief episode about accessibility. Remember, I have Multiple Sclerosis, which affects my stamina, balance, and vision. I can stand, I can walk. Unless I’m in a small room, I need forearm crutches for walking or an electric wheelchair. I can fold my wheelchair, roll it, and assist in getting it in and out of the car. I am not wheelchair dependent. I walk a minimum of 3500 steps a day, every day. Not all at once, but in segments. I fatigue, but I can recover relatively quickly. I manage my double vision, most of the time. I can hear with hearing aids, sometimes too much. I can breathe, talk, eat, and toilet unassisted. My disabilities and pain levels are mostly moderately annoying. I describe a personal adventure with my extended family and those I’ve met along the way. Clearly, your adventure would be different. People with all ranges of abilities travel the Camino. Preparation and assistance are key. See several resources in the show notes.
My companions and I are all 70+ years old. During these 16 days, we traveled about 160 miles (260 km) on the Camino de Santiago Pilgrimage from Porto, Portugal. I went 70 miles (113 km), averaging 4600 steps or 2 miles a day walking and the rest in my electric wheelchair. I had help finding accessible ways and maneuvering. We dealt with roots, ditches, streams, stairs, sand, gravel, slippery slopes, and other obstacles in rural areas. I fell over backward in my chair once. I’ll put a link in the show notes to YouTube of it. I was recording at the time of the fall.
In urban areas, we scouted cutouts, maneuvered around construction, crazy traffic on narrow roads, crowds, stores, restaurants, churches, and cathedrals. And OMG, the elevators – tiny, tiny, tiny. Find one elevator experience linked to YouTube. The image for this episode is of one ridiculous cutout into a store, perhaps designed for a two-foot-long bicycle, worthy of a belly laugh. The European airports provided considerably better assistance than American airports. Touring a twelfth century castle I was shocked, shocked that it wasn’t wheelchair accessible. I motored and walked around anyway.
We made hundreds of little and big decisions about handling obstacles and my safety. Key word: we. I made some decisions as I do in routine life, I had help, more than I thought I would need.
As I reported in the last episode, the most significant disability would have been no charger, but as in 2019, my biggest handicap was not speaking Spanish or Portuguese. Our hosts went out of their ways to communicate as best they could. I am eternally grateful.
I had the time of my life!!
...more
6min
May 08, 2022 Camino de Santiago 2022: Pilgrimage with Angels
Lost my wheelchair charge on Day 1. OMG. Busted. Until angels stepped in. Grateful, grateful, grateful
Blog subscribers: Listen to the podcast here. Scroll down through show notes to read the post. Watch the video here
Subscribe to Health Hats, the Podcast, on your favorite podcast player
Please support my blog and podcast.
CONTRIBUTE HERE
Episode Notes
Prefer to read, experience impaired hearing or deafness?
Find FULL TRANSCRIPT at the end of the other show notes or download the printable transcript here
Contents with Time-Stamped Headings
to listen where you want to listen or read where you want to read (heading. time on podcast xx:xx. page # on the transcript)

Please comment and ask questions
at the comment section at the bottom of the show notes
on LinkedIn
via email
DM on Instagram or Twitter to @healthhats
Credits
Music by permission from Joey van Leeuwen, Drummer, Composer, Arranger
Web and Social Media Coach Kayla Nelson @lifeoflesion
The views and opinions presented in this podcast and publication are solely my responsibility and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute® (PCORI®), its Board of Governors or Methodology Committee. Danny van Leeuwen (Health Hats)
Sponsored by Abridge
Inspired by and grateful to Linda and Mike DeRosa, Kate Higgins, Mary Lawler, Ann Boland, Ed Lomotan, Carole Blueweiss, David Bourne
Links
The video version of this episode
Related podcasts
https://health-hats.com/pod156/
https://health-hats.com/pod154/
https://health-hats.com/days-6-12-camino-de-santiago-rejuvenated-inspired-not-yet-peaked/
About the Show
Welcome to Health Hats, learning on the journey toward best health. I am Danny van Leeuwen, a two-legged, old, cisgender, white man with privilege, living in a food oasis, who can afford many hats and knows a little about a lot of healthcare and a lot about very little. Most people wear hats one at a time, but I wear them all at once. I'm the Rosetta Stone of Healthcare. We will listen and learn about what it takes to adjust to life's realities in the awesome circus of healthcare. Let's make some sense of all this.
To subscribe go to https://health-hats.com/
Creative Commons Licensing
The material found on this website created by me is Open Source and licensed under Creative Commons Attribution. Anyone may use the material (written, audio, or video) freely at no charge. Please cite the source as: ‘From Danny van Leeuwen, Health Hats. (including the link to my website). I welcome edits and improvements. Please let me know. [email protected]. The material on this site created by others is theirs and use follows their guidelines.
The Show
Okay, let me see if I could tell you a story while I'm going. So it's the story of angels. And I started the first day on our trip. I realized that for whatever reason, I didn't have my charger and I had a Plan A, Plan B and a Plan C. With a Plan A was that we find somebody in Porto that could sell a charger that was appropriate. Plan B was somebody who would rent me a chair that had a charger. And I just take the charger and Plan C I guess I had a plan D. Plan C was to take just to rent a chair, another chair, and then the plan was to have my son Simon get one from. The plan D was, he did get the charger from the company in Austin.
When I got my truck, well plan, they didn't work. Nobody had plan B didn't work because. Like there's nothing to rent because I would've had to bring the chair back to the Porto from Santiago de Compostella. Plan D was that the company ForceMech couldn't ship it directly because they weren't allowed.
So I, we ended up calling like all these different companies. I didn't, I actually, I called nobody, my wife, Linda few people call companies the hotel that we were staying at. Nothing. So I started arranging with my son to have the chargers sent to him in Boston, and then he would ship it next day delivery. If the charter cost of $200 to get it through the travel agent who would then get it for me. Meanwhile, we got a phone call. Linda got a phone call from one of the company, people that one of the companies that she had spoken with and they said, oh, we just been thinking about you and you just so wanted you to, you know, be able to, you can't imagine how you could go without a charger and it would ruin your vacation. And they, and they said, so we called all our customers or a bunch of our customers, and we found somebody that had a charger you could use. And they went to that person, borrowed it and then they drove it to our hotel. And I've, that's what I've been using. That's an angel. And you know, my son, the ForceMech company, everybody did their part, but it never got out of with FedEx Brussels. So two weeks later, I'm going to get it. Just one more. I'm already way to go home. That's my story.
...more
6min
April 24, 2022 Reprise: Camino de Santiago. Rejuvenated, Inspired #21 & 164
Heading to Portugal. Ready. Listen to last episode from '19 Spanish Camino. Sounds of tapping of my canes, white storks, cathedral bells chiming. Stay tuned.
Blog subscribers: Listen to the podcast here. Scroll down through show notes to read the post.
Subscribe to Health Hats, the Podcast, on your favorite podcast player
Please support my blog and podcast.
CONTRIBUTE HERE
Episode Notes
Prefer to read, hard-of-hearing or deaf?
Find FULL TRANSCRIPT at the end of the other show notes or download the printable transcript here
Contents with Time-Stamped Headings
to listen where you want to listen or read where you want to read (heading. time on podcast xx:xx. page # on transcript)
Proem.. 1
Advantages of progressive illness 03:20. 1
Heading out shortly 04:45. 2
Week 2 06:01. 2
Inspired 07:14. 2
Quieting my mind 09:31. 3
Tap, tap, tap of my two canes 11:58. 3
Mobility package 15:45. 3
White storks in Portomarin 16:14. 4
Santiago de Compostela Cathedral 16:39. 4
Heading home to Boston 17:35. 4
Reflection 17:56. 4
Links
Rien MacDonald's Hope Initiative podcast
Maria Xenidou's Impact Learning podcast
Regina Holliday's Cinderblocks conference
Marly Camino Guided Tours
Related podcasts
Camino de Santiago Episodes
Please comment and ask questions
at the comment section at the bottom of the show notes
on LinkedIn
via email
DM on Instagram or Twitter to @healthhats
Credits
Music by permission from Joey van Leeuwen, Drummer, Composer, Arranger
Web and Social Media Coach Kayla Nelson @lifeoflesion
The views and opinions presented in this podcast and publication are solely the responsibility of the author, Danny van Leeuwen, and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute® (PCORI®), its Board of Governors or Methodology Committee.
Sponsored by Abridge
Inspired by and grateful to David Bourne, Carole Blueweiss, Rien MacDonald, Maria Xenidou, Regina Holliday, Mary Lawler, Ann Boland, Mike and Linda DeRosa, Kate Higgins, Cynthia Meyer
About the Show
Welcome to Health Hats, learning on the journey toward best health. I am Danny van Leeuwen, a two-legged, old, cisgender, white man with privilege, living in a food oasis, who can afford many hats and knows a little about a lot of healthcare and a lot about very little. Most people wear hats one at a time, but I wear them all at once. I'm the Rosetta Stone of Healthcare. We will listen and learn about what it takes to adjust to life's realities in the awesome circus of healthcare. Let's make some sense of all this.
To subscribe go to the blog https://health-hats.com/
Creative Commons Licensing
The material found on this website created by me is Open Source and licensed under Creative Commons Attribution. Anyone may use the material (written, audio, or video) freely at no charge. Please cite the source as: ‘From Danny van Leeuwen, Health Hats. (including the link to my website). I welcome edits and improvements. Please let me know. [email protected]. The material on this site created by others is theirs and use follows their guidelines.
The Show
Proem
I'm getting ready to go on a pilgrimage to Portugal and Spain. It's the Camino de Santiago. And for those of you who've been following me, know I've been podcasting about it. I've been podcasting about my previous trip in 2019 when we went to Spain and my training. I've gotten a lot of comments on these episodes, and mostly they're attaboy comments, but some asked me if I'm afraid. Aren't I scared? I think that's a good question. At first, I just wanted to dismiss it. What could happen? I'm going with friends, lots of other people are on this pilgrimage. It was safety uneventful in 2019 when we went. But to be honest with you, yes, I have some fear. I have a “what if” kind of thing. What if this, what if that, what if I have an exacerbation of my MS? What if I fall? What if I hurt myself? And I worry about that stuff? I do. I've been accused of being pathologically optimistic, and I am. I like to look on the bright side and plow ahead, looking forward to adventuring. But I do have my periods of fear. You can't have a chronic progressive illness, like multiple sclerosis and always be pathologically optimistic. That would be insane. I will say that MS is seriously annoying. MS sucks. It really sucks. But I'm the kind of person with my demons at night, whether it's waking up in the middle of the night, worrying about, oh my goodness, what's this ache? What's this pain? Is this the beginning of the end? Or have dreams? And I have dreams where I'm out of control, where all of a sudden, I'll find myself somewhere, and I have no assistive device. I have no friends. I just feel like I'm in danger. So, my fears are nighttime fears for the most part. But it's a good question.
Advantages of progressive illness
I do feel that I have some advantages and some of the benefits that I have are that I've been adapting for years. The neurologist said I had it for twenty-five years when I was diagnosed with multiple sclerosis. And when we pieced it back 25 years, I could see that I was having episodes, and it was being diagnosed as cardiac disease. And I would get a cardiac workup. But I adapted, and that's what I'm good at. I'm except good at accepting what is and then adapting. And I know that certain fundamentals are essential. The fundamentals are. Drink water and keep moving. Those are the two most important fundamentals. Keep moving, just keep moving because if I stop moving, it's over. Then, once you can't, it's hard to recover when you stop moving. And then I know my physical therapist and my chiropractor, my massage therapist, you have the aches and pains of activity. Not so much the aches and pains of inactivity. So that's good. That's good.
Heading out shortly
So, I'm going on this pilgrimage. I'm going to share the last of three episodes that I did in 2019. That episode was about Days six to 12on the Spanish Camino. I'm really looking forward to going, we're going shortly, and I'm prepared. I'm as prepared as I'm going to be. And I'm with friends, and it's just being out there and having an adventure with my honey is just my idea of a good time. I'll be talking to you along the way. I plan to video and record; I will pay particular attention to accessibility and whatever kind of adventures come our way. And I hope I'll be able to include my compatriots depending on their comfort with recording. And I'll see you around the block. Take care.
Week 2
Good morning. It's day 10 of the Camino de Santiago Pilgrimage. I'm going from Palas de Rei to Castaneda, Spain - about 14 miles. Palas de Rei is a large town that feels urban, small urban. And I'm going to Castaneda, which is a small town. So that'll be different. And I confess to being pretty grumpy when everybody finally made it to the hotel last evening, and we went out to eat and hang out. I don't know why I was grumpy. Nothing particular. I'm not particularly feeling left out. Just grumpy. I guess part of the ups and downs of life. And so, this morning, it's about 9:00 in the morning, and I'm waiting for 10 o'clock. I'm going to get picked up to taxi me and the luggage to the next place.
Inspired
I've been feeling inspired this morning. I've been listening to Rien MacDonald's Hope Initiative podcast. I highly recommend it. He's a fabulous interviewer, and he knows such interesting people. He brings out the best. He started interviewing his 12-year-old sister and then his mom and his dad and his grandmother and a bunch of friends in a car trip and a man who was cleaning his windshield, and now I was just listening to a marathoner or who did like 47 marathons in 47 days or 48. I don't remember. But anyway, I was inspired by him. And then, I was inspired by Maria Xenidou's Impact Learning podcast. It’s terrific. They gave me a lift, so I'm not so grumpy. And I had a text exchange yesterday with Regina Holliday, who has the Walking Gallery, and she has a Cinderblock conference in July, which I think is fabulous. I'm going to put something together for her conference. The topic is Rest and Rejuvenation, which seems appropriate here in the second week of my pilgrimage. My wife and I were trying to remember when we last took two weeks off. Goodness, it was 12 years ago. We went to Amsterdam with my uncle Leon, which was a blast. But otherwise, we've gone away for a week or a few days. But two weeks, that’s different. Focusing on rest and Rejuvenation is a good idea.
Quieting my mind
I can't believe how much I enjoy just listening to the birds and the wind. It quiets my mind. I know you're shocked to learn, but I have a very active mind that never stops, which works sometimes, if not most of the time. But it's nice to quiet it and just listen. So now I'm hearing just out the window. You probably can't hear it, but I'm hearing Road sounds. And at least a couple of different kinds of birds. I see the swallows floating around, catching the bugs. It's a beautiful day. The sky is blue, totally blue. And in the distance, I can see a dozen windmills upon the hill. It is supposed to be well into the 80s today, which will be challenging for the walkers. And tougher me with MS. Hot as hard. Really cold is hard too. I think my temperature regulation is not what it once was. But anyway. Alright more to come after I get to the next stop.
Now a word about our sponsor, ABRIDGE.
Use Abridge to record your doctor's visit. Push the big pink button and record the conversation. Read the transcript or listen to clips when you get home. Check out the app at abridge.com or download it on the Apple App Store or Google Play Store. Record your health care conversations. Let me know how it went!"
Tap, tap, tap of my two canes
Ok. I'm at the Albergue Turistico Salceda. I'm in Salceda, bucolic farmland....
...more
21min
April 17, 2022 Patient Advocates on National Boards: Mind the Sausage
Engaging patients differs depending on the role. Those on national Boards lead, strategize, advocate, communicate. Adam Thompson is on the Board of NQF. Listen in.
Blog subscribers: Listen to the podcast here. Scroll down through show notes to read the post.
Subscribe to Health Hats, the Podcast, on your favorite podcast player
Please support my blog and podcast.
CONTRIBUTE HERE
Episode Notes
Prefer to read, experience impaired hearing or deafness?
Find FULL TRANSCRIPT at the end of the other show notes or download the printable transcript here
Contents with Time-Stamped Headings
to listen where you want to listen or read where you want to read (heading. time on podcast xx:xx. page # on the transcript)
Proem.. 1
Introducing Adam Thompson 02:38. 1
Patient-caregiver advocates on national Boards of Directors 04:21. 2
Activist, Advocate, Conduit, Leader 06:15. 3
The Ryan White HIV/AIDS Program 09:42. 4
Pulling the curtain back. Feeling our oats. 13:52. 4
The right place to make a difference and re-charge 18:26. 5
Learn, coach, mentor 20:43. 6
Listen, reveal, shout 25:50. 7
Levers of power. Drunk the Kool-Aid. Now what? 30:56. 8
Transparency. The sausage gets made. 34:17. 9
More on conduits 39:39. 10
Engage, dissemination, act 41:02. 10
Is seeking public comment enough? 42:54. 11
Reflection 45:00 11
Please comment and ask questions
at the comment section at the bottom of the show notes
on LinkedIn
via email
DM on Instagram or Twitter to @healthhats
Credits
Music by permission from Joey van Leeuwen, Drummer, Composer, Arranger
Web and Social Media Coach Kayla Nelson @lifeoflesion
The views and opinions presented in this podcast and publication are solely the responsibility of the author, Danny van Leeuwen, and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute® (PCORI®), its Board of Governors or Methodology Committee.
Sponsored by Abridge
Inspired by and grateful to Nikki Montgomery, Matthew Pickering, Jan Oldenburg, Danny Sands, Matt Hudson, Dana Gelb Safron, Nakela Cook, Christine Goertz, Kristin Carman, Luc Pelletier, Jan Oldenburg, Sharon Levine, Kara Ayers
Links
Adam Thompson, LinkedIn
National Quality Forum (NQF)
PCORI (Patient-Centered Outcomes Research Institute)
Dr. David Nash
Ryan White program
Dolores Dockrey
Dr. W Edwards Deming called it profound knowledge.
Related podcasts
https://health-hats.com/pod110/
https://health-hats.com/pod145/
https://health-hats.com/pod153/
About the Show
Welcome to Health Hats, learning on the journey toward best health. I am Danny van Leeuwen, a two-legged, old, cisgender, white man with privilege, living in a food oasis, who can afford many hats and knows a little about a lot of healthcare and a lot about very little. Most people wear hats one at a time, but I wear them all at once. I'm the Rosetta Stone of Healthcare. We will listen and learn about what it takes to adjust to life's realities in the awesome circus of healthcare. Let's make some sense of all this.
To subscribe go to https://health-hats.com/
Creative Commons Licensing
The material found on this website created by me is Open Source and licensed under Creative Commons Attribution. Anyone may use the material (written, audio, or video) freely at no charge. Please cite the source as: ‘From Danny van Leeuwen, Health Hats. (including the link to my website). I welcome edits and improvements. Please let me know. [email protected]. The material on this site created by others is theirs and use follows their guidelines.
The Show
Proem
As a nurse, I studied individual health. Then I became a student of organizational health. That led me to management and leadership - all with the mind to get stuff done. Done for people, with people, by people -patients, caregivers, and direct care clinicians. My role changed at each step. My bag of tools grew. I learned to be a good leader, coach, and mentor. Sometimes great. Sometimes I reached my goal when I had one—my success measure: Bat .500 - Success half the time. Now I’m old, nearing the end of my career, and I’m on a national board, the Board of Governors of PCORI (Patient-Centered Outcomes Research Institute). As a life-long learner and master networker, I started looking for other people Identifying as patient-caregiver stakeholders on national boards. I found our guest, Adam Thompson, recently. He’s on the board of the National Quality Forum (NQF). I’m a member of NQF and serve on several committees and panels. Matt Pickering, a Director at NQF, appeared on Health Hats, the Podcast a few months ago. NQF’s Mission: To be the trusted voice driving measurable health improvements. Its Vision: Every person experiences high-value care and optimal health outcomes. There’s way more to it than that. Let’s meet Adam and learn more.
Introducing Adam Thompson
Health Hats: Good morning. How are you?
Adam Thompson: So glad it's Friday. This was finals week for graduate school, and the first half of our thesis was due. It's all the sort of widgets and planning pieces, which is you change one thing in a document, and then there are seven other documents you got to go change it in. So, it was just like, oh my God, all week.
Health Hats: What is your role, and where are you in this?
Adam Thompson: So, I am just about to finish my master's in public health. I started just before the pandemic. It was not the worst time to get a master's degree. I will say that.
Health Hats: I got my MPH at the University of Minnesota's ISP Program. And it was one of the first distance learning programs. The whole philosophy was that you had to be in the industry and use your work as your laboratory.
Adam Thompson: Yup. Ours was very similar.
Health Hats: And it was an excellent education.
Adam Thompson: Have you ever met or come across Dr. David Nash in your work?
Health Hats: It's a familiar name, but I can't say how.
Adam Thompson: He's one of the crown princes of population health management. He does a lot of work there. He founded a school of population health out of the Jefferson Health Enterprise in Philadelphia. I went to school because I thought, Ooh, population health. That's cool. And it was run by the lead qualitative researcher. So that made it even cooler.
Patient-caregiver advocates on national Boards of Directors
Health Hats: Okay. What I wanted to chew on with you is this business of being a patient caregiver activist and being on a national board. So, I'm on the board of governors of PCORI (Patient-centered Outcomes Research Institute and you're on the board of
Adam Thompson: the National Quality Forum,
Health Hats: The National Quality Forum. First, it's a hoot to have that seat, and to be in a leadership role is different than being an activist. Not that one doesn't inform the other. But it's a different role. At least for me, I feel like my responsibility is to the whole organization. And so, I feel like I had to hone my listening skills throughout my career. Because I would have to say that it is not my strongest muscle. I feel like it's even -it's on steroids. The making all the connections, listening to other board members who I'm so fortunate that the board of PCORI is brilliant, just brilliant, and inspiring. And I have so much to learn, and I love learning. But it means shut mouth, open ears. Anyway, tell me a bit about your experience?
Activist, Advocate, Conduit, Leader
Adam Thompson: I absolutely agree that coming from the community of people with HIV, we are very rooted in our agitation, activism, and advocacy. And as a community, adept at understanding where you deploy what method? What are you doing in this environment? And in our community, we've thought about it in a framework where agitation is when someone disagrees with you. There's not a problem. They don't want to do anything about it. Activism, people are aware there's a problem. They're just not motivated to do something. And advocacy is, we've all agreed that there's a problem. And we want to do something about it collectively. As I've worked through my community before, joining what I would call the culture of quality right here in the United States. I learned how to recognize when a system is listening. How to hear, right, when people listen to you. And I think, as a result, I feel a great responsibility. I feel like my business is the human condition. At its core, what I try to do is, see experience and understanding. Find a way to translate it and then an appropriate frame for the environment in the context we're trying to inform with that experience. And so, for me, I agree with you, right? It's like I had to listen a lot. When I first started doing quality measurement work, I remember the summer was learning statistics. And I was like, oh my goodness. I called physicians. And even they were like, Adam, I don't do this. You have to talk to somebody else. And I learned. I listened. And I think if there's any wisdom that I've gained from it, I'm not sitting at those tables at NQF because I'm an accomplished clinician. I'm not sitting there because I have developed a groundbreaking measure to solve all our disparities. I think I'm there because I have found a way to be a conduit for my community's experience and understanding and how to bring that back to the community. I think what I've learned is that I look for opportunities in my experience, both sitting on various committees and expert panels but also as a board member, to find the moments where that experience, that narrative, that collective sort of like voices of the people that come from the spaces and places that I walk in and the people that I hang out with walk in. And try to find the moment when it's mostly going to inform that opportunity. I'll be the first to say,...
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48min
April 03, 2022 Portugal Camino Pilgrimage: Training with Disabilities. Fun.
Not about walking miles & managing shoes. My training includes mobility and audiovisual prep. Bear with my experiment. Podcast, YouTube, & article. A bit rough.
Blog subscribers: Listen to the podcast here. Scroll down through show notes to read the post. Watch the video here
Subscribe to Health Hats, the Podcast, on your favorite podcast player
Please support my blog and podcast.
CONTRIBUTE HERE
Episode Notes
Prefer to read, experience impaired hearing or deafness?
Find FULL TRANSCRIPT at the end of the other show notes or download the printable transcript here
Contents with Time-Stamped Headings
to listen where you want to listen or read where you want to read (heading. time on podcast xx:xx. page # on the transcript)
Proem.. 1
Training Day 1: Cold 01:21. 1
Walking, pushing my chair 05:46. 2
Day 1 Training Debrief 06:37. 2
Crossing a busy street. 07:35. 2
Reflection 08:31. 2
Please comment and ask questions
at the comment section at the bottom of the show notes
on LinkedIn
via email
DM on Instagram or Twitter to @healthhats
Credits
Music by permission from Joey van Leeuwen, Drummer, Composer, Arranger
Web and Social Media Coach Kayla Nelson @lifeoflesion
The views and opinions presented in this podcast and publication are solely my responsibility and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute® (PCORI®), its Board of Governors or Methodology Committee. Danny van Leeuwen (Health Hats)
Sponsored by Abridge
Inspired by and grateful to Linda and Mike DeRosa, Kate Higgins, Mary Lawler, Ann Boland, Ed Lomotan, Carole Blueweiss, David Bourne
Links
The video version of this episode
Related podcasts
https://health-hats.com/pod156/
https://health-hats.com/pod154/
https://health-hats.com/days-6-12-camino-de-santiago-rejuvenated-inspired-not-yet-peaked/
About the Show
Welcome to Health Hats, learning on the journey toward best health. I am Danny van Leeuwen, a two-legged, old, cisgender, white man with privilege, living in a food oasis, who can afford many hats and knows a little about a lot of healthcare and a lot about very little. Most people wear hats one at a time, but I wear them all at once. I'm the Rosetta Stone of Healthcare. We will listen and learn about what it takes to adjust to life's realities in the awesome circus of healthcare. Let's make some sense of all this.
To subscribe go to https://health-hats.com/
Creative Commons Licensing
The material found on this website created by me is Open Source and licensed under Creative Commons Attribution. Anyone may use the material (written, audio, or video) freely at no charge. Please cite the source as: ‘From Danny van Leeuwen, Health Hats. (including the link to my website). I welcome edits and improvements. Please let me know. [email protected]. The material on this site created by others is theirs and use follows their guidelines.
The Show
Proem
In the background, you hear my wheelchair as I train for our 200-kilometer Portugal’s north coast to western Spain hike coming up soon. I feel 10-years-old and 70. Ten, because I’m jumping up and down in my head and want to sleep in the car till we go. Seventy because I am a two-legged, cisgender old white man of privilege who gets around with his Forcemech electric wheelchair and Ergobaum forearm crutches. My training is not about walking miles and managing my shoes but includes mobility and audiovisual prep. So, bear with me as I experiment with both. You’ll be hearing about my mobility training during the podcast and video and watching the results of my audio-video experimentation. It’s all a bit rough. And fun, fun, fun. I’ll take you through a couple of training days in varied weather and on different paths. I’ll post show notes with a transcript for you readers and a link to my YouTube channel for you watchers.
Training Day 1: Cold
Hey, there. I'm doing my training. Believe it or not, I'm doing my training to go on to the Portugal Camino. That's a pilgrimage that we'll go along the coast, on north up the coast from Porto, Portugal to Spain, which is an ancient pilgrimage. And I'm my training, unlike hikers, to see how many miles they can walk. For me, it's more Since I'm a wheelchair and two cane fellow, I need to build up my endurance to be able to go. I'm hoping five to seven miles a day on an assessable part of the trail. And to do that, I need to get some more stamina and figure out how much sitting I can do, how much pushing my wheelchair what kind of stretches I need to do. And so today is about a month and a half before we go. And I'm going to. My goal today is to tool five miles on a bike path. I'm crossing a road, and they don't stop even though they're supposed to. And I'm going to go on a bike path, and what I know so far, it's cold today. First, you could see me. I bundled up. When you ride in the chair, it's a little less. When you walk you’re generating a bit of heat, but in a chair, not so much. Figuring out layers. Today it's probably 25. I'm hoping it'll be warmer in Portugal. I'm pretty sure it will be, but this is what I have here in Boston and what I'm doing. So, my routine is to see how long I can ride in the chair because my chair is built for portability and foldability, not for ergonomics. And I'm not a person who lives in their chair. I am a person who can walk. I could walk about 2000 steps unencumbered. So not sure how much I could walk pushing a chair here in Boston in the cold, but we'll see. But I can't sit for too long. The key is how long can I sit? I need to change position, stretch, and walk a little. And I'm also trying out this selfie stick. I'm still figuring out how to attach that to my chair. And so, there are all these things like cushions. I bought a different cushion, but because I need lumbar support.
Now a word about our sponsor, Abridge. Use Abridge to record your doctor's visit. Push the big pink button and record the conversation. Read the transcript or listen to clips. When you get home, check out the app at abridge.com. Or download it on the Apple app store or Google play store. Record your healthcare conversations. Let me know how it went.
Walking, pushing my chair
Okay. Now I'm walking, pushing my chair. I've gone about 1.1 miles in a chair. Now I'm going to walk a little bit. I saw this car go by where in the passenger seat, somebody had tied up a mask onto the headrest. Looking at it, then I think, why do you do that? And I felt that they wanted to drive out on the highway. You can use the lane to the lane when you have more than one passenger. Anyway, silly.
Day 1 Training Debrief
Hi there. A little follow-up after my escapades today, training. I learned that you need to screw the top of the drinking bladder bag properly, so you don't spill water all over the backpack, which I did. The selfie broke after about an hour of using it. My chair ran out of juice after four hours. And I'm not sure if it's because I hadn't charged it, or it was cold or whatever. The layers were okay but a little restrictive. And now that I'm several hours out, I'm sore in my back, and my neck is tired, so that's all interesting.
Crossing a busy street.
Here we go.
Reflection
A disjointed narrative and video, but as I said initially, I’m training. You a get a taste of what it’s like. It’s a hoot and a half.
Time. One hour 42 minutes, 17 seconds. Total distance, 5.0 miles. Average speed 2.9 miles per hour. Split speed, 2.9 miles per hour.
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10min
March 20, 2022 Decision Aids: Tools to Support Conversation About Choice.
Decision aids with Dr. Daniel Matlock. Complexity of decisions, agency of decision-makers, timing, the black box, answering questions as they arise.
Blog subscribers: Listen to the podcast here. Scroll down through show notes to read the post.
Subscribe to Health Hats, the Podcast, on your favorite podcast player
Please support my blog and podcast.
CONTRIBUTE HERE
Episode Notes
Prefer to read, experience impaired hearing or deafness?
Find FULL TRANSCRIPT at the end of the other show notes or download the printable transcript here
Contents with Time-Stamped Headings
to listen where you want to listen or read where you want to read (heading. time on podcast xx:xx. page # on the transcript)
Proem.. 1
The fragility of life strengthens 01:50. 1
Early health decisions for the family 04:22. 2
Endless questions about decision aids. Who, why, what, how? 06:18. 3
Stakeholder participation developing decision aids 10:17. 4
Biased to what? 11:08. 4
As the stakes go up, enter the caregiver & family as stakeholder 11:35. 4
Changing level of agency. So many decisions, like putting in a kitchen 13:12. 5
Who are decision aids for? 15:07. 5
Shared decisions 16:21. 5
One-time decisions, ongoing communication 18:50. 6
Tracking decisions and their impact 19:51. 6
We decided what? How'd it gone? A black box 25:35. 7
Design decisions – in the clinic or outside 27:32. 8
Where do I go to get questions answered when I have them? 27:32. 8
Reflection 31:49 9
Please comments and ask questions
at the comment section at the bottom of the show notes
on LinkedIn
via email
DM on Instagram or Twitter to @healthhats
Credits
Music by permission from Joey van Leeuwen, Drummer, Composer, Arranger
Joey van Leeuwen Quartet playing Mou's Blues
Web and Social Media Coach Kayla Nelson @lifeoflesion
The views and opinions presented in this podcast and publication are solely the responsibility of the author, Danny van Leeuwen, and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute® (PCORI®), its Board of Governors or Methodology Committee.
Sponsored by Abridge
Inspired by and grateful to Geri Baumblatt, Jodyn Platt, Josh Richardson, Janice McCallum, Lacy Fabian, Michelle Lenox, Michael Mittleman
Links
All of our team’s decision aids are freely available at www.patientdecisionaid.org.
Dan Matlock's email
Sharing Decisions About Systemic Therapy for Advanced Cancers
Related podcasts
Health Hats Series: Young Adults with Complex Conditions Transitioning from Pediatric to Adult Medical Care
Health Hats Series: Choices About Your Health with Your Team
About the Show
Welcome to Health Hats, learning on the journey toward best health. I am Danny van Leeuwen, a two-legged, old, cisgender, white man with privilege, living in a food oasis, who can afford many hats and knows a little about a lot of healthcare and a lot about very little. Most people wear hats one at a time, but I wear them all at once. I'm the Rosetta Stone of Healthcare. We will listen and learn about what it takes to adjust to life's realities in the awesome circus of healthcare. Let's make some sense of all this.
To subscribe go to https://health-hats.com/
Creative Commons Licensing
The material found on this website created by me is Open Source and licensed under Creative Commons Attribution. Anyone may use the material (written, audio, or video) freely at no charge. Please cite the source as: ‘From Danny van Leeuwen, Health Hats. (including the link to my website). I welcome edits and improvements. Please let me know. [email protected]. The material on this site created by others is theirs and use follows their guidelines.
The Show
Proem
Welcome to another installment in my series on medical decision-making. I doubt this series will ever end. How can it? Our experiments of one or societal experiments of medical action or inaction never cease. I met our guest, Dr. Daniel Matlock, at a conference recently. Dr. Matlock is the Director of the Colorado Program for Patient-Centered Decisions at ACCORDS (The Adult and Child Consortium for Outcomes Research and Delivery Science) and the interim Director of the Division of Geriatrics at the University of Colorado. He is board-certified in Internal Medicine, Geriatrics, and Palliative care. His research aims to fundamentally change and improve how patients decide about invasive cardiovascular technologies.
The fragility of life strengthens
Health Hats: Dan. Welcome. Thank you. It's very nice of you to join us today. I wanted to just start with getting to know you. Can you think back about the first time you were aware that health was fragile? What was happening at that time in your life?
Dan Matlock: That's such a great question. You did warn me about this question ahead of time. So, I had some time to think about it, and I couldn't come up with a specific event, but I have some thoughts on it. I grew up in the suburbs, pretty safe, white kid, not any challenges growing up. My grandparents lived in Texas. They died when I was in high school or later. I didn't deal with a lot of deaths growing up. I was a healthy kid and didn't deal with many illnesses growing up, myself or my family. And as I think of the things that drove me to medicine, it wasn't like some experience of the fragility of life. But then I will say when I got in through engineering training, and I get into residency, and I'm seeing patients, I don't think I got officially depressed, but I was down about the culture of medicine. And it was just how we do things to people instead of with them. And it was because they were fragile. I didn't like what I was seeing. And that's what has driven me into the research I'm doing. Because we haven't done a good job as a medical culture, acknowledging the fragility. In many ways, we're in a fight. Somewhere in the last hundred years, people getting sick and dying went from being sad and tragic at times to being a failure of science or a failure of medicine. And I think somewhere that well-intended thing that happened when awry. That's what pushed me into palliative care, geriatrics, and hospice because I felt like these were underserved people. Cause we weren't dealing with the fragility. And then I think, especially the hospice and palliative care work, I've always said, yes, some of these things are hard. I've had patients that I've teared up with, and I'm not a big crier generally, but real experiences. And I think it's made me a better husband and a better father. Because it does just remind you daily that life is fragile, and that daily reminder for fragility enriches my life. It reminds me that, okay, this was a bad day, but I need to put a smile on cause my kids need that. And I'll be happier, too. And it's that reminder that does that.
Early health decisions for the family
Health Hats: On your LinkedIn page, you say I'm trying to improve how older adults make decisions surrounding invasive technologies. What was the first decision you had to make, or what was an early decision you had to make about your health or your family's health?
Dan Matlock: Yeah. That's the thing there. There haven't been many in my own family, my personal life. I will say lately, I have had to make medical decisions. I'm a little overweight and have some challenges now that I'm getting in. I'm getting a little older and have sleep apnea, take I have mild diabetes. So, most of the medical decisions I've been facing with these, you might say, small decisions, but they have big consequences over time.
Health Hats: So, like lifestyle decisions?
Dan Matlock: Lifestyle, medicines. There's a new weight loss medicine they pose to me that I was looking for a decision aid. Did we know if this is good and those kinds of decisions that I've been faced with personally? What are the pros and cons of this? And so lucky personally, my wife's been healthy. My kids are healthy, though, although, through the pandemic, some of my kids' mental issues have started coming out. I'm starting to wrestle with some decisions there. I have a kid with gender dysphoria who's 14 wanting to take hormones. I want to support him for who he is, and I know hormones aren't that great. Testosterone hasn't been all that great for men, in some ways, certainly from the cardiovascular perspective. It hasn't been that great for men. I'm wrestling with now, and my wife and I are. But yeah, it's a hard question because I'm not one of these people who has this experience. It was hard writing essays in med school. Cause that's what many people write about is some beautiful experience. And I just didn't have that.
Endless questions about decision aids. Who, why, what, how?
Health Hats: But so here you are. And your focus is on making decisions and working with people. So, what goes into that into developing decision aids? What does that mean? Like how do you decide what to work on? What goes into developing something. How do you know it's any good? Who's it for? I just get all these questions.
Dan Matlock: Yeah. The whole idea of the, a lot of the work I do in decision aids are a bit of a hot topic. How I got into them was funny. When I was a geriatric fellow, I did my residency, debating whether I wanted to do geriatrics or palliative care? And I was thinking of trying to get boarded in both. And I am boarded in both, but I only did a fellowship in geriatrics, but during my geriatric fellows, I was working at our VA nursing home. And there were two patients that I was caring for who was there for hospice care. And both had these defibrillators, which is one of those cardiac interventions that I have gotten into. One of them had metastatic cancer, colon cancer, and he was dying. And the other had an incurable infection that had been seeded several of his artificial joints and was not clearing w
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35min

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