Wednesday, April 27, 2011

The Doctor and The English Teacher

Twenty some years ago, when I married my amazing husband and was completing my degree, I had no idea just how helpful that degree in English Education would be.  It appears the marriage between a physician and an English Educator is now much more valuable.  From an article published in Medscape on April 21, 2011, healthcare workers are now responsible to make sure that all their patients are literate.  The article does state "health literate" and then goes on to explain what this means:

"The problem of health literacy is widespread and goes beyond those who can't read or those who don't speak English." P Weiss Chairman of ACOG Committee on Patient Safety.

Here is the US Department of Health and Human Services Quick Guide to Literacy:

  • Tailor speaking and listening skills to individual patients. Use open-ended questions starting with the words "what" or "how," and use medically trained interpreters when needed. Especially during the informed-consent process, but also in general, check patients' comprehension by having them restate the health information given in their own 
  • words. Encourage staff and colleagues to use culturally sensitive plain language to obtain training in improving patient communication.
  • Tailor health information to the intended user by ensuring that it reflects the target group's age, social and cultural diversity, language, and literacy skills. Include the target group in the development (pretest) and implementation (posttest) phases of developing information and services to improve effectiveness of the program. Consider cultural factors, including race, ethnicity, language, nationality, religion, age, sex, sexual orientation, income level, and occupation when preparing health information.
  • Develop written materials conveying no more than 4 simple messages per handout. These materials should focus on action and give specific recommendations based on behavior rather than on the underlying medical principle. Use the active voice instead of the passive voice, use familiar language, and avoid jargon. Use culturally relevant visual aids such as drawings or models for key points, use 12-point type size or larger, and leave sufficient white space around margins and between sections.

In general, I am not opposed to any of these and completely agree that it is important for patients to understand fully their choices.  But, I, who consider myself literate have a hard time comprehending how one of the items they suggest is even remotely manageable.  The suggestion to develop written materials conveying no more than 4 simple messages per handout - sounds easy enough - but contrast this with what the Texas State Medical Board requires when informing patients about non-conventional treatment:

(2) Disclosure. Prior to rendering any complementary or alternative treatment, the physician shall provide information to the patient that includes the following with the disclosure documented in the patient's records:
(A) the objectives, expected outcomes, or goals of the proposed treatment, such as functional improvement, pain relief, or expected psychosocial benefit;
(B) the risks and benefits of the proposed treatment;
(C) the extent the proposed treatment could interfere with any ongoing or recommended medical care;
(D) a description of the underlying therapeutic basis or mechanism of action of the proposed treatment purporting to have a reasonable potential for therapeutic gain that is written in a manner understandable to the patient; and
(E) if applicable, whether a drug, supplement, or remedy employed in the treatment is:
(i) approved for human use by the U.S. Food and Drug Administration (FDA);
(ii) exempt from FDA preapproval under the Dietary Supplement and Health Education Act (DSHEA); or
(iii) a pharmaceutical compound not commercially available and, therefore, is also an investigation article subject to clinical investigation standards as discussed in paragraph (7) of this subsection. 

All of this seems incredibly reasonable and patients should absolutely know what they are choosing - but physicians can't do both - they can't be simple and thorough.  To the rescue, the English teacher who may or may not have certification in ESL - the one who was taught that the general population doesn't read above the 8th grade level (no matter how much money we throw at our public school system).   And regardless of the amount of time and money you spent on your own education - the physician or teacher should never assume that you can think past the end of your nose.

My remedy - Those that are choosing to go into the healthcare field should be matched with a spouse that has an English Teaching degree with a focus in grammar and technical writing.  This should not be optional.  It will be an arranged marriage of sorts - that way we can make sure that all patients receive their medication and can read the prescription too.

Tuesday, April 19, 2011

Organic- When it matters

Organic: If you're a parent or a savvy foodie, this word passes your lips everyday. It describes produce that is grown without potentially harmful pesticides. Sure, many experts insist such chemicals are safe. But with a rise in information, you're probably more vigilant about what goes into your body and/or your child's, and with good reason. "Babies eat more than adults, pound for pound, and are more vulnerable to environmental toxins," says Alan Greene, MD, pediatrician and author of Raising Baby Green.

To lower your chemical load, you don't need to take an all-or-nothing approach. Start with a change or two based on what your family regularly eats. These seven staples are a good beginning.

Organic milk can cost about 50 percent more than conventional milk costs. But, Dr. Greene says, "If you want to make just one change, this is it." Conventional milk contains antibiotics and artificial hormones, as well as pesticides. Experts worry that all these hormones could kick-start early puberty, considering how much milk kids drink on a daily basis. Plus, recent research from Newcastle University in the United Kingdom found that, compared with conventional milk, organic milk contains significantly higher levels of heart-healthy fatty acids and antioxidants.  Also milk is not your best source of calcium - and comes with problems of its own.  According to some sources, milk is the number one cause of childhood asthma.  In our house we opt for organic rice milk - if you are choosing soy make sure that it is organic - NO exceptions.
Potatoes make the Dirty Dozen list put out by the Environmental Working Group (EWG), a nonprofit devoted to food safety, meaning that potatoes are one of the 12 most pesticide-contaminated fruits or vegetables. The EWG also found that 81 percent of potatoes still contained pesticides after being washed and peeled. Kids take in plenty of spuds as french fries -- another reason to limit their consumption. Adults, too, love the taters: According to one survey, they account for 30 percent of all veggies eaten by adults.
Peanut Butter
If PB&J sandwiches are a lunchtime favorite with your kids, it may be time to try an organic spread. "The pesticides used on peanuts are found to be especially toxic," Dr. Greene says. What's more, since 1996 there's been a dramatic rise in peanut allergies. Is it the peanuts or the pesticides....? Genetically modified soy may cross over into the peanut crop, he adds, which could account for this upswing.  In addition, if you are not using organic PB you need to be aware that most are filled with high fructose corn syrup or sugar.  
Baby Food
"Our body and brain grow faster from birth to age 3 than at any other time," Dr. Greene says, adding that "if you're going to pick only one time to go organic, it should be from conception to age 3." Kate Clow, of Chatham, New Jersey, adheres to this rule: "I try to give Owen, my 10-month-old, all organic because he's so young, but for the older girls, who are almost 3 and 5, I avoid just the Dirty Dozen."  Now take this information and apply it to LOTS of other items which will be in another blog.
The average American consumed 94 pounds of tomatoes in 2006, mainly in the form of tomato juice, tomato paste, and ketchup. Kids love this condiment: It makes the perfect dip for everything from veggies to eggs. It's superhealthy, too, as it's the number-one source of lycopene, a nutrient that helps to lower the risk for cancer and heart disease. Research has found that organic ketchups are 57 percent higher in lycopene than their conventional counterparts and dish up double the antioxidants. Also notable is what most organic ketchups don't have: SUGAR and artificial flavors -- which is why we say Ketchup is for the hot dogs and hamburgers - all other meats - JUST EAT!
If yours is like most American homes, the fridge is stocked with apples, applesauce, and apple juice. This fruit is the most commonly eaten after bananas and the second most commonly used in juices after oranges. However, apples are second on the Dirty Dozen list. What's more, the organic version has been found to have higher levels of disease-fighting polyphenols and other phytonutrients, so go organic with this one.
Antibiotics are used to promote growth in livestock, and those drugs may make it into your system too. And most American beef comes from cattle that is corn- or grain-fed, which is not healthy for us. Organic, grass-fed beef tends to be leaner and has five times the omega-3 fats, which are good for the heart. Organic beef can be tough to find. To locate organic beef in your area, visit or your local farmers' market.  Or visit your local SPROUTS.  Nolan Ryan beef found in most Kroger stores is a great alternative.
The Dirty Dozen
These earn the distinction as the most contaminated by pesticides; buy organic when possible!  In addition, fruit from Chile is HIGH in pesticides.  I am a huge fan of Costco because they do such a great job of supplying organic products -  but in the winter almost all fruit is from Chile, where standards are not the same.
* Peaches
* Apples
* Sweet bell peppers
* Celery
* Nectarines
* Strawberries
* Cherries
* Lettuce
* Grapes (imported)
* Pears
* Spinach
* Potatoes 
Should be bought organic if at all possible - when not possible make sure that all are washed and peeled well.  Then make a great dinner knowing that you are "serving" your family well.
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