aging

Connecting Health, Aging, Geriatrics, & Innovation

February 7, 2014

What exactly does geriatrics have to do with the buzzing areas of innovation in aging, and in health care?

Several months ago, at a Bay Area gathering related to innovation and aging, I remarked to one of the organizers that these events generally didn’t seem to include much conversation about the health needs of older adults.

“Oh, we’re not doing health. We’re doing aging,” was the reply.

Ah. I see.

I was a little surprised by this statement, but not very. Obviously, if you are a hammer, everything tends to look like a nail. I’m a physician specialized in the care of aging adults, so when I look at an elderly person, I see the underlying health concerns and age-related vulnerabilities.

But over the past several years that I’ve been talking with people interested in “aging” (e.g. in public health school, at the caregiving website where I used to write, and now with the entrepreneurs and innovators wanting to serve the “aging market”), I’ve noticed two recurring issues:

People often think of aging issues and health issues as different topic areas. Because of this, people offering to help with life problems in aging adults often don’t make as many connections to health issues as they could.

Consider an older person who is having trouble with shopping and cooking. Sure, you can arrange Meals on Wheels, or get a care circle to start helping with the groceries, or you can might even consider assisted-living. (And if you are a worried family caregiver losing sleep over this situation, you should definitely seek out support.)

But what about the health problems contributing to this functional decline? Is there cognitive impairment? Poorly treated arthritis pain? Fear of falling?

The ideal way to help such an aging adult is to integrate the social and life interventions with the right type of medical evaluation and interventions.

People don’t understand what geriatrics is. Ergo, they don’t understand how what we know and do might be relevant — and useful — to what they are trying to do.

Oh sure, some people know that geriatrics has something to do with taking care of the elderly; a well-informed minority even know that geriatrics is the health care of older adults.

But, really, what does “health care of older adults” mean? This definition is vague about who’s an older adult, what makes aging adults need changes in health care, and what constitutes said health care.

Connecting Life, Health, and Aging

Recently I was invited to be on a panel about aging, health, and technology. The event was titled “Challenges & Opportunities in Developing Products for Older Adults,” hosted by the Bay Area Health Technology Forum.

I decided to see if I might be able to address these two issues during my ten minute talk to the group.

Here is one of my slides from my talk:

Thoughts? Feedback? Please post in the comments below!

(PS: I also experimented with a different definition of what is geriatrics in the talk. I’ll write about that in an upcoming post.)

The ePrognosis App: On Life-Expectancy & Healthcare Decision-Making

December 13, 2013

[This post was first published on The Health Care Blog on 11/22/13.]

Last month an intriguing new decision support app launched, created by experts in geriatrics and palliative care. It’s meant to help with an important primary care issue: cancer screening in older adults.

Have you ever asked yourself, when considering cancer screening for an older adult, whether the likely harms outweigh the likely benefits?

Maybe you have, maybe you haven’t. The sentence above, after all, is a bit of wonky formulation for the following underlying questions:

How long is this person likely to live, given age and health situation?
Given this person’s prognosis, does cancer screening make sense?

The first question seems like one that could easily occur to a person — whether that be a patient, a family member, or a clinician – although I suspect it doesn’t occur to people perhaps as often as it should.

As for the second question, I’m not sure how often it pops up in people’s minds, although it’s certainly very important to consider, given what we now know about the frequent harms of cancer screening in the elderly, and usually less frequent benefits.

Furthermore, there is abundant evidence that “inappropriate” cancer screening remains common. “Inappropriate” meaning the screening of people who are so unwell and/or old that they’re unlikely to live long enough to benefit from screening.

For instance, one astounding study found that 25% of physicians said they’d order colon cancer screening for an 80 year old with inoperable lung cancer. So it’s clear that improving the decision-making around cancer screening would help improve healthcare safety, quality, and value.

Enter the ePrognosis Cancer Screening app, which is the first app created by the UCSF-based ePrognosis team. It’s free in the iTunes store, and according to co-creator Eric Widera, a geriatrician and colleague of mine, it was designed to be used by the public as well as by clinicians.

The app basically works like this:

You tell it whether you’re interested in screening for breast cancer, colon cancer, or both.
The app asks you 15 questions about yourself, your health, and whether or not certain activities are difficult for you. (The questions are a combination of the Lee and Schonberg mortality indices; see here for the questions and relevant scholarly citations.)
You are then presented with a statement on whether cancer screening is recommended, along with a nifty speedometer graphic illustrating the balance of harms vs. benefits.
If you click “Learn more” you are shown a series of pictographs illustrating information on expected harms and benefits of screening, along with information on what proportion of similar people will die over the next 10 years whether or not they get screened for cancer.
You can also click share and reportedly send the report to another person. (Note: I wasn’t able to get this to work for me.)

For more information on the app, including some good screenshots, you can read theGeriPal post introducing the app.

Using prognosis: From research to ePrognosis to…app?

So will the app work as its creators hope? Meaning, will it help patients and clinicians make better decisions about cancer screening in older adults? And will it reduce inappropriate cancer screening in older adults?

Prognosis is, after all, a thorny topic. Even if you can get decent prognostic information at the time you need it, going through discussions and decision-making based on this information is not easy. For instance, this qualitative study of older adults found that although most participants were open to discussing life expectancy, about a third perceived such discussions as not useful, or even harmful. (Interestingly, 64% of participants felt that their physicians could not correctly estimate their life expectancy.)

The ePrognosis project itself was meant to address the first part of the challenge: the fact that practical prognostic information is hard for front-line clinicians – and regular people — to find. Consider this: even today, UpToDate has no topic page on how to estimate life expectancy in older adults, despite many guidelines now urging clinicians to factor prognosis into medical decisions. (For a useful slideshow on why we should use prognosis, see here.)

Instead, UpToDate has a page titled “Communication of Prognosis in Palliative Care”, authored by UCSF’s Alex Smith, a co-creator of ePrognosis. This resource has terrific content on how clinicians can discuss prognosis, but because of its title, may not be easily spotted by doctors searching for a quick way to figure out life expectancy. (“How to talk to patients about how long they’re likely to live” might catch more notice among generalists.)

I myself like the ePrognosis website in concept. That said, I recently found myself sheepishly admitting to Alex that I’ve hardly ever used it. Why? Mainly because my patients tend to be quite elderly and frail, and I feel that I’m already incorporating a sense of their limited life expectancy into my recommendations and conversations with them.

And herein lies the rub: the clinicians who think of using ePrognosis, or of incorporating life expectancy into their decision-making, are probably not the ones who most urgently need to use something like ePrognosis. (Not that we’re perfect – I’m sure using more decision support would help me — but at least we’re not the type to order cancer screening on an 80 year old with inoperable lung cancer.)

In general, the ePrognosis story illustrates a common challenge in improving healthcare quality: the problems that experts see at the population level (excess cancer screening in frail elders) are experienced very differently by the clinicians and patients on the ground (clinicians and patients have historically had enthusiasm for screening).

But changing the behavior of individuals – which is what you need to improve a quality problem – is very hard, especially if people remain embedded in their usual environments. Although expert guidelines and advice do have an important role to play, it’s usually not nearly enough to counter the habits and attitudes of the people in the trenches.

Still, when it comes to better healthcare for older adults, creating the tools to calculate and communicate life expectancy is a good start. Once a tool exists, it becomes possible to see how people respond to it, refine it, improve it, and also think of how to make it more available to the right people at the right time. One could even imagine certain tools being embedded into the clinic processes that nudge clinicians and patients towards (or away from) certain actions.

Now, where do you think we should go from here, if we want to use prognosis to improve healthcare, and healthcare value, for older adults? The creators of ePrognosis are looking for feedback and suggestions as to next steps. So check out the ePrognosis website, try out the app, and share some thoughts in the comments.

I just plugged information on a current elderly patient into the ePrognosis Gagne index and it predicts a 30% chance of death in the next year. Hm… perhaps I’ll reread that UpToDate page on discussing prognosis, as this patient is due for an advance care planning conversation. That page describes a five step process for discussing prognosis.

Should that be in an app?

[There are some interesting comments on this post at THCB; add your thoughts either here or there.]

Health 2.0 Tools for the Elderly

November 8, 2013

[Guess what: the upcoming Health 2.0 Europe conference is featuring a special session focused on how digital health can meet the needs of aging adults! The following post – first published on THCB – is by Maneesh Juneja, who is organizing a “Tools for the Elderly” session at Health 2.0 London.]

In 2 weeks’ time, at Health 2.0 Europe, I am moderating a pre-conference workshop ‘Health 2.0 Tools for the Elderly’. Dr Leslie Kernisan wrote a blog post after attending the recent Health 2.0 Silicon Valley conference, observing that most Health 2.0 solutions are not designed with the elderly in mind.

That’s why I was very impressed when Health 2.0 invited me to curate and moderate the workshop on Nov 17th in London. We have 11 different technology solutions designed specifically for the elderly being demonstrated at the workshop. Having worked in the pharmaceutical industry, I acknowledge that technology is only one out of the array of solutions available to society.

Looking at the forecasts about the aging population, it’s way too easy to view the elderly as a burden, not a resource. Older people with their talents, wisdom and life experience have much to share with younger members of society. Could technology be used to connect those opposite ends of the age spectrum?

We’ve got a demo of GeriJoy, by Victor Wang, who gave a talk at TEDMED 2013, on how virtual companions might help ease our caregiving crisis.

On 1st Oct 2013, Silvia Stefanoni, Chief Executive of HelpAge International, said:

“The world is rapidly ageing: people over 60 years of age already exceed children under 5, and by 2050 they will outnumber children under 15. However, the continual exclusion of aging from national and global agendas is one of the biggest obstacles to meeting the needs of the world’s aging population.”

In the recently published Global Agewatch Index, in which 91 countries were ranked on social and economic wellbeing of older people, the UK was ranked 13th. Turkey was ranked 70th, below Dominican Republic & Ghana. Even the country that spends the most of healthcare, the USA, was ranked 8th.

This isn’t just about people getting older, but about their families and caregivers. What are the ways in which technology can help a son or daughter caring for a parent that has Alzheimer’s? Intelesant, winner of a Guardian award for Innovation with Technology, will be demonstrating their ELMA tool, for End of Life care. We don’t often hear End of Life Care being discussed in society, let alone at health technology conferences.

The UK set up the 3 million lives initiative, looking at how telehealth and better self care at home could improve the wellbeing of 3 million people with long term conditions and/or social care needs. I attended the inaugural Internet of Things World Forum (IoT) last week, where a vision of a future where billions of devices will be connected to the internet was shared. I’m really curious about the impact that ‘sensors’ may bring to our world.

With 13% of the UK population being non-white, what are the cultural differences? We have Janet Jadavji, as part of the panel discussion, who will be sharing her perspectives on how different communities are dealing with elderly relatives.

It’s not about the latest technology, as the digital divide does exist. 69% of people aged 75 or older in the UK have never used the internet. We will have a demo from SpeakSet, who have developed technology that connects families via the TV!

We will also have a talk from Sarah Reed, who will sharing valuable insights from her considerable experience with caring for older people. Beyond the headlines, Sarah will shed light on the daily challenges that elderly people face, and where the opportunities for technology are.

Urbanization is something that is changing the landscape of the planet, half the world’s population live in cities and this proportion will rise. Loneliness is a problem, and not only impacts physical health but mental health too. Jeremy Hunt, Health Secretary in the UK, recently remarked that 5 million people say TV is their main form of company. In light of these trends, I wonder if technology can help us stay connected to elders, wherever WE might be in the world?

It’s easy to be overwhelmed by the scale of the challenges posed by aging populations in every country. However, I believe that by coming together, having open and mature conversations, we stand a chance of making a ‘tangible’ difference in the lives of billions.

Today, you may think that the needs of older people are not your problem. However, everyone gets old. In curating this workshop, I’ve observed that many of the innovators I met developed an idea driven by their own personal experience of caring for an elderly relative. Through courage and tenacity, they channelled their frustration into developing a product or service that could make all the difference.

What if you could play a role in building technology that could help older people and their families in the future? Whilst improving outcomes and reducing the cost of care is important, how might technology enable the healthcare system to also provide more ‘compassionate care’ to the elderly?

Getting to Better End-of-Life Care for Older Adults

October 25, 2013

[This post was first published on my Geriatrics for Caregivers Blog on 10/24/13. Am reposting here as I think the topic is relevant to the GeriTech audience.]

What is good care at the end-of-life, and how can we do better as a society?

This is the question that the Institute of Medicine (IOM) is now studying, and they have created a “Committee on Approaching Death: Addressing Key End-of-Life Issues.”

As part of their research into the current state of end-of-life care, the IOM is inviting the public to send them comments via this online comments page. (Comments must be submitted by November 1st, 2013.)

In particular, the IOM wants to hear about the following topics:

Barriers to and opportunities for improving care for individuals and their families,
Patient and family experiences with care, and
Health care provider experiences.

Now, as you can imagine, addressing end-of-life issues is a big part of what we do in geriatrics. Furthermore, I’m thrilled to see the IOM addressing this issue, since their reports are highly respected and often end up influencing policy and funding.

So I was very glad to provide some comments to the IOM, and encourage others — family caregivers, geriatric care managers, clinicians, or really anyone who has had personal experiences with end-of-life situations in the US — to submit comments as well.

The best reports, after all, result from the academics’ expert opinions being informed by the experiences of those of us in the trenches, trying to navigate real end-of-life situations.

My comments on Better End-of-Life Care for Older Adults

Below, I share the comments that I’m submitting in response to the IOM’s questions.

Question 3: If you are a health care professional, please tell us about your experiences in providing care to individuals with serious progressive illness or condition and their families. What are the problems, opportunities, challenges, and successes you encounter? Does the term “end of life” impact the willingness of the individuals you work with to engage in the provision of care or the willingness to receive it? Please indicate what type of professional you are (discipline/specialty).

I’m a geriatrician and general internist; I used to work in a federally qualified health center but now I have a small consultative practice, which complements existing primary care. I have special interests in educating family caregivers, and in leveraging technology and online resources to improve geriatric care.

Problems with end-of-life care:

People often haven’t reflected on, and then planned for, how they’d prefer to die.
Just importantly, they haven’t planned for the type of medical care they want in their last years of life.

Specifically, people don’t think of how they’d prefer to orient medical care during those last years when they may be steadily declining due to dementia or other chronic illnesses and frailty.

Patients and families often don’t realize it when a chronically ill person is likely in the last few years of life.

This is partly because clinicians often don’t discuss prognosis and when death might happen. And patients tend to not ask, unless they’ve been diagnosed with cancer.

Helping patients and families understand that they are probably in the last years of life is often quite hard.

For clinicians, it takes time, it takes good communication skills, and it takes a willingness to engage in an emotionally charged conversation.
Most primary care clinicians are lacking the time and training to have these conversations.

My personal experience is that as a doctor it’s been easier to discuss prognosis and end-of-life planning when working on a hospital-based palliative care consult service than in a primary care setting.

Because palliative care consults tend to happen in the context of an acute health crisis, I think this helps everyone focus on a difficult topic.
In the outpatient setting, there is a lot of pressure to postpone awkward topics. Plus it’s very hard to find the time to open the can of worms and deal with it compassionately.

Elderly patients often have their care divided between many specialists, each very focused on his or her diseases of interest, and they tend to want to do everything possible for those disease.

Primary care doctors struggle to integrate the care.
We have no good methods for helping patients and doctors figure out when to start shifting the goals of medical care, other than signing patients up for hospice, which tends to happen very late in the game, if at all.

We under-use palliative care, both for symptom management and for thoughtful discussion of goals for medical care.

Many people – patients, caregiver, clinicians – think that it’s just for the very end-of-life, and don’t realize that it’s an approach that can be pursued without “giving up” or signing up for hospice.
I’ve often witnessed families turn down palliative care, even though they would’ve likely found it beneficial. Suspect this is boils down to communication issues.
Other families who would like palliative care services find themselves unable to access them, especially in the outpatient setting.

Opportunities:

I like the POLST paradigm and find using POLST helpful, esp as a framework to guide a conversation about what kind of care a patient wants when future health crises occur. It shouldn’t be the beginning and end of advance care planning, but it’s a helpful tool.
We now have easy-to-use online tools to help individuals and families reflect on preferences for care in the last stages of life. I like PrepareForYourCare.org, and also TheConversationProject.org.

Question 4: What do you see as the biggest barriers to care (for individuals with serious progressive illness or condition) that is appropriate and easy to access?

The biggest barrier to better end-of-life care for older adults — or those suffering from serious progressive illnesses — is that our current paradigm for end-of-life care is best suited to supporting people as they die of something relatively predictable, like advanced cancer.

We don’t have a wide-spread approach to help older people – and their families — through their last few years of decline. (This stage — in which living, declining, and dying overlap — is very compellingly described in Katy Butler’s recently published book, Knocking on Heaven’s Door. )

Incidentally, this is the geriatric approach, but right now it’s treated as an art practiced by only a small number of clinicians, rather than a broader approach around which to organize care services for millions of aging adults.

Other barriers to better end-of-life care:

Primary care clinicians don’t have the time and training to discuss planning for last stages of life with patients and families.
Older adults find their care split between multiple specialists.Primary care clinicians often are not able to help patients and families coordinate care and navigate through the last stages of life.
Palliative care services remain largely based in hospitals, and are hard to access in outpatient setting.
The conversations needed to help patients and caregivers plan for the last stages of life are poorly reimbursed.
Society generally favors medicine having a role in saving lives and extending lives, rather than medicine helping people prepare for and cope with physical decline, and eventually death.
Intensive medical services (hospitalizations, diagnostic tests, specialty consults) are easy to get. Services to support elders and caregivers at home, or to help them manage chronic illnesses at home, much harder to get, even though these services are especially important during the last stages of life.

Question 5: What three changes in the U.S. health care system could improve care of individuals with serious progressive illness?

Three key changes to improve end-of-life care for older adults:

We should broaden end-of-life to mean the last years of life, and we should develop a healthcare pathway for chronically ill and declining people who are likely in their last years of life, as is described in this “MediCaring” white paper by Dr. Joanne Lynn.

Of note, the UK has developed a Gold Standards Framework along similar lines; we should study their approach and try to learn from their work.

We should provide primary care clinics with the time, training, and tools to help patients and families engage in meaningful planning for the last stages of life.

This is especially important for those primary care clinics that serve older adults, as navigating the last stages of life becomes relevant for just about every older person.

We should plan end-of-life services differently for children and younger adults than we do for the larger population of (mainly older) people who are likely to experience decline and dependence before dying.

Although these populations have some overlaps in their end-of-life needs, we’ll do a better job figuring out how to meet their needs if we consider them separately.

——

Decline, death, and dying will always be challenging for people and their families, as well as for the clinicians who serve them. Still, today in the US it often ends up being much more difficult and distressing than it has to be.

If you’ve had personal experiences with end-of-life situations, I hope you’ll share your stories and ideas with the Institute of Medicine. Remember, comments must be submitted by November 1st.

Knocking on Health 2.0’s Door

October 18, 2013

[This post was first published on The Health Care Blog on 10/16/13. See comments here, including one from Katy Butler, calling for a grassroots movement to demand changes in Medicare that would support more high-touch services and Slow Medicine. Hear hear!]

I recently attended the flagship Health 2.0 conference for the first time.

To avoid driving in traffic, I commuted via Caltrain, and while commuting, I read Katy Butler’s book “Knocking on Heaven’s Door.”

Brief synopsis: healthy active well-educated older parents, father suddenly suffers serious stroke, goes on to live another six years of progressive decline and dementia, life likely extended by cardiologist putting in pacemaker, spouse and daughter struggle with caregiving and perversities of healthcare system, how can we do better? See original NYT magazine article here.

(Although the book is subtitled “The Path to a Better Way of Death,” it’s definitely not just about dying. It’s about the fuzzy years leading up to dying, which generally don’t feel like a definite end-of-life situation to the families and clinicians involved.)

The contrast between the world in the book — an eloquent description of the health, life, and healthcare struggles that most older adults eventually endure — and the world of Health 2.0′s innovations and solutions was a bit striking.

I found myself walking around the conference, thinking “How would this help a family like the Butlers? How would this help their clinicians better meet their needs?”

The answer, generally, was unclear. At Health 2.0, as at many digital health events, there is a strong bias toward things like wellness, healthy lifestyles, prevention, big data analytics, and making patients the CEOs of their own health.

Oh and, there was also the Nokia XPrize Sensing Challenge, because making biochemical diagnostics cheap, mobile, and available to consumers is not only going to change the world, but according to the XPrize rep I spoke to, it will solve many of the problems I currently have in caring for frail elders and their families.

(In truth it would be nice if I could check certain labs easily during a housecall, and the global health implications are huge. But enabling more biochemical measurements on my aging patients is not super high on my priority list.)

Don’t get me wrong. There was a lot of cool stuff to see at Health 2.0; a lot of very smart people are creating remarkable technologies and tools related to healthcare. The energy, creativity, and sense of exciting possibility at a gathering like this is truly impressive.

And yet, most of the time I couldn’t shake the feeling that all this innovation seemed unlikely to result in what our country desperately needs, which is more compassionate and effective healthcare for Medicare patients and their caregivers.

The need to improve healthcare is particularly urgent for those seniors who have 3+ chronic diseases, or have developed cognitive and/or physical disabilities, since health issues seriously impact the daily lives of these patients and their caregivers. And of course, these patients are where most of the healthcare spending goes.

So here we have a group that uses healthcare a lot, and their problems are the ones who challenge front-line clinicians, healthcare administrators, and payors the most. And we love these people: they are our parents, grandparents, and older loved ones. Many of us are even taking care of them, sometimes to the detriment of our own health.

Knock knock. Who is listening? Where is the disruptive innovation we need to help elders, caregivers, and their clinicians?

Real impediments to the Health 2.0 Revolution

“Ready to Revolutionize Healthcare?” asks the Health 2.0 homepage.

Yes, I’m ready. But we’ve got a ways to go before these revolutionary tools can actually revolutionize the average older person’s experience with healthcare.

Why? Two key reasons come to mind.

1. Most solutions not designed with the Butlers in mind. As best I can tell, most innovators don’t have the situation of the Butlers in mind when they design their healthcare solutions. They neither understand the situation from the point of view of the Butlers themselves, nor do they understand the situation from the perspective of the front-line clinicians who could and should do better.

For instance, did the Butlers need games to maintain healthy behaviors and keep Mr. Butler walking and exercising after his stroke? Did they need for all interventions to be considered in light of “Healthspan” rather than “lifespan”?

(What is Healthspan for a slowly declining person with dementia and incontinence anyway? We geriatricians think of improving function, wellbeing, quality of life. And most importantly, of prioritizing the issues because you can’t possibly address them all so go with a combination of what matters most to the patient and what seems most feasible.)

And did the clinicians involved need predictive analytics to help them identify when Mr. Butler was at risk getting worse on some axis that the population health management gurus are worried about?

Which of these innovations will help patients, caregivers, and front-line clinicians establish an effective collaboration on mutually agreed-upon goals, and tailor healthcare to the patient’s situation and needs? How to convert population level processes regarding outcomes and cost-containment into real improvements in the healthcare experience of most elderly patients?

Finally, Medicare is the 600 pound gorilla in healthcare, both as a payer and as what most healthcare providers spend most of their time serving. You want to change healthcare? Change how we care for seniors. (And I don’t mean the healthy ones over-represented at AARP.)

2. Too many solutions to choose from. If you are a patient or caregiver, and decide to consider a new approach to weight loss, or timed toileting, or tracking a symptom: the number of approaches you could try – whether tech enhanced or no — is overwhelming. Especially if you research online.

If you are an individual clinician — or a smaller practice — and would like to consider a new and improved way of doing things: the choices are overwhelming. (A lot of primary care is provided by small practices; there’s obviously a trend towards consolidating but also some backlash.)

Now of course, big organizations have more resources with which to choose solutions for their providers, and big payers can choose solutions for individual patients and families. But unfortunately, when tools aren’t chosen by those who use them, users tend to end up with crummy user experiences.

There is probably an innovative way to work around this and make it possible for end-users to more easily find tools that are a good fit for them. But until those innovations become widely available, I think many in the trenches — patients, caregivers, and clinicians — may find that supposedly helpful innovations are actually not so helpful…a frustrating state of affairs when one is overwhelmed with the challenges of helping an aging adult in declining health.

Islands of relevance at Health 2.0

At an event as big as Health 2.0, there are of course pockets of activity relevant to the care of geriatric patients. There was a session on tools to help family caregivers (which covered two care coordination tools and two sensor/alert type tools) and another on nifty tech to help patients take their meds.

And of course, there was the justifiably popular Unmentionables panel, led by Eliza Corporation’s Alex Drane, which highlighted pervasive issues that affect health but that we tend to not talk about much. These include financial stress, relationship stress, and caregiving. (Good recap of the panel at Healthpopuli.com, and I LOVE that caregiving is high up on this list.)

Words to keep in mind

Alex reminded the Health 2.0 crowd that when it comes to helping with health, we must meet people where they are at. “Health is life; care, completely; empathy absolutely.”

As for me, I found myself thinking of a quote from Larry Weed and “Medicine in Denial.”

“The religion of medicine is not feats of intellect. The religion of medicine is helping to solve the problems of patients, and the compassion involved in the very act of care.”

Similarly, for those who evangelize digital health, and believe that new technologies will revolutionize healthcare, I would say:

The religion of healthcare should not be feats of technology. The religion of healthcare should be to help solve the problems of patients and caregivers, and the compassion involved in the very act of care.

And I’d also recommend they read “Knocking on Heaven’s Door,” or something similar, while attending exciting conferences and planning to revolutionize healthcare.