Health Hats, the Podcast

My son. Mike, died 19 years ago, age 26. Wasn’t born with a tattoo telling him how long he had to live. Blood, married, intentional families. Love & boundaries. 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 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 2021. 1 Open Hearts 2018 03:27. 1 Love myself 2002 04:43. 2 He met a girl 2018 09:50. 3 Birthday wishes for the old guy 2002 11:44. 3 Spiritual health 2018 12:40. 4 Lifetime warranty 2018 17:19. 4 Not personalizing death 2018 19:32. 5 Leave me a sign 2018 27:53. 6 Reflection 2020 30:00 7 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, Boston Drummer, Composer, Arranger Sponsored by Abridge Thanks to these fine people who inspired me for this episode: Robert Doherty, Simon and Ruben van Leeuwen, Ann Boland, Anica Madeo, Andrea Condit, India Duncan, Lenore Nowicky Links Related podcasts and blogs https://health-hats.com/superpower-accepting-what-is-1-99/ https://health-hats.com/best-spiritual-health-dying/ https://health-hats.com/pod138/   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. 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 2021 I wasn’t born with a tattoo on my ass telling me how long I have to live. Welcome to the third anniversary of Health Hats, the Podcast, episode number 149. On November 15th, 2018, the first episode honored my son, Mike Funk, who died on November 18th, 2002, nineteen years ago, age 26, of metastatic melanoma. Mike, a wise poet, found his best spiritual health in that last year of his life. Hence, the most memorable sentence in my life. I wasn’t born with a tattoo on my ass telling me how long I have to live. I’m grateful to have known Mike, my son, our brother, our friend. I resurrect this episode to celebrate Mike and celebrate family – blood family, married family, intentional family. Mike was part of our intentional family. He was our son from other parents. Mike and I mused often about family especially in his final year. As you can imagine his intense feelings about his blood family and his intentional family colored those conversations. Ever the poet, we talked about the challenge of family as unconditional love, especially when you’ve been treated badly, neglected, abused, and left. We spoke about boundaries, unconditional love with boundaries, standing up for yourself, protecting yourself, setting limits. On this anniversary of dying, podcasting, life, I’m celebrating my families, my supporters, listeners, readers, and compatriots. I miss Mike, my mom, Ruth, my Uncle Leon, my sister-in-law, Peggy, my friend Bob Doherty. The partial list grows longer as I continue to experience life. Yet, life is good. Gratefully, here you go, episode one, ninety-nine, and 149. Happy Thanksgiving. Open Hearts 2018 Health Hats: In this session, I’ll share some tape of an interview with Mike a few months before he died. Bob Doherty conducted that interview and some thoughts and stories from me. One day, Mike and I were sitting at the kitchen table, talking about dying and superpowers. And Mike thought that he and I had the same superpower. We both accept what is. Not the ‘life sucks, what’re you gonna do’ variety of acceptance, but the ‘yup, here is impending death, how can we live our best lives’ variety. ‘Yup, he died young. Young death happens a lot. You open your heart, and tragedy walks right in. What’s the alternative, closed heart? Not for me. So, let me set the stage for

These three stories, my doctor and me, equity in health systems, care of children with severe heart problems, all contain a problem desperately needing fixing, choices – some based as research, others not – some action taken or no action. How can we continually learn from experience, share that cumulative experience to inform future choice-making and action? Blog subscribers: Listen to the podcast here. Scroll down through show notes to read the post. Please support my 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 Underwhelming response to brilliance 03:41. 1 Pitches, no home runs 05:26. 2 Invoke curiosity without commitment 8:47. 2 Reflection 11:00. 3 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 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. Music by permission from Joey van Leeuwen, Drummer, Composer, Arranger Web and Social Media Coach Kayla Nelson @lifeoflesion Inspired by and grateful to Amy Price, Duane Reynolds, Matthew Hudson, Laura Marcial, Melissa Reynolds Sponsored by Abridge Support Health Hats, the Podcast financially Links A framework for value-creating learning health systems AHRQ About Learning Health Systems Pregnancy and Fibromyalgia by Melissa Reynolds   Related podcasts and blogs https://health-hats.com/accessible-yoga-honor-your-body/ https://health-hats.com/everyone-included-research/ https://health-hats.com/hardwiring-continual-learning/ 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. 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 When first diagnosed with Multiple Sclerosis, my neurologist told me he was expert in treating groups of people (populations) with MS, but he didn’t know crap about me. His job was to learn about me, and my job was to learn about MS. I shared what was important to me in my life, and he taught me about MS and treatments. We slowly learned what worked for me in care and treatment and what didn’t and re-examine year after year. In last week’s podcast episode, we chatted with Duane Reynolds from the Just Health Collaborative. He guides health systems in creating cultures of belonging, enabling a fair and just opportunity for everyone to achieve optimal health. I wonder what worked and what didn’t among the interventions his clients tried? When I worked at Boston Children’s Hospital, I was fascinated by their Cardiology Department’s Standardized Clinical Assessment And Management Plans (SCAMPs) to promote, not require, care standardization. SCAMPs “offered a clinician-designed approach to promoting care standardization that accommodates patients’ individual differences, respects providers’ clinical acumen, and keeps pace with the rapid growth of medical knowledge.” In lay terms, that was similar to my neurologist. People are different. Understand them, their preferences, stay up to date with research, make a treatment/care choice, and document what worked and what didn’t. Re-examine. Continually learn. These three stories, my doctor and me, equity in health systems, care of children with severe heart problems, all contain a problem desperately needing fixing, choices – some based as research, others not – some action taken or no action. How can we continually learn from experience, share that cumulative experience to inform future choice-making and action? Underwhelming response to brilliance I have introduced this idea of co

Duane Reynolds of the Just Health Collective reflects on a layered approach to combating racism. Individuals drive organizations that live within systems. Blog subscribers: Listen to the podcast here. Scroll down through show notes to read the post. Please support my 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 Duane Reynolds and the Just Health Collective 03:13. 2 Research into key drivers of health inequity 07:08. 3 How do root causes and interventions align? 09:53. 3 Organizations and communities operate on different time frames 12:55. 4 Individuals drive organizations that live within systems 16:06. 4 Eureka! Belonging. 18:45. 5 Reading the room 20:53. 5 Transformative change for employees 23:46. 6 Difficult conversations at home – the learning journey 26:41. 7 My education and support systems 30:45. 8 Reflection 33:34. 8   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 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. Music by permission from Joey van Leeuwen, Drummer, Composer, Arranger Web and Social Media Coach Kayla Nelson @lifeoflesion Inspiration from Fatima Muhammed Ighile, Neely Williams, Lisa Stewart, Ame Sanders, Matthew Hudson, Robert Doherty, Jason van Leeuwen, Benjamin Anderson, Nikki Montgomery, Michelle Whitt, Lisa Masinter, Janice Tufte Sponsored by Abridge Links Here is a direct link to the Just Health Collaborative website the Institute for Diversity and Health the Institute for Diversity and Health of the American Hospital Association Centering Health Equity podcast: https://centering-health-equity.squarespace.com/ Medium: https://medium.com/just-health-collective Just Health Collective Village Benjamin Anderson Rural Health Equity for the Colorado Hospital Association Invisible Woman, a plastic model of the human body with a removable pregnant abdomen Related podcasts and blogs Here are some of many episodes including health equity https://health-hats.com/pod110/ https://health-hats.com/pod133/ 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. 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 1960 I discovered that I didn’t belong. I was eight. My parents supported Kennedy for President. Everyone else’s parents supported Nixon. My eyes opened. My family was different. My parents were active in the Fair Housing Movement. They hosted businesspeople of color from Africa. No one else knew anyone of color who wasn’t a maid or landscaper. Boys carried sweaty, folded-up pictures of scantily dressed girls they got from their older brothers and giggled about them in the restroom. My mom had introduced my sister and me to the Invisible Woman, a plastic model of the human body with a removable pregnant abdomen. I didn’t get the attraction to those nudie pictures. I remember our Unitarian minister, Russell Bletzer, talking to us kids about belonging. That strange, lonely feeling had a name. My parents were holocaust survivors. They never mentioned belonging. Not until high school did I meet a crew where I felt I belonged—what a relief. I didn’t realize I was a white person of privilege until I was in nursing school. More about that later in the episode. The recognition of my privilege led to my embarrassment of that privilege. I hid it for forty years by saying I grew up in Chicago and Detroit rather than the tony suburbs of Highland Park and Grosse Pointe. Now, diversity, inclusi

I’m not the sharpest knife in the musician drawer. Disheartening. I wish I were better. If wishes made me play better… All I can do? Keep at it. In the last two years. I’ve gone from “I can’t do this, I’m quitting” to “I need to be better.” One foot in front of the other. If this were health, I’d advise that you never get better in a straight line- always many dips and rises. No dip, no rise. I do like the rise. Gotta live with the dips. Blog subscribers: Listen to the podcast here. Scroll down through show notes to read the post. Please support my 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) I’m as good as I am 00:28. 1 Hiding, confidence, woodshedding 02:27. 1 Gigging, a dose of reality 04:42. 2 Peaks and valleys 05:52. 2 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 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. Music by permission from Joey van Leeuwen, Drummer, Composer, Arranger Web and Social Media Coach Kayla Nelson @lifeoflesion Music, Midnight Mambo composed by Oscar Hernandez, played by Lechuga Fresca, Latin Band Inspired by and grateful to Joey van Leeuwen, Oscar van Leeuwen, Leon van Leeuwen, Kayla Nelson, Jeff Harrington, Jennifer Keeney, Cynthia Meyer Sponsored by Abridge Support Health Hats, the Podcast financially Links Related podcasts and blogs https://health-hats.com/listen-to-the-music/ https://health-hats.com/pod120/ https://health-hats.com/pod109/ 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. 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 After last week’s arcane episode (Arcane means understood only by a few) about Cost in Healthcare, here’s something lighter and more familiar – plying a craft as a dedicated amateur, in my case, as a musician. I’m as good as I am I left for the gig determined and fearful. I’ve spent six to ten hours a week playing my horn since I got the new baritone sax stand. I hadn’t played for eight weeks with my back pain and inability to carry the weight of the fifteen-pound horn on my shoulders and neck. The new stand holds the sax independently so I can play sitting or standing. Working with my long-time teacher, Jeff, I’ve made considerable progress on feeling the form of the tunes, keeping my place with decent phrasing for my solos. I’ve made it a point to solo on three tunes each session the band plays, a stretch for me. Our alto player couldn’t make the gig; I would be one of two horn players. I was determined to solo on six tunes to fill the gap, I felt the fear about my ability or lack thereof. I’d be as good as I am – sweaty hubris, to be sure. Hiding, confidence, woodshedding My usual practice at gigs and rehearsals is to hide behind the other horn players for the melodies and choruses, reflecting my lack of confidence. I play softly; I stop when they stop. I don’t always understand the form – the arrangement. It changes frequently with our democratic style of arranging. I briefly led an effort to create a spreadsheet to keep track of the decisions about how the tunes begin, solo order, what happens between solos, how we end. Some reluctance among my bandmates to do that and some eagerness. I advocated with “At least we’ll have something to change.” But we didn’t keep it up, and I didn’t study it and keep it up for myself. A couple of tunes had a small bari sax part critical to the song. I worked on those for hours (woodshedding) to come in at the right place, w

What does healthcare cost mean? I can’t explain it. Listen to Matt Pickering from Nat Quality Forum help us out. Consider serving as a patient rep with NQF. Blog subscribers: Listen to the podcast here. Scroll down through show notes to read the post. Please support my 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 Matthew Pickering 05:37. 2 Value to whom? 07:48. 3 Moving from volume to value 11:37. 3 Quality and cost measures help choose plans and providers 13:41. 4 Consumer seats at the table 15:06. 4 Cost, is it real? 17:09. 5 Measures inform and inspire, don’t they? 22:27. 6 Cost is different. Smoke and mirrors? 25:23. 6 Do consumers use this cost and quality information? 27:45. 7 Who would want to sit on this cost committee? 30:51. 8 Participating 34:33. 9 Reflection 36:40 10 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 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. Music by permission from Joey van Leeuwen, Drummer, Composer, Arranger Web and Social Media Coach Kayla Nelson @lifeoflesion Inspiration from John Shaw, Danny Sands, Cynthia Cullen, Ellen Schultz, Janice McCallum, Michael Mittelman, Edwin Lomotan, Lacy Fabian, Michael Millenson, Amy Price, Tania Dutta, Uma Kotagal Sponsored by Abridge Links Matthew Pickering LinkedIn National Quality Forum (NQF) Cost and Efficiency Measure Standing Committee Better Ways to Cut Healthcare Waste What Is Value-Based Healthcare? New England Journal of Medicine PCORI: Patient Engagement CMS: Person and Family Engagement Related podcasts and blogs https://health-hats.com/zen_relationshipcentered_measure/ https://health-hats.com/pod137/ https://health-hats.com/infodemiology-too-much-not-enough/ 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. 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 If a grocery store, car dealer, hardware store, eBay, Amazon charges $100 for something, how much does it get paid? $100. If a healthcare provider (doctor, physical therapist, clinic, hospital) charges $100, how much does it get paid? It depends. It depends on the type of insurance, type of patient, service type. Type of insurance might be Medicare, Medicaid, private, none. Patient type means young, old, tall, short, full head of hair, bald, parent, grandparent, child. No, that would be too easy. It has nothing to do with the patient. It’s about the relationship with the clinician – acute episode, continuous relationship, referred by another clinician, etc.). Specific types of service (medical, surgical, X-ray, lab, radiation therapy, preadmission testing, more than 200 types). All to figure out cost. Cost? What does health care cost even mean? When politicians talk about costs, they’re referring to federal and state spending on health care. Hospital administrators and physicians talk about the money they spend on the resources needed to care for patients. Business leaders mean the price of insurance or the amount they spend on their employees’ health care insurance plans. Regular people think about out-of-pocket costs, the amount we spend beyond what insurance covers, plus costs of lost wages, childcare, transportation. You get the drift. Full disclosure – I will not be able to explain cost according to Medicare. I’ve been part of healthcare for almost 50 years, and I tried to study it further these past few days, and I cut myself off after 12 hours – I’m neve