Power Dynamics & Virtual Health: Protecting Professional Boundaries in an Unbounded Web

Virtual Health – however that’s defined – has become a hot topic lately, especially in light of the rapidly evolving two-way real-time Web. Power dynamics – the interplays between patient and provider – must be protected in order to safeguard patient rights and protect their dignity, privacy and well-being. There’s more to virtualized practice than may be apparent on the surface.

Here are some thoughts, including an explanation of what I am (half-humorously) calling the “intimacy-boundary membrane”. [Link to video]

Power Dynamics & Virtual Health: Protecting Professional Boundaries in an Unbounded Web from Phil Baumann on Vimeo.

Patients are increasingly demanding online ways of interacting with their providers. As social media evolve, improve and proliferate, the ePatient movement will continue to expand and the healthcare industry will have to develop ways to meet the demand.

This movement, however, will have to ensure that it does not overlook the important behaviors all health care providers must express. It will also have to mature so that we aren’t left with a virtual health care landscape that is little more than a circus of amateurs. Experience matters more than content.

But social media is also rapidly shortening the spaces of intimacy and boundaries between people. This means that as health care professionals interactively enter the Web, the tension between intimacy and boundaries will increase.

We could say that there exists a safety zone between intimacy and professional boundary. These zones have traditionally been worked out for in-person clinical relationships. Online, however, we have a long way until we establish a collective understanding of how these technologies affect our virtual health care experience.

Since the space is shrinking to a thin wall, I’ve decided to call this problem the intimacy-boundary membrane. How do we go about protecting that membrane? Is this metaphor useful? You tell me.

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Time Value of Health

Traditional Polish pączki
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Let’s introduce a simple term to an old problem in health care. As health problems increase, and their costs rise, we need to start thinking about ways to make it easier for the public to improve the lifestyle choices they make.

What you do today influences what happens tomorrow. Eat a deep fried donut today, have a heart attack later in life. Your health has a time value. Let me explain.

DO YOU KNOW THE TIME VALUE OF YOUR MONEY?

The concept is simple and it borrows from finance the concept of the time value of money:

A dollar today is worth more than a dollar tomorrow.

This is important because the opportunity cost of taking a dollar tomorrow is the investment that you could make with that dollar today. In terms of health, exercising today is an investment of effort that pays of in the future. Another way to look at it is the future value of a donut:

The future value of eating a donut today is a heart attack years later.

THE TIME VALUE OF YOUR HEALTH

It’s a simple concept. One of the reasons Americans are so unhealthy these days is because we don’t consider the consequences of our lifestyle choices in ecnomic costs. Invesment always involves effort, sacrifice and consideration of options. Long-term investors almost always enjoy prosperity over the course of their lives. The essence of (good) capitalism is discipline and self-restraint. So my definition of the Time Value of Health is this:

The time value of health is the interest you accrue from delaying the cost of an acute or chronic disease later in life.

If you don’t think that the time value of money is a matter of health, just look at the primary cause of our current economic health. Do you think that if all of the people involved in the biggest ponzi scheme in history exercised discipline, that we’d all be in better financial health?

Weight-management is harder for some people than others. So is daily exercise. Our culture isn’t helping: as we move more online, it’s easier to forego healthier choices that enhance our cardiovascular systems.

HOW CAN I USE THE TIME VALUE OF HEALTH IN MY LIFE?

The Time Value of Health doesn’t require complex calculations. It doesn’t need a number. It just requires a little imagination. Don’t make too much of this concept I’m offering you.The next time you’re tempted to go nuts on foods that you don’t need, ask yourself a simple question: is it worth the pleasure of eating this eclair to endure a stroke in 20 years?

Consumers If your a consumer, consider incorporating the idea into your lifestyle. Don’t be a nazi about it. Maybe just use it to save the goodies as a treat once in a while, or for your weekend. Create zones of healthy living. We all need indulgences (there’s health in feeling good about a nice dish). Investing some effort and discipline how you live earns a healthy return over time. What’s more, often the returns pay sooner: being fit and active produces a sharper, happier mind.

Providers If you’re a healthcare professional, consider ways of introducing the Time Value of Health into your practice. You probably don’t have much time anymore to give long speeches with tons of advice (too bad). A simple meme can often travel far. What’s to lose?

Readers Does this intuition pump help? Is it frivilous or does it offer a meaningful practical way to help improve the lives of good people who have a hard time with making healthy choices? The next time you grab those wings, or all that sugar in your coffee, could you imagine yourself on the floor panting in agony for breath in front of your children or granchildren?

What is the time value of your whole life?

(Sorry for tempting you with those donuts above. It’s OK, one won’t hurt you, will it?)

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Are You Serious?

The Thinker, Artist's rendering of the sculptu...Image via Wikipedia

The healthcare industry is full of serious people. They should be serious, shouldn’t they? After all, health care is serious business. Life is at stake and life is sacred. But if you had to choose between two different kinds of providers, which one would you prefer: the serious one or the responsible one? The two kinds aren’t necessarily the same. Being serious is an emotion. Responsibility is a state of awareness. That difference could seriously influence the quality of your treatment.

THE COST OF BEING SERIOUS

Most of the people in health care are good, competent and emotionally secure human beings. Unfortunately, there are also a lot of angry people in the same industry. I know that I don’t want an angry surgeon or ticked off nurse giving me a medication. Do you? Could anger stem from being serious? I believe that it could.

Our culture teaches us to be serious. There’s nothing wrong with being serious per se. But it’s worth a peek at what grows beneath the word. The root word of serious is seryows, which sounds a bit like sorrows. Ours is a serious world. It’s also sorrowful. Perhaps there’s a connection. If language influences our perceptions and behaviors, then we need to re-think what we teach our children. Otherwise, they will grow up to confuse seriousness with responsibility. They will be depressed. Look around you if you think I’m exaggerating.

THE BENEFITS OF BEING RESPONSIBLE

Fortunately, our culture teaches us to be responsible too. Resonsible is rooted in respuns, or response. Responsibility by definition requires action, a reply. Being responsible, however, is not the same as being serious and yet our culture often equates and confuses the two words. That’s an error that might be costing us lives.

I understand the need for bearing a sacred sense of emotion when providing care to patients. I’m not arguing against the sacred. I am arguing for stripping away the assumptions we make which prevent us from being our most responsible. Experienced professionals have smashed medical equipment against walls because they were serious about saving their patients’ lives. That’s pretty serious. It’s not responsible, especially when the equipment is life-saving.

Many health care facilities still tolerate this madness. Why? I think it’s because some of the people who run those organizations are serious about healthcare and they’re afraid that by condemning the serious behavior they are violating the sacredness of life. Health care is an ancient business. It’s an historical confluence of religion, warfare, science, art, culture and just about everything else that makes a civilization. So it’s not much of a wonder why the healthcare industry is so serious about being serious. The industry can do better. It’s your health, so it’s your responsibility too.

If you want to find out for yourself, offer to volunteer at your local hospital. See if there’s anything you can do to lighten things up.

LESS SERIOUS. MORE RESPONSIBILITY.

I think it’s time we publicly recognize the difference between being serious and being responsible. The two aren’t necessarily mutually exclusive; but the semantic relationship might just be too close for us to dismiss.

I know I want to be responsible. If that means I have to be less serious, so be it. Nursing might be a lot more fun. It should be. After all, life is a stake and life should be fun. Fun is a responsiblity of the living. Seriousness is for the dead. It’s our responsibility to save our sorrows for the dead. That’s how we rescue them.

If being serious leads to anger and anger leads to error, then we need to be less serious and more responsible. Life is at stake and life is sacred. Seriously.

If you have ideas on how to improve our health care responsibilities, please comment here. If you like what your reading, subscribe to my feed and we can continue the discussion.

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