Showing posts with label average Walmart shopper. Show all posts
Showing posts with label average Walmart shopper. Show all posts

Saturday, July 4, 2009

My Purple Door

Three of my four grandparents emigrated to the USA from Sweden, and one of the highlights of my adult life has been reconnecting with cousins in the small village where my father's people have lived for hundreds of years. Sweden is a rural country of 9 million people, with a population size that mirrors my home state of Georgia and a land mass similar to California's.

Sweden's bucolic beauty shares elements of the pacific Northwest, coastal New England, and Alaska. Most remarkable, at least to my American eye, is how Sweden's infrastructure complements its natural beauty. No suburban sprawl, no ribbons of strip malls connecting one group of Walmart shoppers to the next, few fast food outlets beckoning always-hungry, rarely-satiated citizens.


Homes in the country, like the one here that belonged to my great, great grandparents, are usually painted wood. They showcase traditional designs and palates, contributing to a landscape that is even more beautiful than the sum of its parts. (If you get a chance to bet on the color of a house in rural Sweden, choose barn red; light gold; or wedgewood blue. You're going to win.)

One night, while drinking with my cousins, it occurred to me to ask about the social customs and constraints that produced such a holistic landscape. "Stefan," I asked, "What if a Swede wanted to paint his house purple? Could he do that?" My cousin paused to be certain he understood the question, explained a little about local zoning, then said, "But a Swede would never want to paint his house purple."

This led to the telling of a story about the desirability, from the Swedish point of view, of being an average citizen, "a middle Svenson," as my cousin explained it. In Sweden, people are discouraged from living or behaving in ways that substantively distinguish them from their peers. This doesn't mean that individuals aren't creative or expressive. It simply means that one's efforts should reflect established norms, building upon principles, traditions, and aesthetics that have withstood the test of time. A person who painted his house purple would invite unwelcome attention, irrespective of how lovely the shade. So would a person who parked a broken washing machine on his porch.

My cousin's insight helped me understand why the Swedish countryside looks the way it does. The explanation helped me understand a little more about rural Georgia, too.

Culture impacts more than paint colors and where old appliances are laid to rest. Take health outcomes for Georgia and Sweden, two locales that share both population size and challenges that come with providing care in rural settings:
  • In Sweden, deaths of infants in the first month of life--a statistic that's considered a reliable marker of overall population health--number 2.1 per 1,000 live births.
  • In pockets of Georgia, where the least healthy and poorest citizens are clustered, the neonatal death rate is 17 per 1,000.
  • Some of Georgia's citizens do much better, with neonatal mortality rates in the weathiest suburbs at 4.2 per 1,000.

These comparative health outcome data are especially important for Americans, who, like me, can access highest end healthcare and often believe they have something to lose when the subject of healthcare reform is broached. Sweden's best--a best that represents outcomes for all citizens, not just the healthiest and weathiest--is far better than what the most privileged Georgian can expect.

The take-away? No matter how well you think a market-driven healthcare economy works, it's important to remember that you can't buy what doesn't exist.

My husband, an ex-pat Canadian and naturalized American citizen, worries less than I do about identifying an appropriate healthcare model for Americans to emulate. Americans, he says, are not like anyone else, even though we are, in point of fact, a little bit of everyone else. My husband believes that a uniquely American solution, one that accepts our good intentions, bad behaviors, unparalleled diversity, and independent ways will emerge. I hope he's right.

From the looks of our front door, I kind of need him to be.

Friday, June 19, 2009

Meaningful Use: Your prescription shouldn't have to look like this

I spent a year studying medication safety at the Institute for Safe Medication Practices, the nation's only patient safety organization devoted solely to medication error prevention and safe medication use. So I'm always on the lookout for ways to help others see what I learned to see.

My friend had a friend-of-a-friend deliver a load of pine straw to her home the other day. The delivery man left an invoice, and my friend asked me to interpret the name of the company so that she could write a check.


Take a look and see what you think.

I guessed "Chevrolet" (even though it seemed like a weird name for a handyman service.) My friend frowned. She's a middle-school math teacher, and she's detailed-oriented. "Leave it blank," I suggested, "and mail it. Mr. Pinestraw can fill it in." More frowning. (This suggestion was clearly not welcomed by my friend, one of the most reliable people I know, someone who dots her i's and crosses her t's and is not in the habit of leaving things blank.)

Several days later, my friend mentions she's going to drop the check for Mr. Pinestraw off, having finally tracked him down via telephone and clarified the name. "Cherokee!" she says triumphantly!

To average Walmart shoppers like myself, health policy and IT discussions about how $20 billion dollars in economic stimulus funds are going to be put to meaningful use sound a lot like Charlie Brown's teacher: "Waoao waoaoa waoaoa wah woaoao."

So, let me draw on the med safety expertise and call out a few suggestions for how I think monies spent for meaningful health IT should be visible to healthcare consumers:

1. People who prescribe medications should use a system more sophisticated than the pine straw delivery guy's to communicate high-stakes drug information. 1,400 commonly prescribed drugs have names that look-alike or sound-alike. People can, and do, die when drug names are confused with one another.

2. Pharmacies should be able to receive prescription data in a format that does not require the tenacity of a middle-school math teacher on summer holiday to decipher.

3. Your electronic medication history--housed with your physicians, pharmacy, and any consumer portal you choose--should move seamlessly into hospital data repositories and be accessible, with your consent, during planned and emergent encounters.

 
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