The 13 year old is all about hard work.  He is diligent…the last one to leave the gym, the extra credit work is always done.  But what he isn’t, is flashy.  No glad handing for him.  No chest bumps, no jokes with the coach, he just comes and does what he’s there to do.  And most of the time, it pays off.  His coaches reward his hard work, his grades are good and he has a great circle of friends.  But, there are also those who take his reserved behaviour as snobbishness.  Some see him as standoffish.  He’s not.  But, as we know, perception matters. 

He has a really engaging friend who doesn’t seem to work as hard, is talented but not more talented than the others and, yes, is as charming as they come…and that works for him.  Really works for him.  Coaches run plays for his style…even though they don’t often pay off.  Teachers grant him allowances, and his circle of friends just grin and shake their heads in amusement…sometimes bemusement.

And, a few of those friends shake their heads in frustration.  They don’t understand why people don’t see through the style to notice an occasional lack of substance.  And as we all know, that’s because that is simply the way the world works.

You see it in the workplace all the time.  The person who quietly works at their desk getting the necessary chores done and the tough assignments completed is overlooked in favor of the individual who spends time strategically positioning themselves on choice assignments.  You see it in politics…the best man (or woman) doesn’t always win…but the most charming and engaging often does.

So, what does someone who is heavy on diligence and slightly lighter on style do?  

I’d like to tell the 13 year old that you just work hard and it all works out.  That’s not what i told him.  I told him to continue to work hard, to hone his skills, to get the grades…AND to smile more, tell a few jokes and (to the person who is at their desk all day doing the work) get out and shake a few hands.

Personality does matter…but so does all the rest.   

Really?  If you are unhappy with the way others do the things that you didn’t step up to do — then next time, do it yourself.

It takes no time at all to complain but countless hours and effort to volunteer to take on that extra assignment…the cookies for the class party…the coaching of kids who haven’t a clue about how to play the game…the hosting of a family party, etc. 

So, next time you think that colleague could have done it better or that class mother or parent coach should have done it your way…take a deep breath and instead of telling them off…simply tell them “thanks for taking that on.”

Or, next time, step up and do it yourserlf.   

So, when her symptoms started to get worse, she called her medical group to schedule the needed precautionary test…you know the test that would enable us to see if we could prevent something from getting worse and requiring more care, more dollars, etc.  And, she’s lucky.  She has great medical insurance that doesn’t require a primary care referral before seeing a specialist and doesn’t require pre-clearance of testing.

So, explain why then, when she called her medical group to schedule the test they told her that she had to see her primary care physician first? 

Ok, so she sees her primary care physician who tells her that she probably needs the test in question…the one she knew she needed in the first place.  But first, she has to take a test to see if she needs the test.  What?

Ok, so she takes the test to see if she needs the test…guess what, test #1 showed she needs test #2…no kidding.  Plus, test #1now gives her permission to see the specialist.  She is unclear as to why she needs to see the specialist before taking test #2 (which should have been test #1).  He’s going to tell her she needs to take test #2…which she already knows.  And, knew from the start. 

Ok, so she goes to the specialist (a month has gone by because she has a job, kids, a life…) and guess what…specialist tells her she needs test #2 (which should have been test #1).  It’s good she doesn’t have a heart condition because all these surprises would certainly have been tough on her ticker!  But wait, we don’t know that she doesn’t have a heart condition…we’re going to find out though because before she can have test #2, she has to have an EKG which i guess would qualify as test #1-1/2. 

So, now she’s had 3 doctor’s visits, 2 tests, a bit of bloodwork…all before she goes to have test #2 (which should have been test#1) where, by the way, if there’s a problem it can actually be fixed during test #2 — no separate procedure.  So, what it boils down to is she could have had the ultimate test, gotten a problem fixed and moved on, all in one event.  But that’s not what happened.

So, why all the extra steps?  CYA and $$.  The medical group will surely bill the insurance company for all the prelim visits and conversations.  The test to determine if if test#2 was neded surely costs a pretty penny…and it gives all the MDs the cover they need to show that they didn’t do 1 test, they did 2…in case something gets missed. 

This kind of inefficiency is what drives the costs up.  Frankly, it underscores the access to care some of us have…but if we were saving steps and costs on people with access, wouldn’t we be better able to provide care to others?

Clearly, there are big complex issues that need to be sorted out…these range from how to take the inefficiences out of children’s health insurance, medicare and medicaid in a way that maintains access to care but minimizes fraud and waste, to how to help innovative businesses continue to have protection on their innovations such that they can fund research and even fund a greater level of access to free medications and procedures than they do today.  Complex issues..absolutely.  But, in the need to address the complexity, we seem to have forgotten some basics that will save costs and improve care.  Following are 10 things for the experts to consider when reshaping what healthcare will look like in America:

1.  Incentivize health professionals, employers, insurers and individuals to focus on wellness.  Taking the steps to prevent serious disease will pay huge dividends in the future.  Smoking cessation, weight reduction, avoidance of asthma triggers, stress management…all of these preventative approaches slow the use of healthcare services and delay the acute events that drive traffic to emergency rooms and result in costly procedures.

2.  Fund “well” clinics and encourage routine check-ups including basic testing — incorporate nutrition and prevention into the discussion and mandate (and incent for) routine visits.

3.  When you knew ytou family physician and trusted his or her advice, you were more likely to skip the extra ice cream cone (you might run into them at the ice cream parlor).  Relationships with healthcare providers are critical and ensure better compliance with wellness programs.  We must enable people to build relationships with community healthcare providers.   Not just physicians.   If you know the nurse practitioner or physician’s assistant at your local wellness center, you will use that facility vs. the emergency room when flu symptoms strike or allergies are out of control. 

4.  Reward compliance with medications.  Asthma well-managed on a day-to-day basis reduces use of ER services for acute attacks.  Consistent use of prescribed cholesterol-lowering medications not only reduces risk of a heart attack but also may have beneficial effects beyond heart disease.  Consider medications for chronic health conditions to be a preventative action and incent proper behaviors for prescribing as well as taking medications proven to prevent serious complications.

5.  Reimburse allied health professionals and make them the front lines of care.  Nurse practitioners, physician assistants, certified diabetes educators, pharmacists…all can play critical roles in front line medicine — particularly in doing what it takes to keep people well.  Empower them…and importantly, pay them.  Studies have shown that diabetes clinics that employ regular use of certified diabetes educators are more likely to have a patient population with A1C levels in accordance with treatment guidelines.  But, there is a shortage of certified diabetes educators because there’s little incentive to take on this role plus, many diabetes clinics are not adequately reimbursed for their involvement.  Imagine the cost-savings of having people committed to helping a person with diabetes stay in control…reduced use of endocrinologist time, less medication and fewer hospitalizations not to mention the reduction in devastating complications of diabetes from cardiovascular disease to blindness to amputation.

6.  Work with insurers and private entities to get Americans to invest in their own health.  Encourage programs that enable Americans to invest dollars toward their goal of losing weight or stopping tobacco use…and then double or triple their investment when they succeed.  It’s a win-win.

7.  Partner with and reward employers that take care of employee health. 

8.  Healthcare is community-driven.  Work with municipalities to identify the resources, networks, support systems and leaders in their communitie to set up initiatives that will help its citizens to be healthy.  Set up systems to measure success and reward that success.  Whether it’s funding for community education, eldercare or the environment in their city, when a municipality does the right things to improve health while reducing care, other services should benefit.

9.  Foster innovation.  We are fortunate that we live in a world where medical innovation has turned acute and deadly diseases into chronic conditions.  That is part of our cost issue…we live longer.  But, the more we foster innovation, the more likely we are to make less expensive, more effective forms of life-saving technology.  Think of that first computer — bulky, unwieldy, expensive — further innovation led to efficiency, mass availability and even reduced costs.  We need to encourage the same in healthcare.  Innovation for the cure is important.  Innovation for efficiency and mass availability is even more important.

10.  Remember the CARE in healthcare.  Make decisions because they will help people stay well…not just because they will cut costs. 

So, here were my reality checks this week:

Reality check 1:  We met with a client to talk about how to educate a very niche audience about their offering.  Social media made sense for this particular client’s audience — except he had no idea about anything related to social media.  He had heard of Facebook but had never seen a Facebook page.  He sort of knew what blogs were but didn’t understand why people might read them vs. reading a column in a newspaper.  His product is sold online.  He understood e-commerce but nothing else.  And here we were, off on a riff about social media replete with jargon and apps and icons and the poor guy felt like he was on another planet.  For a moment, so did we…we forgot that not everyone speaks the language of digital as fluently as their native tongue!

Reality check - slow down, don’t assume knowledge and drop the jargon please.  And wherever possible, use visual aids.

Second reality check — we pr types have been analyzing the communications about swine flu.  Too much? too little? Too inflammatory? Who said what and could they have said it better?  No question people are scared but should the be scared?  But, wait, why is my 10-year-old walking around the house with a can of Lysol cleaning all the door knobs in the house?!? 

Um, he doesn’t care how the news is reported.  He just knows he doesn’t want to get sick.  Reality check — who cares how they’re doing it, if the news is scaring people, find a way to provide reassurance.  Give the numbers — and put them in context.  Explain that it’s a flu…it can be managed.  Report the news — and the news we can use. 

So, it’s good to know that there’s a little thing we can do to make ourselves feel better and be perceived in a successful light…act proud even when you don’t feel proud. 

Today’s New York Times (www.newyorktimes.com) reports on recent research by Jessica L. Tracy of the University of British Columbia and Richard W. Robins of the University of California that shows that feelings of pride can help people weather difficult storms and actually result in body language and expressions that make others see those people in a more dominant, likeable light.  Apparently, there are common expressions — involving a head tilt and a certain smile — demonstrated by all people experiencing a proud moment.  And, when those expressions are witnessed by others, they like us more, are more likely to assign higher status to us and all of that, in turn, makes us feel good.

Now, the researchers say that you can basically fake that attitude of pride.  But personally, I think it would be hard to pull off without being arrogant unless you did some method acting and remembered particularly proud moments and the feelings they evoked. 

But, maybe there’s something the non-great actors amongst us can do…we can take pride in the little things.  We can take a moment to feel proud about helping a colleague, a child’s ability to master a task they had struggled with, the good work and success of friends and family.  Maybe we can also take a moment to make others feel proud…celebrate their work…appreciate the small things they do and…feel proud because we made them feel proud.

It’s tough out there and it’s very easy to get demoralized in the face of budget cuts, staff reductions, friends losing jobs and prices going up.  But, just this week, we:

•  brought in two cool projects
• a team pulled off a great presentation to a client that took them out of their comfort zone and made them feel proud in the process
• reconnected with former colleagues who have overcome some challenges only to be celebrating personal and professional successes and wanting us to join them for the task ahead, and 
• got fabulous and well-deserved notice for a long-standing client with one of the junior members of the team really reaping the credit for the great work accomplished

Sure, we had some tough moments too.  It would be very easy to let the tough overshadow the good but why let that happen? 

It’s the successes that motivate so we need to focus on them even as we deal with the tough stuff.  And yes, Seton Hall won…so, all in all, a good day.

Changes in the workplace — even small ones — seem to create drama.  Last week, i suggested to some colleagues that we could track their work better so that they could better understand where critical resources were being spent.  One person thought that was great - two others thought I had clearly lost my mind.  So we made some little changes — for now — because the big changes were just too much for them to handle.

Changes to team dynamics are fascinating to watch.  Just watch the politics when a new player is added to a sports team — or a new colleague joins the workplace — or a new pet joins the family (the hamster/guinea pig dynamics are something to behold).

Never mind if you try and switch up the holiday plans.  I really wanted to go somewhere warm for Thanksgiving…okay Christmas…New Year’s?  You guessed it, none of the above.  The little one would have none of it.  Who would cook the turkey? Where would Santa drop the gifts?  Where would we light the menorah?  The stress was too much to bear.

So, rather than stress anyone out, each year I indulge my need for change with new hair.  This year, a backward look at what I think is my original color (hard to say as it’s been a while since I’ve seen it).  While I resolve to try and keep other’s stress to a minimum in the new year, I still have to indulge my need for change and wish everyone out there a Happy New Hair! 

It’s easy to blame drug manufacturers for “charging too much.” But, as we’ve talked about in prior posts, it’s not that simple.  The process of true drug discovery and innovation is expensive.  It’s easy to blame payors — government or private — for not making humane decisions.  But, that’s too pat a response as well.  Money is tight.  Cuts need to be made and the more expenive treatments are often the most innovative and life-saving.

Here’s the answer…we need to become a nation of savers…not just from a financial perspective but from a health perspecive.  The vast majority of Americans are born healthy. But, through poor lifestyle decisions, over-indulgence, stress, lack of exercise, lack of sleep, we chip away at our health.  We don’t store up wellness for a rainy day.  We don’t take the steps needed to help our bodies through rough times or prevent the onslaught of disease.  And then, when we resort to medications to protect the hearts that were once strong, clear the excess sugar from our bloodstream, minimize damage to blood vessels from plaque and high blood pressure, we erode the healthcare coffers of our personal fortunes and the nation’s as well.  And, we complain about the cost.

If we want to fund innovative medicines with government support, we have to stop being wasteful withtheir resources.  If we want to have access to lifesaving medications and devices when our bodies are attacked by the unpreventable scourges of disease or simply the wear and tear of a long life well lived, then we have to do our part to reduce the expenditures on those conditions that are preventable.  We have to invest in our health by protecting it.

The good news is that wellness is less costly — personally as well as to payors, employers and governments — than illness. 

Wellness is as inexpensive as employers negotiating healthful options in their subsidized cafeterias. 

Wellness is as thrifty as a 30-minute walk during lunch hours or after dinner. 

Wellness is as economically sound as stress reduction classes in the workplace or yoga in your living room. 

Wellness is school nurses having sunscreen for recess and hand sanitizer in the classroom.

Wellness is a commitment that pays off.  The reduced spend on docor visits, medications and medical procedures positively impacts our personal pocketbooks, our employers resources and the government’s ability to say “yes” to Bruce Hardy.  It just means we have to say “no” to those things we know deplete our personal health resources and “yes” to those things that fund our health bank.

In our school system, parents are encouraged to teach music in the classroom to supplement the music the children get as part of the regular curriculum.  Back when my eldest son was in 2nd grade (about 5 years ago), I was asked if I could approach music in the classroom with an eye toward celebrating the end of Black History month and the beginning of Women’s History month — so I combined music with  discussion that began with Duke Ellington and ended with Aretha.  We talked to the kids about how difficult it was for Black musicians to get club dates or hotel rooms when they traveled.  We talked about how women earned so much less than men.  We played music and ended with a rousing, chairs as drums, performance of RESPECT that resulted in the teacher across the hall chastising us all!  As fun as all that was, the best was the moment when one of the little girls, full of righteous indignation upon hearing how tough things were for Duke and other Black musicians as well as women who sought equality, stood up on her chair and said “What do we do about this?!?”  At the time I said, “we’re still working on it.”

My kids and their friends know women who are CEOs and earn more than many of the men around them.  They have a neighbor who started the first black-owned investment bank.  Their friends are boys and girls of many races, nationalities, religions and genders.  They also know white women who clean homes for a living and white men who are landscapers and handymen.    It is as natural for them to assume success for a person of color as it is for them to assume success for themselves.  And, that is wonderful.  And, it is not how it is everywhere.  But it is certainly much better than how it was when I was a child.

The big historic moment is wonderful and worthy of celebration and reflection.   But the little steps…those that got most of our children to take the election of a person of color to the highest office in our nation as part of the natural order…are worthy of reflection and celebration too.