We took buddy upstate yesterday for a little swim in Pine Meadow Lake. He needed a bath. He’ll swim for hours if we let him.
“Ok for Al Jazeera to come tomorrow to the office?”
Cheryl, the co-founder of Sherpaa, just hit me up on Skype to ask me this question. I’ll chalk this up to “things I never thought would ever happen when I finished my residency nearly 6 years ago.”
Meet Dr. Ezra Feinberg. Ezra is our clinical psychologist. We’ve come to re-think the standard $250, 50-minute weekly therapy session. Sometimes you only need a 15 minute chat to feel safe and comforted. Sometimes you may need visits over the next month with a therapist to help you get through a breakup, or you may need intensive therapy with a psychiatrist for longer to help you overcome a serious issue. All our clients are different, so we’re envisioning ways to make mental healthcare work best and most affordably for you. Ezra will guide you to exactly who and what you need.
What’s your favorite thing about being a psychologist?
Working one-on-one with patients is definitely my favorite thing about being a psychologist. The therapeutic process is intense and challenging, but helping people to improve their lives is the reason I got into it in the first place.
What makes NYC special to you?
It’s the energy. There’s no other city with this kind of energy, and it brings out the character in everyone. It’s also a pain in the ass, but I’ll never leave New York.
Besides being a psychologist, how do you spend your time?
Time with friends and family of course, and lots of time reading, seeing films, listening to music, playing music, exercise, and eating delicious meals prepared by the various culinary geniuses in my life.
Tell us about your decision to become a psychologist.
It hit me shortly after I graduated from college. I thought “that is something I could do” which was immediately followed by the thought “but not right now.” It would be another five years before I entered my doctoral program. I knew it was a big decision and I wanted to be ready.
We all know healthcare is broken. What is it about Sherpaa that makes
you feel like you’re part of the solution?
The “care” part of our current healthcare system has gone unaccounted for. By providing access to doctors and specialists right away Sherpaa makes people feel cared for, and feeling cared for is a crucial step in becoming healthy, no matter what the ailment.
After ‘Music for Airports,’ Brian Eno turns to hospital soundscapes
Brian Eno, the former member of Roxy Music widely credited with inventing ambient music, is working on light and sound installations designed to provide a “healing environment” inside hospitals. It’s a fitting setting; Eno’s ambient work, as exemplified by albums such as Ambient I: Music for Airports, is said to have been inspired by his own experience of spending an extended period in hospital following a car crash.
There are two fundamental ways that Big Pharma can make money:
The DSM-V is being released on May 22nd, which is the bible of psychiatry where new mental health diseases are described. It’s a very political book and the American Psychiatric Association owns the content. However, writing it is best described as “It is as if J. K. Rowling had produced her Harry Potter sequels in a glass studio with fans looking on and banging the windows whenever she typed something they didn’t like.”
Most people agree that this version extends the role of psychiatry into our daily life even more extensively and will help more of us qualify as patients.
But the real issue is:
“The D.S.M. has enormous impact on the public health. It determines which conditions insurers will cover, which drugs regulators will approve, which children will receive special-education services, and which criminal defendants will be able to stand trial and, in some cases, how they will be sentenced. Psychiatry has already reached far into our daily lives, and it’s not by virtue of the particulars of any given D.S.M. It’s because the A.P.A., a private guild, one with extensive ties to the drug industry, owns the naming rights to our pain. That so significant a public trust is in private hands, and on such questionable grounds, is what we ought to worry about.”
Hi cureforbedbugs
I think that you make some excellent points so I have reblogged your post.
As a partner of someone who is pre-diabetic and at risk due to a family history this is something dear to my heart.
I think that this sort of approach can be useful for some people but thank you for pointing out some clear dangers
Paul
Through app, diabetes is gamified as a monster to be tamed
mySugr makes it more fun for diabetics to monitor and treat their condition by treating it as a virtual monster that reacts to their actions.
Full Story: Springwise
As someone whose anxiety disorder is very intimately connected to an obsession with blood sugar levels, this strikes me as a potentially catastrophic idea for a lot of people.
Diabetes management does not (necessarily) benefit from trying to control blood sugar completely at all times. It’s an odds game — lower A1C’s and lower post-meal spikes seem to generally level the playing field in terms of complications. The idea that diabetes management is not a challenge of controlling the minutiae in your everyday life but rather a broad set of strategies you use to remain healthy is kind of a microcosm for pathologies of management of chronic (or “chronic,” as when people are “diagnosed” with things that are not actually diseases — like, you know, being healthy and fat at the same time) conditions.
When you look at the flipside of this, that obsession with one’s well-being is pretty closely aligned to anxiety, depression, and related conditions that will end up fucking you up way worse than diabetes alone — since on top of the basic harm they also worsen the diabetes management — you have to start weighing the pros and cons of being too worried about your day to day management. You need to learn to forgive yourself and not trust what cognitive therapists would call “catastrophizing” — imagining that every false move can be extrapolated to your own death, say.
Diabetes isn’t a “monster.” You deal with it, and you try to get better, and you don’t get obsessed with tracking every little detail. It’s not something that needs “gamification,” it’s something that needs an approach that values body and mind as connected things, as opposed to, you know, your body being a bad guy you need to kill.
I just watched the video from the designer, who is a type I diabetic himself (I never got to meet my grandmother, because no one knew how to treat her type I diabetes when she was alive).
I want to go easy here, because there’s a lot of love built in, and the designer has worked hard and earnestly to make something that’s meaningful to him.But I have to agree strongly with cure, above. I know people who have to deal with chronic health conditions, and the overall goal is not to add cognitive load to that management. I know the books and webinars this developer has gone through to arrive at this particular strategy, but those are mostly sold to him by purveyors in 21st c. snake oil. It might be oil, and it might come from snakes, but it will not heal your app.
The MySugr developer added points, feedback, and additional demands to a complex system of health management. Those aren’t what will make it funner, easier, more playful, or more meaningful. They will make it more demanding — as cognitive consideration and as actions to undertake.
This can work — we do things that are difficult all the time, like play chess, or Words With Friends, or whatever. But this is none of those, and it’s not the point systems in either one that makes them meaningful.
Further, to the points made above, this presents the condition as something to oppose, rather than something to metabolize and live in dialogue with. This is serious stuff, and if it can be made playful, make it playful. But not by treating the condition of your body as an enemy to conquer, and not by fighting it with baroque checkins, points and missions.
Think about the behavior you want to encourage, and think about what might produce that behavior. If you want it to be playful, it might not take diabetes as its nominal subject. It could be about anything fun in the world. The only criterion should be that when you engage with it, you change your behavior — or mindset — in order to do so. Lots of playful systems do that: soccer changes how you interact with people around you, tetris changes how you see the world, and the nike fuelband works precisely because it is neither precise nor prescriptive.
I don’t mean to discourage such an earnest approach, except that the earnestness of it is exactly where it falls short. I hope to see health-related efforts in the future that have genuine playfulness in their beating heart.
Anthony bought me a new poker on Etsy for my backyard fire pit. It’s awesome.
As part of Obamacare, Medicare won’t pay hospitals for patients who are re-admitted for the same condition within 30 days of being discharged from the hospital. Because our hospitals profit off sickness, prior to this, hospitals would discharge patients half well and then make more money by re-admitting the patient. Medicare is trying to change this profiteering. So hospitals are investing in care coordinators to keep people out of the hospital for at least 30 days assuming that an investment in care coordinators will make up for the losses from readmissions that aren’t reimbursed.
In 2011 the Department of Veterans Affairs halted a program in which patients with chronic lung disease were supposed to learn to take better care of themselves (via a care coordinator) when 28 patients in the program died, in contrast to 10 deaths in the group receiving typical care.
Typical care meaning patients go home and only half understand their plan. Fascinating for a few reasons. First, Obamacare legislates the practice of medicine that may actually be more harmful than good. And second, is sometimes the best thing to do is stay away from care and not follow the doctor’s orders upon discharge? Are intensive, by the books, treatment plans instituted upon discharge doing more harm than good?
One of the main issues in healthcare is that doctors must do something. It’s very difficult for them psychologically and legally to just do nothing. We’re doctors. A pat on the back isn’t the same thing as tangible medications designed to change some chemical process in your body. It’s what we do. It’s what the public expects. And it’s what holds up in court. Sometimes I wish we could just prescribe a placebo, like they do in Germany. We’d probably be a healthier country.
It’s not about passion. Passion is something that we tend to overemphasize, that we certainly place too much importance on. Passion ebbs and flows. To me, it’s about desire. If you have constant, unwavering desire to be a cook, then you’ll be a great cook. If it’s only about passion, sometimes you’ll be good and sometimes you won’t. You’ve got to come in every day with a strong desire. With passion, if you see the first asparagus of the springtime and you become passionate about it, so much the better, but three weeks later, when you’ve seen that asparagus every day now, passions have subsided. What’s going to make you treat the asparagus the same? It’s the desire.
via kottke
“They’re more interested in what you could call the nonstory-ness of life — how existence is filled with the devices of fiction, yet they never congeal in a satisfying way; most of our epiphanies are false or self-justifying ones, except for the handful that turn out to be true and meaningful, and that we muster the strength and perseverance to act on and make permanent.”
Well said. For all those who think Mad Men is boring…
Testing out tumblr’s new selfie function.
I had some friends over last night. We bbq’ed some burgers, made a bonfire, and had some s’mores. Buddy and Doc were two lucky recipients of leftovers.
It’s hard describing how we do things here at Sherpaa. Stories always help!
So, with every client’s permission, we’re sharing real life stories that happened here at Sherpaa.
We received a phone call from a client complaining of sudden onset shoulder and back pain that was worse upon taking breaths. Based on the series of standardized questions we ask each and every patient with these symptoms, we narrowed our potential diagnoses to musculoskeletal back pain vs. a pneumothorax. A pneumothorax (pl. pneumothoraces) is an abnormal collection of air or gas in the pleural space that separates the lung from the chest wall and which may interfere with normal breathing. It can be a serious emergency and we needed to act fast. We had three options:
Immediately send this client to the ER
An urgent care center
Or directly to the radiologist
We knew the absolute fastest way to determine if this was a pneumothorax was sending this patient directly to the radiologist. So we called up the radiologist and within 30 minutes the patient went to the radiologist and we had the results. Fortunately, there was no pneumothorax. It was just muscle pain and we had the gold standard test to prove it.
If we would have sent the client to the ER or the urgent care center:
They would have asked the same questions and done a physical exam
Test: Chest X-ray
Time: 8 hours in the ER or an hour and half in the urgent care center
Cost: $1500 in the ER or $500 in the urgent care center
But we asked all the right questions over the phone, skipped the physical exam because the physical exam isn’t the gold standard, and sent the client directly to the radiologist for a $40 chest x-ray saving all kinds of inconveniences and money. And we confidently ruled out something scary. We treated his muscle pain and we’ve been in regular contact with him via email and we’re happy to report he’s now almost all better.
We simply rethink how healthcare is delivered and we make it speedier, more convenient, and less expensive.
