Choosing Wisely: Health Care


Are you concerned about how much you’re spending on health care? Are you wondering if the blood test, X-ray, or MRI your doctor recommends is absolutely necessary? Maybe you don’t make it a habit to discuss the pros and cons of testing with your doctor because, after all, he or she is your doctor and always chooses wisely what is best for you, right? I do trust my own primary doctor’s recommendations, because she listens to me, closely. And she carefully considers whether or not a test is needed, then explains to me the reasons for her recommendation. Here’s the rub: We have a conversation about evidence-based practices before making any final decisions. In other words, she engages with me, as a human being – someone with worries, fears, doubts, and needs. So why am I sharing this with you? Last fall my husband went to his primary doctor for a physical exam. A month later we received a bill from the hospital she is affiliated with; the charges for routine blood work were far greater than I had expected. Though we have health insurance, like most people, we must first fulfill a yearly deductible, which doesn’t include copays and coinsurance. When I asked a representative from the health insurance company how they arrived at the number my husband and I were responsible to pay, and who decides on the formula, he answered with what amounted to the following: hospital charge – some random number chosen by a faceless person = contracted rate – deductible – ten percent co-insurance. I had no choice but to reach for the Advil in the kitchen cabinet nearby.

There’s more. Health insurance company administrators treat people not as human beings but as fixed codes that should fit snuggly into pre-printed, micro-millimeter boxes. So, since my husband’s doctor advised him to take Vitamin D supplements, because his lab work showed it to be low, we received another bill charging us a nominal fee for what our health insurance called a “consult.” (That single blood test alone cost us a chunk of $125.29.) It didn’t matter that the “consult” took place during his physical – it didn’t fit into the insurance company’s pre-fab, coded square for “preventative care.” But isn’t that why we have physicals, not only to be examined, but also to discuss what measures we can take to improve our overall health? That sounds a lot like the dictionary definition of “preventative”: the branch of medicine concerned with prolonging life and preventing disease.” If my husband’s doctor didn’t speak with him about his Vitamin D level, how else would he have known that he needed supplements? Health care has become much like an a la carte menu.

Here’s the good news: A friend and author at Strategy Health Care, Dr. Gene Lindsey, led me to a handy resource when I reached out to him with my concern about health care costs. That resource is Choosing Wisely. Launched, in 2012 by Advancing Medical Professionalism to Improve Health Care (ABIM), the goal of Choosing Wisely is to encourage dialogue between providers and patients in an effort to prevent unnecessary medical tests, treatments, and procedures. A practitioner of cardiology for nearly four decades, and President and CEO Emeritus of Atrius Health and Harvard Vanguard Medical Associates, I trusted Dr. Lindsey’s recommendation, as much as I trust my own primary doctor.

Choosing Wisely offers lists of health-related topics created by medical specialty societies, and represents evidence-based recommendations providers and patients should discuss. Topics range from plantar fasciitis to cancer drugs. Each topic includes information about when tests and procedures are deemed appropriate. The recommendations should not be relied upon to decide health care coverage, but to provoke conversation about whether or not particular treatments are necessary.

While reading through the list on Vitamin D testing and supplementation, this is what I learned: Testing doesn’t improve treatment. Most of us have low Vitamin D levels, but not “seriously low levels.” It’s recommended that we get a little more sun, eat foods rich in Vitamin D, and if we don’t get a lot of sun or eat enough D-rich foods, we should talk to our doctor about supplements. According to Choosing Wisely, “Getting tests that you don’t need often leads to treatments you don’t need, or treatments that can even be harmful. For example, if you take too much vitamin D, it can damage your kidneys and other organs.” And “doctors are ordering tests six times as often as in 2008.” Of course, there are conditions that warrant Vitamin D supplementation, like osteoporosis, and any disease that damages the body’s ability to absorb the vitamin.

Take a look at Choosing Wisely, and look out for yourself, your body, your health, because it’s you that matters.











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Benefits of Gratitude


Every year, on the last Thursday of November, American families, friends, neighbors, and the otherwise lonely, gather together to celebrate Thanksgiving. For many of us, this year will be no different, and we’ll engage in yet another gastronomic extravaganza. We’ll gnaw on spiced and tenderized turkey wings, eat forkfuls of oven-baked stuffing, scoopfuls of buttered mash potatoes, cleanse the palate with a slice or two of cranberry sauce, and slip into our sweatpants to make room for the must-have dessert: pumpkin pie. We will likely eat ourselves into a tryptophan daze.

Some of us may even dress up in native American costumes, or as Pilgrims, recalling what we learned in history class, how the Plymouth colonists and Wampanoag Indians indulged in a three-day affair of eating, fishing, and hunting in November 1621, celebrating what is acknowledged as the first Thanksgiving. In the winter of 1620, after much of the Pilgrim population was killed, the colonists requested help from the native Indians, who taught them how to hunt, fish and plant crops. In return, the Pilgrims invited the Wampanoag to feast on their bounty of ripe food to celebrate their first successful autumn harvest.

While the narrative of Thanksgiving is partly about how varying cultures and races can gather together and actually get along, the holiday is a time to reflect upon what we are thankful for – in other words, gratitude.

A few weeks ago, while engaging in meditation during a yoga class, the instructor spoke in a melodic chant, with the goal of centering our thoughts on self-appreciation and appreciation for others. She encouraged us to hold onto equanimity and to release ourselves from attachment and aversion, then asked us to imagine sharing that peace of mind with others – loved ones, friends, strangers, even those with whom we are experiencing a somewhat challenged relationship.

As I focused on my breath, filling my lungs with the sweetness of a Sunday morning, I thought about the once-upon-a-time gratitude journal in which I wrote daily statements of thanks each day. I couldn’t recall how long it had been since I had written in that journal. As the yoga instructor had encouraged, I carried my mindful practice into the rest of my day, also bringing with me the theme of gratitude. I told myself I would start a new gratitude journal, in which I would jot down brief observations, thoughts, anything that reminds me I have a lot to be grateful for: the hand-knit afghan my mother-in-law gave me, hot water, a refrigerator full of food, socks with no holes.

In my research about the benefits of gratitude, I learned that keeping a gratitude journal does more than remind me I have a lot to be thankful for. Studies have shown that gratitude improves our emotional, mental, and physical health. It makes us happier, helps us sleep better, inspires us to exercise more, keeps us connected, increases our social capital, makes us more productive and less envious, motivates us to make decisions.

If it’s that easy, writing in a gratitude journal five minutes each day as a means to improve our long-term well being, by more than ten percent researchers say, then I’m in, hook, line, and sinker. Are you? I can’t think of a better time than now, November, National Gratitude Month, to start penciling the page with, “I’m grateful for …”

“This a wonderful day. I’ve never seen this one before.” ~ Maya Angelou



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A Tribute to Oliver Sacks


The following tribute to Oliver Sacks, an eminent neurologist, prolific writer, and quintessential humanist who died from cancer at 82 on August 30,  is dedicated to Christy Lyn Bailey, who died from Inflammatory Breast Cancer (IBC) in June 2015. A good friend to many people around the world, she lived each day with passion and curiosity – she traveled to nineteen different countries, completed marathons and triathlons, left her corporate job and joined the Peace Corps. Christy also pursued her passion for writing and teaching: she earned an MFA, and taught creative writing to university students, and to homeless children. And she wrote a memoir, which tells of her journey toward acceptance after losing her hair to alopecia areata

Christy was a first-rate storyteller, and shared her IBC experience online with countless compassionate readers. Each story she shared revealed her bravery, sensitivity, love, and gratitude. As her mother says, “She dreamed big.”  Christy worked hard to survive, to say all she needed to say, to write what she needed to write, but mostly she gave to others – right up until she fell into a peaceful and ever-lasting sleep. 

Do you feel your work is done? Do you have more to do, to give, to write, to say? Oliver Sacks leaves us to ponder such existential inquiries in his essay, “Sabbath.”

It’s evident he had more to say, even as his death drew nigh: Fourteen days before he took his last breath, the New York Times published “Sabbath.” In the essay, Sacks speaks out about his withdrawal from the Jewish rituals he grew up with, his indifference to his parents’ beliefs, and his addiction to methamphetamines. In the context of his sexuality, he speaks to how the writing of his newly released memoir, On the Move, allowed him to finally unearth what he had kept buried away for far too long:  “I had been able, for the first time in my life, to make a full and frank declaration of my sexuality, facing the world openly, with no more guilty secrets locked up inside me.”

Sacks was also the kind of man who thought deeply about others. His natural curiosity and interest in the world around him, and likely his sense of isolation from his family who questioned his sexual orientation, drove him to venture far from his family in England. In 1960, as a new physician, he left for Los Angeles, where he found what he called a “sort of connection.” Still, Sacks yearned for some deeper meaning – lacking that, an addiction to methamphetamines lured him in. But he recovered, slowly, and found his way: He worked as a physician at a chronic care hospital in the Bronx, where his fascination with his patients mobilized him to tell their stories, unfathomable stories he felt it was his mission to share. That’s when he became a storyteller, a storyteller of the human condition. Those stories span the pages of The Man Who Mistook his Wife for a Hat, in which Sacks shows the struggles of his patients living with various neurological disorders. At the same time, he eloquently describes the resilience of the human spirit, making each and every individual he writes about real life human beings on the page. Sacks’ curiosity and interest in others is steadfast and palpable in the other dozen books he has written such as Hallucinations, Awakenings, and The Mind’s Eye.

It’s Sacks’ open, empathetic, and introspective storytelling that prompts us to ask of ourselves, “What moves us? What must we share with others? In his essay, “Altered States,” though Sacks suggests that drugs is a “shortcut” to “transcendence,” he’s also clear about one thing: that understanding can be found through other means. As Sacks reminds us in the essay, the point is “To live on a day-to-day basis is insufficient for human beings; we need to transcend, transport, escape; we need meaning, understanding, and explanation; we need to see over-all patterns in our lives. We need hope, the sense of a future. And we need freedom (or, at least, the illusion of freedom) to get beyond ourselves … to travel to other worlds, to rise above our immediate surroundings.”

That’s exactly what Oliver Sacks and Christy Bailey did – they rose above their “immediate surroundings.” They left us with the and abundance of hope.

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The Pain Scale


Where do you rate your migraine, back pain, abdominal pain? A two, a five, a ten?

A few weeks ago I went to see my physical therapist for hip pain. “On a scale of zero to ten, ten sending you to the emergency room, how bad is your pain?” she asked. Pain is universal, and, like most of us, I’ve been asked to choose a number from the pain scale time and again: in the weeks and months after my pelvis, foot, ribs, and lower back fractured in a car accident, when my bowel got all tied up in a knot, and when a cyst on my ovary ruptured.

In 1999, the Veterans Administration established pain as the fifth vital sign, requiring medical professionals to assess pain using the pain scale, a practice introduced by hospice in the 1970s. But how accurate is that scale? While one’s heart rate, blood pressure, and temperature can be objectively measured, pain is subjective. It’s based on perception, which is influenced by a whole host of factors: attitude, stress, culture, upbringing, age, gender, and more. One’s five may be another’s eight. And what about all the fractions in between two whole numbers? Couldn’t one’s pain be a five and two-thirds? What about chronic pain? Doesn’t that change our perception of overall pain? Are you more apt to assign an eight to, say, your recent foot pain because you’re sick and tired of the pain? Or are you more likely to give that toe, say, a three because you’ve become used to pain and can no longer decipher a three from a four or an eight?

I’ve never met anyone who said they’ve never felt physical pain. There are too many opportunities: paper cuts, stubbed toes, headaches, toothaches, back and neck aches. Why is there a zero on the pain scale anyway? It seems useless. As Eula Biss says in her essay “The Pain Scale,”  “Zero doesn’t behave like other numbers.” When we count, we don’t start with zero: “Zero, one, two, three.” Zero is merely a placeholder, a midway point between one and minus one, for instance.

Because I’m not good at making decisions, I’m not partial to the pain scale.

I think pain is best described with real life descriptors: throbbing, stabbing, crushing, needling, nauseating, a quadruple knot in the gut, the hottest part of a fire, a butcher knife to the toe. I want to tear apart my skin and crawl out of my body. I want to scream, scream, scream.

If you were asked to describe your pain, past or present, what would you say?

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A “work of literature”

“Melissa’s memoir will be very well received as a true work of literature.” 

Award-winning writer and author of Committed: A Memoir of the Artist’s Road.

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“Riveting Memoir”

When in 2003 an elderly driver plowed into a busy Santa Monica farmers’ market, 36-year-old Melissa Cronin’s life was shattered in an instant. In her riveting memoir, Cronin takes us through her journey of recovery as she slowly rebuilds her life anew. Writing with the expert eye of a medical professional, Cronin’s prose is at times tender, funny, lyrical, and always painstakingly honest. [Her Memoir] will astonish readers with a reminder of our human resilience and the power of story in our precarious lives.“
∼ Alexis Lathem 

Award-winning poet, journalist, and writing instructor.

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“Melissa has turned life into art”

“Melissa writes with surety and much fine purpose. She [has] found the perfect structure for her memoir as well as a compelling voice with which, she, as a narrator, [has] turned life into art.” ~Sue William Silverman

Award winning author of the memoirs The Pat Boone Fan Club: My Life as a White Anglo-Saxon Jew, Love Sick: One Woman’s Journey through Sexual Addiction, Because I remember Terror, Father, I Remember You, and Fearless Confessions: A Writer’s Guide to Memoir.

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A “Compelling” Project

“[Melissa’s] memoir is one of the most compelling projects I have come across during my tenure at Vermont College of Fine Arts.” ~ Rigoberto Gonzalez
Author of Butterfly Boy: Memories of a Chicano Mariposa, winner of the American Book Award from the Before Columbus Foundation.

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