How much should my employer get to know about my activity?

As is true with an increasing number of employers, my new organization provided me with a free fitness tracking device. I sync it daily, and I'm earning incentives (mostly cash) based on my level of activity. If I track what I eat and engage in online health challenges, I can earn even more.

I have to admit that I find this little device (more accurately, a Virgin Pulse Max) motivating. Every morning, my Max greets me with a "Good morning, Jennifer" and a heart symbol on its screen. It's neat to accumulate activity badges and see my Max smile at me when I achieve my goal steps for the day. It's not cumbersome to use, and the cash incentives are nice.

While the jury is still out on the cost savings related to these worker incentive programs, they are becoming increasingly popular. I like the idea of being rewarded for making healthy choices, and it makes sense on a lot of levels for companies to promote health and wellness among their employees.

And yet.

I admit to some hesitancy, at times, with my Max. Adding another item to my daily "to do" list gets annoying; I have to clip Max on my waistband every morning and unclip it at night. It's a small device and easy to misplace (or for a cat to bat off my bedside table). I have to remember to sync Max regularly to earn my incentives. And, I have concerns about who might be doing what with my data. Who, precisely, is getting to see the data I upload? How much should my employer get to know about my activity? What I eat? How much I'm sleeping?

I also wonder how fair it is for companies to be able to punish employees for not engaging in wellness programs. Although some companies only reward desirable behaviors, some also have financial penalties for employees who refuse to participate and/or have unhealthy behaviors (tobacco being the most common). I worry that some employees may feel financially coerced to participate; they may not feel that they can afford to leave incentive money on the table (or pay penalties).

So, these are the issues I wrestle with when I attach Max to my waistband every morning. I enjoy the motivation, I think companies should promote employee wellness, but I'm bothered by privacy and fairness concerns.

I already know, though, that tomorrow morning I'll clip Max on again.

Healthcare costs should matter (even to business-adverse docs)

This morning, I had the privilege of attending a grand rounds lecture across town given by Dr. Chris Moriates titled "First Do No Harm: High Value Care From the Front Lines." Dr. Moriates is among the team at Costs of Care dedicated to "transforming American healthcare delivery by empowering patients and their caregivers to deflate medical bills."

Confession time: when I start hearing about finances in medicine, part of my brain tends to shut down. I usually find most everything "business" oriented dull and difficult to comprehend. I have no interest in getting an M.B.A. or even ever being an office medical director; budgets and dollars and numbers are simply not my forte. But bear with me, because even this cost- and budget-adverse physician found Dr. Moriates' presentation highly compelling and actionable.

His lecture centered on these key premises:

1. Tests or treatments that physicians order that do not help their patients' health contribute mightily to wasteful healthcare spending, on the order of around 210 billion U.S. $ a year. This spending not only hurts our country as a whole but hurts our individual patients.

2. Although there are many issues regarding health care costs that physicians don't have direct control over, we can choose to not order tests or treatments that the evidence base clearly tells us are not helpful or even harmful.

3. Just telling doctors what to do (or not) and showing them the evidence base to back it up, however, is insufficient to create meaningful change. Cultures and systems of care have to make it easier for us to choose the right thing than it is to choose the wrong (or even less-right) thing.

I often feel overwhelmed and powerless when it comes to the problems with health-care costs, especially as someone who is not naturally gifted at understanding business and finance. What can I, as just one individual doc, do to play my part in making this gargantuan problem better? Thankfully, a great resource exists to help me play my small part: the Choosing Wisely campaign.

The Choosing Wisely website provides lists of "Things Providers and Patients Should Question," which are divided by specialty. Each specialty has a list of 5 common practices that have a strong evidence base behind them that physicians should adopt in most circumstances.* You can find the list for Family Medicine here.

By incorporating the 5 Choosing Wisely recommendations for Family Medicine into my practice, I can help prevent patient harm and unnecessary healthcare spending. It feels good to know that I do have the power to make a difference after all! I appreciated how Dr. Moriates distilled these complex issues into simple, straightforward concepts that I can apply, both a family doc and a residency educator.


* of course, there are exceptions to every rule. Choosing Wisely isn't, as far as I can tell, advocating "cookie-cutter medicine." Hence the lists are things we should "question," not hard and fast rules. But, most of the time, our decisions should probably fall in line with the evidence base.

My favorite-est apps, 2015 style

Being in academic medicine often equals juggling multiple projects and responsibilities at a time, and I have come to rely heavily on a small suite of apps to keep me doing what I need to do and going where I need to go. I'm frequently on the prowl for whatever is latest and greatest in that arena, so I thought I'd share a few of my recent and not-so-recent finds in the spirit of New Year's life (re)organization.

Evernote
I had been a casual Evernote user for much of 2014, but it was only toward the end of the year that I made the time to really learn how to optimize this app. The 2-3 hour investment has paid off nicely; I am enjoying the ability to keep items, notes, and clips related to multiple work and non-work projects neatly filed and organized away. I recommend using Evernote for a few weeks to get familiar with the bases, but then don't wait as long as I did to explore its richer functionality; there are lots of useful articles on the Evernote website as well as free e-books (no worries - they're short!) worth checking out to learn more.

CloudMagic
Toward the end of 2014 I was getting fed up with the default iOS Mail app. It wasn't syncing well with my Gmail, not to mention that the gestures just felt more and more clunky. My work institution uses Outlook, and I had to play with several apps before identifying one that worked equally well with both Outlook and Gmail - here 'tis. I'm still learning some of this app's features, but I really like its "cards" feature that lets me quickly send something to Evernote or Pocket.

Timeful
I am just getting to know Timeful, but I think that we will be BFFs before long. Timeful is like my own personal assistant - I tell it what I need to get done and how long it will take, and Timeful suggests where in my schedule I can plan to do it. Again, with several different projects within my residency faculty position going on simultaneously, Timeful is helping me budget my time wisely and ensure that what needs to get done has a set time to get it done. Maybe not everyone needs that much micro-organization, but I am learning that, without it, I struggle to stay on task.

Pocket Informant
PI (not to be confused with "Pocket" as mentioned above) has been my go-to calendar and to-do app for a few years, and every time I look to see if anything better has come along I realize just how good PI is. I like the seamless integration between calendar and to-do lists, as well as the highly sophisticated way you can personalize both. PI integrates my Outlook and Google calendars seamlessly and lets me organize my to-do lists to my OCD-heart's content.

Any great apps you'd like to share?

Inbox zero: look out, 2015!

It's been a while again.
I know you're shocked. ;)

I'm not usually a New Year's resolution type, but I took advantage of some down time at the end of 2014 to take inventory of my current projects and responsibilities, along with trying to figure out where I'm losing time to inefficiencies (Muda, you lean followers might say).

Part of my regaining equilibrium has involved taming the almighty e-mail inbox. I am not normally prone to clutter; my work e-mail inbox is typically quite tidy, as is my electronic health record inbox. But something about my personal Gmail just got too overwhelming, and for the last couple of years I have just let things pile up. I've lost one too many important messages lately, though, so this past weekend I resolved to tackle the great beast and gain control.

Using Gmail's search function, I created tags to identify and sort everything important. After moving all of those messages into their new folders, I unsubscribed to at least a dozen e-mail feeds that I hadn't made time for in ages and knew I wouldn't miss. I created searches again for each of these and deleted them all en mass. Ditto for searches including the terms "reservation" and "confirmation" (all for events in the past - why was I keeping these?).

After setting up some filters for messages I wanted to archive but not necessarily review immediately (bank statements, etc), I was more than 1/2 way through my 1K+ messages. I scrolled through the rest, sorting out a few things here and there to keep, and voila! 19 messages left. I will create tasks in Pocket Informant for those new messages and then get them archived.

I know that taming my e-mail won't solve everything. But it has helped me to regain a sense of control. Now I am confident that what will come into my inbox is important and won't get lost.

So bring it on, 2015. I'll be ready.