Life Is Like That!

Memoirs of a free spirited blogger

Are you looking for a tropical getaway? Then a visit to Cairns, Australia, with added attractions to ‘Kuranda,’ the spectacular ‘Atherton Tablelands’ and the ‘Great Barrier Reef’ may be your answer.

Just twenty-seven kilometers northwest of Cairns is ‘Kuranda,’ a small beautiful, tropical village hidden in the rainforest. This place is open to tourists all year through. Apparently, there are several options provided by many day tour operators running scheduled trips to the village from Cairns, including a combination of going up on the Kuranda scenic train and returning on the sky rail cable car (or the other way around). Both forms of transport are fun and give a totally different perspective of the journey.

My husband and I opted to do the scenic train ride. We were picked up from our hotel by a coach that transferred us to a railway station. As we embarked on this journey, we were stepped back in time as we viewed the history of Kuranda and the construction of this fascinating railroad through one of the most inhospitable terrains in the world. Situated against a mountain backdrop and on the banks of the Barron River, this small town is somewhat unconventional. As history goes, Kuranda was established as a railway station in the eighteen hundreds when the logging and mining were large industries on the Atherton Tablelands. As an outpost, this township became known as a place to stock up on goods. When the industry declined, Kuranda evolved into a ‘hippie village’ where radical culture thrived. The Queensland government recognized the tourist potential, and with the establishment of the famous Skyrail, Kuranda rose to its present prominence.

As we arrived in the village, we saw a bedlam of tourists like us pouring in by thousands of coaches, trains and by Skyrail cable cars. The heart of town was a hive of activity with markets, restaurants, shopping, and wildlife parks.

Clearly, there is no dearth of things to do or see once you there. The most difficult decision is what and how much to fit into an afternoon. Spending a night, there is possible with several small boutique style boarding houses and a caravan park if cash strapped. A myriad of cafes, restaurants, and takeaway food shops cater to the international palette at very reasonable prices.

If you are a shopping buff, you will be in heaven on market days. The lives of Kuranda locals revolve around the markets, which operate every day but are larger on Wednesdays, Thursdays, Fridays, and Sundays. There are some excellent bargains on local arts and crafts and items like opals, didgeridoos, t-shirts, and exquisite paintings using natural ingredients. The ‘Art- is a relatively newer attraction to the village Main Street featuring many specialty boutiques and restaurants.

Some of the other attractions in Kuranda include riverboat cruises, the aviary, and the world-famous ‘Butterfly Sanctuary.’ The ‘walk-through’ bird enclosure with hundreds of native avians is one of Australia’s biggest zoological eco-attractions. The Australian Butterfly Sanctuary, set in a rainforest enclosure, brings out the innate child in you as you chuckle in delight at the fluttering tropical colorful, active butterflies around you. Further, a visit to the Barron Gorge lookout, especially after the heavy rain, is spectacular. There are many beautiful walking trails for the adventurous, though caution is necessary after a downpour as landslides are common!

The skysail has won many major tourism awards and is considered the longest cable ride in the world. It is a truly unique experience. There are two stops in the journey where you can alight and learn about the genesis of the rainforest as well as walkabout and take in the mystical flora and fauna. At the bottom of the Skyrail is ‘Tjapukai‘- an Aboriginal Cultural Centre, where you can meet and interact with genuine aborigines and learn about their life and culture. The ‘Kuranda Bottom Pub’ adjacent to the railway and Skyrail stations, is popular with locals and visitors alike. The pub offers affordable lunches and a hundred percent Australian ale in a traditional garden setting.

Kuranda Rainforest Tours conducts excellent excursions on the river and in the surrounding first. These tours are excellent value, and the tour guides take you on a friendly and informative adventure through the area briefing you on its floral fauna, perils, and sustenance. The Clohesy River is an experience for the strong-hearted. The four-wheel-drive tour first weaves through the forest along the scenic Lake Morris road. It then turns abruptly into the thicket of vegetation bashing through rivers and up treacherous precipices of Lake Morris, the freshwater source of Cairns city. As you ponder over this sublime setting, fine tea, and a selection of delicious treats are served. At the same time, a local meteorologist introduces you to the mysteries of this habitat and entertains you with fascinating stories about ravaging tropical weather. Upon leaving the lake behind, the four-wheel-drive tackles the Clohesy River road winding over sparkling creeks and rugged terrain, along with giant fig trees and enormous termite mounds up to seven feet in height before returning you to your hotel.

From the discerning luxury lover to the adventurous and hippie, Kuranda has something for everyone and a promise to make your holiday an unforgettable experience.

At a traffic signal at Chowpatty beach in Bombay, (Mumbai) India, I once spotted a young boy clad in a dirty white vest and khaki shorts. His hair was disheveled and his deep black eyes sparkled with determination. I found him racing from car to car begging for alms. Seeing me stare at him, he smiled and came up to me with anticipation. I asked him his name. “Kisan” he chirped. “What will you be when you grow up?” I inquired. Kisan twitched his nose, scratched his head and replied – “A phillum star“! (film star) backing his declaration with a melodramatic recitation of a dialogue from an old Hindi classic flic – ‘Sholay‘. Amused, I asked why he was begging instead of studying towards his objective. “No job memsaab, no money and mother in hospital“. Apparently he had been forced to leave school to shoulder responsibilities of an ailing mother and two younger siblings. I felt sorry for him and decided to help him. I gave him a ten rupee bill. He cried out in sheer delight. For him, I appeared as a Messiah out of the blue. I told him that I would visit him the next day and help him start with a small time business.

The next day, I got him shoe polish, a mattress, brush, a few rags and a shoe stand. “From now on you are a shoe polishwalla“, I declared. I asked him to earn his living by polishing shoes during the day and attending school at night. Kisan held my feet with gratitude as I prepared to leave feeling like a good Samaritan.

A few weeks later while passing Chowpatty beach again, I curiously looked out for my ‘shoe polish master’. As the taxi pulled up at the traffic light, I was astonished to find Kishan back on the streets asking for alms. I beckoned and expressed great displeasure at his plight. “Memsaab there is more money in begging than in shoe polish business” he said. He waited expectantly for a minute and realized that I was too taken back to respond. Without a second glance I watched him take off for the next car before the lights turned green…Not to miss an opportunity at earning his daily wage.

Sigh! That’s life I guess…

Kakadu, the first Australian area inscribed on the UNESCO list of World Heritage Properties, is a natural wonder of the world. The area was so called in honor of the early aboriginal settlers of this region who spoke ‘Gagudju‘, as recorded by Baldwin Spencer, a great anthropologist in 1911. These Gagudju- speaking people were almost gone by the time Kakadu was declared a national park and were replaced by the stronger ‘Kunwinjku‘ speaking people from further east.

Being of great scenic beauty, it contains a rich cultural and natural heritage unequalled elsewhere and provides refuge for many tropical species. It comprises of spectacular wildlife habitat, which ranges from the high plateau to forest woodlands, monsoon rainforests to open savannah-flood plains dotted with ‘billabongs’ to mangrove-fringed estuaries to the coastal beaches of Arafura Sea. At the heart of Kakadu is the South Alligator River, upon which all life depends on water.

A home for wildlife, Kakadu boasts sixty species of mammals, including kangaroos, dingos, possums, bats and dusky rats. The park is famous for its reptiles, the most dangerous of which is the Australian Saltwater crocodile often found patrolling waterways throughout the area. Frill-necked lizards and water pythons are common. It is a paradise for water birds- magpie, geese, and egrets that flock together in the wetlands. Lorokeets, finches and parrots are also found in large numbers in the woodlands.

Due to the vast disparity in local seasons, the aboriginal inhabitants of Kakadu divide the year into six distinct seasons! The ‘Gunumeleng‘ (October, – December), which is the pre-monsoon season of hot, humid weather characterized by an explosive growth of plant and animal life. It also happens to be an egg gathering time. The ‘Gudjewg‘ (January-February) is a time of violent thunderstorms heavy rains and flooding. The third season is ‘Banggereng‘ (March) when most plants are fruiting and animals are carrying their young. Expenses of water recede and streams run clear. Aggressive storms flatten high spear grass. Next comes the season of April and May called ‘Yegge‘, bringing early morning mists. This shallow wetlands and billabongs are carpeted with waterlilies. Drying winds signal it is time for burning bush to ‘clean’ the country and encourage new growth for grazing animals. ‘Wurreng‘. is the cold weather with low humidity. Creeks cease to flow and floodplains quickly dry out. Burning continues, dampened by dew at night. The months of August and September mark ‘Gurrung‘, a windless and hot season during which the land lies dormant. It is time for hunting file snakes and long necked turtles.

Kakadu is not only home to a spectacular natural topography and wildlife but also boasts the longest continuous surviving culture in the world. Local aborigines have. been living in this region for at least forty, thousand years! Their descendants are still to be found here. Kakadu and Arnhem Land contain one the longest continuous records of rock art in the world. The Gagudju speaking tribe left a legacy of art treasures on the shelter rock surfaces throughout this world renowned region. Because of these features it has become a tourist attraction. Frequent visitor areas include the Ubirr Art Site, the East Alligator River, the Bowali Visitor Centre and the Nourlangie Rock with its fascinating human occupation site, well preserved art galleries and scenic points. The Yellow Water boat cruises are a sheer delight for those who enjoy wildlife. Mornings and evenings are the best times for walking, climbing and sightseeing. The park has a great feeling of continuity with the elements and offers the entire spectrum of tropical diversity condensed into one national park, while each reaction still boats its own uniqueness. Fishing, camping canoeing, photography, wildlife, or even traditional art – you have it all here in Australia’s emerald cap.

Bullying is perhaps the single most destructive experience we’ve all come in contact with. Most of us may have confronted with bullying during our childhood as either a victim or as a silent spectator. However, bullying isn’t just limited to a person’s early years. It can also confront you in adult life at your workplace or even now through cyber space. No matter where a person comes in touch with bullying, the bottom line is that it soul crushing. It is an unpleasant experience that can completely destroy your self-esteem and often sucks the happiness out of you. It is therefore important to learn to create a world where empathy and inclusiveness is the norm.

Tanya, was our friend’s daughter. She was a pretty, but a sensitive child. Tanya suffered from meningitis in infancy, leaving her with a speech defect – shamefully an object of ridicule at her school!

One evening we were invited for dinner. At the table Tanya seemed unusually pensive. Her mother knew that things were not going well at school. She had heard of a Christmas wish contest on the local radio and thought it would be good for Tanya to participate. She broke the news to Tanya whose eyes lit up at the thought. The contest sounded like fun. As the young girl thought about what she wanted a smile adorned her face. She quickly penned down a letter for Santa stating that she was a lonely seven year old, with a stammer. She also suffered from asthma and eczema. Kids in school did not love her because of this and was treated like an outcast. She wished that for just a day, people would stop making fun of her and being hurtful. She only wished that she had friends to play with. She signed her name and carefully sealed the letter while each of us at the dinner table wondered what she could have wished for.

At a local radio station letters poured in for the ‘Christmas wish contest’. When Tanya’s letter arrived, the manager read it with tears in his eyes. So touched was he that he thought of getting it published in the local newspaper. The next day a picture of Tanya and her letter to Santa made front page news.

Suddenly the postman was a regular at the Shah residence. Envelopes of all sizes addressed to Tanya arrived daily. Each letter had a special message for Tanya. She now began to realize how many friends she had.

Tanya was granted her wish of a special day. Teachers and students at school expressed much remorse at their insensitivity and of having ostracized her. They promised to try more sincerely to accept this wonderful child as one of them. Today Tanya has friends everywhere including school.

Hence, we all need to create more opportunities to teach empathy to our children as well as other’s. We also need to have compassion for ourselves as victims of bullying, no matter how long ago it occurred. Always remember that harm caused by others may hurt us, but it cannot define us. As Michael J Fox once said- “One’s dignity may be assaulted, vandalized, and cruelly mocked, but it can never be taken away unless it is surrendered.”

Strolling through the streets of Alice Springs I was struck by traditional art exhibits – how different this art form was from elsewhere in the world. On gazing hard and reading about it, I realized what a beautiful visual language it was, an imagery that was part of aboriginal life – a connection between their past and present, the supernatural and mundane.

Aboriginal art was first appreciated by the white Australian sometime on the 1940’s when debutant artist Albert Namatjira’s water color paintings took the Australian art market by storm.

In 1971, Geoffrey Bardon, a non-aboriginal teacher at Paunya School in Central Australia aroused interest among aboriginal elders of the community in putting up a traditional mural on one of the school walls. Jack Phillipus and Billy Stockman Jlapaltjarra, working as groundsmen at Papunya School were encouraged to commence the project. Shortly after work began, other members of the community became enthusiastic and joined in, creating a mural named ‘Honey Art Dreaming’. Due to then government’s regulations, the mural was destroyed but it sowed the seeds of propounding aboriginal art. From this quiet beginning in a remote aboriginal community one of the most important art movements of the late 20th century grew, followed by development of Papunya Tula Company, an Australian art gallery focusing on both economic and cultural activities – an association that helped artists’ sell their work.

The ‘Papunya Art Gallery’ intrigued me the most. As I entered I saw the most ancient representation of the aboriginal art – the dot. and bark paintings. Wet, stripped bark sheets are dried for a couple of days and then pressed by heavy logs of wood to prevent from curing, before painting on them. These exhibited indigenous folklore in symbolic form using earthy colors. Then there are the oversized trumpets called didgeridoos and boomerangs fashioned from native trees all decorated with aboriginal art. I learned that bark paintings were traditionally prepared as an accompaniment to sculptures and carvings for religious ceremonies. They only had life and significance during the ceremony and were subsequently discarded or hidden away. Bark paintings as a salable art form became established only around the 1960’s.

Dot paintings are the traditional visual art forms; patterns that are created from small dots of paint, which cover the entire surface of the paining. These dot patterns, many of which are symbols, are easily recognized by those familiar with the legends and stories they illustrate. Symbols for campfires, walking paths, animal tracks, fertile soil for wild yams, and water sources are common elements of aboriginal paintings each created in colored dots. Bright colors have become more common, but traditional dot painters used pigments made from natural materials, giving their paintings an earth-toned palette. The dot paintings made by aboriginal people of the central desert are based on a thousand-year-old tradition of sand painting. Therefore, there is no ‘right’ way to view the piece: no horizontal, no vertical, no up or down. This art may be hung any way that the viewer wishes, even placed flat, which was the artist’s perspective when it was painted.

Apart from these two main formats, the cave paintings are the most common form of aboriginal fixed art. This medium gave artists considerably more scope than the laborious techniques of rock engraving. Again the pigments were all earthy colors – natural ochers of red, yellow, white pipeclay, black manganese oxide or if not available, crushed charcoal and charred bark. Most pigments were obtained locally or by barter. The artist’s palette was a flat stone on which the hard pigments were ground to a powder, then mixed with water or natural fixates such as emu fat, eggs of the sea going turtle, wax and honey of the wild bee and sap from orchids.

One of the most fascinating aspects of aboriginal art is their concept of ‘dreamtime art’. The head of each aboriginal tribe or clan is an elder who illustrates in a story form a mythological figure typical to his or her clan. stories are woven around this figure and passed down verbally generation after generation. This figure is extensively illustrated in that tribe’s art for giving rise tp their ‘dreamtime art’.

Present day galleries in Australia have capitalized this art form, a heritage that they can call ‘Genuinely Australian’. Quoted market values for this once ‘disregarded native scribble’ roll easily into thousands of dollars today. I for one with my penchant for any art was most intrigued by this strange art form and hope to spread awareness of its uniqueness and beauty to the rest of the world through this blog post.

It was the year 2000. In January, our small twin-engined plane had whirred into the sky on a sultry summer morning from steamy Darwin towards mystical Alice Springs. Dawn broke out in an array of strange iridescence so native to the southern skies and we gently rolled into a quaint little airstrip seemingly in the middle of no-where! Precisely…. Alice Springs!

This oasis in the Great Australian Desert sprung up in the 1870’s around a permanent waterhole chosen as a base while constructing overland Telegraph lines across Australia. Named after Alice Todd, wife of the then construction manager of this project, Alice Springs soon attracted tourists and migrants in search of a better life in the 1880’s and blossomed over decades of its present strength of 45,000.

My husband and I sauntered down the brown stoned pedestrian walk of Todd Mall, the city’s commercial hub to discover the numerous idiosyncrasies of this strange place. Shops that sold oversized bamboo trumpets called didgeridoos to boomerangs fashioned from native trees and decorated with aboriginal art. The dot and bark paintings exhibiting indigenous. folklore in symbolic form using natural earthy colors were absolutely fascinating. Boughs of willows hung down like tapestry and offered sanctuary from the blazing desert sun as they sprung up all over the walk and nestled little cafes in their shade. Cuisine from the world over was proffered at these cafes to cater to tourists – the main fraction of all visible population. The north end of Todd street brought us to Anzac Hill from where a panoramic. view of Alice Springs with botanical gardens at its fringes, the dry meandering bed of the Todd river with the MacDonald ranges in the backdrop could be savored.

We were just beginning to realize the mystique of this secluded habitation…pondering over what promise it held for us during our one year’s proposed period of stay here.

This blog post was written for Center for Health Innovation and Implementation Science at IU School of Medicine, while I was a Strategic Digital Communications intern back in 2018-2019.

Technology has taken a place in caring for our loved ones by providing some wonderful tools, both for those with Alzheimer’s and for those who care for them. This can include engaging a loved one with Alzheimer’s, aiding with behavioral management, creating a safer environment, or monitoring from a distance. Below are two examples of how technology can be useful in engaging with those who have Alzheimer’s or other related dementias.  

IPod and earbuds  

I recently visited an adult daycare center to explore volunteer opportunities with them. There, I chanced upon an elderly man in his late 70’s who seemed to be enjoying his time there. I was told that he had Alzheimer’s and that he came in three times a week. This allowed him an opportunity to engage with other seniors in a safe and structured environment while his wife, the primary care giver, got a chance to take care of her own personal and health needs, manage their home and keep up with her church commitments.  

Towards the end of the day when others were departing, I noticed that he suddenly became agitated by the commotion of the departures of other fellow seniors.  However, what took me by surprise was that in order to minimize his agitation and risk of wandering out the door with them, this care center and his wife had collaborated on loading an iPod with his favorite classical music. With earphones and an iPod, he was soon enough easily soothed. He became focused on listening, seeming less distracted by the commotion of the late afternoon.  This was technology in action!  The iPod turned out to be a great solution, both for his agitation and for his safety. 

Videography and memory jogging 

In yet another example, a group of high school children from Michigan worked on a project to create a real-life video experience for individuals facing memory loss. This idea was sparked off by the CEO of EHM Senior Solutions, a senior living and care provider in Saline, MI.  

For this project, four students from Saline High School’s STEAM Program (science, technology, engineering arts and manufacturing program) were paired with adults with memory impairment. All the students were asked to record images and interviews from a person’s life that he or she could access to help with memory recall.  Students worked closely with team members of EHM’s Memory Support Center and Adult Day Program. They also received training from a project manager and videography leader from iN2L (It’s Never 2 Late), the technology company that supplied its touchscreen FOCUS tablet to record and store the videos.  

According to Deb Hipp at Alzeimers.net (2018), “The FOCUS tablet offers brain fitness and memory games but can also hold personal photos and videos to prompt memory recall. Around 2,000 senior living communities in North America use iN2L’s touchscreen technology in group and individual settings to provide better memory care for residents” (para 7). 

Helmer, one of the senior high school students, was assigned to Arlene who, lived at EHM’s Brecon Village’s Memory Support Center. Helmer feared that she’d mistaken someone else for her video subject. Fortunately, EHM staff steered Helmer away from trying to form a connection with details that Arlene could not always remember. She was told to start with simple things. They guided her towards connecting with her through human emotions. Helmer spent three months filming and editing Arlene. The mobile device broke down barriers of age and cognitive differences between Arlene and Helmer.  Arlene was thrilled with the new device that she had not seen before and Helmer was proud of the content she would put together that captured this person’s life. 

In Arlene’s interview video, Arlene’s daughter nudged Arlene to recall her old Girl Scout camping nickname, “Fearless,” and that of her co-leader, “Doubtful.” When Arlene heard that name, she chuckled and said how she forgot about Doubtful. At another point, Arlene sang along to her favorite song, “Let Me Call You Sweetheart.” During the interview, Arlene often fumbled, when she was unable to recall how many children she had. Other times, her eyes would light up, when she talked about her love of reading or her thirty years delivering Meals on Wheels. Helmer also took a video of Arlene’s quaint house, which was set back on a yard filled with swaying sunflowers and a vegetable garden. Arlene had tended that garden for years, selling the produce and donating 50% of proceeds to a food bank in Ann Arbor.  

At the end of this project, Arlene’s daughter also received her mother’s video on a tablet. This way she could easily access memory-jogging footage, allowing her to connect with her mother.  So, instead of initial awkwardness when a parent cannot remember their children’s names, the images would aid in relating to one another.  

Implementing innovations in Alzheimer’s care 

As is evident from the above two scenarios, technology use to reach an individual with Alzheimer’s or dementia can be helpful. Technology definitely helps in maximizing independence, improving quality of life, reducing neuropsychiatric symptoms, and reducing caregiver burden. Who would have thought technology, now embraced by so many in younger generations, would have applications for one with Alzheimer’s? Changes in care like this are innovative, and implementing them is simple.   

If only we had technology like this in the 90’s. It would surely have helped us in connecting with my grand mom in-law – a victim of Alzheimers.

Citations

Walker (2018, May 8). Navigating the world of Alzheimer’s disease: An Educational Guide for Family Members. Retrieved from https://commons.emich.edu/cgi/viewcontent.cgi?article=1608&context=honors

National Institute on Aging (2019, May 22). Alzheimer’s Disease Fact Sheet. Retrieved from https://www.nia.nih.gov/health/alzheimers-disease-fact-sheet

It’s alarming to read headlines regarding deaths caused by overdoses. The misuse of opioids – including prescription pain killers, heroin and other artificial opioids have become a severe national crisis affecting public health. Beyond public health, opioid addiction also affects social and economic welfare. According to the Centers for Disease control and Prevention, “In the United States, the total economic burden of prescription opioid misuse alone is $78.5 billion a year, which includes the costs of healthcare, lost productivity, addiction treatment and criminal justice involvement.”

Healthcare experts, including researchers and implementation scientists, are working to combat the deadly toll that this epidemic is wreaking on society. One of the ways to tackle this problem can be through a simple “nudge” technique. According to Richard Thaler and Cass Sunstein (2008), “Nudge is a concept in behavioral sciences that describes an intervention that ‘alters people’s behavior predictably without forbidding any options or significantly changing their economic incentives” (pg. 6). If a heavy object is nudged by just one person’s index finger, it might not move. However, if enough people nudged together, real change might be created. The same goes for population health and the opioid crisis.

In recent years, interest in practice improvement through nudges has grown due to the transparent, inexpensive and effective influences they have on behaviors towards specific program/practice goals. A research study published in JAMA Surgery (2018) is a perfect example. The authors observed that by lowering the default number of prescription pills from 30 to 12 in a multi-hospital electronic medical record system, there was a significant decrease of opioid prescribed after ten standard outpatient surgical procedures without an increase in analgesic refill rates that would indicate inadequately treated pain. The authors described this strategy in their study as a “simple, effective, cheap, and potentially wide-reaching intervention that can be harnessed to help change the culture of opioid overprescribing among providers.” The study demonstrated that a nudge could be useful in changing prescribing behavior in health care.

In yet another study published in the Journal of American College of Surgeons (2018), researchers showed the spillover effect of making a change. When doctors changed their postoperative prescribing for one procedure, those habits trickled down into their prescribing behavior for other unrelated processes. Once doctors changed their practices to safer ones, the path of least resistance became the new, more reliable approaches. They are now familiar processes instead of new and unknown. The main hurdle to overcome was the first change, which required a nudge.

A study led by ER physician Kit Delgado at the University of Pennsylvania found a simple way to nudge emergency department doctors in the right direction by setting the electronic medical records system to default to the recommended 10 opioid pills to treat acute pain. In this experiment with the electronic medical record system, weekly prescribing patterns were compared for 22 weeks before and after the default number was changed. To choose a different quantity, doctors had to opt out of the default and click a different option or manually enter the number. An unintended positive outcome was a decrease in the proportions of doctors prescribing fewer pills, which fell from 20 percent to 15 percent. The Philadelphia Inquirer quoted Dr. Delgado, “This default-setting approach has expanded to 50 hospital emergency departments as part of an opioids study called Reduce. The three year project also gives individual prescribing reports to physicians so they can assess their patterns. If they realize they’re not meeting a performance target, it’s very motivating to change behavior.”

Researchers are making continued efforts in testing “nudges” to improve healthcare, such as using prompts in electronic medical records and using text messaging to boost prescribing of lower-cost generic drugs. Hence, nudges can be designed to remind, guide or motivate behavior. The Center for Health Innovation and Implementation Science at the Indiana University School of Medicine can provide the necessary tools on changing human behavior. Through education and engagement services, healthcare professionals can learn a proven, evidence-based change methodology that has been designed specifically to improve healthcare: Agile Implementation. To learn more, visit: https://hii.iu.edu/

Citations

Chiu  AS, Jean  RA, Hoag  JR, Freedman-Weiss  M, Healy  JM, Pei  KY (July 2018).  Association of lowering default pill counts in electronic medical record systems with postoperative opioid prescribing. JAMA Surg. doi:10.1001/jamasurg.2018.2083

Florence CS, Zhou C, Luo F, Xu L (2013). The Economic Burden of Prescription Opioid Overdose, Abuse, and Dependence in the United States. Med Care. 2016; 54(10):901-906. doi:10.1097/MLR.0000000000000625.

McCullough, M. (2018). As addiction crisis grows, Penn’ nudges’ doctors to limit opioid prescriptions. The Philadelphia Inquirer. Retrieved from https://www.inquirer.com/philly/health/addiction/as-addiction-crisis-grows-penn-nudges-doctors-to-limit-opioid-prescriptions-20180118.html

Thaler  RH, Sunstein CR. (2008). Nudge: Improving Decisions About Health, Wealth, and Happiness. New Haven, CT: Yale University Pre

Physician burnout in the US is reaching epidemic proportions as we seek for health care system solutions that optimizes people’s health and is yet affordable. Fundamentally, if we could better influence the health-related decisions that take place between a clinician and a patient, we would be making significant strides towards the triple aim. This is where behavioral economics can come into play.

Our behavior is powerfully influenced by our emotions, identity and environment, as well as by how options are presented to us. Traditional economics is rooted in the assumption that people make rational, self-interested decisions based on a strict cost/benefit analysis of their options. By contrast, the sub-field of behavioral economics acknowledges that common psychological factors, such as aversion to loss or the desire for fairness, also influence people’s decisions.

In order to find gentle but effective ways to change the behavior of both clinicians and patients towards optimal outcomes, providing a healthy nudge, has shown to be effective in randomized trials. By creating more favorable decision-making environments, we can take advantage of cognitive biases to encourage high-value care.

For physicians, a nudge for example could be used to increase referrals to cardiac rehabilitation for patients who have had a heart attack. This has been established as a best practice but typically requires various steps on the part of the referring physician. Conversely, a nudge might be deployed to dissuade a physician from utilizing unnecessary diagnostic testing.

For patients, nudges can promote adherence to exercise programs or medication regimens, or visits to a physician. There are many elements of healthcare that are dependent on the patient’s behavior and though patients are highly motivated to improve their behavior, this can be hard. The key solution therefore is to design the right incentives for both patients and physicians.

One fundamental example of a nudge that is based in behavioral economics is the power of defaults. Defaults take advantage of the status quo bias — a preference for continuing the current state of affairs. Health systems can employ defaults in myriad ways to promote high- value care. For example, when electronic order-entry programs default to generic drugs instead of brand-name ones, clinicians are more likely to prescribe generics.

Another example of a nudge is lottery based rewards. State lotteries capitalize on the innate regret aversion of the human mind. Providers can use the same trick on patients in tandem with pill-bottle technology that allows medication adherence to be monitored remotely. A lottery can be held each week, with, a given dollar amount prize going to the patient whose number is drawn at random. But patients are ineligible to win if they did not take their medication. The fear of getting a message that their number was drawn but they were ineligible to win because of non-compliance is a powerful motivator.

Again, the phenomenon of loss aversion offers an avenue for changing clinicians’ behavior. Research suggests that losses have about twice the psychological impact of commensurate gains — and the fear of a monetary loss can therefore produce a greater behavioral response than the opportunity to gain the same amount of money. Massachusetts General Hospital, for example, used a strategy of up-front incentive payments in an effort to improve hand hygiene, increase electronic prescribing, and reduce emergency department use. Physicians were given incentive payments in advance of the measurement period, separately from regular paychecks.

Further, people have a strong psychological need to maintain a positive self-image. Pairing performance incentives with appeals to self-image and professional identity provides an additional lever for meeting quality and efficiency goals. Making public some component of physicians’ performance, atleast within organizations, may enhance the effect of monetary incentives.

The New York Times also says – “Health insurers are betting that behavioral economics can improve quality and lower costs. Blue Cross Blue Shield (B.C.B.S.) of Massachusetts is using a variety of behavioral economics concepts to pay its doctors — including delivering incentives at the organizational level; peer comparisons and bonus payments for continuous improvement instead of absolute thresholds. In Hawaii, Blue Cross Blue Shield is experimenting with joint incentives for doctors and patients to meet diabetes care goals” (Khullar, D.; 2017; para.17).

Start-ups like the Brooklyn based company Wellth, for example are also jumping into the nudge game by having developed an app to reward patients for taking their medications.

So then is behavioral economics better directed towards patients or toward clinicians? The evidence suggests that the answer is both. Dr. David Asch, executive director of the Penn Medicine Center for Health Care Innovation led a study that consisted of four groups, each of which was seeking to achieve LDL cholesterol reduction in patients: Physician incentives ($1,024 per patient who achieved his or her cholesterol target after 12 months), patient incentives ($1,024 for achieving the target), shared incentives ($512 each to the physician and patient for achieving the target), and a control group. The results showed that patient incentives or physician incentives alone did not produce significantly greater cholesterol reduction than the control group. But shared incentives did boost results. According to him- “It takes two to tango. It takes a physician to prescribe and a patient to take it, and in a lot of strategies to improve health care, we target one or the other. We don’t think about using them together. We’ve all been taught about the clinician-patient relationship and how important it is. Why aren’t we using this effectively?” (Hutt, N.; 2018, para. 29).

To conclude, a more complete view of human behavior seems necessary for more effective medicine. Health is fundamentally the product of myriad daily decisions made by doctors and patients, and by uncovering what truly motivates us, we may be able to nudge one another toward wiser decisions and healthier lives.

Citations

Kullar, D. (2017). How Behavioral Economics Can Produce Better Healthcare. New York Times. Retrieved from https://www.nytimes.com/2017/04/13/upshot/answer-to-better-health-care-behavioral-economics.html

Khullar, D., Chokshi, D., Kocher, R., Reddy, A., Basu, K., Conway, P., & Rajkumar, R. (2015). Behavioral Economics and Physician Compensation — Promise and Challenges. The New England Journal of Medicine, 372(24), 2281-2283.

Four years ago, I found myself sitting nervously in the doctor’s office for my annual physical check-up, unaware that I was about to receive alarming news. When the results came in, my heart sank—I was pre-diabetic! My A1C blood sugar levels registered at 5.6, just shy of the warning zone where diabetes could take hold. The benchmark for pre-diabetes ranges from 5.7 to 6.4, and there I was, teetering on the edge of a troubling health fate.

Panic quickly set in as I turned to my doctor, the fear of complications and the possibility of a diabetes diagnosis looming large in my mind. “Does this mean I could face serious consequences, even death, from full-blown diabetes?” I blurted out, anxiety coursing through me.

My doctor leaned in, her tone calm and reassuring. “Not at all! Look on the bright side; it’s not diabetes yet. You have the power to take control of your health and reverse this.”

Her words struck me like a jolt of electricity, awakening me to the urgent reality of my situation. It was the wake-up call I desperately needed, setting me on a path to reclaim my health and make lasting changes.

Over the past couple of years, I have been keeping a log of my caloric intake, paying particular attention to my carbohydrate consumption. I have shifted towards a low-carb, high-protein diet, and I have reduced my sugar and salt intake. Most importantly, under the guidance of my fitness coach, I have been engaging in enjoyable exercise routines. I also take Metformin to help maintain my glucose levels within a normal range. Additionally, my doctor periodically checks my blood levels of hemoglobin A1C to ensure they have not significantly increased.

Diabetes is one of the most significant health challenges we face today, affecting approximately 30.3 million Americans—many of whom, nearly one in four, are unaware that they have the condition. The link between diabetes and serious health issues, such as cardiovascular disease and high blood pressure, is clear. Additionally, this chronic illness can lead to various complications, including strokes, diabetic retinopathy, kidney problems, digestive issues, and nerve damage.

Living with diabetes, whether it’s Type 1, Type 2, or gestational, can be incredibly challenging and often overwhelming. It’s essential to recognize these feelings and understand that you are not alone on this journey. The good news is that there is hope. Recent advancements in treatment are transforming diabetes management. Innovative therapies developed over the last decade have made a significant difference. For example, non-invasive A1C tests allow doctors to measure and monitor blood glucose levels with greater precision.

According to Innovation.org, new forms of insulin and autoimmune vaccines are now available in convenient pen formats. These advancements not only improve patient adherence but also reduce the risk of hypoglycemia. Additionally, exciting once-daily oral treatments have been developed that help slow the progression of organ complications in patients. Notably, recent trials of oral insulin have demonstrated that early intervention can delay the onset of type 1 diabetes by an impressive average of 31 months.

Moreover, there are promising breakthroughs on the horizon in the fight against diabetes. Among the most notable developments is a groundbreaking oral treatment designed to address diabetes in a completely new way. This potential first-in-class drug targets two distinct pathways in the body, effectively inhibiting the molecules responsible for glucose transport in and out of cells—work that occurs independently of insulin.

Researchers are exploring a revolutionary slow-dissolving molecule that could keep insulin in the body for more than two weeks. Imagine a future where daily injections are no longer necessary!

Even more remarkable is the ongoing research into an enzyme treatment that might potentially reverse diabetes itself. In preclinical trials, about 40 percent of participants remained in remission for three months after stopping their diabetes medication. Although it is still early in the research, the future of diabetes treatment looks incredibly promising.

With these innovative therapies making significant progress, we are closer than ever to finding a true cure for diabetes. In the meantime, effective management of diabetes is crucial. Regularly monitoring blood sugar levels, maintaining a healthy weight, staying active through exercise, and being mindful of your diet are essential steps on this journey.

When it comes to managing my pre-diabetes, I’ve discovered some powerful strategies that really work for me. Here’s what I’ve found helpful:

Healthy Snacking is Key: I always keep nutritious snacks on hand—things like hard-boiled eggs, an assortment of veggies (think baby carrots, crunchy cucumber, and crisp celery sticks) paired with hummus, or a scoop of low-fat cottage cheese topped with berries. These snacks not only satisfy my hunger but also curb those pesky cravings throughout the day.

Prepping Before Social Events: Before heading to a social gathering where the food options might be limited, I make sure to have a healthy bite. This way, I’m less tempted to indulge in less wholesome choices.

Build Your Support System: I surround myself with family, friends, and cheerleaders who support my healthy lifestyle. Having a solid support network is invaluable—it makes the journey so much easier and more enjoyable.

Fun with Fitness: Exercise doesn’t have to be a chore! I love going on long walks in nature with my husband and diving into fun fitness training sessions with my coach. Finding activities I enjoy has made staying active a blast!

Be Kind to Yourself: Remember, it’s okay to stumble sometimes. We’re all human! If you have a day or a week that doesn’t go as planned, don’t dwell on it. Tomorrow is always a fresh start and another chance to make healthy choices.

Embracing these strategies has made a world of difference for me, and I hope they inspire you, too!

Citations

Combating Type 2 Diabetes. (2017, Nov 13). Retrieved from https://innovation.org/diseases/autoimmune/type2-diabetes/combating-type2-diabetes