Did you know that today 20 million family caregivers regularly perform a range of tasks for family members or friends? That’s according to AARP. The fact is, many of us are – or will become – caregivers, and that most of us have never been trained to do some of the often complex tasks that will be needed.
Fortunately, there’s more and more online help available to caregivers. So, in honor of National Family Caregivers Month, here’s my latest blog post for Sixty and Me about some of the instructional videos available now:
A year before Isabella de la Houssaye reached the summit of a 22,840-foot-high mountain peak in the Andes with her daughter Bella, she had been diagnosed with stage 4 lung cancer.
The 55-year-old, an outdoors enthusiast, and her husband David Crane had five children, aged 16 to 25, all of whom had conquered outdoor adventures together with the family and as individuals. So after recovering sufficiently from grueling cancer treatment and feeling stronger, Isabella was determined to have other adventures with each of her children, individually, in large part to impart life lessons to them.
The climb to the top of Aconcagua in Argentina with college-junior Bella, with a team that included a New York Times reporter and photographer, is a remarkable story of almost unimaginable challenges, courage, grit and determination. It was featured in a lengthy article in the Times that you can read here.
One passage in the story that I found especially moving – and thankfully its lesson is not dependent on climbing a mountain to learn from – records Isabella’s attitude about illness:
“So much of who I was was defined by my physical strength,” she said. “It’s definitely hard being sick and saying goodbye to the person you were before. You have to redefine yourself, and you don’t want to define yourself as a sick person. I’m learning that you have to find acceptance with the decline.”
Facing Mortality Head-On
Her story is inspiring, to say the least. But I must admit that after I read it, I knew that if at some point I am diagnosed with a life-threatening illness, my first thought would not be: let me call my son and propose that we climb a 22,840-foot-high mountain together. As I kept thinking about Isabella’s ultimately successful ordeal, though, I wondered: what would I do (after emerging from a period of hiding and mourning my life under the covers)?
It’s an important question, one that many of us don’t think about much. How do I know that? For the past several months, I’ve been giving “Conversation of Your Life” talks to various groups. It’s all about advance care planning: having the conversation with loved ones about your treatment preferences if you cannot speak for yourself; choosing a health care proxy; preparing an advance directive; and communicating with your doctors about what you want and what you don’t want. Essential issues.
What I try to stress, though, is that the first and most important part of this process of communication is to communicate with yourself. That is, to confront your mortality head-on. So much flows from that. It isn’t all about medical treatments, just as serious illness itself isn’t just a medical issue. It’s about what you feel you want and need to do before you can no longer do it. It’s about how you want to live the rest of your life – honoring your sense of what gives your life meaning and purpose. It’s about the kind of legacy you want to leave. It’s about who you want to surround yourself with. And unfinished business to attend to.
When I talk about this fundamental part of communication, I sometimes ask my audience, who has given some thought to this? What are you envisioning? The response? Crickets, typically. Either no one has given this any thought, or people feel too shy or embarrassed to share.
Sharing Your Values
So I’ll share some of what I’d like. If I am gravely ill and still have my wits about me, I’d like a big good-bye party, with lots of food and lots to drink. I’d like to hear from family and friends about what I’ve meant to them, what they’ll remember, how I’ve affected them and funny stories they can tell. All the wonderful and moving things that people say at funerals that the deceased don’t get to hear. (At least we don’t have any evidence that they do.) I want to hear it before I go.
And, speaking of food: We’ve been hosting Thanksgiving and Passover for decades and in recent years our small family has happily grown to include seven grandchildren and cousins’ grandchildren, aged six and under. As you might imagine, these events are like organized chaos, but always seem too short. One reason I love to keep doing this is that I am hoping that all the younger-generation cousins and their children will continue to recognize how precious these times are and will keep the tradition going.
Clearly, Isabella had grander things in mind, but fundamentally she wanted to impart her values and wishes to her family. She succeeded in accomplishing what she set out to do. After reaching the summit, Isabella said, “It was so important to me that Bella and I have this experience together. I really wanted her to see that when things get hard, you can find a place inside yourself to keep going.”
(Note: This is a guest blog, from Teresa Greenhill, co-creator of MentalHealthForSeniors.com, a website dedicated to providing information on physical and mental fitness.)
Mental health is a serious issue among seniors. In fact, depression affects about 5% of people over 65 as well as up to 13.5% of older adults who require home healthcare. While depression is a common problem, it’s not a normal side effect of growing older. Depression should not be something we simply endure as part of the aging process. If you’re experiencing depression, keep reading to find out how Medicare can help you cover your treatment and support your mental health in the long run.
Mental Health Services Covered by Original Medicare
Original Medicare—also called Medicare Parts A and B—covers a variety of mental health services. Medicare Part A covers the costs of mental health care for hospital inpatients, including therapy and medications administered in a hospital setting. When it comes to outpatient mental health services, Medicare Part B covers one depression screening every year. In addition, it covers psychiatric evaluations, diagnostic tests, medication management, family counseling, and therapy with licensed mental health professionals such as psychiatrists, psychologists, and social workers. However, seniors using these services should be aware of deductibles and copays. After you reach the deductible for Medicare Part B, you will have to pay 20% of the cost for each mental health service.
Unfortunately, Original Medicare alone does not cover prescription drugs or other essential services that can support your mental health treatment. This is why many seniors opt for a Medicare Advantage plan. Medicare Advantage plans offer all the same benefits included in Original Medicare, plus coverage for services like vision, dental, hearing and prescription drugs to help improve your quality of life.
Finding the Right Medicare Plan
There are over 3,700 Medicare Advantage plans available across the United States, so how are you supposed to choose one? Start by making a list of services that you need covered. For example, you may need prescription drug coverage if you’re prescribed medications to treat your depression. If you have vision or hearing problems, make sure your plan covers these services as well—taking care of your physical health is crucial to good mental health. Untreated hearing loss, for instance, can lead to cognitive impairment! Additionally, many Medicare Advantage plans have in-home support services which can significantly improve quality of life for people facing mobility limitations.
Medicare Advantage plans that provide access to wellness programs may also be a good choice for people with depression. Research from McMaster University a public research university in Hamilton, Ontario, Canada, shows that staying active plays an important role in treating and preventing depression. Additionally, any senior with Medicare can also take advantage of a free annual wellness visit. During this visit, seniors can discuss prevention strategies with their doctor and develop a personalized plan for avoiding mental illness in the future.
Ensure Your Mental Health Provider Accepts Medicare
Since many psychiatrists opt out of Medicare, you may have trouble finding a mental health professional that accepts your health coverage. Fortunately, U.S. News recommends a few steps patients can take to find the mental health care they need. Start by talking to your primary care provider about your mental health concerns. Your doctor may be able to prescribe medication for your condition and refer you to professionals who they know accept Medicare. If you enroll in a Medicare Advantage plan, ask for a list of covered providers. For seniors who live in rural communities, telepsychiatry is a superior option to forgoing mental health care altogether. This service may be covered by Medicare, depending on where you live.
Is Your Mental Health Service Recognized?
On the other hand, you also need to ensure that your Medicare plan recognizes the mental health services you intend to use. CMS (the Centers for Medicaid and Medicare) recognizes mental health care provided by clinical psychologists, clinical social workers, clinical nurse specialists, psychiatrists, physicians assistants, nurse practitioners, and general practitioners. Non-medical doctors—like social workers and psychologists—must be Medicare-certified. Also, ensure your mental health care provider accepts Medicare’s approved amount for the services they’re providing to you.
Along the same lines, make sure that your Medicare plan will cover your prescription drugs. If you opt to stick with Original Medicare, you can add a prescription drug plan with Medicare Part D. Alternatively, you can choose a Medicare Advantage plan that includes drug coverage—most plans do. Either way, be sure to choose a drug plan that covers your prescriptions. If you cannot find a plan that covers all of your medication, consider choosing a plan that covers your most expensive drugs. It’s also important to check that your plan covers the pharmacy that you would like to get your medications from.
Depression is a serious problem that can accelerate aging and exacerbate age-related physical issues. Fortunately, seniors have several avenues for treatment. And, thanks to Medicare, you don’t have to spend a fortune to receive treatment for depression or any other mental health problems. Don’t hesitate to seek the treatment you need now.
I’m sure you’re as sad as I am, on hearing the news about Jeopardy’s Alex Trebek’s Stage IV pancreatic cancer diagnosis. Can we even imagine Jeopardy with someone else? Well, apparently, Alex can’t either because he’s vowed to “fight this” and “beat it,” and make good on the remaining three years of his contract.
But I’m sad too, at his reliance on the kind of terminology that seems to infect so much writing about serious illness. It’s a battle. No, it’s a war. You want to win it.
Here’s what comes from seeing illness through that lens: if your disease progresses, does that mean you’re not fighting hard enough? If you’re too tired or even grumpy to be positive and put your best foot forward, does that mean the disease is winning the battle? And if your family and friends are urging you on to keep fighting, does that mean you’re disappointing them and that it must be some character weakness in you, if you just don’t want to?
Illness can be unpredictable, wily and complicated. It is not necessarily amenable to your strength of will and your determination to overcome it. Instead, how about dedicating yourself to treatment, doing your best to eat, sleep and live as well as you can for as long as you can?
I would have liked to have heard that from Alex. I also think he has a great opportunity to teach his audience about the nature of serious illness, the shock to the system, the ups and downs, the complications, the satisfaction of good days. And how great would it be if he sent out another message, telling us about his advance directive, and why he made the choices he’s made?
So I wish nothing but successful treatment ahead for Alex, and at least another three years on that contract. But please, no more war metaphors!
We are now in the midst of the 2019 film awards season, after the kickoff of the always amusing and entertaining Golden Globes. It reminds me that for some time, I’ve longed (in vain) for some kind of media awards event for accurate portrayals about late life. But to whom would those awards go? Alas, few recent films and TV programs might qualify.in late life, frailty, illness, death, loss and grieving don’t translate into blockbuster ticket sales.
But in the past year I’ve found a few standouts, mostly online, that deserve recognition. So in the spirit of the season, let’s call it the “Comfy Awards,” and I’m awarding “Comfys” to:
BoJack Horseman, “Free Churros,” Season 5, Episode 6, on Netflix
I should tell you that I feel that animated films and television programs can have more artistry, humanity and complex storytelling than many conventional live-action films. I’m a huge fan of the Toy Story films, Inside Out and most recently, the brilliant Isle of Dogs, for example. I’m also a huge fan of Bob’s Burgers on TV.
But right now BoJack Horseman is probably my favorite. This Netflix series chronicles the “Hollywoo” (that’s what Hollywood is called here) life of BoJack Horseman, a self-loathing and depressed former TV sitcom star, voiced by the actor Will Arnett. The premise of this world is that a dizzying variety of anthropomorphic creatures interact easily and regularly with human beings. BoJack’s agent, for example, is a cat, Princess Caroline, voiced by Amy Sedaris. The show is by turns hilarious, bitingly satiric, poignant and occasionally moving.
“Free Churros” is a stunning example of the latter. It consists of a 20-minute monologue by BoJack, who is delivering a eulogy to his mother. It is more of a stream-of-consciousness and it artfully suggests why BoJack is as self-involved, troubled and self-destructive as he is.
This is what struck me: Loss and grief are so much more complicated for those who have had strained or stormy relationships with their parents. There’s so much unfinished business. So much anger and resentment on top of the heartache of feeling a void that will never be filled. BoJack clearly had a fraught relationship with his mother (and an even more difficult relationship with his father). This episode beautifully captures all of pain and ambivalence about losing a parent in these circumstances. And still manages to end with a very clever joke.
“What Doctors Know About CPR,” Topic (online magazine)
I think it’s hard to prepare an advance directive if you don’t know precisely what some measures – like cardiopulmonary resuscitation (CPR) – really entail. Most of us have a general idea, probably from watching heroic and often extremely successful CPR episodes on our favorite medical TV shows. And using that as our guide, we might reasonably think, why not opt for that? There are plenty of reasons why not, in fact.
But it’s one thing to be told, or to read, about the risks and dangers of CPR; it’s quite another to see a graphic representation of what the process and its more often than not ill effects are. For that, we thank Dr. Nathan Gray, a palliative care physician at Duke University School of Medicine, who wrote and illustrated a graphic piece about the realities of CPR for Topic, an online magazine.
“CPR begins when a heart stops, the last domino to fall on the cascade toward death,” Dr. Gray writes. He illustrates a Code Blue being called, the mechanics and impersonality of the process and the statistics showing how few people actually survive intact.
“Until you witness it in person it can be hard to capture the inhumanity of our medical routine,” he writes. He urges the medical community to not let technology interfere with its humanity.
The piece is essential reading, and undoubtedly I will be using it in future talks about advance care planning.
Time Goes By blog, Ronni Bennett
Ronni Bennett has been writing her blog Time Goes By all about aging, for some time. But I didn’t discover it until several months ago when Kaiser Health News wrote a story about her.
Last fall, Bennett’s doctors told her that her pancreatic cancer had metastasized to her lungs and her peritoneum (which lines the cavity of the abdomen) and that there were treatment options but no cure for her condition. Now, if I’d been given this news, my first inclination would probably have been to hide under the covers in bed. Bennett’s inclination, though, was to write about it. And to keep writing, because for her that was a way of better understanding herself. Her hope was to approach the last chapter of her life “alert, aware and lucid,” she said.
“There’s very little about dying from the point of view of someone who’s living that experience,” she told Kaiser Health News. “This is one of the very big deals of aging and, absolutely, I’ll keep writing about this as long as I want to or can.”
Reading Bennett is, in fact, like having a great talk with a good friend. She is great company, amusing, touching and honest above all. About what she calls her terrors. About the ridiculous moments (she needs a new heater and thinks, Really? Now?) and the transcendent moments (a carefully guided psilocybin trip that she says has given her a greater sense about life and death). She has a large, avid readership and her honesty has made it possible for readers to share their stories, too. She also posts “The Alex and Ronni Show” — videos of her Skyped conversations with her ex-husband.
Most recently, she wrote: “However short or long my remaining days may be, it is a great gift I have received, knowing my death is near. It led to what I think is the most important question in the circumstance: what do you want to do with the time that remains?”
That’s a question we all need to think about. So, I’m awarding a “Comfy” to Ronni Bennett for the great service she is doing for all of us.
Do you have any suggestions for “Comfy” awards? I’d love to hear about them!
Because June is LGBT Pride Month, I wanted to talk about an issue that rarely gets the attention it deserves. It certainly has not been raised in the midst of the discussion following the Supreme Court’s decision over a baker’s right not to bake a wedding cake for two men.
The fact is, when advanced illness strikes, elders who are gay, lesbian, bisexual, transgender or gender non-conforming face more challenges than their heterosexual peers. They are likely to have more complex health conditions than their heterosexual peers, made worse by postponing or not seeking care. Social isolation is a major issue as LGBT seniors are three to four times less likely to have children, twice as likely to live alone and twice as likely to be single. And they may be in poorer financial straits. Going back into the closet out of fear of neglect, disapproval or abuse, is not uncommon.
Their fears are not unfounded. In Spring 2011, six organizations who advocate for elders and for the LGBT population published a study: “LGBT Older Adults in Long-Term Care Facilities: Stories from the Field.” Among the highlights: Only 22 percent said they could feel open about their sexual orientation with staff at a nursing home, assisted living or other long-term care facility. Of those who lived in long-term facilities, or cared for those who did, the most frequently reported problem was negative treatment from other residents, followed by verbal or physical harassment by staff. Moreover, 51 percent reported staff refusing to provide basic care (such as toileting, bathing or feeding.
Some respondents shared a litany of sorrows and stories of lives derailed, couples separated by family members who had legal authority over the facility resident; feelings of loneliness and isolation because of disapproval by other residents or staff; having aides attempting to get people to “repent” for their sins; choosing to go back into the closet for fear of neglect or harm.
For those living with HIV, there are associated issues to worry about, including cardiovascular disease; cancer (non-AIDS); liver, kidney and neurological diseases; osteoporosis; and frailty. Up to 30 percent of people living with HIV have abnormal kidney function, which, untreated, can be fatal.
And if contending with serious illness is a challenge for gay and lesbian people and those living with HIV, it presents even more hurdles for transgender individuals. Owing to a combination of mistrust in the health care system and experience of rejection, discrimination or simple lack of medical knowledge by health care professionals, transgender individuals are at a higher risk for long-term diseases.
But in the midst of this sorry state of affairs, many people and organizations are working to make LGBT elders’ lives better: to make them feel more welcome in senior housing and long term care settings; to train direct health care workers to treat them more equitably; and to address their needs with expertise, kindness and compassion.
One example is Garden State Equality (GSE), a large LGBT organization in New Jersey, where Bianca Mayes, Health and Wellness Coordinator, heads the organization’s Pledge & Protect program. The program is designed to educate all health care providers, including nurse practitioners, doctors, therapists, dentists and other direct service providers, as well as staff in long-term care developments. It also urges service providers, organizations and long-term care facility owners to pledge their commitment to advancing equitable treatment.
Three levels of training are offered, and training covers four general elements: an exploration of gender identity terminology; an overview of historic and current discriminatory practices; general health care disparities and needs (lack of insurance, transportation, poverty, homelessness, lack of legal protection, lack of cultural competence); and recommendations, including ways to design intake forms to be inclusive.
Why focus on intake forms? They are a person’s introduction to a care setting and they can either make that person feel welcome, or alienate and intimidate him or her. Garden State Equality has designed a template for an inclusive intake form, which it shares with trainees. (You can contact email@example.com for a copy.) That has been particularly well-received because, as Mayes pointed out, the intake form “is their Bible.”
Mayes told me that “People want to do the right thing; they just don’t know how.” For example, most people – LGBT or heterosexual — aren’t asked about their sexuality, orientation, history or gender identity. She stressed that “if you apply these practices to everyone, it’s not uncomfortable anymore.”
Mayes started implementing the program in November 2017. It has reached more than 125 health care professionals. GSE has also sent out information to seven sites in two counties in New Jersey. This coming weekend, Garden State Equality and the Green Hill senior living development, will hold a one-day LGBT Senior Housing and Care Expo that will include speakers, panels, vendors and a networking lunch. It will be free to the public. This summer GSE plans to host 10 focus groups serving all 21 counties to help produce a statewide needs assessment.
GSE estimates that there are some 100,000 LGBT men and women over 55 living in New Jersey. Mayes’ biggest hope is that more health care providers will reaching out to the LGBT community.
“They’re not necessarily going to come to you and their needs are dire,” she said.
Happy National Healthcare Decisions Day! Actually, it’s a whole week, starting April 16. The Day was created to remind all of us of the importance of having a conversation with our family and friends about what kind of care we’d want, if we couldn’t speak for ourselves; and of having a written advance care directive and a health care proxy to speak for us.
And, in honor of the week, my book, “Last Comforts: Notes from the Forefront of Late Life Care,” is now available in all e-book venues – Kindle, Nook, iBooks, Kobo and more — for the new low, low price of $5.99!
It’s a good week to think about your bucket list, too, which I wrote about in this Sixtyandme.com post.
Personally, I’ve never been a fan of the idea of coming up with a bucket list. At heart, and I’m sure I’m not alone in this, my clear preference is to focus on the less spectacular but just as satisfying smaller pleasures of daily life. And being grateful for the sometimes unexpected joys to be found there.
The photo accompanying this post is a good example of what I mean. I’m sure that seeing the Grand Canyon is probably atop lots of bucket lists. My husband and I were fortunate enough to be able to visit the South Rim a couple of years ago and of course, it was breathtaking. But here was my favorite moment (although the photo doesn’t do it justice). We had emerged from lunch around the same time as a heavy rain had stopped and there – so close you could practically reach out and touch it – was a rainbow. An unexpected, once-in-a-lifetime vision.
But my bucket list skepticism changed before I read about research conducted by the Stanford Letter Project at the Stanford University School of Medicine. As Dr. VJ Periyakoil, founder of the Stanford Letter Project, pointed out in a compelling opinion piece in The New York Times, it’s important not only to write down several things you’d like to accomplish, experience, see or share – and update your list from time to time as your feelings change – but also to share this with your physicians.
Why? Because they need to know what’s important to you if they are going to provide the best possible care for you, the individual.
If you’re having a problem identifying three to five main goals, Stanford has come up with a handy toolkit to help you. So share the list with your doctor. If you have a chronic illness, the toolkit advises, “Ask your doctor what you need to know about your health and illnesses and if they will prevent you from reaching your goals. Especially ask them about if any treatments they are proposing will prevent you from living your life as you wish to.”
Rethinking the bucket list question, I considered another reason why sharing your list with physicians is an excellent idea. The truth is, so much of thinking about advance care planning and preparing advance care directives has to do with what we don’t want. CPR, yes or no? Feeding tubes, yes or no? Mechanical ventilation, yes or no?
The bucket list, on the other hand, is a clear roadmap for our loved ones and physicians to understand what we do want. So it can be a lovely, positive complement to the admittedly sobering and potentially unpleasant work of envisioning our end-of-life care preferences.
Here’s my early Valentine’s Day gift to you! It’s a chance to win a FREE Kindle version of my book, “Last Comforts: Notes from the Forefront of Late Life Care.”
Enter before Feb. 14 and you could be among the 20 winners of this award-winning book about educating ourselves and our loved ones about the best possible care in our later years, to avoid medical crises down the road. It’s a book with a lot of heart and a lot of practical guidance, too!
The giveaway will only last from Feb. 1 to Feb. 14, so enter now. And if you already have the book, be sure to tell your friends!
When you’re sitting and waiting in your doctor’s exam room, are you thinking of yourself as a revolutionary? Victor Montori, MD, wants you to.
Dr. Montori, physician and researcher in the science of patient-centered care at the Mayo Clinic, has spent considerable time addressing other physicians and physician groups about the failings of what he calls “industrial health care.” That it fails to notice patients – in the sense of not listening to patients, not understanding nonmedical events in our lives, not paying attention to what we value most. That it standardizes practices for patients like this, rather than caring for this patient.
But in short, he believes it is time for a patient revolution led not by physicians but by the public. Health care reform – itself no easy feat to accomplish, much less debate – is not enough, he says: “It is time for a patient revolution not only because it has patient care as its goal but also because it believes citizens — healthy people, patients who are not too sick to mobilize – must lead the way.”
If there is a manifesto for this nascent movement, it is Dr. Montori’s book Why We Revolt. The book’s essays describe what is wrong with our health care system, how it has corrupted its mission, how it has stopped caring. It does not get into the weeds of national or state public policies, or explore alternatives to the kind of financial incentives that help perpetuate our current system, but it does propose “a revolution of compassion and solidarity, of unhurried conversations and of careful and kind care.”
A few nuggets from the book:
“If completely successful, care should enable patients to be and do, minimally hindered by illness and treatment.”
“What actions to take depend on the patient situation, the options available and what patients value. For most people, the situation they face is never simply medical.”
Minimally disruptive care focuses on “advancing the human situation of each patient with the smallest possible health care footprint on their lives. It calls for patients and clinicians to shape care to respond well to each patient’s situation in a manner designed to fit easily within chaotic lives.”
“Shared decision making is an empathic conversation by which patient and clinician think, talk and feel through the situation and test evidence-based options against the patient’s situation. [It] is a human expression of care.”
“Care is a fundamentally human act, one that manifests in the dancing art of conversations…A revolution of patient care must harness the power of conversations.”
In 2016, Dr. Montori founded The Patient Revolution, a nonprofit organization whose mission is “to arm people to tell stories; stories about their lives, stories about their capabilities and limitations, and stories about what risks, benefits and trade-offs look like from their point of view. We want people to tell these stories in exam rooms and hospital rooms, in their communities and in the rooms where decisions get made.”
The Patient Revolution is a multidisciplinary team of collaborators with backgrounds in clinical practice, clinical research, design, health policy, and storytelling. The team, which has spent more than 10 years developing tools and programs to help patients and doctors communicate better, have done extensive work in shared decision making and minimally disruptive medicine.
I spoke with Maggie Breslin, director of the organization, who was also part of that team at the Mayo Clinic. She said that the Patient Revolution’s aim “is for patients, caregivers and communities to drive change. It feels like what health care is supposed to be about.”
The team’s focus right now is on reaching out to individuals at the community level. Currently they are partnering with communities in Minnesota, to co-develop issues around health care access. “It’s still early days,” she noted.
Useful Communication Tools
It’s said that political campaigns are conducted in poetry, while governance is conducted in prose. The same might be applied to the Patient Revolution. While Dr. Montori may have the soul of a poet, the organization’s website offers very practical prose guidance to help us navigate our conversations with our physicians.
For example, here are five questions they encourage you to think about, write responses to and practice how you’ll ask them:
I want to talk about…
It is important to me because…
It might help you to know…
I want this conversation to lead to…
I’m nervous this conversation will lead to…
Also useful are tools to help you frame that conversation with your doctor by talking about your life and your values. For example:
What is one nonmedical thing about your life that you think the doctor should know?
What is one thing your doctor is asking you to do for your health that is helping you feel better?
What is one thing your doctor is asking you to do for your health that feels like a burden or feels harder than it should?
Where do you find the most joy in your life?
As the late poet, feminist and civil rights activist Audre Lorde wrote, revolution is not a one-time event. But if you’re starting to feel more like a health care revolutionary now, and you want to find ways to advance the movement in your community, you can find ways to get involved at http://patientrevolution.org. You can also order Dr. Montori’s book there.