Monday, November 25, 2019

Who Owns Gratuitous Language: Democrats or Republicans?

We’ve all heard it – Trump’s language is so simple, so, so simple.  We snicker when we hear linguists say he talks like an 8 year old, - words have few syllables, and short repetitive sentences

"I’ve got the hottest brand in the world."
"I’m a very stable genius…like really smart."
"The conversation was perfect."

No guesswork in understanding these sentences.  About  5th grade level.

A fact: Trump speaks to many millions of Americans and they hear him.  They understand Trump’s language.

So. a few days ago, just when I thought I’d heard enough painfully tortured questions asked to Fiona Hill and David Holmes, I did a double take during Chairman Schiff's summing up of the day.  No simple language for this Democrat.  

Mr. Holmes, you testified just as Vindman said, Col. Vindman said that he warned Zelensky about getting involved in US politics. They don’t question that, they didn’t take issue with that. So why smear this Purple Heart recipient? Just like the smear of Ambassador Yovanovitch, it’s just gratuitous. They don’t question the facts; it’s just gratuitous. The attack on you, Mr. Holmes, that you were indiscreet in mentioning this conversation to others.
We learned that a dedicated public servant named Marie Yovanovitch, known for fighting corruption, widely respected throughout the diplomatic corps, was ruthlessly smeared by Rudy Giuliani, by the president’s own son, by their friends on Fox prime time and a whole host of other characters. Her reputation was sullied so they could get her out of the way, which they did. And you’re right, it was gratuitous. The president could’ve gotten rid of her any time he wanted, but that’s not enough for this president. No, he has to smear and destroy those that get in his way, and someone fighting corruption in Ukraine was getting in his way, so she’s gone. She’s gone.

FYI: Definition of  gratuitous:
uncalled for; lacking good reason; unwarranted.
given or done free of charge
Half the adults in the US read at 8th grade level and lower.  
“Gratuitous” is about an 11th grade level word, likely not understood by half of adults in the US. Millions of people.

Using “gratuitous” 3 times in less than 3 minutes, well….that’s gratuitous

Saturday, October 5, 2019

Confessions of a Low Health Literate Woman

This week I was reading a thread on the IHA Health Literacy Discussion List and once again,  contributors were talking about what tools they would use to assess a person's health literacy in clinical settings.  Should it be the  NVS, TOFHLA, REALM and BRIEF.  

My reaction, and thankfully some of the contributors as well, was - OH NO. Are we still there! The 1990s when we naively believed that health literacy was a competency someone had or didn't have - static.  And that these crude reading and computation tasks could point us somewhere useful. 

Careening to 2020 we should be well on our way to accepting that these early notions of what health literacy is were based solely on deficit models - what people COULDN'T DO.  Not about what real people are capable of, what they negotiate and get done in their lives.  What we call a person's health literacy is far more changeable and interesting than any computing about how many calories a serving of ice cream has. 

But I didn't want to be mean spirited and say just that.  So I pondered it and finally decided the best thing I knew to do was talk about me and my own flawed understandings of health.  Full disclosure - I'm a fairly smart lady, good credentials in the field of public understanding of health and science - but, well.... you decide if I am low health literate. 

Last June I went to a dermatologist because I had some occasional redness on one side of my face and sometimes it felt a bit numb.  Quite frankly, after all my teen years with acne, I think I should be rewarded with the clear skin my age group is entitled, sans makeup.  For some reason he skipped over possible allergies and went straight to the big stuff – auto immune disease and my “asymmetrical face”.  Didn’t use the “L” word but I could see it in his beady eyes. 

A week later, through an alert from my patient EMR, I read that “all my tests came back negative/in the normal range.” By then it was start of summer and I figured a tan would take care of that little problem. I didn’t make a follow up appointment in spite of reminders. I didn’t have Lupus and as for the facial symmetry, I just had to accept Wikipedia’s little jab - “facial symmetry has been shown to have an effect on ratings of attractiveness in human faces.”  It’s all good.

Unrelated in every way to the discovery that I had an asymmetrical face, I had a recent run-in with a change of medication dosage. Full disclosure - I’ve been bad with numbers, percentages, fractions, computation, all my life.  My parents even had to hire a math tutor so that I could pass the math section of NY State high school Regent’s exam and graduate. 

So, my doctor, not the beady eyed one, and I talked over increasing my anxiety meds just a skosh.  You know - tariffs, the stock market, impeachment talk and the clear devolution of civility abounding, it seemed good evasive action.  She explained I would add a second pill – 37.5 mg. along with the first.  That would be a total 187.5 mg.  I asked her why I couldn’t just take one bigger pill. She said that the next dose up would be 225 mg.  “Oh, I see.  Of course,” I said looking straight at her. I pondered the math all the way home but it wasn’t until I sat with pad and paper that I could figure out why I had to take two pills.

Oh, and as for medical forms - I haven’t met one that liked me.  

“Excuse me. When it says “recent surgeries” is that in the last 10 years – I am 70 and 2010 seems recent to me. “

“Excuse me. Should I check where it says “emphesyma, shortness of breath, sarcoidosis” because I really can’t breath well with this cold.

“Here in smoking history do I pick “smokeless tobacco” I use e-Cigs.

“Excuse me. When it says “I consent to pay any reasonable costs related to this procedure” how do I know what that means?  What the costs are?”

“I didn’t check off “paresthesias”  - not sure what that is.  I don’t think I have that.”

“I had some spots on my skin that the doctor took off.  Should I check where it says “history of cancer”.

--> In closing - the Big Lots near me got a shipment of Italian wafer cookies - vanilla.  The price too low to advertise here.  I bought many of the prettily wrapped packages – foil lined – so old word civilized.  The nutrition label says 4 wafers = 150 calories.  But when you break off the wafers it looks like there are two stuck together. My unfortunate dilemma – am I eating 2 wafers / 75 calories, 4 wafer/150 calories or really 8 wafers @ ________well I can’t do the math!

--> .

Monday, September 30, 2019

Kentucky Medicaid - there's no shame in calling it "work"

Federal officials have approved work requirement proposals in seven states — Arizona, Arkansas, Indiana, Kentucky, Michigan, New Hampshire and Wisconsin.

And the more I clicked on the links for the painfully disguised Medicaid work requirement in Kentucky, what they mysteriously obfuscated as the Path Community Engagement Requirement, the more I concluded that this rebranding of a work requirement has 2 big downsides:

#1 As I talked about in the previous post "community engagement" doesn't jump off the page saying "work" requirement. Writing critical health coverage information that is high barrier - hard to read and use, frustrates and demeans consumers and perpetuates the health disparities agenda. 

#2  Not using the word "WORK" diminishes the very value of the work it wants to encourage.  What's so wrong with calling taking care of a relative work!!!