Live Life Love | Volume Forty-One

Hi Everyone,

I hope this message finds you getting ready to have (or, better yet, already having) fun for the holidays with family and/or friends. After Christmas, I generally spend the week leading up to New Year’s setting up all the goals I hope to crush in the year ahead. However, after spending some time with one of the interviewees from this quarter, Morten Hansen, I think I am going to instead spend the next week figuring out what to leave behind in 2017.

My worldview boils down to the idea that every person should have opportunities to have fun and enjoy exceptional experiences. Going into 2018 I want to ensure I save enough focus and energy to really push that agenda forward—especially for those at-risk of these things being elusive. Good cheer, joy and the power of play should be accessible to all. These concepts generally foster gratitude, which we know is good for the mind and spirit. If you do not believe me, just ask the other interviewee from this quarter, Amanda Krantz.

Business, Innovation and Entrepreneurship: Morten Hansen is a world-renowned organizational consultant who is a thought leader in many areas of business. Morten wrote the book Great by Choice with Jim Collins. In my interview with Morten Hansen we discuss his latest book, Great at Work, looking at how top performers work less while achieving more.

Health and Wellness: Amanda Krantz is the CEO of DohJe, an amazing health technology company focused on eliminating the friction patients face when trying to convey gratitude to their health care providers. In my interview with Amanda Krantz we discuss the power of gratitude, as well as what DohJe is doing to improve the lives of nurses and other healthcare workers.

Life Experience: This quarter the family and I have done a pretty good job getting ourselves around North Carolina. We spent some time in Ashville (one of the top three U.S. cities for hippies according to Estately), as well as getting to ride an entire reenactment of the Polar Express (pictured) in Spencer, NC.

Polar Express | Spencer, NC

Contribution: This quarter I helped a friend and coworker with her efforts in the upcoming Cycle for Survival. Also, in the spirit of contributing to the fun and good cheer of others, I made a donation to the Toys for Tots Foundation.

Next month, I am going in for my second hip surgery—this time a full replacement. I am not completely freaked out. I have a good doctor. I also have a close friend whose business it is to sell these things (who I am grateful is trying to help me navigate through the process). That said, I imagine there will be significant cabin fever in January (during the recovery phase) and would love to hear from you if you feel so inclined.

Wishing you and yours a fun and prosperous 2018!

In health,
Dr. Rucker

Interview with Amanda Krantz about the Power of Gratitude

Generally, I do not break the fourth wall when creating these bios, but I am making the exception here because in the spirit of appreciation, I am grateful that my path crossed with Amanda Krantz. I had the pleasure of meeting Amanda at a 2013 Lean Startup Conference in San Francisco. At that point Amanda was just starting DohJe (for more on her story, see: Why I Left a Comfortable Corporate Gig to Bring More Gratitude to Healthcare), almost 5 years later DohJe is now an amazing health technology company doing incredible things. In addition to DohJe, her list of note-worthy accomplishments includes serving in the Air Force, receiving an M.B.A. from Harvard Business School, and co-founding Notify.Me.

1) DohJe (doe-jay), the name of your company, means ‘thank you’. What is the company’s origin story?

I came up with the idea DohJe because I really wanted to thank a nurse after the birth of my first child. It was a C-section and I did not find out all the things she had really done for me until after she had left her shift. She stayed after her night shift and waited because they had no post-partum rooms, so I was in an OR recovery area. She basically stood guard so that they would not try to take the baby off to the nursery— she just did because. When I went to try to track her down to thank her, there were all these various barriers to finding her.

Life gets in the way, and I never actually thanked her. Fast-forward three more years, I have my second child and this time I had another crazy situation where I had a nurse come in and went way above and beyond. This time, several months later, I thought, “I can’t let years go by and not thank her.” I ended up tracking her down, and at that point the conversation was, “I need to know how to thank you in the way that’s most meaningful to you. Please tell me what I can do.” I didn’t want to just leave cookies for the floor because she personally had done so much. I wanted her to know, and I wanted her supervisor to know.

That’s when I started learning about nurse burnout and how any form of appreciation is so helpful. Just a thank you was enough. Originally, it wasn’t going to be a business. It was just going to be an app that we were going to create for patients to thank nurses and other healthcare workers. In our first pilot, with UCSF, is when we learned that there’s been a change in healthcare where they were starting to really recognize the value of real-time peer to peer gratitude—creating cultures of gratitude and appreciation.

2) As you have developed DohJe over the years, what has surprised you and/or stuck out regarding the power of gratitude in the workplace?

First, just how powerful gratitude is, especially for a brand new nurse. We had a nurse that we had never met, send us an email thanking us for creating DohJe because she was getting ready to quit. Actually, I think she had not graduated yet. It was her nursing internship, or she was on the floor working and had really run into lateral violence and just was really disillusioned at how bad the working conditions were, and was looking at switching careers. Through DohJe she received one note from her patient, and that one thank you note was enough to remind her why she’s doing what she’s doing. Then she wrote us to tell us that she decided to stay a nurse after that one note. That was my aha moment, gratitude actually changed the course of her life.

Second, it surprised me how many people were like me that wanted to thank someone but never did. Whether it’s you don’t know what to say, or there is not an easy way to say it, you end up not doing it. But when it’s made easy, a ton more people will thank the person who helped them.  Spending so much time now seeing the effects of gratitude on the sender and the receiver, I will catch myself not expressing my gratitude and make more of an effort to actually thank someone and let their supervisor know, in everything from airlines to customer service calls. Research has now validated the two-way power of gratitude—but experiencing it myself, I have seen first hand how it affects my own well-being.

3) It is fairly well-established that burnout is a major problem in health care. Gratitude has been shown as a useful empathic tool to mitigate the effects of burnout among health care workers. However, you have uncovered that there are unique attributes about the nursing profession that make this difficult. Why are nurses a special case in this regard?

You have a very intimate experience with your nurse. Their name just isn’t front and center. With the doctor, it’s always like, “Dr. So-and-so will see you now…” and their name is all over your EMR and your paperwork. However, I’d argue you are much more intimate with your nurses. We will get inquiries from patients that say, “Hey, I’m trying to find this nurse. She’s from here. She’s got these many kids.” They’ve had all this time together. They know personal things about them, they’ve connected on a personal level, but because of the way things are currently set up may not know the name.

To have a public place that nurses can be found is becoming more critical because more and more patients are expecting to be able to find people on social media: LinkedIn, Facebook, Twitter. More nurses are now on these platforms than when we started. However, this is not the right platform for gratitude. Many nurses do not want patients to go find them and thank them in a public forum. That’s their personal space. Therefore, having a dedicated place that patients can go and find them directly is really helpful.

One final point, many hospitals think that the various existing feedback channels (e.g. patient satisfaction surveys, etc.) are enough. However, family members are sometimes also deeply affected during the process of medical treatment. None of those channels are effective for the family members to thank nurses. If you think about when someone who is in the ICU, a cardiac patient or oncology, the care that’s given to the family members— I mean some family members live in the hospital during these times of crisis. They are often very grateful for what the care of a family member—as well as for themselves—trying to get through a situation that they’ve never experienced before. They go through it with these people—none of their friends or family members outside of that have any idea, and they’re now more connected with these people than they are anyone else in their life. Those family members don’t have a way through any of the existing mechanisms to express their gratitude directly to any of the staff.

4) Like many digital health offerings, one of the obstacles you have had to face is the ability to integrate with other systems. What have been some of your other obstacles? And what does DohJe look like in 5 years when you successfully navigate around these?

This is a fascinating question because we’ve taken the approach to avoid having to integrate with anything. As we’ve been doing this now for four years, the landscape is changing. Before, there was an opportunity for innovation groups, and service excellence committees, and rogue health care departments to experiment. Now the CIOs and IT departments are demanding more integration regarding their technology partners. Before it was harder to get approval to integrate, so we chose not to. Now, it’s not uncommon for hospitals to have 200 digital health tools— and they want these things to be more integrated.

Fortunately, our system was built [in the beginning] as a web app with APIs that can plug into almost all systems. I would say over the next five years, DohJe in some form will be the front-end interface that connects with any health care system and all the pieces work together nicely. We are recognized as one of the most authentic and genuine ways to collect real gratitude, and then we plug this content into the system of record of the health care institution.

Lastly, we want to flip the ownership of this type of gratitude on its [current] head. The people that we work with, the nurses and health care workers that have a DohJe gratitude locker—this “locker” holds their thank you notes. In our experience, gratitude that’s delivered through survey systems generally relies on manual ad-hoc systems, sometimes the gratitude gets delivered but it is held hostage in the hospital’s HRIS system. It is not portable.  Giving ownership of the gratitude to those who earned it makes good business sense, too. Using DohJe has been shown to increase employee engagement and reduce sick time at hospitals like Delta County Memorial Hospital.

We say, “You have,” as a caregiver, “a digital thank you locker,” so that the gratitude is yours. You can plug the content into your employer’s HR system so that you can get recognized career-wise, but the control and ownership belongs to the caregiver. This way, when you leave, you get to take your thank you notes with you. They are not artifacts that belong with your previous employer.

5) Based on the wisdom you have earned up to this point in your journey with DohJe, what takeaway can you share that one can immediately put into practice using the gift of gratitude to improve the life of others?

I am going to improve your question… let’s answer: put into practice using the gift of gratitude to improve the life of others and their own life. When you feel grateful, express it! Take the step to let someone know. We often hear people ask, “Well, I don’t know what the perfect thing to say is?” The number one thing we have heard from those that get DohJe notes, any thank you helps. People can never hear thank you enough. Some people will write these really long heartfelt notes of gratitude, and others will just say, “Thank you for your compassion,” and both of those make a huge impact. After you express it, you feel better too, whether you can express it as a quick thank you or a long one. When you feel grateful, say it.

Interview with Morten Hansen about Being Great at Work

Morten Hansen is a world-renowned organizational consultant who is a thought leader in many areas of business, some of the most notable being collaboration and high performance. Morten wrote the book Great by Choice with Jim Collins. His new book, Great at Work, discusses ways top performers work less while achieving more. Morten holds a Ph.D. from Stanford and has held various teaching assignments at some of the world’s leading business schools including Harvard, INSEAD, and the Haas School of Business at University of California, Berkeley.

1) In conducting research for your new book Great at Work, you discovered that top performers spend their hours differently, and in somewhat counter-intuitive ways than one would expect. What is one of the traits/habits of these peak performers that surprised you?

One of the findings that surprised me the most is that top performers seemingly collaborate less than their counterparts. This is not to suggest that top performers are not great collaborators. What my research does suggest is that top performers are very deliberate about what collaborations they accept—meaning they often say ‘no’ to projects more than they say ‘yes’. However, when they do say ‘yes’ to collaborating they go all in. This allows top performs to fittingly maintain focus on a limited number of projects, mitigating any need to dilute their energy at the expense of not performing well on what really matters.

2) As workers, we seemingly spend too much time simply disseminating and regurgitating existing company information through meetings and in-person presentations. As a result, we leave little time for learning. What are steps organizations (and individuals) can take to change this?

First, we need to understand that meetings are most useful when reserved for discourse and debate. Organizations often underestimate the opportunity cost associated with meetings. If a meeting of ten employees in not effective, one might wrongfully attribute the time as an hour wasted—but the true cost is not simply the wasted hour. The time wasted is the cumulative time of every employee in the ineffective meeting [ten hours in the hypothetical example]. Even worse is the fact that the result of a non-effective meeting is generally the need for another meeting. Bad meetings have a propensity to perpetuate more meetings. There is a reason the coffee cup adorned with the words, “I Survived Another Meeting That Should Have Been an Email,” exists.

Why do we have a meeting when the objective [of the meeting] can be aptly achieved with an annotated PowerPoint presentation, saving everyone time? Yet, that is the state of most business meetings today. Even worse, now you see people having pre-meetings for meetings. There are edge cases where this might make sense. For instance, a presentation to a C-suite, a Board, and/or an investor group. That said, the trend of poorly run meetings is alarming. The best way to change this is to reduce the number of ineffective meetings your organization allows to take place.

3) You mention in your writing that one of the best ways to cope with complexity is, “fight it and simplify.” What are some strategies that one can utilize (regarding their work and/or daily routine) to evaluate what has enough merit to stay, and what can be successfully shaved away (with limited risk)?

To answer your question effectively, let me draw a distinction between complexity and someone with a massive task list. These are two different problems, with somewhat different strategies to resolve. There are various accessible tactics one can use to deal with a personal task list. Regarding complexity, complexity is generally a managerial problem—because managers tend to be great at adding complexity but can have a tougher time when it comes to simplifying processes. There are a number of reasons this is likely the case, but a couple are that: 1) complexity lends itself to vanity key performance indicators (KPIs) which are easier to massage/manipulate—or worse contrive—so that if a meaningful KPI is off a compelling story can still be told; 2) Similarly, complexity often looks like work.

For example, the communication platform Slack is growing in popularity. In certain business applications, Slack likely has its place. However, I have consulted with various companies using Slack. Invariably when I ask a CIO how they are measuring the effectiveness of tool like Slack, they say, “we are not”. They see their workers always using it, so they make the assumption that the addition of this new tool has benefit. People are busier, yes, but what should be measured is how the tool has increased or decreased performance and that is not taking place. When you add or make a change to a system, it is important to accurately measure the effect on the KPIs that matter. Unfortunately, all too often this does not take place.

To fight complexity, you need to look at the established system and/or processes to see what can be eliminated without an effect on achieving your primary objective(s). Evaluate what steps and resources are not essential. Ask yourself, “are the KPIs currently in place good measures for what the system is trying to achieve? Or, do the existing KPIs pull focus away from what is truly desired? What can be simplified without affecting the end result?” Answering these questions honestly, and making corrections and improvements will improve focus, as well as free up resources, to move the most important objectives forward with more force and better performance.

4) You advocate that people only try to improve one skill at a time? What is the rationale here? And, how can one determine the threshold of mastery to know that they can effectively begin to work on additional skills?

From the various academic work on deliberate practice, we know that most people get better at something when they focus their learning on a specific task. It is difficult for us to get good at something if we are diluting our attention on several things at once. While teaching at the Harvard Business School I had to acquire skills in case method [teaching methodology] to effectively lead the classroom. When I first began teaching at Harvard I found it somewhat challenging because there are at least five things you need to be really good at to master this teaching method. Trying to master all these skills at once meant I was not effectively focusing on any of them [and it wasn’t effective]. Instead, I focused on what I believed was the most important aspect until I felt ready to focus on the next.

I am not aware of an evidence-based threshold of mastery that one can use as a measuring stick to move on to another skill. Six weeks might be a good place to start, anecdotally, at the discretion of the individual. If someone can effectively learn a new skill every 6 weeks, that would equate to 8 new skills in a year, which represent significant personal growth. The takeaway is that there is evidence to suggest that working on 8 skills at 6-week intervals is likely more effective than trying to learn 8 things all at once over the course of a year.

5) There are times when advice about “working smarter” is viewed critically. For instance, when Tim Ferriss popularized the concept of batching email communication (to increase efficiency) many knowledge workers scoffed at the notion that the advice was practical in the real world. What is a piece of advice you can give about working smarter that anyone can put into practice regarding, “work less and achieve more”?

For those that work for someone else, it is learning to feel comfortable saying “no” to your boss. This, of course, is a skill that will be refined differently somewhat and is dependent on each person’s particular situation [and their relationship with their boss], but this is something many people do not do well—if at all. However, when you develop this skill it gives you back more energy and focus, which you can apply to achieving more based on all the principles we have been discussing (and I further outline in Great at Work).

Successfully applying this advice will require trust and communication with your boss, something you will need to develop if it is not inherent. While at Boston Consulting one of my colleagues successfully achieved this by simply sending out a weekly recap email to those he directly reported. Before I was aware of this practice, myself and others in the firm were always amazed at this person’s capacity to achieve while the rest of us at times felt overwhelmed. Come to find out it was his ability to communicate and negotiate his priorities that set him apart from others.

The Science of FOMO and YOLO

I recently went to the French Laundry to celebrate my parents’ 50th wedding anniversary. Those that are connoisseurs of gastronomy are aware that the French Laundry is one of the most exciting culinary experience one can have. Nonetheless, I watched in amazement as many of the tables around me spent a majority of their time one their smartphones.

Before I throw stones at a glass house, let me admit I am one of those people who is persistently switching between my different social media accounts to get that thrill of superficial acknowledgment, or reciprocating in kind by admiring the adventures of my friends through the use of my thumbs.

The Science of FOMO and YOLO

But what happens when never missing an act on the theater of life becomes more important than life itself? A subtle reminder of this happens on any busy metropolitan street, as one can observe the masses walking seemingly aimless of their immediate presence, digitally immersed in the details of someone else’s life. In fact, considering almost everybody uses their smartphone while driving, almost all the time, it would seem many of us are less anxious about dying than missing out on someone else living.

Fear of missing out, or FOMO for short, refers to the persistent worry that others are having rewarding experiences for which we are not included. The origin of the acronym is credited to Patrick McGinnis who used it in his Harbus article Social Theory at HBS: McGinnis’ Two FOs. In our world of constant accessibility of information — through social media and other channels — we are seemingly bombarded with prospection that others are having more fun than we are. The reality, however, is that there are practical restrictions preventing any of us from doing it all. To think otherwise is folly.

Despite this reality, we still want to fool ourselves into believing we live in a world of infinitely obtainable options. If only you are let in on “the secret” the world is full of abundance for the taking. We are hijacking the beauty of situational intimacy for the cheap thrill of vicarious displacement. The desire to be continuously connected with others and see what they are doing is a feature of FOMO. A report by J. Walter Thompson (JWT) showed that Millennials are the most affected by this phenomenon (JWT, 2011). However, Generation Y is feared to be affected at increasing rates, too. With the help of social media, FOMO is pervasive and has the ability to negatively impact us all.

So why does FOMO exist and is there any way for those that suffer from it, to mitigate its effects?

Satisfying Our Desires

The motivation for many behaviors can be explored by tracing them back to our innate needs. Experts suggest that the link between FOMO and psychological needs is quite direct. Experimental psychologist Dr. Andrew Przybylski of the University of Essex in the UK argues that when our basic needs are not satisfied, we are more likely to gravitate towards social media. Digital engagement brings superficial satisfaction regarding some of these needs. For instance, through social media we can feel more in touch and connected with others, as such our subjective social competence increases, and we get more opportunities for perceived action (Przybylski et al., 2013).

However, science is exposing several negative aspects of continuous online engagement. For example, some people engage with social sites to avoid negative emotions and get away from the dissatisfactions of everyday relationships (Ellison, Steinfield, & Lampe, 2007). When this is true, the state of FOMO can act as a habit loop accelerant between the individual’s need to mitigate negative emotional states and excessive social media engagement (Riordan et al., 2015). A study by Przybylski and his colleagues showed that people who are low on autonomy, competence and relatedness (the three basic needs according to the self-determination theory) tend to report higher levels of FOMO (Przybylski et al., 2013).

One hypothesis is those suffering from FOMO might be desperately trying to restore their inner psychological balance. However, any perception of balance is generally short-lived and instead a vicious cycle of comparison and loss of authenticity begins to take hold. Other needs that people, particularly adolescents, might be trying to gratify when excessively relying on social networking sites include the need for popularity and a sense of belonging, A study published last year in the journal Computers in Human Behavior supported this assertion. Their findings suggest adolescents with a stronger need for popularity and affiliation exhibited a higher sense of FOMO and fueled it by using Facebook more intensely (Beyens, Frison, & Eggermont, 2016).

The Dangers of FOMO

Psychologists have anecdotally suggested for some time that those that significantly suffer from FOMO degrade their well-being and happiness over time, and now there is hard science to support this assertion. In one of their studies, Przybylski and his team showed that FOMO is linked to lower mood and life satisfaction (Przybylski et al., 2013).  People who have been overly enchanted by social media are often suffering from a feeling that they have not made good choices. FOMO can hit you from two sides in this regard. On one side, an internal yearning to be connected and elevate your life to that of others on your feed; on the other, indignation and/or envy about the things you might be missing out on and/or that others seem to have. These emotions left unchecked can spiral.

Moreover, a recent study from the University of Otago in New Zealand showed that in college students, FOMO is a factor that can drive this group to riskier behaviors, including alcohol (ab)use. For instance, compared to students who do not worry about “missing out”, those who do are significantly more likely to engage in impulsive acts while drinking that they later regret (Riordan et al., 2015). However, to perhaps justify FOMO another expression has surfaced to justify the negative effects of FOMO. YOLO or ‘you only live once’ is often used to explain the wild things that go on in our lives that when examined ex post facto look like poor decisions.

YOLO — Friend or Foe?

Research shows that FOMO is somewhat linked to a desire for more social engagement and the pursuit of activities that satisfy innate needs. The approach taken by many affected by FOMO is based on an inherent need for extrinsic rewards, where gratification is sought somewhere from the outside oneself (e.g. confirmation by others), while neglecting methods for more sustainable intrinsic motivators. To solve some of the mysteries of FOMO, we might need to look where one can gain positive social experiences, finding happiness from within (instead of experientially).

While YOLO could be frowned upon by those who consider themselves ‘mature and responsible’, the concept does have potential psychological merit. It feels somewhat rebellious. It also emphasizes living in the Present and doing your best to have fun with what life presents you. YOLO brings that allure of authenticity back and challenges you to be you — regardless of the consequences. Often YOLO experiences encourage one to wander from the safety and try something novel. If the YOLO experience is not coerced, the locus of control is moved internally. Moreover, if a YOLO attitude is paired with a dose of prudence it can be expansive, beginning with replacing mindless activity on Facebook and Twitter and for those lucky enough leading to peak experiences.

When we try something new, the almost universal fear of failing is there looming.  Studies show that we are likely more anxious about an unknown outcome than we are about a negative one that is known to us (Arntz & Hopmans, 1998). Yet, when we can get the courage to face the unknown, there is an opportunity for personal growth. An experiment by Arnoud Arntz and Miranda Hopmans of the University of Maastricht, Netherlands, showed that the pain of a new experience (even if it is uncomfortable) is likely to bring us less subjective pain than that of a known negative experience.

To get out of the grips of FOMO completely, we may need to upgrade YOLO and take our adventures to another level. YOLO is a lot about the pleasures of the moment. But science (ever since Aristotle) shows us that to get a sense of genuine purpose and meaning, we need to nurture personal development and feel as though we are living our fullest potential (Huta & Waterman, 2014). YOLO is not just about hedonism, it is great when we can find positive (offline) experiences, but it can be even more positive if these new experiences are seen as worthwhile. New experiences are the best when we feel that we are learning, developing and/or growing.

YOLO Might Be Good for the Soul and Mind

Research from Massachusetts General Hospital and Harvard Medical School shows that unique experiences have the power to activate a part of our brain called the amygdala, which is the part of our brain that helps us with learning (Weierich et al., 2010). When we completely immerse ourselves in something new, other parts of our brain can momentarily become inactive. When this happens the novelty of the experience can complete absorb us and silence our inner critic and the quiet mental space of contentment found in these moments is great way to combat the noisy world of FOMO.

Sources & further reading:

Arntz, A., & Hopmans, M. (1998). Underpredicted pain disrupts more than correctly predicted pain, but does not hurt more. Behaviour Research And Therapy, 36(12), 1121-1129. doi:10.1016/S0005-7967(98)00085-0

Beyens, I., Frison, E.  & Eggermont, S. (2016). “I don’t want to miss a thing”: Adolescents’ fear of missing out and its relationship to adolescents’ social needs, Facebook use, and Facebook related stress. Computers in Human Behavior, 641-8. doi:10.1016/j.chb.2016.05.083

Ellison, N., Steinfield, C., & Lampe, C. (2007). The benefits of Facebook “friends”: Social capital and college students’ use of online social network sites. Journal of Computer-Mediated Communication, 12(4),1143-1168.

Huta, V., & Waterman, A. (2014). Eudaimonia and Its Distinction from Hedonia: Developing a Classification and Terminology for Understanding Conceptual and Operational Definitions. Journal of Happiness Studies, 15(6), 1425-1456.

JWT (2011). Fear of missing out (FOMO). Retrieved from

Przybylski, A. K., Murayama, K., DeHaan, C. R., & Gladwell, V. (2013). Motivational, emotional, and behavioral correlates of fear of missing out. Computers in Human Behavior, 291841-1848. doi:10.1016/j.chb.2013.02.014

Riordan, B. C., Flett, J. A. M., Hunter, J. A., Scarf, D. and Conner, T. S. (2015). Fear of missing Out (FoMO): the relationship between FoMO, alcohol use, and alcohol-related consequences in college students. Annals of Neuroscience and Psychology, 2:7.

Weierich, M. R., Wright, C. I., Negreira, A., Dickerson, B. C., & Barrett, L. F. (2010). Novelty as a Dimension in the Affective Brain. NeuroImage, 49(3), 2871.

Live Life Love | Volume Forty

Hi Everyone,

This 40th edition of the newsletter marks a decade of the Live Life Love Project. I reflect back on the last ten years with an immense amount of gratitude. Along the way, more than 80 people have shared their wisdom with us. Personally, since I make my intentions so public, I have benefited from learning, sharing and introductions from many of you. I attempt to reciprocate by contributing to a various array of your worthy endeavors each quarter, but I acknowledge — given all that I have received — the deficit lies with me. As such, I am upping my contribution game moving forward.

In 2011, in volume 14 (“It’s not all good…”), arguably one of the most noteworthy editions of this newsletter (the provocative subject line got the most opens to date, but also the most unsubscribes), I mentioned that although I was using Rudyard Kipling’s “If” as a guidepost, I was on the hunt for something new. A suitable replacement finally found me this quarter (just in time to move into another decade of adventures) via the poem “The Dash” by Linda Ellis.

If you have not heard it before, it is worth a listen and/or read. Its essence is such that not much more needs to be said by me this quarter. I hope you enjoy the poem as much as I do.

I have got some great interviewees this quarter to mark this 10-year milestone, both are remarkable leaders in the field of health technology. I hope you enjoy these, too.

Business, Innovation and Entrepreneurship: It was my honor this quarter to sit down with Steve Groves, CIO of GoodLife. He is a remarkable individual that I feel privileged to call a colleague. Steve was recently recognized by Forbes as one of the Top 20 Social CIOs. My interview with Steve Groves about fitness technology can be found here.

Health and Wellness: This quarter’s health and wellness interview is with one of the co-founders of the Health 2.0 movement, Matthew Holt. Along with Health 2.0, Matt also founded The Health Care Blog, which the Wall Street Journal called the leading insider voice in the field [of health care]. My interview with Matt Holt about Health 2.0 can be found here.

Life Experience: Lot of great experiences this past three months. For anyone that might be keeping score, moving to North Carolina this quarter has been an adjustment, but we are steadily finding our fun. This quarter I also got to attend my first World Domination Summit (top), take my parents to The French Laundry (middle) and bowl in the private bowling alley underneath the White House (bottom) at the Harry S. Truman Bowling Alley.

Various adventures, Q3 2017

Contribution: This quarter I doubled down on my efforts to support Chris Tsakalakis and all he does for the American Heart Association. I gave money to those affected by climate change by donating to a Texas Hurricane Relief fund. I contributed to my friend’s effort to honor her mother while taking part in the Canary Challenge (our discussion of loss is what led to “The Dash” being shared with me). Lastly, I gifted musical equipment to the Community Music Center of San Francisco.

Last quarter, I committed to making this project more about the wonder of fun, and I plan to uphold that pledge moving forward. In the past edition of the newsletter I discussed above (volume 14), I made some of my intentions public and was pleasantly surprised by the rewards of that exercise. I would like to see if this type of success is repeatable. So here it goes: it is my intention to have a bestselling book and a Chief Experience Officer role by the fifteenth anniversary of this project.

That’s the plan for my dash; if you have the time to leave a message in the comments, I would love to hear an update on how you plan to live your dash.

In health,
Dr. Rucker

P.S. In August, I got my first solo cover. For those who are interested in fitness technology, you might enjoy the read.

Interview with Matt Holt about Health 2.0

Matthew Holt is the eccentric Co-Chairman of the Health 2.0 Conference.  Before helping launch the Health 2.0 movement, Matt was a survey researcher at Harris Interactive, as well as being involved with the Institute for the Future.  In 2003, he started The Health Care Blog, one of the first blogs of its kind to specifically address the trials and tribulations of health care. Matt has an undergraduate degree from the University of Cambridge and a Master of Science degree in Health Services Research from Stanford University.

1) Often great innovation is figuring out what will not change over time (in contrast to being “disruptive”). In that spirit, what are three commonalities of companies/innovators that you have seen have successful longevity in the health technology space?

One, companies that have developed for the inpatient side of the hospital and grow from there. Put more broadly, you need to get embedded properly in an organization, which does not change dramatically over time and is willing to adopt you. The two obvious examples are Neil Patterson with Cerner and Judy Faulkner with Epic. The industry on this side of things does not move that fast, so if you are lucky enough to get your foot in the door, your company is inherently going to have longevity. Getting the timing right is very important as well.

Two, the need for care is not going away, so companies that make care more accessible. I believe telehealth will have longevity for this reason. Teladoc has been around 15 years, MDLive has been around at least a decade. These companies have longevity because they have an expansive model, which works for health plans, pharmacy chains, providers as well as direct-to-consumer. Provide a solution to a long-standing problem, and you should do relatively well.

Three, companies that build broad-based platforms. Additionally, you need to figure out your user interface and experience so it is good enough that a lot of people adopt it. Companies that build quality technology to track activity, diet and other lifestyle choices [like the companies Under Armour scooped up in this space] are good examples.

2) Insurers are starting to fund the tracking of consumer consumption of healthy activities that support personal well-being (e.g. United/Fitbit, Aetna/Apple, etc). How do you see this flow of capital effecting consumer health technology in the foreseeable future?

The good and bad reality of this situation is that as a consumer product good, health wearables are getting so cheap they are becoming ubiquitous; however, they are also getting commoditized. The commitment is low — similar to a gym membership — and like a gym membership, you see a lot of drop off after the initial purchase.

Insurers are getting involved because the costs of entry are lower and they are looking for any way to motivate us — if even by a nudge — toward healthier behaviors. There is discourse in the wellness space if this stuff actually makes a difference. That said, this trend is a win for most in the chain. Manufacturers sell more devices, payers are not investing much and get to see if this moves the needle, employers get to say they are doing something, and employees get these devices for next to nothing. In short, I agree it’s a trend. I think that we’ll see more of this kind of stuff as we try to figure it out whether there are real rewards to tracking behavior beyond professional athletes and peak performers and condition-specific wearables, where I believe there is enough evidence to make the assertion that wearables add a lot of value.

3) Currently, there are unprecedented health technology advancements (e.g. CRISPR) that have the potential to significantly accelerate human evolution. In this context, how do you believe health technology will redefine what it means to be human over the next generation?

This is a question better suited for Daniel Kraft, but I’ll give it a try. I always used to joke that I thought that the future of health care was when most people could email their doctor, which many of us still cannot do effectively yet we want to move on to cure Cancer and using Big Data.

Let’s start that we know that if we exercise and eat better, that’s half the battle. I have little doubt that eventually technology is going to make that easier, better, faster and make it more effortless. In that sense, the construct of willpower might change.

It is important to consider how this technology is affecting our environments, too. It is changing how we think about providing service to people. Something as simple as improving food portability could help change our eating habits for the better. Maybe CRISPR can change your genetics so that sugar tastes bad. Who knows?

The next generation will see us aiming at improving the impact and efficacy of drugs on diseases by manipulating the drugs and/or the genome to improve outcomes. At some point we might start designing humans to avoid disease all together and to live longer, but that will be a while. For those interested in that, I recommend checking out Aubrey de Grey’s stuff. He outlines eight things we need to fix to make this happen. It is worth watching if this topic interests you.

4) There have been a lot of digital health products that purport they can change user behavior. However, history suggests that many of these products and services have overpromised and under-delivered on their claims. What is a good example of a company getting it right in the “behavior change” genre, and what can we learn from them?

Companies that are doing this well have pervasive mechanisms for compliance. Medisafe is one that I like in this area. Good companies look at deliberately getting you from X to Y. However, some areas are hard. For instance, nutrition is particularly hard, and even with great technology, the truth is people just do not keep up with that type of change because technology has not solved the problem that some behavior change is hard.

That said, technology around cognitive behavior therapy treatments — treating things like anxiety, depression, PTSD and insomnia — seem to be making headway. A British company called Big Health has come out with a program called Sleepio that is really interesting.

Canary Health is also another interesting example. They have created technology to bring Kate Lorig’s work on self-management to a broader audience, and that has helped people with diabetes change their lives for the better — so there are examples of success in this space.

5) What is the last thing you remember regarding Health 2.0 that made you sincerely say to yourself, “this changes everything” and why?

Okay, I am going to steal my answer here from Indu Subaiya. It is the advancements in Google Home and Amazon’s Alexa in combination with FHIR. This is really exciting her.

If you split up the various layers of interoperability — and say maybe voice is the first layer — FHIR can then get into the data and stick it in to any functional layer you want. In fact, FHIR (if it works), may actually change how we deliver care and how patients experience care.

That’s the big picture excitement. Small picture, there’s a real cool company called Medal we had on last year, which figured out how you get data out of a EMR by basically printing it using the print driver from a standard computer. Super clever idea, totally bypassing the need for APIs. One more, which was shown this year, is a company called Suggestic. They have got this super cool augmented reality, where you hold your phone up over a menu and it makes you aware of the things you can and cannot have based on your dietary restrictions.


Interview with Steve Groves about Fitness Technology

Steven Groves is the CIO of GoodLife Fitness, the largest fitness provider in Canada (and the fifth-largest fitness provider in the world). In addition to this role, Steve also spent more than 11 years on the Board of Directors of London Bridge Child Care Services, recognized throughout North America as a leader in the area of non-profit early childhood education. He was recently recognized by Forbes as one of the Top 20 Social CIOs.

1) If you had a magic wand and could improve a way technology is being misused in health clubs today, what would it be and why?

I think at this point, my perception is that we are not focused enough on a holistic view of the member beyond the four walls of our own clubs. I do not think we are necessarily misusing technology. Rather, the focus has been too much on technology that can be used exclusively to advance our clubs’ agenda, which is different than looking at technology for the betterment of our members — whether or not they choose to do some of their activities inside of our clubs or outside of our clubs.

When some of the first wearables came into our industry, things like the bodybugg — back whenever that was — bodybugg was intend to be worn predominantly outside of the club. Ironically, many probably took it off to work out because it was clunky. It seems to me as though — we as an industry —are not really focused enough on the overall outcomes that our members are looking for. We could be better at helping them with the selection of the right technology to get the results they’re paying us for. The truth is this technology is not necessarily going to be specifically aligned with improving what is happening within the four walls of our club.

2) There is a growing acknowledgement in our industry that we need to be better at catering to a wider spectrum of consumer types, e.g. age groups, aspiration types, gender differences, etc. This is in contrast to prescribing a “one size fits all”offering. How have you seen technology most amply and effectively applied to help support this effort?

One example is ResMed. They are a medical company. My understanding is they are one of the largest manufacturers of CPAP devices. They have also created bedside devices. Being the experts in sleep, they have created this bedside device that uses sonar-style technology, and the device passively monitors your sleep activity. Previous versions of sleep monitoring devices were either uncomfortable or [the new ones] do not work that well. So what ResMed did is devised this device that sits there and it monitors your sleep: it monitors your breathing, it monitors the temperature of the room, it monitors sound levels in the room … it can basically see your body in the dark. The signal from the device is bouncing off the water in your body and can pass through everything else, so it can actually see right through your blankets, any material you might have on top of you. I could not believe how accurate this thing is … from your phone you get this wave pattern that is reflective of exactly your breathing pattern.

So ResMed, having such a massive data set that they have collected about how people sleep, by their claim, can accurately predict when you’re in light sleep, when you’re in deep sleep, when you’re in REM sleep, when you’re actually awake. And then the device picks up on a whole bunch of other pieces of information around the environment that you are sleeping in. So there’s the noise level, and room temperature, and maybe one or two more data points. From a personalization standpoint, coming back to your question, what I found was most interesting is that after it learned about your sleep patterns for a week, it starts to get prescriptive. It asks you an eight-question survey each day. How much caffeine did you have today? How much alcohol did you have today? Etc. Then it starts to prescribe ways to improve.For instance, it started creating for me — clearly, very unique to my own personal situation — it was the first true prescription that I have seen that was catering to my own personal unique needs. This is circumventing the spectrum all together; this is catered to the individual.

3) What can United States club operators learn from our Neighbors to the North? Where are areas of difference that Canadian clubs get right and the United Statesmaybe could do better?

It may be a naïve perspective, because honestly I do not spend a lot of time within U.S. club operations, but my sense is that U.S. operators have the luxury of having so many other competitors and peers within the country — in other words, the sheer number of clubs is massive — that I don’t think U.S. operators necessarily feel the need to look outside of the Americas, or let’s say North America even, for ideas and new ways of doing things. I get a sense that your market is very insulated in that way.

Whereas in Canada, we are small — especially here at GoodLife — we do not really have any peers in the country. The second-largest club chain in the country is also ours, Fit4Less. What we do, and I think we do quite well, is work with a lot of club operators globally. We have really benefited from some of the learnings that we have gathered from people in Europe and Asia — in particular Australia.

This may be an unfair assessment — a naïve assessment. However, I get the sense the U.S. market is a bit of an echo chamber.There is a lot that we can learn from other operators from the East, and from others in the West. I get the sense in the United States there is a feeling that you do not need to necessarily go outside your country’s boundaries for ideas. If true, that is limiting.

4) Discourse about data “interoperability”in the health club industry has almost boiled over, and the concept of data interoperability means different things to different operators and CIOs. What does it mean to you and why (or why not) is interoperability in our industry important?

I want to deal with technology I can plugin to a system and have it functionally do what I want. I like the software IFTTT. I think in the case of IFTTT, they call this type of flow “channels.” I want to be able to take hardware and software — ranging for IoT and SaaS platforms — and feel confident anything that will be useful to the clubs and/or our members can be channeled, plugging into a workflow management system I control.

I want the same easeI use IFTTT to get my Nest thermostat to report that my living room is over 80 degrees through a text message sent to my mobile phone — I want this ease of integration with the technology I use to run our clubs.

So when people say to me, “What does interoperabilitymean to you?” I use that as an example just to get them thinking about it. If a new member rides a piece of Life Fitness cardio equipment — they jump on one of our bikes — and it is the first time that they’ve been on that bike, and they’ve tapped their RFID to acknowledge they’re on the bike (so we know it’s them) I want to be able to have that trigger fire an event somewhere. For example, the trigger goes to a CRM platform that fires off a quick email giving them tips on that particular piece of equipment, and how they should be using it properly and safely … a simple recipe to enhance the member experience.

If I can start to get you to understand IFTTT, then I can start talking to you about and Enterprise Services Bus, and the integration of APIs, and having an open API architecture. So many of the APIs in our industry do not expose even 30 percent of the features and functionality of the actual UX of the system. This is frustrating, because I do not always want to have to use the UX of the platform that we purchase, and in many cases we as technology experts arrogantly think we can do better, and so we really want to write something ourselves. The current state of affairs is limiting. We end up having to write our own APIs in a lot of cases, just to create an abstraction layer. Salesforce and Amazon Web Services built their products with an API integration strategy top of mind, then theyadded the UX/UI layer. The fact that much of the technology in our industry was built the opposite way just shows a level of immaturity that our industry still has.

5) In your opinion, what is your favorite underappreciated and/or unknown health club technological addition? An uncommon product or service that almost always results in a significant return on investment for the club that adopts it.

ShapeLog is intriguing for me in this regard. I found out about ShapeLog through the Fitness Industry Technology Council podcast that Josh Trent does. I had never heard of it before, and quite frankly I have not heard of anybody else talk about it since. It is a fairly simple technology in that it is a device that you mount on the cable of selector equipment — the pulley equipment that we all have in our clubs — and what it does is it is able to measure the tension that’s being applied to the cable as the weight is being lifted off by the user.

It’s able to measure the tension, and from that it is able to calculate how much weight you’re lifting. Which in and of itself is kind of cool, then wirelessly they can send that information, so that it displays on your device. They are effectively able to record your workout. The part that really intrigued me was the fact that how you and I lift weight is unique to each of us, and apparently is almost as unique as our own fingerprints. What this product is doing is capturing 100 pieces of data per second — I believe that is the number they had given us in the demo — through native accelerometers and tension monitoring. The device creates a unique pattern of my lifting and lowering of the weight and stores this information in its database. Now, the next time I sit down and I do my next set of reps, it knows that that was me, and so it is actually able to track my workouts without me having to go up and log in, or tap an RFID chip onto the equipment. It eliminates a set in the identification process, making the ability to track less invasive and more passive.

How Great User Experience (UX) Might Be Killing You

If you read my newsletter, you are aware that the past two years have been a bit challenging for me in some respects. I have gone from being an avid long distance runner to now walking with a limp. My care up until recently was with one of the biggest integrated managed care consortiums in the United States. Unfortunately, in my case, working with them has been a disaster, and I am now shopping for a better way to treat my condition. However, that is not what this post is about. I am sharing it because my personal trials and tribulations treating a painful hip created the impetus for exploring a direr situation — a situation on which I believe my eclectic professional experience with UX and healthcare gives me a unique point of view.

How Great UX Might Be Killing You

There are pros and cons, strengthens and weak points, within any complex system — the healthcare system is no exception. When weak points are not looked at critically, that is when we can run into serious problems.

A National Emergency

In 2013, a group of scientists from the Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Stanford University and Mayo Foundation for Medical Education and Research provided hard evidence that something was not right with the opioid prescription rates in the United States. When they analyzed the prescription rates of opioid and non-opioid therapy for non-cancer pain in the period between 2000 and 2010, their data revealed some interesting trends. Although patients’ reports of pain remained unchanged in this period (pain was the main cause for one fifth of all visits to a doctor), opioid use nearly doubled (it went from 11.3 percent to 19.6 percent). Just as intriguing was their finding that the use of non-opioid pharmaceuticals did not follow the same trend. Only opioids were on the rise. Researchers struggled to find any association with patient, physician or practice characteristics that could explain the increase (Daubresse et al., 2013).

Leonard Paulozzi and his colleagues from the Centers for Disease Control and Prevention (CDC) cite even gloomier figures. They report that the sale of prescription opioid drugs keeps increasing; in fact, they quadrupled in the period between 1999 and 2010. In 2010, enough opioids were prescribed to medicate every adult American for a month (Paulozzi, Jones, Mack, & Rudd, 2011). To the best of my knowledge, this data has not improved in the past couple of years. The issue became so widely recognized that in 2014, a White House Summit was held to address the impact of opioids on American society (Clarke, Skoufalos, & Scranton, 2016), and just a couple weeks ago President Trump acknowledged that the opioid crisis is a national emergency.

Furthermore, the opioid epidemic has led to a significant increase in addictions, drug overdoses and deaths among Americans. To put this in perspective, the number of deaths from drug overdoses is now approaching the number of road deaths per annum. More people are dying of opioid poisoning than “street drugs,” drugs like cocaine and heroin (Paulozzi, Budnitz,& Xi, 2006). Many health experts are warning that this epidemic is worsening. The current state of affairs is having a grave impact on public health and safety, not to mention the financial burden it is putting on health insurance (estimated at $72.5 billion per year as reported by the National Drug Intelligence Centre).

Many health professionals offer strategies on how to better manage pain and minimize the risks of opioid overuse and misuse. However, we should not forget the fact that the number of patients experiencing pain has remained about the same over the past decade. Nonetheless, opioid prescriptions have been increasing. Why is that?

Hard Pill to Swallow: Is Patient-centered Design Part of the Problem?

I have built a reputation for my expertise on user experience and healthcare. A significant portion of my working hours is spent innovating ways to improve the satisfaction, engagement and fun end users have with digital health products and various fitness consumption modalities. While getting my Ph.D., I also did a lot of practicum work assisting physicians with employee burnout protocols (through an affiliation with a hospital group in the Bay Area; important to note, it is not the same group mentioned at the beginning of this post). During my work as a doctoral candidate on physician burnout, after malpractice lawsuits, the number one thing I heard that contributed to physician burnout was the cognitive burden a company called Press Ganey put on this particular physician group. If you are not familiar with Press Ganey, they are one of largest companies in the “patient satisfaction” business and their purported “mission” is to “support health care providers in understanding and improving the entire patient experience.” Simply put, they collect patient feedback data on doctors, and many times these assessments are tied to a physician’s livelihood.

More and more doctors and health experts have been recognizing that the increase in opioid use is correlating with the increasing emphasis on patient satisfaction. This might seem paradoxical at first (it did to me; after all, design thinking and great UX is about empathy and making the end user happy, right?), but it actually makes a lot of sense once you look at the facts at a macro level. Jenice Clark and Alexis Skoufalos of Thomas Jefferson University, Philadephia, and Dr. Richard Scranton of Pacira Pharmaceuticals conclude their article on the opioid epidemic in America with an insightful opinion from an expert panel:

It takes mere seconds for a primary care physician to write a prescription for an opiate; it takes 30 minutes to explain why he/she is unwilling to do so. (Clark, Skoufalos, & Scranton, 2016, p. S-7)

After digging further, I found patient satisfaction data now also gets reported via the HCAHPS survey. This is becoming a widely used healthcare quality metric. In fact, it is becoming the national standard for collecting the “patient experience” — so much so, scores from these surveys are starting to be incorporated into calculating reimbursements. In other words, in these cases, happy, drugged up patients indirectly mean more resources for a physician’s practice. Although patient satisfaction is a very subjective metric, it is used quantitatively to evaluate and compare physicians and determine financial compensation, job retention and promotions.

Are There Cases Where Grading UX Should Not Be Measured by the User?

Some experts warn that the “positive patient experience” is not necessarily linked to better health outcomes either. For example, in an article titled The Cost of Satisfaction, Joshua Fenton of University of California, Davis and his colleagues found that patient satisfaction was linked to:

  • higher admission rates,
  • greater overall expenditure,
  • higher prescription drug use and
  • increased mortality rates (Fenton, Jerant, Bertakis, & Franks, 2012).

Their nationally representative sample showed that satisfied patients did not necessarily fare better when compared to those that left their doctor’s office less satisfied. The rub: they are actually more likely to die!

Furthermore, studies show that patients often ask for services that are not clinically indicated. For instance, Kravitz et al. (2005) found that patients’ requests have a big effect on physicians prescribing antidepressants. Also, physicians whose patient rating affects their livelihood are more likely to budge and agree to patient requests (Pham et al., 2009). Patients expect their demands to be met. If unsatisfied, patients often now have a direct lever to affect a physician’s livelihood.

I Would Like the Credit, but I am Not the First to Stumble Upon This

Aleksandra Zgierska, Michael Miller and David Rabago of the University of Wisconsin-Madison, Madison (2012) believe that patient satisfaction surveys are generally a helpful initiative and can be a driver of positive change. However, they can also contribute to the prescription of addictive medications such as opioids.

When looking at these “patient satisfaction” instruments critically, you will often find the first question on the survey is an enquiry if you were satisfied with the way your doctor treated your pain. Since modern day primary care physicians experience time pressures, time-consuming discussions on alternatives to opioids are not necessarily promoted (for more on the burdens of modern healthcare, see my interview with Matthew Heineman about healthcare in America). When faced with high patient volumes and demands for interventions, it can be easier for doctors to simply write a prescription. In this way, the patient often leaves the (brief) office visit initially happy.

After working with burnt out physicians for several years now, I have an immense amount of empathy for this employee group. As such, it is very important to note that the harm here is not just to patients. As Zgierska, Miller and Rabago warn, these practices also can leave clinicians in emotional and moral distress. In fact, it is likely that the opioid epidemic is a silent yet significant factor in the explosion of cases of physician burnout. When you peel it back, it really is becoming a no-win situation for everyone.

When Great UX Gets in the Way of Great Outcomes

In my case, I likely need a hip replacement, but the integrated managed care consortium I was a part of does not like to perform replacements on people under 50 — especially males. Why? Although younger candidates have better surgical outcomes, this group (my strata) also has higher readmission outcomes. Having to get a second hip replacement is a more complex procedure and often has much graver outcomes than an initial replacement.

The most egregious aspect for me was that even though this consortium was impeding my effort to get better, the medical staff would still ask about my activity level during every office visit (by way of the worn out script of their rudimentary health risk assessment, affirming to me there was no real understanding of my condition). I’d have to inform them every time I was there because I would love to be more active. Instead of ever really developing a path forward, I’d routinely leave with a prescription for NSAIDs and/or opioids. It was more advantageous for them to keep their costs down and alleviate my symptoms than address the problem.

When I started to complain to other colleagues in healthcare, I quickly realized this is the elephant in the room. The over-prescribing of opioids is additionally concerning when many suggest that long-term use for chronic, non-malignant pain has more cons than pros. It brings many side effects, including gastrointestinal issues, confusion, respiratory problems and increased risk of infections and tumor growth (Clarke, Skoufalos, & Scranton, 2016). Inappropriate prescribing also means that more drugs become available to the general public through black markets, leading to further abuse and addictions. Ultimately, I have now stopped taking all prescribed painkillers and just suffer through the pain until I can treat the condition and not the symptoms. My current UX is terrible but at least I’m not a dope.

Do You Want Great UX, Or Do You Want Great Healthcare?

When it comes to improving the quality of care in our hospitals, I am not attempting to marginalize that pain assessment and pain management are two important standards. However, patient satisfaction — originally designed to promote quality of care — has in some cases undermined the principles of good medicine. This may sound contrarian from someone who generally advocates for patients to become the smartest person in the room about their particular condition, but maybe some decisions should be left to the people most qualified to make them. We need to foster systems that afford doctors the luxury of treating conditions and not simply addressing symptoms.

Instant gratification has its place, and it is natural to want to avoid discomfort. However, in this particular narrative, it is not a good replacement for legitimate treatment options. The current system is rigged to make you sicker. That has got to change, especially in cases like mine where there are better treatment options. Great UX is not always in the user’s best interest. In fact, as this post outlines, it can lead to many ill effects — on a personal, national and global level.

Sources & further reading:

Clarke, J. L., Skoufalos, A., & Scranton, R. (2016). The American Opioid Epidemic: Population Health Implications and Potential Solutions. Report from the National Stakeholder Panel. Population Health Management, 19 (Suppl 1), S1-S10. doi:10.1089/pop.2015.0144

Daubresse, M., Viswanathan, S., Alexander, G., Yu, Y., Chang, H., Shah, N., & … Kruszewski, S. (2013). Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000-2010. Medical Care, 51(10), 870-878. doi:10.1097/MLR.0b013e3182a95d86

Fenton, J., Jerant, A., Bertakis, K., & Franks, P. (2012). The Cost of Satisfaction A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality. Archives of Internal Medicine, 172(5), 405-411.

Kravitz, R., Franz, C., Azari, R., Wilkes, M., Hinton, L., Franks, P., & … Feldman, M. (2005). Influence of patients’ requests for direct-to-consumer advertised antidepressants: A randomized controlled trial. Journal of the American Medical Association, 293(16), 1995-2002. doi:10.1001/jama.293.16.1995

Paulozzi, L., Budnitz, D., & Xi, Y. (2006). Increasing deaths from opioid analgesics in the United States. Pharmacoepidemiology and Drug Safety, 15(9), 618-627. doi:10.1002/pds.1276

Paulozzi, L., Jones, C., Mack, K., & Rudd, R. (2011). Vital signs: Overdoses of prescription opioid pain relievers — United States, 1999–2008. Morbidity and Mortality Weekly Report, 60(43), 1487-1492.

Pham, H., Reschovsky, J., Landon, B., Wu, B. & Schrag, D. (2009). Rapidity and modality of imaging for acute low back pain in elderly patients. Archives of Internal Medicine, 169(10), 972-981. doi:10.1001/archinternmed.2009.78

Zgierska, A., Rabago, D., & Miller, M. (2012). Patient satisfaction, prescription drug abuse, and potential unintended consequences. JAMA – Journal of the American Medical Association, 307(13), 1377-1378. doi:10.1001/jama.2012.419

Live Life Love | Volume Thirty-Nine

Hi Everyone,

I hope your summer is off to a great start and you are finding your way to having tons of fun. I am starting to really enjoy further deconstructing the topic of fun. Seneca said, “we suffer more in imagination than in reality,” which is likely true. However, I believe we can make a case that we enjoy more contentment in imagination than in reality, too. So, if it is true that contentment is subjective (academics acknowledge this by measuring happiness through subjective well-being instruments), then a strong case can be made for the benefits of architecting a life through positional economics and taking measures to increase one’s prospects to engage in fun opportunities. In an attempt to practice what I preach, the family and I have made the decision to move from California to North Carolina — freeing up some resources for more life experience and (hopefully) more fun. Time will tell if we feel like the reward (opportunities for fun) outweighed the risk (loss of existing support systems).

More on that in future editions; for now, here are some more great interviews with two modern pioneers in digital health.

Business, Innovation and Entrepreneurship: This quarter, we look at the entrepreneurial side of digital health with Ryan Tarzy. Ryan is the current director of the Incubation Studio at CoverMyMeds. Before this position, he served as SVP of Business Development for PokitDok and has co-founded two companies, Medikeeper and Playful Bee. The interview with Ryan Tarzy about digital health can be found here.

Health and Wellness: This quarter’s health and wellness interview is with Daniel Freedman about virtual fitness. Daniel originally co-founded CyecureBox, a successful cyber security tool. He has since gone on to focus his efforts on the development of his new company BurnAlong — a virtual fitness startup that aims to help people find the time to exercise. The interview with Daniel Freedman about virtual fitness can be found here.

Life Experience: This quarter, I got to experience Lightning in a Bottle. It is an unbelievable festival with stunning art, good music, and lots of great educational sessions. I got to meet and learn from Dr. Jack Kreindler (@drjackUK) and Dr. Adam Gazzaley (@adamgazz) while partaking in some shenanigans with good friends and enjoying the scenic setting of California’s Central Coast.

Lighting in a Bottle | Bradley, CA

Contribution: I was able to donate time, as well as money, this quarter. Through TECHquality, I helped improve the gender gap in digital health by mentoring a co-founder of the company Cleanopy. I also donated to former interviewee Jeff Atkinson’s son during his Tour de Pier effort, as well as donated a car to the East Bay SPCA.

It is the anniversary of my brother’s passing. Brian left a legacy through amazing memories with quality friends — a testament to the value of making time to enjoy and experience life. I believe he would be proud of the direction I have taken this endeavor and the directive to focus on fun for a while. His life is certainly a reminder to make the most of the time we have. My hope is to honor him by making sure I maximize people’s ability to have fun with the short time we have been given. The next edition will mark 10 years of this project. It has been quite a journey so far, and I look forward to it being a lot more fun as we continue on. I’m grateful that you are a part of it.

In health,
Dr. Rucker

P.S. I was featured in the Wall Street Journal this month; good piece about fitness technology for those interested: Your Gym’s Tech Wants to Know You Better
P.S.S. I plan to be in Portland in July for the World Domination Summit. If you are going too, please let me know … I’d love to meet up.

Interview with Daniel Freedman about Virtual Fitness

Daniel Freedman graduated from the London School of Economics (LSE). He started his career as a journalist and worked for several publications, including the Wall Street Journal and Forbes. He contributed to the bestseller “The Black Banners,” a book about Sept. 11 and the United States’ war with al-Qaeda that was published in 2012. Freedman later shifted his interest to the technology sector, working at tech startup Apploi and co-founding CyecureBox, a cyber security tool. After transitioning from Manhattan to Baltimore, he has been focusing on the development of BurnAlong, a startup that aims to help people find the time to exercise. During his eclectic career, Freedman has also held posts at the United Nations and the U.S. Senate.

1) What currently excites you about virtual fitness? How have things evolved from the days of Jane Fonda VHS tapes to the virtual fitness experience a user can consume today?

I think what’s really changed today is virtual fitness is allowing people to bridge the online and the offline fitness experience. New ways of delivering virtual fitness can finally bring people the “real” experience that they want, as opposed to having disconnected, lonely experiences with static content.

If you look at video games, the virtual world bridges that divide. If I go back to when I was a kid, if I wanted to play video games with a friend, I had to travel to their home. Today, my nieces can play with one another and/or their friends online, from their respective homes in different cities. They can see and speak to each other no matter where they are in the world. It’s the same in the business world where work tools like Skype and Google Hangouts have connected us.

What’s exciting to me in the fitness space is being able to bridge the divide and give everyone access to the experiences they want, when they want them. Fitness is about relationships, purpose and motivation. New advances in virtual fitness now allow us to do that at scale, with your workout buddies wherever they might be.

2) What are the limitations of delivering virtual fitness, and how have you seen this effectively mitigated?

If you go into any gym or studio, anywhere in the world, and ask, “Who is the most popular instructor here?” And then you ask them, “When was the last time someone said they can’t make a class, or was away for the summer, or traveling for work, and so could you film the class?” Odds are the instructor will say it was within the last two to three days. This reflects a massive lost opportunity for gyms and studios, because their members would prefer to choose a virtual experience with their favorite instructor, rather than strangers, if given that option.

BurnAlong does that, bridging that divide, giving people the connection to their favorite instructors/their friends, at a time and/or place convenient for them. And instructors can gain an insight into what people are doing outside of the gym, and help keep them on track.

3) Throughout the process of your product development, what has surprised you about virtual fitness delivery and consumption while building BurnAlong?

One big surprise is the willingness of people to try something different from home, or get started on their fitness journey. We see with companies, that often people have heard about top local instructors, they’re very curious to try them out, they’ve just never had the time, or confidence, or motivation, to actually take the class. But being able to experience it at home, from the comfort of their own home, makes a big difference.

We see this especially with companies and their employees. Right now, for many, five percent of employees participate in wellness programming. What we’ve found is that it’s not that the other 95 percent of the company isn’t interested. On the contrary, there are just a lot of barriers to attend (e.g. schedule, family commitments, aversion to working out with co-workers in an open setting, etc.). We found that virtual fitness is great for those who do not like exercising in front of others (especially colleagues and/or strangers).

For instance, yoga can be intimidating if you do not understand it. Virtual fitness allows someone who wants to be a little more confident before they subject themselves to other peers seeing them engage in activity [to get some practice]. They can get accustomed to movements, gain familiarity before engaging in the activity in a group setting.

For an instructor, this can be quite eye opening. Big personalities can be intimidating. Virtual fitness allows participants to understand the instructor, the class, they get to know the routines — a relationship is built before having to step in an unfamiliar setting. Through this process, a user can take steps to understand group dynamics before leaning in.

Virtual fitness is a great way to onboard new entrants into fitness who would have been too intimidated to ever get started otherwise.

4) Exergaming is a facet of virtual fitness that has had a lot of press but seemingly always falls flat after the initial hype (i.e. Wii Fit, Pokemon Go, etc.). Why do you think gamification has ultimately not lived up to the hype, and do you see this changing in the future?

Anything can get boring, unless it’s changed up. It’s the same limitation of the old way of delivering virtual fitness — where you’ve only got the same 10 options and the expectation is you are meant to keep going through that same 10 classes over and over again. Most people who buy fitness DVDs don’t buy only one; these folks have got piles of them. They want choice and variety. If there were only 10 books that everyone wanted to read, there wouldn’t be a need for Amazon, right? So too for fitness, there’s not just 10 ways of working out; the rise of boutiques reflects the desire for so many different people to work out in so many different ways.

The appeal of attending fitness classes in person with friends is that while the workout may be similar, the instructor will change things up, and your friends will chat about different things. The conversation is going to be different every week. What virtual fitness can now do is bring that variety to you in your home, with your friends, with fresh content from instructors, when you can’t make it in-person.

5) How do you see fitness evolving over the next five to ten years? How will virtual fitness change the way people currently consume fitness?

What we believe in at BurnAlong, and what our product is based on, is that people increasingly want unique experiences. I think virtual fitness has got the power of bringing fitness to people wherever they are — that specific type of experience that they want whenever and wherever they want it. We believe the virtual compliments the in-person experience, rather than replacing it (which most online companies believe).

The virtual can also bring special classes to places where previously people didn’t have that experience. People talk to friends across the country and all over the world about their favorite instructors; now those friends can experience those classes with that friend. Geography no longer needs to be a limitation.

In five years, I might wake up planning to attend my favorite cardio class at eight o’clock in the morning, but I wake up and Amazon’s Alexa or Google Home or another connected device will say to me, “Daniel, your noon meeting has just been moved, and you do not have time to physically attend your eight o’clock class. However, I’ve notified your instructor that you’re going to be joining online rather than in person.”

My co-worker Harry who takes the class with me is in London for work, and will be taking the same class virtually since it is his favorite, too. We choose to take the class live together. I log in at eight o’clock, wave to Harry and the instructor, who sees me and says, “Thanks for joining Daniel. Sorry you couldn’t come in person. You know I see your heart rate is already at 140, good run earlier … Daniel, you are already ready to go!”

It’s an experience where, just because you cannot do something in person, you are no longer limited. The virtual world bridges that divide, makes people more efficient, and allows them to use their time more effectively without sacrificing quality. This will only continue to improve in the years ahead

You should never be in a situation where just because you are traveling this week, or just because you can’t get a babysitter, or just because you had to work late … you can’t get the type of fitness experience and expert guidance you value and deserve.