Darshan
Hey everyone, welcome to another episode of DarshanTalks. I'm your host Darshan Kulkarni. It's my mission to help you trust the products you depend on. And as part of that, one of those things is actually going and applying and seeing if if you can actually help people, and that involves proposals, and I'm hoping that we're going to get a chance to talk about that today. I'm an attorney, I'm a pharmacist, and I help companies with FDA regulated products. So if you think about drugs, wonder about devices or obsessive pharmacy, this is the podcast for you. Again, do you have to state this is not intended to be legal advice. So don't look at it as such. It's also not intended to be medical writing advice. So don't don't look at that as such, either. I do love these podcasts because they're a lot of fun. I find myself learning something new each time. So if you if you like what you're hearing, please like please subscribe, please share. And I know our guest today would appreciate it if you would share because people will learn a lot and love it. Our guest today is a frequent guest of ours. We've been we've really really enjoyed having her on before and we're excited to have her on again today. And we're going to talk a little bit about his health literacy and we've talked about that before. But what is that like running a small business and how has COVID affected them. So if you care about any of those issues, look for I look forward to you tuning in. Our guest today is the CEO of health literacy media. She can be found actually at Kohler co Leary at health literacy dot media. So you should be able to find that it's also on your screen as you speak. But our guest today catina Neary Hey, Tina, how are you?
Catina
I'm excellent. How are you doing?
Darshan
Good, good, good. I'm excited to be here. The it's Now luckily, I'm in the northeast, as you know, and it's starting to get a little less humid, which is nice. our case it's been so this week,
Catina
had brag brag,
Darshan
if you would where you are right now,
Catina
it's miserable in the Midwest. So we're, we're reaching the point of, you know, 9500 degree days every day, high humidity, my poor kids are in a soccer camp this week, they're trying to figure out how to adjust the time, because it's so hot by the end of the day that they're not legally allowed to play. So they don't, they don't know what to do about this. And it's really funny because the team that manage the logistics for this tournament sort of goes all around the country to do these things. And they're not their own fields. So they've rented these fields to us. And they didn't know that they didn't have water live in the field. And so they're sort of running back and forth to, you know, big chain grocery stores to make sure they have enough water. And the kids can refill bottles and all of these things because it's just miserable. So yeah,
Darshan
as a former fat kid, I have to say that I'm legally prohibited from playing soccer is my dream scenario.
Catina
12 year old is sort of like, you know, how hot does it have to be? And if it's if it's not about the heat, you know, money bothers me. And you know, he's got all these sort of lists. And I'm like, you asked for this, you know, six months ago, you wanted to do this. So here we go.
Darshan
Here we go. So So let's talk a little bit about the fact that how, but we're still on COVID, we're still stuck inside. How has that been for business?
Catina
You know, it's really interesting for business. So you know, in February in March of last year, we started to sort of see that things were going to be complicated, and we didn't have a good indication of what was going to happen. And it was complicated, and things were very concerning. And then we had all of the support from the federal government with paycheck protection, and all those things that got us through the summer, which was fantastic, because most of our main partners had really slowed down their decision making. So they were trying to conserve resources, particularly our pharma partners, while they figured out what they were going to have to redirect toward COVID, both internally and externally. So there was a period of just sort of a stall and an unknowing. And that really went into the fall for us. Which meant that from a strategic planning perspective, when we were budgeting last year, we didn't know what we should budget or what we shouldn't budget, we were having real challenges of figuring out sort of month to month what was going to be realistic. But then interestingly, starting in about November, things really started to pick up again and you know, I'm hesitant to say this out to the world, but we're actually having one of the better years we've ever had now, as people have gotten back to work and sort of figured out you know, the pandemic may be with us for a while. However, we know how to work from home. We know how to make decisions about applying resources to this particular situation, we know what employees can do. So So things have sort of gotten better, ironically. And of course, we do help communication. So there's a lot to be done around COVID communications, particularly as you know, so many people have been vaccinated, but not enough to keep us all safe. And we're looking at these sort of next waves. I'm in Missouri, so we're back under mask mandates now. So everybody's masking again. And we still don't have the little ones vaccinated. So the masks are even a bigger deal, obviously. But Missouri is a hot mess. So again, there's a lot to be done a lot of work in this this area. So we're excited to be part of that. It's unfortunate that this is the work we have to do. But if, if this is what exists in the world, we want to be part of helping be the solution.
Darshan
So what I'm hearing you say is you're actually helping with addressing the issue of inadequate vaccination is that I'm not saying putting a client or anything, but that's part of the work in general, you're helping with?
Catina
Sure. So we're doing, we have a handful of grants to focus on vaccine related issues, and communication around vaccine related issues. So we're working with a couple of groups in Tennessee and Nashville. So the state of Tennessee got a reasonable amount of resources, to address vaccine hesitancy and to go into communities and have good conversations with people about what their choices are, and help them figure out what's the safest choice in their individual situation. So we're supporting the messaging in those communities. We've done some work here in Missouri. But we recently received information that a large grant is funded through our partners at the University of Florida in Gainesville, that allow us to work with five or six sites, it's still processing, what the sites will be. So we'll know in the next couple of weeks who we get to work with, but it's a sort of a national collaborative to focus on these same issues. And the team there, Linda Kotler and her group, at the University of Florida in Gainesville, have some great ideas about community engaged methods, including, you know, using boats in Florida to go out and reach people and will truly where they are. And so that's pretty exciting. We're excited about that.
Darshan
But that's really interesting. So what I'm hearing you say, and correct me if I'm wrong, but you're you're a making the effort to actually meet people where they are. But one of the questions I'm trying to understand is, there's so many different reasons people are saying, I don't want to take the vaccines. And if that's true, when you're trying to create a comprehensive plan to address that, how do you go about figuring what is the right phone to hit? What is the right message to hit? Because there's no way you can with one message, if everyone that's involved? So do you do the Pareto principle or you go 8020? Or how does that work? Yeah, I
Catina
mean, I think this is sort of classic marketing, PR kind of work, where you're thinking about segments of populations, and you have different messages, depending on where you are. So you have sort of core messages. And I think one of the things that we're learning is there's so much misinformation around COVID. So we have to figure out how to combat misinformation, without being so directive and authoritative that we turn people off. So I saw, I saw something last night on one of the news stations and you know, right or wrong, I don't know that. I don't know that I agree with this point. But they mentioned that one of the main government voices around COVID was so politicized and polarized that just his voice changed people's mind in a negative way. Now, for certain people who have not been vaccinated. So who knows who's the right voice? Right? Who's the right one voice that those voices that are so trusted? Aren't the right voices for certain people. And so in my experience, and community engaged work, what I would say is that the voices are the folks from communities, right? Like if you get people that are the trusted sources, I mean, these are old school methods, when you're going to churches and schools and, you know, city leadership and in all of the people who are the sort of gatekeepers in those communities, and convincing them that they need to speak to their communities about what's the healthiest choice for the people in that community. It's a different conversation, and everybody can have that sort of individual conversation armed with messages that resonate makes sense for those specific groups. So we have to create a lot of messages certainly because everybody has a different concern, a different worry. So there's the you know, the microchip people and the people that think it hasn't been tested long enough and the people that you know, I'm reading a lot right now of people saying things like, Well, you know, my aunt, uncle brother, got, you know, the vaccine and you know, two days later he was in the hospital and never came out. And you know, that's a sort of a fundamental misunderstanding of correlation and causation. So in all likelihood the person was exposed before they got the vaccination, all kinds of other things that were going on led to poor health and the decline. That's, that's a different situation. But, you know, when they're looking at it in the time sequence, you know, the biggest and brightest thing in their head is while the person got the shot, and they're dead. And so, you know, they're misattributed but but it's, it's visceral, and they believe it. And so how to help them sort of walk through that is not, you know, a quick, you know, postcard or soundbite that's a real conversation to help them understand what else was going on, how did that work? You know, what other health conditions that the person have, you know, it's not necessarily their problem to figure out what happened to their family member, but it's influencing the choice that they make so so to some degree, you have to have that conversation, even if you don't have the medical facts. So you have to start to talk about science and how the vaccine works and how exposures work and what else is going on. And that's a complicated set of messages. But that's one set of problems that people are having. And, and they believe it strongly. I mean, the number of times I've seen this lately on my social media of from people that, you know, I know, well, who were just really concerned based on their perception that something bad happened because of the vaccination. So again, we have to talk about all of those things, and they're all different messages. And we have to start, I'm a social worker by training. So how do we start from the place the person is, rather than applying a message that we think might be, because for example, if they're not a person that's worried about a potential microchip, and you start talking about that you can obviously reinforce something that wasn't even the problem to begin with? So how do you figure out where a person is choosing deliver the right message and move forward from that conversation?
Darshan
So So I've always understood the role that health literacy plays in your company plays to be more creating, crafting, drafting and writing out the message? How often do you find yourself actually getting into these conversations, to actually talk to people.
Catina
So for us, we're sort of limited. So our job is to create the messages for other people to deliver. However, part of what we also do is train the people that have the conversations on how to be health literate in their communications. So this idea of starting where the person is active listening, really thinking about what they're saying, tailoring the message to the conversation, giving the person space to speak. You know, we see that a lot with folks who are in the medical field who, you know, are really directly impacted and are scared and concerned, and they have the facts, and they just want people to know what they know. And so the force of their message is so strong, that it can be off putting for some people. So you really have to sort of train them to a different style and a different approach. And it's unfortunate, because they ought to be able to be who they are, and use the messages in the way they are. And there ought to be, you know, we wish for respect for all of us for our relative positions. But the reality is, you know, individuals are the expert in their own lives, they need to be able to understand it from their frame of reference, and they need to hear it in a way that that they can process and understand. And that's all health literacy. So training those people, those messengers, to have conversations in ways that are acceptable and approachable and receivable accessible is part of what we do.
Darshan
So So as you're having these conversations, you're having these trainings, one of the things you mentioned is that healthcare, healthcare professionals are often the people you have to almost come down. How is that received?
Catina
So it depends, right? It depends. You know, in taking this out of COVID, we have this conversation with healthcare professionals all the time about health information. So what we find is, often, it's, it's really hard for doctors to change the way they communicate. So doctors really are, you know, pressed for time, they've got a lot going on. We've trained most physicians into sort of a mentality of, you know, they're the responsible person who has the information, and they deliver it, and a person is supposed to receive it. So for many times, you have to undo that training, and help them understand that, you know, people don't always understand what you mean, and they don't always accept information, but that top down approach, and sometimes they change and sometimes they don't, nurses, nurses are really trained to think about this. So when you start to talk to nurses, social workers as well about these kinds of things, you're sort of rolling them back to their roots anyway, and helping them sort of remember sort of who they are and what they care about. If they've gotten away from that a lot of people have and a lot of people are really good about that already. So they don't need more training. We have to help them think about how they train the people around them and They sort of continue that in a time where things are stressful, and they don't maybe have the time that they need. So how do we apply this, given the context of the current environment, and then a lot of the people that we train are community health workers and folks who are coming from communities, and don't have much training at all. And so the challenge here is to not take away the unique individuality of this person that helps them connect with the community as they are, but help them have the skills and strategies to not be lost in the messaging.
Darshan
So let me ask a really basic question, because it seems so intuitive what you're doing. And when you say you're kind of like, Well, yeah, that makes sense. But but the part I don't even understand is, who are I know, you said, health care workers. But where do you get these? Is it? Are you talking about a physician working in their regular private practice? And in the hospital that you're educating? Or is it tense? Does it tend to be public health? And therefore these are physicians working for NIH, or something of that, like, what are you educating? When do they get the forum to engage?
Catina
Right, so all of those things, so in COVID times, there's a lot of community health, sort of setting practitioners. And so we work with a lot of clinics and folks who are going out to get their patients. And those folks come together, and they're, you know, trying to use available messages, they're trying to figure out how to have this conversation. And they're really time limited. So there are lots of sort of short webinars and conversations about how to do this. And, and we've been involved in many of those, I think I've mentioned before on another podcast, but premier St. Louis, for example, has done a really good job of this, they've put together a group of providers who represent the community, all kinds of providers, you know, doctors, nurses, and social workers, all kinds of health professionals, but they've trained them to really focus on what's the right decision for you, which is a different conversation than physicians often have. So it's different than diagnosing but it's talking about sort of, what do you need to know? What do you need to understand? What are your questions? What are your concerns? How can we work through this with you so that you can make the decision. So we've been able to support that conversation with some health literacy pieces. And then also with, you know, our work with Nashville and other places, we've been able to sort of plug in and help people think about that. Outside of COVID, though, we do it all the time with big healthcare systems and other groups, where we help train people to have conversations that are, you know, more health literate, we turn a lot of medical students actually. So that's one of the cool things to do is if you can train people early on in their medical training, you can really start their career on the right foot. And they haven't sort of practiced into behaviors that are less patient friendly. So that's a really nice thing. So we get to do lots of those. Last year, we did them all virtual, but this year, we've been able to do some face to face again, which is really nice. So we've had a good time doing that. So I just a couple weeks ago trained the residents at St. Louis University, and so you know, 100 or so of these, these people, early career at the same time, and you know, all of them have good instincts, all of them are going into this for the right reasons. But a lot of people just haven't thought about it yet. So when you start to sort of ask them the questions and help them think about some of the issues, you know, you're sort of removing a blind spot for them, so that they start on the right foot. You know, they know a lot about medicine, they don't often know a lot about insurance, which is not seemingly a big deal until you start making prescribing decisions that people can't afford, or don't align with their values or their culture or other things. And so we spend a lot of time talking about that in the context of health literacy of how do you sort of think about this person's whole life and have the right conversation so that you're, you know, providing care for the whole person, not just sort of the the one thing that that you think they've presented for
Darshan
that is so fascinating, because I love the idea of getting them when they're young and talking to them and re reminding them almost, of why they're doing this because in the end, I like to believe that all of us went to healthcare to help people. And sometimes somewhere along the line you it becomes a job. And that's probably when you should get out of health care, because that's or to be reminded of why you're doing this again. That I think anyways, the question I have out of that is when you talk to these medical students, do they? How do you find that it changes how they behave like do they help you with volunteer drives and stuff and then you see sort of that different spark in their eyes as they talk to people or is it more I got this I was always into this or Well, how does that happen? And play itself out.
Catina
So so some of both. So sometimes we have people that say this is really important. And we see them again and again. And they come and they volunteer and they, they do other things. And they're super busy, though. So a lot of times people are like, Okay, this is just one tool in my, my sort of bag of tricks. And I'm going to apply this over and over. I think it's really important, though. years ago, I don't know, five or six years ago, we were doing a health literacy summit, and one of our speakers was a physician, also from St. Louis University. And he had done a study, he'd been spending time sort of understanding burnout in young doctors. And one of the things that he found and he talked about a lot is, so much of the reason that doctors were they were starting out depressed, actually, they're starting out anxious and depressed, and with serious health issues, because they were disconnected from what was important to them in the first place. And so they didn't get to see patients soon enough, all of these sort of human characteristics and components of medical care had sort of been stamped out through the process of medical school. And so what they found is if you could connect people back to communities and sort of give them permission to be human again, and to do this work, they were stronger doctors, they were more mentally focused, they were more able to do their work. And so I think health literacy is a real important part of that. We see, you know, we're not unique in doing this. A lot of universities have communications departments that do health literacy work, I think they're really trying hard to integrate into med school curriculum. In particular, there's always a challenge, because the curriculum is big and bloated already. And so where does this fit. But again, we do these little trainings that are part of orientations and things like that, and it's just a chance to sort of see them, let them know this exists. And again, it's not so hard to understand that once you help people see it, that they can't integrate it, the application can be harder. And you have to practice that sometimes. But this is not the only dose that people get, if it's interesting to them, if you never tell them that it's important, and you never tell them that it's okay. You know, they're never going to have that opportunity.
Darshan
So that really brings you to the the second question, right, which is the idea that this tool set? Well, actually, I have two questions. But the first question is, I have no idea if you know the answer to this question. But do you find some doctors to be more open to these ideas and others, and what I'm thinking about is, I've generally thought of surgeons, and I know a ton of surgeons and I say this with a great deal of respect to them. Surgeons tend to be very, very focused on I want to do surgery. This is I'm not like, I want to help people, but I'm not a public health person general. On the other hand, I would see like a family practitioner being more I want to work with people, there's a public health issue, and I'm, I'm therefore, or is a medical students too early in that food chain to even think about those things? And how does it all play out? Based on what you can tell?
Catina
So I don't ever think it's too early to start talking about being human and communicating well, and being respectful of the other people in the conversation. So I'll say that to begin. But I will also say that, I agree with you that boss specialty, some people are better at it than others generally. You know, surgeons are a great example they don't, they have so much else they have to learn to do. People don't spend a lot of time helping them learn to communicate. Some people are naturally gifted, you know, you see some surgeons who are, you know, department heads and things like that part of their other skill set has has been the sort of people skills, the soft skills, some of that transitions to patients, but for a lot of people, it really doesn't. The issue, though, or the question is, as patient How much do you care, so when you're actually in surgery, you want the best surgeon? And if they have other people around them that communicate, maybe that's okay. Perhaps, and you know, we all want to be better. But, you know, maybe we don't have to beat surgeons up necessarily, if they're not all uniquely good at being communicators. The same for, you know, radiologists, and you know, their whole groups of people that maybe make selections based on other technical skills that aren't necessarily communication, and that's okay. But we have to think about what our team looks like and who is the communicator and how do we make sure we have good conversations. A lot of family doctors, as you point out are fantastic. And my mom sees a doctor here who is just so good at this every I go to her visits with her and every time I go, I compliment him on what a good job he does, and how well he explains things and, you know, he's rolling around on the chair and he's drawing pictures for and he's, you know, pointing on her body, you know, she's got a knee problem and sort of pointing toward the areas and explaining all the pieces and, you know, he goes through the same things over and over. It's documented in the chart and clear language. I mean, it's fantastic. But I've been with another family member To see a doctor in psychiatry where you would think they would be a fantastic communicator, and you know, get the after visit study and it's illegible, right? Like, just completely full of jargon completely not understandable. And so much so that, you know, I've seen the family member be upset about it, because, you know, they're not able to read it, and it makes them feel like they're sicker than there they are. And, you know, what does this mean? And so, you know, I don't know that it's completely, completely related to the specialty you choose, some of this is sort of our human characteristic as well. But um, you know, we should talk about this a lot more, we should talk about it early. And often in people's careers, we should really reinforce that, that it's okay, it's good to be a good communicator. And in fact, you know, as a lawyer, you know, this, I mean, people, like, nobody wants to be sued, you're less likely to be sued if people like you, if people feel like you've listened to them. If people feel like you're understood, there are all kinds of studies about this, you can make horrible mistakes, and be a caring person and not get sued. You can make really little tiny mistakes and be sued sort of embarrassingly badly. Because people don't like you. So you know, there's a reason for this skill to sort of protect your practice to protect your time. If you don't care about being a good human, and being a good human is just, you know, a lot of people do care about that. And I think you're right, people go into medicine generally, because they care.
Darshan
Yeah. So I'm going to ask one last question. As you know, we're well over our time, but I'm gonna ask one last question, because always, this time flies every single time. But these conversations to me are getting into that public policy discussion. As we start getting into these public policy discussions, one of the things that starts rearing its head, is the idea of social determinants of health. Are you finding that these skill sets that you're imparting are potentially leading up to or at least enabling the conversations in the future on what is your state in terms you as a patient for physicians or clinicians to have, where they are now understanding better what their patients are going through, or therefore trying to address the needs of the patient where they are, from a social determinants of health standpoint, than if they did previously, if you will?
Catina
So that's that's the that's the hypothesis, right? Like, so we believe that health literacy is a social determinant. We also believe that it's a two sided builder. Yeah. It's considered a social determinant of health. So your ability on the patient side, your ability to sort of get information, either hear it, read it, you know, learn it from your environment, take that information and use it to make your own decision determines your health in many ways. And it's a stronger predictor than a whole bunch of other social determinants in a lot of ways. And so piece one is absolutely an individual's ability to process and use information toward their health is important. But on the other side of that, once we start to think with providers about how they communicate, and how they support individuals, this is an area where they can make more change than many other social determinants, right? Like this is a really modifiable interaction. So if we we train this, if we think about it, if we prioritize it, we can make a big impact for sure. Or at least, that's the hypothesis. That's what we've been doing.
Darshan
Well, I'm sure we'll we'll be seeing more and more and more information to support that, that we'll find out. So, you know, our usual questions, based on what we discussed, what would you like to ask the audience?
Catina
You know, what, every time we have this usual question, I'm always stunned by it again, I get so excited about the conversation that I forget to think about what I'd like to ask the audience, but um, you know, I think the things that are interesting to me from an audience is, you know, where, where are you seeing this happening in your practice settings? So I'm assuming that most people listening here are people who are providers, they're in healthcare, there's a reason they show up here? So where's health literacy showing up? Where is it not? And is it only the writing and you know, it's really easy to sort of sit this down and say, Okay, well, if we get this to sixth grade, the reading level, everything's going to be cool. Are people having these integrated conversations about verbal communication and in how we sort of situate the context of health literacy in a more meaningful and deep way?
Darshan
Okay, and I usually try to answer the question I, since I don't work in a practice like that, I'm not sure I can, but we'll look for the answers that come up. My next question, what did you learn this month?
Catina
What did I learn this month? I'm going to change your question because it's not what I've learned this month, but it's what I'm excited about this month for I'm really excited this month about just sort of the reality that we're able to choose So I felt like most of last year, I spent sort of worried and stressed and not sure what was going to happen. And I'm still worried and stressed and not sure what was going to happen. But I'm seeing groups be more flexible, I'm seeing people sort of get back to joy. And people are sort of finding ways to sort of live in this new environment that is not quite as heavy as it was before. Yeah. So I'm seeing people adapt in a way that I wasn't sure. You know, I think for a long time, it was like, you know, we're either going to be like this and sort of be scared and miserable, or we're going to go back to what was before. And I'm seeing something that's completely different, that we're sort of adapting and figuring out, you know, what, what's the new reality look like? And, you know, we're finding we're finding important, you know, important differences and how we do things.
Darshan
It's funny to say that I was actually reading, like an old joke on Facebook, I think, and speaking about change. They said, We really need to get rid of the, of the idea of the saying of avoiding something like the plague because apparently we don't just thought it was kind of funny. Last question, because by the way, everyone who wants to reach out to catina, go to go to see Oliveri at health literacy dot media. But the last question, what makes you happy this week.
Catina
Despite it being really miserably hot, I get to go swimming a couple days. It was just really nice to be out with kids be in the pool sort of cooldown and experience something normal. So I just said, you know, we're not going to go back to normal, but there are these sort of peaks at normal where it's like, Okay, this is this is a real summer, this is the, we can see this, we're all sort of again, this, this idea of like we're having joy and everything is not sort of scary and miserable and uncertain.
Darshan
Awesome, awesome. And again, if you guys want to reach me, you can find me on darsan talks.com. Or just go to Twitter and find me at DarshanTalks. And catina thank you again so much for coming on. I'm looking forward to having you on again.
Catina
Thank you. It's fun conversation,
Darshan
always pleasure as always.
Catina
This is the DarshanTalks podcast, regulatory guy, irregular podcast with host Darshan Kulkarni, you can find the show on twitter at DarshanTalks, or the show's website at DarshanTalks.com
