Wednesday, January 23, 2008

Where's the Fat Lady?

Fans of J.D. Salinger may remember the Catcher in the Rye, but the Disease Management Blog thinks Franny and Zooey was J.D.’s finest work. In it, the college-attending, 1950’s heroine, Franny, becomes disillusioned by her meaningless life. Lacking access to the answers offered by our more modern age, like attending a rave or the joys of body art, she turns to repetitive prayer. It’s up to her elder brother and precocious radio-star Zooey to get her to snap out of it. After giving the reader a literary bus tour of the Upanishads, Zen Buddhism and Christian mysticism, Zooey finally hits pay dirt when he reminds his sister about the Fat Lady. Franny’s anxieties are eclipsed by the satori-provoking metaphor of lifelong service to this least-of-us child of/symbol of God.

Heavy stuff indeed. So what does this have to do with anything? Well, my blog, my posts. But seriously, the Disease Management Blog recently had the pleasure of touring a disease management call center, which was an industrial-strength, football-field sized, white-noised cubicle farm of nurses telephonically “engaging” persons of chronic illness. When I was invited to sit in on an HIPAA compliant “outbound,” the nurse took the time to show me a simple hand-made present and a handwritten thank-you letter sent to her by one of her diabetic patients. While she appreciated the small gift, it was gratitude in that note that was memorable for the two of us. Its value will never be captured in a per diseased member per month transaction.

There are several lessons here. The first is that Franny and Zooey is a good read if you're a JD fan and like that sort of book. It’s an option for that next plane trip. The second is that the sheer scale and complexity of these call centers is remarkable. Don’t turn down an opportunity to see one. Third, the remote coaching telephony from a good nurse to an interested patient is not automatically the Vytorin of health care: it can make a remarkable difference in individual patients’ lives. Fourth, the nurses that work these centers are good. Really good. And finally, while it’s fun to cross swords over what to do about the national cost and quality of chronic illness care, the Fat Lady not only appreciates the disease management nurses. She also writes to us from the center of our healthcare policy debate.

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