I am back in DC this time, and this photograph was taken at gate A1, San Francisco airport, and shows a VirginAmerica employee leading a mini US Open Golf Tournament at the gate before boarding. The gate area right before a transcontinental flight is probably the last place you expect to see community being created, but this was what was attempted yesterday. Just the fact that the VirginAmerica staff person stood in front of, instead of behind, the podium, says something about being as close to your customer as possible.

At the restaurant Slow Club in San Francisco, we were greeted with this notice when our bill arrived. I think this is a novel and interesting way to bring price transparency to health care. It’s especially interesting that in San Francisco, there’s probably more price transparency coming from this restaurant than from the industry itself (see the middle link from this post about that). I suggest that they go one step farther and publish the health care cost component of every menu item. This just may help spur more consumer interest in the accountable, affordable, evidence-based care system.

The other photograph is of a few jets from the airline people are tired of hearing me talk about, VirginAmerica.

I recently pulled several articles to help leaders understand Web2.0 better. That’s what’s in the links below.

The image is one that I snapped while taking a flight recently. It reflects the accommodations an already troubled industry is having to make to support our health (or lack thereof).

• CDC trends in obesity 1985 2001 - CDC trends in obesity 1985 2001. Disturbing.
• A List Apart: Articles: Take Control of Your Maps - Useful article about integrating mapping visualization
• A List Apart: Articles: Accessible Data Visualization with Web Standards - Really nice article on simple data visualization using CSS
• VM — Being There, Mar 01 … Virtual Mentor - The use of telemedicine technology, while convenient, can at times be inadequate, as shown in the portrait painting entitled The Doctor, where the physician stays at the bedside of a gravely ill child and offers his presence as comfort to the family. Virt
• Notional Health Server | Economist.com - A flagship service adrift - problems with online booking at the National Health Service
• Health 2.0 | Economist.com - Technology and society: Is the outbreak of cancer videos, bulimia blogs and other forms of â??user generatedâ?? medical information a healthy trend?
• Social networking | Joined-up thinking | Economist.com - Social-networking sites are not just for teenagers. They have business uses too
• Sources and acknowledgements | Economist.com - Helpful links for Web2.0 research from the Economist
• What sort of revolution? | Economist.com - Both good and badâ??but it’s too early to say in what proportions
• The wiki principle | Economist.com - Are many minds better than a few?
• Compose yourself | Economist.com - Journalism too is becoming interactive, and maybe better
• It’s the links, stupid | Economist.com - Blogging is just another word for having conversations
• Among the audience | Economist.com - The era of mass media is giving way to one of personal and participatory media, says Andreas Kluth. That will profoundly change both the media industry and society as a whole

This article is very interesting to me, because I seem to be living the statistic:

In the air, health emergencies rise quietly - USATODAY.com

I have been on several flights in the last 2 years with medical emergencies on them. On the last one, there were so many doctors on the flight, that the flight attendants actually turned people away from assisting. On two I have been on, I was the only physician on the flight, but not the only allied health professional (nurses are as important as physicians in these situations).

I’m glad this is being reported on, because I think that this issue should be recognized and there are some opportunities for us to do some things:

1. Establish helpful guides for patients deciding whether to fly or not. For example, a person recently discharged from a hospital with a new medication regimen may be at risk on a transcontinental flight
2. Establish helpful guides for airline personnel for working with in-flight physicians and nurses. This includes seeking out the right expertise, and maybe a 30 second coaching session on procedures like using the air to ground radio and what is available and not available on board (and there’s usually a medical kit with a lot of useful things on board).
3. A guideline about intervening on a flight plan. One thing that was confusing for me in the times I assisted surrounded landing a plane in an emergency - this is the kind of thing I don’t want anyone to be guessing about. If a patient is critically ill, there should be an option to order a plane down to get help, and maybe scripting that goes with this. What’s possible though - how long does it take to land a plane and is it better to continue on and bring medics on board? Sometimes, it’s the humane thing to do to get help quicker.
4. A guideline for medical providers to prepare documentation and work with flight crew to maximize their talents in an emergency. Maybe an introduction as to who has medical experience and what they can do (perhaps as part of the 30 second orientation I spoke of).
5. Maybe, a guideline for patients and providers. In an in the air emergency, people encounter very intense moments and form something of a bond. I think it is therapeutic in some cases for the provider to connect with the patient/family after the incident is over, or with the patient’s regular provider in some cases. I did this with one family and it was really special.

I also have to make a broader societal call for our profession to engage in making medication reconciliation a norm in all parts of care, and in involving patients in their care by giving them access to all of their medical information (as I did in this blog post about a medical emergency I attended to on the ground). Informing and empowering patients throughout the process of care prevents a devastating outcome in these situations. None of us wants a family member in distress in a situation where they do not have accurate information about their health care regimen that they can either tell someone or have written down from their physician.

An in-air medical emergency is both an intense time and a time when people come together to do the best they can to help another person. I am a big fan of creating a process where everyone can maximize their talent and minimize their anxiety during a life or death situation.

If anyone else has attended on an emergency or seen one in the air, let me know your thoughts. Comments are open.

Since I have been talking to folks about flying Virgin America lately, here are a few additional photos for this week, from the interior of the cabin. I couldn’t resist taking one of the in seat-computers booting up (notice the Penguin).

I’ve been evaluating the experience in the context of the little bit of study I have been doing of the airline industry , and paying attention to the way the staff carry themselves and the airline markets itself. Even though the safety video was tongue in cheek, it held my attention and prompted me to pay attention to safety issues prior to take off. After reading about the work of flight attendants, I am predisposed to paying attention to the work they do to support a safe flight experience.

Feel free to post comments about your experiences here.

February 15th through February 16th:

The first few links are from the history of diversity in various industries’ and their impact on quality, affordability, and safety.

• “Fly Me” - TIME - National Airlines pleads innocence in 1971 to the “Fly Me” campaign despite flight attendant protests.
• Classic TV Commercial Jingles: Braniff presents “The Air Strip” - A commercial dubbed “outrageously sexist” for its portrayal of flight attendants.
• Coffee, Tea or Tails? - TIME - Article from 1974 about Continental’s “We Move our Tails For You” ad campaign
• Health Care Renewal: GE: We Bring More Conflicts (of Interest) to Light - An example of a purchaser that struggles with supporting an affordable care system, and supporting an un-affordable care system at the same time.
• No Pharma Funding | When Memorial Sloan-Kettering Cancer Center in New York City stopped accepting commercial support for its continuing medical education activities last January, many at the institution had their doubts that the program would survive - CME without industry support is possible. I would tend to favor events that are less fancy and have less bias.
• apophenia: open-access is the future: boycott locked-down academic journals - A more assertive argument around locked down journals.
• Running a hospital: You can take your $15 fee and … ! - I wonder how relevant peer review is in general. I am going to start a tag cloud on this and keep track.

Working the Skies: The Fast-Paced, Disorienting World of the Flight Attendant

It was interesting to juxtapose a book about the ideals of a profession (See: Now Reading: A Fortunate Man) with one about a profession in transition. “Working the Skies” is about the world of the flight attendant, and in contrast to “Femininity in Flight,” is more about the contemporary world of flight attendants, told from their perspective.

That story is one about a job that was created as a temporary assignment and then grew up to be a profession in an industry that has both high emotional significance to society, and that struggles every day.

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I became interested in this book as the story of a profession that started from scratch in the 20th Century, whose ranks grew from a population of a social minority - women in the workplace. In many ways, the story of flight attendants parallels the stories of other health professionals, including physicians and nurses. In my own medical school, which opened for business in 1967, you could walk along the “wall of fame” and at a glance see how the number of women in each class grew from year to year. It was only in the year after mine that there were as many women as men in the entering school class.

I have also grown up in the Jet age, and in an era where a lot of legal rights that minorities now have, have been in place. I recently visited the National Partnership for Women and Families, where I saw legislation that that group helped to enact, including the Pregnancy Discrimination Act and the Family Medical Leave Act. When I saw the physical representation of these laws, and the years that they were enacted, it was a powerful reminder to me that a lot that we take for granted today took a lot of work by dedicated individuals to make them part of society.

It was with this interest that I learned about the history about the flight attendant profession.

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