"Nickel and Dimed: On (Not) Getting By in America" (Barbara Ehrenreich)

Last week, I was walking with one of my patient-centered mentors, David Sobel, MD, through one of my favorite museums in Washington, DC., The National Portrait Gallery. As I brought him to one of my favorite pieces, I asked him if he read this book, and he told me it was one of the most influential books he’s read. “Have you gotten to the Wal-Mart section yet?” he asked. I have, and I have to say I agree with his assessment.

This book preceded a more modern version of living among the corporate natives which I reviewed previously, Punching In, by Alex Frankel. Unlike Alex Frankel’s adventure, Barbara Ehrenrich goes completely native, adopting the lifestyle of a minimum wage worker, down to eating, living, and surviving (or attempting to) in several different American cities. Her jobs include being a server in several restaurants, a house cleaner for a large national franchise, and a stint in retail.

We learn some realities of these jobs - it’s never really okay to not always be doing something, even if there’s nothing to do. One of her places of employment calls this “time theft.” So there’s a constant flow to the work, some of it useful, some of it not. The profiles of her coworkers describes the conditions that the working poor must accept - not having first month’s rent and deposit may mean spending $60 a night in a motel, an irrational yet necessary way to survive. The quality of life that Ms. Ehrenrich accepts for her assignment is concerning bordering on dangerous - a single woman in an efficiency with no screen on the window on the ground floor.

As I read this with an interest in employer-based health, I also learned a lot.

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I am here at the WIxRed Conference in Washington, DC, the annual conference of the Center for Information Therapy and in my comments, decided to include some information about the work I am doing with California Healthcare Foundation to connect Californians to good chronic illness management. I mentioned that this is the first time I have posted a project “in evolution” for the world to assess and give feedback. Crowdsourcing my job - let’s see how it goes, and thanks to CHCF for allowing me to give this a try.

A few pics, first (click on any to see larger size)

One of the important aspects of this work is the employee / patient perspective. We are looking to include a patient / employee advisor in planning the project, and a conversation I had just now confirms how valuable this could be.

I was told that in many workplaces, there are rules about bathroom breaks, ie when they can be taken. Because of this, some patients will skip taking blood pressure medication that may require more trips to the bathroom.

It was so interesting for me to hear about this because at the very same time, I’m reading “Nickel and Dimed: On (Not) Getting By in America” (Barbara Ehrenreich) which brings home the reality of modern workplaces for those making minimum wage (or less). Look for that review in the next few days.

I’d like readers to think about this example, and give me more ideas if you would - what are some ways that a chronic illness impacts your work life, even for illnesses that some people don’t think about? What are the a ha’s that maybe the medical system isn’t aware of? Thanks for your input. The example above is a reminder of the value of patients as partners in planning and implementation.

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.

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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