Can a Food Delivery Service’s Business Model be a Solution to Food Deserts?

This post expands on the topic discussed in my latest (July 2014) column in The Seattle Times: “In a dietary rut? Here’s how to escape it.

Food conversations occur multiple times a day for me. I talk to patients frequently about dietary changes. I enjoy various cuisines and am fortunate to live in a city with an abundance of locally sourced food and a booming restaurant scene. However, as is the case for many people, figuring out weeknight meals while working full time is always a challenge.  Long clinic days don’t allow for much time pouring over a recipe or spending much time in the kitchen. An easy solution is to order food for delivery. But, even in Seattle, what’s quick is not always healthy. Besides, I happen to rather enjoy cooking. With time just as scarce on the weekend, what’s a healthy, fresh food seeker to do?

I discovered and signed up for a meal delivery service called Blue Apron at the beginning of the year. Blue Apron sends you a box of the ingredients you need to cook a meal for two (or 4 or 6, etc) three nights a week, along with instructions that fit one side of a glossy, 8×11 inch recipe card. You provide your own cooking oil (usually olive), salt, pepper, and water. Most items are premeasured, but you do have to do some prep work (chopping, slicing, dicing etc). It prices out to $10 per person per meal. While this is cost-prohibitive for some people (I can certainly whip up less expensive meals myself), it is unlikely I can have a set of recipes as varied as what Blue Apron provides. Discovering new vegetables, herbs, grains, and foods from other regions is invaluable. You learn to make things like salad dressings and pickles from scratch (with much fewer ingredients and preservatives!). It never feels boring to eat these meals. I can control the oil and sodium content of the food.  And since I grocery shop much less, I spend less on overall by not picking up extraneous items. I also don’t waste bulk ingredients for a specific type of cuisine that I might only make once. This service also eliminates my personal pet peeve, which is the “oops, I forgot to pick up an ingredient” emergency in the middle of cooking.

Blue Apron 1

Blue Apron 2

Can a system like this – at a lower price point – be an answer to food deserts across America? Food deserts are areas where people have limited access to fresh produce due to financial and/or geographical reasons. There has been a push (as part of First Lady Michelle Obama’s Let’s Move! Campaign) to try to engage Americans in healthier eating, with grocery stores being set up in such food deserts to make healthier items more accessible to residents in these areas. The results, however, have been disappointing. Reports state that the people living in those communities were more aware of the new store, but they never actually changed their purchasing or eating habits. Seattle, where I live, is the complete opposite of a food desert, yet some of my patients [and myself when I was younger and much less aware] seem to virtually live in one.  It might be due to cost, ethnic/familial culture, lack of time, or habit. I recently went to a cooking class where everyone in the group other than myself did not cook much. Though they had been to a few cooking classes, they never reproduced the dishes they learned. Perhaps a food delivery service like Blue Apron might provide the missing piece for healthy eating in food deserts and elsewhere by bringing the produce and the instructions to the individual.

Another plus with Blue Apron: you can engage your kids in healthy eating, too. The glossy handout with bright pictures is a great way to have kids go on a “treasure hunt” for different ingredients. They are naturally drawn to the little packages and surprise treasures in the box. They will learn about different foods along with you, and, if you include them in the process, you can draw them into eating foods they have never seen before, starting them on a lifetime of food exploration and awareness and less food anxiety than we have been experiencing in our current generation.

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A few notes: 

While there are more food delivery services (like Plated), I haven’t tried them, so I have limited this piece to my experience with Blue Apron.

Be aware that if you have dietary restrictions or preferences, food delivery services may accommodate some but not all restrictions. If your doctor has placed you on a specific kind of diet, this type of service may not be right for you.

If you do want to try your hand at using Blue Apron, there is a fair amount of chopping and peeling involved. Taking a knife skills class can help you be safer and more efficient in the kitchen.

Also, I found that I prefer to eat more vegetables in a meal than what is provided with Blue Apron, so I occasionally supplement with vegetables procured from my local farmers market (a great thing to do in the summer). I could also sign up for vegetarian meals on the service, as a solution.  

 

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International Women’s Day 2014 in one single picture

International Women's Day 2014 in one single picture

Photo taken by Julie Smolyansky at Nakivale Refugee Settlement in Uganda.
(If you care about the issues of women and girls in the U.S. and around the world and are not yet following Julie Smolyansky, you should. She is an inspiring voice and role model.)

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You’ve Come a Long Way, Baby

50th Anniversary of the Surgeon General's Report on Smoking and Health

Yesterday marked the 50th anniversary of the landmark Surgeon General’s report on smoking and health. It really wasn’t that long ago that smoking was a way of life. As the author points out in this piece on why people smoke, even doctors had cigarettes in their mouth while examining patients back then. The Surgeon General himself, Dr. Luther Terry, was a smoker until a few months before he made his speech in 1964. And for something so deeply ingrained into the culture, so addictive, and a major part of the economy – the report was given on a Saturday in fear of a negative stock market response – we really have seen a remarkable decline in smoking.

The antismoking campaign is a major public health success with few parallels in the history of public health. It is being accomplished despite the addictive nature of tobacco and the powerful economic forces promoting its use.

-          CDC

We now have a better understanding how diffusely tobacco affects the body. People who smoke are at higher risk of everything we worry about getting: cancer, heart attack, stroke, vascular problems leading to leg amputation, and looking older. I see many adult children of smokers who have never smoked, deterred by their parents’ habit. But many children and young adults continue to experiment with smoking, often thinking that they can quit anytime. Unfortunately, smoking continues to be glorified in other settings. Hollywood practically gives them away, somewhat reminiscent of cigarettes being provided to US soldiers in the past.

We’ve come a long way, but we’ve got more work to do.

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It was a quiet year….

Two Thousand Thirteen was a quiet year for my blog. But it was a busy year of doctoring with 10-12 hours in clinic most days, an additional 2-3 at night, plus a few hours on most weekends. [We can analyze why over a drink sometime]. Of many sacrifices a full-time primary care practice necessitates, blogging was one of them. Also falling victim to the work schedule were guitar lessons, dinners with friends, and medical conferences I had planned to attend. Reading? Shopping? All of those seemed like luxuries. I missed writing on this blog, which was a nice way for me to reflect on this complex world of medicine.

However, in 2013, I did continue to work out regularly (for my own sanity, and – yes – I think of this as an achievement considering my schedule) and I wrote regularly for the Seattle Times as a columnist for the On Health section of the paper. I continued my position as a committee member with the Women in Medicine group of the Washington Chapter of American College of Physicians, and we hosted various increasingly successful events during the year. I continued to serve as an advisory board member for an IT company, learning more about the complexities of IT systems, networking, and EHRs. I mostly listened on Twitter, often inspired to write posts, but lacked the time and energy to put my best work into it. However, it was wonderful to keep up with some of writing of some of the colleagues I admire. And the best part of 2013 was that I had the honor of having one of my pieces published in a book (more on that in a future post).

We are fully into 2014 and New Years’ Day already feels like it was long ago. My schedule has not changed, but there is one thing I know for sure – this year won’t be so quiet for my blog.

Posted in General Musings, Primary Care, Social Media, Work-Life Balance | Tagged , , , , , , , , | Leave a comment

The Pursuit of Mastery in the Worlds of Medicine and Wine

SOMM movieMedical school becomes a blur after a few years in practice. You forget about all the hours spent in classrooms and then every night after a quick dinner. You somehow block out the “pimping” [There is a nice explanation on what this word means in medical school here] and public humiliation of being questioned about topics not quite under your belt. The worst feeling? The fear of wondering if you will master medicine enough to do no harm.

Medical training is, quite frankly, a brutal process that can make or break a person. Your every fear can come up during this process. It’s not enough to pass tests or to know the Krebs cycle. It takes physical and mental resilience to get through seven-plus years of intense training and learning. Then, imagine being a partner to someone going through this. The partner will always be secondary to the subject of study. And it almost has to be be that way… for a time. Missed birthdays and weddings…. Late nights studying with fellow students or your assigned cadaver…. Fictional television shows about doctors-in-training often focus on casual sexual relationships or budding romances. But in real life, I’ve seen marriages dissolve and people have nervous breakdowns under the stress, as well.

I had forgotten about all these details, anyway, until I recently watched Somm, a documentary about four men trying to pass the Master Sommelier exam. What is a Master Sommelier (MS)? See below (from website):

Cour of Master Sommeliers

I was completely engrossed in the personalities of the candidates for the MS exam. While it may seem to have very little to do with medicine, I couldn’t help but see my medical student self (and former classmates) in these young men. If you’ve ever been a medical student or lived, breathed, and ate a specific topic for a specific goal, all the while foregoing sleep and relationships, you might relate to this movie. (Insert artist, musician, scientist, etc. here).  The marathon-like effort rewards a few, though many try. There are currently only 135 Master Sommeliers in North America and 19 of them are women. There have been 214 worldwide who have been given the title of Master Sommelier since the exam’s creation.

After you watch Somm, you realize drinking wine is clearly only one tiny part of becoming an MS. Many people have some knowledge about wine or medicine. But mastering these fields involves intense study to quickly calculate and retrieve applicable and accurate information. It also takes a certain amount of competitiveness, observed one of the MS candidates in the documentary who was formerly a baseball player, to attempt to pass “a test with one of the lowest pass rates in the world.” Even some of the terms they use to describe aspects of a wine’s taste or smell (“a freshly opened can of tennis balls”), while seemingly completely bizarre, are reminiscent of some of the unusual analogies we use to characterize various things in medicine. “Ground glass” on a CAT scan of the lung, for example, is not ground glass, but it is the best way to describe something and recognize it quickly.

If you’re curious about the world of wine, what it takes to be an MS, or the psychology of the pursuit of mastery of a subject, I would recommend watching Somm. Though the documentary is a little drawn out, it is not particularly long and you look forward to the ending to find out if any of them passed the test. 

Interestingly, at a recent dinner I had the opportunity to speak with an MS who was working at the restaurant. Everyone at our table had just seen the movie the previous night and we queried him about his experience studying for and taking the MS exam. He did corroborate that it was an intense period of study to learn all the minutiae and details about wine. He reflected that it was all about “the hunt” (to pass the exam). However, he said that in the end, after you pass, “fifty percent is about people skills.”

True in wine as it is in medicine.

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(*please note that original version of this post stated there were 135 Master Sommeliers. To clarify, there are 135 in North America and just over 200 worldwide.)

Posted in Film, Medical Education, Medicine and the Arts, Not Medical...Or Is It?, On the Lighter Side | Tagged , , , , , | Leave a comment

Social Media Encourages Initiators in Medicine

Funny how the blogosphere echoes some of the thoughts that have been incubating in my own mind… A few posts have caught my eye recently. One that I have been meaning to comment on was Dr. Vartabedian’s piece “Do You Initiate or Respond?” which characterizes physicians, in general, as trained responders rather than initiators [give it a look, it’s a quick read].

I had myself been concurrently pondering the same idea (though classifying it as reactive versus proactive in my own mind, but we mean the same thing). As Dr. V points out, doctors are reflexive and very much good at it.  We are nimble thinkers on our feet when faced with problems, calculating a large number of variables to try solve problems in -let’s face it- a very short period of time, all the while doing our best to navigate through a myriad of emotions along the way. The importance of this notwithstanding, I wonder if immense talent is being untapped when leadership (aside from hospital/clinic administrative roles) and innovation is not instilled, honed, or even valued from the start of medical education to the end of one’s career.

After all, how much can one learn about leadership when working essentially in isolation (particularly in the outpatient setting) and with a compensation system that rewards “doers” more than “thinkers”? Sure, doctors can work effectively with their medical team and with patients. But the creative energy and solutions that can come from putting some of the brightest minds – ones who work on the frontlines of medicine – together to really tend to the larger problems in healthcare has been sorely missing.

Physicians who blog or create content online are Initiators, and their passion for innovation can awaken the creative part of the mind that has been quieted by the noise of daily clinical work. (If you tell me that part of your mind does not exist, you really have not gotten your head out of the charts for some time). And this is why I keep coming back to social media despite the growth of my full-time practice and its demands for my time. When used more as a learning tool rather than an advertising tool, social media can do more to teach a doctor about leadership and initiation than can a lifetime of working in a clinic or hospital.

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Difficult Interactions in Medicine: Lessons to be learned from the food service industry?

She sat in her crisp, white coat, probably not much older than I am now, leaning back with all of the assurance of someone who recently completed a cardiology fellowship, newly hired by the academic medical center to which I was applying for residency. One of the first of many interviews for me, the conversation was anything but smooth. She clearly wasn’t sold on me. To remain genuine and avoid canned responses, I never bothered to research popular interview questions. Unfortunately, that also explains why I fumbled a little bit when answering “What three people who are not alive would you like to meet?” 

I had just about given up on getting a good review from my interviewer, especially considering that she had already met some of my brilliant classmates whose parents worked for the same institution. But she had one more question for me. “So,” she said, twisting her chair to the left with her arms crossed, looking at me a little sideways. “What makes you think you would make a good doctor? What have you done in the past that makes you think you would be a good physician?”

My answer was ready…and not because it was rehearsed. It wasn’t the volunteering in nursing homes and Habitat for Humanity. It wasn’t the good grades. It wasn’t even because I was a caregiver at one point or because I had spent countless hours in labs.

 “Waitressing, actually.” I said this without hesitation and with an even tone. “I learned a lot by interacting and talking with customers.” I knew I was taking a chance with this seemingly unsophisticated response, but I didn’t seem to have much to lose at this point.

“You know,” she said, looking surprised, suddenly animated, and mildly… exasperated? She turned to face me square on now. “My best friend keeps telling me the same thing. I don’t get it, but she keeps telling me that it’s true.”

And then the ambience changed.

***

This having been my – paraphrased – experience years ago, I could not ignore a recent article entitled: “Do Starbucks Employees Have More Intelligence than Your Physician?

The short answer is: Yes… and No, of course.

Articles like this paint a sharp caricature of the emotionally “unintelligent” physician. Here, Dr. Peter Ubel points out that Starbucks employees “undergo rigorous training in how to recognize and respond to customer needs,” and he describes the Starbucks solution for dealing with unpleasant interactions, called the “Latte Method” (listening, acknowledging, taking action, thanking, and explaining).  He contrasts this with the physician whose nose is buried in labs, insensitive to the emotional needs of his patient.

Needless to say, a barista’s work and a physician’s work are not quite the same. A negative interaction within a doctor-patient environment is less like one in a food service industry and probably more similar to one experienced, say, by an airline customer service representative and a customer who finds himself unexpectedly stranded after his flight is cancelled, trying to get home in time for his mother’s funeral. (A free coffee rarely solves this sort of problem.) The intensity of emotions tends to be quite high, the variables are many, and there can be a certain level of uncertainty that is uncomfortable for both parties involved. AND, there are multiple other people waiting in line with other high-intensity needs. There are certainly some doctors who seem oblivious to the emotional state of their patients. But there may be other factors, as well. For example, a burned out physician will find it difficult to empathize, and physicians who are essentially running on hamster wheels may feel too pressed for time to address complaints effectively. That being said, I happen to like the “Latte Method” described in the Forbes piece, as it can be applied to various aspects of our personal lives and across different industries.

A lot more work should be done in early medical training to help future doctors acknowledge and effectively deal with the unpleasant interactions between doctor and patient. Out of training now for some years, I was interested to hear about a group called The Balint Group, which focuses on exploring the doctor-patient relationship. Our clinic, The Polyclinic, has a Balint Group, so I decided to join and explore this subject some more. In this group, the meeting begins with one physician presenting a recent difficult or uncomfortable interaction. The rest of the physicians then discuss it by exploring both sides: what it must be like to be the doctor and what it might be like to be the patient in the case. It is very non-judgmental and not meant to be a problem-solving session. While many times there is no one right answer, the mere act of thinking about and discussing this topic can help improve interactions during the regular workday. I would recommend The Balint Group to any physician with an interest in the doctor-patient interaction.

Perhaps Dr. Ubel is on to something when he suggests that Starbucks employees have more emotional intelligence than physicians. Until these goggles that help detect facial cues become available and universally accepted, doctors will have to rely on their own radars, which may be fine-tuned with some more training. While I am not sure I could survive the Starbucks pace at this point, I did sign up some time ago to be a volunteer server for a local culinary and job training and placement program called FareStart. Who knows? I may come back a better doctor for it. 

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