Tomorrow

On November 26, 2013 I arrived in the city of Saskatoon in the province Saskatchewan, Canada.  It was close to midnight when I passed through security.  The agent looked at my passport and asked about my business in Canada.  I told her I was speaking at the university.  She asked for proof.  I was taken aback as I have never had to prove what I was doing before on a speaking engagement.  I responded, “Are you asking to see my speaker’s contract?” She smiled a tight smile and said, “Yes, unless you want to come with me to the back office.”  Fortunately, I print out my speaker’s contracts and take them with me on trips.  So I handed over the correct papers.

Then she noticed I had declared that I had tools with me.  She asked what type of tools.  I responded paintbrushes, as I am an artist. She looked at me. 

“I thought you were a speaker, “ she said.  I said, “I am both.”  She asked if I would paint while in Canada.” I told her yes.  She then said, “You won’t be leaving any paintings in this country will you?”  I responded,  “No.” I usually leave paintings where I create them; but I could see discretion was the better part of valor in this situation.

So now it is February and I am preparing to mail a painting to the Academic Health Sciences Network at the College of Health Sciences in Saskatoon.  My contact asked me to explain the painting entitled: “Tomorrow.”

At most venues, I get to listen to other speakers and I paint about their words and the thoughts of the audience members.  At this event it was a pre-conference day and I was the only speaker.  So I set up in the hallway outside of the university library.  I began to paint on a gallery jacket to bide my time until the students spoke to me.   After painting for a while in silence, the custodial staff came over.  They asked some great questions and I told them about patient empowerment.  The students mostly walked by. They occasionally shared shy smiles and quickly averted their eyes. 

I have painted in pathways and hallways in South Korea, the United States and Australia.  It usually takes folks a while to walk up and start asking questions.  In Saskatoon, I spent most of my hours in the hallway alone.

So I painted the hallway.  I painted it with rapid brushstrokes as though life itself is zipping by.  I painted the snowy expanse outside.  There is little difference between the snowy ground and snowy sky.  I painted myself painting. 

Then I added the janitor who spoke to me.  He stands indistinct with one hand clenched and the other holding a mop.

Finally, I added the scholar behind me diploma in hand. She stands where I cannot see her.  The wind of the corridor whips at her hair and robe.  Her cap has been blown away. She firmly grasps her diploma high above her head, as if to say: “My eye was on the prize. I never lost sight of the goal.”

The scholar is based upon the twitter stream.

I tweeted my dismay that no one was stopping to talk to me.  One student tweeted back saying I should not judge so harshly.  She had seen me painting but did not want to interrupt.

I later spoke before a room filled with students and faculty.  Many people tweeted to the hashtag #sahsn13 that day, quite a few were professors, medical providers and patient advocates.  I even got to see a dear twitter friend @bonnycastle live tweet in person. Thanks to @symplur you can still see those tweets.  I looked up all the handles that were tweeting and it looks like only two students tweeted to the hashtag.  Only two students shared their thoughts publically with wider world during this opportunity.

So if this painting can tell you one thing let it be: Please interrupt!  Please speak out to the world that wants to speak with you.  Please set aside raised hands and patient waiting and embrace your voice.  Life is passing by so quickly.

Before you know it, it will be Tomorrow. 

Spinning the Message

Imagine a society where your device is never far from your hand.  No matter how important you are or how low, you never go out socially without your technology.   The line between work and personal life  is hopelessly blurred. You cannot even take your kids to the park without pulling out your device and following the most recent thread.  Does this sound like our wired society in 2013?

Well, I am actually describing the world of the average woman in the Middle Ages.  Back then every woman, regardless of age or rank, was expected to fill their day with meaningful work.  So each woman would carry their spindle and distaff  (also called a rock) with them to social occasions.  Sometimes they would even gather for this purpose and it was called “a rocking” I guess the modern equivalent of that would be a “tweet-up.” It was a constant frenzy of thread creation. 

But there were times that it was considered appropriate to put down the spindle and focus on friends, family and spiritual well being.  People would “unplug” (Or would that be unlace?) during the 12 days of Christmas. 

I don’t know about you, but I see a pronounced absence of social media voices during the holidays.  Other than the occasional status update or twitter competition most folks are MIA from December 25 to January 6^th.  Perhaps that is exactly the way it should be.  Perhaps the holidays are time focus on family and friends and spin stories rather than messages in the media.

But today is January 7, Distaff Day.  Today we pick up our devices once more and we will spin the threads that will make this year.  Those threads will form the weft and warp of healthcare policy. 

2013 will be an amazing year in healthcare and patients must be in the forefront of creating that message.  I look forward to following your threads.









                                                      Photo courtesy of Ted Eytan

The Sleeper

A couple weeks ago, I was listening to NPR and was amazed.  Well, I am often amazed listening to NPR, but this was in reference to a specific program.  It was Science Friday, the reputable Science Friday and they were discussing crustal displacement theory.  

My late husband Fred and I were introduced to the theory through the book Fingerprints of the Gods in 1995.  This was a really edgy theory proposed by  Charles H. Hapgood.  Charles even shared his theory with Albert Einstien in the 1950’s and received his support.  Earth crust displacement theory was considered rather odd by much of the scientific establishment.  Unlike plate tectonic theory, the gradual movement of the continents, crustal displacement theory supposes that dramatic sudden shifts can occur.  Imagine if you will, the sections of an orange floating loose within its peel.  Imagine that peel suddenly shifting 155 degrees around.  That would be a polar shift.  Landmasses would be in completely new latitudes.  Antarctica could be temperate.

It was an fantastic theory almost 20 years ago when I first heard about it and I was amazed to hear it had garnered enough scientific interest in the years hence to be debated in the mainstream scientific press.  For many years, it had seemed that people were far more comfortable with the incremental change of plate tectonics than the rapid change in perspective required for understanding a polar shift.

I thought crustal displacement theory could easily be applied to the world of health care.  For many years the world of medicine was a slow world of focus groups and command and control.  But then social media came and the picture began to change rapidly. 

Social Media is the reason I know Emily Hackel.  She lives in New York and works for Edelman, a global marketing and public relations agency.  I met her initially through Twitter.  I met her later in real life and she is a vibrant soul who lights up with intensity as she discusses health care.   

She just joined the Walking Gallery and her jacket is  “The Sleeper.”

I named it thus, because in this painting Emily holds the world dangling on a string.  Here is the moment of tension; here is the yoyo move known as the sleeper.  It is that moment of taunt suspense before the next move begins and the world spins and shifts upon it axis.   Upon this yoyo world the continents are covered with well-known social media sites and the oceans flow with Twitter birds.

When my sister was in high school she wrote an original oratory “Life is like a yoyo, it has its ups and downs.”  I thought about that speech as I painted this.  In our fast world of social media, I see those ups and downs on a daily basis.  I see a world that is very rapidly changing.  Ideas and individuals that were considered too edgy are rapidly becoming mainstream.

I am glad to know amazing young women like Emily.  I would have never met her without Twitter and its currents.  I am glad she lives in time where she can talk about polar shifts and our changing world and be taken seriously. 

NeuCare

When I was little I cherished my Golden Books.  I loved their compact shape and brightly colored pages.  I would run my fingers over the shimmering gold covered spine of the book.  I would beg my Mother to read it one more time.  

We did not buy many children's books; we could not afford them.  But upon occasion, I would see the Golden Books display in the grocery store.  I would plead with my Mother, 'Please could we get one?"  She would look down at me with her warm brown eyes and smile a half-smile.  I would grasp the book with my pudgy hands filled with anticipation while standing bare-foot on the cool gritty grocery store floor.  And she would say, "Yes."  That night she would read to my sister and me and we would cuddle against her. 

That is what Golden Books meant to me: approachable, affordable and accessible to families.  So when I met Dr. Ryan Neuhofel via the internet and heard about the amazing things he was doing in Lawrence, Kansas I painted his jacket with Golden Books forefront in my mind.  

 

Ryan had opened offices using a model often referred to as Concierge Medicine or Direct Primary Care. Now, I know when a lot of folks hear concierge medicine they think of huge upfront retainer fees, brass door handles, marble floors and fine buildings.  When I hear the word concierge, I think of the kind hard working folks in an apartment building like mine. I recall all the years when I lived in buildings without a concierge.  I remember what it felt like to fend for ourselves, while the hall flooded, the bugs came or packages were returned since no one was home.  

My vision of concierge is defined by a sense of pragmatic appreciation, but my son's vision is defined by the bellman's cart.  One of the cooler features of living in a building with a concierge is access to a bellman's cart to unload deliveries.  We would check out the cart and our son would ride with great joy.  That image, in part inspired this painting.  This is Ryan's Jacket and it focuses on NeuCare his family practice.   It is a vintage jacket and represents a time when house calls were part of life.

 

In this painting the sky is partially night and partially day.  A moon with the face of a clock fills the horizon symbolizing 24hr care.  To the far right in the background a home is upon the hill, because Dr. Neu makes house calls.  From that house a road winds down into the foreground.  Upon the path a group of children are walking along pushing and pulling a bellman’s cart crossed with a little red wagon.  

One of these children is a young doctor Ryan he looks with interest at an Ipad screen his patient is showing him.  Dr. Neu has an amazing social media presence using Youtube, facebook and twitter with equal competence and joy.  The website he built for Neucare has clear and affordable upfront pricing that offers a safety net for so many Lawrence citizens in need of care. 

Perched on the cart a young Mrs. Andi Neuhofel holds a pharmacist cup and pestle, as she is the pharmacist at Neucare.  Pushing the cart from behind a young boy clasps a few bills in hands as he pushes the cart along.  This is the money he has been saving while still accessing the care he needs.

On the weekend of September 21-23 Ryan and Andi took time from the busy practice and their young children, and participated in the Partnership with Patients Summit.  Dr. Neu’s speech on Doctors in Social Media was one of the most popular speeches at the summit.  Lawrence Kansas is lucking to have this fine young doctor who cares so much about the health of his patients, physically, emotionally and financially.

Thank you Ryan for putting all your energy into creating a care model that is accessible to all and in my mind sparkles just as much as the Golden Books of my youth.

Inside the Mirror

When I was young, I had a compulsion to find out how things worked.  This usually led to creative destruction.  I know exactly how a music box works because I dismantled my jewelry box, tossing out the painted paste board, velveteen lining and plastic ballerina. 

The important part was inside.  I loved the little brass machine that wound with a key.  I loved to listen to the metallic plinks as the metal keys were forced upon the raised nodules of the rotating barrel.  I cherished the simple elegance hidden for years by the bulky form of the jewelry box.  It was liberating.      

But my deconstruction did not stop with the music box.  I also wanted to see inside a mirror.  Mirrors were amazing things that created a world in reverse. One day I ripped the brown paper backing off of my mirror.  Then I scraped at the black paint on the back of the glass.  My scraping revealed a silver expanse.  I scraped at that layer and reached clear transparent glass.  

I was disappointed.  I could not see inside the mirror.  I could not see that most amazing space between the darkness and the glass.  I knew that was where the magic happened.  I knew another world lived inside the glass. 

Have you met Melinda Watman?  She knows it feels to be between worlds and stuck within the looking glass.



This is her jacket "Inside the Mirror."  

In this painting there are two Melinda's.  There is the Melinda buried within folds of flesh and the Melinda that lived inside the looking glass.  Inside the darkened glass a thin healthy Melinda waited.  She waited to get out.  She waited for the year to pass and the time to come when the worlds would reverse.  

Melinda spent years trying unsuccessfully to reach her goal weight.  She then began to research bariatric surgery.  She had a background in nursing, but she wanted to be aware of all the ramifications of her decision. She dove into social media and discussed her options on chat boards.  During her research she was amazed that there were few unbiased sites that would discuss the pros and cons of surgery.



Melinda is now the woman who once was tapped within the glass.  Her body is lean and healthy, as is her mind.  She has since founded a company called BSCG (Bariatric Surgery Consulting Group.)   She hopes to help others come to a decision about what is the right choice for them.  

Welcome to the Gallery Melinda.

Media and the Message

Regina. 

That is my name.  I have known why it is my name since I was a small child.  It is etched within my mind beside my childhood prayer: “Now I lay me down to sleep, I pray thee Lord, My soul to keep.  If I should die before I wake… “

I am named after my great Aunt Regina Roggow.  She died in 1906 when she was only 5 years old.  She shares a grave with her little brother Erwin who was only three.  They died of Scarlett Fever.  If you are parent, you might have gotten those little slips of paper that warn of an instance of strep throat in the classroom.  After getting the note you probably watched your child more closely and perhaps made a trip to your local doctor to pick up some antibiotics. 

My great grandparents did not pick up antibiotics; there were none to be had, instead they picked out a headstone. 

When I was a child, I would visit this small grave on the wind swept prairie of Oklahoma.  I would grasp plastic grave flowers in my pudgy fist.  I would step carefully through stickers and cockleburs that would catch upon my ankle socks.  I would walk towards the back of the cemetery to the children’s section.  I want you to think about that.  The children’s section.  So many children died back then they had their own space.  Here the tombstones were smaller and often depicted lambs.  I would kneel at Regina’s grave and press the flower deep into the red dirt.  I would cry for a child I had never met.

When began I visiting Regina’s grave she had already been dead for over 70 years.  It was hard to read her name on the weathered granite.  I would trace the indentations with my little finger.  The years passed. I grew and Regina’s name faded.  Recently my Aunt Minnie asked the folks at Pellow Monument Works in Enid Oklahoma if they could do anything to improve the text on the grave monument. Aunt Minnie wanted the visitors to be able read the stone.  The Pellow team said they could.  The painted it with black lithochrome and then re-sanded the granite to its original tone.

Now its message is crisp and clear. Regina has monument on the prairie in Oklahoma.  Now due to this post, she will have one online as well. 

When I speak, I speak for children like Regina and I speak for men like my late husband Fred Holliday.  I, like many who work within patient advocacy, want to make sure our loved ones did not die in vain.  We want the world to remember them, and through telling their stories effect great and positive change.

Sometimes due to our personal sorrow or anger our messages are not clear or can be off-putting.  Sometimes due to inexperience we will say things that are considered rude within the world of social media.

I am writing this post to address the etiquette and protocol within social media as it applies to advocates and the communities to which they post.

Advocating from sixth stage of grief.   You probably know about the five stages of grief: denial, anger, bargaining, depression and acceptance.  A good friend of mine named Trisha Torrey wrote about the sixth stage of grief calling it Proactive Survivorship.  Proactive survivors have gone through the five stages of grief and want to help others.  They still remember their sorrow and anger, but they do not let these emotions control their advocacy or cloud their message.  They have replaced blame with hope and their story is not tragedy; it is triumph.  These advocates are often the most effective.

Some advocates are still actively experiencing anger and depression.  It is hard for them to hear the joy and success of their counterparts.  Often these two groups will be at odds with each other.  Please take a deep breath when you post to other members of the social media community.  We all have experienced suffering; we all have a reason for being here.  We may just be at different stages of the journey.

The smiley face is your friend.  In tweets or in facebook comments there is not a lot of time for nuance.  If you say something quickly and think it can be taken in a negative way the simple emoticon J can do much to eliminate ruffled feathers.

Don’t spam your friends. When you have a new link or post that you are excited about do not cut and paste it repeatedly in every forum or group.  Sometimes the post is of extreme importance with a limited window of action ie; public comment period is almost over, tweetchat is tonight or a reporter is looking for content relevant to a dead lining story. We will understand a deluge then.  Rather than over-posting, posting it where it is most appropriate, then tailoring your message to the group will help with spread.  If you become known as an advocate that spams multiple groups with the same post, your messages may become synonymous to white noise and disregarded.

Everything in Moderation. Do not attack a advocate personally for their thoughts on a subject.  We are all working toward a common cause of improving the patient experience. Try to be civil in your debate.  If you are concerned about comments directed to you in a public forum, contact the poster privately if possible.  If that is not possible, contact the moderator or admin.  They can remove inappropriate comments.  Know that certain types of comments can result in an advocate being blocked from a site.  It is important that list serves and facebook groups be safe places where people feel comfortable speaking truthfully and with respect.  Group membership will decline if the space feels like the Wild West.  I have seen too many groups loose valuable membership because of poor self-moderation of comments.

Know your social media platform

Twitter is a caused based platform.  In twitter we use hastags: #hcsm (healthcare social media) or #ptsafety(patient safety) to follow concepts or chat sessions.  This is usually done in a very public way and most accounts are open.  The stream of comments can be searched through google and those who tweet should know that their writing could be seen by anyone.  On twitter you can follow people who do not follow you back.  You can comment to them directly by posting in the public stream.  If you wish to say something privately you can send them a direct message if they can follow you back.  Direct messages are like short private emails between two people.

Facebook is a wonderful tool for finding people.  This platform is more closed.  I have never been able to find a facebook comment during a google search, though I can find the person and their interests.  In facebook, you can communicate by including a friend’s name within your post and it will appear publically on your wall as well as their own.  This is a good tool if you know this person well and know the message is very much inline with their life and mission.  If you think it might not reflect their worldview it is not considered appropriate to post it on their wall.  If you wish to say something privately a facebook message is used.  A message can be between two or more individuals but is not a public form of communication.  Copying the text contained in a message and sharing it without permission is considered a breach of trust.  Please always ask permission before sharing private messages with other people.

Your blog is your voice.  The blog is an amazing tool.  Here your can explain your stance in patient advocacy in great detail.  Unlike a website, it is rarely static and very easy to update.  You can post links to your blog on both twitter and facebook.  A lot of misunderstanding occurs online when you do not have the space to explain yourself in full.  A blog can give you the time and space to be clear and if you enable comments you will get questions directly.  Enabling comments will also help you to understand the hard job of moderating comments, a challenge that facebook administrators are well aware of.  Empathy is a good and valid teacher.

Writing in all capitols in twitter or Facebook is perceived as screaming or yelling in this space.  If you served in the military you may have written in all caps for clarity, but online this can be very off-putting.  It often reflects badly upon the person who posts in such a way.  There are many who will not read what you have to say when you do this, so do it rarely, choosing a word or two for special emphasis.

It may be called SoMe, but it is really about us!  In social media it is crucial to listen and share.  Talking and posting is important, but this relationship works because of give and take.   It can be very off-putting to other advocates if we post constantly about our own cause without focusing on and sharing the content of other speakers in this space.  It is very important to network our messages with other advocates, providers and thought leaders.  Look at the places you comment.  If you are constantly redirecting everyone to your own site and campaign, you are monopolizing the conversation. 

You are creating a monument to those you loved.   Remember all that you say in the world of Social Media reflects back on you.  It reflects back on your loved ones as well.   There are often times I wish to “blow a gasket” in this space.  And as you well know, I have, but this too with moderation.  Do not become a flamer, for flames breed fire and fire consumes all. 

When I die, I would like my body to be donated to science or burned.  I do not want a gravestone. If my family or friends wish to visit a grave they should visit little Regina Roggow’s grave.   She died too soon and I hope in some small way I have lived for her.  The only monument I will ever need is already being inscribed. It is crowd sourced and is the product of social media.  You can find it in the google search field by typing Regina Holliday artist.

Remember when you post online you too are building your monument or marker in this mortal coil, do so honestly and with dignity.

These were just a few thoughts upon this subject.  I am a big believer in crowd sourcing so please feel free to comment in the comment field to further expound upon protocol in patient advocate social media.

Dance With Us

I must admit, I met her on twitter and thought she was named for a bird.  My dyslectic mind inserted an “R” where there was naught, and @healthcarewen became @healthcarewren.  I thought I saw her fly as a diminutive creature across the channels of social media from hashtag to hashtag from conference to conference.  I wondered how she stayed so in touch on twitter as I soon found out @Healthcarewen was Wen Dombrowski, MD a physician focused on joy within elder care.

After meeting her in person at HIMSS12, I realized my initial vision of her was not far off the mark.  Wen is slight and when I hugged her I could feel her fragile bones.  Her thoughts flew high at HIMSS12 and she was often re-tweeted at that event.  Do you know the simple wren is often called the king of the birds?  In a tale that was told in ancient times, all the birds had a contest to see who could fly the highest.  The magnificent eagle outpaced all those below.  As he reached the height of his endurance and prepared to turn back, a little wren burst forth from his plumage and soared above to the highest height.  It was such a smart and clever little wren.

Wen uses a similar strategy to engage deeply within healthcare social media.  She attends every public health event she can; when an event is private and costly she tries for scholarship or entry as a blogger.  Any conference that turns down Wen does so to their detriment, for her voice is great and mighty in this space.  Sometimes when Wen cannot attend in person, she still makes her presence known by tweeting based on comments and providing a more astute summation than those who actually attended the conference.

Wrens are famous not only for their kingly status, but the complicated lyrical melodies they sing.  I am so glad Wen has joined us in the Walking Gallery for Wen does all her amazing outreach within social media, while asking only one thing in return: dance with us.  You see Wen works constantly with senior populations and she sees the joy that music and dance bring into their life.  This is Wen Dombrowski’s Jacket: “Dance with Us.”

In this painting two patients dance with Wen.  The patients are woman in their golden years, and for them that phrase is not a euphemism for the aged.  Both women relish in the dance, thinking not of wrinkled flesh and rocking chairs.  Instead, the rhythm guides them, their eyes and minds sparkle with light. They will dance as long as they can, and when balance fails and they can dance no longer, the music will still excite and they will hum and sway in their joy of the song.

I recently had the honor of hearing a presentation on dementia at my local hospice.  The speaker Mary McDonald, MD was amazing.  She explained our declining years in relation to the beginning.  Life is lived in reverse; milestones once reached now topple down in a domino cascade of loss.  We cannot dance, we cannot stand, we cannot eat solids; and so it goes until we near an end that mimics the beginning.

When we are born we must breathe, suck and swallow.  We must have these skills to live.  These purely functional skills are accompanied by something else.  Within moments of being born we are embraced.  Our parent’s arms encircle us as they hum and sing a lullaby.

We enter this world surrounded by joyful song and music. Thanks to doctors like Wen we will enjoy our golden years surrounded by music. 

Who taught you how to be a patient?

On a recent Saturday my son Isaac, Ben Merrion and I filmed a short video about Electronic Medical Records.  Our video was called "Your Medical Record Follows You."  You can vote in favor of it here.



It is part of the "What's in Your Health Record? Video Challenge" from Challenge.gov  There are many videos that were submitted and they address the need for patient medical record access.  This is a cause which is near and dear to my heart.  I urge you to peruse the videos listed.

Our video was about a very special day last year when Isaac and I went to a local clinic to get his eye checked for pink eye.  The clinic was DC Immediate and Primary Care.  I was amazed when we entered the facility.  The receptionist handed my five year-old son a netbook and asked him to begin building his electronic medical record profile.

I was so happy!  I speak about the empowered patient at venues nationwide, but now it was happening right in front of me.

Isaac filled out what he could and I did the rest.  We submitted his profile online using WiFi.  Then Isaac settled into his chair and began researching snakes on YouTube.



Soon it was time to be seen by the doctor.  Isaac carried the netbook into the appointment.  The doctor checked his eyes then we googled "Conjunctivitis" and talked about his condition.



Isaac and I left very happy about his experience.  A couple of months later we went to his regular check  up at Kaiser Permanente.  Isaac sat impatiently on the examination table as his doctor typed information into his medical record.  After answering a few of her questions, Isaac jumped down off the table, walked over to her keyboard and asked her, "When is it my turn?"



Before Isaac and I created a video about this story, I painted a Walking Gallery jacket about it. Here my son Isaac is holding the netbook we used at DC Immediate and Primary Care surrounded by classic toys.

Now, when he plays doctor he expects to see a computer or tablet being used. This made me think of how we teach our children to become empowered patients. Do you remember playing with your Fisher Price hospital? Did you play more with the doctor or the patient? Was the care a balanced partnership? Playing Operation as youngster gave me the impression that surgery is a joke, medicine is about making a pile of money and avoid that buzzing alarm at all costs.  The toys we choose and how they are designed very much impacts the way our children relate with the world around them.  I want to see a doctor's kit with technology included, not a black satchel with an antiquated head mirror.

If you ask to see a toy cash register at Child's Play (the toy store I have worked in most of my adult life), I will show you a register with a working calculator and a pretend credit card function. I would never show you the 1970's Fisher Price cash register with side crank handle and mechanical bell. It is no longer available. Registers are not made like that anymore.  So, why does every doctor's kit I see look like it came right out of 1970? We can do better. We owe it to our children. I respect and revere our youth. They are so capable and flexible in their thinking.

We teach our children through play.  If you watch this video you will see Isaac pulling a little wooden toy dog.  It has a carry pouch on it that is labeled HealthIT.gov. Isaac the patient, pulls this dog along and it follows him. 

SOCIAL media JUSTICE

My husband Fred had a favorite story about John Ford, and Steven Spielberg told the tale. The story was an account of the day that Steven Spielberg met John Ford.

The story went something like this. Steven was really young and had been making a few super 8 movies and he had the opportunity to meet John Ford in his studio office. After waiting for about an hour, Mr. Ford came in and Steven Spielberg began to speak with him for a few moments. Mr. Ford said, “So, you want to be a picture maker.” John Ford then gestured at a series of pictures on the wall. He asked Steven to describe what he saw. Steven started to describe the Native Americans and objects within the picture. That was not what John Ford was looking for. “No, no, “ he said. “Where is the horizon?” Steven said that it was at the top of the frame. Mr. Ford asked Steven to describe the next picture. Again Steven began describing the Calvary and elements, and again Mr. Ford was frustrated. “No, no. Where is the horizon?” Steven looked and said, “It is at the very bottom of the painting.”

John Ford said “When you are able to distinguish the art of the horizon at the bottom of a frame or at the top, but not going right through the center of the frame, when you are able to appreciate why it is at the top and why it is at the bottom, you might be a pretty good picture maker. Now, get out of here.”

That is a great story and Fred would tell it to his college film students and I would tell it to my pre-k art students for years to come. I loved that story because it makes it very clear that the angle from which you view things has an effect on how you view things.

This idea was reinforced yesterday at Isaac’s follow-up doctor appointment at the new Kaiser Permanente building by Union Station. He was meeting with a Nutritionist and was sitting in the waiting room section for internal medicine. Within the space, a kiosk had been placed to go online free of charge. Isaac walked over. He was very excited to find an accessible computer, but was quite disappointed when he tried to use it. The angle of the screen was set and fixed at an upward facing position. Isaac tried to adjust it as he would at home on our Mac, but the screen would not budge. He walked away his shoulders slumped.

Isaac had just been placed at the bottom of the frame.

I thought of all these things in relation to the jacket I was creating for Andre Blackman. Andre can be found on twitter as @mindofandre . He writes and speaks about the power of new media, social media, health 2.0, public health, mobile health and disparities. He sees a new future where the old tools of public health 1.0 are discarded and the power of Health 2.0 embraced.

So, I painted a new vision for Andre, a lady Justice for our time. This is “SOCIAL media JUSTICE.”

In this painting, an African American woman stands proudly. In her right hand she holds the scales of justice and in her left a suckling babe. A halo of binary code encircles her head and she is wrapped round within a golden cloth. Twisting around and behind her is a segment of film depicting icons from health, our life and social media.

Look at how she hefts the scales. This is not a dainty Roman deity with her hand lightly holding a tool of measurement. No, this lady hefts the scales as a weightlifter would, for justice is heavy. She looks unflinchingly down upon us, as she is slightly elevated within the frame. She is real and powerful. She is far removed from the artificial beauty that is often slathered on the faces of young women in our world. She is our future and represents all the wonderful regular people/patients who are joining a worldwide conversation on health.

The babe in arms suckles in contentment in his mother’s embrace. He feels safe and secure, held by an arm that so often holds a sword in other depictions of justice. Why a babe and not a sword? We must change the way view problems and populations. Our tangled healthcare web is not a Gordian’s knot to be sliced through. It is a tapestry, now tangled, that must be rewoven upon the loom.

What tools will knit our raveled sleeve of healthcare? Twitter, Facebook, e-patients, new apps, and old medicine are tools we use combined. We must activate doctors, playwrights, musicians and techies and splice them onto the same reel. That is how we heal the child. That is how we heal ourselves.

Only by working together can we create great change. By finding and embracing this concept of Justice, we can set a new horizon.