Patient Centered Care at the Cleveland Clinic

“Every life deserves world class care.”  How’s that for a slogan?  The Cleveland Clinic delivers again with its digital media.  You might remember their first video on empathy in healthcare from 2013, which encouraged viewers to imagine living in someone else’s shoes for the day. Today I want to share with you the latest video from the Cleveland Clinic’s empathy series, titled, Patients: Afraid and Vulnerable.  Watch what happens when the provider becomes the patient.


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Free Access to Medicine X 2014!

That’s right. You did not mis-read.  You have an option to register for live, online access to a number of the sessions at Medicine X through Medicine X’s Global Access Program, September 5-7th. It won’t give you access to the breakouts, but you will get access to the conferences plenary proceedings, live photos and other updates to your phone, tablet or computer.  And did I mention, it’s free? Stanford’s Medicine X conference is everything I love about what’s changing in healthcare.  It is an inclusive conference specifically designed to encourage participation and interaction.  There’s a real revolution happening in healthcare. There’s a growing focus on patient experience, and social and online platforms are now being heralded as legitimate ways to empower patients. The best part? This revolution is being driven by physicians and patients, together.  I’m registered, and I think you should too!


Global Access 2014 Medicine X Stanford


If I haven’t given you enough reason to register, let me give you two more:

  1. The IDEO workshop.  Ok, so you can’t access this via the Global Access Program, but still.  It’s IDEO, one of the most innovative, interesting and coolest companies around. If they think this conference is important to be a part of, then you should too! (Yes, I still have a crush on IDEO.)
  2. The Mascot. Medicine X has a mascot named is Zoe Chu.  She’s a French Bulldog who has a twitter page and leads walk & talk sessions at Medicine X.  Given that this blog is named PUGTATO, I need say no more. Smooshy faced dogs can teach us so much.

I’ve been talking patient experience and being your own healthcare advocate for as long as I can remember.  People used to look at me like I was crazy. “Liz, patients will just do what their doctor says,”  or “Liz, that’s just the way it is,” or “Oh, we could never do that here.”  These were all too familiar sayings I used to hear, everyday.  All that is changing as providers, industry and patients are now seeking ways to work together to improve the delivery of healthcare. Don’t get me wrong.  There’s a lot of work to do.  Patient-centered healthcare design and use of interactive technology are still not standard of care. Conferences like Medicine X hope to change this.

“Providers, industry, and patients are now seeking ways to work together to improve the delivery of healthcare.”

Improving patient experience is good for patients and it’s good for business.  When patients perceive the quality of their care to be high, they are more likely to use additional services offered by a providing institution/provider and they are more  likely to remain loyal to their provider, coming back year after year.  What may seem like a “soft” measurement, patient experience scores can truly generate revenue and profits.  In one study of 82 hospitals, a 1% standard deviation increase in perceived patient quality scores resulted in a 2% margin increase.  In fact, a 2013 benchmarking report by the Medical Group Management Association (MGMA) showed that practices that achieved “better-performing” status surveyed their patients and surveyed them more frequently.  I am also going to also infer from this statement that “better-performing” practices took it a step further, and not only surveyed their patients, but acted  on the results.  As you may remember, one of my biggest pet-peeves is asking for feedback but not acting on the results! Additionally, almost 10% of these “better-performing” practices tied some portion of physician compensation to patient experience.

I hope you take advantage of this opportunity to register for Medicine X’s Global Access Program.  Participation is what drives change.  We are all responsible to make it happen, and together we can.  If you log in- let me know!  Tell me what you liked and what you want to hear more about!

Want more? Check out these posts:

Lactation Cookies: Kitchen Workout #32

August is National Breastfeeding Month and I’m 10.5 months into my first gig as a full-time working, breastfeeding mommy. It was definitely not the easiest in the beginning, especially when our daughter was a little 5 lb 10 oz munchkin, but with support and encouragement from my husband, my family, and my friends, I’ve exclusively breastfed our daughter from day one.

This leads me to a Lactation Cookie that has been nothing short of awesome, in my opinion. So what is a Lactation Cookie, anyways?  A Lactation Cookie is a cookie full of Galactagogue ingredients.  Galactogogues are foods/herbs that promote lactation.  It’s best to note, that in order to maintain a good breast milk supply, the key ingredient is nursing.  Lots of it.  Frequently.  Emptying your breasts on a regular basis tells your body to make more milk.  Use it or lose it happens to actually apply here.

Emptying your breasts on a regular basis tells your body to make more milk.  Use it or lose it happens to actually apply here.

I was blessed with a healthy supply of milk even without the cookies. However, in the beginning, I ate these cookies frequently. I mainly ate them because they were delicious and if they helped with milk production, well, that was a bonus.  I also ate them because I wanted to make sure that we would have plenty of milk stocked away in our freezer. I knew there would be a number of work trips on the books for me after maternity leave. Thankfully, I have been fortunate to work for a breastfeeding friendly company that has supported me in my efforts to be a working and breastfeeding mommy. For that, I am very thankful.

I should throw it out there that these might not work for you, that I am not a healthcare provider, and I’m certainly not offering medical advice. I didn’t have a low supply issue.  I’m just a working mommy passing along tips that I have found extremely helpful to ensure that I am able to breastfeed our daughter for as long as she/I want to. Breastfeeding takes dedication, support, and for me, because of my job, a commercial grade vaccine cooler and ice bricks. (More to come on this next week.)


breastfeeding, pugtato, lactation cookies, tips, milk supply

There is no room for food in our freezer.


This lactation cookie recipe makes a TON of cookies and they freeze well. My anecdotal experience has been to start by eating 5 cookies on Day 1, then two a day for as long as you want. I generally had them at night with a cup of tea, before bed. If you have an over abundance of milk like I do, then when you eat these cookies you may have WAY more milk than you want.  I ended up having to cut myself off the cookies completely because I was having to wake in the middle of the night to pump due to engorged agony.  I finally got my supply back in check.  Then yesterday, I found a frozen bag of the cookies and decided to eat three for dessert. Today, I regret that decision.  Let’s just say….. I woke up feeling like my baby was 5 months old again, needing 40 oz of milk a day and my Medela Freestyle has been getting a workout today.

If you are looking for more information on breastfeeding, breastfeeding issues, milk supply, pumping tips, etc, etc, I highly recommend my all time favorite breastfeeding website, KellyMom.  It has been my go-to website for breastfeeding information. So without further adieu, please enjoy these cookies and happy breastfeeding!

Lactation Cookie pugtato breastfeeding tips milk supply


1 cup butter
1 cup sugar
1 cup firmly packed brown sugar
2 eggs
4 tbs. water
2 tbs. flax seed meal
1 tsp vanilla
2 cups flour
1 tsp baking soda
1 tsp salt
3 cups oats (NOT quick cooking but the rolled whole oats)
1 cup chocolate chips
2-4 TBS Brewer’s yeast (I used 4 TBS- you can buy this at Whole Foods, it comes in a 1 lb canister)
1 TBS Molasses


  1. Preheat oven to 350 degrees
  2. Mix the flaxseed meal and water and let stand for 3-5 minutes.
  3. Beat butter, sugar, and brown sugar well, add eggs and mix well.
  4. Add flaxseed mix and vanilla and beat well.
  5. Sift together flour, brewer’s yeast, baking soda, and salt.
  6. Add dry ingredients to butter mix. Stir in oats and chips.
  7. Scoop onto baking sheet and bake for 12 minutes. Let set for couple of
    minutes then remove off baking sheet.

Club Sandwich with Avocado, Fried Egg, and Spinach: #31

I love a good sandwich, so when I saw Malcolm and Jillian’s insanely delicious looking Club Sandwich on their blog, FROM AWAY, it became an instant contender for PUGTATO’s Kitchen Workouts. I happen to be a sucker for sandwiches held together by toothpicks.  Something about them is just enticing.  They are always delicious!  It must be because they are exploding with ingredients.

When I find a new blog, one of my favorite things to do read is the “About” section.  I like to know about the writers.  It’s interesting to learn why the bloggers are writing and to gain a little insight into someone else’s world.  This tidbit from FROM AWAY’s “About” section had me instantly hooked:

We don’t have any training or experience in the restaurant business, don’t own any fancy cookware, and have no special equipment. We don’t even own a decent knife. We believe, however, that anyone who cooks, regardless of skill level, can make interesting, inspired, delicious food. Our goal is to help our readers do just that.” ~From Away

I love that philosophy! Approachable, delicious food. Count me in. This sandwich delivers. It is pleasing to the eyes and the tastebuds. In addition, I experienced the nirvana that is perfectly frying my egg, on the first try.  Whatever you do, do not overcook your egg. Over cooked eggs have a distinct sulphur taste (and smell) and you want some drippy deliciousness dripping down your sandwich. (Trust me.)

Now, I suggest you take a moment to peruse FROM AWAY, roll up your sleeves, and dig in to this messy, towering take on a Club sandwich as #31 in PUGTATO’S Kitchen Workouts.

pugtato club sandwich recipes creativity turkey spinach avocado egg


Club Sandwich pugtato kitchen workouts creativity cooking

From Away’s California Club

(Original recipe available here.)

  • 1/4 cup mayonnaise
  • 1-2 canned chipotle chiles in adobo sauce
  • 3 slices sandwich bread, toasted white, wheat, whatever kind you desire
  • raw baby spinach leaves
  • deli turkey (we got a pound, super thinly sliced)
  • tomato, sliced
  • bacon, cooked (amount to your discretion_
  • 2 slices Swiss cheese
  • 1/2 avocado, peeled, pitted, and sliced
  • 1 fried egg, over-medium


  1. Make your chipotle mayo.  Chipotle peppers are spicy so PUGTATO’s suggestion is to start with less than more- you can always add but you can’t take out!  Combine the mayo and peppers in a food processor or by using an immersion blender.
  2. Let the sandwich building begin. Bottom Layer: Take one pice of toast and slather it with the spicy mayo.  Top with spinach, then tomato, turkey, turkey, cheese.  Amount of each subject to your taste.
  3. Middle layer:  Slather another piece of toast with the mayo and place mayo’ed side down on the bottom layer.  Now slather the top of that piece of bread. (PUGTATO’s Optional ingredient: a 3 mile run, to burn off guilt due to excessive necessary mayo-ing.) Top with spinach, avocado, turkey, tomato, cheese, bacon.
  4. Top layer:  On top of the bacon, delicately place your perfectly fried egg and piece of toast that has been slathered with the chipotle mayo.
  5. Carefully, squish your sandwich just a little bit so the egg yolk drips down and coats your sandwich.  Insert toothpicks, cut on a diagonal and enjoy.


How to avoid committing PUGTATO’s Top Three Social Media Faux-Pas

Have you ever wanted to delete that Facebook post or Tweet right after you posted it?  Found your content copied and pasted on someone else’s blog or profile?  Gave permission for a reblog only to discover the link to your original work was left out?

social media faux pas blunders pugtato etiquette


One thing I have learned as I have built this blog and grown my own social media network, is that online etiquette is a skill that requires real, conscious effort.  If you have ever been the brunt of other’s online faux-pas, you know how frustrating that can be.  To help demystify how to be a courteous , contributing member of the online world, today I give you PUGTATO’s Top Three Social Media & Online Faux Pas, and how to avoid committing them.



PUGTATO’s RECOMMENDATION:  Just don’t.  ALTERNATIVE: Come up with your own or ask for permission to share the content you like.

Content comes in all forms, blog posts, profiles, websites, collateral design, brand messaging.  Creating that perfect blog post, LinkedIn profile or branding takes time.  Lots of it.  There’s a reason that you were drawn to the content of one online media over another, and that’s the hard work of someone doing research, drafting, re-drafting, throwing out the tenth draft, starting over, and finally coming up with those perfect words that draw you in. So, if you like what you see, come up with your own using what you liked as inspiration.  You will then appreciate how much effort goes into creating that perfect post, job description, professional summary, etc.

Asking for permission to share content is another alternative to coming up with your own.  If permission to reblog, or share, is granted, list the real author and include what you like about the content. After all, your readers/followers have connected with you because they are interested in hearing from you!  Add your perspective/comment to the piece and make sure to include a link back to the original work with a clear statement that you are not the author.  Don’t be offended if the author does not want you to copy and paste an entire post and asks you to just provide a summary with a link.  In WordPress this is very easily done by using the “reblog” button at the bottom of a post.  It will generate the correct link and trackback for you, while providing your page with a summary.


PUGTATO’s RECOMMENDATION: Stop, think and read before you post. ALTERNATIVE: Pretend you are on national television every time you post.  If you wouldn’t say it on national TV, don’t say it online.

YAY! Social and the online world provide a platform to voice opinions for the world to see!  Oh wait…the whole world can see.  Ya get what I’m sayin’?  My advice is to stop, think and read before you post. Don’t post when you are angry, tired, or under the influence.  You know that driving while intoxicated is dangerous, so is posting online.  While deleting that tweet, Facebook post, link share or blog post might seem like an easy quick answer, there is this thing called cache, and it saves permalinks.  Many times this means your post lives on, for a while, after you delete it.  Just ask some of the people who lost their jobs over one bad post.  It happens.


PUGTATO’s RECOMMENDATION: Say thank you.  Say it a lot.  ALTERNATIVE: Say thank you more than you think you should.

Social communities thrive on participation.  They are, in fact, social.  When someone stops by your blog to read, thank them.  When someone shares your post, thank them again.  When you get a retweet, thank that person too.  When someone takes the time to read and comment on your work, comment back, thank them.  Get the picture? When social becomes a one way street and you push out content without acknowledging your readers, two things happen: 1) you run the very real risk of losing reader engagement, 2) you’ve lost sight of the purpose of social media.  You might as well just stand in front of a mirror and talk to yourself. Another way to say thank you is by reading other people’s work!  Search around for some blogs you like and actually read them after you hit follow or subscribe.

Those are PUGTATO’s Top Three Social Media and Online Faux Pas.  Remember, you are what you tweet, so be nice.  Don’t be a twerp.  Tell me… What’s the biggest social media faux pas you have experienced?

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Avocado, Blackberry, Spinach, Goat Cheese Grilled Cheese

Upgrade your grilled cheese experience with PUGTATO’s Avocado Blackberry Grilled Cheese.  This grilled cheese is decadent, different and tasty. This is #30 in my creative brain workout called PUGTATO’s Kitchen Workouts!

blackberry avocado grilled cheese

PUGTATO’S Avocado Blackberry Grilled Cheese

  • Pesto, jarred or make your own
  • Goat Cheese, crumbled
  • Avocado, thickly sliced
  • Spinach
  • Blackberries, smashed
  • Mozzarella
  • Bread
  1. Prep all ingredients.
  2. Butter Bread
  3. Make sandwich open-faced, layering in this order starting closest to the bread for side one:
    • Pesto
    • Mozzarella slice
    • Smashed blackberries
    • Goat Cheese Crumbles
    • Spinach
  4. Side Two:
    • Pesto
    • Mozzarella slice
    • Goat Cheese Crumbles
    • Smashed Blackberries
    • Avocado
  5. Turn Heat on Medium, place each side into pan, cook covered until cheese is melted
  6. Take pieces of bread out one at a time and smush together.
  7. Enjoy!

avocado blackberryngrilled cheese

Help! School is turning my child into a french fry!

Or that’s my fear, anyways.

We have always been healthy eaters and I thank my parents for raising me on vegetables and balanced meals. A couple of years ago my husband and I watched Jamie Oliver’s Food Revolution and we were horrified to see the awful food children are being fed in our school systems. When Jamie came back for season two, well, lets just say that the US public school system was not ready to welcome him and the season was a flop. Schools appeared to be focused on one thing- doing the bare minimum to get “nutritious” food to our children all while getting the cheapest, most processed food available.  Saving on the bottom line now is only going to cost our future generations more in the long run as diabetes, cancer and heart disease all plague our population.

I’ll tell you one thing.  We don’t eat like that at home, and I would not want my child to have processed or sugary foods as her only healthy school luncheschoices for eating.  (Yes, I hear you nay-sayers, I can pack a lunch. And I will, when that time comes.)  In a world where the government considers pizza a vegetable , and where a third of our population is obese, it is time to look in the mirror! You are what you eat.  So, if you eat pizza and french fries every day, well, 1+1=2, if you know what I’m saying.

My beef with school cafeterias goes all the way back to my days as an elementary student.  Yes, you read that correctly.  My elementary school decided to use disposable trays, and as a 4th grader, I decided to start the Jr. Environmentalists League, which refused to throw away trays and started spreading the word about recycling and saving the planet.  You might say that I irritated many a cafeteria worker that year.  I happen to be pretty persistent. Especially about causes that I believe in.

Today I’m asking for your help to team up with Real Food for Kids Montgomery, an advocacy group that wants our children in Montgomery County, MD to have healthy, REAL food options.  Currently kids can get a chocolate milk and a cinnamon bun for free in their classroom.  I can’t believe that is even true. (Someone please tell me I’m wrong.  This is just what I have been told.) Real Food for Kids has done great work helping our local schools to start to make changes to remove additives from some foods our children are offered, and to increase transparency about what our children are being offered as choices.  Many parents are not happy when they learn about the wide availability of processed salty or sugary snacks available to kids.  Real Food for Kids wants to help Montgomery County Public Schools to increase healthy choices like vegetables, fruits and water.  Instead of pre-cooked, reheated processed foods, RFKM aims to get fresh cooked meals on the plates of our kids.

Real Food for Kids Montgomery will be testifying in front of the Board of Directors of MoCO PS June 3rd in Rockville, MD and presenting a petition in support of their cause, no scratch that, our children’s cause.  Please take a moment to read the petition and sign it!  Even better, if you can attend, do it!  For more information please email  If you want to testify use this email  If you can’t do either, please share this post so others know what is happening.

If you need some additional facts here are some from the petition:

  1. Currently one-third of all American children are overweight, and of that group, approximately 17% are obese. Since 1980, obesity prevalence among children and adolescents has almost tripled(1), leading to a lifetime of chronic illnesses. If this trend continues, one-third of all children born in 2000 or later will suffer from diabetes at some point in their lives(2).
  2. In Maryland, the prevalence of diabetic adults has grown from 6.8% in 1999 to 8.7% in 2008, which continues to be above national levels(3). In addition, there are significant racial and ethnic disparities. Black females (12.5%) in Maryland have almost double the diabetic rates of white females (6.8%)(4).
  3. Nationwide, 40% of children in African-American and Hispanic communities are suffering from overweight or obesity(5). Given a growing body of research that suggests that obesity is associated with poorer academic performance beginning as early as kindergarten(6), this could help explain some portion of the achievement gap.
  4. Within MCPS schools, many a la carte and vending items sold are high in sugar (note: the American Heart Association recommends that children ages 4-8 consume no more than 3 teaspoons and pre-teens and teenagers consume no more than 5-8 teaspoons of added sugar daily)(7). They also contain ingredients found to be less than safe by the Center for Science in the Public Interest(8). Often, students will select and eat these items instead of fruits, vegetables, and meals. In addition, most of the foods served in MCPS meals are processed and contain additives, some of which have been shown to cause cancer, hyperactivity, and other behavioral impairments in children(9).”

We are lucky in Montgomery County, MD to have some of the highest rated public schools in the country.  This is MoCoPS’s opportunity to take a leadership role in revolutionizing the way our children are educated and fed.  It certainly won’t happen over night, and it won’t happen with out an internal champion.  Change is never easy.  Change for the right reason is always good.  Let’s do this MoCoPS.  Let’s show the rest of the country how we revolutionized school food and taught our children healthy habits for life.

more fruits and vegetables in montgomery county maryland schools

Apple Cider Pulled Pork

We had an Apple Pie Moonshine making birthday party for my husband and I needed a main entrée to complement the palette of the drink. Enter, Apple Cider Pulled Pork.  After perusing through a few recipes, I decided to head on over to Gimme Some Oven because Ali has yet to steer me in the wrong direction.  Her recipes are delicious and I suggest you check her blog out!  Also- I noticed we have the same slow cooker, so obviously, this recipe was meant to be.

I didn’t change a thing about this recipe other than doubling the marinade and using 5 lbs of pork shoulder due to the amount of people we were feeding.  I made this one for the same party where we had PUGTATO’s famous Reese’s Peanut Butter Cup Trifle, which you should also make.

Apple Cider Pulled Pork Pugtato

I put out some vinegar based BBQ sauce to top the sandwiches.  The taste of the sauce the pork cooks in is so good that you really don’t need extra sauce, but I have a need to always have extra sauce on hand so, c’est la vie! We love Guy Fieri’s “Carolina No.6 Mop and Slop“(spicy, vinegar based) and “Bourbon Brown Sugar BBQ” (tangy, sweeter, thicker, still has a kick).  No chemicals, just good sauce.  YUM.

Since I can take zero credit for this recipe and I changed nothing- I send you to Gimme Some Oven for a big mouthful of deliciousness. Quickly, head on over to GIMME SOME OVEN’S APPLE CIDER PULLED PORK!