When she explains something, she makes War and Peace look like a pamphlet.
I took the patient to the operating room due to peer pressure.
So last night, Orthopedics nailed the labia.
When she explains something, she makes War and Peace look like a pamphlet.
I took the patient to the operating room due to peer pressure.
So last night, Orthopedics nailed the labia.
Are you a health care professional who has an interest in international health? Are you interested in improving medical care in Haiti?
Take a look at the great work being done by the METI Project. You can read about the organization, the help, and the skills they are bringing to St Luke’s Hospital in Port-au-Prince. Check out their blog to track the journeys from each of the METI teams that have already been to Haiti.
And if you are a RN, PA, PT or MD who would like to get involved, complete the online application here. http://metiproject.org/get-involved/medical-professional-application/
When the Medicaid expansion portion of the Affordable Care Act was put into place, experts and health policy wonks knew that the expanded insurance coverage for the poor wouldn’t only mean access to hospital based clinical care. After all, nearly one in five uninsured Americans between the ages of 18 and 34 and making less than 138% of the federal poverty level suffer from mental health and substance abuse disorders. In states that opt to expand Medicaid under the ACA, those people would be eligible for coverage that includes mental health treatment.
Unfortunately, states that decide not to expand Medicaid under the Affordable Care Act will leave more than 3.7 million Americans with mental illness without health-care coverage, and therefore out in the cold.
“Let’s just throw weed killer into your belly.”
“It’s like deep throating the aroma.”
“Your lack of planning is not my emergency.”
The Huffington Post yesterday pulled some data from the Commonwealth Fund about the amount of money going into Medicaid expansion. As you may or may not know, the 2012 Supreme Court ruling on the Affordable Care Act (aka Obamacare) made Medicaid expansion optional for the states. So far, 20 states have opted out of expansion (although a few are renewing their push to expand).
It turns out that rejecting expansion also means rejecting billions of dollars in federal funding. Two of the states that would have benefited the most? Texas and Florida, who stand to lose more than $9 billion and $5 billion, respectively, by 2022. If there was anything to make a political campaign on… this just might be one of them…
Individuals without health insurance are quickly coming up on an important deadline. According to regulations in the Affordable Care Act, individuals must purchase health insurance for 2014 by March 31st or face a penalty when filing their taxes. With the looming deadline, the Obama Administration is aggressively pursuing these individuals. But maybe those efforts don’t need to be nationwide…
It turns out that half of the nation’s uninsured live in relatively small geographic areas. Half of uninsured adults under 65 live in just 116 of the nation’s 3,143 counties, while half of all 19-39 year olds without insurance live in 108 counties. This last group is critically important to success of the Affordable Care Act because they tend to be young and healthy – a group that costs insurance companies less and will ultimately subsidize insurance for older and sicker individuals.
In fact, nearly 2 million uninsured individuals live in Los Angeles County, which accounts for roughly 5% of the national uninsured population, while nearly 30% of residents in Harris County, Texas (home to Houston) are uninsured. Federal efforts have shifted somewhat to metro areas like Dallas, Miami, Atlanta, and Philadelphia – particularly since these cities are located in states that are not running their own insurance exchanges.
For years, women who turn 40 have been told by their doctors that they’ve reached the age at which they have earned a new rite of passage – the yearly mammogram. Ever cautious against the unrelenting threat of breast cancer, women have been told that this one exam could be the difference between life or death in the battle against the theoretical breast cancer that their body may be harboring. Increased funding to breast cancer research and advocacy organizations like Susan G Komen Foundation have turned breast cancer into an impending threat for every woman, further raising awareness of the need for mammograms.
Given the “pervasiveness” of breast cancer and the emphasis on mammography, the medical community was shocked when in 2009, the US Preventative Services Task Force recommended that women before the age of 50 forgo routine annual mammograms, and the decision to pursue mammography should be tailored to the individual patient and discussed with her physician. Those recommendations have largely been ignored by physicians and their patients, as advocacy organizations like the American Cancer Society and physician organizations blasted the task force, claiming it was abandoning women and preaching a dangerous lesson for preventative medicine.
What will likely be hailed as a landmark study was released by the British Medical Journal this week, and unless you’ve only been paying attention to the Sochi Olympics and the winter storm, you probably heard a thing or two about the study.
To quote the New York Times, “One of the largest and most meticulous studies of mammography ever done, involving 90,000 women and lasting a quarter-century, has added powerful new doubts about the value of the screening test for women of any age.” The study randomized nearly 90,000 Canadian women between the ages of 40 and 59 to undergo either yearly mammogram and clinical breast examination or just clinical breast examination alone. The purpose of the study was to see if cancers that couldn’t be felt on exam (nonpalpable) were clinically important or not; if you couldn’t feel the cancer, would it actually kill you?
The researchers claim the results show that clinically non-palpable cancers don’t actually matter much, with an equal number of women dying from breast cancer in both groups. They go on to say that not only did mammogram fail to yield a survival advantage, but that the women who underwent yearly mammograms were also subjected to an increased number of unnecessary interventions, including surgery, radiation, and chemotherapy as well as psychosocial stress.
The notion that mammography isn’t as helpful as originally thought is not a new one. Researchers, public health experts, and physicians have for years thought that the importance of mammography has diminished as newer treatments for breast cancer have emerged, making detecting early stage breast cancers less important. It turns out that many cancers grow slowly or not at all; many women may likely to die from other conditions before the cancer would ever become relevant. Some cancers even shrink or disappear on their own. the problem is that once detected, no one really knows if the cancer will actually be life-threatening.
Given all the attention that breast cancer receives, this new study is unlikely to sway the opinions of many women and their health care providers. But could it be that mammography is being overperformed, subjecting countless women to unnecessary treatments? We learned that PSA testing for prostate cancer ultimately proved to be overutilized… is mammography next? Certainly, the study provides one more piece of evidence for the US Preventative Services Task Force to mull over when they next meet to discuss breast cancer screening. It certainly should make every woman pause… and ask their doctor.
CVS stunned both the business and public health communities yesterday when it announced that it was ceasing the sale of tobacco products at all of its locations starting in October of this year.
According to the company, tobacco and associated purchases make up a small portion ($2 billion) of their annual revenue. Given the increasing role that CVS has been playing in health care with its Minute Clinics, the company decided that continuing to sell tobacco products didn’t fit with its overall role in health and wellness as a pharmacy. CVS also recognized that the revenue lost from tobacco sales would likely be recouped in the growth of its pharmaceutical products and clinic services, as well as increased payments from insurers for helping customers quit smoking. The move was applauded by medical and public health advocates as a major step forward in reducing tobacco consumption and improving the nation’s health.
But the CVS decision raises many important questions. Is CVS underestimating the impact that the decision will have on its bottom line? Will CVS start selling e-cigarettes? Will other pharmacy chains like Walgreens and Rite Aid follow suit? If CVS is trying to become a “wellness company”, should it be selling soda, candy, and snacks that are linked with increasing obesity rates? And does the CVS decision really matter to tobacco companies?
As it turns out, the bulk of tobacco sales come not from pharmacy chains but convenience stores like 7-Eleven, gas stations, and discount chains like Family Dollar (and no, the irony is not lost on me there). Drug stores account for only about 4% of tobacco sales. While decreasing the availability of tobacco products is important for reducing consumption, the CVS decision will hardly make a dent in overall tobacco sales. If anything, the average person will find another place to buy them. That said, the CVS move is a great step forward in the fight against tobacco use related illnesses. Strong work CVS.
We’re fond of highlighting how much more the United States spends on health services, but an idiosyncrasy that receives less attention is how much less we spend on other social services. …
Of course, in the political arena, the discussion isn’t framed as “expanded coverage or expanded social policy”. Instead, we’re stuck with polemics about “expanded coverage… or not.” As complicated as insurance is, we default to it in health policy because it seems the most facile way to confront medical problems. That doesn’t make it the most effective way—but it’s hard to be optimistic about changing the terms of the debate.
~Adrianna McIntyre (The Incidental Economist)
If you’ve walked into any hospital recently, you’ve probably noticed the noise level on patient care floors, with your ears being assaulted by the sounds of multiple ringing alarms. It’s long been established that the noise level in hospitals isn’t good for patients trying to recover, with some advocating for checking vitals less frequently on patients as well.
Those alarms can sound like incessant beeps to patients and families, but they contain important and necessary information for doctors and nurses. The problem? Too many alarms means caregivers can’t keep track of which ones are truly important. A never ending barrage of alarms can lead to so called “alarm fatigue”.
NPR recently did a piece of “alarm fatigue” by following administrators at Boston Medical Center. They found that on one of the patient floors, caregivers experienced on average 12,000 alarms a day. So Boston Medical Center decided to turn some of those alarms off, focusing on the truly important alarms. It’s just one case of where less might actually be more in medicine. Not all of the alarms were necessary, giving caregivers a wealth of useless data. Caregivers are much more likely to respond to the relatively few alarms, and nurses have reported that it’s much more pleasant at work
The hospital says patients like it better too. Noise levels are down, and when they press the nurse-call button, the nurses are more likely to hear it.
You might be the jerk of the week if you happen to be the CEO of Bayer, who made the following statement with regard to the pharmaceutical company’s responsibility to produce drugs.
But the quote really does generate the obvious question. What exactly is a pharmaceutical company’s responsibility? As corporations, are drug companies solely responsible to profits and shareholders or do they have some responsibility to produce life-saving drugs that might not make them money? Do pharmaceutical companies have a responsibility to provide drugs to those in third world countries who can’t afford them? I personally have an opinion on the matter, but curious to hear what the rest of you think.
the first and third quotes require some explanation. Surgical residents across the country are preparing for their in-service exam, and many are using as program called Test Weapon which gives you a score per particular category/topic.
wow, I’m terrible at anus!
“I’m pretty sure I go to the gym more than other surgery residents combined.” … “oh, so you went once?
there’s a lot of deep reds. especially the anus.
If you are a healthcare professional and haven’t read John Nance’s book Why Hospitals Should Fly, I highly suggest you shell out the money and read the book. It’s a easy read and does a great job of thinking up a fictional hospital that strives to be the best in patient safety and quality of care. Yes, it’s fictional but that doesn’t mean that many of the ideas that Nance espouses in the book couldn’t be introduced into real life. I’ve quoted a few passages from the book previously, but this one is one of my favorites.
If you want to sail in a boat that floats, and I tell you that to do so you need to repair the holes in the hull and not ust be exceptional at bailing, it would be pretty stupid of you to go sailing off without plugging those holes, right? Well, that’s the same principle. Want to keep your patients safe and satisfied? Here are the ways to accomplish that, how to make a high-reliability organization out of a high-risk enterprise. You want result B? Then you use method A. That simple. But if you think it’s okay to keep on killing a few hundred thousand patients a year and feeding the coffers of malpractice lawyers because change is deemed too expensive or difficult, or too scary and uncertain, then go ahead and avoid change and keep on doing it the same way.
If a human system is routinely producing results you don’t like, it’s because that system is perfectly designed to give you just those results. So, if we’re killing an average of 10 patients a year at Our Lady of Reasonable Good Outcomes Hospital, that’s because that hospital’s systems are perfectly designed to relieve 10 patients per year of their lives unnecessarily.
~John J Nance (author, Why Hospitals Should Fly)
I stumbled on this blog post written by a nurse, framed as a letter to the family of her ICU patient. I think it speaks well to the ups and downs that medical professionals, and ICU nurses in particular, go through daily. It also illustrates the tension between families and medical providers in the especially tense ICU setting.
The excerpt below is just the tip of the iceberg but sets the tone of the entire post.
Working in the Intensive Care Unit (ICU) is an experience that can’t quite be put into words. It’s fast-paced, intense, and the stress of some situations can even occasionally make my own heart rate go up as high as one of our trauma patients.
Some people love us. Some people hate us. I can promise you that you do not want to be a patient in my unit. If you are then that means you’re really sick. But I can also promise you that if you end up here you will get stellar care by a team of the best health care providers available.
Often times we may act a little wacky though. We may seem rude at times. Maybe you catch us acting totally inappropriate for the situation at hand. Maybe you’ve even thought, “how can they act that way with all this going on with my family member?”
Well, we have our reasons.
From the moment the Affordable Care Act was first passed, conservative critics of the law have cried foul, deriding the President as the law as “socialist” – claiming that the ACA is the next step toward socialized medicine.
Well, there’s probably a few socialists out there that are offended by that statement. In fact, Greg Pason, the national secretary for the Socialist Party says that “Obamacare cannot be considered socialist in any way.” I would think that Greg Pason might know the definition of socialist, but if you don’t believe him, try this on for size.
Socialized systems don’t rely on health insurance – at least now how it’s provided in the United States. Socialized medicine (think the United Kingdom or Canada) is: 1) publicly-funded, 2) national health care system, and 3) supported through progressive taxation.
Sound familiar? No? That’s right – because it’s not how we do things in America. Under the ACA, health care is largely being delivered by private practitioners and hospital systems – not a national health care system. Insurance is being provided by private insurers – something the ACA encourages by creating health insurance exchanges to promote insurance run by capitalist insurance companies. The ACA is actually creating a health insurance marketplace, increasing competition among insurance providers and decreasing monopolies – the complete antithesis to socialism.
Requiring everyone to carry insurance doesn’t equal socialism. In fact, one could argue that the system in place prior to the passage of the ACA was tantamount to socialism. Socialism, by definition, involves the redistribution of wealth from the haves to the have nots. Let me explain. In a nation where nearly 50 million people are currently uninsured, if one of those uninsured has an accident, the rest of us end up paying for it – namely through inflated medical costs and higher insurance premiums. With the inclusion of the individual mandate, the ACA is basically requiring those receiving “welfare benefits” – those who’s uninsured care is being paid by the rest of us – to pay their respective dues. (Personally, I don’t really view being uninsured as that great of a “welfare benefit” since medical care often bankrupts these individuals – but I digress.)
Additionally, when the details of the law were being ironed out, the Obama administration initially floated the idea of having a federally offered insurance plan that anyone in the United States could purchase. That “public option” was quickly dropped from the law as there was concern it would be perceived as “socialist” and step toward single-payer health care.
It’s far too soon to know if the Affordable Care Act will work, and much more likely that further revisions will be needed. The only thing for certain is what it isn’t – socialism.
Studies on patient outcomes and surgical quality have focused largely on pre-operative and post-operative measures that are often easy to study and analyze. For example, the Surgical Care Improvement Project (SCIP) utilized by the Centers for Medicare and Medicaid Services (CMS) focuses on a number of quantifiable measures such as timely administration of pre-operative antibiotics to prevent wound infections, administration of blood thinners to prevent blood clots, and post-operative blood sugar control. All of these measures have been shown to reduce morbidity and mortality in surgical patients, but even the strictest adherence to these protocols has failed to reduce the disparities in patient outcomes following surgery.
But it is clear, especially to those of us in training, that not all surgeons are created equally. Just as in any other field, there are those who perform at the top of the pack and others who are less than stellar. Pauline Chen comments on this in her New York Times blog, focusing the light on a perhaps the most important and often ignored factor – the surgeon’s skill. New research out of Michigan seems to suggest that a patient’s outcome is directly related to the dexterity of the surgeon. In the study, surgeons with higher mortality rates took 40% more time to complete an operation than top-ranked surgeons. Their patients also had higher chances of developing significant complications – wound infections, pneumonia, bleeding, etc – and were much more likely to require re-operation or readmission.
The obvious problem? How are patients to know? Currently, patients often rely on word of mouth from friends and relatives to select a surgeon, the recommendation of another health care provider, or are simply assigned to the “surgeon on call”.
Since I follow Chen’s posts, I couldn’t help but notice another one of her other posts about surgeons in training. The combination of these two posts almost certainly leads one to believe that an alarming trend in surgical quality may be brewing. The second post begins with an anecdote about a stellar new surgeon that arrived while Chen was in residency, one who is quicker than most of his colleagues and whose patients fared better. His secret? The hundreds of operations he had participated in during residency.
Which is why recent research about residency training is so concerning. With the adoption of work-hour restrictions such as the 80 hour work week, research suggests that residents are losing out on almost a year’s worth of experience. The surgical landscape has changed over time to less invasive operations – meaning less experience at performing surgery “the traditional way” with larger open incisions in case of complications. Additionally, better medical management of certain illnesses has rendered surgery almost obsolete, reducing the number of procedures the typical resident sees during training.
If indeed a patient’s post-surgical outcome is highly dependent on the skill of the surgeon, and the skill of the surgeon is highly dependent on their operative experience, then it only stands to reason that a patient’s outcome is correlated with a surgeon’s operative volume. And with the reduction in work hours and the changing landscape of surgery, there may very well be a looming quality gap in patient outcomes.
For the past few years, Facebook has allowed its users to construct a “Year in Review”, full of highlights from the past year – photos and status updates that received the most “likes” or comments from other users. To be honest, I just did mine today because to me, a year in a review truly cannot be done until the year is virtually over. But before I ran the year in review, I wondered what it would look like, what would be featured, and what I could gather from that review…
Indeed, the past year has been one full of changes and challenges, of fulfillment and turmoil, of triumphs and terror. It has been punctuated with tremendous highs – graduating with a Masters in Public Health, traveling to and operating in Haiti, becoming an uncle again, enjoying my relationship with my significant other and growing into a better person as a result. The year has had its share of lows as well – the uncertainty of returning to general surgery training, readjusting to a “work/life” balance upset by medicine, feeling rusty and inadequate as a physician and surgeon, grappling with a challenging personal issue involving my family, and grasping and coming to terms with the immeasurable loss of my grandmother.
I certainly would not have survived without the love of my dearest friends, a love that became all too clear after the terrifying events of the Boston Marathon bombing and ensuing lockdown. There are moments in life where you wish for your family to be close by, to hug and to hold your parents and to have them tell you that everything will be okay. Sadly, my family does not live near Boston, and in those horrifying moments after the bombing, it was my friends that I turned to for comfort, support, and camaraderie. They are the rocks on which I rely for strength, the shoulders to cry on, and the ears to talk to. It has been said that friends are the family we choose for ourselves, and I like to think I’ve chosen wisely.
So yes… I wondered what that “year in review” would reveal. And then… I remembered why I love New Year’s Eve so much to begin with, because New Year’s Eve is not meant to be a time to only rewind, regret, and wonder what could have been. Reflecting on the year that has gone is great but only as a stepping stone for the year ahead. For those who don’t like New Year’s Eve, those who get bogged down in the mad dash of the holiday season and the need to figure out what to do, New Year’s Eve isn’t about the best party plans or sitting alone wallowing in self-pity. New Year’s Eve is a gift we are given each year, an opportunity to change the bad, to put our fears, regrets and sorrows behind us, and to start over again with a clean slate. New Year’s Eve is the ultimate chance to look ahead, not backward. So take a moment to reflect and ponder, generate your “year in review” and remind yourself of all the good times. Then ask yourself not what could have been – but what should be done. And once you have your answer, raise your glass and toast to what will be.
I’d be a bad justgngr if I didn’t mention that today was supposed to be the last day for individuals to purchase health insurance on the insurance exchanges.
For those of you who do your Christmas shopping last minute and similarly have waited to purchase health insurance – you’re in luck. The Obama Administration pushed the deadline to midnight on Christmas Eve. Apparently there was a record amount of traffic on the Healthcare.gov website this morning, prompting officials to push the deadline back another day.