“Buried deep within the over 1,000 pages of the massive US Health Care Bill (PDF) in a “non-discussed” section titled: Subtitle C-11 Sec. 2521— National Medical Device Registry, and which states its purpose as:“The Secretary shall establish a national medical device registry (in this subsection referred to as the ‘registry’) to facilitate analysis of postmarket safety and outcomes data on each device that—‘‘(A) is or has been used in or on a patient; and ‘‘(B) is a class III device; or ‘‘(ii) a class II device that is implantable.

Donnerstagabend. Es schüttelt, es bebt, es kocht… die ganze Nacht. Schlafe erst am Freitag gegen 7 Uhr morgens ein, wache gegen 10 Uhr wieder auf. Muss zum Arzt. Rufe meinen Doc an.

„Aber Frau L., unsere Praxis hat freitags nur bis 10 Uhr Dienst.“

„Aber… Aber, es geht mir dreckig, ich brauche ein Medikament, es dauert nicht lange, Dr. K. kennt mich doch ausführlich, ich meine – er braucht nur einen Blick auf mich zu werfen und weiß sofort, was in mir vorgeht, er ist wie ein Röntgenapparat. Please!“

„Ok, Frau L. Aber seien sie spätestens um 11 Uhr da.“

Ich rufe Taxi an, schminke mich nicht, kämme mich nicht – gegen alle meine Prinzipien – bitte nicht lachen, wer weiß, was einem am Tag passiert. Vielleicht erkennt mich noch Herr Wichtig nicht oder Herr Super läuft mir gerade heute über den Weg? Und dann??? Ich warte auf mein Taxi… Ich warte… Ich warte. Stehe endlich vor der Praxistür. Geschlossen. Sheat! Riesensheat SOGAR. Ich friere, will nach Hause, muss aber zum Arzt. Habe einen Aushang entdeckt.

„Hallo, hallo! Ich brauche Hilfe! Sie haben heute Vertretung für Dr. K.“

„Neee… Wie?! Kann doch nicht sein. Aber sicher nicht… heute haben wir keine Vertretung!“

„Habe zwar Schmerzen, bin aber nicht blind – hier steht schwarz auf weiß, dass sie heute die Vertretung haben. Ihre Tel.-Nr. steht auch drauf.“

Die Dame hört nicht auf zu sprechen: Es sei eine Unverschämtheit vom Dr. K., dass er freitags seine Praxis so früh zumacht! ELF Minuten später: „Kommen sie vorbei“, sagt sie. Ich komme, nein, ich schleiche mich langsam Richtung Gemeinschaftspraxis hin, ich kann nicht laufen, ich spüre nichts mehr. Drei solariumgebräunte blonde Damen empfangen mich schön synchron mit einem Kopfschütteln. …Hätte ich mich doch lieber schminken sollen???

„Sind sie vom Dr. K. ???“, sechs Augen schauen mich wie eine Außerirdische an.

„Jjjjaaa…“

„Fühlen sie die Formulare aus und setzen sie sich kurz im Wartezimmer hin.“

„Jjjjaaa…“

Nach 30 sek. werde ich aufgerufen.

„Guten Tag, bin Dr. L. So, SOOOOO… Dr. K. hat also die Praxis schon zu?“

Ich stehe und staune: Ich sehe zum ersten Mal in meinem Leben eine Ärztin, die viel ungesünder als ihre kranken Patienten aussieht.

„Machen Sie ihren Rücken frei. Rauchen Sie?“, fragt sie mich, „Ihre Lunge ist NOCH frei. Ich kann Ihnen KEINE Medikamente verschreiben. Sollte eine Verschlechterung auftreten, was möglich ist, gehen Sie am Montag zu Ihrem Dr. K. Danke.“

Ich stehe und staune. Kann kein Wort aussprechen, es schüttelt, es bebt, es kocht. Ich bin kein Mensch, bin ein Kassenpatient, bin das Schwein. Am Freitagabend gare ich in meinem Dampf – die Gartemperatur erreicht 39,8* Grad… Mein Fleisch wird ganz zart. Am Samstag und Sonntag fühle ich mich schon wie gegrillt – irgendwie heiß, steif, trocken, aufgespießt. Sein oder nicht sein – bin ich ein Mensch oder ein Schwein?

Montagfrüh. Ich stehe schon vor acht Uhr vor der Praxistür. Musste nicht aufstehen, bin nachts gar nicht eingeschlafen.

„Was haben Sie, Fr. L.?“

„Also… Ich habe Symptome A, B, C… und…“

„Hören Sie auf zu reden, schweigen Sie! Bewegen Sie sich nicht, oder doch… kommen Sie! Schnell! In das Zimmer 2. Sprechen Sie nicht!!!“

Ich stehe und staune. Mein Doc kommt sofort.

„Schweinegrippe.“

Ich stehe und staune. Verdammt, ich bin doch das SCHWEIN.

Christmas Shopping

It’s that time of year again when we start our Christmas shopping, the malls are packed and we are all frantic to get the best deals and check off our family’s Christmas wish list.

Just remember that the people who are serving you are doing their best. Stay patient and enjoy the season!

‘Twas the night before Christmas, when all through the store
Not a customer was friendly while they came through the door
The cashiers were rushing to check out their gifts
In hopes that the customer wouldn’t want to through them off a cliff
Their children were home all snug in their beds,
While their parents fought with others to get their favorite threads

And the manager in her office hiding from the mob
Had just settled down from arguing with a long winded knob.

When out in the parking lot there arose such a clatter
The staff sprang from the store to see what was the matter.
Away to the lot they flew like a flash
Running through the crowds and almost causing a car crash

The moon was a glow with the new-fallen snow
Which gave it a luster to vehicles below
When, what to our wondering eyes did appear
But a sleigh and eight reindeer

With a plump little man, so cute and quick
We all knew that it must be St. Nick
More rapid than a Ferrari his coursers they came,
And he shouted and whistled, and called them by name;

“Now, Dasher! now, Dancer! now, Prancer and Vixen!
On, Comet! on Cupid! on, Donner and Blitzen!
To the top of the store! to the top of the mall!
Now dash away! dash away! dash away all!”

So up to the store-top the coursers they flew,
With the sleigh full of goodies, and St. Nicholas too.
And then, in a twinkling, we heard on the roof
The prancing and pawing of each little hoof.

As we rushed back to the store scrambling about
St. Nicholas appeared there was no doubt
He was dressed all in fur, from his head to his foot,
And his clothes were all tarnished with ashes and soot;

A bundle of goodies he flung on his back,
He shook his head and wanted to attack
His eyes were angry his mouth did not smile
He glared at us all as he walked down the aisle

Why are you fighting, why are you in a hurry?
Look at this CSR, all she does is worry
She’s doing the best she can with an overwhelming amount of work
And you are all upsetting her, you’re acting like jerks

Don’t forget the meaning of Christmas joy
It has nothing to do with a shiny new toy
Remember to say thank-you and take a deep breath
Lines will be long but there’s no need to stress

Everyone’s doing the best that they can to help speed things along
Stop and be friendly and hum a Christmas song

And he smiled at us all and winked at the CSR
She smiled back and was ready for some well deserved R&R

We all looked at each other and felt ashamed
For after all, the things we bought did not mean a thing

We ran to the lot as he took off with his crew
We all looked up hoping for his last cue
And we heard him yell and he flew out of sight
“Happy Christmas to all, and to all a good-night.”

It’s difficult enough to attend to and comprehend what patients are telling us, especially given the disparities in language, varying abilities to be articulate, and the intense emotions involved. However, many of us would agree that the real challenge is understanding what our patients are not telling us—reading between the lines of what is actually said. Patients mainly communicate to express physical, informational, and/or emotional needs. Many factors (e.g., pain, anxiety, lack of information) may get in the way of their expressing these needs clearly. In order to respond to what they may feel are communication difficulties, patients may need to say something without really saying it. As Gwen van Servellen points out, explicit expressions of these difficulties are usually accompanied by deeper meanings. Here are a few that van Servellen identifies:

“I hate to have to tell my story over and over again.” Can I be spared some of this wasted energy and humiliation?

“Each doctor I talk to tells me something different.” Can I even trust my doctors if they’re not together on this?

“My nurse looks ‘overwhelmed.’ How come s/he isn’t able to respond to me?” What work do they do if they’re not taking care of me?

“My nurse says, ‘I’ll be back in five minutes’ and s/he doesn’t come back at all.” I can’t trust what s/he says to me.

“People come into my room all day without asking my permission.” Who should be in my room? How can I tell if they’re supposed to be here? What is going to be done to me?

“They can’t figure out why I’m sick.” Do they really know and they’re just not telling me?

Trust is key in the health care outcomes both patients and providers seek. As van Servellen asserts, the handling of interpersonal difficulties is both the contributor to and the result of effective (ineffective) healthcare delivery.

van Servellen, G. (2009). Communication skills for the health care professional: Concepts, practice, and evidence (2^nd Ed). Sudbury, MA: Jones and Bartlett Publishers.

3020774    การดูแลผู้ป่วยนอก    Practice in Out Patient Care

การตรวจรักษาผู้ป่วยที่แผนกผู้ป่วยนอก ควบคุมและเป็นที่ปรึกษาของแพทย์ประจำบ้านปีที่ 1

(Managing the patients, supervising and giving consultaion to the first year residents in the out-patient department.)

(3020774 จุฬาลงกรณ์มหาวิทยาลัย)

This is an interesting article that discusses the way a hospital system decided to change the way it provided care and establish a goal for the future by addressing patient care and patient perceptions.  That is unique in this field, but what really caught my eye was the fact that the model was developed mainly on the input from nurses who were actually giving that care.  That is unheard of!

It is very nice to see an article that gives credit to the nursing staff and actually has nice things to say about their collective abilities to facilitate changes that make things better.  In this instance, the patients themselves gave the model a good response.

Anyway, read the article here or visit the original and read some of the other articles found there.  It is worth your time, I think, to read and think about this process.  Maybe you can initiate something similar in your own system?  It’s not impossible, but I agree change is always hard.

________________________________________________________________________________________

ThedaCare, a four hospital community health system based in Appleton, Wisc., is a leading healthcare delivery system and is nationally recognized for its continual process improvement efforts. The hospital recently implemented one of its widest-ranging improvement efforts — a truly integrated, collaborative model to guide all inpatient care. The collaborative model has been widely successful in improving the quality of patient care and making that care more efficient, according to Kathryn Correia, senior vice president of ThedaCare and president of Appleton Medical Center and ThedaClark Medical Center in Neenah, Wisc.

“Lean” process improvement
In 2003, ThedaCare executives searched for a way to accelerate the health system’s process improvement efforts and stumbled upon lean management — a management and process improvement method that is focused on eliminating activities that do not add value to the organization’s end product. Executives from the health system found a company in their own backyard that had successfully implemented lean processes to the manufacturing of outdoor equipment and set forward in implementing these same processes in their hospitals.

“We knew there was a lot we didn’t know, but we decided to get our hands dirty and jump right in,” says Ms. Correia. “We brought in facilitators and held week-long rapid improvement events where groups of employees examined various processes and recommended improvements. We looked at the various results from these events and selected a few areas to work on first.”

The hospitals started with improving administrative aspects of hospital processes, and then moved to examining enterprise value streams. Eventually, hospital leaders began to focus on improving inpatient care in order to differentiate ThedaCare’s inpatient services from its competitors, and put an improvement group to work to figure out a way to meet this goal.

“We decided that our vision for the future was creating a unique inpatient and ER experience, which relates back to the mission of our hospitals, and this became part of our strategic plan,” says Ms. Correia. “What resulted from about 18 months of process improvement events examining this was a total redesign of our inpatient care — a truly breakthrough and innovative model for collaborative care.”

Model of success
After a year of trialing the new, employee-developed collaborative-care model, ThedaCare began implementing it system-wide — a process which is expected to be completed by 2012. The model has proven extremely effective so far, reducing costs associated with inpatient stays by 25 percent, patients’ length of stay by 25 percent and various error margins to nearly zero and significantly increasing patient satisfaction scores.

According to Ms. Correia, the model’s effectiveness is due to the input of front-line employees in developing the model. “Innovation happens synergistically. We knew we had to figure out what our differentiator would be in the future for inpatient care, but we weren’t quite sure what it would be,” she says. “Nurses had a good concept of what they wanted collaborative care to look like, but we needed lean processes to really develop something we could implement.”

ThedaCare’s collaborative care model is truly groundbreaking and will likely serve as a model for many other hospitals as they look to integrate their services and provide more collaborative care. The model is composed of six critical elements, all of which encourage the collaboration of caregivers and the removal of non-value added activity in the provision of inpatient care. The six elements are:

1. Collaborative rounding upon admission. Within 90 minutes of admission, a nurse, physician and pharmacist round on a patient and his or her family and collaboratively develop a care plan specific to the patient. The three-way rounding ensures that all providers understand and agree upon a patient’s course of care, and the presence of the pharmacist additionally reduces the possibility of harmful drug interactions, says Ms. Correia.

2. Evidence-based plans of care. Each patient receives his or her own evidence-based single plan of care, which integrates services from various departments within the hospital. The care plans are developed using care guidelines from Milliman Care Guidelines, a Milliman Company, and all disciplines combine to form a single integrated plan.

3. Nurse as manager of care. In ThedaCare’s collaborative model, the nurse is the navigator of patient care and is supported by ancillary paraprofessionals. The nurse is responsible for guiding the patient from one phase of care to the next and makes sure that all quality criteria are met during each phase of care. Nurses often suggest options to physicians in order to advance care at a more optimum rate, says Ms. Correia.

4. Tollgates. As patients move through their care plans, nurses ensure that the patients do not move forward unless they meet certain requirements of their last phase of care. These “tollgates” are based largely on care guidelines and time, and serve stopping points along the path of care. When a patient reaches a tollgate, the nurse will only allow the patient through to the next phase of care if it is documented that the patient has undergone certain measures of quality required in the previous phase of care.

For example, evidence-based medicine suggests that pneumonia patient should receive an antibiotic within four hours of admission. Thus, a ThedaCare nurse is responsible for ensuring that all pneumonia patients receive an antibiotic in this time frame, and if this doesn’t occur, the nurse must stop the care pathway and fix the issue before advancing the patient.

5. Electronic medical record. Thedacare uses electronic medical records to track the progress of a patient’s care along his or her pathway and share health information among providers from different service areas within the hospitals. The EMRs also include notifications for tollgates, alerting nurses of the need to evaluate a phase of care.

6. Purposeful design of physical space. Finally, ThedaCare redesigned its inpatient floors in order to make care more efficient. Each patient room includes approximately 80 percent of supplies a nurse would need to care for a patient; this reduces the time a nurse would spend traveling from the room to the central supply location, says Ms. Correia. Additionally, the rooms are designed to reduce the steps staff members take to perform various tasks, thereby making care more efficient.

Learn more about this model here

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There’re five birds on a branch of a tree. One of them just flew away. The other one decides to stay not because it’s safer over here, but it gets used to being here. Two others are still hesitating but determined to fly away. How many are still on the tree in the end?

There’re still four of them.

You may find it ridiculous because the answer is so clear, but how many of us have a clear recognition about such a situation you might be in some time.

Firstly, when a thought of change comes into your mind and it entertains you a great deal with the brighter scenario which this would create to you life. Nobody wants to be exactly the same as they are in five years or ten. You’ve thought a lot about that decision. You think of the good things if you’re successful with it, and you also make a list of what it would take you to achieve that and what kinds of pitfalls can be ambushing somewhere on your ways to success. You read a bunch of books on the subject, subscribe to a great number of newsletters, try to get connected with people who share the same points of view to talk to them and understand more about them. Those are the things you try to convince yourself that it’s a great work you’ve ever thought of and it’s even greater if you would succeed with it.

Not all the people you meet and talk to about the idea is one hundred percent agreed with your idea. Some of they guys even say that your vision is so risky and not worth your endeavors; and some others just say that you’re crazy. You begin to isolate and block yourself and your mind to these criticisms. They can never know how meaningful it is to you life. You’re trying to protect your newly-born idea from getting hurt. And somehow, you finally meet some people who think that you would be regretful forever if you don’t realize your dream for they say if you don’t think your ideas are good then who will? They’re so kind and understanding. All the same, you still ensure that you don’t live the world of your own. You become more careful and patient. You know that perseverance is vital for your achievement.

Nevertheless, will your dreams, ideas and visions become real if you keep on thinking, struggling merely in your mind and not yet take any action? They’re still here in your thoughts, not out there in reality.

Heute ist mir ein wildgewordener Internist vor die Füsse geflutscht. Sachen gibts, die gibts garnicht. Und ich bin nicht so ruhig, wie sich das anhört.

Vor sieben Wochen wurde ich operiert. Gynäkologisch. Die Deppen vom Krankenhaus haben den abschließenden histologischen Befund nun an den Hausarzt geschickt und nicht an meine Gynäkologin. Erfahren habe ich das über das Adressfeld auf dem vorübergehenden Befund.

Nun ruf ich also heute beim Hausarzt an und frag, ob er mir den Befund faxen könnte, dann kann ich ihn endlich zum Gyn weiterleiten, weil dort ja die weiterführende Behandlung ansteht. Sagt die Sprechstundenhilfe: “Gern. Kommen Sie mit der Versicherungskarte vorher vorbei, dann fax ich Ihnen den Befund gleich anschließend zu. Oder mach eine Kopie.” Dachte, ich hör nicht richtig und frag nochmal nach, wiederhole, dass es sich nicht um eine weitere Behandlung oder eine Leistung von ihm, dem Hausarzt, handelt, sondern um die Kopie eines Befundes, der aus Versehen in der falschen Praxis gelandet ist. Sie sagt, “bitte warten Sie kurz” und stellt mich zum Arzt durch.

An der Stelle fragte ich mich eh schon, für was der Typ so Zeit hat an einem Donnerstag vormittag – in Zeiten der alles lähmenden und in Angst und Schrecken Grippe. Da blafft er mich direkt an:

“Na Frau XXX, ich soll also umsonst für Sie arbeiten, stellen Sie sich so eine gute Zusammenarbeit vor? Wissen Sie wieviele Patienten ich habe? Wenn ich jedem einmal im Monat einen Brief auf meine Kosten schicke, hier ein Rezept, da einen Befund, dann kann ich zusperren.”

Ich musste kichern. Diese Art von “ich fass es grad nich, kann aber nicht komplett schweigen und zum Brüllen fehlt mir grad noch ein letzter Impuls”-Kichern.

Er schnaubt weiter: “Wenn Sie also eine Kopie dieses Befundes haben wollen, dann kommen Sie vorbei und bringen mir Ihre Versichertenkarte, damit ich das abrechnen kann. Aus eigener Tasche werden Sie das wohl nicht bezahlen wollen, oder?”

Ich frage zurück: “doch würde ich, sagen Sie mir was Sie für ein Blatt Papier und ein halbes Gramm Toner verlangen und ich brings bar, aber meine Krankenkasse hat damit sicher nichts zu tun.”

“Unter diesen Voraussetzungen steht unsere Zusammenarbeit auf sehr schwachen Beinen, das sag ich Ihnen.”

Musste ich prompt wieder kichern und ich sage lachend: “Hören Sie, ich glaub das alles grad nicht.”

Er: “Glauben Sie mir ruhig, da können Sie sich jetzt wundern wie Sie wollen. Soll ich sie beim nächsten Mal auf eigene Kosten behandeln, verstehen Sie das besser?”

Und da platzte mir dann endlich der Kragen und mein Kichern verflüchtigte sich: “Sie verzichten hiermit auf zwei alte Stammpatienten und zwei gesicherte Einnahmequellen, weil Sie sich weigern mir einen Befund der Ihnen nicht gehört und versehentlich bei Ihnen gelandet ist zu faxen, also kurz, wegen 0,10EURO? Wenn das Ihr Ernst ist, wovon ich ausgehe, ruf ich jetzt bei der Krankenkasse an und frage, dort nach, ob ich Ihnen meine Unterlagen entziehen lassen kann, danach im Krankenhaus, die sollen den Befund nochmal ausdrucken und meiner Gynäkologin schicken. Wünsche alles Gute.”

Die Mitarbeiterin meiner Krankenkasse bestätigte mir, dass so “aggressives” Verhalten eher selten sei, in der Form hätte sie es noch nie erlebt. Leider auch, dass der Befund nun quasi ihm gehört, genau wie meine Akte, und er zu garnix verpflichtet sei. Ich kann eine Kopie verlangen, aber wenn einer so drauf ist wie er, dann ist es auch rechtens, dass er es abrechnet. Macht nur keiner, weils albern ist. Und sie sagte: “Seien sie nur froh, dass sie freie Arztwahl haben und nicht mehr dorthin müssen. Suchen Sie sich einen neuen Arzt, jemand der das Patient-Arzt Verhältnis in dieser Weise stört klingt nicht sehr vertrauenswürdig.”

So sei es. GEHTS NOCH?

“The modern “heresy” that medical care (as it is traditionally conceived) is generally unrelated to improvements in the health of populations (as distinct from individuals) is still dismissed as unthinkable in much the same way as the so-called heresies of former times. And this is despite a long history of support in popular and scientific writings as well as from able minds in a variety of disciplines.”

The Questionable Contribution of Medical Measures to the Decline of Mortality in the United States in the Twentieth Century

by John B. McKinlay; Sonja M. McKinlay

Published in 1977 in the Milbank Memorial Quarterly, Vol. 55, No.3. pp. 405-428

In this study, the McKinlays’ explore a steep decline in the top 10 communicable diseases. (Tuberculosis, Scarlet Fever, Influenza, Pneumonia, Diptheria, Whooping Cough, Measels, Smallpox, Typhoid, Poliomyelitis) This unified decline occurred over a period of about 100 years from 1900 to 1973 . Even the most virulent of these diseases were near their currently flat expression when science developed the means to mass produce vaccines in the years leading up to 1949.

Male and Female Mortality Rates Since 1900

As this chart from the paper shows, the decline in mortality from 1900 to the 1970’s for both males and females was markedly dramatic.

They compare this decline in mortality to similar declines in the communicable diseases listed previously.

Decline in Communicable Diseases since 1900

And also included is a graph charting causes of death from the early 1900’s in comparison to the years just prior to this paper’s publication.

Changes in Causes of Mortality since 1900

Which leads to the authors’ conclusion:

In general, medical measures (both chemotherapeutic andprophylactic) appear to have contributed little to the overall decline in mortality in the United States since about 1900-having in many instances been introduced several decades after a marked decline had already set in and having no detectable influence in most instances. More specifically, with reference to those five conditions (influenza, pneumonia, diphtheria, whooping cough, and poliomyelitis) for which the decline in mortality appears substantial after the point of intervention-and on the unlikely assumption that all of this decline is attributable to the intervention-it is estimated that at most 3.5 percent of the total decline in mortality since 1900 could beascribed to medical measures introduced for the diseases considered here.

This graph shows the diseases and their declines in comparison:

Compilation Graph

I would imagine that even the average lay reader, on viewing this graph of the mass decline, can easily imagine each disease effortlessly reaching current levels without the advent of commonly available vaccines. But if vaccines are not responsible for the dramatic decline in mortality, how else can it be explained?

It is widely known that a sea change in patient survival came after more stringent practices regarding hygiene and sterility of spaces and implements used in medical procedures were undertaken for both patient and physician. And as medicine and science progressed in their research of communicable disease and underlying factors that allowed them to spread. Along the way researchers and doctors also began to understand the things that create health.

Massive public campaigns, programs and projects were implemented. For instance swamps were drained to reduce breeding grounds for mosquitoes. And a broad swath of society, from low to high, were educated about cleanliness and hygiene.

From the CDC’s website:

In 1900 in some U.S. cities, up to 30% of infants died before reaching their first birthday (1). Efforts to reduce infant mortality focused on improving environmental and living conditions in urban areas (1). Urban environmental interventions (e.g., sewage and refuse disposal and safe drinking water) played key roles in reducing infant mortality. Rising standards of living, including improvements in economic and education levels of families, helped to promote health. Declining fertility rates also contributed to reductions in infant mortality through longer spacing of children, smaller family size, and better nutritional status of mothers and infants (1). Milk pasteurization, first adopted in Chicago in 1908, contributed to the control of milkborne diseases (e.g., gastrointestinal infections) from contaminated milk supplies.

Refrigeration became commonly available. That and other household inventions like window screens, indoor plumbing, and strategies to deal with outhouse placement in relation to well placement and other improvements made possible by gains in real income.

Because, according to the McKinlay’s paper:

With the appearance of his book, Who Shall Live? (1974), Fuchs, a health economist, contributed to the resurgence of interest in the relative contribution of medical care to the modern decline in mortality in the United States. He believes there has been an unprecedented improvement in health in the United States since about the middle of the eighteenth century, associated primarily with a rise in real income.

In light of a number of similar reports, which have been ignored or overlooked questions about vaccines begin to center on efficacy versus the potential for harm. There are those “skeptics” who are quick to label any such questions as the “heresy” described by the McKinlays’. One would hope, at this point, they might review the widely accepted definition of skepticism as one of continuing exploration. There are no concrete truths in science, only evolving theories that should, in the best of all possible worlds, be continuously re-examined and re-tested.

We should also consider similar themes of hygiene in relation to income levels through the lens of such ideas as: mandated control of working conditions, food preparation and storage, statutes for safe drinking water and the establishment of agencies dealing specifically with issues of public health. Upton Sinclair’s novel The Jungle can act as a literary touchstone for the ideas presented here.

Now is the time for us to ask ourselves: Would the money spent on the now all-but-neutered health care bill be used more effectively by developing jobs for the populace so that real income levels rise for those most affected by the downturn? Would a combination of public health education and income increases work to reduce the current spate of common causes of death as it did in the first half of the last century even though the cause of mortality has changed? I think we need to take a broader view of what has worked in the past, as it is evident that medicating the problems will not solve them now any more than it did then.

Aus Krankenhäusern werden gern Daten geklaut. Zuletzt gab es zwei Meldungen, in dem zum einen das FBI Ermittlungen aufgenommen hat und zum anderen eine Person verurteilt wurde.

Zunächst wurden aus dem University Medical Center bestimmte Daten (Name, Geburtstdatum, Sozialversicherungsnummer) gestohlen. Bei den Daten handelte es sich um die Neuanmeldungen im Krankenhaus. Offensichtlich gab es bereits seit dem Sommer 2009 Verdachte. Aber erst jetzt wurde dieser endgültig bestätigt. Nun schaut sich das FBI den Fall genauer an.

• Las Vegas Sun: Hospital privacy leak could harm patients
• Las Vegas Sun: FBI looking at UMC records leak

Im anderen Fall arbeitete eine Frau bei John Hopkins Medical. Sie stahl über zwei Jahre Daten von einhundert Patienten und verkaufte diese weiter. Ein Gericht in Baltimore verurteilte sie zu Schadenersatz in Höhe von 200 000 US-Dollar.

• Maryland AP News: Woman Sentenced For Stealing Patients’ Info
• Eintrag in der IncidentDB

These are the best and brightest conservative women in the House.

I am all in favor of cutting health care costs – but that doesn’t mean cutting the throats of patients to save money.

How conservative are they?

Here are their 2008 and 2007 congressional ratings from the American Conservative Union.

• Michele Bachmann (MN) – 100% and 100%
• Marsha Blackburn (TN) – 96% and 100%
• Sue Myrick (NC) – 91% and 96%
• Jean Schmidt (OH) – 87% and 92%
• Cathy McMorris Rodgers (WA) – 92% and 85%
• Candice Miller (MI) – 63% and 72%

All SIX of these women members of the Pro-Life Women’s Caucus!

Very sad.Some doctors, despite fancy degrees,make a cursory examination and arrive at a prognosis.
In this case brain activity should have been mapped or at least pupil dilation examination should have been more thorough.
It is very hard to digest that that this should happen because of inefficiency of the doctors.
Many of us regard doctors next to God, forgetting that medicine is an evolving science ; most of the treatments are exploratory in Nature and these procedures have contra indications as well;some of the medications are effective with out anybody knowing why and how it cures.Classic example is grand mal seizure .We know that this seizure is triggered by sudden increase in electrical discharges in the brain and Eption is prescribed to treat this.But none knows how it works or whether it has side effects.
Because of commercialization of medicine , neither the doctor nor the patient has the time to discuss family history of the patient;nor are the patients interested in slow and steady cure or allowing body to take care with minimal supportive treatment.
It is imperative for patients to inform and discuss with the doctor,your family history,your known allergies and your symptoms.
It is also mandatory on the part of the patients to check the medicines prescribed for contra indications.If yes, inform the doctor and have the medicine changed.Even then you should also chek up on internet about the medicine’s efficacy.This may sound tedious, but will save not only money, but your life as well.
When going for surgery check before hand the anesthesia that is about to me administered and see if it it is compatible with your system for some anesthetics are incompatible.
If you had any disease prior to surgery that has resulted in Edema(especially pulmonary), Nitrous oxide is to be shunned.
While getting tests being carried out make sure at the lab, it is done for the part for which you have problem i.e.what the doctor has prescribed and see that the report is yours when you collect it.Never depute somebody else to collect it.
Also popping pills based on advertisement or based on what your doctor has prescribed earlier ailments is dangerous.
All these jobs are to be carried out by Doctors.Unfortunately,Doctors have no time for patients for they are too busy.

Story:

Conscious but unable to communicate for 23 years after a car accident that was thought to have put him into a deep coma, a quadriplegic Belgian man has described how medical science finally put an end to his agonizing years of silence.

Now able to make himself understood via a computer and specially built keyboard, the man, Rom Houben, said in the Monday issue of the German magazine Der Spiegel that when doctors made the correct diagnosis, it was like starting a second life.

“I shall never forget the day when they discovered what was truly wrong with me — it was my second birth,” Mr. Houben, now 46, was quoted as saying.

Mr. Houben, who was an engineering student at the time of the accident, lives in a care home near Brussels. He was assumed to be in a persistent vegetative state until three years ago, when the breakthrough was made.

In the interview he recalled the aftermath of the car accident that paralyzed him and the realization that no one understood that he was fully conscious.

“I screamed, but there was nothing to hear,” he said. He added that he then became a witness to his own suffering as doctors and nurses tried to speak with him until they gave up all hope.

Using brain scanning techniques, Dr. Steven Laureys, a neurological researcher at the Liège University Hospital, discovered that Mr. Houben’s cerebral cortex was still active.

On Monday, Dr. Laureys, who recently published a paper on comas, said that as many as 4 out of 10 similar patients may have been misdiagnosed.

He also described the moment he realized, for the first time that Mr. Houben was fully conscious. “It was one of those rare moments where you really see that what you are doing is useful,” he said in a telephone interview.

“It was a very big moment not just for me but for the whole team, one of those few much-needed moments” for medical professionals.
http://www.nytimes.com/2009/11/24/world/europe/24iht-coma.html?_r=1&nl=todaysheadlines&emc=a4

Posted by Audiegrl

Resistant strain discovered in Cardiff hospital, prompting concern among health officials

guardian.co.uk/Owen Bowcott—Doctors in Wales have discovered a Tamiflu-resistant strain of swine flu that has been spreading from patient to patient in a Cardiff hospital.

The emergence of an easily transmissible, resistant strain is a worrying development for health officials and appears to be the first documented case in Europe.

Five patients at University Hospital Wales, in Cardiff, were infected and isolated for treatment. All had severe underlying conditions that left them with weakened immune systems. At least three had acquired the infection in hospital.

There have been a handful of reported cases from around the world of Tamiflu-resistant strains of the H1N1 virus. Only one previous case, at a US summer camp, however, involved person-to-person transmission.

The Cardiff patients have been treated with an alternative anti-viral drug. Two have recovered and been discharged and three others remain in hospital, one in intensive care.

Dr Roland Salmon, the director of the communicable disease surveillance center in Wales, said: “The emergence of [H1N1] viruses that are resistant to Tamiflu is not unexpected in patients with serious underlying conditions and suppressed immune systems, who still test positive for the virus despite treatment.“

“In this case, the resistant strain of swine flu does not appear to be any more severe than the swine flu virus that has been circulating since April.“

“For the vast majority of people, Tamiflu has proved effective in reducing the severity of illness. Vaccination remains the most effective tool we have in preventing swine flu so I urge people identified as being at risk to look out for their invitation to be vaccinated by their GP surgery.“

Any spread of a Tamiflu-resistant strain of the virus into the community would constitute a serious public health concern. The government recently reminded those who caught swine flu to take Tamiflu as a first line of medical defense.

More @

CS PURAM- GEETA
Our neighbour was a driver in KSRTC, living in rented house.
His daughter Geeta was a dark, tall, slim girl, working in a shop at Palakad town. She has a younger brother, still in school when, we were there.
An offer came for her hand. The boy is handsome. His parents are well to do, both getting pension, in addition to their savings, a house in Thiruvanthapuram etc. They have only this son whom they want to entrust to a reliable loving girl.
At that point we had to go to Delhi. On our return, we brought Ammu, Sudha’s daughter Meghna, who was only two years old, as there was nobody to look after her, when the parents went to work.
 There was no such decision. We were inside the railway compartment. Damodaran and Sudha were on the platform. When my wife stretched her hands and called Ammu, she jumped into her hands; the train moved. So that was how she came in  our custody. As some wit put it, we bring babies into this world, jus to play with them!
I used to take her wherever I went, in the village. She never showed any sign of remembering her parents; but, when Damodaran and Sudha got into the autorickshaw on their return, after a brief vacation with us in the village, she went away with them, without once turning bach to look at us! My wife was on the point of tears.
One day Geeta came from Thiruvananthapuram. She looked serious. Her man was a spoilt child. After break fast, he goes away with his friends to roam about in the city. At noon, he comes back, takes rest and again, in the evening another outing, returning home after dinner in the restaurants.
Three times, she has to wash his cloths. Always, he goes in clean ironed cloths. Geeta is his washer woman.
An itching caused a nuisance to me. Nothing was visible. Thuppan told me it is caused by small mice. After observing my abdomen he confirmed it.
I went to a doctor, who gave me a medicine to be applied all over my body, for seveal days. No relief came except when it is applied.
Then I poured kerosine oil all over my body. My body became clean. I became fair, but the mice thrived.
Murugan told it comes from the river water. Several persons are victims, not myself alone. It was little consolation.
In March 2000, we came to see Leena’s baby and could not go back to CS Puram, as there was nobody to help her. My mice disappeared, without any reason. I was very much releaved.
The baby born on the auspicious day, when Ammathiruvady is brought to our ancestral home, on Makam of the month of Meenam,every year, was named Ananya.
Premchand, Leena’s father-in-law was also there. They stayed at their son Shishir’s house at Lajpatnagar, quite near to our place, and he woud come to see Ananya daily.
He was younger to me, very jolly, but suffering from diabetes and heart  trouble. Doctors at  AIIMS had recommended biopsy. I think a ring was inserted already.
At his instance I too joined the Yoga course, for ten days, provided by  the AIIMS, free of cost.
Of course, the classes were good, but of no use, unless we continue the practice during our life time. This is not practicable. A proper study to determine the efficacy of the system, I believe, has not been conducted. The pulse rate comes down. That is because we remain in a detached atmosphere, free from normal tensions. The same experience can be had, when we pray at a temple or  church etc.
In the library attached to the Yoga cell, I came across a remarkable book titled POWER HEALING by Dr. Leo Galland. He is a normal allopathic doctor, who examines those cases, where doctors are unable to find out the root cause and fail. He has recorded a number of  strange cases. In one case, doctors treated a patient for heart attack who died after repeated attacks. His investigation revealed that, the patient died of carbon monoxide poisoning. The deceased was working in an old cellar, peeling off plaster, under which the poisonous gas had accumulated, over a long time, in some pockets. THE POISON CAUSED THE SYMPTOMS OF HEART ATTACK.
Another case was a young girl whose skin was extremely dry. She was a schizophrenic patient. Seeig her skin, the doctor told her to take cod liver oil, which contans omega 3 fatty acids. AFTER SOME SIX MONTHS, SHE RETURNED TO GIVE HIM THANKS. She was cured of her mental condition. Now this oil is given routinely to all mental patients in England, I read in the news paper.

I do believe it’s officially that time of the semester where everyone gets cranky, we’re all tired, and we all feel like we’re just … stuck.  I certainly do.  It’s a time when there are loads of assignments due, gobs of exams to study for, and presentations to give.  We’re all feeling the stress and it’s showing.

Time to take a deep breath and settle in for the next 3 weeks.

I’ve also decided not to blog about my recent patient — it’s just too difficult to try to explain what was going on without violating this person’s privacy.  In any event, it was a very educational 2 days of clinical on Wednesday and Thursday.  I learned a great deal about people.

One funny/disturbing/typical story:

It was near the end of our shift, and we had about 5 minutes until post-conference (where we all meet in the staff lounge and discuss our patients — we’re practicing presenting a patient in case the doctors making rounds need to know from us what’s been happening with our patient).  I should preface the rest of the story by saying that, on our floor, we each have one patient for the duration of our shift, and only one.  Not all of the patients have a student assigned to them.  Anyway, I was standing at the end of the hall doing some last-minute computer charting of my patient, and out of the corner of my eye I see a hard-charging person.  I glance up and it’s the mean, nasty, scowling nurse who gives off bad vibes.  She’s moving quickly, and she looks up to my right, and I notice that the room nearest me has its call bell (white light) blinking, but I don’t hear it ringing.  Normally, the student to whom this room was assigned should have been notified and gone to see what the call bell was.  Of course, it wasn’t a student — it was AngryNurse.

She looks at me and says, with a decided sneer at my uniform, “What … students don’t answer call bells anymore?”  I replied in an even voice, “I’m sorry, I was charting and didn’t even see or hear the call bell for that patient’s room.”  To which she huffed and puffed a bit, and said with disdain, “Well, when I went to nursing school we would go running for every call bell, and wouldn’t be caught dead not answering one.”

Well.  Excuuuuuuuse me (said in a haughty tone).  I really really really really wanted to respond to AngryNurse, but I bit my tongue.  I’ve discovered there are definitely 3 types of nurses on our floor when we’re there:

1. Awesome Wants to Teach Nurse:  he/she seems to enjoy us being there; doesn’t mind telling us why he/she does things a certain way; says “hello” and “goodbye” to us; is happy that we’re helping them at all with mundane tasks.
2. Indifferent to the World Nurse:  he/she seems to kind of drift along aside the students, and doesn’t seem to care either way what we do; teaches if it’s a last resort, but prefers to just do things on his/her own and not involve us; says “thanks” when we do something, but doesn’t talk to us otherwise.
3. AngryNurse:  seems to want to slaughter us and send our bones and tendons and organs to the farthest reaches of the globe and proudly bellows how bitter he/she is to the world and generally makes us want to throw up all over the nurses’ station.

by Dr. Brent Lipke DC

Carpal tunnel syndrome is the occupational disease of the 21^st century.  It involves numbness, weakness or pain in the wrist and hand and is caused by pressure on the nerve entering the wrist.

Traditionally it has been treated by wearing a splint, taking anti inflammatory drugs or with surgery, all having limited success. 

Spinal misalignments are often found in the lower necks of patients suffering from carpal tunnel syndrome.  Nerve compression in the neck can block the flow of nutrients to nerves in the arm, shoulder and hand, making them susceptible to injury.  Chiropractic gently restores proper nerve flow from the neck to the hand correcting the cause of the problem.   

To learn more about how a safe, gentle and scientific, Chiropractic adjustment could TRANSFORM your health contact your chiropractor.  If you are interested in a complimentary consultation, CALL me at The Family Chiropractic Centre, 519-837-1234. 

I’m Dr. Brent Lipke, educating you to help you educate others !

We all begin new chapters in our lives. Just as Oprah Winfrey will be moving on so doesn’t the rest of the world. The same is true for those women who have searched and chosen tubal reversal surgery.

Many tubal reversal surgery patients have pretty much the same lives as the rest of us. They grow and begin a relationship and many go on to have children. After they feel their family is complete they have a tubal ligation. But, as in life, things change. Maybe they were not in a good relationship and felt it was not best to have any more children so they had the tubal ligation.

Circumstances change and many women want children after the ligation. This is when they begin searching out tubal reversal surgery. And this is where, for many, Chapel Hill Tubal Reversal Center comes in.

Many women and couples search tubal reversal surgery and find CHTRC. They land on the website and begin reading the blog, tubal reversal message board and watch the videos. They begin talking to others on the message board and friendships are formed that last for years to come.

For those searching tubal reversal surgery there is hope. Dr. Gary Berger and Dr. Charles Monteith take the time to help their tubal reversal patients. They believe the choice to have children is the couple’s decision and not one a physician should make.

Ericka McConnell

The doc-patient relationship can be weird. Your doctor sees you at your most vulnerable (two words: paper gown) and is privy to your most intimate info (the number of sexual partners you’ve had, the precise location of that suspicious mole).

But while you’re an open book, your doc isn’t—and that’s a big mistake. You’re left wondering what he’s thinking when he raises an eyebrow or murmurs a cryptic “hmmm.” Well, wonder no more. We asked top docs to spill the beans on how you can get the best possible care.

Don’t think you’ve got every ailment out there
“A patient will say to me, ‘I saw that pill for toenail fungus—I want that pill.’ And I’ll say, ‘But you don’t have toenail fungus.’ Then they say, ‘My toenails look just like the toenails in the picture!’ Medicine is not like buying a new shirt because the new color is Concord purple and you want to have a purple shirt, too. I tell people, ‘Be glad you don’t have toenail fungus!’” —Zoe Diana Draelos, MD, president of Dermatology Consulting Services in High Point, North Carolina

Just spill it
“Every doctor has those ‘By the way, doc’ patients. They’re the ones who, when I’m getting ready to leave the room, say something like, ‘By the way, doc, I’ve been having burning when I’m urinating.’ It’s an important issue, but they wait until I’m on my way out to mention it. Tell me something like that right away.” —Raul J. Seballos, MD, vice chairman of preventive medicine at the Cleveland Clinic

Forget what you saw on TV
“I hear a lot of, ‘I want this test. I saw it on TV. ’ You should get the test you need, but it may not be what you saw on television. Just because a TV personality and her best friend had CT scans of the heart doesn’t mean you need one.” —Nieca Goldberg, MD, medical director of the Women’s Heart Center at the New York University Langone Medical Center and author of Dr. Nieca Goldberg’s Complete Guide to Women’s Health

Don’t worry about your hairy legs
“I don’t care if you haven’t shaved, OK? Please do not apologize for the state of your toenails, your legs, or anything else. I am so not looking.” —Katharine O’Connell White, MD, MPH, OB-GYN at Baystate Medical Center in Springfield, Massachusetts

Next: Be honest about exercise

Be honest about how much (or how little!) you work out
“I sometimes ask patients: ‘Are you physically active?’ and they say to me, ‘Yes, I’m really active.’ Then they talk about how they drive their kids here and drive them there and pick them up. Being busy is not the same thing as being physically active. You have to actually move your body. With exercise, more is better, but anything is better than nothing. The minimum level of physical activity needed in order to actually see real health improvements is 30 minutes of moderate-intensity exercise, like brisk walking, every day.” —Sharonne N. Hayes, MD, director of the Women’s Heart Clinic at the Mayo Clinic in Rochester, Minnesota

Don’t think of the spa as a medical facility
“I see a lot of intelligent people who have gone to spas to get fillers, or they get them in a friend’s living room. It shocks me. These are medical procedures that should be done in a medical facility. There’s a huge difference in terms of the sterility and the guidelines followed, and a lot of patients don’t realize that.” —Marta I. Rendon, MD, medical director and founder of the Dermatology and Aesthetic Center in Boca Raton, Florida

Get a second opinion—but not from your mom
“Please don’t shop around for a second or third or fourth opinion until you hear the answer you want. I’ve had patients call and ask for my advice. Then they call back to say they talked to two or three other people, who may or may not be doctors, and those people said something else. We don’t treat by consensus. What to do about your discharge or some other problem isn’t a consensus decision. You’re more than welcome to go somewhere to get a second opinion from a doctor, but people will say, ‘Well, my mother said this.’ That’s great, but is your mom a nurse or a doctor?” —Katharine O’Connell White, MD, MPH

Don’t shop for skin-care advice at the mall
“ I know a lot of people who will spend $300 on skin-care products at Sephora, but they aren’t willing to spend $30 in my office. I wish I could tell all of them: Don’t take your skin-care advice from the 16-year-old behind the makeup counter at the mall—she’s 16! Talk to your doctor.” —Carolyn Jacob, MD, director of Chicago Cosmetic Surgery and Dermatology

Know the facts
“I’m always so surprised that the average woman thinks contraceptive pills routinely cause cancer, strokes, heart attacks, or blood clots, for instance. The noncontraceptive health benefits of the Pill—such as uterine and ovarian cancer protection, acne prevention, less PMS and menstrual cramps, fewer ovarian cysts—far outweigh the risks for most women.” —Suzanne Trupin, OB-GYN in private practice with Women’s Health Practice in Champaign, Illinois, and clinical professor of OB-GYN at the University of Illinois at Urbana-Champaign

Ask yourself: Is this a real emergency?
“I’ve been paged for a yeast infection at 8 p.m. on a Sunday evening. We’ve all had them. And, yes, they’re miserable. But don’t page the doctor at home in the evening about a yeast infection when you can call the office 12 hours later. On the flip side, if you are having a gyno emergency, I really do want you to call me. A real emergency would be heavy bleeding (filling more than one pad or tampon in an hour), severe pelvic pain that hasn’t gotten any better with over-the-counter pain medication, and—if you’ve recently had surgery—any fever or concerns about what your surgical incision looks like.” —Katharine O’Connell White, MD, MPH

Ericka McConnell

“Doctors have favorites, and they’re lying if they say they don’t,” says Katharine O’Connell White, MD, MPH, an OB-GYN at Baystate Medical Center, in Springfield, Massachusetts. Here, docs reveal how to score some major points.

Send a note
If your doctor has gone above and beyond for you, send a thank-you card or e-mail; doctors treasure them. “Every doctor I know has a box of notes from patients,” Dr. White says. “On the days doctors are feeling really bad and overwhelmed, they pull out those letters to remind them that they do make a difference.”

Take their advice seriously
Put some real effort into following your doctor’s suggestions for getting healthier. “A lot of things I ask patients to do are really hard: quitting smoking, exercising, losing weight,” says Sharonne N. Hayes, MD, director of the Women’s Heart Clinic at the Mayo Clinic in Rochester, Minnesota. “You’ve got me at ‘Hello’ if you walk in 20 pounds lighter and say, ‘I’ve been exercising 30 minutes a day, and I quit smoking.’ If you add, ‘You helped me do it,’ boy, that lifts me. It gives me that extra encouragement to work harder with the next patient who maybe hasn’t heard the message.”

Be friendly
Sure, you need to discuss your symptoms, but doctors really appreciate it when they can relate to patients on a more personal level. Suzanne Trupin, MD, clinical professor of OB-GYN at the University of Illinois at Urbana-Champaign, says some of her favorite patients are “my fellow knitters who bring in their current projects and show me what they’re working on. Or my patient who buys books at tag sales and leaves me one to read every time she comes in.”

Spread the word
Love your doc? Refer your friends and family to him or her. “A referral is the best compliment to a doctor,” says Raul J. Seballos, MD, vice chairman of preventive medicine at the Cleveland Clinic. Adds Marta I. Rendon, MD, medical director and founder of the Dermatology and Aesthetic Center in Boca Raton, Florida: “My favorite patients are my ambassadors. When they refer a friend, and that person comes in and says, ‘Oh, my friend so-and-so just loves you,’ that wins me over.”

 
Related Links:

To be a vagabond;

roaming the schizophrenic streets

enveloping my body, my essence

with the cockeyed man

urinating on a crucifix

his raspy slur—The apocalypse is near

fondling my virgin ears.

so much for carpe diem.

To be a voyeur;

my Jezebel eyes

stalking lovers

while they climax

eyes stutter, loins shudder

as if being pierced

by Jesus himself.

 To be a swinger;

drinking the sickle-celled blood of strangers      

erect bodies

pounding to the beat of djembes

a monsoon of bodily fluid

breeding across the white floor.

To be a patient;

 licking the shaft of the cell

 urine slithering down the white walls

 quenching thirst

my injections for the week.

To be loved;

a foreign concept

hardens between my crotch

in fact, absurd, with a capital A

like Duchamp’s urinal

draining the gaze of

capitalistic Draculas.

To be a poet;

committing ANARCHY on paper

 prose as ammunition

exorcizing readers from the mundane

to a realm of blasphemous pleasure!