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When Public Health Legislation Is More Effective Than Physician’s Advice

Last month, my family was involved in a scary traffic accident en route to the Family Medicine Education Consortium‘s North East Region meeting. I was in the left-hand eastbound lane of the Massachusetts Turnpike when a westbound tractor trailer collided with a truck, causing the truck to cross over the grass median a few cars ahead of us. I hit the brakes and swerved to avoid the truck, but its momentum carried it forward into the left side of our car. Strapped into child safety seats in the back, both of my children were struck by shards of window glass. My five year-old son, who had been sitting behind me, eventually required twelve stitches to close a scalp laceration. Miraculously, none of the occupants of the other six damaged vehicles, including the truck driver, sustained any injuries.

Family physicians like me, and physicians in general, like to believe that the interventions we provide patients make a big difference in their eventual health outcomes. In a few cases, they do. But for most people, events largely outside of the scope of medical practice determine one’s quality and length of life, and Read more »

*This blog post was originally published at Common Sense Family Doctor*

When You Don’t Live Near A Trauma Center…

Years ago I had a conversation with a surgeon at our facility.  He was unhappy that a seriously injured trauma patient came to our facility after a MVC.  ‘These patients shouldn’t come here Ed, they should go to a trauma center!’

Fair enough; we aren’t a trauma center.  Not a Level I, not a Level II or III; not even a level 0.5!  But we are the only hospital in a large rural county, and the closest, largest facility for portions of a few other counties nearby.  The nearest hospital with neurosurgery and thoracic surgery is at least 30 minutes further away.

The problem is, torn blood vessels, crushed spleens,  collapsed lungs, swollen brains don’t look at the clock, and cars aren’t designed to wreck only near trauma centers, any  more than assailants shoot and stab people only within proximity of appropriate care.  (It rather defeats the purpose of attempted murder, you know. )

Recently, my partner had the same conversation with the same surgeon.  The patient had been shot twice and was hypotensive.  ‘These patients shouldn’t come here!’   We understand, the conditions may not be ideal and trauma is, to be quite honest, fraught with medical and legal peril. Read more »

*This blog post was originally published at*

Driving Safe Cars Can Save Lives

New England Patriots NFL quarterback Tom Brady was on his way to practice when he crashed into a minivan which allegedly ran a red light. His Audi S8 car T-boned the other vehicle a few blocks from his home. A relieved New England Patriots owner Bob Kraft noted after the accident:

“[Tom] arched and prepared himself and we’re just lucky with the glass and angles. We have a lot to be thankful for. It was really a miracle…We’re very, very lucky. Patriot Nation is lucky he had his seatbelt on.”

Was it simply luck or good car design and mechanical engineering? Crumple zones and the passenger cage of a car when built for maximum safety decrease injury. Yet, unfortunately, there is significant variability among safety in cars. Brady walked  away from the accident for a variety of reasons.

As a future hall of fame quarterback, Brady has lightning fast reflexes when analyzing defensive blitzes and options when throwing the football. Quickly bracing himself for impact may have helped. Wearing a seatbelt definitely helped. What may have helped the most was the type of car he drove. Read more »

*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*

ER Physician Dies In His Own ER

This is one of the saddest stories I’ve read in a while. H/t to GruntDoc.

Dr. Michael Sanchez, who in a few months as director of University Hospital’s busy emergency department slashed waiting times and reduced the number of patients turned away because of overcrowding, was struck and killed while jogging Sunday afternoon.

His own emergency department colleagues tried to save Sanchez without recognizing him because of the extent of his injuries. Only after he was pronounced dead did they learn it was Sanchez, hospital staff said.

Police said Sanchez was struck in the 11600 block of Bandera Road about 1:40 p.m. Sunday. The driver told police he was on his way to get the brakes on his SUV fixed when his cell phone rang. As he answered it, he said he spotted Sanchez on the side.

According to a police report, Smith said he hit the brakes and the car swerved onto the shoulder, striking Sanchez and sending him onto the hood of the car.

A witness said the driver swerved across two lanes before striking the victim. Police said no charges have been filed.

Rufe said Sanchez had so much enthusiasm and energy for the job, it made some of his colleagues skeptical about him. But it was that drive that allowed him to push the department beyond the way things had traditionally been done.

“He was telling me one day, ‘I love my job. I love what I do. I love my family. We have a wonderful home. I can’t ask for anything else. And now the possibility of a residency program. I’m just a fortunate person,’” Rufe said.

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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