September 11th, 2008 by Dr. Val Jones in Uncategorized
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This reflection is from a previous blog post…
When the president of a country dies suddenly, they say that the citizens forever remember where they were, and what they were doing, when they first heard the news. I’ve heard people discuss their personal circumstances when they received word that President Kennedy was shot. For some reason, that sort of news is a memory fixative, preserving individual experience along with national tragedy.
For me, 9/11 was one of those events. I was getting off a night shift rotation at a hospital in lower Manhattan, sitting in morning report, dozing off as usual – my eye lids sticking to dry corneas, my head feeling vaguely gummy, thoughts cluttered with worries about whether or not the incoming shift of residents would remember to perform all the tasks I’d listed for them at sign out.
And as I dozed off, suddenly our chief resident marched up to the front of the room, brushing aside the trembling intern who was presenting a case at the podium at the front of the dingy room. “How rude of him” I thought hazily, as I shifted in my seat to hear what he had to say.
“Guys, there’s been a big accident. An airplane just crashed into the World Trade Center.”
Of all the things he could have said, that was the last thing I was expecting. I shook my head, wondering if I was awake or asleep.
“We don’t know how many casualties to expect, but it could be hundreds. You need to get ready, and ALL of you report back to the ER in 30 minutes.”
I thought to myself, “surely some Cessna-flying fool fell asleep at the controls, and this is just an exaggeration.” But worried and exhausted, I went back to my hospital-subsidized studio apartment and turned on the TV as I searched for a fresh pair of scrubs. All the channels were showing the north tower on fire, and as I was listening to the news commentary and watching the flames, whammo, the second plane hit the south tower. I stared in disbelief as the “accident” turned into something intentional. I remembered having dinner at Windows on the World the week before. I knew what it must have looked like inside the buildings.
I was in shock as I hurried back to the hospital, trying to think of where we kept all our supplies, what sort of injuries I’d be seeing, if there was anything I could stuff in my pockets that could help…
I joined a gathering crowd of white coats at the hospital entrance. There was a nervous energy, without a particular plan. We thought maybe that ambulances filled with casualties were going to show up any second.
The chief told me, “Get everybody you can out of the hospital – anyone who’s well enough for discharge home needs to leave. Go prepare beds for the incoming.”
So I went back to my floor, recalling the patients who were lingering mostly because of social dispo issues, and I quickly explained the situation – that we needed their beds and that I was sorry but they had to leave. They were actually very understanding, made calls to friends and family, and packed their bags to go.
And hours passed without a single ambulance turning up with injuries. I could smell burning plastic in the air, and a cloud of soot was hanging over the buildings to the south of us. We eventually left the ER and sat down in the chairs surrounding a TV in the room where we had gathered for morning report. We watched the plane hit the Pentagon, the crash in Pennsylvania… I thought it was the beginning of World War 3.
The silence on the streets of New York was deafening. Huddling inside buildings, people were calling one another via cell phone to see if they were ok. My friend Cindy called me to say that she had received a call from her close friend who was working as a manager at Windows on the World. There was a big executive brunch scheduled that morning. Cindy used to be a manager there too… the woman’s last words were, “the ceiling has just collapsed, what’s the emergency evacuation route? I can’t see in here… please help…”
That night as I reported for my shift in the cardiac ICU, I was informed by the nursing staff that there were no patients to care for, the few that were there yesterday were either discharged or moved to the MICU. They were shutting down the CICU for the night. I wasn’t sure what to do… so I went back to my apartment and baked chocolate chip cookies and brought in a warm, gooey plate of them for the nurses. We ate them together quietly considering the craziness of our circumstance.
“Dr. Jones, you look like crap” one of them said to me affectionately. “Why don’t you go home and get some rest. We’ll page you if there’s an admission.”
So I went home, crawled into my bed with scrubs on, and slept through the entire night without a page. The disaster had only 2 outcomes – people were either dead, or alive and unharmed – with almost nothing in between. All we docs could do was mourn… or bake cookies.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 9th, 2008 by Dr. Val Jones in Uncategorized
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I was catching up on my Wall Street Journal blog reading, when I came across a post about a physician who was sued for prescribing painkillers to a patient who proceeded to crash her car. The crash killed a pedestrian, and the victim’s wife is now suing the driver’s doctor. Obviously, this case sends chills down physician spines – as it seems that we are now held responsible for patient behavior outside of the the doctor-patient relationship or hospital setting.
Beyond the outrageousness of the case itself, is the sad subtext found in the comments section. Physician after physician respond that they are leaving medicine or have ceased clinical practice. They say that they’d never allow their children to become doctors, and that no amount of compensation is worth the risk and sacrifices of a career in medicine. It’s really depressing to read about such low morale.
For those physicians remaining – I do see a couple of bright spots. First of all, concierge medicine (or “micropractices” where patients pay cash for services) permits the doctor to see fewer patients at the same salary. Removal of the administrative headaches associated with insurance reimbursement as well as the frenetic pace of “volume uber alles” dramatically improves quality of life and patient satisfaction. The physicians I know who have switched to cash-only businesses are very happy.
Second, working as a physician for the US military has one major advantage: you cannot be sued. The idea is that military physicians do their very best to take care of the troops, but it is recognized that military personnel are at great risk for physical harm due to the nature of their job. The Feres Doctrine stipulates that military personnel cannot sue the government for perceived (or real) poor medical outcomes related to active duty. In cases of medical negligence (for veterans and off-duty military personnel), the government may be sued, but not the individual physician.
So, if the tyranny of medical malpractice attorneys becomes unbearable, one might consider practicing in a VA or military hospital. Sounds crazy, I know… but it’s worth a look! Of course, a better solution would be for the next administration to take on Tort Reform in a serious way, and promote tax breaks and facilitate health savings accounts for Americans who’d like to have more control in how they spend their healthcare dollars. Maybe then they could sign up for an affordable concierge practice and at last both doctors and patients could be happy again?
What do you think?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 8th, 2008 by Dr. Val Jones in Uncategorized
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Last week I attended a press conference about healthcare reform at the National Press Club. The most interesting of the 4 speakers was Grace-Marie Turner, president of the Galen Institute. In a recent editorial in the Wall Street Journal, Ms. Turner argued that,
The complex problems in our health sector are best cured by a bigger dose of market competition, not more government intervention.
I had the chance to interview Ms. Turner after her lecture.
Dr. Val: You’ve said that “we’ve got to come to a uniquely American solution to our healthcare crisis.” What does that mean?
Ms. Turner: I speak a lot in Europe, and they really believe that we have a permanent underclass of 47 million people who never have access to our healthcare system. They imagine that they’re bleeding in the streets. We know that’s not the case. Everyone has access to healthcare through emergency rooms – but this is an inferior way to access healthcare. People end up getting treatment at the end of an illness rather than the beginning when things could be better treated, and it’s much more expensive. We need to solve the problem of health insurance.
The movement of “consumerism” is something the world is looking to us to figure out. In other countries their concept of “innovation” is adopting diagnostic codes and payment structures for a system of treatment. We’ve had that for over 20 years in America. When we talk about innovations we mean new ways to respond to consumer needs. The fact that we don’t have so many rules and regulations guiding the entire structure of the healthcare experience means that we can innovate. We can create diversity of care options.
Most of the major research-based pharmaceutical innovations occur in America because we don’t have price controls and we don’t have restrictions on access to care. These are unique aspects of the American healthcare system, and even though Europeans criticize us, they’re always looking to learn from us.
Dr. Val: Why are “medical homes” important?
Ms. Turner: In this increasingly complex healthcare system, people need to have a place to go where their care will be coordinated. That may be a physician’s practice, but it can also be an electronic medical home where people have their medical records kept in one place, and where they have access to different specialists that they can use to coordinate their care. The medical home is really a beacon for more accurate, coordinated and more productive use of our healthcare system.
Dr. Val: You mentioned that there is a “workforce crisis” in our healthcare system — that there are not enough primary care phsyicians to meet demands. Yet you also said that If people could buy health insurance across state lines we could solve a lot of the access issues. How can both be true?
Ms. Turner: It’s a chicken and egg problem. We’ve got to increase access to health insurance. We can’t have 45 million people feeling that they’re blocked from predictable access to healthcare. Once you get tens of millions more people into the healthcare system, then you’re going to start to see a lot of pressure to better utilize the resources that are currently in the system. For example, people don’t always have to go to a doctor for something that a mid-level medical professional could provide them.
I predict that more people will begin to purchase high deductible insurance in case of major accidents or catastrophic events – but they’ll want more control over their routine access to the system, including convenient care clinics and complementary and alternative medicine. If we allowed cross-state health insurance purchasing, it would force the system to meet the needs of consumers for more affordable and convenient care.
Dr. Val: You said that increasing access to complementary and alternative medicine is about giving people “more choices.”
Ms. Turner: I’ve heard so many stories about people who were getting their care through their health insurance providers – guided through a predictable pattern of specialist care. And then when they swithched to a health savings account, they could access the system the way they wanted to. So many of our health issues are behavior-related, and it seems that alternative medicine practitioners can have success in helping people modify their behaviors. The more we have top-down regulatory prescription of what the system will pay for or not, the more you eliminate the alternative practices that might be very helpful to people. I’d like to see a lot more pluralism in our healthcare system, and expanding government intervention is not going to help us achieve that goal.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 5th, 2008 by Dr. Val Jones in Uncategorized
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This week yet another study has confirmed that losing weight (and keeping it off) requires more effort than we initially imagined. Apparently, we really do have to “work our butts off” to be fit for life. It seems that half an hour a day is not going to cut it. Obese women in this study had to exercise for at least an hour a day to maintain their weight losses.
One commenter simply said that a better idea would be to not become overweight in the first place. Well, the train has already left that station! Still, parents need to take heed – once a child becomes substantially overweight, he or she is likely to struggle with that weight for a lifetime.
Perhaps it is easiest to intervene at the very earliest stages of our lives. As for me (and the >3000 of us in my weight loss group) it looks like I’ll be trying to get a full hour of exercise in every day! Care to join me?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 4th, 2008 by Dr. Val Jones in Uncategorized
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This interview is a continuation from part 1.
Dr. Val: How did Simon contract the MRSA infection?
Dr. Macario: That will remain the biggest mystery of my life. No one knows how he picked it up. In Simon’s case there was no entry via the skin – he had no cut or boil or surface evidence of infection. He contracted the community associated strain of the bacterium, which is much more virulent than the kind people get in hospitals. It seems that the MRSA superbug somehow got into his body via his lungs. It’s possible that he touched something with MRSA on it and put it in his mouth and then breathed it in. Unfortunately, there’s just no way to know where he got it.
Dr. Val: How many children die of MRSA infections/year in the US?
Dr. Macario: According to the Centers for Disease Control and Prevention, in 2005, nearly 19,000 Americans died from MRSA infections. During the same year, there were 134 cases of MRSA in children. Actually, more people in the US die from MRSA every year than from AIDS.
Dr. Val: Tell me what you’re doing to promote awareness of MRSA.
Dr. Macario: I have a Ph.D. in Public Health, and when I received the autopsy report stating that Simon’s death was caused by community-acquired MRSA, I was dumbfounded. I hadn’t even heard of MRSA before. In fact, in my career in Public Health I thought that infectious diseases were no longer much of an emphasis because of the terrific job we’ve done in eradicating most diseases through vaccine programs and antibiotics. I assumed that lifestyle issues (nutrition, physical activity, early detection, and safety precautions) would be the focus of my career.
It was a real eye-opener to me to live through the loss of a child to a menace I thought we had under control. Sixty years ago families had large numbers of children, knowing that some would be lost to infectious disease. That just isn’t the way we think anymore. But MRSA is a threat that could essentially take us back to a time when Americans died of infections quite commonly. MRSA is a superbug that is highly resistant to most antibiotics we have. It’s only a matter of time until it’s resistant to everything.
I’ve begun working half-time with Dr. Robert S. Daum at the MRSA Research Center at the University of Chicago Medical Center, Department of Pediatrics, Section of Infectious Diseases (Chicago, Illinois). Not only are we studying how contagious MRSA is (in home and jail settings), we are also studying the most effective way to treat MRSA infections.
Dr. Val: What should doctors know about MRSA and children?
Dr. Macario: There are 506 new drugs approved by the FDA for development… only 6 are new forms of antibiotics. That’s because the antibiotics are not so profitible. Antibiotic customers are short term users – they need the antibiotic for a short time and then they’re healed. Contrast that with a drug like Lipitor, something that people need to take every day for a lifetime, and you’ll see why statins are more of a priority for drug company development than a new antibiotic that could combat MRSA.
Doctors need to realize that MRSA is a growing threat, and we may not have a good treatment for it in the near future. There is a new strain of MRSA (the “community associated” strain) that can be found anywhere – schools, homes, locker rooms, and gyms. This strain is more virulent and more resistant to antibiotics than anything we’ve seen before.
Dr. Val: What advice do you have for parents to protect their children from MRSA?
Dr. Macario: Wash your hands frequently and thoroughly, clean surfaces with bleach, don’t share personal items like towels and razors. Parents should NOT run to antibiotics for any possible illness their child may have. Don’t use antibiotic soaps. Antibiotics should be considered the absolute last resort. If we keep using them for viral illnesses or when we don’t really need them, we’ll just fuel the drug resistant MRSA.
Dr. Val: What’s the most important thing you’d like to tell Americans about MRSA?
Dr. Macario: This new strain of MRSA (community associated MRSA) can affect anyone. Young, old, middle aged, healthy or sick. It can attack a person as healthy as basketball star Grant Hill. It happened to my healthy baby, and it can happen to your family. People must view antibiotics as a sacred last resort to treating disease. If they overuse and misuse them, MRSA and other resistant strains of bacteria will continue to mutate and become even more prevalent and dangerous.
My husband and I are both highly educated, I keep my house immaculate, I vaccinate my kids, and they never went to daycare centers. It doesn’t matter what socioeconomic strata you’re in, race, gender, ethnicity or age – MRSA doesn’t discriminate. It can happen to you.
But to leave this on a brighter note: my husband and I had another son after Simon died. His name is Dylan, and has brought a lot of joy to our lives.
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For more information about MRSA, please check out StopMRSAnow.org
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
