July 7th, 2008 by Dr. Val Jones in Health Policy
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This is one of the worst ideas I’ve heard of in a long time – “secret shoppers” in the ER (h/t KevinMD and Dr. Wes). In an attempt to assess hospital quality, patients with fake complaints are sent to the ER unannounced to see how they will be triaged and treated. In one case, a woman complained of stroke-like symptoms (headache, slurred speech, and difficulty moving the left side of her body). She underwent a head CT (which was normal) and then signed out of the hospital against medical advice.
Let me tell you why this “secret shopper” idea is so bad:
1. The woman was exposed to unnecessary brain radiation via the CT scan – this risk is acceptable if a patient’s life is in danger, but why would a normal person wish to be exposed to additional radiation? I smell a law suit in her future…
2. The woman’s triage experience could not possibly represent the average stroke patient experience because she could not replicate the signs of a stroke and (if she tried) any good ER doc or neurologist would know that she was faking. A patient faking the symptoms of a stroke would likely be treated differently than a patient with objective signs.
3. Wait times are dangerously high in ERs across the country. Bumping legitimate patients with “secret shoppers” is unethical and downright dangerous.
4. If hospital staff know that some of their patients will be fake, this could result in mistrust of symptoms or stories and a backlash against real patients who might be confused with secret shoppers.
The ER secret shopper movement was clearly conceived by people who don’t understand the complexity of healthcare, and are applying reductionist principles that will cause unanticipated consequences. Physical harm to the shoppers, longer wait times for real patients, further mistrust by the medical community, and inaccurate quality assessments are only the beginning. I hope the AMA voices their disapproval of this practice.
Quality is better assessed by an average of real patient experience, along with data comparing treatment protocols with medical records. Fake patients have no place in the ER.
What do you think?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 6th, 2008 by Dr. Val Jones in Book Reviews
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I met the author of Glori: A Different Story
(Nicole Lynn Hannans) here at Revolution Health a couple of months ago. She is a vibrant, beautiful young woman who had a child in her late teens. Nicole explained to me that the vast majority of America’s teen pregnancy resources are dedicated to prevention. Once a teen becomes pregnant, there is very little support for next steps. For this reason, young mothers have difficulty completing a college education and are often trapped in a lifelong cycle of poverty.
As a young African American woman, Nicole was determined not to become a statistic. Despite all the odds, being homeless and surrounded by her boyfriend’s drug dealing business, she managed to escape that life and attended The College of William and Mary as a single mom. She wrote Glori: A Different Story, to inspire other pregnant teens to go and do likewise – knowing that no matter what the odds, an unexpected pregnancy does not prevent women from achieving their potential in life.
The story begins with Nicole as a carefree teen, enjoying outings with friends and flirtations with guys. In preparation for her prom, she ponders her date options. She decides, against her better judgment, to go with a charismatic “bad boy” football player whom she suspects may be dealing drugs. But she finds his charm irresistible and he persuades her that her fears are unfounded.
Soon Nicole is dating this young man (RaKeim) and is deeply attached to him. Sadly, her life begins to spiral out of control as she realizes that all of her suspicions were correct – he is a crack dealer trying to live the life of a big time “gangster.” RaKeim is narcissistic, unfaithful, abusive, and obsessed with money. Nicole gets pregnant, moves out of her home to be with RaKeim and cannot seem to come to grips with who he is rather than whom she hopes he will be.
While reading the book, every fiber in your being wants to scream, “Get out, Nicole, he’s no good for you! Run!” But RaKeim knows just how to play with her emotions, and she is reeled back in time and again. A prophetic statement from a doting aunt punctuates the madness of homelessness and crack fiends: “It takes time to get a relationship out of your system.”
And it did take several years for the RaKeim poison to work its way out of Nicole’s life. The turning point came one night when he tried to steal their baby, and then broke down the apartment door and beat Nicole. After menacing calls, being threatened with a gun, and in-person harassment, Nicole came to realize that she would never be safe. The police were unwilling to issue her a restraining order without further proof of RaKeim’s potential for violence. She had to handle this one alone.
As luck would have it, RaKeim was in and out of jail, which gave Nicole some relief from his behavior. During that time she graduated with high honors from the College of William and Mary, enrolled in a Master’s Program, got a job working with sick children at NIH, and found love again.
Nicole’s straight forward account of her struggles makes a few things quite clear: 1) women are not adequately protected by current domestic violence protocols 2) psychopathic men have an uncanny ability to manipulate their victims 3) overcoming the odds is a matter of will, determination, and very hard work and 4) a mother’s love for her child can inspire her to achieve greatness.
If you’re interested in learning more about Nicole’s life, please check out her website at www.nicoleink.com Her book is aptly named: Glori: A Different Story, and I hope that it inspires many other young moms to reach for glory – and to triumph over adversity.
*** Join Nicole’s Group – Click here***
Further resources for teenage moms:
The Healthy Teen Network
Planned Parenthood
Girl Mom
National Family Planning & Reproductive Health AssociationThis post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 3rd, 2008 by Dr. Val Jones in Medblogger Shout Outs
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Happy 4th of July…
Enjoy your barbeque…
But please don’t eat one of these: Krispy Kreme Bacon Cheeseburgers – (h/t KevinMD) or enter a hotdog eating contest.
Need help with losing weight? Join my weight loss group!
Need some brain food? Check out Dr. Rich’s wonderful Independence Day medical blog round up.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 3rd, 2008 by Dr. Val Jones in Expert Interviews
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If you or your friends or family have a disability, there’s no reason you can’t enjoy a vacation at Disney World. This post is a continuation of my interview with Bob Minnick, the Technical Director of Global Accessibility and Facility Safety at Walt Disney Parks and Resorts. He explained to me how Disney theme parks are committed to providing access to guests with disabilities. I’ve captured some highlights from our discussion here, and then summarized the services offered to guests with disabilities.
Dr. Val: Why is Disney so committed to universal access?
Minnick: Walt was all about guest service – he wanted the place to work for everybody, even guests who have unique needs. Our mantra is “guest service,” not “compliance.” We do things because it’s the right thing to do. For example, we were building wheelchair-accessible rides long before the ADA (Americans with Disabilities Act) became law. Also, we won’t patent a ride vehicle design because there are only so many ways to make rides accessible. If we invented a great idea and patented it, then nobody else could use it. Since we’re about creating access for everybody, we don’t mind if people use the idea or approach to improve the world we live in for people with disabilities.
Dr. Val: This must cost a lot – what’s the business case for it?
Minnick: I’m truly blessed to work for a company that “gets it.” We want to bring our guest service amenities to everybody. It’s the right thing to do, and it’s the Disney brand. For us, it’s worth the investment to give everyone the opportunity to experience the joy and magic of Disney parks. All the senses are stimulated at Disney – scents, sights, sounds, and touch and we want to enable as much of the sensory experience as we can for all our guests.
Dr. Val: Do any of your competitors go out of their way like you do to accommodate guests with disabilities?
Minnick: Many in the industry are doing a great job accommodating their Guests with disabilities. We have some unique services that many of them don’t offer. For example, the reason why we provide hearing and visual aids is that our rides are designed to tell a story. You can build an iron roller coaster to create a “motion” experience of being turned upside down and thrown about. But we tell a story with our rides and we want to bring that story to life for everybody.
Services for Guests with hearing disabilities
Sign language interpretation is provided at many shows, 2 days a week at all of the parks (except Animal Kingdom).
Assistive listening service (ALS): amplified audio and captioning technologies are bundled into a Blackberry-sized device that is free of charge and may be carried throughout the parks.
Services for Guests with visual disabilities
Audio Description: Visually impaired individuals can listen to a description of what’s happening on stage or in the shows in between the audio narrations. It is also equipped with a GPS module so that as the guest walks around the park, it offers a way of finding information and tells you where you are.
Braille is available on most park maps. There are Braille guide books available as well.
Services for the Guests with mobility disabilities
Seated parade viewing – special roadside sections exist for guests in wheelchairs so that they get a clear view of Disney parades without other guests standing in front of them.
Zero grade entrance to pools. Gentle slopes (rather than stairs) lead in to all water attractions. This facilitates wheelchair entry and is safe for young children.
Aquatic wheelchairs are provided as needed.
Accessible golf carts are available. They are designed to allow the seated rider to be raised up to standing level so they can swing a club more easily.
Special design features of rides. Many rides are designed so you can’t tell if a guest is in a wheelchair (this normalizes the experience, especially for kids). A special “spur track” feature takes the coaster car offline so that the guests with disabilities can take as long as they need to get in. Then the car rejoins the next line of coasters and enters the ride stream. Toy Story Mania is an innovative ride that provides an optional, closed-captioning service with a shooting mechanism designed for people who can push a button but can’t pull a trigger.
Practice vehicles are available just outside the entrance to various rides. Guests can practice transfers, and getting in and out of the ride vehicle before getting on the actual ride. They can even have pictures taken in the model vehicle.
General Services
Guest Assistance Cards are available to customize services to the needs of individual guests. Customized cards include requests for shade while waiting to enter a ride, the ability for parents to use strollers in lieu of wheelchairs for young children with disabilities, a front row seat pass, a pass to enter attractions via special entrances, and a green light pass for the Make-A-Wish Foundation participants.
Alternate entrances are available for all attractions so that guests with special needs may be ushered in discretely as needed. This design feature is particularly useful for guests with cognitive disabilities who cannot tolerate waiting in lines.
Dietary accommodations are made by Disney chefs trained to prepare food to accommodate special dietary needs.
Make-A-Wish Foundation is a partner of Disney’s. Children with terminal illnesses whose last wish is to go to Disney World are offered special accommodations and service, free of charge.
Emergency medical services are available at all theme parks in case a guest has an immediate medical need. EMS staff arrive within minutes of any distress call.
Bob Minnick summarizes it this way: “Walt Disney World is a place where everybody gets to be a kid. It levels the playing field for children with disabilities – even 60 year olds wear Goofy hats. Everyone’s having fun and acting funny, so it really normalizes the experience for guests with disabilities – because no one stands out or feels different from others.”
*For more information, visit the Disney guests with disabilities website.*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 2nd, 2008 by Dr. Val Jones in Celebrity Interviews, Expert Interviews
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Would you know what to do if someone in your office collapsed in front of you and became unresponsive? Having a defibrillator handy could save their life – and it’s important for you to know how to use one. I interviewed Dr. Jon LaPook, Medical Correspondent for CBS Evening News with Katie Couric, to get his take. [Interesting factoid: Jon became passionate about cardiac defibrillators after a friend of his died while exercising at a gym in NYC. The health club did not have a defibrillator on site – which could have saved his friend’s life.]
*Listen to the podcast*
Dr. Val: What is a defibrillator?
Dr. LaPook: It’s a machine that can convert a life threatening heart rhythm (like ventricular tachycardia or ventricular fibrillation) back into a normal beating pattern. It uses a pulse of electricity to do this. These machines are potentially life-saving.
Dr. Val: Why is it important for offices to have them on hand?
Dr. LaPook: About 1.2 million people in the United States have a heart attack every year and 300,000 of those have “sudden death.” The reason why these people die is not because of the heart attack, but because of the irregular heart rhythm that accompanies it. When the heart isn’t beating in a coordinated fashion, it can’t pump blood effectively and people pass out and ultimately die if there’s no intervention.
If a defibrillator is used to administer a shock to the chest during one of these life threatening heart rhythms, there’s a much higer chance that the person’s life will be saved. For every minute of delay (from the time a person collapses) to receiving a shock to the chest, their chance of survival decreases by 7-10%. So it’s very important for people to get defibrillation quickly.
Dr. Val: How do you use a defibrillator?
Dr. LaPook: When you first see someone collapse and become unresponsive, all you have to do is get the defibrillator and press the “on” switch. It will talk you through the next steps. Remember that the first step is always to have someone call 911 so that EMS will be on its way while you continue CPR. Then you expose the victim’s chest so that you can apply two sticky pads, and the defibrillator will tell you where to put the pads. Then it will analyze the victim’s heart rhythm and decide if it requires a shock to get it beating in a coordinated way. If a shock is recommended, the machine will announce that and ask you to step away from the person. Once the shock has been received, it will then give you instructions for CPR (which includes chest compressions and rescue breaths) until EMS arrives or a pulse is able to be felt. If a person doesn’t require a shock, the machine will not give one – so there’s no risk of harm to the victim.
It’s important for people not to be intimidated about defibrillation because it’s really very simple and can save a life.
Dr. Val: What are a person’s chances of surviving a cardiac arrest?
Dr. LaPook: Nationally, your chances of survival (without intervention) are about 4-6%. If you receive CPR, your chances increase to 15% but with a defibrillator – especially if it’s used quickly – the chances are 40% or higher.
Dr. Val: What do you think about the new research suggesting that rescue breaths may not be as important for CPR as initially thought?
Dr. LaPook: I spoke to Dr. Rose Marie Robertson, who is the Chief Science Officer at the American Heart Association, and she said that in a “witnessed arrest” (when you actually see someone collapse) it doesn’t seem to make a {big} difference if you do rescue breathing (i.e. mouth-to-mouth resuscitation) or not. The reason they studied this is because one of the main reasons why people don’t perform CPR is the “ick” factor of mouth-to-mouth resuscitation. As it turns out, chest compressions alone are about as successful at saving lives as traditional CPR. However, if you’ve been trained to do the rescue breathing technique, you should definitely use it. The key to CPR is “hard and fast” chest compressions, about 100 compressions per minute. Whatever form of CPR you use, the key to success is using the defibrillator as soon as possible, ideally within several minutes.
Dr. Val: What should people working in an office environment know about first aid?
Dr. LaPook: The most important thing is for people to be trained in CPR, the Heimlich maneuver, and defibrillator use.
Dr. Val: Are there enough defibrillators out there nowadays?
Dr. LaPook: Not at all. At the very least, defibrillators should be in every single health club in America. I also think they should be installed in every office building and be widely available at schools.
A cardiologist friend of mine told me about some parents who lobbied for their daughter’s school to purchase a defibrillator. (They were in tune to cardiac issues in children because their daughter had an arhythmia called Wolff-Parkinson-White syndrome.) Two years after the school purchased the device, the girl – only 13 years old at the time – collapsed while walking past the nurse’s office at the school. The nurse saved her life with the very defibrillator that her parents fought so hard for. So defibrillators are incredibly important, and although they’re not inexpensive (about $1200), you really can’t put a price on life.
*Listen to the podcast*
*Check out Dr. LaPook’s defibrillator training video with Katie Couric*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
