November 9th, 2007 by Dr. Val Jones in Opinion
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“One major responsibility of an expert is to know what to ignore.”
— Scott Haig, MD
Health information is more plentiful and accessible to patients than ever before. As a physician I am thrilled that people are empowered with knowledge to take control of their health, but I am also sincerely worried about the “misses:” misinformation, misconceptions, misdiagnoses and mistakes.
The great sculptor Michelangelo believed that every piece of marble was a beautiful statue just waiting for the artist to remove the parts that didn’t belong. I believe that this principle applies to health information – the utility of the information is directly proportional to the reader’s ability to ignore the parts that are irrelevant or incorrect. Google cannot remove the irrelevant, because it can’t evaluate the science behind various claims, appreciate the nuances of an individual’s life circumstances, or confirm a diagnosis. No, as powerful and wonderful as search engines are, they are mere marble. The master sculptors in health information are physicians – trained for at least a decade in the art of analyzing data, appreciating the connectedness of various symptoms and body systems, and focused on chipping away at the irrelevant to uncover personalized solutions and cures – they are the artists whose experience and insight can make the difference between life or death.
Are sculptors flawed? Sure. Are some better than others. Yes. But the bottom line is that information in the hands of a person who can apply it in an intelligent, personalized, and relevant way is our best shot at good, quality healthcare. There is an art to medicine, and the trick is to know what to ignore. Find a good sculptor and stick with him/her so that you can live your very best and avoid the “misses!”This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
November 8th, 2007 by Dr. Val Jones in True Stories
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Today a dear friend of mine told me a horror story about her recent trip to a hospital ER. She has kidney stones, with rare bouts of excruciating pain when they decide to break off from their renal resting place and scrape their way down her ureters.
My friend is a stoic person who also doesn’t like to cause trouble for others – so when she was awoken at 4am with that same familiar pain, she decided not to call an ambulance but rather drive herself to the ER. She also chose not to call her doctor out of consideration for his sleep needs.
She managed to make it to the triage desk at her local hospital and was relieved to see that the ER was quite empty. There were no ambulances in the docks, no one in the waiting area, and no sign of any trauma or resuscitations in the trauma bay. She approached the desk trembling in pain and put her health insurance card, driver’s license, and hospital card on the desk and let the clerk know that she was in incredible pain.
The clerk responded,
“Lady, I saw you walk yourself in here. There’s no way you’re in that much pain. Sit down and fill out this paper work!”
My friend replied in a soft voice,
“Please, can you help me fill out these forms? I can barely see straight and can’t concentrate well. I have a kidney stone and it’s excruciating.”
Tears fell softly from her face as the clerk rolled his eyes at her.
“Yeah, I’m sure you do. And I bet you’re allergic to everything but Demerol.”
My friend started becoming frightened, realizing that she was being pegged as a “drug seeker” and would be punished with a long wait time for pain medication. “Please let me just speak to the triage nurse.”
“Sure, sweetheart,” hissed the clerk. “I’ll get him when you’ve finished your paperwork.”
And so my friend sobbed as she tried to fill in her address, phone number, insurance information, etc. on the paper form at a hospital where she had been treated for over 7 years for ovarian cancer. All of that information was in their EMR, but the registration process would not be waived.
The triage nurse slowly emerged, still chewing a bite of his steak dinner. “What have we got?” He said to the clerk looking out into a waiting room populated only by my sobbing friend.
The clerk replied to him under his breath. The nurse rolled his eyes and sighed heavily. “Alright lady, let’s get you back to an examining room. Follow me.”
My friend followed him back to the patient rooms, doubled over in pain and was put on a stretcher with a thin curtain dangling limply from the ceiling.
She couldn’t control her tears. She couldn’t get comfortable and she moaned softly as she took short breaths to explain her past history. She handed him her business card, explaining who she was and that she was not faking her pain. The nurse made no eye contact, jotted down some notes in a binder, and prepared to leave the room.
“Listen, your crying is disturbing the other patients,” he said, yanking the curtain across the front of the room to block her visually, as if the curtain would make her disappear.
Hours passed. My friend had no recourse but to writhe on the stretcher and cry out occasionally when the pain was too intense too bear. She asked for them to order a CT scan so they could see the stones. The nurse ordered it, a physician never came to examine her.
Four hours later my friend was greeted by a physician. “You have kidney stones. One is in your right ureter, and there are others sitting in your left kidney. Do you need some Dilauded?”
“Yes please!” said my friend, hoping that some relief was in sight.
“Alright, the nurse will be here shortly.” Said the doctor, glancing at her chart without completing a physical exam.
The shift changed and a new nurse came in to place an IV. She was gruff and complained that my friends veins were too small. “I’ve never seen anyone with a kidney stone need this much pain medicine” she snapped with a suspicious tone.
Five hours after her arrival at a virtually empty ER my friend received pain medicine for her kidney stone. She is a cancer survivor and national spokesperson for patient advocacy. In her time of need, though, she had no advocate to help her. No, she received nothing for her years of service, for her selfless devotion to helping others, for her tenderness to patients dying of a disease with no cure.
That night, my friend did not even receive the benefit of the doubt.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
November 4th, 2007 by Dr. Val Jones in News
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Harvard researcher, Dr. George Church, is spearheading a project that would make complete personal genome mapping available for a mere $1000. I read his research subject recruitment disclaimer. Here is a choice excerpt:
Volunteers should be aware of the ways in which knowledge of their genome and phenotype might be used against them. For example, in principle, anyone with sufficient knowledge could take a volunteer’s genome and/or open medical records and use them to (1) infer paternity or other features of the volunteer’s genealogy, (2) claim statistical evidence that could affect employment or insurance for the volunteer, (3) claim relatedness of the volunteer to infamous villains, (4) make synthetic DNA corresponding to the volunteer and plant it at a crime scene, (5) revelation of disease lacking a current cure.
I wonder what personal genome mapping means from an ethical and legal perspective? Are we equipped to handle the possible privacy violations and prejudice inspired by DNA coded predispositions? On the one hand, customizing medical treatment to a person’s genes offers some of the best hope for optimal care and cures. On the other hand, having your genes on public display could put you at risk for the five problems described by Dr. Church.
These are exciting and frightening times.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
November 3rd, 2007 by Dr. Val Jones in Expert Interviews, True Stories
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I had lunch with an extraordinary physician today. She came to the US from Pakistan 30 years ago with a medical degree, a little girl and a baby on the way. Since she was a foreign medical grad, she had to accept a position at a less competitive residency program in New York’s inner city (even more violent and dangerous then than now). She made it through, with several near muggings and death threats but longed to work at a hospital where she and her girls could be safe.
One day she came upon a large, clean naval hospital and on a whim decided to join the military so she could work there. She served for two decades as a navy physician, and learned many life lessons along the way.
As I hung on her every word, my friend told me about her experience with navy pilots. She said that one of the scariest maneuvers is landing a plane on a dark aircraft carrier on a rolling sea. The pilots dreaded these drills, and truth be told, the officers were more worried about losing a 3.2 million dollar jet to the ocean waves than the life of one of the pilots. “There will always be another pilot. They’re not in short supply. But the planes are expensive.” This was the attitude drilled into the young aviators.
In order to land the plane in the dark, the pilot had to learn to trust completely in his optical landing system. It more or less consists of a pin icon with a ball on top, and a series of red, yellow, and green lights. The goal is to keep the ball well centered so that it remains green for landing. Achieving this is called “flying the ball.” In total darkness with crashing waves and a rolling deck, a successful arrested landing is difficult and perilous.
As I looked at my friend, a petite and beautiful woman, I tried to imagine what life was like for her as a young Pakistani resident – pregnant and alone in a concrete jungle filled with graffiti, trash, and drug addicts. Her life has been an incredible journey with ups and downs, and amazing success against all odds.
“How did you do it?” I asked her, shaking my head. “How did you get where you are today through all that adversity?”
She paused for a moment, then grinned slowly as she replied: “I learned how to fly the ball.”This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
November 2nd, 2007 by Dr. Val Jones in Announcements
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For those of you who missed the Blog Talk Radio interview last night, you may enjoy the audiocast at your convenience by going to Dr. Anonymous’ podcast archives and clicking on the Dr. Val show.
We talked about:
- How I got started with blogging
- How I came to Revolution Health
- What Revolution Health is and does
- Abnormal brain MRIs
- Kevin Everett’s spinal cord injury
- MRSA
- Cough medicine and kids
- Concierge medicine
- The Internet and the future of healthcare
- My Halloween SNAFU
Click here to enjoy the conversation (you should start the podcast at minute 8 since we had technical difficulties with the audio prior to that minute). Thanks for listening!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
