May 25th, 2009 by EvanFalchukJD in Better Health Network
Tags: English Language, healthcare, HHS, How to understand, Kathleen Sebelius, Language, Unintelligible
No Comments »
Writing about health care reform, Peggy Noonan complains of the decay of the English language:
A reporter asked a few clear and direct questions: What is President Obama’s health plan, how would it work, what would it look like? I leaned forward. Finally I would understand. [Secretary of Health and Human Services Kathleen] Sebelius began to answer in that dead and deadening governmental language that does not reveal or clarify, but instead wraps legitimate queries in clouds of words and sends them our way. I think I heard “accessing affordable quality health care,” “single payer plan vis-a-vis private multiparty insurers” and “key component of quality improvement.” . . . . As she spoke, I attempted a sort of simultaneous translation. . . . But I gave up. Then a thought crossed my mind: Maybe we’re supposed to give up! Maybe we’re supposed to be struck dumb, hypnotized by words and phrases that are aimed not at making things clearer but making them obscure and impenetrable. Maybe we’re not supposed to understand.
Noonan is on to something, but it’s not what she thinks. What she’s hearing is real-life language of our health care system from the people in charge of it. And it’s not just government officials who talk this way — Sebelius’ language is just as common in the private sector.
It reveals the deepening divide between how people talk about health care and what it really means to be sick. Noonan jokes that if Sebelius’ child were to get a high fever she might say “This unsustainable increase in body temperature requires immediate access to a local quality health-care facility,” instead of just “We have to go to the hospital.” But I don’t believe that.
When a loved one is sick, all the abstract ideas melt away. It becomes about trying to get help from a doctor, and a doctor doing his or her best to help.
You might think our health care system would be set up to make that process easier. But it isn’t.
Patients and doctors report in overwhelming numbers how dissatisfied they are with what they see as the interference of well-meaning insurers, governments and others.
You might also think that the reform conversation happening in Washington would have the doctor-patient relationship at the forefront. But it doesn’t.
Look at the “eight principles of health care reform,” proposed by the President and supported by the big players in health care:
(1) protecting families’ financial health, (2) making health coverage affordable, (3) aiming for universality, (4) providing portable coverage, (5) guaranteeing choice, (6) investing in prevention and wellness, (7) improving patient safety and quality, and (8) maintaining long-term fiscal sustainability.
What does all of this stuff mean? How do you talk about health care and not even use the word “doctor” or talk about “patients”? Worse, I’m not sure more than one or two of these even qualify as “principles” as that word is normally used. So what’s going on?
I don’t think anyone is trying to deceive anyone. Like Sebelius’ choice of words, the list is as much of a description of the problem as a solution to it. We don’t have a consensus of what is really important in health care, so we avoid the problem altogether by using vague language that everyone can support. What’s worrisome is that vague, abstract talk is almost certain to lead to vague, abstract solutions.
Before we try to reform health care, let’s first talk about it in plain, clear language.
*This blog post was originally published at See First Blog*
May 24th, 2009 by eDocAmerica in Better Health Network, Health Tips, Humor
Tags: Cluster Headache, Family Medicine, HA, Headaches, Internal Medicine, Migraines, Neurology, Tension Headache, Tips, Treatment
No Comments »
One of our most revered faculty members, Lee Archer, MD, a neurologist, provided a copy of the handout he gives to his headache patients. With his permission, I adapted it for use with my own patients. I thought it was so good that I asked him if I could publish it on my blog so that others could benefit from his advice.
Headaches are incredibly common and usually frustrating for providers. It has become increasingly evident that chronic or frequently occurring headaches are often virtually impossible to identify as either “migraine” or “tension” headaches and often simply are called “chronic headaches”. Treatment often becomes a revolving door of trying new medications that sometimes work, but more commonly don’t. And, even worse, many headache patients gradually simply become dependent on addictive pain medications just to try to cope with their often daily discomfort.
But, there are some really basic things about dealing with chronic headaches that we should never forget to try. So, without further ado, here is his advice:
Ten Steps to Overcoming Your Headaches
There are some things that everyone can do to help their headaches. There are a number of things you can besides just take medication to help their headaches. If someone follows all of these directions, the need for prescription medication is often dramatically reduced if not eliminated.
1. First and foremost, taking pain medication everyday is definitely not a good idea. Daily pain medication tends to perpetuate headaches. This is true for over-the-counter medications like Excedrin and BC powders, as well as prescription medications like Fiorinal, Midrin, and “triptans” like Imitrex, Zomig, Relpax, Frova, etc. Exactly why this occurs is unclear, but it is a well established clinical finding. Anyone who takes pain medications more than twice a week is in danger of perpetuating their headaches. Occasional usage of pain medications several times in one week is permissible, as long as it is not a regular pattern. For instance, using pain medication several days in a row during the perimenstrual period is certainly permissible.
2. Regular exercise helps reduce headaches. Exercise stimulates the release of endorphins in the brain. These are chemicals that actually suppress pain. I encourage people to aim for at least 20 minutes of aerobic exercise (like walking or swimming) five days a week if not daily. In addition to helping reduce headaches, this also will prolong your life because of the beneficial effects on your heart.
3. Stress reduction is a definite benefit in reducing headache frequency and severity. Headaches are not caused by stress alone, but can make most headaches worse. There are no easy answers for how to reduce stress. If it is severe, we can consider referral to a therapist for help.
4. Too much or too little sleep can trigger headaches. Pay attention to this, and note whether or not you are tending to trigger headaches from sleeping too little or too much. People differ as to how much sleep is “right” for them.
5. Caffeine can precipitate headaches. I encourage patients to try stopping caffeine altogether for a few weeks, and we can decide together whether or not caffeine might be contributing. Abruptly stopping all caffeine can trigger headaches, too, so try to taper off over a week.
6. NutraSweet (aspartame) can cause headaches in some people. If you are drinking multiple servings/day of beverages containing NutraSweet you might consider trying to stop that, and see if your headaches respond.
7. There are some other foods they may trigger headaches in some people. Usually people learn this very quickly. For instance, red wine will precipitate migraines in many people, and chocolate, nuts, hot dogs and Chinese food triggers headaches in certain cases. I generally don’t advise omitting all of these foods, unless you notice a pattern where these foods are causing headaches.
8. If I give you a prophylactic medication for headaches, you should take it daily, as prescribed. If you have trouble tolerating it, please let me know and we can consider using something else. No prophylactic medication works in every patient with headaches. Generally, each of the medications works in only about 60% of people. Therefore, it is not uncommon to need to try more than one medication in any given patient. We must give any of these medications at least four to six weeks to work before giving up on them. It generally takes that long to be sure whether or not a medication is going to work.
9. Keep a calendar of your headaches. Use a standard calendar and mark the days
that you have a headache, how severe it is on a scale of one to ten, what you took
for it and how long it lasted. Also note anything that you think could have
precipitated it. By keeping this over time we can tell if our efforts
are helping.
10. Riboflavin (vitamin B2) 400mg daily helps prevent migraines in many people. It
comes in 100mg size tablets, so you will need to take four of them each day. You
can add it to anything else we try. You do not need a prescription for it.
Do you have chronic headaches? If so, I challenge you to apply these ten principles, then come back and provide a comment on this blog post!
Thanks and good luck!
*This blog post was originally published at eDocAmerica*
May 23rd, 2009 by Jon LaPook, M.D. in Better Health Network
Tags: Alzheimer's, Alzheimer's Association, Alzheimer's Disease, Dementia, Geriatrics, Internal Medicine, Neurology
No Comments »
The answer is “yes.” An estimated 5.3 million Americans suffer from Alzheimer’s Disease, the majority – 5.1 million – over the age of sixty five. Research suggests that less than 35 percent of people with Alzheimer’s or other dementias are properly diagnosed. Early diagnosis is crucial for many reasons, including:
1) There are medications available today that can reduce symptoms in many people – at least temporarily – and improve the daily lives of patients. There are also trials of new drugs that researchers hope will slow or stop the underlying processes that cause Alzheimer’s in the first place.
2) Knowing what’s going on can lessen anxiety and allow for planning – not only for patients but for their families, friends, and caregivers.
3) Although Alzheimer’s causes 60-80 percent of dementia in patients over 65, there are other causes that need to be considered, especially potentially reversible ones due to medications, alcohol, low thyroid, low B12, depression, and infections. Dementia can also be caused by tumors, increased pressure, blood clots and other abnormalities within the head itself that can be detected by a CT or MRI of the brain. And patients with “vascular dementia” due to problems such as multiple small strokes (that may not have caused any other symptoms) can be treated with measures that include medications and lifestyle adjustments to lower their cardiovascular risk.
The Alzheimer’s Association is a terrific resource for information about Alzheimer’s and other forms of dementia. Its website includes ten warning signs for Alzheimer’s Disease.
May 22nd, 2009 by Nancy Brown, Ph.D. in Better Health Network
Tags: American, Culture, Failure To Launch, Growing Up, Personal Responsibility, Psychology, Teeanagers, teens
No Comments »
Many of us are conscious of the fact that not only has our culture extended adolescence to about age 22, now “adultescence” seems to be becoming the norm. This phenomenon is experienced by parents whose adult children return home after college, for whatever reason – some financial, others just not sure what else to do – creating a large number of “failure to launch” scenarios for parents who should be retiring and worrying about their own parents, without adult children to worry about, too!
Paralleling this process seems to be what my daughter, a rising senior in high school, describes as her own “I won’t grow up” crisis. She drives, she works, she makes decisions, she has friends and a boyfriend, she is excited about her summer plans, applying for college as well as going to college, and perceives her life as supported, magical and pretty darn perfect. So, why on earth should she look forward to being a grown-up?
What is the motivation? What do adults in our society have that teens and young adults who go to college do not – well let me see – marriages, bills, worry, stress, chores, a full time job, a house, cars to purchase and maintain, kids, colleagues, bosses, pets, neighborhood issues – and so on.
Newsflash folks, by giving our teens the rights and privileges associated with adulthood at younger and younger ages, we have effectively removed their motivation to grow up and leave home! Parenting has become a lifelong profession as we uberly competent and supportive parents have created a generation of young adults who do not need to become responsible for their own lives, and we have made it exceedingly difficult to answer the question – why should I grow up?
Beats me, is all I can say!
This post, Teenage Personal Responsibility: What Is The Motivation To Grow Up?, was originally published on
Healthine.com by Nancy Brown, Ph.D..
May 22nd, 2009 by Medgadget in Better Health Network
Tags: Clothes, Design, Fashion, Hospital, Hospital Gown, Patient Gown, Robe
No Comments »
Earlier this week we reported on an effort at North Carolina State University to develop a better patient gown, seeing how no one ever liked the conventional tie-in-back style. To be honest, we weren’t particularly excited about the aesthetics – the design looked like a copy of typical nurse’s scrubs we see every day. Turns out that the University of Cincinnati has teamed up with Hill-Rom Company, Inc., of Batesville, Indiana, to brainstorm through possible innovations to improve the gown, the results of which will be shown at the university’s June 12 fashion show.
Here’s from the University of Cincinnati via gizmag:
And so, the solution eventually offered by the UC students is a “Progressive Recovery Collection.” These are options for multiple gowns that can, importantly, all be created from one pattern – a practice that would cut down on waste and inefficiency.
The options are:
One gown for seriously ill bed ridden patients. Another gown for the somewhat mobile patient. A third gown for the fully ambulatory.
The most important thing for a bedridden patient is to prevent pressure ulcers, according to Brooke Brandewie, a student who graduated from the product-development track of UC’s fashion design program in June 2008 and who is now working at the Live Well Collaborative as a design research associate.
“We created a gown that will allow the mattress to be the mattress. The gown is open backed for high-risk, immobile patients so the areas on the body (most susceptible to pressure ulcers) can be healed from the mattress technology, without fabric bunching in between,” Brandewie explained.
In addition, this gown (and the others created by the students) provides easy access at the shoulder – via slits and closures in the design – so that caregivers may operate IV units or other drug-delivery tools.
The students recommend that this gown – and the related versions – be made from naturally anti-microbial materials like bamboo or crabyon (a material actually made from crab shells).
There’s nothing as comfortable as a bath robe, or your own clothes that you wear at home. And that’s the inspiration behind a gown created by the UC students for the semi-mobile patient. It mimics “comfort clothes.”
Said Brandewie, “As the patient improves in condition, they will ‘graduate’ to the next gown appropriate for their condition and mobility. It not only represents the patient’s progressive physical improvement, it provides a psychological boost as well,” said Brandewie.
Like all the UC-created gowns, it closes not via standard ties currently in use with hospital gowns but via a closure like a bathrobe belt. It’s secure, comfortable, can fit to almost any size and is also more flattering to the human figure.
The gown has a full back and a kangaroo pocket in the front, recognizing that the patient will lie in bed, sit in a chair, stand and walk. Portions of the gown are made of special material to wick away moisture and sweat.
And in recognition of the reality that patients sitting or resting will be colder than those on the move, this gown comes with accessories: A scarf with a pocket, arm warmers, leg warmers and shawl, all made of bamboo jersey to integrate both extreme softness and anti-bacterial characteristics.
More at gizmag…
Flashback: “Down With the Gown” Redesigns Drab Hospital Wear
*This blog post was originally published at Medgadget*
