A five year old British girl who had her outer limbs amputated due to meningitis (meningococcemia with meningitis accompanied by gangrene of the extremities would be our guess) has received a new pair of legs.
The high tech carbon fiber pair is of the variety commonly seen on competitive Special Olympics athletes, some of whom run faster than old fashion legged people. Ellie’s parents say that she already walks twice as fast as her previous conventional prosthetic pair.
We believe that medical devices will greatly improve Ellie’s life in the future, and hopefully she can one day receive a proper pair of Deka arms.
Several years ago, I was telling a patient about the importance of doing routine screening for skin cancer – by far the most common type of cancer in the U.S., affecting over a million people a year. She volunteered that she was covered, that she was seeing a dermatologist routinely for Botox injections. “Does he do a complete head-to-toe exam?” I asked. Her pause and sheepish expression told me all I needed to know. She wasn’t at all covered – because she was never uncovered.
Fortunately, the majority of skin cancers found each year are basal cell or squamous cell – the types that have a very high chance of being cured. The National Cancer Institute estimated that fewer than 1,000 people died from these “non-melanoma” cancers in 2008. Melanoma is another story, affecting over 62,000 Americans a year and causing over 8,400 deaths. The majority of melanomas occur in older patients but almost 1 percent are diagnosed under age 20 and almost 8 percent are found between ages 20 and 34. So you’re never too young to start thinking about ways to prevent skin cancer and ways to keep track of what’s happening with your skin.
Since I was in medical school in the mid-’70s, the number of yearly cases in the U.S. has more than doubled. Early detection is likely one reason for the increase but nobody is exactly sure what has been causing the dramatic rise. What is clear, however, is that early detection is the name of the game when it comes to curing melanoma. The earlier a lesion is found, the better the chance of cure – which brings us to the main point of this blog. Everybody should be getting routine head-to-toe skin exams. This means looking from head to toe at every millimeter of your body, including where the sun doesn’t shine. Skin cancers can occur in any location of the body, including the armpits, scalp, between the toes, in the groin or anogenital area – anywhere! Routine self-exam should be part of your screening regimen. If a partner is available who can examine hard to see areas such as the small of the back – all the better.
In addition, I feel that routine screening should include a well-trained health professional who is interested in performing a careful skin exam. This is where it can get tricky. We live in a time when sub-specialists abound – even among dermatologists. A patient may see a cosmetic dermatologist several times a year for Botox injections. The dermatologist may glance at areas of exposed skin but the patient should not feel that a full screening skin exam is being routinely performed. The patient I described at the top of this blog had magical thinking – somehow reasoning that she’d received skin cancer screening just because she’d seen a dermatologist, even though she hadn’t taken her clothes off! Trust me: no doctor is good enough to detect skin cancer without examining the skin.
When the CBS Doc Dot Com team was brainstorming for segment ideas recently, producer Jessica Goldman came up with the idea of following her through a complete evaluation with a dermatologist. That brings us to today’s episode with New York City dermatologist Dr. Francesca Fusco, who covers a wide range of skin issues, from cancer prevention to cosmetic dermatology.
I met a patient today in the emergency department and had what is becoming a common interaction. Despite feeling quite ill, the woman had taken the time to prepare for her visit. When I first spoke with her, she enumerated her symptoms and how frequently she had suffered them. Then she reached into her purse, pulled out a stack of printed pages derived from several medical Internet sites – all of them names you would recognize. The pages covered her specific symptoms, a wide range of possible conditions, and a myriad of treatments. Some of the information was good, and some of it was not so good. But, the information was better than it would have been a year ago, or even six months ago.
This patient’s preparedness pointed out to me how well-informed many consumers are becoming as they attempt to manage own health. The fact that she may have been influenced by some misinformation merely underscores how much responsibility there is for information quality control, and how much of the assurance process is being delegated by default to the individual patients.
My take on this is that certain aspects of healthcare are increasingly shifting to self-care. Between the increased strain on healthcare resources (when was the last time that a doctor in a busy practice could expect to spend more than ten minutes with a patient) and increase in specialization, patients are forced to encounter numerous clinicians and coordinate their responses, in effect becoming navigators of the health care system.
Rather than resent it, I appreciate it when a patient is well informed, particularly if they have the ability to understand some of the basics of disease and disease management. The Internet has vastly changed the landscape of possibilities for understanding and confusion. The sheer quantity of health information that is easily and rapidly available to consumers via the Internet is staggering, and far exceeds what was formerly available to trained medical professionals.
If the reader is not overwhelmed and can apply practical filters to what is presented, then he or she becomes an educated patient. An educated patient makes smarter decisions and tends to be a strong partner in the treatment decision process.
The caveat is that every patient must recognize his or her limitations, and not attempt to self-treat beyond prudent boundaries, which will be determined over time. Of course, if one acts on incorrect information, that is a formula for failure, or worse. But what about good information? The downside of the increasing ubiquity of information occurs when any patient becomes overly convinced of particular facts of his or her diagnosis or treatment in the absence of proper clinical oversight.
I’ve heard colleagues tell stories of patients that were so completely convinced of a self-diagnosis based on articles they read online that they ended up opting not to pursue the treatment path recommended by their providers. These patients inevitably ended up back in the doctors’ offices, having lost precious time. What this points out is that doctors have the greatest advantage to put everything in context. My advice is simply to be cautious. Even if the source is a trusted medical encyclopedia, “good information” misunderstood or misapplied can slow down the process. The goal is to apply superb information to make a layperson better informed, not overconfident.
As far as getting reliable information into a patient’s hands, in my relationship with Healthline Networks, I’ve advised on and reviewed Healthline Treatment Search, a product that creates customized, medically-guided pathways to inform and empower consumers on important health decisions. Whereas most treatment information is embedded deep within articles on health websites, Healthline Treatment Search surfaces a semantically-generated, stand-alone list of possible treatment options for diseases and conditions. The current release covers nearly 1000 health conditions, and includes 4,500 treatment options and 1,200 over-the-counter and prescription medications, with content from ADAM, Cerner Multum, Gale Cengage, Natural Standard, and others. It is Healthline’s policy that feedback from users, both consumer and professional, will allow their experience and observations to improve the product.
Not everyone is in agreement that the Internet is the best place for a consumer to begin his or her search to diagnosis or for treatment. But I would doubt whether this trend will be curtailed, because as the tools improve, we are witnessing increased demand for information. No other information source with the breadth and reach of the Internet looms on the horizon.
What do you think? If not with information from the Internet, how might we as professionals help empower consumers as they take control of their healthcare decisions? Perhaps another way would be to truly empower practitioners to use the Internet and electronic medical records for decision support, for we are also in need of assistance. Let me know.
Walgreens made some headlines with their program to give free acute care services to those who are unemployed.
Before you think that they’re doing this out of the goodness of their hearts, Jaan Sidorov gives a more practical reason.
Doctors rarely would drop patients who have recently gone on Medicaid, or worse, lost their health insurance altogether. Why? As Dr. Sidorov writes, “Today’s patients with no or non-remunerative insurance were not only yesterday’s richly insured but tomorrow’s also. These providers know that when the economy eventually turns around, these patients are going to join the ranks of the employed/insured.”
Walgreens is applying the same principle. Today’s uninsured patients will, more likely that not, have insurance in the future, and will repay Walgreens back for helping them out during these tough times.
So, rather than patting Walgreens on the back for their kindness, you should be noting their business shrewdness instead.
I was taking care of a man who was on bipap. (Bipap is a form fitting mask that goes over the mouth and nose to help augment breathing. It has successfully been used numerous times in place of intubating patients and putting them on ventilators.) He was becoming restless and tired of the mask. I had to wait for the doctor to come and see him, though, before I could remove it.
Due to his medical condition, it was very important that he get an aspirin that day. Since I couldn’t give it to him by mouth (because of the mask), I had to explain to him that I’d need to give it rectally as a suppository.
He nodded his consent and I proceeded to give the aspirin.
A short while later, the doctor came to see the patient and agreed that we could take the bipap mask off for awhile. I happily entered the patients room to take the mask off… and before it was even off his face, he stuck his finger in the air and said,
“FOR THE RECORD, that is a hell of a way to take an aspirin!!”
It’s a hell of a way to give one, too.
*This blog post was originally published at Gina Rybolt, RN’s Code Blog.*
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A five year old British girl who had her outer limbs amputated due to meningitis (meningococcemia with meningitis accompanied by gangrene of the extremities would be our guess) has received a new pair of legs.
