Better Health: Smart Health Commentary Better Health (TM): smart health commentary



Latest Posts

Facebook: The School Reunion That Never Ends

No Comments »

CNN posted today that “Facebook is as large as the US Population.” That’s a lot of computers connecting in a lot of homes and communities all over the world but at what cost?

None to Facebook. They announced today they are finally making money.

But what about to us and our kids? Are we paying a price for being so socially networked?

Read more »

*This blog post was originally published at DrGwenn Is In*

Why Is Food and Drink Prohibited At The Nurse’s Station?

No Comments »

Over the last several weeks I have received numerous emails dictating the enforcement of work place rules regarding eating and drinking in nursing areas and other areas with patient charts. It seems everyone, from the Chief of Staff to the CEO to the Head Nurse In Charge has been making it very clear that drinking in work areas won’t be tolerated. I have at times been confronted by dutiful staff doing their jobs with a robust sense of confidence to enforce this potentially dangerous patient safety issue.

Or so I thought. Whilst speaking with one of Happy’s friendly colleagues, I learned that the issue of food and drink in the work place has nothing to do with patient safety. Like my colleague stated so eloquently, if there is data that can be presented to me that shows my action of drinking coffee at the work stations would some how harm my patient, I will gladly stop immediately. Discussion finished.

But as I learned from my colleague, the issue of food and drink at the nurse’s station or anywhere near patient charts has nothing to do with patient safety. In fact, the regulations are in place to protect ME from myself.

That’s right, the coffee Nazis are cruising the halls with reckless abandonment searching for violators of the hospital wide coffee ban on rounds not because patients could be harmed, but because I could harm myself.

You see, it turns out my distinguished colleague was told these regulations were not CMS or JCAHO regulations, but rather OSHA regulations.

So I looked it up

“OSHA does not have a general prohibition against the consumption of beverages at hospital nursing stations. However, OSHA’s bloodborne pathogens standard prohibits the consumption of food and drink in areas in which work involving exposure or potential exposure to blood or other potentially infectious material takes place, or where the potential for contamination of work surfaces exists 29 CFR 1910.1030(d)(2)(ix). Also, under 29 CFR 1910.141(g)(2), employees shall not be allowed to consume food or beverages in any area exposed to a toxic material. While you state that beverages at the nursing station might have a lid or cover, the container may also become contaminated, resulting in unsuspected contamination of the hands.

Here are the actual OSHA regulations

1910.1030(d)(2)(ix)

Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas where there is a reasonable likelihood of occupational exposure.

1910.141(g)(2)

Eating and drinking areas. No employee shall be allowed to consume food or beverages in a toilet room nor in any area exposed to a toxic material.

In other words this is not a patient safety issue, but rather an employee safety issue. The Joint Commission has no specific standard on the issue other than for hospitals to comply with OSHA regulations.

So with that in mind, I have two comments regarding the issue:

  1. As a private practice physician who is not employed by the hospital, I would suggest that these OSHA rules do not apply to me and therefore the hospital risks no retribution for noncompliance from the accreditation arm of the Joint Commission, which is why I suspect the issue comes center stage for hospitals everywhere. If necessary, I will gladly sign a waiver to relinquish my rights to compensation should I ever contract a blood born pathogen or other communicable disease from drinking my coffee.
  2. If the hospital believes this is a patient safety issue and wishes to make their regulations stronger than those of OSHA and apply them to ALL people in areas with patient pathogens, I will gladly relinquish my daily fluids when I am shown the data regarding patient harm AND the hospital also bans all patient guests from bringing food or drink into the patient’s room. If this is a patient safety issue, it must apply to everyone should they wish to make their rules stronger than OSHA guidelines.

Until this is resolved with rational thought, perhaps over a round of coffee, I’m going to carry one of these around:

It always seems to work for patients.

*This blog post was originally published at A Happy Hospitalist*

Will Decreasing Physician Salaries Reign In Healthcare Costs?

No Comments »

That’s a sensitive topic that progressive reformers often bring up as one way to control health spending.

Over at Slate, Christopher Beam takes a balanced look at the issue. He acknowledges that, yes, American physicians get paid proportionally more than the average employee when compared to other countries.

But that should always come with the caveat that other countries, like Great Britain and France, heavily subsidize medical education, while the average American medical student graduates with debt in excess of $150,000. Furthermore, the cost of medical malpractice insurance is significantly more fiscally burdensome for doctors Stateside.

Listen to Princeton’s Uwe Reinhardt, a favorite economist of health reformers, who says, “doctors’ take-home pay (that is, income minus expenses) amounts to only about 1 percent of overall health care spending, or about $26 billion. That’s a drop in the ocean compared with overhead for insurance companies, billing expenses for doctors’ offices, and advertising for drug companies. The real savings in health care will come from these expenses.”

Indeed.

By the way, thanks to Mr. Beam for including a quote and link from yours truly.

*This blog post was originally published at KevinMD.com*

Will Taxing Soft Drinks Solve The Obesity Problem?

1 Comment »


This week’s New England Journal of Medicine contained a very, very interesting proposal put forth by a few prominent physicians and researchers working on the obesity crisis in America.

They propose that beverages loaded with sugar should be considered a public health hazard (much like cigarettes) and should be taxes. The proposal calls for an excise tax of “a penny an ounce” for beverages like sugar sweetened soft drinks that have added sugars. They cite research that links obesity to heart disease, diabetes, cancers, and other health problems. They say sugar sweetened beverages should be taxed in order to curb consumption and help pay for the increasing health care costs of obesity.

They estimate that the tax would generate about $14.9 billion in the first year alone and would increase prices of soft drinks by about 15-20%. That is big money, but at what cost?

My personal opinion is that while the tax would generate a lot of money that could be put to good use on anti-obesity programs, it is singling out one industry when obesity has numerous contributing factors. Calories Americans are getting from beverages have actually gone down in the past decade, but obesity rates still climb. Soft drinks alone are not making us fatter.

Americans need to pay closer attention to portion sizes and overall calories coming into their bodies from all sources. We know that Americans also eat too much fried food, candy, ice cream, etc. Should we tax everything that is “bad” for us? Absolutely not! And these foods are not “bad” when consumed in reasonable quantities in reasonable frequency.

We also need to learn how to move our bodies more to burn off some of the sweet treats that we love to indulge in. Weight loss is a simple equation that I don’t get tired of explaining again and again: Move more and eat less.

Taxing soft drinks will not decrease heart disease risk…exercising more and losing body fat by consuming less calories definitely will!

This post, Will Taxing Soft Drinks Solve The Obesity Problem?, was originally published on Healthine.com by Brian Westphal.

Healthcare Rationing: When Is It OK?

No Comments »

In his last post, DrRich considered the differences between a system of healthcare rationing in which individual autonomy is honored, and one in which the good of the collective takes precedence. DrRich concluded that the former is more desirable than the latter, since the latter would amount to throwing aside the Great American Experiment. In response to this post, an astute reader calling him/herself Jupe wrote:

. . in the case of a limited supply of an effective vaccine during a deadly epidemic, it doesn’t weird me out to think of docs and nurses being prioritized over, say, me. Or a hypothetical situation of military leaders being prioritized in the event of bio warfare  So it’s not that collectivism inherently offends me across the board.

In my mind there seems to be some sort of invisible line in there somewhere, but I can’t identify what it’s based on or exactly where it’s at, or why. I just know when it’s been crossed.

Jupe then continues, quoting Ezekiel Emanuel on setting rules for healthcare rationing. Emanuel says, “. . .Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia.”

Jupe continues:

[That] just screams “line WAY WAY WAY CROSSED! HOLY CRAP!” to me. I know (well, deeply suspect) there actually is a fundamental difference between “doctors, nurses and military first to be immunized in the event of a bio-warfare attack” and “no antibiotics for the feeble minded” but I can’t pinpoint it outside of “it just intuitively seems right/wrong”.

DrRich interprets Jupe’s question as follows: Why does it intuitively seem OK to ration healthcare in the manner described in the first instance, but not in manner described in the second?

The most obvious answer would be that in the former case there’s an emergency, and extraordinary times call for extraordinary measures. For instance, in times of a war that threatens our survival, most of us would agree that a military draft – perhaps the ultimate sacrifice of individual rights for the good of the collective – is appropriate. And Lincoln, who was fighting a war whose explicit purpose he defined as upholding the Great American Experiment (i.e., to see whether a nation “conceived in liberty and dedicated to the proposition that all men are created equal could long endure”) was himself quite willing to violate individual freedoms to achieve that goal. For instance, he was willing to suspend habeus corpus and jail newspaper editors for sedition. Read more »

*This blog post was originally published at The Covert Rationing Blog*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »

Commented - Most Popular Articles