September 9th, 2008 by Dr. Val Jones in Uncategorized
Tags: Hospitals, Relationships
3 Comments »
I was catching up on my Wall Street Journal blog reading, when I came across a post about a physician who was sued for prescribing painkillers to a patient who proceeded to crash her car. The crash killed a pedestrian, and the victim’s wife is now suing the driver’s doctor. Obviously, this case sends chills down physician spines – as it seems that we are now held responsible for patient behavior outside of the the doctor-patient relationship or hospital setting.
Beyond the outrageousness of the case itself, is the sad subtext found in the comments section. Physician after physician respond that they are leaving medicine or have ceased clinical practice. They say that they’d never allow their children to become doctors, and that no amount of compensation is worth the risk and sacrifices of a career in medicine. It’s really depressing to read about such low morale.
For those physicians remaining – I do see a couple of bright spots. First of all, concierge medicine (or “micropractices” where patients pay cash for services) permits the doctor to see fewer patients at the same salary. Removal of the administrative headaches associated with insurance reimbursement as well as the frenetic pace of “volume uber alles” dramatically improves quality of life and patient satisfaction. The physicians I know who have switched to cash-only businesses are very happy.
Second, working as a physician for the US military has one major advantage: you cannot be sued. The idea is that military physicians do their very best to take care of the troops, but it is recognized that military personnel are at great risk for physical harm due to the nature of their job. The Feres Doctrine stipulates that military personnel cannot sue the government for perceived (or real) poor medical outcomes related to active duty. In cases of medical negligence (for veterans and off-duty military personnel), the government may be sued, but not the individual physician.
So, if the tyranny of medical malpractice attorneys becomes unbearable, one might consider practicing in a VA or military hospital. Sounds crazy, I know… but it’s worth a look! Of course, a better solution would be for the next administration to take on Tort Reform in a serious way, and promote tax breaks and facilitate health savings accounts for Americans who’d like to have more control in how they spend their healthcare dollars. Maybe then they could sign up for an affordable concierge practice and at last both doctors and patients could be happy again?
What do you think?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 8th, 2008 by Dr. Val Jones in Uncategorized
Tags: News, Pharmaceuticals, Research
1 Comment »
Last week I attended a press conference about healthcare reform at the National Press Club. The most interesting of the 4 speakers was Grace-Marie Turner, president of the Galen Institute. In a recent editorial in the Wall Street Journal, Ms. Turner argued that,
The complex problems in our health sector are best cured by a bigger dose of market competition, not more government intervention.
I had the chance to interview Ms. Turner after her lecture.
Dr. Val: You’ve said that “we’ve got to come to a uniquely American solution to our healthcare crisis.” What does that mean?
Ms. Turner: I speak a lot in Europe, and they really believe that we have a permanent underclass of 47 million people who never have access to our healthcare system. They imagine that they’re bleeding in the streets. We know that’s not the case. Everyone has access to healthcare through emergency rooms – but this is an inferior way to access healthcare. People end up getting treatment at the end of an illness rather than the beginning when things could be better treated, and it’s much more expensive. We need to solve the problem of health insurance.
The movement of “consumerism” is something the world is looking to us to figure out. In other countries their concept of “innovation” is adopting diagnostic codes and payment structures for a system of treatment. We’ve had that for over 20 years in America. When we talk about innovations we mean new ways to respond to consumer needs. The fact that we don’t have so many rules and regulations guiding the entire structure of the healthcare experience means that we can innovate. We can create diversity of care options.
Most of the major research-based pharmaceutical innovations occur in America because we don’t have price controls and we don’t have restrictions on access to care. These are unique aspects of the American healthcare system, and even though Europeans criticize us, they’re always looking to learn from us.
Dr. Val: Why are “medical homes” important?
Ms. Turner: In this increasingly complex healthcare system, people need to have a place to go where their care will be coordinated. That may be a physician’s practice, but it can also be an electronic medical home where people have their medical records kept in one place, and where they have access to different specialists that they can use to coordinate their care. The medical home is really a beacon for more accurate, coordinated and more productive use of our healthcare system.
Dr. Val: You mentioned that there is a “workforce crisis” in our healthcare system — that there are not enough primary care phsyicians to meet demands. Yet you also said that If people could buy health insurance across state lines we could solve a lot of the access issues. How can both be true?
Ms. Turner: It’s a chicken and egg problem. We’ve got to increase access to health insurance. We can’t have 45 million people feeling that they’re blocked from predictable access to healthcare. Once you get tens of millions more people into the healthcare system, then you’re going to start to see a lot of pressure to better utilize the resources that are currently in the system. For example, people don’t always have to go to a doctor for something that a mid-level medical professional could provide them.
I predict that more people will begin to purchase high deductible insurance in case of major accidents or catastrophic events – but they’ll want more control over their routine access to the system, including convenient care clinics and complementary and alternative medicine. If we allowed cross-state health insurance purchasing, it would force the system to meet the needs of consumers for more affordable and convenient care.
Dr. Val: You said that increasing access to complementary and alternative medicine is about giving people “more choices.”
Ms. Turner: I’ve heard so many stories about people who were getting their care through their health insurance providers – guided through a predictable pattern of specialist care. And then when they swithched to a health savings account, they could access the system the way they wanted to. So many of our health issues are behavior-related, and it seems that alternative medicine practitioners can have success in helping people modify their behaviors. The more we have top-down regulatory prescription of what the system will pay for or not, the more you eliminate the alternative practices that might be very helpful to people. I’d like to see a lot more pluralism in our healthcare system, and expanding government intervention is not going to help us achieve that goal.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 5th, 2008 by Dr. Val Jones in Uncategorized
Tags: Parenting, Weight Loss
4 Comments »
This week yet another study has confirmed that losing weight (and keeping it off) requires more effort than we initially imagined. Apparently, we really do have to “work our butts off” to be fit for life. It seems that half an hour a day is not going to cut it. Obese women in this study had to exercise for at least an hour a day to maintain their weight losses.
One commenter simply said that a better idea would be to not become overweight in the first place. Well, the train has already left that station! Still, parents need to take heed – once a child becomes substantially overweight, he or she is likely to struggle with that weight for a lifetime.
Perhaps it is easiest to intervene at the very earliest stages of our lives. As for me (and the >3000 of us in my weight loss group) it looks like I’ll be trying to get a full hour of exercise in every day! Care to join me?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 4th, 2008 by Dr. Val Jones in Uncategorized
Tags: Hospitals, News, Parenting, Pediatrics, Research, Vaccines
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This interview is a continuation from part 1.
Dr. Val: How did Simon contract the MRSA infection?
Dr. Macario: That will remain the biggest mystery of my life. No one knows how he picked it up. In Simon’s case there was no entry via the skin – he had no cut or boil or surface evidence of infection. He contracted the community associated strain of the bacterium, which is much more virulent than the kind people get in hospitals. It seems that the MRSA superbug somehow got into his body via his lungs. It’s possible that he touched something with MRSA on it and put it in his mouth and then breathed it in. Unfortunately, there’s just no way to know where he got it.
Dr. Val: How many children die of MRSA infections/year in the US?
Dr. Macario: According to the Centers for Disease Control and Prevention, in 2005, nearly 19,000 Americans died from MRSA infections. During the same year, there were 134 cases of MRSA in children. Actually, more people in the US die from MRSA every year than from AIDS.
Dr. Val: Tell me what you’re doing to promote awareness of MRSA.
Dr. Macario: I have a Ph.D. in Public Health, and when I received the autopsy report stating that Simon’s death was caused by community-acquired MRSA, I was dumbfounded. I hadn’t even heard of MRSA before. In fact, in my career in Public Health I thought that infectious diseases were no longer much of an emphasis because of the terrific job we’ve done in eradicating most diseases through vaccine programs and antibiotics. I assumed that lifestyle issues (nutrition, physical activity, early detection, and safety precautions) would be the focus of my career.
It was a real eye-opener to me to live through the loss of a child to a menace I thought we had under control. Sixty years ago families had large numbers of children, knowing that some would be lost to infectious disease. That just isn’t the way we think anymore. But MRSA is a threat that could essentially take us back to a time when Americans died of infections quite commonly. MRSA is a superbug that is highly resistant to most antibiotics we have. It’s only a matter of time until it’s resistant to everything.
I’ve begun working half-time with Dr. Robert S. Daum at the MRSA Research Center at the University of Chicago Medical Center, Department of Pediatrics, Section of Infectious Diseases (Chicago, Illinois). Not only are we studying how contagious MRSA is (in home and jail settings), we are also studying the most effective way to treat MRSA infections.
Dr. Val: What should doctors know about MRSA and children?
Dr. Macario: There are 506 new drugs approved by the FDA for development… only 6 are new forms of antibiotics. That’s because the antibiotics are not so profitible. Antibiotic customers are short term users – they need the antibiotic for a short time and then they’re healed. Contrast that with a drug like Lipitor, something that people need to take every day for a lifetime, and you’ll see why statins are more of a priority for drug company development than a new antibiotic that could combat MRSA.
Doctors need to realize that MRSA is a growing threat, and we may not have a good treatment for it in the near future. There is a new strain of MRSA (the “community associated” strain) that can be found anywhere – schools, homes, locker rooms, and gyms. This strain is more virulent and more resistant to antibiotics than anything we’ve seen before.
Dr. Val: What advice do you have for parents to protect their children from MRSA?
Dr. Macario: Wash your hands frequently and thoroughly, clean surfaces with bleach, don’t share personal items like towels and razors. Parents should NOT run to antibiotics for any possible illness their child may have. Don’t use antibiotic soaps. Antibiotics should be considered the absolute last resort. If we keep using them for viral illnesses or when we don’t really need them, we’ll just fuel the drug resistant MRSA.
Dr. Val: What’s the most important thing you’d like to tell Americans about MRSA?
Dr. Macario: This new strain of MRSA (community associated MRSA) can affect anyone. Young, old, middle aged, healthy or sick. It can attack a person as healthy as basketball star Grant Hill. It happened to my healthy baby, and it can happen to your family. People must view antibiotics as a sacred last resort to treating disease. If they overuse and misuse them, MRSA and other resistant strains of bacteria will continue to mutate and become even more prevalent and dangerous.
My husband and I are both highly educated, I keep my house immaculate, I vaccinate my kids, and they never went to daycare centers. It doesn’t matter what socioeconomic strata you’re in, race, gender, ethnicity or age – MRSA doesn’t discriminate. It can happen to you.
But to leave this on a brighter note: my husband and I had another son after Simon died. His name is Dylan, and has brought a lot of joy to our lives.
***
For more information about MRSA, please check out StopMRSAnow.org
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 3rd, 2008 by Dr. Val Jones in Uncategorized
Tags: Hospitals, Parenting, Pediatrics
2 Comments »
I had the honor of interviewing Dr. Everly Macario about the the tragic death of her young son, Simon Sparrow. Simon was a healthy one and a half year-old baby who came in contact with a deadly form of Methicillin-Resistant Staphlococcus Aureus (MRSA). The bacteria got into his blood stream and ended his life just 2 days later. Everly has become a tireless advocate for MRSA awareness. This is her story:
Dr. Val: Tell me what happened to Simon.
Dr. Macario: Simon was a very healthy, breast-fed baby, born at full term with no history of illness or immune disease. When he was about 15 months old he caught what I thought was a throat infection. He wheezed a bit when he breathed so I took him to the doctor. The doctor reassured me that he seemed to have a mild case of bronchitis, and gave me some albuterol, prednisone and antibiotics.
Simon did well for a few days until he woke up on a Friday morning with a primal terrified shriek (a sound neither my husband or I had heard from Simon before) and a fever. My husband decided to take Simon to the Emergency Room immediately. Once there, the doctors ran the standard battery of tests (e.g., chest X-ray, oxygen-level test) only to speculate that he may be an asthmatic kid.
I could tell something was really wrong given how irritable Simon was… he truly was inconsolable. When my husband came to pick us up, my husband noticed Simon’s lips were blue as we were walking out the ER doors. We went back in and pointed this out to the doctors. They, once again, measured his oxygen level and informed us that he was within normal range. We then went home and gave Simon some albuterol administered via an inhaler. When we did this, Simon’s eyes rolled back into his head in such a way that really alarmed us. But, we said to ourselves, “he’ll be fine, he’s just sick like any other kid his age gets sick, it’s temporary, he’ll be fine….”
That afternoon, Simon vomited the little milk he had had that morning, and lied limply in my arms – something that terrified me as I was used to a more wiggly and restless Simon when he would get ready for a nap. He kept asking for “agua” (water in Spanish) and drank about 4 “sippy” cups of water, only to vomit all of it soon-after. I really panicked when his cheeks and forehead were cold and his lips were turning blue again. His nostrils were also flaring and he was breathing so heavily at this point that his chest was expanding and contracting “in and out” in the shape of a barrel. I called the doctor to have her hear Simon’s labored breathing, at which time she said, “Hang up and call 911.”
As soon as Simon was wheeled in to the ER, doctors hooked him up to everything imaginable (oxygen, nebulizer, IVs for medication and pain relievers). And, I kept hearing, “Your child is very, very sick. Your child is very, very sick.” At this point I became absolutely hysterical – “basket case” would be the technical term. Simon kept looking at me with his chocolately-brown eyes, and long curly eye-lashes, repeating, “Agua, agua, … agua.”I was so completely terrified and felt so utterly helpless that my reaction was to call my parents. I had to leave Simon to call them. As soon as I got off the phone I ran back to where Simon had been, only to learn he had been brought up to the ICU, where he was going to get intubated so that he could breathe more easily.
I was brought into a conference room where one of the pediatric emergency room doctors sat me down and began to tell me that Simon had an infection but the source was yet unknown. Her tone was almost too muted and the pace at which she spoke seemed very slow. From this point on, doctors kept coming in and out of the room with updates – basically, Simon had gone into septic shock and his blood pressure was dropping. One fellow who tried to be encouraging said, “Most kids leave the ICU.” It was this fellow, however, who said later that evening that she “didn’t want to lie, that Simon was going downhill.”
By the time my husband arrived and we were allowed to see Simon, I knew in my soul Simon was dead. Jim and I gathered around the bed on which Simon was lying, along with what seemed like 10 doctors, representing every specialty in medicine. The attending said that they had to get Simon on ECMO (the “heart-lung machine” or “extracorporeal membrane oxygenation”) as this was “his only chance.” I begged the ECMO expert to do what he could to save Simon.
From that point on until Saturday morning, Jim and I desperately and despairingly prayed for Simon to come out of this sepsis state somehow. Doctors came in regularly to update us but we knew the chances were not good when we heard things like, “We’re not sure if your son is going to make it at this point.”
While on ECMO, Simon became incredibly bloated and his skin turned purplish and scab-like.He had solid plasma “tears” coming out of his eyes. He did not look like Simon.
Late morning the next day, Jim and I decided to take Simon off of the ECMO machine, as he was not responding to it at all, and he was pronounced dead at 12:45 p.m. Still no precise cause of death.
Two months later, from the autopsy, we learned, as was suspected, that Simon died from “Methicillin-Resistant Staphylococcus Aureus” (MRSA), probably the “community-acquired” kind versus the hospital-based one. Neither my husband nor I had ever heard of it. MRSA is a virulent antibiotic-resistant bacterium. We have since learned that because of the over-prescription of antibiotics and the use of antibiotics in animals that we eat, we have created an environment that causes “weaker” bacteria to die off, allowing stronger competing strains to survive. MRSA is only treatable with vancomycin, that is assuming you know that is what you have contracted.
It seems unfathomable that a healthy, hearty, and beautiful little boy could have breathed in such a bacterium – one that attacked his organs by releasing lethal toxins – and in less than 24 hours was gone. MRSA took my son swiftly and totally.
***
Please see the next blog post for the rest of the interview with Dr. Macario.
Everly is a spokesperson for STOP MRSA Now.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
