March 9th, 2009 by DrRob in Better Health Network
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Healthcare is bizarre. Anyone who spends significant time in its ranks will attest to the many quirky and downright ludicrous things that go on all the time. But I am not sure people realize just how strange our system is. Perhaps it would be interesting to see what it would be like if other parts of our lives were like healthcare.
1. Get up in the Morning
The first thing that happens in your day is that your alarm fails to go off. Although you have major things happening, nobody ever has explained to you exactly what you are supposed to do and when. You watch the morning TV show and it seems that some experts say you should go to school while others say you should avoid school at all cost. You call a friend who says that she knows someone who went to school and it destroyed their liver. Another friend goes to school every day and is just fine.
Confused, you turn to the Internet and go to a website that explains that you should base your schedule on the pattern of tea leaves in a cup. This site claims that your normal schedule is actually fraught with secret appointments that will, unbeknown to you, make you have cancer. It states that those people in power are making you go through this dangerous schedule so they can make money off of you. They don’t care for you like the people who made this webpage (and for $400 you can have 6-months of magic tea leaves).
Finally, you decide that you are going to go with the majority opinion and go to school.
2. School
You go to your bus stop and wait. You keep waiting. You know that the bus was supposed to come at 8 AM, but after an hour you begin to wonder if you missed it. Calling the bus service, you find out that the bus got caught up doing some extra routes. There is a shortage of buses, and so the ones that remain have to do twice as many routes as is feasible. After a two hour wait, the bus finally arrives to take you to school.
The first teacher comes into the classroom and looks very distracted. She teaches general studies and is staring at a curriculum that contains a huge amount of subjects. As she is doing her lessons, she furiously takes notes on her own teaching so that she can submit documentation to the school board and prove that she taught you. This is the only way she gets paid.
In total, she teaches for about 15 minutes and documents her teaching for 45 minutes. You want to ask questions, but the bell rings and you have to move on to your next class before any can be answered.
The next teacher only teaches a small specialized subject. This teacher is paid four times more than the first teacher. Instead of teaching and answering questions, however, he is constantly making you take tests. Apparently, the school system pays a huge amount for making you take tests, but very little for teaching lessons that would make you do well on those tests in the first place.
School is finally over, but you don’t feel like you got much out of it (except for taking a lot of tests and getting more confused). You decide that a trip to the store would perhaps make you feel better.
3. The Grocery Store
Upon entering the grocery store, you notice something odd. There are very few different brands of items stocked on the shelves. Your choice is limited to only the brands that have struck the best deal with the grocery chain. These brands have to send the grocery store a large “rebate” check because they are carried exclusively in this store.
When you go to the meat counter and ask for some steak, the butcher asks you if you have first tried the ground beef. You may not purchase steak unless you have first tried and disliked the ground beef. The ground beef, of course, is actually ground turkey, but the butcher says that these two are basically interchangeable and so the substitution is permitted.
The grocer can’t post prices because all customers have different negotiated prices. Posting prices, in fact, would be considered collusion since other grocers could find out exactly what this grocer is charging. Some congressman in California decided that grocers are all crooks and should not be allowed to share what they charge for things.
You go to the cash register to pay. The total is $380, but the cashier informs you that your negotiated price is only $150. A poor person behind you has not had the chance to negotiate a price and so must pay full price for everything.
There are a few people in the store who don’t have to pay anything. They have had the price negotiated for them by the government, and so will come to the store very often. They sometimes come for real food, but are often coming for candy and cigarettes – all paid for by the government.
This experience leaves you more tired and confused, and so you decide to go home.
4. Home
Coming home, you notice that your house is under construction. There is a new wing being built that contains all sorts of the newest and fanciest gadgets, such as flat-screen TV’s, the fastest computers, and wonderful new kitchen appliances. Going into the house, you notice that there is no running water or heat. Apparently, there are all sorts of grants and low-interest loans to pay for the fancy gadgets, and so contractors find it much more profitable to do that instead of fixing water or heating.
Your mother is in the kitchen trying to make dinner, but instead of cooking she is staring into a cookbook and at the ingredients you brought from the grocery store. You assume she can make due with what you brought, but she just sighs helplessly. Despite the fact that your mother is incredible at improvising meals, she is required to follow a cookbook that doesn’t fit the ingredients that are available. This makes dinner taste pretty bad. Your mother, obviously angry about this, gives you a weak smile and tells you to finish what is on your plate.
After dinner, you settle down to watch some television. As you are finally starting to relax, a knock on the front door breaks your peace. At the front door stands a police officer. ”You are only authorized to be in the house for two hours today, so I am going to have to ask you to leave.”
You try to explain that two hours is not enough to get the rest you need, but the officer threatens a stiff fine and forces you to leave. Before you can get your necessary things, you are forced to leave – without an explanation of how you are supposed to survive on the streets.
(to be continued)
**This blog post originally appeared at Dr. Rob Lamberts’ blog, Musings of a Distractible Mind.**
March 8th, 2009 by Emergiblog in Better Health Network
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Nursing is an extremely interesting profession. It’s either absolutely off the deep end or it’s totally unique. From the entry levels of practice to the terminal degrees available, nursing doesn’t look like, act like or educate like any other profession.
And it shouldn’t. Because nursing isn’t like any other profession.
*****
Let’s take entry level into practice. How’s that for jumping into the frying pan?
You can start nursing with an AA degree that should be two years but can’t really be done in two years so it’s actually more like three years with all the pre-requisites done first.
Whew!
Or…you can go for a BS degree which takes four years and can actually be done in four years unless you have to go a summer session (like my daughter), which really makes it over four years. This is supposed to be the desired entry level for practice. HOLD YOUR FIRE, I SAID “SUPPOSED TO BE”!
Or…
If you already have a BS or a BA degree, you can go into an entry level Master’s Degree program because it is really dumb to go back and get an AA degree because you already have a BS degree and you really don’t need one of those again, right, and the MS degree program is only 12 – 18 months.
And somehow through all this, you have become an RN.
Congratulations!
But…now you are wondering if you should go for a higher degree….
*****
So…
If you have an AA and you want to get your BSN you can go back to school either on campus or online, for which you will pay a lot of money as there are a lot of RN-to-BSN programs out there to help you if you think maybe you should do it as the BSN is SUPPOSED to be the desired degree and you feel as though it is your professional duty to do it, but you won’t get any more money for it or anything, but you will have BSN after your name which, if you are like me, is worth every penny and every bead of sweat….
Sorry, I digress…
Or, if you want to do something other that bedside nursing you can take that BSN and get your BSN-to-MSN either on campus or online or if you are really ambitions you can go right for the RN-to-MSN programs since you have an AA degree under your belt and now you can be a manager or a nursing instructor or work in public health and make approximately 50% less than you did as a staff nurse, but hey, you are willing to sacrifice for your profession.
Right?
But it gets better!
You can take that BSN or MSN and head for a doctoral program if you really want to do research and teach, that would be a PhD, or wait!, you want to be an advanced practice nurse or nurse practitioner as they are called and now you have to have your doctoral degree when you only used to need an MSN but they changed the rules and now to do that you need a doctoral degree called the DNP, which is different from the PhD because it is a practice doctorate as opposed to a research doctorate…..
*****
No wonder folks outside the profession think we’re off-the-wall.
But we aren’t.
We’re unique.
Our profession is flexible.
In spite of the light-hearted take on the educational opportunities, if you read between the lines what you see is that there is an entry level into nursing for everyone at any stage of their lives who are willing to work for that “RN” after their names.
What you see is an unbelievable number of opportunities to advance your education in a variety of ways. If you want it, it is available. No four-year-undergrad-followed-by-three-years-graduate school, like lawyers. Unless that is what you want to do. We have options. In that, we are unique.
What you see is a profession that has two terminal degrees in the PhD and DNP. Now, I’ve heard there is some controversy about this, having two doctoral pathways in nursing. I see it as flexibility in being able to receive a higher education that will take your career where you want it – to the classroom/research or to an increased responsibility for patient care.
*****
Nursing does not have a lockstep education pattern. We don’t have a “one size fits all” education system because we don’t have “one size fits all” nursing opportunities.
And we most definitely don’t have “one size fits all” nursing personalities.
Think about it. Nursing allows changes in specialties. Unlike law or medicine, we can change our focus and switch our area of specialty long after we’ve entered the profession.
*****
Sure, we argue and debate amongst ourselves. All the way from the best way to become a nurse down to whether or not we have one or two terminal degree options.
But folks, we’re all nurses. We are more alike than different and at our core we are solid.
So maybe we need to come together (Beatles reference!) and realize that all the different factions of nursing need to embrace the fact that we are nurses.
We can do that, I’m sure of it.
Because nursing is unique.
And that’s why we do what we do.
**The post was originally published at Kim McAllister’s blog: Emergiblog.com**
March 8th, 2009 by Dr. Val Jones in Announcements, Expert Interviews, Health Policy, Medical Art
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In yet another example of a fortuitous Twitter connection, Tim Clarke, Deputy Director of Communications for the National Museum of Health and Medicine reached out to me after I tweeted about Walter Reed. He graciously offered to give me a guided tour of the museum, located on the Walter Reed campus where I volunteer with the Red Cross.
We spent about an hour reviewing some fascinating exhibits, including the history of body identification techniques. If you’re a fan of NCIS, then you should run (not walk) to this museum to gain insight into the incredible evolution of forensic science over the past 150 years. The exhibit begins with Paul Revere’s dental tools (did you know he was a part-time dentist?) and the story of how he identified the body of a fallen soldier for whom he’d done some unique silver smith work.
The time of death and relative age of human remains can be gauged by bone erosion (they become smoother with age) and material evidence (the type of button found near the remains can be used to identify the season of death – larger buttons were used for heavy winter overcoats for example) among other things.
Did you know that finger print analysis is not automated? Apparently, to this day, a technician must be involved in the computer-generated comparisons because finger prints are too complex for 100% accuracy with computer models.
However, with the advent of DNA analysis, extraordinary advances have been made in our ability to identify remains. In one particularly fascinating case, Charles Scharf’s body was identified after his wife brought in a letter that he’d sent to her from Viet Nam in 1965. She had kept it in a plastic bag in a shoe box since that time. Charles had sealed the letter with his saliva, and because of the excellent condition of the envelope, tiny pieces of DNA remained in the glue. In 2006 pathologists were able to link his remains to his DNA sample, and finally confirm his fate.
Modern autopsies can be performed rapidly with the guidance of CT scanners. The likely internal injury that caused a soldiers death can be identified via CT, and then rapidly confirmed by pathologists. Research into armed forces injuries can result in improved equipment and increased safety. In one case, a retrospective analysis of CT scans demonstrated that military personnel had larger chest cavities (on average) than initially thought – this resulted in the provision of longer needles for chest tubes in trauma bays.
And speaking of trauma bays, the museum has transported an entire trauma tent from Balad Air Force Base in Iraq to memorialize medical care during the war. A 3000 pound concrete slab of flooring provides the base of the exhibit, complete with original blood and betadine stains, gouges in the plastic floor sealant, and duct tape. Original metal tent doors and canvas show evidence of sand storm damage, with sand still coating the tent air ducts. Action photos taken at the trauma bay surround the exhibit. Nothing brings home the reality of war like this living 3-D memorial.
Just to the left of the tent is a large photo of a Black Hawk helicopter and a wounded soldier being carried by EMS through a canvas archway. On the ceiling of the archway is an American flag. I turned to Tim and asked him why the flag was on the ceiling and he said,
“That was so the soldiers could look up from their stretchers as they arrived at the medical facility and know that they were ‘home.’ They were safe now, and were going to be taken care of.”
Tim also introduced me to the Abraham Lincoln exhibit, where the bullet that sealed his fate (along with skull fragments, a tuft of his hair, and his surgeon’s sleeves) are on display. It’s an extraordinary feeling, being so close to history.
I’m really glad that I had the chance to experience history with Tim, and I strongly recommend that you contact him to set up your own guided tour. If you’re a member of a professional society, or are coming to DC for a meeting or event, why not make the National Museum of Health and Medicine a part of your travel plans?
March 7th, 2009 by Dr. Val Jones in Medblogger Shout Outs, Quackery Exposed
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Dean Ornish writes:
…let’s use science to evaluate ideas that might seem a little weird or offbeat, but deciding a priori that an idea is stupid or worthless just because it doesn’t fit the conventional paradigm is, in my humble opinion, the epitome of being unscientific.
Dr. Benway responds:
There’s weird and then there is weird.
Diet and excercise affecting cancer? Plausible.
Naturopathy? Weird.
Subluxations? Homeopathy? Delusional.
MDs selling self-branded supplements? Embarrassing.
Chelation and coffee enemas for kids with autism? Evil.
I believe you are the plausible wrapping paper surrounding a coalition of crazy, weird, embarrasing, and evil ideas that some want to “integrate” into the universal health care bill.
Healthcare is bizarre. Anyone who spends significant time in its ranks will attest to the many quirky and downright ludicrous things that go on all the time. But I am not sure people realize just how strange our system is. Perhaps it would be interesting to see what it would be like if other parts of our lives were like healthcare.
