January 24th, 2007 by Dr. Val Jones in Announcements, Opinion
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On New Year’s Eve when many people are drinking champagne and worrying about who they should kiss at midnight, Dr. Brian Fennerty, Section Chief of Gastroenterology at Oregon Health & Science University is fighting to keep patients alive in the Intensive Care Unit. Severe internal bleeding has put these patients’ lives in jeopardy, and Dr. Fennerty stays with them all night, ordering blood transfusions and tamponading their bleeding.
Dr. Jack Cook, US Navy veteran and former submarine commander, is under a mountain of medical charts. At 67, he is spearheading the transition from paper records to an electronic medical records system for his group practice of primary care physicians in Virginia. He wants his patients to have the opportunity to experience chart portability – something he believes might save their lives in cases where they are brought to the ER in an unconscious state. Although this project will take his group 2 years to complete, and cost untold hours in lost wages (with no clear reimbursal benefit for his practice) he is making the investment for his patients’ sakes.
In the middle of a teleconference, Dr. Iffath Hoskins, Chair of Ob/Gyn at Lutheran Medical Center in Brooklyn, excuses herself to perform an emergency C-section on a young woman with a complicated pregnancy. Against all odds she saves both mother and baby, and reschedules the teleconference for late that evening so she can complete her interview on time for a feature article at Revolution Health.
Just returning from Africa, Dr. Leo Lagasse, Vice Chairman of Ob/Gyn at Cedars-Sinai Medical Center, is preparing for his next mission’s trip with medical residents and faculty. His non-profit organization, Medicine for Humanity, has been behind countless trips to Afghanistan, Kenya, and Eritrya – serving impoverished women with medical problems. Dr. Lagasse takes time out to explain to me the link between smoking and cervical cancer for an article I’m preparing.
Dr. Charlie Smith is spending the afternoon with his son Jordan in Arkansas. Jordan was accidentally shot in the chest by a child with a BB gun, tearing a hole in his heart that caused him to go into cardiac arrest. He was rushed to the hospital where surgeons resorted to cardiac massage to keep him alive – he survived the ordeal, but his brain never fully recovered from the temporary lack of oxygen. He was rendered permanently bed-bound, and raised at home by his loving parents. Dr. Smith created a company called eDocAmerica to allow him to work from home and spend more time with Jordan. eDocAmerica is devoted to answering consumer medical questions via email.
At Harlem Hospital, Dr. Olajide Williams works tirelessly to raise awareness of stroke symptoms in a high risk inner city population. He organizes outreach through musical youth initiatives, lectures nationally to narrow the racial gap in quality care, and declines all prestigious medical recruitment offers. He is steadfast in his devotion to his community – no matter what the cost. Dr. Williams spends part of his weekends preparing blog entries for Revolution Health.
These are only a handful of the wonderful physicians associated with Revolution Health. I hope you’ll enjoy getting to know them through their blogs, articles, and future contributions. They are here for you… to support your need for credible information, to answer your questions, and to help guide you towards optimum health.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 17th, 2007 by Dr. Val Jones in News
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Thanks to med blogger Kevin MD for highlighting an interesting, though cynical, comment about the extended wait times that many people have in getting an appointment to see a dermatologist.
“It’s just as well that there’s a long wait. Someone who comes in with a rash is likely to be biopsied and end up with a scar. If they wait until an appointment is available the rash will probably have cleared up.”
The Boston Globe explains why consumers are having a hard time getting dermatologist appointments:
“In dermatology, the waits are created both by patient demand and, some believe, by dermatologists’ shifting their time to new, more lucrative or complex procedures. Public service campaigns have heightened fear of skin cancer, and melanoma cases are rising, meaning more people are seeking appointments.
At the same time, some dermatologists are devoting time to cosmetic procedures, or to skin cancer surgery that used to be done by general surgeons. Meanwhile, the federal government limits the number of residents hospitals can train, and hospitals would have to create more dermatology slots at the expense of other specialties. This means the number of dermatologists entering practice each year has remained flat, at about 300 nationally, making it difficult for practices to hire new doctors. Just as many have been retiring in the past five years.”
Have you had a hard time finding a dermatologist?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 9th, 2007 by Dr. Val Jones in True Stories
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An attorney from the hospital where I used to work called me out of the blue. He asked me if I remembered a Mr. So and So. “I’m not sure,” I said uneasily. “The name does sound familiar.”
Slowly the case came flooding back to me. I was on call on a weekend covering the neurosurgical step down unit. A nurse paged me to tell me that someone couldn’t move his legs. I asked if it was a new problem. “Yes, he could move them just this morning.”
I ran to the patient’s room and found an anxious appearing, young obese man lying flat in bed with a neck brace on. He had recently had a cervical laminectomy (a neck spine procedure). “I can’t move” he said, a bead of sweat trickling off his brow. “Can you feel anything?” I asked.
“Nothing below my neck.”
I took my metal tuning fork out of my coat pocket and pressed it firmly on his toe nail bed to see if he’d withdraw from pain. Not a flinch. My heart started racing. This is a surgical emergency.
I called the neurosurgery team and told them about the sudden paralysis. They arrived on the floor in under a minute, confirmed the diagnosis, grabbed the chart and took the patient to the O.R. immediately.
Hours later I heard that the man had had a rare complication of neck surgery – a small arterial hemorrhage that rapidly compressed the spinal cord. The surgeons evacuated the blood immediately – though it was anyone’s guess if the man would fully recover.
And apparently he didn’t. Four years later he was suing the hospital for malpractice, and I was named in the lawsuit.
“But I didn’t do anything wrong,” I told the attorney.
“Well, you’d better read the record,” he said ominously.
**See my next post for the end of the story!**
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 7th, 2007 by Dr. Val Jones in Opinion
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I used to believe, quite naively, that hospitals were depressing places simply because no one had noted the connection between environment and recovery. It seemed that white walls, antiseptic scents, and cork boards were somehow required of hospitals – and no one had bothered to imagine anything different.
I thought that the solution was fairly simple – get some creative minds to come in and make recommendations for change. So one day I called the chair of the department of interior design at Parsons School of Design and asked whether she might send her students to my hospital to consider how to improve our situation. She was intrigued with the idea – and we soon had an entire team of bright young designers measuring the floors and windows, considering the limitations of our square footage, and getting to work on some dramatic proposals for exciting change.
Several months later the Parsons students made a presentation to our hospital’s executive team, and this was met with great enthusiasm. We all thought that we were on the verge of an exciting breakthrough for patient wellness. But alas, in the end not a single design suggestion was implemented as our administrators told us that there was no money available for environmental improvements.
I found out much later that our acting CEO was making about ½ million dollars per year in salary at the time. All the while the poor patients had to recover in a grim void of sensory stimulation.
There is ugliness in hospitals – and it runs deeper than the white walls. As with many sectors, money is the deciding factor regarding whether or not something gets done. I think that hospitals should take a hard look at their white walls, and the white linings of their executive pockets and ask themselves whom they were built to serve.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
December 29th, 2006 by Dr. Val Jones in News
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Well, I fell for it again – that panic that follows breaking news that a drug once thought to be safe was now causing some horrible, unexpected side effect. I nervously wrung my hands as I thought of all the proton pump inhibitors I had prescribed for heartburn in the past. Did I hurt my patients? Are they all lying in a hospital somewhere with pins in their broken hips?
I took a deep breath and decided to go back to the source of the news. There it was – the offending research study in the Journal of the American Medical Association. I read it carefully – looking for the devil in the details. And lo and behold, the caveats started slinking off the pages.
First of all, the “44% increased risk of hip fractures” sounds really bad, doesn’t it? Well, what if I said that a person’s risk of getting a hip fracture (IF they were over 55 years old AND took a proton pump inhibitor for over a year straight) was 1.44 in 1000 whereas if they never took the medicine, their risk would be 1 in 1000. Does that sound as bad? Well, I’m actually saying the same thing.
There were some other interesting details – men were significantly more likely to get fractures than women 1.78:1000 compared to 1.36:1000. There was no explanation as to why that might be. Also, I noticed that there was no discussion of a potential confounder – which of these patients were in nursing homes? In my experience, patients in nursing homes often automatically get proton pump inhibitors – and stay on them indefinitely as “GI prophylaxis.” Now if you’re sick enough or demented enough to be in a nursing home, then you’re probably at higher risk for falls… which would be a good reason why people on proton pump inhibitors break their hips more frequently, right? If you fall more frequently, then – bingo – there goes your increased risk for fractures.
Well, the research does seem to suggest that there’s a trend – people who take proton pump inhibitors for long times in higher doses may have a higher risk of fractures. But the jury’s still out on why that may be. For most folks in the US who are under the care of a watchful physician, their dose and duration of taking the medicine doesn’t put them at increased risk at all.
So to me the take home message is that people shouldn’t stay on proton pump inhibitors indefinitely, which isn’t really news to me. I hope that this blog entry has reduced your anxiety level… stay tuned for more critical analysis of research findings.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
