June 18th, 2008 by Dr. Val Jones in Announcements
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I wanted to let you know about a wonderful new online resource for pregnancy education here at Revolution Health. I helped to develop the Advanced Answers Pregnancy Center along with a team of experts from Columbia University’s Department of Obstetrics and Gynecology. It is a comprehensive, multi-media educational tool to help women (especiallly high risk moms-to-be) learn about their pregnancy and birthing options.
I’m very proud of Dr. Mary D’Alton’s team for their outstanding work on this unique center. Where else on the Internet can you find cutting edge, consumer-friendly pregnancy information written by the top minds in maternal health? I guess you could say that I feel as if I’m the proud new mom of a pregnancy education center!
I also want to tell you about another exciting tool that I helped to build: the momScore. This is the first heatlhcare quality index targeted specifically for women. With the help of an interactive map of the United States, women can compare how their home states stack up against others on women’s health issues. How mom-friendly is your state? View the momScore tool to find out.
Thanks for checking out my two new “babies” – knowledge is power, so go get some!
*Advanced Answers Pregnancy Center*
*The momScore*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 17th, 2008 by Dr. Val Jones in Expert Interviews, Health Policy
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Ken Thorpe, Ph.D., is the Executive Director of the Partnership to Fight Chronic Disease, and is admired and respected by many of the “movers and shakers” in Washington. The outpouring of appreciation for his work was quite evident during the recent half day-conference entitled, “Fighting Chronic Disease: The Missing Link In Health Reform.” I had the chance to speak with Ken to get his thoughts on chronic disease and health reform.
Dr. Val: What are the most important things that the general public needs to know about chronic disease?
Dr. Thorpe: Two things. First of all, they need to know whether or not they have a chronic disease. For example, about a third of diabetics in the country don’t know they have diabetes. So Americans need to be screened appropriately for potential chronic diseases like cancer and diabetes.
Second, if you do have a chronic disease, there are simple ways to manage it. Management needs to be coordinated through a primary care physician. Basic things like blood pressure and blood sugar need to be monitored on a regular basis. Diet and exercise are also a critical compenent of chronic disease management. The good news is that most chronic illnesses are manageable, but patients need to be actively engaged in their health. Medication compliance and consistent lifestyle modification under the care of a PCP is the way to go.
Dr. Val: What should people know about the Partnership to Fight Chronic Disease?
Dr. Thorpe: We want to get patients (or “consumers”) involved as a voice for healthcare reform. Patients are the key to making our healthcare system simpler, less-expensive, and less administratively complex. We believe that health reform is possible. We must not become frustrated with our inability to fix everything today, but if we start with the right set of issues and really work collaboratively to solve them, we really can make life better for patients and physicians.
The patient community should go to our website and learn the facts about chronic disease and help to educate their local politicians and community leaders about it. I would encourage them to spearhead community-based interventions to promote weight loss and prevent obesity. We just released a book about “best practices” for achieving healthy behavior modifications. It is full of local program ideas to help prevent chronic disease – and it’s all based on initiatives that have a proven track record of success. Our best practices book is an ideal guide to community-based interventions that can make a difference.
Dr. Val: You say that we need a different delivery model to treat chronic disease. Can you explain that?
Dr. Thorpe: Chronic disease management requires a team-based model. Nurses, social workers, and mental health providers should work with patients at home. We need a more proactive model where we engage patients in managing their disease so that we can prevent unnecessary flare ups. For example, with diabetes, if you don’t control your blood sugars on a daily basis, you’re far more likely to go on to require a limb amputation. Our current delivery system does not allow this type of management – interacting with nurses at home, for example – because nobody pays for it. So we need a different payment model and a different delivery model.
Dr. Val: Do you think that online health websites can make a difference?
Dr. Thorpe: I think that online programs should engage people in education – so that they can understand the connection between weight, diet, exercise, smoking, and chronic illness. Only 15% of the population understands the gravity of these issues and how it affects the cost of their health insurance.
Online sites that allow people to track their progress (and chart how they’re managing their disease) may also help people to become more actively engaged in their healthcare.
Dr. Val: How can we encourage people to adopt healthy behaviors?
Dr. Thorpe: Incentives always work. We have to give better tools to people who want to change their behaviors. We have to make it easier for them to manage their health at their places of work. For example, some employers conduct health risk appraisals with their employees and then put together care plans and even have a nurse practitioner available at the work place to check on progress. That way the employees don’t have to take time off work to see the physician after hours.
We can also make a difference in schools – we need consumer advocates to continue to demand healthier school lunch programs and increased physical activity for kids. Consumer advocacy at the community level is critical to our success in the prevention and management of chronic disease.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 13th, 2008 by Dr. Val Jones in Medblogger Shout Outs
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Some bloggers’ clinical vignettes speak volumes about why doctors are exasperated with their day-to-day work lives. Here are a few good ones:
From White Coat Rants:
A patient from a nursing home was transferred by ambulance to our ED with the following chief complaint:
Mental status changes not responsive to albuterol [an asthma puffer].
Of course now we’re stuck trying to figure out how much this patient’s mental status has actually changed. I never could figure out how in the heck nursing homes can determine that an essentially non-verbal patient is having a mental status change. She sat in the bed, watched me walk around the room and smiled. So was she blinking less, or what?
I was waiting patiently on the next ambulance run for a patient with nasal congestion unresponsive to Ex-Lax.
From Ten out of Ten‘s Medical Jeopardy:
Answer: Massive Diarrhea
Question: What is the end result of eating nothing but beans and peaches all day?
People are so weird.
From Musings of a Dinosaur’s Anything Else?:
The perils of the open-ended question in a new patient interview:
Me: Tell me about your health.
Patient: I have hypertension and a little arthritis in my knees.
M: Anything else?
P: No, that’s all.
M: What medications do you take?
[presenting bag full of bottles, we find:]
Cozaar
Hydrodiuril
Lipitor
Zoloft
Ativan
Ultram
Celebrex
M: Why do you take the Zoloft and Ativan?
P: Oh, the Zoloft is for anxiety and the Ativan helps me sleep.
M: Anything else?
P: No, that’s all.
M: What about this Lipitor?
P: Oh, I stopped that about three years ago. It’s just for people who eat a lot of fat in their diet. I don’t think I need it.
M: Ok. When did you last have blood work done?
P: About four years ago.
M: And when did you last see a doctor?
P: About four years ago.
M: Any other medical problems?
P: No, that’s all.
M: Are you allergic to any medicines?
P: I get a rash with penicillin, and oh yeah! I have this weird rash that comes and goes. I’ve seen all the specialists downtown and no one knows what it is.
M: Anything else?
P: No, that’s all.
M: Anything run in the family?
P: My brother had a heart attack when he was 42, and oh yeah! I have a 30% blockage.
M: When did you find this out?
P: About four years ago.
M: Anything else?
P: No, that’s all.
M: Do you need any of these meds refilled?
P: Just the Celebrex.
M: Most of these other bottles also say “no refill” on them.
P: Oh, I have more at home. I just dumped them out and brought the bottles.
M: How much more do you have at home?
P: About two weeks.
M: How about if I write refills for all of them.
P: Ok.
M: Anything else?
P: No, that’s all.
M: Can I do some blood work on you today?
P: Sure. Oh, and I see a cardiologist, rheumatologist and orthopedist too. Can you send copies to them?
M: No problem.
Anything else?
P: No, that’s all.
M: Are you sure?
P: Yes.
Do you know why dinosaurs have no hair? It’s because I pulled it all out this morning.
We really do need a common, interoperable medical record system.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 12th, 2008 by Dr. Val Jones in Opinion
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I’ve written about raw milk before, but here again we find it making front page news. There has been a recent FDA raw milk crack down in California, and I believe that’s a good thing for public health reasons. Although raw milk enthusiasts ascribe mystical powers to the product (some say its natural microbial flora can cure everything from asthma to autism), I don’t see anything mystical about the pathogens that can grow in room temperature milk: e. coli, salmonella, listeria and even tuberculosis. If you like the taste of raw milk and don’t mind the risks associated with imbibing warm body fluids of manure-encrusted bovines… then go right ahead. But please, don’t put your children at risk.
The New York Times exposed the raw milk counter-culture phenomenon last year. Grocery store milk has been heated and packaged in a nearly sterile fashion so that no harmful bacteria are in it. Farmers collect raw milk from cows, then send it to a processing plant where it’s pasteurized (a heat treatment) and homogenized (blending the creamy part with the skim part) it before packaging the milk for human consumption. This process has virtually eliminated milk borne illness in this country, but now certain farmers are threatening to reverse that progress.
So why are people fascinated with raw milk and seeking out farmers who will sell them milk prior to heat treatment? Raw milk does taste very good, and there’s no doubt that the creamy layer that floats on the top is delicious. In New York City raw milk has a black market, cult following. Should you jump on the bandwagon?
As my regular readers know, I grew up on an organic dairy farm, and had the pleasure of handling cows up close and personal for at least a decade. In fact, their sweet-smelling grass breath, and not so sweet-smelling cow patties are etched permanently in my mind. Cows are curious, somewhat dim witted, and generally oblivious to the terrain upon which they tread.
Cows will stand in manure for hours without a moment’s regret, should you present them with fresh hay to eat or some nice shortfeed. They drop patties on the ground, in their troughs, and occasionally on one other. Their flicking tails often get caked with manure as they swish flies away and they scratch their udders with dirty hooves as well.
This is why when it comes time to milk them, farmers need to wipe their udders carefully with a disinfectant scrub before applying the milk machine. Mastitis (or infection of the udder teets) is not uncommon, and is a reason for ceasing to milk a cow until the infection has cleared.
And so, the cleanliness of raw milk depends upon whether or not the farmer removes all the excrement carefully, scrubs the teets well, and remembers not to milk the cows with mastitits. It also matters whether or not the cows are harboring certain strains of bacteria – which often don’t harm the cow, but cause very serious problems for humans.
Did I drink raw milk as a kid? Occasionally, yes. Were my parents super-careful about the cleanliness of the milk? Yes. Did I ever get sick from raw milk? No. Would I give raw milk to my kids? No.
I appreciate that epicures want to experience the flavor of raw foods, but for me, the risks are simply not worth it when it comes to milk. There is no appreciable nutritional benefit to drinking raw milk (in fact, store bought milk is fortified with Vitamin D, which is critical for healthy bones), and it caries a small risk of serious infection. I agree with the FDA’s ban on interstate sales of unpasteurized milk, and would not want to see raw milk available widely for general consumption. Of course, to get around this ban, some companies are selling raw milk and cheese under the label “pet food.”
It’s a crazy country we live in – anti-bacterial hand wipes, soaps, gels, plastics and an insatiable appetite for raw milk. As a doctor, I throw up my hands. Is raw milk getting a raw deal? Some farmers may feel that way – but this former farmer is pleased to have access to safe, clean milk. What do you think?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 12th, 2008 by Dr. Val Jones in News
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TRUE: New York City adults have more genital herpes than the national average (26% versus 19%). One commenter replied, “Well, that’s what you get from ‘Sex in the City.'”
FALSE: A practical joke sparks Internet health myth: cell phones can cook an egg or pop popcorn. People really will believe anything.
FALSE: Some folks in India swallow live fish to stimulate coughing and to “clean the esophagus” and cure asthma. Must be an interesting feeling to have a live fish swimming around one’s stomach! Of course this doesn’t work. h/t to Happy Hospitalist
TRUE: More and more Muslim women are having their hymens restored so that they will appear to be virgins on their wedding night. I wonder about those women who are born with small or nearly absent hymens? Will they be punished? And what about the men who made the women non-virgins? This NYT story is quite upsetting.
TRUE: The media misrepresents health information 2/3 of the time. Fewer and fewer people are willing to take the time to get a story straight. When perception is nine-tenths of reality, science and truth are in jeopardy.
TRUE: Marijuana smokers enjoy lax laws in Mendocino County, California. It’s legal to keep up to 2 pounds of marijuana and 25 live plants in one’s home. How much marijuana does one really need for medical purposes?
FALSE: Gummy bears do not have internal organs. However, this artist has a wonderful imagination.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
