August 17th, 2007 by Dr. Val Jones in True Stories
3 Comments »
I was pleased to receive an email invitation from Dr. Jon Mikel from Unbounded Medicine to blog about surgery. He writes,
“Please feel free to post anything related to surgery,
like surgical procedures, mistakes during surgery or during your training,
lessons learned, tips, first operation done solo, memorable operations,
memorable patients, jokes, your point of view about surgery, or even why you dislike surgery or surgeons (if that is the case).”
As my mind wandered through all the possible posts I could prepare, I settled on a touching story that highlights the life of a wonderful surgeon named John Schullinger. Dr. Schullinger was the surprised recipient of one advanced case of intussusception in a 10 month old baby girl. The baby was shipped to him from a distant general hospital where they didn’t have any pediatric surgeons to take the case. On arrival the baby was moribund – septic and seizing, with an abdomen distended with gangrene.
Dr. Schullinger explained the gravity of the baby’s condition to her mom, promised not to give up on the baby, and took her to the O.R. for a bowel resection. Against all odds – and having to resect everything from the terminal ileum to the sigmoid colon – the baby made it through. A jubilant mother thanked the surgeon, and promised to keep in touch, though the family would be moving out of the country.
Every Christmas, the baby’s mom sent Dr. Schullinger a card from Canada – detailing her daughter’s growth and accomplishments and thanking him again for saving her life. Each Christmas he responded with a hand written note, expressing his pleasure with the child’s progress.
This ritual continued each year for 25 years until one day the young woman went to visit the surgeon and thank him in person. She was interviewing for medical school at Columbia, the same institution where Dr. Schullinger had saved her life nearly a quarter century earlier. It was a tearful reunion and touching for both surgeon and patient – because they could see how operations can change lives, and how babies that you operate on can grow up to be physicians who help other babies.
Dr. Schullinger saved my life – but his influence reached far beyond his technical skills in the O.R. His compassion and faithful follow up responses to my mom showed me what being a doctor is all about. My fondest hope is that I’ll live up to his example.
So for all you surgeons out there… you work longer hours than most others on this planet, you sacrifice your lifestyle to serve others, and yet you rarely see how your work impacts families long term. I am here to thank you on behalf of all those who can’t or don’t – please take courage from this story. You never know if the patient you operate on will come back and take over the scalpel for you one day…
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 15th, 2007 by Dr. Val Jones in Expert Interviews
No Comments »
The Washington Post featured an article about how social networking tools like Facebook are influencing student socialization at college. Some say that the frenetic texting, online communications, and iPhone chatter are causing students to lose the ability to socialize normally in-person. Others say that technology levels the social “playing field” for introverts. I interviewed Revolution Health’s psychologist, Dr. Mark Smaller, to get his thoughts on the matter. Feel free to add your perspective in the comments section of this blog.
Dr. Val: The article
suggests that technology can become a social crutch, keeping people from making
new friends. Do you think that the
Internet can isolate students from one another?
Dr. Smaller: I think the long term impact of the Internet in
social interactions is unclear. For now
such technology does allow students to remain in touch with one another
instantly, but that’s not too different from what the telephone did for
previous generations. If anything, I’d
say that technology can interfere with isolation, especially for the new
college student away from home for the first time. If there is a propensity for isolation, any
activity in excess – reading, school work, drinking, etc. will become the means
to continue that isolation.
Dr. Val: Do you think
that social networking and Internet based methods of communication are
particularly healthy for introverts?
Dr. Smaller: Being able to communicate sincerely or
genuinely but indirectly and not in person may help the otherwise shy person. Some of our most brilliant artists and
writers have used their craft as a means to communicate to others in ways they
could not in social situations.
Dr. Val: Overall do
you think that socializing via the Internet is a good thing or a bad thing for
college students?
Dr. Smaller: One things is certain on and off the Internet:
relationships for children, adolescents, and adults can become quite intense
with this way of communicating because of fantasy and anonymity. Previous generations used the art of letter
writing to express intense feelings, followed by the telephone, and now online
communication. What they all have in
common is the essential human need to connect – including the satisfaction of
doing so and the frustration when it chronically does not occur.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 12th, 2007 by Dr. Val Jones in True Stories
5 Comments »
This week’s host of medical grand rounds invited individuals to submit blog posts that feature stories about “sudden change.” As I meditated on this theme – I realized that one of my patients played a key role in my sudden career change from academic medicine to joining a healthcare revolution.
As chief resident in PM&R, I spent a few days a month at an inner city clinic in the Bronx, helping to treat children with disabilities. The clinic was dingy, overcrowded, largely windowless, and had waiting lines out the door starting at 8am. Home health attendants generally accompanied the wheelchair-bound children to the clinic as many of them were orphans living in group home environments. The kids had conditions ranging from cerebral palsy, to spinal cord injury from gun shot wounds, to severe spina bifida. They sat together in a tangled waiting room cluttered with wheelchairs, walkers, crutches, and various prosthetics and orthotics. There were no toys or even a TV for their amusement. The air conditioning didn’t work well, and a lone clock ticked its way through the day with a bold black and white face.
The home health aides were eager to be called back to the examination rooms so that they could escape the oppressive conditions of the waiting room. I opened the door to the room and called the name of one young man (we’ll call him Sam) and an aide leapt to her feet, knocking over another patient’s ankle-foot orthosis in the process. She pushed Sam’s electric wheelchair through a series of obstacles to the exit door and back towards the examining room.
Sam was a teenager with cerebral palsy and moderate cognitive deficits. His spine was curved into an S shape from the years of being unable to control his muscles, and he displayed the usual prominent teeth with thick gums of a patient who’d been on long-term anti-seizure medications. He looked up at me with trepidation, perhaps fearing that he’d receive botox injections for his spastic leg muscles during the visit. His wheelchair was battered and worn, with old food crumbs adhering to the nooks and crannies.
“What brings Sam here today?” I asked the home health aide, knowing that Sam was non-verbal. She told me that the joystick of his electric wheelchair had been broken for 10 months (the chair only moved to the left – and would spin in circles if the joystick were engaged), and Sam was unable to get around without someone pushing him. Previous petitions for a joystick part were denied by Medicare because the wheelchair was “too new” to qualify for spare parts according to their rules. They had come back to the clinic once a month for 10 months to ask a physician to fill out more paperwork to demonstrate the medical necessity of the spare part. That paperwork had been mailed each month as per instructions (there was no electronic submission process), but there had been no response to the request. Phone calls resulted in long waits on automated loops, without the ability to speak to a real person. The missing part was valued at ~$40.
I examined Sam and found that he had a large ulcer on his sacrum. The home health aid explained that Sam had been spending most of his awake time in a loaner wheelchair without the customized cushioning that his body needs to keep the pressure off his thin skin. She said that she had tried to put the electric wheelchair cushion on the manual chair, but it kept slipping off and was unsafe. Sam’s skin had been in perfect condition until the joystick malfunction. I asked if he’d been having fevers. The aide responded that he had, but she just figured it was because of the summer heat.
Sam was transferred from the clinic to the hospital for IV antibiotics, wound debridement, and a plastic surgery flap to cover the gaping ulcer hole. His ulcer was infected and had given him blood poisoning (sepsis). While in the hospital he contracted pneumonia since he had difficulty clearing his secretions. He had to go to the ICU for a period of time due to respiratory failure. Sam’s home health aide didn’t visit him in the hospital, and since he was an orphan who was unable to speak, the hospital staff had to rely on his paper medical chart from the group home for his medical history. Unfortunately, his paper record was difficult to read (due to poor handwriting) and the hospital clerk never transferred his allergy profile into the hospital EMR. Sam was violently allergic to a certain antibiotic (which he was given for his pneumonia), and he developed Stevens-Johnson Syndrome and eventually died of a combination of anaphylaxis, sepsis, and respiratory failure.
When I heard about Sam’s tragic fate, it occurred to me that the entire system had let him down. Bureaucratic red tape had prevented him from getting his wheelchair part, poor care at his group home had resulted in a severe ulcer, unreliable transfer of information at the hospital resulted in a life-threatening allergic reaction, and a lack of continuity of care ensured his fate. Sam had no voice and no advocate. He died frightened and alone, a life valued at <$40 in a downward spiral of SNAFUs beginning with denial of a wheelchair part that would give him mobility and freedom in a world where he had little to look forward to.
Sam’s story was the last straw in my long list of frustrations with the healthcare system. I began looking for a way to contribute to some large scale improvements – and felt that IT and enhanced information sharing would be the foundation of any true revolution in healthcare. And so when I learned about Revolution Health’s mission and vision, I eagerly joined the team. This is a 20 year project – creating the online medical home for America, with complete and secure interoperability between hospitals, health plans, healthcare professionals, and patients. But we’re committed to it, we’re building the foundation for it now, and we know that if successful – people like Sam will have a new chance at life. I can only hope that my “sudden change” will have long lasting effects on those who desperately need a change in healthcare.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 24th, 2007 by Dr. Val Jones in Expert Interviews
2 Comments »
A new study in the journal Sociology of Education suggests that obese girls are only half as
likely to go to college as non-obese girls.
I interviewed the study’s author, Dr. Robert Crosnoe, to learn more
about the relationship of weight, self-esteem, and peer popularity to the
education of young women.
Dr. Val: What did your study reveal about the impact of
obesity on the education of young girls?
Dr. Crosnoe’s response – audio 1
Dr. Val: How does popularity figure into the equation?
Dr. Crosnoe’s response – audio 2
Dr. Val: How do you explain the gender gap – that obesity
didn’t seem to influence whether or not boys went on to college?
Dr. Crosnoe’s response – audio 3
Dr. Val: What should we do based on the study results?
Dr. Crosnoe’s response – audio 4
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 20th, 2007 by Dr. Val Jones in Opinion
3 Comments »
Little did I know that there is a raging debate about whether or not it’s a good idea to circumcise male babies. I was reading #1 Dinosaur’s blog and almost fell off my chair at the passionate series of comments. Apparently, 90% of American males were circumcised in the 1960s, but that rate has dropped to about 57% today.
Pro Circumcision: circumcision decreases the rate of transmission of HIV and HPV and is hygienically desirable. It does not appear to adversely affect sexual function, is a fairly minor and non-traumatic procedure, and is a reasonable health intervention.
Against Circumcision: condoms are more effective at reducing HIV and HPV transmission than circumcision. It is ethically wrong to circumcise an infant because he cannot give his consent and the procedure is painful. Some people believe that there is an important sensory nerve in the frenulum that is often severed during circumcision.
The American Academy of Pediatrics takes the position that: Existing scientific evidence demonstrates potential medical benefits of
newborn male circumcision; however, these data are not sufficient to
recommend routine neonatal circumcision.
The American College of Obstetricians & Gynecologists takes no position: Newborn circumcision is an elective procedure to be performed at the
request of the parents on baby boys who are physiologically and
clinical stable.
I had always assumed that circumcision was a personal choice that people didn’t feel that strongly about one way or the other. I guess I was wrong!
Why do you think this topic is so passionately debated?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
