June 4th, 2007 by Dr. Val Jones in Opinion
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In a bleary eyed state I misread a blog post by PandaBearMD. He was on one of his well- written, sarcastic tears, and (jokingly) blamed nursing salaries for the rise in healthcare costs. I didn’t get the humor of that, and proceeded to defend my nursing colleagues. Of course, I took some hits for being unable to recognize sarcasm, but this event got me thinking about nurses…
I have always been grateful for the wonderful work that nurses do – and as I think back at all the amazing feats they’ve accomplished in front of my very own eyes, I thought I’d start a list:
NICU: can place an I.V. in a 1 lb preterm baby with veins the diameter of hair (but docs: don’t TOUCH the baby!)
ER: can put an I.V. in a 400 pound, anasarcic patient with no palpable pulses.
Psychiatric ED: can convince a fulminantly psychotic, violent patient to sit quietly and play with a teddy bear while waiting for the doctor to see him
Medical Floors: can clean up a fecal mess so foul that even the anosmic wouldn’t have the courage to enter the room – and do it in such a way that the patient feels no personal embarrassment
OR Nurse: will anticipate the instruments needed for an unforseen surgical complication and have them ready for use before the doctor gets a chance to ask for them
Pediatric ED: can distract a small child with stuffed animals, toys, and picture books so successfully that they don’t notice sutures being placed in their hand.
Obstetrical Nurse: can withstand the force of a 200 pound leg pressing against her for hours on end as mom bears down to push the baby out of the birth canal
Rehab Nurse: can get any patient out of bed, single handedly, and with little obvious effort (while the rest of us call for the Hoyer Lift, and 3 resident physicians)
This is just the beginning of a long list of magical things that nurses can do… please share some of your favorites!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 14th, 2007 by Dr. Val Jones in True Stories
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I was reading a touching post in Fat Doctor’s blog about her
son – how she wanted to protect him from mean kids who would inevitably hurt
him at some point along his school career.
She spoke about how painful child vs. child cruelty can be, and how some
of us carry those wounds and insecurities into adulthood.
I was a bookish little girl, pudgy with pale skin, freckles
and braces… unathletic but enthusiastic.
Our gym teacher liked to begin each class by appointing two team captains
and allowing them to choose teammates one after the other until everyone had
been assigned a team. So whether we were
going to play softball, floor hockey, basketball, or any other sport, it always
began the same way, two captains vying for the top athletes to build a team
that could crush the other.
The outcome was predictable.
The top “jocks” were usually selected as team captains, and they
proceeded to invite their favorite friends to their team, followed by the
mediocre kids, and finished with the chubby or clumsy kids at the end.
I was usually chosen second to last. But there was one little girl who finished
last every time – Tina Appleberry. She
was book smart like me, but although she wasn’t chubby, she had poor eyesight
and thick glasses and was rather uncoordinated and fearful of balls. Most kids didn’t like Tina because she was awkward
and unattractive. And I used to watch
her facial expression as she listened to the reticent team captain calling her
name last… because there was no one else to call.
Tina was a sad girl, and the years of being selected last
for sport teams had taken a toll on her.
She lacked self confidence, she was easily embarrassed, and she fully
believed that she wasn’t worth much at all.
I felt so badly for her… and shared her pain. Being second to last wasn’t that much easier
– and I loathed gym class. I would try
to get my parents to write as many excuses as I could think of to get out of
it, so I didn’t have to suffer the humiliation of my peers testifying in unison
that I was nearly the worst person in my grade at sports.
One day we had a substitute gym teacher. She clearly had no idea who the jocks were or
what the pecking order of kid selection was supposed to be. I was putting on my sneakers in the corner,
wishing that I could be invisible, when she walked up to me and announced that
I would be a team captain that day.
There were sighs and snickers as I followed her to the middle of the gym
floor and stood next to the class’s top jock, Johnny Tanner. The rest of the class lined up in single file
in front of us so we could see our range of choices.
The teacher told me to choose first. I surveyed the children lined up against the
wall, eyes fixed on me, eager to see who I’d pick first. I paused.
“I call Tina Appleberry,” I said. And you could have heard a pin drop. Tina almost fell over in astonishment. She slowly walked towards me to stand by my
side, lopsided pigtails and all. I
smiled at her, she smiled back. The
other kids didn’t know what to make of my choice – some thought I was stupid,
others thought I didn’t understand the rules (that you choose your favorite kid
first). But that day I knew that I had
won a small victory – a victory that outweighed the sum of all gym game
outcomes in grade school. And I can only
hope that Tina remembers that she was not always chosen last –and that her childhood
wounds are a little less deep because of that day.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 27th, 2007 by Dr. Val Jones in News
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Congress recently directed the Centers for Disease Control
(CDC) to undertake a study in partnership with the Institute of Medicine (IOM). The goal was to establish nutrition guidelines
for government-subsidized nutrition programs in schools nation-wide. These guidelines are meant to help combat the
growing rates of overweight and obesity in US children.
The standards may surprise you in their restrictiveness – no
beverages with more than 5 calories/serving are permitted (excluding milk or
soy milk) unless the child is involved in rigorous physical activity for more
than 1 hour in duration (then they can have a sports drink such as Gatorade). No items with more than 35% of calories from
total sugars are permitted, and all bread and cereal items must be whole grain. There are also restrictions on fat and salt
levels in the food. Artificially
sweetened drinks and caffeinated beverages are not recommended. The IOM also calls for removal of all junk
food and soda machines, and replacement with fruit, milk, and healthy snack options.
Reading these guidelines I thought, “Wow, if kids really ate
this way we probably would make a big difference in obesity rates.”
And then I wondered… “But will these kids just go home and
eat a box of oreos and a liter of coke at the end of the school day? Is it enough to have a healthy food
environment at school, but not at home?
What is the role of parents in this?”
What do you think?
Are the IOM’s recommendations likely to 1) be followed by all schools 2)
make a difference in childrens’ weights?
Is there anything else you’d recommend?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 18th, 2007 by Dr. Val Jones in Opinion
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Ask any American if they think
their current healthcare system is operating smoothly and efficiently, and
you’ll hear a resounding “NO!” Adjectives such as
“confusing, complicated, and disorganized” are often used to describe
our current state, and for good reason. The science of medicine has
advanced enormously over the past 50 years, but somehow this rapid growth in
knowledge has been plagued by chaos. With every new therapy, there’s a
new therapist – and the result is a fragmented assortment of tests, providers,
procedures, and administrative headaches. So what does a patient in this
system really need? She needs a coordinator of care – a compassionate
team leader who can help her navigate her way through the system.
She needs a central location for all her health information, and an easy way to
interact with her care coordinator so she can follow the path she has chosen
for optimum health. She needs a medical home.
Primary care physicians (especially family physicians, pediatricians, and
internal medicine specialists), are ideally suited for the role of medical team
leader in the lives of their patients. It is their job to follow the
health of their patients over time, and this enables them to make intelligent,
fully informed recommendations that are relevant to the individual. Their
aim is to provide compassionate guidance based on a full understanding of the
individual’s life context. The best patient care occurs when
evidence-based medicine is applied in a personalized, contextually relevant,
and sensitive manner by a physician who knows the patient well.
Revolution Health believes that establishing a medical home with a primary care
physician is the best way to reduce the difficulty of navigating the health
care system. We believe that our role is to empower both physician and
patient with the tools, information, and technology to strengthen and
facilitate their relationship. Revolution Health, in essence, provides
the virtual landscape for the real medical home that revolves around the
physician-patient relationship.
What’s the advantage of having a medical home? Jeff Gruen, MD, Chief
Medical Officer of Revolution Health:
1. Care is less
fragmented: how many times have you heard of friends with multiple medical
problems who are visiting several physicians, each of whom has little idea
of what the other is doing or prescribing, and none of which are focusing
on the big picture? When a single physician is also
helping to “quarterback” the care, there is less chance that
issues will fall between the cracks, and less chance that consumers will be
put through unnecessary and costly tests or procedures
2. Care is better:
studies have shown that excellent primary care can reduce unnecessary
hospitalizations and assure that preventive tests are performed on
time. One study for example showed that the more likely
it is that a person has a primary care family physician, the less likely
it is that they will have an avoidable trip to the hospital. This
makes intuitive sense: a physician who knows you is critical to have if
you were to get very sick and need alot of medical
attention.
3. Care is more holistic:
medical care is part art and part science and good care requires the
clinician to understand something about the whole person they are caring
for. Many complaints that are seen in primary care practices are
physical manifestations of underlying emotional, family or adjustment
issues. A good primary care clinician who knows the individual and
family is more likely to strike the right balance between appropriately investigating
physical causes for complaints, and addressing more subtle underlying
causes
So to physicians and patients alike, we say, “Welcome home to Revolution Health.”
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 13th, 2007 by Dr. Val Jones in News
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The recent death of hundreds of beloved pets was traced back to a wheat gluten factory near Shanghai, China. The wheat gluten, a thickener used in pet food, was contaminated with melamine (a chemical used in plastics, fertilizers, and flame retardants). It is believed that the melamine may have been processed or stored in the same containers used for the gluten.
How did the contaminated gluten make it into over 100 brands of US pet food? Chinese ingredients are less expensive than American ones, and so large companies purchase many plant and animal products from China to save on costs. The fact that over 100 brands were recalled speaks to the pervasiveness of Chinese agricultural products contained within American food products.
A very alarming article was published by Forbes Magazine, describing the serious quality control problems that China has been having, and America’s limited ability to screen incoming goods:
Over the past 25 years, Chinese agricultural exports to the U.S. surged nearly 20-fold to $2.26 billion last year, led by poultry products, sausage casings, shellfish, spices and apple juice.
Inspectors from the U.S. Food and Drug Administration are able to inspect only a tiny percentage of the millions of shipments that enter the U.S. each year.
Even so, shipments from China were rejected at the rate of about 200 per month this year, the largest from any country, compared to about 18 for Thailand, and 35 for Italy, also big exporters to the U.S., according to data posted on the FDA’s Web site.
Chinese products are bounced for containing pesticides, antibiotics and other potentially harmful chemicals, and false or incomplete labeling that sometimes omits the producer’s name.
The problems the [Chinese] government faces are legion. Pesticides and chemical fertilizers are used in excess to boost yields while harmful antibiotics are widely administered to control disease in seafood and livestock. Rampant industrial pollution risks introducing heavy metals into the food chain.
Farmers have used cancer-causing industrial dye Sudan Red to boost the value of their eggs and fed an asthma medication to pigs to produce leaner meat. In a case that galvanized the public’s and government’s attention, shoddy infant formula with little or no nutritional value has been blamed for causing severe malnutrition in hundreds of babies and killing at least 12.
Assuming that Forbes has not overstated the case, Americans have good cause for concern about the safety of food that includes ingredients from China – is it only a matter of time before the pet food debacle is played out in humans? I don’t know, but I’m worried. Do you know of any other credible reports about this problem? Please share!
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
