Republicans have been waiting a long time for this moment. They have tried, time and again, (and again and again!) to repeal Obamacare. Now at long last, after sixty previous attempts to overturn the Affordable Care Act, commonly known as Obamacare, their moment has arrived. Continue reading “7 Reasons Why President Trump Can’t Repeal Obamacare.”
Recently I read an article in the NY Times by Elisabeth Rosenthal. She’s the same author of the enlightening article “My doctor charged me $117,000 and all I got was this lousy hospital gown” That may not have been the exact title of the article. Continue reading “Why Doctors Don’t Like to Send You Test Results.”
Like a lot of people, I get pretty numbed to gun violence on television. I stopped watching the local news because all they seem to show is news about shootings. The general public’s perception about gun violence is that it’s always somebody else, that the person who was shot had somehow been involved in crime. The numbness we feel to gun violence often ends for most of us when things hit close to home, when you or someone you know is affected. Continue reading “Doctors’ Prescription to Reduce Gun Violence”
I enjoy fielding questions from patients. Yes, I sense you’re rolling your eyes, but really, anything that I can answer that helps keep them out of the hospital is, I feel, time well spent. Recently though, I’ve been fielding a number of questions that have me concerned. These questions often have a leading tenor about them like, “are you using stem cells for COPD yet?” The questions imply that stem cells are the de rigeur treatment for COPD. Now I may not be at the leading edge of any fashion, but being unfashionable in my treatment regimens? Never!
I can’t blame anyone for wanting to seek out treatments for COPD. It is after all, a leading cause of death and illness in the U.S. And it’s widely regarded that the changes caused by COPD/emphysema in the lungs are permanent. While there are now several different treatment options for emphysema/COPD, very few can prolong life. So if I had a family member with emphysema, I might naturally seek out treatments for COPD that go beyond the usual treatments, and with all the hype surrounding stem cells, why not take a look?
What people find when they google “stem cells and COPD” is in a word, distressing. It’s a fantasy world full of promises of health, healing, and better breathing. Equally distressing are the things that people who visit these sites aren’t recognizing: the greed, lies, lack of ethics, illusions, and misleading claims. Continue reading “Stem Cells and COPD: What You Need to Know.”
As a sleep physician, I spend a lot of time educating patients about what sleep is and how it works. Sleep, as I often explain, is not simply the lack of being awake; anymore than landing a plane is simply the lack of flying. It’s becoming increasingly understood that sleep is an actively generated state, created by a series of neuro-hormonal changes which work in concert to nudge the brain into the sleep state. To stretch the plane analogy further, if being asleep were like the plane being on the ground, then falling asleep is like the act of landing the plane. And just like when you land a plane, there are a lot of variables that are involved. There are numerous events that must happen in succession, each affecting and triggering other events which ultimately induce the brain to sleep. A recent study demonstrates just how watching too much television can wreak havoc in this delicate process. Here’s just a few of the ways that television can ruin your sleep.
5. Watching television makes you go to bed later.
Television watching has steadily increased in our society, and its migration into our bedrooms marked a time when it began to disrupt our collective sleep and sleep habits. The most obvious effect that this might have is the most simple; we stay up later watching a program that has our attention. This few minutes a night may seem innocent enough. But our brains have a pre-determined amount of sleep they need to function well. When we miss that sleep we build up a “sleep debt” that can make us tired all of the time. Even if we catch up on a bit of sleep the next day, unless that sleep debt is paid back, the brain will still be fatigued.
4. Watching television alters your brain’s bedtime habits. Continue reading “Top 5 Ways That Television is Ruining Your Sleep.”
As a regular follower of social media, I am keenly aware of changes in the healthcare landscape as it relates to social media. While there’s much talk about the impact of social media in healthcare, most of the action sits on the consumer side of the equation. Much of the medical world has to yet to tap into its potential. For most healthcare providers social media engagement amounts to little more than watching as others dip their feet, testing the waters. A few watch as they anticipate their own entry into the arena. Still many others watch with the expectation that the water would soon become bloody.
So its with a burlap full of salt that I read various healthcare social media stats promulgated in various infographics, twitter feeds, and blog posts celebrating Medicine 2.0 powered by social media. Collectively they hash and rehash a series of surprising statistics that aren’t exactly bogus, but aren’t exactly completely factual either.
A recent one caught my eye with the claim was that “53% of physicians practices have a facebook page”. This was curious to me, because as I read this in the physician lounge and took my own poll, the results was much closer to 5% than 50%. Continue reading “The Shocking Truth Behind “Shocking” Healthcare Social Media Statistics”
Idiopathic Pulmonary Fibrosis is a disease which involves progressive scarring of the lungs of unknown cause (hence the term idiopathic). The median survival from the time of diagnosis is 2 to 3 years, though the course is variable and many patients deteriorate rapidly.
There is little in the way of effective treatment and no cure other than lung transplantation.
There are excellent resources available to learn about this disease.
For Physicians: The CHEST Foundation website includes information for patients and physicians. I have found this helpful in answering many common questions for patients with newly diagnosed IPF. The author is a pulmonologist whose father died from IPF.
In addition, the Pulmonary Fibrosis Foundation conducts numerous activities throughout the year and is a great resource for information about the disease.
It was with much fan-fare that 2 American aid workers were airlifted from across the world and brought to Emory University Medical Center where they began experimental treatment for Ebola. We hope for a full and speedy recovery for them and others like them who do God’s work.
But it appears to me that lost in this conversation are myriad others who need help but never get it. Right now, humanitarian work is being done all over the world, and in very dangerous places. These people knowingly put their life on the line for others. Yet tragically, some of them are injured or sickened in the service of others. But for them, the call from the CDC offering to med-evac them out never came. There was a girl, who died of malaria while in Kenya. Or the young man who was serving in Egypt. Or a myriad other aid workers who die while serving their fellow human beings.
Also at issue, and it needs to be asked, at what cost are we saving lives? Who decides who gets what may have been, all told, a hundred thousand dollar medical evacuation? Susan Grant, the Chief Nurse for Emory Healthcare, in an article for The Washington Post rightly downplayed the infection risk posed by bringing these patients here. She went on to say:
“The purpose of any hospital is to care for the ill and advance knowledge about human health. . . As human beings, we all hope that if we were in need of superior health care, our country and its top doctors would help us get better”
This statement brings to mind others that need saving. They don’t work in far away lands, they live here in the U.S, right across town, in fact. They don’t have fancy, exotic diseases. Their conditions have names like diabetes, heart disease, hypertension, and lung cancer. Right now many of them are getting collection notices for their inability to pay from medical centers like Emory University. Others have been trying to get appointments at tertiary centers like Emory. Only they’re told that their insurance is not accepted there, or their co-pays and deductibles will be more than they can afford.
How would Ms. Grant justify the incredible expense spent on this endeavor to those people? What would she say about the necessity of this experiment, a clinical trial with an N = 2? Could she really tell those sweating in the Atlanta heat after their electricity got shut off that this was all really for their benefit?
I don’t know how to solve the ethical dilemma here. While I am hope for a cure on the one hand, I cringe at the highlight this places on those at the bottom end of America’s healthcare disparity gap. Perhaps someday in the distant future they can take solace in knowing that they didn’t suffer for naught. Because if they ever contract ebola, there will be a cure waiting for them.
As I was watching CNN news recently, I noted in the headlines different ways Obamacare is failing. Current problems discussed were the customers’ sticker shock of high deductible plans (up to $12,700 for families), the president blaming the insurance companies for having substandard plans, and the people blaming the president for losing their current insurance.
One patient even complained, “My new health care plan tripled in price, and now, it is like having a third loan to deal with, including my car and home loan.”
The current law and regulations being implemented under Obamacare will ultimately lead to sicker patients and low quality care for three reasons:
1. Older doctors will retire early fed up with the system. These older doctors feel that the loss of a patient-physician relationship and the burdensome regulations (ie. paperwork) will choke off their ability to provide good care. In addition, their expenses are increasing with these new regulations. Add in the projected cuts in reimbursement up to 26%, and their livelihood will be threatened. These cuts could force these doctors out of practice or force them to stop seeing Medicare patients simply because their expenses (which rise yearly) are exceeding their declining reimbursement, which has declined steadily over the past several years already. Continue reading “3 Ways Obamacare is Destroying American Healthcare.”
I can recall, though it seems quite long ago, my first Basic Life Support (BLS) course as a first year medical student. The instructor dutifully demonstrated on a mannequin to eager young medical students what to do if someone is found unresponsive. Shaking the unmoving mannequin she said loudly, “Sir, are you ok?” Then hearing no response she showed us how to check for a pulse and spontaneous breathing. “if not present” she said, “call for help and start CPR”. Me, ever the smart-ass, took my own approach. “Sir, are you ok?” Then, grabbing the mannequin tightly to my chest “NOOOO! why? WHY?!”
This didn’t enamor me to the instructor very much and earned me most of the difficult clinical scenarios of the day.
Classes like these are now mandatory for those working in hospitals. Just about all employees have to go through BLS training, and many employees in more advanced clinical settings are also required to take Advanced Cardiac Life Support (ACLS). ACLS is an advanced skill set taught to medical personnel who work in areas of the healthcare field who may have encounters with patients that require interventions beyond the scope of BLS.
Those of us in the medical field who are required to recertify ACLS have long dreaded the process of ACLS recertification. Part of that is because it can be an intense course that makes many feel nervous. Part of it is also because it is expensive and time consuming. But the greatest reason why most who undergo ACLS training object to it is for a different reason entirely: they feel that is simply unnecessary. Continue reading “It’s Time to Move On From ACLS Certification.”