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Top 5 Ways That Television is Ruining Your Sleep.

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.”

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The Shocking Truth Behind “Shocking” Healthcare Social Media Statistics

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”

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September is Pulmonary Fibrosis Awareness Month, Learn More About This Deadly Disease.

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 Patients: The Pulmonary Fibrosis Foundation and Coalition for Pulmonary Fibrosis. Both resources provide information regarding patient support groups,  fund raising, and advocacy.

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.

Related Article:     A Simple Test Can Determine Prognosis in Idiopathic Pulmonary Fibrosis

 

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The Ones that Emory Didn’t Save

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.

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3 Ways Obamacare is Destroying American Healthcare.

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.”

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It’s Time to Move On From ACLS Certification.

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.”

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To Reform Healthcare, America Needs to Look to its Doctors.

Our healthcare system is sick and dysfunctional. A vicious cycle of blame is happening between Washington, health insurance companies, and the patients. And it is quickly demoralizing this nation and simply increasing costs with more administrative regulations. It is raising questions regarding the future of healthcare in the United States.

And we need answers.

Surprisingly, in all of this, doctors are rarely mentioned.  As if doctors do not know the intricacies of how the health care system works.  As if doctors are not there for their patients 24 hours per day, ordering tests or doing procedures that can benefit a patient’s well-being.  As if doctors are not dealing with denials from the insurance companies on a daily basis, losing valuable hours to menial paperwork that could be spent caring for our country’s sick.

Doctors have a duty to care for their patients and are the engines that put health care into motion. They yearn to maintain that physician-patient relationship that is important to the care of our patients.

Unfortunately, doctors are not being directly involved in the health care reform debate despite being on the front lines of care.  They have an opportunity to provide valuable insight into the day-to-day operations of this health care machine. Continue reading “To Reform Healthcare, America Needs to Look to its Doctors.”

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“When I Was a Resident”: Duty Hour Rules Do Not Define Me

Recently, Rebecca Ulep wrote a rebuke of recent resident duty hour restrictions and their potential negative effects on physician education in a post entitled “When I Was a Resident”: How Duty Hour Rules Are Creating a Lost Generation of Physicians. Many practicing physicians agreed with these sentiments, while most residents did not. Our expanding #PulmCC community brought me  into the acquaintance of one the latter, who agreed to write a post taking the other side of the argument. Scroll down for the article, and hit the link above to read the original post. And follow the #PulmCC hashtag on twitter to keep up with relevant material and participate in future #PulmCC twitter chats. 

I argue with my father a lot. He works as an intensivist at a community hospital in Indianapolis while I am about to graduate from a highly academic internal medicine program in Chicago. Needless to say, we have very different perspectives.

He sometimes expresses views similar to those written in a previous article, “When I Was a Resident”: How Duty Hour Rules Are Creating a Lost Generation of Physicians. I started residency the first year that the new intern duty-hour regulations were put into effect. After explaining these rules to my father, he asked me: “How do you guys learn? When I was a resident, we did not have limits to how many patients we saw. I would be working until five or six in the evening on my post-call day and then stay to work a moonlighting shift.” I, then, delightfully asked him if that was before or after penicillin was discovered.

The field of medicine has undergone many changes (yet we still carry pagers…that’s for another rant), some for better and some for worse. There has been much debate over potential benefits and detriments that come with the changes in duty-hour regulations.  I can only speak to the culture at my own institution, but in my experience, there is one thing that has not changed: the pride we take in our work. This is why I take particular issue with the overly dramatized notions brought up in the aforementioned article. Continue reading ““When I Was a Resident”: Duty Hour Rules Do Not Define Me”

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“Doctor, can I record this conversation?”

It’s happened to me a couple of times already. But the question in the title of this post was never asked. Rather I was informed later on that my conversation with a patient or family was recorded without my knowledge. Smart phones have made it all too easy for patients to secretly record conversations with their healthcare providers. Simply hit a button,  lay it innocently down by your side in the office or hospital, and patients get an instant video or audio capture of a conversation with their physician.  When my medical team and fellow physicians found out about the unauthorized recording of our conversation, the news was met with a combination and anger and disgust.

That reaction, it seems,  is typical of what most physicians would feel in the same situation. Why would a physician be upset about a patient secretly recording a conversation with them?

Well, simple, really. Most physicians are in chronic fear that the next person to hear/view that recording will be a malpractice lawyer, dissecting it,  consonant by consonant,  probing for potentially actionable material. The recording, in the physicians mind, changes the nature of the physician-patient relationship. It makes the patient a potential adversary, it makes the doctor feel as if they are in front of a jury and can not speak frankly, it makes them feel as if they are unworthy of trust. In other words, physicians do not like being recorded because they assume that the person recording them has negative motivations.

But let’s pause for a moment and look at this a different way. . . what if they don’t have negative motivations? Continue reading ““Doctor, can I record this conversation?””

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The PROCESS Trial: End of the Line for Central Lines?

A lot of things change for doctors once we’re done with training. Most of us leave behind the ivory tower that is the academic medical center to plow the common fields of private practice. We no longer have the weekly journal clubs, the Grand Rounds, the CME lectures. But what we gain is practical hands-on experience with what works, and what doesn’t. A nuanced knowledge of what’s accepted vs. what’s acceptable.

One such area has been the approach to sepsis. Manny Rivers et al published  their game changing study on early goal directed therapy (EGDT) in the treatment of septic shock in 2001, and the result became scripture in the field of Critical Care Medicine. The knowledge that tying sepsis resuscitation to the measurement of central venous oxygen saturation (ScvO2) and central venous pressure (CVP) using a central venous catheter, lead to a surge of recommendations.

The brain trust spewed forth these recommendations in various forms;  Surviving Sepsis Campaign, Sepsis guidelines, Sepsis bundles, Sepsis video games and Sepsis action figures. Somewhere in that sentence I may have transitioned to hyperbole.

Those of us in clinical practice didn’t always follow the drumbeat. Many of our patients with sepsis it seemed, did just fine without a routine central line or blood transfusions, or dobutamine drips. Why use invasive measures when we don’t really need them, and we’re not really sure that they’re helping? Still, when I talked to my ivory tower friends, the response was same, “We always use central lines and follow the EGDT”, they would say.

In case you’re thinking that I’m a maverick, well, it wasn’t just me. Surveys/studies that have looked at compliance with EGDT show compliance anywhere from as low as 0.1% to just above 50%. Clearly people were pushing back against the guidelines, and many began to publicly question whether results of EGDT could be generalized to the general population with sepsis. Continue reading “The PROCESS Trial: End of the Line for Central Lines?”