Archive for the ‘Health Care’ category

Flash 55 – Doctors/Nurses Texting In OR (Mine is Only 55 Words.)

December 16, 2011


Doctors, nurses, online in the OR.

Makes sense (sort of):  human eyes evolved to catch light flickers–maybe the next meal, or predator, while that tabled blob of flesh?  He’s not even edible!  (By most.)

Little screens, mirrors, handheld reflectors, our customized world.  While the aforesaid blob–a wristband–wait!

A sale!  Prices slashed!!!!


(The above is my 55 word Flash Friday about all those nurses and doctors texting in the OR, then going out into their cars and texting some more.  A sure way to keep the hospitals filled!  Tell it to the G-Man.  And have a great weekend.)

March Winds; Mental Health; Greater Parity In Health Care Legislation

March 30, 2010

Brain Chemistry

March is nearly over.  Anyone who lives in the gale force winds of downtown Manhattan will be extremely glad to see its end.  This includes my old dog Pearl, who, despite her near perfect bladder control, peed once in the apartment and once in the lobby this evening in an effort to avoid spending any time at all in the rain-spattered winds outside. (Darn you, Pearl!)

Somehow these gusting winds and my leaking dog bring up… mental health.  Forceful emotions, mood swings, bouts of depression, clinging to a fence post, or something worse, and (you got it), the recently passed health care legislation.

One of the changes wrought by the new legislation is a greater parity of treatment for mental and physical health issues.   This is, of course, welcomed by mental health professionals;  even an outsider, like myself, tends to agree that a greater focus on mental health seems needed in this country (and I say this not only as an observer of the Tea Party movement.)   The National Institutes of Mental Health estimate that approximately one in four Americans suffers from a diagnosable mental disorder in a given year, and about one in seventeen from one of the most serious mental illnesses;  an illness that affects one’s mind, one’s ability to really perceive and truly gauge reality, one’s self, the people around one, can certainly put a halt to one’s ability to function in the world as powerfully as a physical illness.   (To say nothing of putting a serious dent in the old happiness budget.)

The greater parity makes sense too because the line between mental and physical health is sometimes thinly drawn;  both just seem so chemical.    As one ages, one becomes particularly conscious of how circumstances, conditioning, genetics, chemistry, all seem to play upon each other in one’s brain.  (I have to confess that I base this statement on instinct more than scientific measurement.  I can feel in my water that it’s true, however.)

One problem with the new parity is that the benefits of many mental health treatments seem very uncertain;  side effects can be problematic;  some treatments lose efficacy over time;  additionally, some people whose functioning really isn’t very impaired may seek ongoing and expensive treatment (people who just really like the attention of a therapist).   Of course, efficacy, risk, side effects, and over or unnecessary usage, are issues with physical health treatments as well; (people who just really like the attention of a physical therapist).   Who knows yet how all of this will play out?    For many (the one in seventeen at least), it seems good that future choices may not be made simply on the grounds of what’s covered.

Inspiring Evening – Obama, Jeter, Jobs

September 9, 2009


Inspiring day/inspiring evening:  Obama delivers great and moving speech about health care.  (I never wanted this blog to be political, but when I hear Obama speak I can’t help but be appreciative.  How did we get so lucky?)

Jeter ties Lou Gehrig’s seventy-year record for hits as a Yankee.   (I don’t know enough about sports to blog about them, but when I see Jeter at bat, I can’t help but be appreciative.  Hurray, New York!)

Even Apple had something to contribute, with Steve Jobs making an appearance at an Apple conference, gaunt after his recent liver transplant, but full of sober gratitude.

I’m not in any way comparing the impact or importance of these events.  But there was something tremendously satisfying, even thrilling, about watching the footage of each of them,  all on the same evening.  Three guys doing their jobs so very well, but also with a workmanlike humility (even Steve Jobs);  three guys waiting through standing ovations, clearly moved at moments, then simply pushing ahead.   (Obama was probably a bit less moved by the ovations than Jobs or Jeter, the standing of congressman a form of literal posturing. )

Jeter’s modesty was especially impressive as he arrived at first base and  immediately bent to take off his shin protector.  Then, he seemed to quietly thank Tampa’s first basemen (who must have congratulated him), and then he simply waited as the crowd roared, twice raising his helmet, gently licking his lips, for the game to go on.

Jobs actually spoke of games in his interview, describing one of the new iPods as a video game device.  (Agh.)

And Obama, thankfully, delivered an opposite message, that the games about health care must stop.  (Though I was happy to hear him say it, I won’t hold my breath.)


Final added note:  I really hope that the substance of Obama’s speech does not get drowned in endless media discussion concerning the rudeness of  Republican Joe Wilson.     Unfortunately, 0ne can already hear it becoming the diversionary topic of the hour (or many many of them).

Blank Mind – DNRs

September 3, 2009

What to write about when your mind is blank and Robert Pattinson is managing to keep out of the lime light?  (It seems that Vancouver, where Pattinson is now filming, is somehow a more polite city than New York.  Who woulda thunk it?)

How about DNRs?  Do Not Resuscitate orders.

Now there’s a subject for the brain dead.  (Sorry.)

What do they mean exactly?

Does putting in a DNR mean that they won’t put those duckfeet paddles to some one’s heart if it’s just missed a bit or two?

Or do the DNRs only come into force after death has held sway for a full two or three minutes?

(Do those paddles even work after two or three minutes?)

In other words, how open to interpretation is a document like that?  Do hospital staff obey it as a matter of rote?  Is it a bright line?  Black and white?

Or can it become applicable only when the person will no longer be himself if resuscitated?  Or is already not himself?   Or is being tortured?  Or is really really likely to be tortured?

I have read that an extremely significant portion of medicare payments goes to the payment of health care costs incurred in the last month of life.

On the one hand, this makes perfect sense.  The last month of life falls at just about the time someone is sickest.

But some studies (such as the one discussed below by the National Hospice and Palliative Care Organization) also seem to indicate that a portion of these expenses result from patients not having discussed their “end of life wishes” with their doctors, (of not having, for example, a DNR).  This type of discussion would ostensibly allow doctors to avoid a situation of having the patient suffer a medically-extended death (rather than life).

I’ve talked to many people about health care proxies, living wills, final wishes.   At least 95% of the ones I’ve talked to say that they do not want their lives to be extended when there is no chance of recovery to a meaningful life.   (There’s also the occasional person, sometimes a medical professional who is insured by and employed by the hospital in which they expect to receive treatment, who says that they want to be kept alive at all cost, with every possible form of treatment, and collecting their full salary.)

Weirdly, it’s not even clear that all the extra treatments do prolong life.  A study of advanced cancer patients by the National Hospice and Palliative Care Organization reported in the March Archives of Internal Medicine, suggested that people who receive less invasive and aggressive treatment live longer than those who receive the more “comprehensive” care.

I have to say that I’ve never heard of the National Hospice and Palliative Care Organization and that such an organization may well have a bias against aggressive care.   Still, the study makes a lot of sense to me (a confirmed disbeliever in advanced institutional medical care).  My dad, for example, hospitalized at the moment, is in danger of being sent to rehab (for who knows how long) to recover from the damage that a day in the ER and a day and a half of hospital care have done.  The hospital’s occupational therapist said that they wanted him to get back to “where he was” before he started their treatment, which consisted almost solely of tests.  I, however, do not believe that rehab is the place for this; “where he was” before they started “treatment” was at home.

Still, it’s all very confusing.   Especially the bit about the DNR.   The doctor asked me about one.   “I’m not saying it’s likely to happen right now,” he said, “but what should the staff do if they go into his room and find that he’s died?”

It’s a harder question to answer than one might think.  First there’s the whole problem of finding one’s voice.

Maybe a little counseling would help.

Except, wait a second.  Aren’t the counselors on these issues the notorious “death panels?”

Scratch that.