Health Care News

 

(Photo of sailboat in the Lake Washington Ship Canal, Seattle, by me.)

I wanted to highlight some recent health care news for my colleagues (not just nurses).  

Group calls for zero tolerance of doctor bullies 

By CARLA K. JOHNSON, Associated Press Writer
Wed Jul 9

Bullying doctors can make nurses afraid to question their performance, resulting in medical errors, according to a hospital group that announced new requirements for cracking down on intimidating behavior.

Outbursts and condescending language threaten patient safety and increase the cost of care, according to a safety alert issued Wednesday by the Joint Commission, an independent organization that accredits most of the nation's hospitals.

Hospitals will be required by next year to have codes of conduct and processes for dealing with inappropriate behavior by staff, said the group's president, Dr. Mark Chassin. Hospitals without such systems risk losing their accreditation, he said.

Powerful doctors mean money for hospitals because they choose where to admit their patients, but they "should not be left off the hook," said Dr. Peter Angood, vice president of the group, which is based in suburban Chicago...

Hostile Hospital Behavior Rapped

July 9, 2008 -- Intimidating and disruptive behaviors from health care workers are "not rare" in hospitals and other health care organizations, and a U.S. hospital accreditation group today put that behavior in permanent time-out.

"By allowing this type of behavior to go unchecked, health care organizations are tacitly condoning it," Mark Chassin, MD, MPP, MPH, president of The Joint Commission, said at a news conference. "Enough is enough."

The Joint Commission's new standards -- which go into effect on Jan. 1, 2009 -- require hospitals and other health care organizations to develop a code of conduct and a system to deal with bad behaviors ranging from being uncooperative to being verbally or physically abusive -- even if the offender is a big shot doctor or an administrator.

BULLYING BEHAVIORS

Acts that interfere with patient care
Medical intimidation can encompass behaviors that range from verbal insults to physical assault, say researchers who've studied the problem for years. The broad category includes the following specific behaviors, outlined in a medical safety journal.
— Profane or disrespectful language
— Demeaning behavior, such as name-calling
— Sexual comments or innuendo
— Inappropriate touching, sexual or otherwise
— Racial or ethnic jokes
— Outbursts of anger
— Throwing instruments, charts or other objects
— Criticizing other caregivers in front of patients or other staff
— Comments that undermine a patient's trust in other caregivers or the hospital
— Comments that undermine a caregiver's self-confidence in caring for patients
— Failure to adequately address safety concerns or patient care needs expressed by another caregiver
— Intimidating behavior that suppresses input by other members of the healthcare team
— Deliberate failure to adhere to organizational policies without evidence to support an alternative
— Retaliation against any member of the health care team who has reported a violation to the code of conduct or who has participated in an investigation of an incident

Cipro, similar antibiotics to get 'black box' warning

Posted July 8, 2008

Washington (AP) _ Drug safety officials are calling for an urgent safety warning for Cipro and similar antibiotics. 

The Food and Drug Administration is ordering the "black box" wording due to evidence the drugs may lead to tendon ruptures. They say the ruptures could result in serious injury that can leave patients incapacitated and in need of extensive 
surgery. 

The makers of the potent class of antibacterials will also need to develop new literature for patients to emphasize the risks. The two leading drugs covered by the warning are Cipro, made by Bayer, and Levaquin, which is made by Ortho-McNeil. 

Tendon ruptures normally result from sports injuries. The link to treatment with the antibiotics is highly unusual, and scientists still don't fully understand why it happens. 

FDA officials said they had received several hundred reports of tendon ruptures. However, FDA officials say many of the serious injuries could be preventable if patients stop taking the drug at the first sign of pain or swelling in a tendon, call a doctor, and switch to another antibiotic. For more information, please visit

http://www.fda.gov/cder/drug/InfoSheets/HCP/fluoroquinolonesHCP.htm

AMA to apologize to black doctors for racism

"The American Medical Association is issuing a formal apology for more than a century of discriminatory policies that excluded blacks from participating in a group long considered the voice of U.S. doctors...

...It comes more than 40 years after AMA delegates denounced policies at state and local medical societies dating to the 1800s that barred blacks. For decades, AMA delegates resisted efforts to get them to speak out forcefully against discrimination or to condemn the smaller medical groups that historically have had a big role in shaping AMA policy...

..."It is true that what the AMA did historically was awful," said Dr. Otis Brawley, the American Cancer Society's chief medical officer. "There were AMA local chapters that actually had rules against black members well into the late 1960s, and policies that made blacks not feel comfortable well into the 1980s."...

On the Net:

AMA: http://www.ama-assn.org

NMA: http://www.nmanet.org

The Discreet Anguish of the Bourgeoisie.

(Photo of restroom wall in Fremont Coffee by me.)

"Blogging: the opiate of the cyber-petit bourgeoisie." - kersplebedeb

1. It's not our fault - at least not entirely.

America's middle-class collapse

"...what makes this coming decline in economic security different from the one visited upon American families in the 1970s, for example, is that we are much less well positioned to withstand the financial buffering. The work of Harvard law professor Elizabeth Warren indicates there is a coming collapse of the middle class and she can prove it with a raft of scary statistics and charts. 

Warren says we are moving toward a two-class rather than a three-class society, where there is a somewhat larger upper class made up of the financially comfortable and then there is the rest of America, people who are "constantly living on the edge of a cliff." These are families who might appear to earn a decent income but they enjoy none of the financial security that we normally associate with middle-class status. 

Warren compares the median American family of 1970 with that of 2003. She unpacks why our savings rate has dropped to zero from a rather healthy 11 percent of take-home pay in 1970, even as the family added Mom as a breadwinner. 

Typically, blame for this lands on families themselves. They're spending themselves into penury by buying designer clothes for their kids and indulging in $4 lattes, say social commentators. 

Not so, Warren counters. She says that Americans are actually spending far less in inflation-adjusted dollars for things like clothes and food, including eating out, than they did in 1970. What has substantially changed, Warren reports, is the cost of big-ticket, fixed expenses. So that even though the income of the median two-parent, two-child family is higher because both parents are employed, the family has less income available to shore itself up against a rough patch. 

Housing costs for a medium-size house (which has gotten modestly bigger since 1970 by adding either a second bathroom or a third bedroom but not both) have increased 76 percent. 

Health insurance costs are up 74 percent. 

Also up sharply are taxes (due to the second income), child care and car-related expenses. Americans keep a car more than two years longer than they did 30 years ago but they now need two cars to get to two jobs. 

These big, inflexible expenses cost the median family three-fourths of its two-earner income. In 1970 they cost half of the single breadwinner's. We now live in a country where there is no financial margin for most families to fall back on in case someone gets sick or a job is lost. Life is far riskier. 

Then add on an energy crisis and you can almost hear the foundation cracking..."

2. Understanding and dealing with the effects;

Head fake
How Prozac sent the science of depression in the wrong direction

"...There's only one problem with this theory of depression: it's almost certainly wrong, or at the very least woefully incomplete. Experiments have since shown that lowering people's serotonin levels does not make them depressed, nor does it does not make them depressed, nor does it worsen their symptoms if they are already depressed.

In recent years, scientists have developed a novel theory of what falters in the depressed brain. Instead of seeing the disease as the result of a chemical imbalance, these researchers argue that the brain's cells are shrinking and dying. This theory has gained momentum in the past few months, with the publication of several high profile scientific papers. The effectiveness of Prozac, these scientists say, has little to do with the amount of serotonin in the brain. Rather, the drug works because it helps heal our neurons, allowing them to grow and thrive again.

In this sense, Prozac is simply a bottled version of other activities that have a similar effect, such as physical exercise. They aren't happy pills, but healing pills.

These discoveries are causing scientists to fundamentally reimagine depression. While the mental illness is often defined in terms of its emotional symptoms - this led a generation of researchers to search for the chemicals, like serotonin, that might trigger such distorted moods - researchers are now focusing on more systematic changes in the depressed brain.

"The best way to think about depression is as a mild neurodegenerative disorder," says Ronald Duman, a professor of psychiatry and pharmacology at Yale. "Your brain cells atrophy, just like in other diseases [such as Alzheimer's and Parkinson's]. The only difference with depression is that it's reversible. The brain can recover."...

...One of the first cracks in the chemical hypothesis of depression came from a phenomenon known as the "Prozac lag." Antidepressants increase the amount of serotonin in the brain within hours, but the beneficial effects are not usually felt for weeks.

This led neuroscientists to wonder if something besides serotonin might be responsible. Duman, for instance, began to study a class of proteins known as trophic factors, which help neurons grow and survive. Trophe is Greek for nourishment; what sunlight and water do for trees, trophic factors do for brain cells. Numerous studies had shown that chronic stress damages the brain by suppressing the release of trophic factors. In a series of influential papers published earlier this decade, Duman demonstrated that the same destructive hallmark is seen in depression, so that our neurons are deprived of what they need.

"The mental illness occurs when these stress mechanisms in the brain spiral out of control," he says.

Once that happens, the brain begins to shut itself down, suppressing all but the most essential upkeep. Not only do neurons stop growing, but the brain seems to stop creating new cells. .."

Missing Connecticut

Here I am, in a Seattle neighborhood that actually has the balls to bill itself as "The Center of the Universe". The weather is perfect. I could literally walk to half a dozen clubs with really good live music - not to mention a decent used book store, a food co-op, and even a vegan restaurant. Cars actually stop to let me cross the street (how weird is that?). I have yet to be bitten by a mosquito. No one worries about Lyme Disease, or West Nile Virus. There is almost no trash on the streets.

I'm sure that it's hotter, more humid, and smoggier in CT.  The mosquitoes are out, at dusk, carrying West Nile Virus, and the threat of encephalitis.  The ozone level is way up, and asthmatics are crowding the ER's. My own breathing would be affected - which is no small thing, on a day to day basis. Kids are getting shot in New Haven. Drivers are dying, practically daily, on I-95. The music scene has been on life support for years. Nothing to do but hide in an air-conditioned room - and try not to think about the bill for the a/c.

Why do I miss this place?

I don't know, but I do. And I love this video. Especially that opening zoooom up the highway, with the music blaring, and then the guy saying, "This is how we f&*%ing do it in Bridgeport. Welcome home." I keep looping that part, obsessively. But, I think the whole video is really well done.

It makes me happy to know that these kids are out there, creating art, creating movies, balancing out the bad karma from the snobs and hedge fund managers (aka economic terrorists) in Greenwich. And it reminds me of that indefinable spirit that I like about the place.

In Which I Finally Run Away and Join the Circus

(Photo of me by a fellow marcher. For more photos of the Fremont Solstice Parade, check out my photostream.)

Yes, they were hiring circus freaks (harharhar) ... or overweight fake gypsies, or something. Anyway, I have been volunteering for, and subsequently marched in the Fremont Solstice Parade in Seattle this past weekend.

Fremont is a hippie/artsy neighborhood, and the parade reflects that. Indeed, it is the very height of the social season here. Rules include no words - just pictures, no motorized vehicles, and no live animals except service animals. Nudity, however, is very much allowed, and a handful of my photos are NSFW.

Despite that, it is very much a family affair, with plenty of children in the parade and the audience - all seemingly unharmed. In fact, I marched at the head of the parade, in a mixed group of adults and children waving tie-dyed streamers from bamboo stalks - and we were immediately after the topless banner-bearer girls, who were immediately after the unofficial contingent of naked, body-painted bicyclists.

This was probably a good thing, as I had been instructed that our job was to "create good juju" - i.e., get people psyched up for the rest of the parade. Between the distractions in front, and the acrobats cart-wheeling behind us, hopefully no one noticed that I spent most of the parade dealing with my own personal wardrobe malfunction. Namely, my bamboo pole kept breaking, as I frantically whirled it like an Olympic "floor exercise" hopeful, taking it down, chunk by chunk, from about 20 feet to about 3 feet.  I consoled myself that at least the waste was biodegradeable ( I think not recycling would be counted as a mortal, as opposed to venial, sin, in this neighborhood), but this did nothing to alleviate my anxiety that my attempts at discreet disposal would either impale a bystander, or cause a tragic cartwheeling accident.

Well, I didn't kill anybody - not that I noticed, anyway.  The bamboo, BTW, had actually been cut down with a chainsaw from somebody's garden by a volunteer. (I asked, because I had noticed how impossible it was to break the bamboo when I was helping to move it, and was actually trying to break it into more manageable pieces. Who knew that bamboo molecules go through a phase change in the presence of large groups of costumed hippies that make them much more susceptible to shearing forces?) Most of the pieces were so big that the parade organizers had resorted to storing them on the flat roof of the parade headquarters building, while they awaited their transformation from camouflage to art. The scarf, beads, etc., were supplied by a fellow participant to jazz up my meager travel wardrobe. In fact, I was also wearing a donated sarong made out of Kente cloth dyed by African schoolchildren that my benefactor picked up during a trip to Ghana. But, at some point, that turned into wardrobe malfunction #2, exposing the bright purple scrub pants that I had worn, in an attempt to comply with the exhortation to wear bright colors.

What can I say ... it's a tough job, but somebody's gotta do it.

Anyway, y'all check out my photos. I just uploaded a ton of them, and they're mostly pretty fun, if I do say so myself.

"Take Away Books That Nerds Don't Deserve"

As a nerdette, bookworm, and nerdcore fan, I am loving this video!!!

"See a nerd reading a book, whatcha gonna do??
 Whomp that nerd!"

Summer Finally Arrives in Seattle

(Picture of musical sculpture at Volunteer Park Conservatory taken by me. For more pix of Seattle, see my photostream.)

So, I was thinking I should write about what I've been doing lately - aside from my favorite 'sport' of staying up way too late, and reading depressing stuff on the internet about politics, economics, energy, and climate change.

I recently went to this terrific event called "The Round" at The Fremont Abbey, right across the street from my condo. It would be like walking from my house in CT across the street to my neighbor's house, in distance terms. Except it was like Beatnik night, at an oh-so-cool former church, with 3 local, talented singer-guitarist-songwriters, a poetry slam winner doing live poetry, and a guy painting live during the music. It's just amazing to me that I could walk out my door and go to something of this quality - without even taking a bus into downtown Seattle. The musicians were really good. The place was packed.  Apparently, it's becoming quite the popular event.

Here's an article about it. I recommend the place to anyone visiting Seattle. I've also seen a great sitar concert there, and am looking forward to finally catching "Tuning the Air".

We recently had more than a week of rain, general gloom, and record-breaking low temps - excellent weather for reading serious books in coffeehouses. Did you know, BTW, that the Chinese both had a major naval fleet centuries before the Europeans and they had solved the naval scurvy problem by packing raw beans, which they sprouted en route, the bean sprouts being high in Vitamin C ? Well, not only do I know it, courtesy of the Jane Jacobs book that powered me through the gloomy weather, and now you know it, but I made sure the barista at Cafe Lladro in Fremont, who had innocently expressed interest in the book, knew it, too.  Because that's how I rock my dorkiness... Nerdcore For Life, Baby! ;-)

Check out my favorite quote from that book; "Not TV or illegal drugs but the automobile has been the chief destroyer of American communities. Highways and roads obliterate the places they are supposed to serve." I was so stunned with the sheer genius of this quote when I read it, that I shared it with the barista, too. I'm sure he thought I was crazy, but he did a good job of fronting like I wasn't.

And, no, I wasn't tying to book mack him. He wasn't my type. Plus, I think he was gay.  I was just all impressed that he had noticed the book, unprompted, and volunteered that he was a fan of Jacob's "The Death and Life of Great American Cities".

But, anyway, now the sun and the warmth are back and I appreciate them more than ever! It's beautiful weather for taking the #10 bus up from 3rd and Pike to gorgeous  Volunteer Park, like I did the other day. Most Seattle-ish park moment; seeing a 20-something guy, sitting cross-legged and barefoot on the grass, wearing headphones, knitting something - using black wool, of course.  This place is just crying out for someone to market a boutique line of organic, Kurt Cobain-inspired yarn, with emo color names like, "Black ... like my soul".

When you're finally ready for a break from the heat, walk down the block and hang out in ultra-cool Victrola Coffee, on 15th, reading The Stranger and watching the local hipsters, with their de rigeur white Macbooks. ( Do they not sell any other laptops in this town? ) Then, it's a nice stroll back down Capitol Hill. Actually, if they hadn't been closed, I would have hit the Seattle Asian Art Museum, in the center of the park, and the well-reviewed Volunteer Park Cafe - oh well, next time. It was more of an outdoorsy day, anyway.

After hanging out at Victrola, I walked back down Capitol Hill, towards Town Hall, on 8th and Seneca, to hear Ahmed Rashid speak about Pakistan and Afghanistan - and how we eff-ed up there.  That was kind of so-so. He is very much a voice of the establishment. He didn't have anything particularly new to say, or any unexpected insights into the recent Taliban jailbreak and Kandahar offensive in Afghanistan.

Sorta wish I had gone to Kung Fu Grindhouse at the Sunset Tavern in Ballard, instead. But, usually I've hit really good lectures at Town Hall. I'm looking forward to seeing Jeremy Scahill talk about his new book about the "controversial" (i.e. skeezy) private defense contractor Blackwater, on the 18th. Although I might do some Solstice parade volunteering, instead, as the parade is almost here, and much remains to be done. 

Oh, and I couldn't resist, so here are some links to stuff I've been reading. Because reading is a big part of my life, and of what I'm "doing" whenever I have some free time;

Gloom and Doom stuff;

One Simple Question
"It started with one simple question posed by [VT] Senator Bernie Sanders to his constituents in an invitation to a town meeting: What does the decline of the middle class mean to you personally?

Over 700 people replied.

A second question was asked in his e-newsletter, The Bernie Buzz: Do you have a story to tell about how gas prices are affecting you?

Over 1200 responses.

“The volume of responses was stunning,” Sanders told me. “Most people in my state — especially in rural areas — do not feel comfortable telling people about their struggles. ‘He has it worse than I do, I’ll be fine. Thanks for asking.’ It’s just not a natural thing [to share these struggles]…. The other point that has to be underlined — this is not an interview at the homeless shelter. These are letters from working families, from middle class families… [and] people who’ve worked their whole lives who expected to have a minimal degree of economic security but are now finding themselves with nothing.”
...
"Sanders has read some of the letters on the Senate floor. He says, “This is simply an effort to bring a dose of reality to the floor of the Senate. It’s not just Vermont. There are other areas of this country that are worse off. It’s important for us to respond to that with appropriate public policies to address this crisis.”

Sanders notes that corporate media has completely dropped the ball in informing the citizenry of the staggering economic inequality of our times. “When you talk about the collapse of the corporate media in terms of responsibility,” he says, “it’s not just the War in Iraq. The other huge story that they have missed is the collapse of the middle class — the fact that we have tens of millions of people working longer hours for lower wages; that we have the highest rate of childhood poverty in the industrialized world. For the first seven years of the Bush administration, [the media was] simply the stenographers for what the President was saying: ‘The economy is robust. We have strong economic growth. Unemployment is reasonably low.’ The metaphor is — it’s like the operation was a success but the patient died. The economy is doing great, except for 90% of the people in the economy. The reality is that we have the hollowing out of the American economy. Median family income declined by $2500 in the last seven years. 8 million people lost their health insurance. 3 million people lost their pensions. This is a strong economy? You’ve gotta be insane to believe that. And yet that is what the Bush Administration was talking about and that’s what the corporate media kept on talking about.”

Sanders believes the mission of progressives at this moment is twofold. “Number one, we have got to let the American people understand that they are not alone,” he says. “What ends up happening when the media doesn’t talk about the reality facing ordinary people, then people think ‘I must be failing, why can’t I make it?’… And the second thing… we have to come up with a progressive agenda which begins to address this economy.”

Reverse Henry Fordism
"...Under Bush, the cost of food has doubled, and of gas has tripled. (Neither food nor fuel are counted in Bush’s phony Consumer Price Index, which consequently understates the gravity of current inflation)..."

Insurance fraud
The lack of transparency in the US healthcare industry means insurance companies can abuse patients by denying their claims

"...Insurers don't generally give out the basis under which they deny claims. Nor do they generally reveal how often they deny claims. How can a person intelligently decide between insurers if they don't even know how likely they are to see a claim denied?

This is not the only information that you won't get from your insurer. In most plans, when people go "out of network", insurers reimburse an amount that is 70-80% of the "reasonable and customary" rate. Typically your insurer will not disclose in advance their customary and usual rate, so patients will not know how much a trip to the doctor will actually cost them until after the doctor submits the claim. In addition, the insurer is free to change their reimbursement rate at its own discretion. It can also, at its own discretion, change what procedures are and are not covered.

The current law basically gives insurers a free hand to abuse patients. It is equivalent to handing over a $12,000 check to a contractor to repair the plumbing and electric in your house and then leaving it to the contractor to decide which repairs they want to do. A contractor that fixed a few pipes and then skipped out would be prosecuted for fraud. An insurance company that effectively did the same thing, by denying care to policyholders, would be paying big bonuses to the CEO..."

The oil we eat:
Following the food chain back to Iraq

Useful stuff;

Best and Worst Cities for Your Job
Think you're on the top of the heap? It's possible you could be making more money and enjoy a better quality of life somewhere else

Are You in the Best City for Your Job?
A high salary goes only so far if the cost of living is even higher. If you want your dollar to go further, maybe it's time to relocate

Interesting stuff;

Guerrilla gardener movement takes root in L.A. area
"...Scott is a guerrilla gardener, a member of a burgeoning movement of green enthusiasts who plant without approval on land that's not theirs. In London, Berlin, Miami, San Francisco and Southern California, these free-range tillers are sowing a new kind of flower power. In nighttime planting parties or solo "seed bombing" runs, they aim to turn neglected public space and vacant lots into floral or food outposts..."

Tale of the Tracks
"If you live in Seattle's South End, you might encounter postcard-size flyers, photocopied from handmade linoleum prints, advertising Seattle Train Yard Bike Tours. Beginning at Georgetown's All City Coffee, you'll be guided on a three-hour tour led by Cameron, a 30-year-old self-taught train aficionado. By the end of the tour—which snakes through SoDo and along the waterfront, past the grain elevators near Elliott Avenue, and ending up in Interbay—you'll know how to read the trains. You'll be able to tell a road engine from a yard engine, you'll know what The Stinker is and where it's headed, and you'll get a glimpse into the workings of our
economy, based on what's moving where along the rails..."

Corrupticut

I am sooo going to be in shock when I get back to CT and start buying gas and paying utility bills again. (Utilities come free with the housing as a travel nurse, and I am currently living without a car in a community with great public transportation.) Interesting that we have the second-highest gas prices in the nation, as we also have the 2nd-highest electricity rates, right after Hawaii. And, if you look at the link to the left on most expensive areas to live in the nation, you'll see that the Norwalk-Stamford area in CT is #1, in terms of rental prices, ahead of even Honolulu!

O.K., and the reason someone would prefer Stamford to Hawaii would be....???  Beats me.

It sure ain't the scenery.

"Connecticut already has the second-highest gas prices in the country, behind California. AAA says the average price of regular gas in Connecticut is about $4.30 a gallon."
Connecticut gas prices stand out
By ConnPolitics.tv Staff, on Jun 8, 2008

I'd love to know where the hell our gas taxes (which are - you guessed it -the 2nd highest in the country) are going. They sure don't seem to be going into repairs for the heavily-used, incredibly decrepit stretch of I-95 that runs through Southern CT, where the word "pothole" serves as a euphemism for an 18' by 18' foot hole that goes through the entire thickness of a bridge deck. Ummm, that's not a 'pothole', people - that's a freaking game of Russian Roulette!

I'd like to put former mayors Giordano and Ganim, former governor Rowland, and current douchebag/senator Lieberman to work doing some honest work for a change. Like repairing that "pothole" ... by hand, in 95-degree heat, with 70-percent humidity. From what I hear about the weather, they could start this weekend.