Health Disparities & Patient Diversity - Our Call to Action

Several weeks ago I saw a patient who exhibited many of the classic signs of depression, depressed mood, trouble sleeping, fatigue, and weight gain, so I administered a PHQ-9, a standard assessment tool for depression and confirmed my suspicions.  We discussed the diagnosis of depression, what it means and options for treatment, as is usual for my practice as a family doctor.  Usually, we (the patient and I) make progress in creating a patient centered approach to address their condition, but that day, I found my usual practice came up short.  

Reform is in the Eye of the Beholder

Medical liability reform is one of the major issues for many state medical associations and societies in 2014, according to the American Medical Association this week.  See the AMA wire article here.

New Hampshire is one of those states, and there are a few bills currently in this year’s legislative session dealing with medical liability reform.  One of these, HB 583, is relative to the proceedings of medical injury claims screening panels, the RSA 519-B panels. 

Head Games

As you read this, the college football season of 2013 will be over.  Florida State has been crowned the final BCS national champion.  The NFL playoffs are in full swing, with the Patriots and Colts playing in Foxboro yet again.  And all the while, even though a major lawsuit dealing with concussions was somewhat settled back in August 2013 (see N.Y. Times article), the hits keep coming.  A look at the NFL’s official injury report for Week 17 showed that 18 players on 32 teams were being treated for concussions.  In this past weekend’s wild-card playoffs, with eight teams playing, at least five concussions occurred, three on the Kansas City Chiefs alone (see SB Nation article).

Right Sizing MOC Exams

Over the past decade and a half, there has been considerable attention given to the utility of Maintenance of Certification (MOC) examinations in order to remain board-certified for many specialties.  As a de novo approach, the impetus was to serve as a better means to keep physicians current with the rapidity of changes occurring in any given specialty.  Ongoing scrutiny regarding the correlation between the MOC, as well as other requisite lifelong learning curricula to support the 10-year re-examination cycle, remain under the magnifying glass as to how efficacious they really are. 

Scared to Death

As a medical student during a surgical rotation in the 90s at the old Boston City Hospital, I started locking the resident’s call room door whenever I was attempting to catch a cat nap.  This came on the heels of the morning after the chief surgical resident was jumped and beaten while he was sleeping in the call room, by a completely random person wandering the floors of the hospital.  Over the years I have seen patients attack patients, nurses, caseworkers and physicians.  All completely random acts without provocation in the middle of emergency departments, hospital wards and out of the way sundry areas like stairwells or the hospital garage.  The incidence and severity of violence is on the rise in healthcare settings.  Dr. Michael Davidson, the 44-year-old Boston based cardiovascular surgeon who was murdered just weeks ago by a patient’s relative, is one recent tragedy.

Slower Growth in Healthcare Spending and Lower Insurance Rates on the Exchange

I was struck by two articles this week about healthcare expenditures and costs. The first, in this week’s Health Affairs, details the various trends and components for measuring our nation’s healthcare expenditures. The authors attribute the slower growth to several factors, including the sluggish economy and greater out-of-pocket expenses for those covered by commercial insurers. The growth in national health spending was 3.9% in 2012 and an estimate of less than 4% in 2013.

Staying True to Our Values.

Happy New Year!  Many bring in the New Year with resolutions to go to the gym, quit smoking, read more, learn a new hobby or skill and the list goes on.  I won't be joining the estimated 40% of Americans who make these resolutions.  Like most Americans, I'm not very good at keeping them.  Rather, I plan to revisit my list of values that help guide me in life, those  things and ideas that anchor me in my work and home life.  The busy nature of our lives as physicians often leaves us with little time to reflect on our days and what gives meaning to the work we do.   

Having Sight Does Not Mean Having Vision

A year ago, one of my patients underwent stereotactic brain surgery to remove a tumor that had been causing dizziness and vertigo. After the procedure, there were no issues with speech, swallowing or cognition, but my patient had significant visual field issues. Double vision, visual field cuts, feeling like ‘being wrapped in cellophane’ were common complaints during the last 12 months. Over time, these issues have gotten better, but are not fully resolved yet. Unfortunately, the vision deficits have caused significant limitations in the ability to drive, use a computer, and return to work. It made me wonder what options are available for the visually impaired in our state.

Stigmatized and Left for Dead, Who Should Make the Call?

Over the past couple of weeks I have become more aware of opinions that could be unfortunate barriers to HB 271 being passed by the Senate.  While participating in an EMS continuing education presentation, the question was put forward as to who might not be in favor of having naloxone (Narcan) more readily available for addicts, their friends, family members and others to administer emergently to anyone whose life is threatened from an opioid overdose.  Surprisingly, there was more than one hand raised.  The supporting commentaries shared a similar concern, that it will only aid and abet abusing illicit drugs.  Others, who are not EMS providers or healthcare professionals, have also recently expressed their biases to not support easier access to Narcan, regardless of its lifesaving potential.  There have been deeper dives and hard looks at the risks and benefits for bystander Narcan to be more readily available.

Have I got your attention?

We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win, and the others, too. - President John F. Kennedy, Sept. 12, 1962

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