So this is it.  The Final Blog.  Election Night 2014.  No pressure.  Why is this night different from all other nights I remember reciting as a kid? Now I know what was meant.  Will our country be realigned politically by the time you read this Wednesday afternoon?  Yup, as the Senate and House of Representatives are now under Republican control.  How will health care fare when the new Congress convenes in 2015?  Could the Affordable Care Act be turned inside out, upside down or overturned?

Coming soon to a roadway near you! HB 1360

Quite some time ago I spent countless hours behind the wheel of commercial vehicles, to the point that I have caught my wife in conversation with others quoting, “Don’t you know? He is a professional driver.”  This usually results in shared chuckles by others, as it is reportedly a commonly recurring outward expression of the Y chromosome, likely overlooked by the mapping of the human genome, and barring XX chromosome counterparts such as Danica Patrick hopefuls on public streets.

CO Toxicity

In support of Gov. Maggie Hassan’s recently signed proclamation naming November as Carbon Monoxide Awareness Month, it is appropriate to share the importance of this timely public health message in my first NHMS blog. 

Many years ago as an undergraduate student at UNH, I volunteered as an EMT for a newly installed hyperbaric oxygen chamber.   A donation from a New York university, the chamber was unusually large in comparison to other chambers and could contain four adults and a patient during a treatment.  I recall some of the distinct differences to the patients, really challenging cases, we treated in the chamber to those I have treated in emergency departments in large inner cities and communities as well.  The one striking commonality is not the severity of any given patient nor the tragedy for those who did not wake up or fully recover from an acute high concentrated exposure, but rather those who had presented after sustained, lower concentration exposures.

Cigarette Tax - Call Your Senator Today!

As you may recall, increasing the New Hampshire tobacco tax has been a key legislative priority for NHMS this session.  Governor Hassan and the New Hampshire House included an important $0.30/pack increase in the state budget bill.  With this level of increase we can expect 4,000 adults to quit; even more children will not start smoking in the first place; $24 million in new money will support the state budget; and the state will realize $1 million in direct health care savings.


Choice of Physician or Network?

My last two posts dealt with the new Health Insurance Exchange, or “Marketplace,” which opened yesterday, and I talked about some of the concerns with the limited options and a limited provider network. What will be the impact for 2014 for our patients and costs? I heard from several of you with your ideas and concerns and thought I would share them with you today.


Violence and Public Health

This year I have written several times about violence and its impact on the public’s health, and last week I shared our N.H. physician survey results indicating that addressing gun violence was a priority for many of you.

Carpe Diem

As many of us reflect on the recent death of Robin Williams, the gifted comedian, actor, husband and father of three, much of the focus in the media this week has been on the issues of depression, substance abuse, addiction and suicide.  It was refreshing to hear some of the commentators talk about depression as a “brain disease” and not use the term “mental illness” as much as might be expected.

Can't always sort wheat from chaff

In follow up to last week’s blog, it may be considered somewhat reflexive to speak to a confounding circumstance in the recognition and treatment of multi-substance abuse and addiction.  Mental illness is intertwined in the management of substance abuse and addiction.  Neither one of these complex conditions are adequately addressed through episodic care, whether it is rendered in an emergency department, a primary care office or from a three-day stay in a psychiatric facility.  Rarely are any of the underpinnings addressed adequately, and quite often the process can be viewed as simply inhumane.

Violence as a Public Health Issue

The violent events of the past year and my writing about them here have provoked strong feelings among our members and raised, I think, good questions like: What can I do as a physician to impact this problem? Do I even have a role?  The problem seems so big that it is very difficult for us to get our hands around.  Are there only policy solutions? Are there clinical solutions?  Are there community solutions? Or, is this just the way things are and we should accept them? 

We asked, you spoke!

"We live on an island surrounded by a sea of ignorance. As our island of knowledge grows, so does the shore of our ignorance." - John Archibald Wheeler, eminent American theoretical physicist

Earlier this year, NHMS conducted a survey to learn more about you, what is important to you, and what you think should be priorities for NHMS. We had a great response and learned the following: