It Will Be a Lifesaver for Many

There have been convoluted discussions regarding the utility in providing educational awareness in how to reduce the risk in risky behavior. Needle exchange programs struggled to get off the ground for years.  Proponents supported disease prevention while increasing access to unused syringes without punitive legal ramifications.  Counterpoints have viewed such options as means to increase illicit substance abuse of those already exposed and to entice others in contemplation.  Data and the tincture of time have borne out the need for ongoing support with a multifaceted approach, incorporating strategies and stop gaps, not to derail well warranted public health initiatives.  “To effectively reduce the transmission of HIV and other blood-borne infections, programs must consider a comprehensive approach to working with IDUs. (IV Drug Users). Such an approach incorporates a range of pragmatic strategies that address both drug use and sexual risk behaviors.

NHMS Membership - Two More Please

Our practices are attached to the swinging pendulum of healthcare debt, reimbursement and corporate drivers.  This blog is not intended to highlight the potential trends of ACOs, hospital mergers and acquisitions, or the impact they will have on the quality of physicians’ professional practices and our patients.  After all, so many providers are well aware of the changes on the horizon.  Many more healthcare professionals are intimately aware of business practices and much more willing to partner with or be employed by healthcare organizations than to weather it alone.  This, too, is part of the swinging pendulum that physicians should be mindful of.  There can be some very positive outcomes for all, but it is important to remain at decision tables and as proactive stakeholders.  To do so, it is essential for physicians to grow more robust and cohesive groups in order to be proactive agents of change.

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. 

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.

It Is In Your Backyard

It was 2 a.m., 22 years ago, when I answered the phone.  My friend’s brother, barely audible, asked if I wanted to buy his parents’ silverware or maybe a saltwater fish tank setup.  He would be over in less than an hour, and we could settle on the price then.  Another close friend was distraught, having just been informed that her daughter, a freshman in college 3,000 miles away, had been found unresponsive on the floor and taken to the emergency department.

MLPs – Current State vs. Future State: What to do with mid-level providers?

While I was recently speaking with a group of physicians, a comment was made regarding mid-level providers.  Somewhat succinctly and pointedly, it was mentioned that the direction of health care is such that patients are more frequently unable to see a physician in primary care settings, specialty clinics and emergency departments.  This is not a new circumstance, but a growing and developing integral transformation in health care occurring over several decades.  Interestingly, the same physician’s practice has MLPs as part of the staffing model, with a very large patient base and a well-regarded reputation.  What is paradoxical is that over the years many patients have commented that they have not seen their PCP at all within that practice, they are seen exclusively by a midlevel in the office who they have come to accept as the provider who knows them better than anyone else in the group, and they are quite satisfied with their PA-C/APRN relationships. 

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.

Desiderata

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?

Stop the Madness

Columbine.  Santana High.  Rocori.  Red Lake.  Chardon.  Sandy Hook.  Reynolds High.  Arapahoe.  Marysville-Pilchuck.  Kids killing kids in school.  15 years.  More than 75 deaths.  More than 100 wounded.  Communities all over this country wondering if they are next.  Americans are 20 times more likely to die via a shooting than any other developed country in the world, and children between the ages 5 of 14 are 17 times more likely to suffer this fate.

Ezekiel's Run

In 1976, a futuristic cinema experience promised a life full of pleasure with just one catch — when you turned 30 years old, the life-clock crystal in your palm turned red, you were on your last day, and unless you wanted to head to the “Carrousel” for vaporization and “renewal,” you had to run.  While “Logan’s Run” may not have been the greatest sci-fi film ever made (“The Empire Strikes Back,” anyone?) it possibly is the reason that no one wants to admit they are a day over 29.  Recently, a new number has been thrust into the medical consciousness as another option for the last year of enjoyable life.  That number is 75, which has been proposed by Dr. Ezekiel Emanuel as his choice for leaving planet Earth for good or refusing further medical care.  See the article in The Atlantic.

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