Author Archives

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A Little Criticism

Taking criticism is hard. Most of us want to hear that we’re special, have great taste, and rock in everything we do. Sort of like Toddlers and Tiaras without the temper tantrums. Unfortunately, life seldom gives us blanket approval for all of our actions.

We misunderstand, we misinterpret, we think we get it, but we don’t.  The person that points out these truths  doesn’t earn our respect and thanks (not even if our underwear is tucked into our skirt or a big piece of spinach is blighting our smile). Instead, our first response is to turn on them.

Disagree with me and you’re wrong, you’re stupid, and/or you don’t understand.

How do we learn, though, if not by criticism? In education, there’s a saying that “you don’t know what you don’t know.”  We’re all blind to our faults and our weaknesses. When someone points them out to us, of course our first reaction is a big HELL NO as we put up our guard to defend ourselves and our self image from our attacker.

But, how can we get better if we don’t take advice from others?

When I went to nursing school, I knew right from the beginning that I knew nothing. It took me ten minutes to reconstitute medications. Twenty minutes to set up an I.V. Putting in a female catheter? Forever. I accepted criticism because I accepted my ignorance. I listened a lot, I read a lot, I took my lumps, and eventually I became good at my trade. But, if I had been defensive, argumentative, and convinced of my own rightness, I would have ended up a hack. I got good because of criticism.

I maintain the most dangerous people in healthcare, and the world, are those that don’t understand their limitations. They will fight to the end of time to defend their rightness. And they are wrong.

I might not always agree when people tell me I’m wrong, but I’ll listen, I’ll think, and I’ll research. Because in this big world full of information, I must accept there are people that know more than me. If I’m not willing to at least hear them out, who’s the idiot?

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Celebrating Labor Day

Labor Day was created as a way to pay tribute to the worker’s of American, particularly those in trade and labor organizations. Today, trade organizations and labor unions are often categorized in negative terms, even while studies show these organizations save lives.

A history of the IBEW notes that: “Some statistics support the fact that one out of two men who entered the industry did not survive their first year.” Currently the United States Department of Labor estimates “The annual fatality rate for power line workers is about 50 deaths per 100,000 employees.”

An article reporting on a  federally backed study on the hazards of working in mines concluded,  “In the past two decades, there have been 18-33 percent fewer traumatic injuries per miner in union mines than nonunion mines and 27-68 percent fewer fatalities per miner, according to a draft of the study sponsored by the National Institute of Occupational Safety and Health.”

An ILR review study purports that “After controlling for patient and hospital characteristics, the authors find that hospitals with unionized R.N.’s have 5.5% lower heart attack mortality than do non-union hospitals.”

In Rhode Island “Between 1998 and 2005 there were 354 fatalities at non-union workplaces throughout New England. During those same years, there were 77 deaths at unionized locations, according to OSHA figures.”

Whether you like unions or not, there’s something to be said for organizations that may very well increase your chances of celebrating another Labor Day. 

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MD Doesn’t Stand for Know It All

Medical doctors are used to people listening to them. Their words are rarely disputed and oftentimes even the most outlandish beliefs seem reasonable when spoken by a doctor. Case in point, Rep. Todd Akin’s comments about rape victims and pregnancy: “From what I understand from doctors, that’s really rare. If it’s a legitimate rape, the female body has ways to try to shut that whole thing down.”

Try as I might, I can’t find any scientific evidence, even on the internet, that rape victims are able to send out ninja assassin eggs to kill rape sperm or deploy mini razors in their uterus to prevent egg implantation.

But, hey, if a doctor said it, it must be…right?

Every day woman are counseled by doctors that taking antibiotics will lessen the effectiveness of their birth control pill. The early data to support this only related to one antibiotic, rifampin. Even though rifampin is now rarely used, and there’s been no subsequent link between the use of other antibiotics and unwanted pregnancies, doctors and pharmacists still perpetuate this myth.

Hyper kid? Your doctor might recommend restricting sugar intake. As we’ve seen on shows like “Toddlers and Tiaras,” filling young children with pixie sticks and energy drinks turns exhausted, ill tempered children into enthusiastic dancers and runway walkers. Scientific research debunks the link between sugar and hyperactivity. Instead parents that believe sugar causes excess energy “see” the effect, even when there is none.

Wear glasses? Some doctors believe it’s because you spent too much time reading in dim light. Even though reading in dim light may strain eyes, it won’t damage your eyes. In fact, strain your eyes all you want on computers, sitting too close to the television, and not wearing your glasses when you need them. None of these will cause permanent damage.

I could go on with doctor misperceptions about using antibiotics, vaccination side effects, and even the use of thong panties, but I won’t. Possessing a medical degree and a title doesn’t automatically make someone intelligent and well informed. Doctors have as many crackpot, half-baked, and totally wrong ideas as the rest of us.

Too bad our representatives in Washington aren’t smart enough to figure that out.

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How Not to Solve the Problem

The Exeter Hospital healthcare worker who picked up unattended syringes of potent narcotics, injected himself, and then either refilled the syringes with saline or replaced them with his own previously used needles, causing at least 32 patients to become infected with Hepatitis C, is not an isolated occurrence. This has happened before and will happen again, unless the real problem is addressed.

The incident is being used as a scare tactic to further a bill requiring certain hospital employees, including lab and medical imaging personnel, to meet national standards in order for the facility to receive Medicare reimbursement.

This will not solve the problem. 
 
People who are entrusted by a hospital to draw up and administer medicine should be held accountable when they don’t safeguard the medication. Even if they are doctors. Even if they are nurse anesthetists. Even if they are registered nurses. Leaving syringes of narcotics lying about is irresponsible and dangerous. Blaming an addict for picking up these syringes makes no sense.

Instead let’s hold accountable the hospitals that don’t follow their own policies on medication security. Let’s expect to hear how the hospital disciplined the healthcare front line staff that made this tragedy possible through their carelessness.

It has nothing to do with the presence or absence of national licensing standards. It has everything to do with accountability. Until hospitals and their employees are willing to admit their part in this tragedy, nothing will change.

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Pain Free Isn’t Painless

There’s no question that, at one time or another, everyone will suffer from pain.  The question is how it will be managed.  In the past, before every ache and pain justified an emergency room trip or visit to the doctor’s office, pain was treated with non-narcotic medications, such as ibuprofen and acetaminophen, as well as rest, ice, and heat.  Now, whether it’s a sprained ankle suffered sliding into home plate or a longstanding backache, pain is routinely treated with the narcotics once solely reserved for cancer.
The choice is not without hazards. Tolerance to the medication (requiring ever increasing amounts to achieve the same effect), addiction (both physical and psychological), and respiratory depression leading to death are all known side effects of narcotic treatment.  Unfortunately, the current mindset that every healthcare encounter includes a prescription combined with the unwillingness to man up, has led to an explosion in legally written prescriptions for narcotics and a corresponding increase in the number of drug related deaths.
In four of the last five years New Hampshire has had more drug overdose deaths than deaths due to car accidents. The majority of these overdoses weren’t from heroin or other illicit drugs, they were from prescription narcotics. 
Why? Obtaining prescription narcotics and selling them is easy.  
How easy? The Union Leader newspaper recently reported the arrest of a suspect with more than eleven hundred 30-milligram oxycodone pills, street value approximately $35,000.00.
Where did the pills come from?  Not from thefts at the pharmacy or factory.
Most likely from thefts of medicine cabinets and the voluntary sale of legally acquired pills. Have a little pain? Get a few narcotics. Need extra money? Sell them. Worried about getting caught? Don’t be.
In New Hampshire, over the counter decongestants are more tightly regulated than prescription drugs. Pharmacies won’t dispense OTC decongestants such as Sudafed or Mucinex D without seeing a photo I.D., noting the purchaser’s name, and ensuing the purchaser hasn’t received more than a specified number in thirty days. You’d think it would be a no-brainer to implement a similar process with prescription painkillers. 
No. There’s no widespread method of keeping track of how many pills someone fills per month. There’s no method to determine if they are visiting multiple doctors, various Emergency Rooms, or using aliases to obtain their pills. Walk into any pharmacy and, with enough cash in your pocket, you can walk out with a bottle of pills with excellent resale value and wide appeal. Convince a doctor you have chronic pain, you can repeat this process on a monthly basis. It’s surprising more people aren’t profiting from this easily exploited system.
Our country regulates alcohol. It regulates firearms. It regulates tobacco. It even regulates over the counter decongestants. What’s so hard about regulating prescription painkillers? Maybe no one wants to force the healthcare system to acknowledge the monkey they’ve put on the back of our society.
I’m thinking it’s easier to just write another prescription.
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I’ll Settle For A Pat Down

Tomorrow I’ll be taking a flight out of my regional airport and will be forced to choose between a full body scan and a pat down.  It’s an easy choice for me, I have no problem with being patted down, but the Transportation Security Administration (TSA) agents never seem happy.  Each time I ask for a pat down in lieu of a full body scan, they try to discourage me. 
Perhaps it’s because they don’t have enough womanpower to accommodate my request. Perhaps the female workers feel uncomfortable and would prefer everyone choose radiation. No matter.  As long as I have a choice, I’d rather have the known hazards of a pat down (essentially none except for the creepy feeling of a stranger’s hands on my body) than risk the unknown hazards of a new technology that’s been implemented without, in my opinion, adequate time and study.  
The TSA, which refers to the full body scanner as advanced imaging technology states it “is safe and meets national health and safety requirements”  and “results confirmed that the radiation doses for the individuals being screened, operators, and bystanders were well below the dose limits specified by the American National Standards Institute (http://www.tsa.gov/approach/tech/ait/safety.shtm).  The Archives of Internal Medicine reports:  “The estimation of cancer risks associated with these scans is difficult, but using the only available models, the risk would be extremely small, even among frequent flyers. We conclude that there is no significant threat of radiation from the scans” (http://archinte.jamanetwork.com/article.aspx?articleid=227603).
Unfortunately I have a hard time trusting these pronouncements.  
History tells us that many times in the rush to develop and market new technology, risks are either underestimated or unknown until something has been used for a period of years and on a multitude of people.  
CT scans became widely available by 1980. After more than thirty years of use, concerns about a possible correlation between CT scans and brain cancer surfaced.  Now the Food and Drug Administration (FDA) has an initiative to reduce unnecessary radiation exposure and notes that CT scans, fluoroscopy and nuclear medicine imaging exams have benefits and risks and “these types of exams expose patients to ionizing radiation, which may elevate a person’s lifetime risk of developing cancer” (http://www.fda.gov/Radiation-EmittingProducts/RadiationSafety/RadiationDoseReduction/default.htm).  
In 2003, DePuy Orthopaedics introduced a new metal-on-metal hip replacement implant. In August 2010 they issued a voluntary recall after discovering a higher than expected number of patients needed revision surgery. 
Vioxx, a medication marketed for arthritis and acute pain, was approved for use by the FDA in 1999. The increased risk of cardiovascular events, including heart attacks and strokes, wasn’t found until a later study in June 2000. An additional warning  was added to the Vioxx label in 2002, but it took another two years before Merck & Co. voluntarily withdrew Vioxx from the market after a third study confirmed the cardiovascular risks. The aftermarket studies for Vioxx were voluntary studies the manufacturer undertook to look at side effects and additional indications. If not for those, Vioxx may have been on the market for many years before its serious, and sometimes fatal, side effects were discovered.  
In all of these cases, decent, hardworking scientists, academics, and government monitors gave their seal of approval for something that turned out to have unintended, dangerous side effects. In all of these cases the product was in wide use before the danger was known.  
In ten years, maybe I’ll have a different opinion on the full body scanner.
For tomorrow, pat me down.