Category Archives: healthcare

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The Healthcare of Politics, Post Debate

First off, I have no issue with anyone who uses their faith to inform their personal life and decisions. I do it. I believe you should, too.

Paul Ryan’s faith believes life begins at conception, therefore abortion is murder. But, if we’re going to allow religious faith to play a role in healthcare, let’s consider all religions and their beliefs.

Jehovah’s Witnesses can legislate against blood transfusions.

Christian Scientists can legislate for prayer instead of medical treatment.

Scientologists can legislate for introspection rundowns instead of antidepressants.

The bottom line is every religion has traditions and prohibitions that impact the healthcare experience of their followers. These items don’t need to be legislated, they are a choice. The Catholic Church and Paul Ryan has no more business making my healthcare choices than my employer does.

Wait. Ryan and the faithful believe that employers should be able to financially restrict an employee’s access to birth control, sterilization, and abortion in the name of religious freedom. Guess religious freedom means religious employers can make the decisions usually best left to a patient and doctor. Today, birth control and sterilization; tomorrow, restrictions on blood transfusions or psychiatric care?

Because if we want to allow faith to legislate healthcare, let’s not stop with the Catholic Church’s agenda. Let’s champion the beliefs of all religions. Sounds good, doesn’t it?

But, taking away healthcare choice from the individual and investing it in the hands of a religious organization is akin to setting up “death panels,” except instead of deciding if an individual is worthy of medical resources, these panels would decide what medical resources are worthy of being used.

As much as I believe in religious freedom, I don’t think your faith should impact my ability to access medical care and procedures. Do you?

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Keep Your Merit Badge, I’m Not a Boy Scout

Portrait of Miss Georgina Pope, head nurse of ...

Portrait of Miss Georgina Pope, head nurse of First Canadian Contingent during the Boer war. Possibly in her nurse’s uniform from Bellevue Hospital, New York (Photo credit: Wikipedia)

Last week Nurse K posted on her blog about a patient‘s last phone call. Read it here.

After wiping away some stray moisture from my eyes and clearing my nose (allergy season, you know), I thought about the moments that define us in our healthcare role.

Hospitals seek out touching stories to bolster their application for Magnet status or adorn their website. Their stories of how the healthcare staff went above and beyond to help a patient usually end up being fairly run of the mill. More in the vein of “the nurse took the time to ensure I knew how to make the bed go up and down” and “the food service staff cheerfully exchanged my tray to accommodate my gluten-free diet” than “someone did something totally unexpected and above/below their pay grade that mattered.” In my hospital experience of being on the receiving end of management’s praise, I’ve found the successes I’ve been credited with are the ones that least define who I am as a nurse.

I was acknowledged once for my help in cleaning up flooded exam rooms after someone left a faucet running over a weekend. The sad truth was administration had made deep cuts in the housekeeping department and there was no one available to clean up the mess. I picked up a mop and started in because we had a waiting room of patients to be seen. Eventually the housekeeping supervisor, embarrassed at his lack of employees, showed up to help. Administration congratulated our team effort to fix the problem. I got official recognition for going above and beyond and a free lunch in the cafeteria. Rather than being thrilled with the “honor,” I was incensed. Of all of the things I did in my job that were truly worthy of recognition, I got an attaboy for pushing a mop for two hours. Two hours I wasn’t available to triage or educate patients. Two hours I didn’t use any of my nursing skills. That is what administration deemed worthy of recognition.  It didn’t go over well when I told them instead of praising me, they should be asking themselves why they didn’t have enough housekeeping staff to handle emergencies.

Instead of addressing the underlying problem many of us face, too much to do with too little time and staff to do it, hospitals try to boost morale with meaningless honors and remain oblivious to the day-to-day things that really matter. And though we are more than willing to share our crazy stories, commiserate over the sad ones, and bemoan the incompetence of administration, we’re not willing to let down the walls and talk about the parts of our job that hit us in the gut and the situations that make us turn our heads so the patient can’t see our tears. We’re professionals. That stuff isn’t supposed to get to us.

But, it does. It stays with us.

And they are the moments I don’t offer up to the public relations machine of the hospital and I suspect many others do the same. Moments that remind us there is more to our job than tasks and checklists and documentation. Moments when we know that our lives will go on, but our patient’s will be changed forever. Because sometimes, in the confusion, turmoil and noise of our professional lives, we take a step back and do the right thing.

Those are the moments that define us.

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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.