LInkworthy 3.3: Dog days

Had enough of the hot weather? Ancient Romans called these the dog days, named after Sirius, the brightest star in the Canis Major constellation, which was ascendant in late July and early August and was believed to turn the weather hot and sultry. Find an air-conditioned place away from the heat, thunderstorms and mosquitoes to peruse this latest edition of Linkworthy, a roundup of reading material recently encountered on the Web.

- Why are so many medical practices and hospitals lagging when it comes to implementing electronic medical records? The reasons are explored in an in-depth article recently published by the Center for Public Integrity, which takes a look at the experiences of individual clinicians as well as the overall policy issues surrounding health technology.

As the article makes clear, it’s more than simply installing a computer in every doctor’s office and at every hospital bedside. Here’s one of many reasons why it’s complicated:

The decision to purchase one of these systems is complicated because they do much more than picture a paper record on a computer screen. They handle more than a thousand details, including a patient’s medical history, current diagnoses and prescriptions. They also have the kind of interactive “real time” features that work almost like computer games: when certain information is entered, the computer talks back with questions, alerts (such as an abnormal lab result), reminders, new screens or choices that demand a response.

Patients might consider all of this the next time they see their doctor or nurse using an electronic medical record – or a paper chart, for that matter.

- Some years ago I spent a day tagging along with the unfortunately-now-defunct Rural Health School, a program of the University of Minnesota that provided intensive, hands-on education on rural health issues for students in the health professions. Part of the day included a couple of hours with a Willmar Police Department crime prevention officer who shared statistics about violence against health care providers and how to stay safe.

It was pretty eye-opening for most of the students, who may not have realized the risks they can face. An article published this past weekend in the Los Angeles Times reinforces this vulnerability and the inadequacy of many health organizations to deal with it.

The story opens with a rather graphic example of violence in the hospital: “The patient was drunk, naked and covered in blood when he burst out of his emergency room cubicle around 2 a.m., brandishing scissors. He lunged at two nurses and began chasing them. It took two police officers and three zaps from a Taser to subdue him.”

According to a 2007 survey in California, nearly 40 percent of emergency room staff said they’d been assaulted on the job during the previous year. Another survey, conducted last year by the Emergency Nurses Association, found that more than one in 10 emergency room nurses reported being attacked at work within the previous week.

Because statistics aren’t well tracked, it’s not clear if violence against health care workers has been on the rise in recent years. The evidence seems to point in this direction, however, and the article explores many of the contributing factors: shortages of appropriate mental health care services, the public’s simmering frustration with the health care system, inadequate training for health care workers on how to recognize a potentially violent situation or how to protect themselves if things escalate, and an underlying belief that a certain amount of violence just comes along with the job.

- What would you do if you faced a $9.2 million hospital bill? The bill, for the care of a young woman who died two years ago at Tampa General Hospital in Tampa, Fla., appears to set the record for the largest hospital bill ever in the United States.

Tameka Jaqway Campbell died from a severe and progressive neurological disease. The $9 million has been billed to her estate. Her mother has refused to pay and has accused the hospital of inappropriate care.

There are at least two important issues entangled in this story: the need for health care costs to be transparent, and the state of palliative care in the United States and how we care for patients when death is the inevitable outcome. Whether Tampa General Hospital will ever collect on even a portion of this bill seems doubtful; even if discounts are applied, the total could still come to $2.25 million.

- When it comes to health care news, does the public want to know about the uncertainties and the complexities or do they want it short and simple? Based on a recent series of conversations with journalists, hosted by the Center for Advancing Health, the preference appears to be for the latter.

Journalists said they’re often encouraged to avoid ambiguity and to choose stories that readers want rather than stories they need, Jessie Gruman writes in the Prepared Patient Forum.

But in the long run, is this best for readers? We may want our health news to be simple, Gruman writes, but if consumers are to be expected to truly participate in their care, what they need is information that’s both accurate and complete.

- Finally, a medley of entries from the health blogs: Why kids often hate sports physicals; the importance for hospitals of paying attention to how the doctors communicate; and a thought-provoking reframing of the obesity-as-public-health-crisis issue.

Image: “Starry Night over the Rhone,” Vincent Van Gogh, 1888.