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.

Linkworthy 3.2: the midsummer edition

Ah, midsummer. What’s not to like about long June days? Grab your lawn chair and laptop for this latest edition of Linkworthy, a roundup of thought-provoking and/or interesting items encountered recently online.

- What do you say to someone who has cancer (or any other serious disease, for that matter)? “You look great” and “What can I do to help?” are not on the most-recommended list for Bruce Feiler, who vented in last week’s New York Times about “‘You look great’ and other lies.”

What’s wrong with “You look great”?

“We know we’re gaunt, our hair is falling out in clumps, our colostomy bag needs emptying,” Feiler writes. “The only thing this hollow expression conveys is that you’re focusing on how we appear.”

He suggests helpful things to say instead: “I should be going now.” ”Would you like some gossip?” “I love you.”

Feiler’s essay seems to have hit a nerve. More than 160 readers responded with their own experience and insights. An especially thoughtful reaction came from Lisa Bonchek Adams, a blogger who has been on the front lines of breast cancer. The problem with lists of what not to say, she writes, is that one size doesn’t fit all – and if people become too self-conscious about saying the wrong thing, they may withdraw altogether:

In those cases you may lose people who may have been well-intentioned. Sometimes forgiveness and compassion need to go out from the person who is sick and not just flow to them.

People who’ve known me for a long time know that I had non-Hodgkin’s lymphoma several years ago. Probably my least favorite on the list of what-do-you-say was “Call me if I can do anything” because it was so vague. What if the one thing I needed most was someone to change the cat litter? Would the response have been “Sure, great!” or would it have been, “Eewww, no thanks”?

People who made non-specific offers of help invariably meant to be kind and supportive, however – and that’s what counts. It seems wiser to cultivate gratitude for people’s good intentions, even when they’re sometimes clumsily expressed, than to react with eye-rolling or annoyance. (Readers are welcome to share their own thoughts in the comment section.)

- “Give doctors a break,” implores Dr. Elaine Schattner, who blogs at Medical Lessons. Her plea is prompted by ”a heartless op-ed” by Dr. Karen Sibert, a Los Angeles anesthesiologist, who asserts medicine cannot be a part-time endeavor.

Is this yet another round in the mommy wars, or is the deeper issue one of balance between work and the rest of life?

The huge investment in a medical education confers some responsibility to use that education to benefit patients, Dr. Schattner writes. But what if a physician truly needs to cut back her hours or stop seeing patients altogether? Macho attitudes about medicine can put tremendous and ultimately harmful pressure on doctors, she writes. “A flexible, more realistic system would allow doctors, in whom the system has invested so much, and who have invested so much of themselves, to take time off when they need it, and flexibility in their schedules, so they can continue in their careers after prolonged illness.”

Other reactions to Dr. Sibert’s op-ed can be found here and here.

- Good news for those of us who can’t imagine life without a companion animal: A new study published in the Clinical and Experimental Allergy journal has found that the presence of a dog or cat in the household doesn’t increase children’s risk of developing allergies.

Researchers followed a cohort of children from birth to adulthood, checking in periodically to collect information about their exposure to dogs and cats. At age 18, 565 of the study participants gave blood samples that were analyzed for the presence of antibodies to dog and cat allergens.

Interestingly, the results suggested that being exposed to an animal during the first year of life seemed to be critical – and that for some people, this early exposure may actually be protective.

The men in the study who lived with an indoor dog during the first year of life had about half the risk of becoming sensitized to dogs as those whose families didn’t have a dog. Both men and women were about half as likely to become sensitized to cats if they lived with a cat during the first year of life.

- How much do you think it costs for adult children to be caregivers for their aging parents – $10,000? $50,000? $100,000?

A new study by MetLife calculates the total: a collective $3 trillion in lost wages, pension and Social Security benefits for those who take time off work to care for their parents. On average, women lose $324,044; for men, it’s $283,716.

The researchers analyzed data from the National Health and Retirement Study to assess how much caregiving is provided by baby boomer adults for their older parents, its impact on their careers and the amount of potential lost wages and retirement benefits.

Among other findings from this study: Adult children 50 and older who both work and provide care for an older parent are more likely to report their health as fair or poor than those who don’t combine work and caregiving. The percentage of adult children providing personal care and/or financial assistance to their parents has more than tripled over the past 15 years and currently represents 25 percent of adult children, primarily baby boomers.

A key conclusion of the report is that workplaces need to become more flexible and adopt policies that support working caregivers. The report also points to a need for more resources to help middle-aged caregivers with retirement planning and stress management.

- Other worthwhile reading: GeriPal, the geriatrics and palliative care blog, reflects on “Lessons I Learned by Examining Miracles.” A compelling story from CNN examines miscarriages and when they become something that requires deeper medical investigation. The latest issue of Proto, the magazine of Massachusetts General Hospital, contains several intriguing in-depth articles. If you have time to read just one, check out “Foreign Bodies,” a fascinating and creepy look at the strange things people swallow and the early-20th-century laryngologist from Pennsylvania who amassed a collection of swallowed objects. The article includes an online photo gallery that will make you think anew about the hazards of swallowing foreign objects.

Photo: Wikimedia Commons

Linkworthy 3.1: Friday the 13th

A roundup of some noteworthy reading encountered on the web in recent weeks:

- I can’t believe I missed this story last month, but here it is, from the Wall Street Journal: The Battle of the Office Candy Jar. Summed up in three words: Proximity + temptation = ruination. My favorite quote from the article: “Even for a person with the greatest resolve, every time they look at a candy dish they say, ‘Do I want that Hershey’s Kiss or don’t I? At the 24th time, maybe I’m kind of hungry, and I just got this terrible email, and my boss is complaining – and gradually my resolve is worn down.”

I hope my newsroom colleague who brought in the leftover Peeps and jellybeans after Easter is reading this.

- Speaking of food, The Atlantic published an article today that takes an interesting look at supermarket design and its influence on what, and how much, we buy – and whether stores can be redesigned to help consumers make different purchasing choices. It may smack of social engineering but it seems to be backed up by some intriguing research.

- Engaging the Patient is hosting a series of guest blogs during Patient Experience Month that explores the line between rhetoric vs. action. Is health care truly becoming patient-centered, or is “patient-centered” just a buzzword?

When it comes to the things that patients care about and that deeply affect their lives, health care often seems to be missing the mark, observes Alexandra Drane, president and co-founder of Eliza, a patient engagement firm.

Dr. Davis Liu wonders: Do patients even want to become empowered? “They simply want to have convenient and personalized care, whether in office, telephone, video or email,” he writes.

Other installments in the series address the current state of patient engagement and the role of health care executives in fostering patient engagement.

- For some serious reading, check out “Neglected to Death,” a series reported in the Miami Herald that uncovers violations and abuses in Florida’s assisted living facilities. Although it focuses on the worst of the worst rather than facilities that are well-run, it’s a cautionary reminder for families to do their research before choosing an assisted living home and to remain informed and vigilant about their loved one’s care.

- Several new entries have been posted in an ongoing series at the Cost of Care blog, exploring some of the difficulties patients encounter in trying to manage the cost of their health care. The entries were submitted last year as part of a national essay contest and include the story of a knee surgery patient who ran into a brick wall while trying to get an estimate of what the procedure would cost, a student who received an unexpected bill, and a man who was both uninsured and catastrophically ill.

- HUMS, or High Utilizers of Medical Services, aren’t always well understood. Indeed, they’re often blamed and criticized for abusing the health care system. The reality, however, is that there’s more to this subgroup of patients than meets the eye. They’re often mentally ill, addicted and/or homeless, and existing public health safety nets fail them all too frequently.

Dr. R. Jan Gurley, who writes about urban health, describes an effort in San Francisco to identify these individuals and the challenges of providing care that’s less costly and more effective. It’s daunting but it’s not an issue that cities can afford to ignore, she writes: “The big question is what we all, collectively, are going to do to address their suffering and premature death – and their inefficient and costly use of safety-net services.”

- Here’s an initiative I can get behind: The Society for Participatory Medicine has embarked on a glossary project to compile the many abbreviations and acronyms used in health care and help the consumer decode them.

An example from a typical medical chart:

CC: SOB

HPI: This is a 52-year-old black female with a long history of CAD and COPD who presents wit SOB of several days’ duration. She has had some DOE but no chest pain or diaphoresis. She has had an MI in the past with CABG in 1999 of 4 occluded vessels.

Although patients are often encouraged to obtain copies of their medical record, one can’t help wondering how much good this will do if they don’t understand the alphabet soup.

The SPM has created an online form (linked above) allowing people to submit abbreviations, acronyms and an explanation of each. The information will be compiled into a glossary that can be used by patients to help decipher and better understand the technicalese in their medical record.

If this is a project you can help with, check it out and consider adding your own entry or two. This is one of those cases in which the more entries, the better.

Photo: Wikimedia Commons

Linkworthy 3.1: Food for thought

There’s been a lot to think about in the health care news that has been dished up lately, starting with the story of CBS reporter Serene Branson, who unexpectedly stumbled over her words during a live broadcast at last weekend’s Grammy Awards ceremony.

Am I the only one who was bothered by the number of media outlets who seized on the footage and ran it over and over and over? Or the noisy chorus of speculation about what might have prompted Branson’s symptoms or the medical treatment she should have received?

As it turns out, Branson had a complex migraine with aura – not a stroke or even a seizure, as many of the armchair diagnosticians suggested. In an interview today on the “Early Show,” she said, “I was scared. I didn’t know what had gone on and I was embarrassed and fearful.”

Episodes like this can sometimes be a teachable moment… or are they? Gary Schwitzer, publisher of HealthNewsReview, blogged this week about having mixed emotions over how the NBC “Today Show” covered the incident. “Granted, Ms. Branson is a public figure whose performance was captured on video,” he wrote. “Does that mean she abdicates any right to privacy about what did or did not happen to her? Is such speculation vital for public discussion? Worthy of 5 minutes-plus of network television airtime? Or is this a matter of capitalizing on a person’s misfortune because you know the story is drawing lots of eyeballs?”

Good questions all, with further comments from readers.

Here’s an interesting piece of news via the Public Citizens Health Research Group, which recently got its hands on a transcript of a webinar held earlier this month for members of the American Society of Plastic Surgery and the American Society for Aesthetic Plastic Surgery. The issue: Surgeons apparently were advised to tone down their communication to patients about the risk of developing anaplastic lymphoma from breast implants.

This particular complication has only recently reached the attention of the public. Although the risk appears to be extremely small, a handful of published case reports indicates that some women have had to undergo chemotherapy and/or radiation, and some have had recurrence of their disease.

According to the transcript obtained by PCHRG, however, the surgeons who participated in the webinar were told to use the word “condition” in communicating with their patients, “rather than disturb them by saying this is a cancer, this is a malignancy.”

It can be a fine line between giving patients adequate information and scaring them with too much. But it’s a whole ‘nother story to deliberately manipulate the terminology in order to present patients with a watered-down version of the facts. I think this is a bad call; readers are welcome to disagree (or agree) in the comment section below.

Millions of Americans are taking statins to lower their cholesterol. This blockbuster class of drugs has been widely viewed as an important advance in the war on heart disease. But are statins really All That? Perhaps not. A very thought-provoking article appears in the most recent issue of Proto, a magazine published by Massachusetts General Hospital, that delves into the wisdom of what we think we know about statins.

Among the questions it examines: Do statins really save lives? Do they benefit women as well as men? Why have some of the clinical studies on the use of statins produced contradictory findings? This is an article that goes well beyond the superficial, displaying why so much about medicine fails to be cut and dried. If you’ve always wanted to know more about statins or about evidence-based care in general, it’s worth a read.

Awhile back I blogged about an essay contest featuring personal stories about patient and provider experiences with paying for health care. The sponsoring organization, Costs of Care, has posted a handful of new stories on its blog, and here they are: Getting an estimate, Cruel shoes, A medical student’s dilemma, A $1,000 coding error, and Not colon cancer. Recommended reading.

Patients are supposed to participate in their care, right? It sounds easy but all too often it isn’t – especially when the patient is sick. Jessie Gruman, president of the Center for Advancing Health and a current cancer patient, blogged this past week about the collision between ideals and reality in A Valentine to shared decision-making. During her first visit with her oncologist, she was still recovering from surgery and was “foggy with fatigue,” she writes. By week 3, she felt well enough to make decisions about which chemotherapy regimen to pursue. Week 5? “I have almost no recollection of this meeting,” she writes. “I feel so sick I can barely sit up.”

Why, she wonders, should we put so much energy into developing “this sweet moment of converging sanity, capacity and data?” Her conclusion: “Because we need a good model.” Go there to read the rest.

This edition of Linkworthy is concluding with a pair of anonymous blog entries, both written by health care professionals and both having to do with cancer: Tragedy of cancer in a small child and Today. How do you explain tragic outcomes? How do the professionals who care for patients make their peace with death when they’re forced to confront it over and over? “i don’t believe there are reasons for accidents and bad genes and screwed up dna, but i do believe there are reasons for faith,” the anonymous OncRn writes. “Especially today.”

Photo: Wikimedia Commons

Linkworthy 3.0

Killer dogs, the physical exam, kiddie meals – what’s not to like about today’s collection of linkworthy tidbits?

Here’s the top question for today: If you’re otherwise healthy, how often should you see your doctor? And how do you know if you’re really getting an adequate physical exam?

As it turns out, neither question has a clear answer. Dr. Lucy Hornstein, who blogs at Musings of a Dinosaur, writes about “The Myth of the ‘Complete’ Physical.” The definition of “complete,” she concludes, can be summed up in two words: “It depends.”

At Kevin MD, guest blogger Dr. Eric Van De Graaf tackles a similar issue: How often to see your doctor when you’re feeling well. My favorite quote: “I don’t know how other doctors do it, but I like to burden healthy-ish patients with as few doctor visits as possible, so I mostly try to set my return appointments for a year.” Thanks, Dr. Van De Graaf; your patients probably appreciate it.

Poor Martha Stewart. She was forced to visit the emergency room last week after Francesca, one of her French bulldogs, bolted into her face, causing her to badly split her lip. The experience, complete with photos, is described on The Martha Blog.

Lest you think this is all rather silly, consider a report that was published a couple of years ago in the Morbidity and Mortality Weekly Review of the U.S. Centers for Disease Control and Prevention. The researchers studied how often people had to visit the emergency room after tripping and falling over their household dog or cat. The number was startling: more than 86,000 a year. Most of these injuries weren’t serious but some victims did end up with broken bones. Does it mean we should all get rid of our companion animals so we can be safer at home? Certainly not, but it gives you pause (or should that be paws?).

Here’s a dismaying development from Tucson, Ariz., scene of last weekend’s tragic mass shooting: Three employees at University Medical Center in Tucson inappropriately snooped into the medical records of some of the shooting victims who were brought to the hospital. All three have been fired, as has a nurse who worked under private contract. For those who think HIPAA is needlessly burdensome, this is a reminder of why the law exists.

Kaiser Health News has been publishing an occasional “First Person” series. The latest installment starts out like this:

The clinic starts at 5 p.m. sharp with a team huddle in the conference room. A black plastic tray of stale bagel halves and crusted cantaloupe sits on the table, remnants of a breakfast meeting, but despite our medical-student hunger, we focus on the task at hand.

Ishani Ganguli, a student at Harvard Medical School, then proceeds to describe what it’s like for students to gain skills in hands-on primary care and why primary care is increasingly becoming an unattractive career option for many doctors in training. It’s a great read.

If you have kids, this last item for you: Yet another study has confirmed what many parents already know – adults tend to have a better diet when they don’t have to take children’s tastes into account. This shouldn’t be surprising. Many kids don’t like what’s supposed to be good for them, and parents often have to resort to chicken nuggets and mac ‘n’ cheese just so their child eats something. To be sure, there are probably other factors at work, such as how snacks and fast food are relentlessly marketed to the younger set. In any case, the blogosphere is having some fun with the reaction to this. I’ll let Cole Petrochko of MedPage Today have the final word here: “Kids eat junk.”

Linkworthy 2.4: The giftwrapped edition

Christmas shopping? Done, done, done. Decorating? Done. Clearing snow out of the driveway? Done (for now, anyway). Baking? Mostly done. Giftwrapping? Need to get on that today. Blogging? Oh, wait. Need to update the blog. So here goes: a condensed version of some of the more linkworthy/thought-provoking items I’ve encountered online recently.

- The health blogosphere has been buzzing in recent days about the story of a middle-aged nurse who underwent an angiography and ended up needing a heart transplant. The case report, which appeared last week in the Archives of Internal Medicine, is unusual for its frankness about the risks vs. the benefits of medical intervention, particularly when the benefits are questionable.

Here’s the case in a nutshell: A 52-year-old woman goes to the emergency room with vague chest pain. After evaluation, it’s determined that she’s unlikely to be having a heart attack, but her doctors decide to order an angiography anyway, just in case. The angiography comes back positive so the patient undergoes cardiac catheterization, accidentally has one of her coronary arteries torn by the procedure, needs bypass surgery, develops heart failure and ultimately requires a heart transplant.

To be sure, this is a rare situation – but I seriously doubt it’s much comfort to the patient or her family to experience a 1-in-a-million cascade of serious complications. The truly ironic part is that the angiography, which led to this medical disaster, was ordered mainly as reassurance and most likely wasn’t even necessary. Lessons from this cautionary tale are discussed in more detail here by Dr. Marya Zilberberg, who is a researcher, physician and blogger at Healthcare, etc., and here, by MinnPost health blogger Susan Perry.

- The cost of health care seems to be on several bloggers’ minds lately. After writing about this issue last week, I came across a couple more blog entries that address the same thing. In “$437 in 60 Seconds,” Bjoern Kils of MedPage Today laments the cost of going to the emergency room for a tetanus shot after a foot injury. Check out the discussion that follows. Although on the surface it’s about the cost of emergency-room care, at a deeper level it’s also about the thought process that needs to happen when patients are thinking about going to the emergency room.

One of the commenters, Dr. Paul Dorio, uses the online discussion as a springboard for his own blog entry: “Emergency? Or Can It Wait – Use Our Resources Wisely.” I’ll reiterate one of the points I tried to make last week: Health care professionals tend to assume the average person should know whether that trip to the emergency room is necessary, and this assumption is often incorrect. But I agree with Dr. Dorio’s message, especially when he says, “Perhaps we could all use better judgment in our decision-making and be more judicious in our use of our precious, shared health care resources.”

Here’s yet another take by Dr. Danielle Ofri, courtesy of the New York Times Well blog, about what can happen when patients insist on expensive testing and doctors feel forced to cave in. She titles it, appropriately, “Patient 1, Society 0.” There’s more food for thought from readers in the comment section.

- In case you missed it, the Minneapolis Star Tribune carried a story this past weekend about an initiative by the St. Paul School District to make all its public schools ”sweet-free zones” by the end of the school year. Good idea? Bad idea? On the one hand, changes in policy and environment can help lead to long-term change in people’s habits. On the other hand, banning sweets in school might ultimately have little effect if the rest of the environment – neighborhoods, the family dinner table and so on – doesn’t change too. Read the article and decide for yourself.

- Since this is supposed to be the season of good will, it’s timely that the Schwartz Center for Compassionate Healthcare has released the results of a national survey on “The State of Compassionate Healthcare in the U.S.” The findings suggest there has been a decline in the ability of providers to deliver compassionate care – but the survey also reinforces how important it is to patients to feel they are cared for.

- Finally, this story by Dr. Sid Schwab totally caught my attention when it first appeared four years ago. Dr. Schwab, a retired general surgeon, no longer actively blogs, but his “Winter’s Tale” about a late-night patient in the emergency room is a classic, both for its ER attitude and the surprise ending. Enjoy!

And there you go – all wrapped up and tied with a bow.

Linkworthy 2.3: Halloween edition

 A roundup of some tricks ‘n’ treats (mostly treats) encountered lately while browsing the Internet.

- Here’s a sweet opener: The New York Times has a conversation with the writer behind the Candy Professor blog and tries to answer the question: Is candy evil or just misunderstood? The opening paragraphs give you an idea of the extreme attitudes Americans can harbor about candy:

For Samira Kawash, a writer who lives in Brooklyn, the Jelly Bean Incident provided the spark.

Five years ago, her daughter, then 3, was invited to play at the home of a new friend. At snack time, having noted the presence of sugar (in the form of juice boxes and cookies) in the kitchen, Dr. Kawash, then a Rutgers professor, brought out a few jelly beans.

The mother froze. Her child had never tasted candy, she explained, but perhaps it would be all right just this once. Then the father weighed in from the other room, shouting that they might as well give the child crack cocaine.

Read the rest. It’s definitely a treat.

- Some treats are a little more complex and not particularly sweet: As the month-long pink ribbon campaign winds down, here’s a thoughtful, and thought-provoking, dual look at how we perceive breast cancer. From the New York Times (again) comes a review of two books. One, “Promise Me,” is the story behind the Susan G. Komen Foundation, arguably the most vocal and well-funded breast cancer advocacy group in the United States, if not the world. The other can be summed up by its title: “Pink Ribbon Blues.” It’s an exploration of the tyranny of positive thinking, the breast cancer marketplace and the scientific uncertainties surrounding screening and treatment for the disease.

The contrast turns on a dime, from inspirational to in-your-face. Dr. Abigail Zuger suggests that both points of view have validity: “The inspirational and the actual, the wish-it-were and the how-it-is; don’t read one without the other.”

- Here’s more food for thought: A nurse practitioner explains why she no longer believes in routine mammograms. I first encountered Veneta Masson’s essay a few weeks ago in the Health Affairs journal and wanted to blog about it. But I got busy and then other bloggers beat me to it. An excerpt from Masson’s essay was even published in the Washington Post, where it was tweeted extensively.

Masson writes, “I shock friends when I admit that I’m no longer a member of the mammogram club.” But far from being heretical, she’s reasoned and articulate – in short, an example of a woman who has weighed the evidence and made a choice. Whether you agree with her or not, this is a treat worth reading.

- Time for a trick, and this is an unsavory one: a compilation of 10 of the worst recent patient privacy violations. (You have to click through a whole bunch of super-annoying links to read about each one, so be patient.) I didn’t have to decide which of these was the worst because the Hospital Impact blog did it for me: health care workers who “shared photos of a dying, nearly decapitated patient in the ER on Facebook for all of their friends – and the world – to see.”

There is a tendency to blame technology for patient privacy breaches, but what about the person who’s using the technology? The real issue here, it seems, is employees who are clueless or unprofessional or immature or venal or all of the above, and can’t (or don’t want to) understand the meaning of patient privacy. I call that scary.

- Is the bad taste gone from your mouth? If so, let’s move on to a final treat. This moving story, about one of the lowliest of hospital employees and the power of human connection, comes from the Notes of an Anesthesioboist blog, written by an anonymous doctor who is an anesthesiologist, mother and ardent oboe player. Her blog was a finalist for the best literary medical blog of 2008. “The Cleaning Guy” was first posted several months ago but it’s a story that’s timeless. Most definitely a treat.

West Central Tribune file photo

Linkworthy 2.2: the weekend edition

If the weather forecast can be believed, it looks as if we have a perfect spring weekend ahead of us to spend outdoors. But in case you have some down time, here’s some worthwhile online reading:

Had enough yet of health care reform? I haven’t, so I found this to be an interesting commentary by Bob Doherty, who blogs about health care policy for the American College of Physicians. It appeared this week in the Annals of Internal Medicine and explores what we know – and what we don’t know – about the impact of health insurance reform. Doherty suggests "we should all take a deep breath" and try to look at the health reform bill more objectively. An excerpt:

Supporters and opponents alike must humbly recognize that no one knows how this complex legislation will play out. Some effects – like reducing the number of uninsured Americans – might be assessed with a higher degree of confidence than, say, longer-term estimates of the effects on the deficit and health-care costs.

For some online discussion and reaction to Doherty’s article, you can check out the comment thread on his blog.

How will the health reform bill affect the private insurance industry and, by extension, the industry’s customers? The Health Care Blog examines the myths and the facts. Maggie Mahar predicts there’s likely to be a shakeout in the insurance industry: "These new rules will make our health care system fairer and more affordable. But the rules also suggest that for-profit insurance may not be a viable business unless insurers learn far more about what is best for patients."

Challenges, challenges. Then again, this is nothing new in rural health care, which all too often gets overlooked when policymakers start carving out their turf. The Wisconsin State Journal of Madison recently launched an intriguing series of stories that explores the unique issues that characterize rural health. The first story addresses the doctor shortage; the second takes a look at the social and geographic factors that may be responsible for a growing gap in health status and outcomes between rural and urban/suburban residents.

The second story, "Life and Death in Park Falls," appears to have sparked some passionate debate among readers, and the comment thread is well worth reading for the extra dimension it brings to the discussion. Many people thought rural health providers didn’t get enough credit for what they do. Wrote one person, "Here in Park Falls I am not just a number, I am a neighbor. The article made it sound like we have no health care but actually we have a very good hospital and clinic and well-trained doctor and nurses."

How much of this is about being willing to make tradeoffs? "Anyone with a major health problem planning to retire in the northwoods should consider the lack of available quality health care before making that move," one person commented. But someone else countered, "Northwoods culture is not about being a hick (not to say we’re Vermont). It’s about enjoying the outdoors and a lifestyle that can only be found in our state’s natural, rural areas. I agree that rural health is a major issue, but those of us that live here are well aware of our choices."

Most of us have seen those lists of "top doctors" that get published from time to time. But are the top docs really all they’re cracked up to be – and are these rankings a good basis for choosing one’s own physician? Dr. Aidan Charles is skeptical, as he explains on his blog in "Beware the Top Docs":

It is only human to seek perceived leaders. But as sometimes seen in politics, those who have reached the pinnacles are often motivated by ambition, charisma and gamesmanship instead of altruism, sincerity and merit.

Dr. Charles also takes on the online rating sites and the insurance rankings based on quality measures.

What if the rest of life was managed like health care? Would we need preauthorization before ordering a meal at a restaurant? Would we unexpectedly get hit with a high deductible for car repairs? Dr. Rob Lamberts speculates on what it would be like in a pair of entries at his Musings of a Distractible Mind blog. The crazy world he describes is entertaining, absurd yet oh-so-close to reality.

Oh dear. Oh dear. Is it OK for doctors to Google their patients? Dr. Kevin Pho wonders on his blog about the ethics of doing this. As long as the information is publicly available, why should it matter? Patients can Google their doctors, after all. It might even be helpful in, say, the case of a psychiatric patient who’s posting threats online, or someone who arrives unconscious in the emergency room. There appear to be few guidelines that address this, Dr. Pho writes, but he suggests that ferreting out online information about a patient isn’t something physicians should routinely do. He himself has "never Googled a patient and can’t see any reason to in a primary care setting."

The lesson for patients, I guess, is to be careful about your online persona. If your physician can Google you, so can everyone else. Just thinking about it has made me decide to end this post right.now.

HealthBeat photo by Anne Polta

Linkworthy 2.1: In the first person

Sometimes the blogosphere is seen as a sea of dreck. But there are also some wonderful real-life stories to be found – worthwhile writing that illuminates a slice of the human experience and causes us to stop, read and reflect. Today’s edition of Linkworthy features a collection of recent personal stories and essays that fall into this category.

If you haven’t been following Dana Jennings’s blog series about his encounter with prostate cancer, this is a good time to get on board. His latest entry: "Living in the Post-Cancer Moment." He writes, "Post-cancer, more than ever, I am stung by the fact that I am here, that I am this I, this improbable soul." Entries in the rest of the series, which appears in the New York Times, can be found here.

From earthquake-stricken Haiti, via Boston hospital CEO Paul Levy’s blog, comes this story of "Bearing Witness to Haiti." It’s written by Jeff Swartz, CEO of Timberland, who flew on board a company plane to bring supplies and help. Here’s how he describes the aerial view as he arrives:

And in minutes, Port au Prince looms ahead, dense, destroyed, honestly not to be believed, from the air. A densely packed city, an up and down city of folded hills, and everywhere you can see… cataclysm.

… I can’t believe the physical destruction. Nor the swarm of humans walking. People walking in the streets – this is one of the overwhelming images of this voyage. Where are they going? What are they seeking? Walking, everywhere. Streets choked with dust and detritus and despair, and folks out walking. Whole blocks just leveled.

Levy shares another story as well, about a 7-week-old baby girl who was pulled alive from the rubble of her home.

What is it like to raise a child with special needs? John Elder Robison has Asperger’s syndrome, a form of autism, and is a writer and speaker on autism. He recently completed the foreword to a new book, a collection of essays by parents of special-needs children, and he has shared the foreword on his blog. An excerpt:

With all the names I was called growing up, it’s no surprise I saw myself as a misfit child. With that self-image, I naturally thought anyone like me must be a misfit, too. However, I know different now. Today I realize that the autistic condition is really the human condition. Our hopes, dreams and feelings are exactly the same as anyone else’s. We just don’t show our feelings in the conventional way, and we don’t respond to other people’s signals as expected.

If you’re interested in the book, the title is "Gravity Pulls You In: Perspectives on Parenting Children on the Autism Spectrum." It’ll be released soon.

My favorite three entries this week are each a variation on a theme: reacting to the death of a patient. Dr. Rob Lamberts muses about a special patient and why his death was inspiring rather than sad. He explains, "Sometimes it’s an honor to be their doctor. We don’t always stand against death, sometimes we get to stand with the dying."

The anonymous OncRN has her own special story to share, about missing a longtime patient who unexpectedly died. In a post titled "looking," she writes: "when it’s five o’clock on friday and you see the doctor you work with is calling your cell phone, your heart skips a beat. all you know for sure is he’s not calling to wish you a happy weekend. you know someone died or is dying but, him? oh please, don’t tell me that… not him."

Finally, here’s Dr. Aidan Charles with a graceful and contemplative essay about attending a patient’s funeral. The opening few sentences:

On the way to the funeral you wonder how you’ll be received by the grieving. Although you are confident that your care for the deceased was sincere, professional, and adept, you still question if others will so assume. There is silence in the car. This is a trip you make alone.

Go there and read the rest.

Photo: Wikimedia Commons

Linkworthy 2.0

Many people I know seem to have been spending the past couple of weeks in a state of semi-hibernation, emerging from their homes only long enough to go to work and run a few essential errands. These cold, snowy winter days can be a great time to do some reading, so here’s a roundup of various interesting/thought-provoking/informative items I’ve run across recently online.

- Most of us have probably heard of the term "herd immunity," but do we fully understand what it means – and the extent to which it can be compromised if we start skipping childhood immunizations? A story in USA Today explores the implications, using several tragic real-life examples, including two from Minnesota families. The article was sparked by a study, published this week in the Archives of Pediatrics and Adolescent Medicine, that found that unvaccinated children are significantly more likely to get sick with whooping cough or chickenpox.

An excerpt from the USA Today article:

Danielle Romaguera’s daughter, Gabrielle, was only 7 weeks old when she died from whooping cough – one week before she would have received her first shot.

Shannon Duffy Peterson of Minnesota says she realized the dangers of diseases such as chickenpox and pneumococcus only after her children became ill. She didn’t vaccinate her son or daughter against either disease after their pediatrician said the shots weren’t needed.

In 2001, both children were hospitalized because of a bacterial illness called invasive pneumococcal disease. Her 5-year-old son survived. Her daughter, Abigale, who was two weeks shy of turning 6, died.

The story is accompanied by an eye-catching chart that shows the change in the average annual number of deaths, before and after effective vaccines were introduced, on common childhood infectious diseases such as diphtheria, measles, rubella and whooping cough.

- Believe it or not, the growth of health care spending in the United States apparently slowed in 2008, at least according to figures newly released by the Centers for Medicare and Medicaid Services. The summary, which uses data collected by the National Health Expenditure Accounts:

U.S. health care spending growth decelerated in 2008, increasing 4.4 percent compared to 6.0 percent in 2007. Total health expenditures reached $2.3 trillion, which translates to $7,681 per person or 16.2 percent of the nation’s gross domestic product. The health spending share of GDP reached 16.2 percent, up from 15.9 percent in 2007.

You can read more highlights here, here and here.

- Should people with chronic illnesses have children? More to the point, how do individuals with chronic illness feel when other people presume to judge their childbearing choices? This question gets Laurie Edwards, who blogs at A Chronic Dose, all riled up. She writes:

I completely understand and respect women/couples who, given their particular life and health situations, decide pregnancy – and perhaps parenthood itself – is not for them. (I am focusing on this in relation to chronic illness; I realize these family-building decisions are incredibly complex absent chronic illness, too.)

But what bother me are the blanket generalizations that people with chronic illness shouldn’t have children because they will pass on their bad genes and/or because that child’s quality of life will not be what it could (should?) be if a parent is sick.

Read the whole post; it’s thoughtful and thought-provoking.

- Americans may be living longer, but the end often can be preceded by increasing debilitation, or what this entry from The New Old Age blog at the New York Times calls "the frail years." Many seniors and their families don’t take this into account, however, as they make health care decisions and plans for their future – and perhaps they should, suggests author Paula Span. She notes that more than two-thirds of Americans who are 65 years old will at some point need assistance to cope with daily living.

- The patient, a vigorous man in his early 60s, had pancreatic cancer, and it fell to Dr. Richard Frank, his new oncologist to break the bad news. In these situations, what do you say to the patient and his family? What is it like to tell a family something that will permanently alter their lives? In the latest issue of the Journal of Clinical Oncology, Dr. Frank reflects on this task, which he describes as "the hardest job in medicine." Read all the way to the end to discover how it turned out.

- Finally, stay tuned later this month for a local connection that’s scheduled to be featured on National Public Radio. Reporters from Minnesota Public Radio interviewed a Dawson-area family last week about music therapy in hospice care, and specifically about the Reverie Harp, which was introduced this past year by Rice Hospice. Rice Hospice staff were interviewed as well. The segment is supposed to air Jan. 26-28 for the "Music That Matters" segment at the end of NPR’s "Performance Today" program, at 12:45 p.m.