HealthyConcerns.com

Surviving the system, courtesy of the ACS

The American Cancer Society has a lobbying arm called the Cancer Action Network [Read about it here.] The ACS CAN recently launched a big initiative for cancer patients called "Surviving the System". They launched it with a Lobby Day which took place on the 20th.

The idea was to get regular people sharing their stories...and reachng out to their elected officials to ask for health care reform, for cancer patients and in general.

While cancer isn't the number one killer in America, it does claim over half a million lives a year. And getting cancer can be devastating to families for more reasons than just the fear and anxiety over our lvoed ones' health. According to a study released to coincide with ACS CAN's Lobby Day:

•  Nearly one in three people diagnosed with cancer under the age of 65 has been uninsured since their cancer diagnosis.  Scientific research shows that being uninsured can adversely impact your chance of survival.
• One in five families affected by cancer have used up all or most of their savings because of health care costs and more than 40 percent have had difficulty affording their health care costs in the last two years. 
• More than two-thirds of Americans under age 65 who tried to find insurance outside their employer couldn’t afford a plan. 

Our family just went through a cancer scare or two ourselves, but luckily we are all covered, well-covered. Imagining the stress of having no or insufficient coverage, on top of the stress cancer brings on its own...well, I wouldn't want to experience that. 

And once again, it begs a fundamental question: Insufficient or non-existent coverage can impact someone's chance of survival. Is it OK that people live or die in this country based not on whether what they have is treatable or curable or not, but rather on their income level or class or employment status? All of which seems highly volatile in this economy. And what if we're talking about children, who surely aren't responsible for their parent's socio-economic status? 

California is experiencing record unemployment, and I'm guessing a lot of people are losing their coverage. Or being forced to choose between paying exorbitant COBRA payments vs. paying for other necessities, like food, shelter etc.

Those people may be very employable, may have new jobs with coverage waiting around the corner. Is it OK that they have to hope that nothing catastrophic happens to them...whether one-time, like a car accident, or chronic, like a cancer diagnosis...while they're toughing out this economy like we all are?

I continue to think it's not. You can read more about the ACS's perspective and their efforts for health care reform on their site and their blog.

My S.O. will be so happy

My S.O. gets infuriated with people who go to the office when they're sick...including me. I am definitely of the ilk that I will go in unless I'm on death's door. He will stay home with a hangnail.

Turns out, at least according to the NY Times, that he may have the better approach.

As a resident, my greatest pride was in never having missed a day for illness. I’d drag myself in and sniffle and cough through the day. Once, I’m embarrassed to admit, I trudged up York Avenue to the hospital making use of my own personal motion sickness bag every few blocks while horrified pedestrians looked on.

Now, though, I see the foolishness of this bravura. And I confront it almost daily in my primary care practice. No one can miss a day — a minute, even — of work, carpooling, volunteering, vacation, anything. “I don’t have time to be sick!” my patients wail. Everyone must soldier on, leaving sick days to those with less important things to do.

Yes, I agree there is a certain sense of arrogance inherent in the idea that people cannot live without me coming into the office. I already work from home one day per week, why not more when I'm sick?

But I also think it's a kind of denial. Like "...if I can make it to the office and work a full day, then I must not really feel so bad..." and it's mostly ourselves we're trying to convince. Combine that with the underlying belief that how sick you are can actually be influenced by how you feel mentally, then it would seem like good medicine to convince yourself you're not so bad off, and go to work.

It all seems pretty flimsy when I write it out in black and white, but time for true confessions...how many of you think exactly that way?

So, apparently I've been doing it wrong: Vitamin D and sunlight

Ever since I found out I have a Vitamin D deficiency (like half the population), I've been trying to get a little more sunlight into my life, unblocked by sunscreen

This consisted mostly of me exposing my face and lower arms to the sun when I got a little chance to. (Not for extended periods of time mind you, I was shooting for 10 minutes.)

Well, apparently, my approach is all wrong. 

Thanks to this link from Jack Norris, RD, I got this very different advice about sun exposure from a Vitamin D expert, Dr. Michael Holick:

“I typically recommend people go out for a period of time—depending on the time of the year, the time of day, the latitude, and the degree of skin pigmentation—if you know you’re going to get a mild sunburn after 30 minutes, I typically recommend about 10, no more than 15, minutes of arms and legs exposure, or if you’re in a bathing suit, abdomen and back exposure as well, 2 to 3 times a week. Always wear sun protection on your face because that’s the most sun-damaged area and it’s only about 9% of your body surface, so it doesn’t provide you with that much vitamin D. Go out, enjoy yourself, get some sensible sun exposure, then put sunscreen on if you plan to stay out for a longer period of time. People with a higher degree skin pigmentation, such as African Americans, are walking around with an SPF of 8 to 15. That’s why they need to be exposed for much longer periods of time and why people of color are at especially high risk of having vitamin D deficiency.”

So yeah, "always wear sun protection on your face". D'oh.

I've been doing it wrong :(

Universal Health Care, examined

Joe Paduda from Managed Care Matters caught my eye with his Top 10 Reasons Universal Health Care is Bad. The thing is that he listed the ten reasons without commentary, although some were willing to go at it over whether these were valid or invalid reasons in his comments.

Friday he followed up with a post examinig Item #1 on his list: "Universal Healthcare Will Lead to Rationing".

I hope he follows up every single item from the Top 10 list in this fashion!

Here's some interesting data to get you hot and bothered to read the whole post:

Here's what a bit of specific data show (excerpted from the Commonwealth Fund report).

• The percentage of U.S. patients who waited six days or more for a doctor appointment when sick was not significantly different from the rate in Canada (23% v. 36%), the worst-performing country
• Only 47 percent of U.S. patients were able to see a doctor on the same or next day when sick, versus 61 percent to 81 percent of patients in the four better-performing nations
• U.S. patients were less likely than patients in Canada (12% v. 24%) but more likely than patients in Germany (4%) to wait four hours or more to be seen in the emergency department
• U.S. patients were less likely than patients in four countries (except Germany) to wait four weeks or longer to see a specialist (23% v. 40%–60%) or to wait four months or longer for elective surgery (8% v. 19%–41%) (Schoen et al. 2005)

Interview with Kevin MD

KevinMD is a long-time and extremely dedicated medblogger. He is one of the more reliable resources for quick links to news and current events in the medical space. I read him (and link to him) regularly.

The Pulse, a healthcare marketing blog, does a nice interview with Kevin here.

Of course Kevin points out what it takes to be a successful medbloggers:

D.J.: Why do you think that you have been so successful in attracting followers?
KevinMD: It’s persistence. When you start a blog you have to stick to a schedule and I post normally three times a day. When you have a readership that looks forward to that schedule, then it can certainly grow.  I have posted almost everyday. There are very few days that I don’t post unless I’m on vacation and what not.  So I think that posting regularly is very important.  I also have different mediums that people can access my blog through. I have the blog itself.  I have a link to my post served up on twitter, so that it exposes the blog to a different audience. People who don’t want to go to blog itself can read my posts through a RSS reader or they can subscribe by e-mail newsletter. Having a variety of means that people can access your writing is important, and the fact that they all go back to the blog - it kind of helps identify your brand within the Internet and that helps increase readership.

Wowsa. I guess we can see why I'm no Kevin MD. Posting 3x per day? Sigh. I'm lucky when I do 3x/month, and you all would probably fall over dead if I blogged 3x/week!

It's nice interview all the way around. he makes the point that there is no barrier to entry to blogging that anything to do with anything other than your time. It's easy, it's cheap, it's accessible. But it does take time. 

He closes with a plug for appreciating primary care more in the country, and I can buy that too.

Check it out.

The second-guessing continues on Richardson case

Terrible news this past week when actress Natasha Richardson died, subsequent to what seemed to be a minor fall while learning to ski.

Such cases always spur second-guessing, and as this post at Kevin MD illustrates, this case is no different. Some people are turning this into a political football, wondering if somehow the Canadian style of national health care system is what did Ms. Richardson in. When I read the actual timeline, it seems clear that this was a case of the accumulation of a bunch of questionable human decisions every step of the way. Throw in the lack of helicopter availability in the area where they were vacationing, and in a case where time is of the essence, they lost it over and over.

The single most questioned decision has got to be: Who turned away the ambulance that arrived 17 minutes after her fall, and why did those EMTs agree to leave without even seeing the patient? The two hours lost right from the beginning is likely be all the delay required to make her situation unsalvageable.

And yet, how many of us would do the same if we felt fine, could walk, talk, etc? Well, maybe not anymore. But just in the comments and links in this BlogHer post, plenty of women share their stories of being bonked on the head and not immediately jumping to get checked out. 

We can only hope that this tragic death convinces people that a head injury is nothing to ignore or "wait and see" about...hit on head? Get thee to an emergency room...stat!

Vote: Good idea/bad idea?

I gotta ask: Will this teddy bear-shaped blood bag designed for use in pediatric wards make kids feel all comforted and cozy?

Or scare the living daylights out of them, giving them nightmares about bloodthirsty teddy bears coming to life and wanting to swallow all their blood?

I'm just asking. Is that so wrong?

Hat tip: Kevin MD.

What do you think of Sanjay Gupta as Surgeon General?

Well, to answer that question, perhaps first you need to know what the Surgeon General actually does. So, for that, you might want to go read the interview Dr. Val does with the 17th Surgeon General of the US, Richard Carmona. 

Now, Dr. Val is clearly not too hep to the idea of Gupta as SG.

But not everyone is so automatically opposed. You can find people on both sides of the argument in the comment thread on this Kevin MD post.

And Robert Laszewski over at Health Care Policy and Marketplace Review actually claims Sanjay Gupta could be a great pick for Surgeon General.

But then there's recent Nobelist and current NY Times columnist Paul Krugman telling us the trouble with Sanjay Gupta.

Not to mention the Daily Green seeming to have strong feelings about it, as evidenced by the post The 6 Most Idiotic Positions of Dr. Sanjay Gupta. Gee, tell us how you really feel.

I really can't say I know what to think. I can't say I think much about the Surgeon General. The only two I can name are C. Everett Koop and Jocelyn Elders. And I can't understand exactly why Obama would expend a controversial selection on such a low-profile role?

All very odd. Your thoughts?

If you're a nurse, you are in demand...for now

One of my favorite jokes goes as follows:

A man dies and much to his surprise he is met by both the devil and God. They tell him he gets to visit both heaven and hell as a tourist and then choose where he belongs. Well, this was quite surprising to him, but pretty exciting. I mean who knew, right?

So he decides to go with a bad new first approach and visits Hell. Again, much to his surprise, Hell seems mostly to be about wine,women and song. Or maybe like Vegas, but whatever the analogy, it was actually a lot of fun.

Then he visits Heaven. Lots of people dressed in white robes sitting around, maybe playing a little harp, but otherwise...a bit of a snooze.

So, when the man returns to the waiting devil and God, it seems like a no-brainer and he chooses Hell.

The devil claps him on the back saying "I knew you were a smart man", and with a snap of his cloven hoof they are back in Hell. Only this time it was quite different...this time there was all the fire and brimstone you might expect...agony, abject fear, the works.

The guy recoils in horror and says, "Hey what is all this? This isn't at all what it was like yesterday!!"

And the devil said, "Yes, but yesterday you were a prospect. Today you are a customer."

This joke ran through my mind when reading this article about the nursing shortage and the desperate measures some organizations are taking to recruit nurses.

Of course at least one blogger thinks fancy recruiting strategies are pretty useless, if ongoing working conditions suck. Retention is the ultimate recruitment, in other words. Makes sense to me. 

I'm hiring for a key position at my company right now, and I've been struck by how all the second round candidates have told me about how impressed they've been to meet the other members of our team during that second round (they met only me for a first round) and see their passion and commitment. Meeting our team was, I believe, a big plus and will help me in my recruitment.

I wonder if these institutions are able to use their current staff as recruitment tools? If not, it's no wonder they're in trouble.

Hat tip: Kevin MD.

Healthy Concerns still somewhat unusual

Or at least, I think it must be, because how else can I explain being honored with inclusion in this 100 Best Health Care Policy Blogs list from the Radiology Technician Schools site?

It used to be unusual that I was a layperson blogging about health at all. But now there are lots of "PatientBloggers".  However, most of them blog about a particular condition from which they suffer...whether chronic or acute.

I blog randomly about my random thoughts about health care, coverage, politics etc.

And in that, I think, I am still unusual :)

Thanks RT folks!