Category: Healthcare Management

Don’t Wake Me Up Again!!!

Check this out. What you will see is not a happy story. It is the tale of an ICU nurse who after decades of fighting the good fight for her patients, just finally had to quit.

The interesting part of the story here is the part of ICU nursing that finally did her in. Sure, critical care carries with it more than its share of heartbreak and death. Comes with the territory.

That’s not what got her. The last straw was working hard to maintain an 86 year-old patient during her last days. Suffering unnecessarily. Because her family couldn’t let her go.

Bottom Line. Interesting juxtaposition. So much of what we see on TV news these days is about “exclusive access to one of the nation’s busiest ICU’s.” Patients on respirators, clinging to life after being cut down prematurely and summarily by the deadly coronavirus. Wham, Bam.  

But here we see a different kind of stressor on ICU personnel. The all too frequently encountered life that has been forced, yes forced, to go on too long. Interesting that is not the pandemic, but the far more routine end of life drama, that did this ICU veteran in!

Practicing Culturally Competent Medicine

In our last post, we talked about two key factors involved in working toward the elimination of racial disparity in healthcare. 

1. Getting an understanding of basic medical differences that characterize minority patients in important ways that need to be taken into consideration in treating them. 

2. Developing efficient systems for delivery of healthcare to underserved minorities.  

Done deal? Nope. Today we need to add another consideration into the mix. “Cultural Competency.” An understanding of social and cultural factors that need to be taken into consideration in working with minority patients. Differences in their social structures. In their values. In their beliefs. 

Check this out. What you will see is a plan for incorporating cultural competency training into medical education. An increasingly prevalent and important trend in medical schools in the U.S.

Bottom Line. SO. We now have three important factors to take into consideration in working toward eliminating racial disparity in healthcare. Understanding, delivery and now cultural competency. Lots of important things to keep in mind. And worth it!!!

Eliminating Racial Disparity in Healthcare

As a member of the Board of Directors of Volunteers in Medicine on Hilton Head Island, I spend a lot of time thinking about how to reduce racial disparity in healthcare. In many ways, it is what VIM is all about. Using volunteer healthcare providers, we are an extremely cost-effective way to get more care to underserved minority populations. All good. Efficient delivery. 

BUT. There is another whole factor in reducing racial healthcare disparity. For lack of a better term, let’s call it “understanding.” Check this out. What you will see is an entire CME program aimed at reducing racial disparity in healthcare by improving practitioner understanding of fundamental differences in the physiology of African American patients vs. their white counterparts. Lots of differences. Fundamental differences. Differences that matter in terms of how these patients should be optimally treated.  

Bottom Line. And a lightbulb goes on. Eliminating racial disparity in healthcare requires a one-two punch. First, understanding. Developing an awareness of metabolic and other differences between white patients and black and brown patients that require differences in therapeutic approach. Second, delivery. Organizing a clinical approach that cost effectively delivers the targeted care to the underserved.  

Understanding. Delivery. Put those two elements together and you can make an important dent in racial disparity in healthcare.  

Let’s do it!

Restraints In The ER

No need for you to pay for access to the full article in the journal to which I am referring you. The synopsis you get for free is all I want you to think about today.  

Check this out. What you will see, even in this synopsis, is thought provoking. We are told that patient “agitation” in the ER is:

-A growing problem

-Typically dealt with by applying restraints and/or hoods, and the use of sedatives

-Likely to cause physical and/or psychological damage to the patient, not as a result of the agitation itself but as an outcome of the restraints employed. 

I am sure that this has always been a problem, but in the post George Floyd era, it is clearly, and appropriately, getting increased attention. 

Bottom Line. But what to do? Very appropriately, the authors call for the use of “evidence-based algorithms” to decide which coercive measures to employ in a particular set of circumstances.    

Nice words in an academic journal, but difficult to implement when in the middle of the night, you are confronted with a large, drug overdosed and flailing patient who is spitting at the healthcare providers while claiming he has COVID.

I am thinking that excellent practical training, closely supervised experience and a large dollop of common sense are what is needed to deal with this increasingly important issue.

Then again, doesn’t everything sort of work that way?

Women Are Better Hospital CEO’s!!!

That is a bit too general a statement, so I need to go back and qualify it. There are all kinds of measures of hospital CEO quality. Things like the profitability of the institution, for example, or relative freedom from adverse litigation. That’s not what we are talking about here. 

Check this out.  What you will see is a study demonstrating that women hospital CEO’s improve the “interpersonal care experience” in their institutions faster than do men, especially in the most “complex executive job environments,” like hospitals that are large, in very urban environments, or both.  

Bottom Line. That finding got me to wondering. Why is this the case? By way of response, the researchers argue that this is a demonstration that CEO’s “personal values” wind up being reflected in the institutional setting, and that women are more prone to value “patient centeredness” than men.  

This all reminds me of a blog I posted several months ago, in which I directed you to a physician’s blog that offered 12 reasons why female doctors are better doctors than are their male counterparts. So. All of this leads inexorably to a hopelessly sexist and sarcastic question: What are men doing in medicine anyway?  

Mitigating Covid-19 Also Mitigates Flu

Check this out. What you will see is an article with a simple message. That is, worldwide efforts to mitigate the spread of COVID-19 have also significantly reduced the incidence of influenza.  

DUH! Of course they have. But there is a bigger point here, though an equally simple one. It is…

Bottom Line. Issues of Public Health are often handled on a bug-by-bug basis. This is clearly far from optimal. What if a more holistic perspective were adopted? Consider what could happen if everything that had to do with Public Health, from mitigation to information dissemination, were handled systematically and prospectively. Worldwide.  

I think things would have turned out very differently than the havoc we have seen over the course of the last 6 months! 

Will An “Alcohol Curfew” Slow The Covid Virus???

Nah!!! Check this out. What you will see is the announcement by the Governor of North Carolina instituting an “alcohol sales curfew” in his State.  AND. We have the same stupid law in South Carolina.

In my prior post, I commented on our Country’s failure to follow the principles of Health Psychology in dealing with the pandemic. You know, little things like disseminating communications that make sense. BUT. Here we see the Governor ordering bars in his state not to sell liquor between 11 p.m. and 7 a.m. every night. 

I live on Hilton Head Island, where people come to vacation and party. Take a ride with me past the “Triangle,” a grouping of restaurants and bars on an eponymously-shaped piece of land. What you will see is Super Bowl Sunday-sized crowds every night, rubbing shoulders at each of the packed bars with not a mask in sight.  

Bottom Line. Aw c’mon! Could somebody please explain to me how bringing the curtain down on this show at 11:00 p.m contributes significantly to safety? 

My guess? I bet it just gets people to start drinking earlier and harder. What a perfect way to wrestle a pandemic to the ground! 

The Death Of Primary Care

We have talked before about the financial difficulties that PCP’s are having as the result of the COVID-19 pandemic. As reported in our previous posts, it is a simple fact that patients are staying away from PCP’s offices as a special form of social distancing, i.e., not wanting to go to places where they might encounter sick people and get infected. And due to the impact of PPE shortage and other factors, many doctors’ offices have been closed to personal office visits.  

But check this out. What you will see are survey results indicating that many PCP’s are not ready for a second surge (Are we done the first one???) of COVID Infections. And the lack of preparedness has many faces. A recognizable one is lack of Personal Protective Equipment (PPE). It isn’t just ICU’s that need masks and gowns, and they remain in short supply. Psychological preparedness is also weakening. Doctors are just getting tired of trying to plan for a future where so many things are unknown. And finally, there is the lack of financial preparedness. Fewer than 50% of practices report that they have enough “cash on hand” to remain open.  

Bottom Line. While the daily death toll from the pandemic is horrible enough, here is the big question for the day. What happens if a significant percentage of Primary Care Practices close, as this article predicts “in weeks not months” due to the lack of financial support? And by year end?  

There is little doubt that the face of U.S. healthcare will be changed substantially by the pandemic. Those of us in the pharmaceutical vertical had better start thinking about what that “new normal” will look like, and how we too will have to adapt!  

72% Of Survey Respondents Have Altered Their Utilization Of Healthcare

Check this out. What you will see is a phenomenon that is playing havoc with physician incomes and even the ongoing viability of some practices. That is, patients continue to demonstrate a significant desire to be tested for COVID-19, this despite the fact that testing negative doesn’t mean that you don’t have or won’t contract the virus, and that testing positive doesn’t get the patients any treatment because there isn’t one. HOWEVER. Patients are postponing any other elective medical treatment in order to stay out of physicians’ offices where they fear they might become infected.  

In another related survey, nearly half of independent physician group practices reported that they have had to lay off or furlough staff, and hospitals are also suffering major revenue shortfalls.  

Interestingly, 90% of patients report that they have no trepidations about going to a pharmacy to pick up a prescription, with only 9% using home delivery. This despite the fact that many pharmacies are now testing for COVID-19, so that potentially infected patients are crossing their thresholds. Interestingly, most patients report a willingness to be tested for the corona virus themselves in a pharmacy setting.

Bottom Line. Think about the psychology of this for a moment. Unless I have just totally missed something, I have neither seen nor heard any communications programs, from any source, aimed at getting patients to feel better about accessing routine medical care. Wouldn’t you think that medical systems and/or pharmaceutical companies and/or somebody would find it worthwhile to mount such a campaign? 

In the absence of such outreach, all patients are exposed to via nightly news are horrible images of videos shot “inside one of the busiest ICU’s in the country,” chockablock full of comatose COVID19 patients on ventilators. 

So, here’s a question. How long is it going to take for patients to feel safe going to a doctor’s office again? I am thinking Elton John had it right when he sang “I THINK IT’S GONNA BE A LONG, LONG TIME! “

Lessons From The Pandemic

Check this out. What you will see are the musings of a physician as the pandemic continues to unfold. You will see how COVID-19 has actually increased the focus of a doctor who used to wander, procrastinate. Not anymore!

Bottom Line. But the real point of this piece is a question. Post pandemic, will medicine attempt to return to the old normal? A multiply flawed system where doctors have lost control? Or will it learn lessons from this time and actually come back stronger and better than ever?

We shall see!