Monthly Archives: October 2013

Surgeon’s Death Spurs Painful Debate On Docs As ‘Face Of Health Care System’

Flowers are left outside the Brigham in honor of the slain Dr. Michael Davidson. (Robin Lubbock/WBUR)

Flowers are left outside the Brigham last week in honor of the slain Dr. Michael Davidson. (Robin Lubbock/WBUR)

Shocked and saddened by last week’s shooting at Brigham and Women’s Hospital, Dr. Miranda Fielding wrote a blog post that appeared on KevinMD, a popular site that gets 5 million clicks a month: “The Legacy of Dr. Michael Davidson.”

KevinMD, as founder Dr. Kevin Pho puts it, aims “to share the stories of the many who intersect with our health care system, but are rarely heard from,” including practicing physicians. He adds: “The public often doesn’t know what it’s like to work in our health system. KevinMD.com gives them an unfiltered view of our world.”

Dr. Michael Davidson (Courtesy of Brigham and Women’s Hospital)

Dr. Michael Davidson (Courtesy of Brigham and Women’s Hospital)

In the case of Dr. Fielding’s post, that unfiltered view reveals not only deep pain at a distinguished colleague’s death but also a far broader discomfort with serving, as one commenter puts it, as “the face of the health care system” — a system that sometimes harms patients, medically or financially.

In her post, Miranda Fielding — the pen name of a California-based radiation oncologist who blogs at The Crab Diaries — recalls from her own professional past a gentle colleague who was viciously beaten by a former patient, and writes:

When we graduate from medical school, we take the Hippocratic Oath, which in the modern version not only exhorts us to heal the sick, but to exhibit warmth, sympathy, and understanding. Let our patients and their families extend those same traits to us as we complete our daily rounds. Let our clinics and hospitals be places of healing, and not of killing. Please let us do our jobs.

I only wish that I had the answers to the groundswell of anger, frustration and resentment voiced in the comments on my blog.
– Dr. Miranda Fielding

Her post has been shared on Facebook more than 40,000 times, and sparked more than 150 comments. The post, Dr. Pho emailed, “clearly touched a nerve with my audience and highlights the sacrifice that health professionals make every day.”

But the response to the post highlights more systemic issues as well. Among the comments, the most popular, by a writer identified only as “guest,” refers in part to the report that the alleged Brigham shooter had complained in the past about a medical bill for the heart attack that killed his father:

What we as a profession appear to be (willfully) unaware of is that we doctors are the face of the healthcare system. To the extent that we do not speak up, protest and advocate for our patients when they are taken advantage of by hospitals and insurers, we provide a face for patients to blame. Anyone who doesn’t think that corporate executives and hospital administrators take full advantage of the opportunity to hide behind us as they maximize profits at the expense of our patients, is a fool.

We may think that because we go through our days bathed in an aura of self-righteous goodness (Look how we’re the smartest person in the room! How hard we work! How little sleep we get! How many of our child’s soccer games we’ve missed in order to care for our patients! How we do all this without even mentioning it to our patients, because that’s how good we are!), that that is how our patients see us as well.

But they don’t. They see the fancy cars in the parking lot, the children going to elite prep schools, the expensive hobbies like equestrianism, the hospital system charging $8,000 for a 15 minute emergency room visit that ended in death, the collection agency coming after a grieving family. And they blame us for not doing more.

Responded another commenter:

This is a horrible tragedy for all involved — him, his family, friends, colleagues and his other patients. And for other docs out there who are now more afraid. My heart aches for the victim of this violence and for all of us.

But you’re right. This did not happen in a vacuum. Continue reading

How 3D-Printing Helped A Little Girl With A Rare Facial Defect

Check out this excellent story about a little girl named Violet born with a rare defect, a Tessier facial cleft, that left a fissure in her skull, and how 3D-printing is helping doctors take on these kinds of complicated surgeries. The piece is in today’s The New York Times and written by health reporter and CommonHealth contributor Karen Weintraub, who offers a little background:

Violet Pietrok was born nearly two years ago without a nose. Her eyes were set so far apart that her mom compared her vision to a bird of prey’s. There was a gap in the skull behind her forehead.

There was no question she would need drastic surgery to lead a normal life. But few surgeons have seen patients with problems as complex as Violet’s. Her parents, Alicia Taylor and Matt Pietrok, who live near Salem, Oregon, brought her to Boston Children’s Hospital, to Dr. John Meara, who had operated before on kids with Tessier facial clefts.

As part of Children’s Pediatric Simulator Program, Meara was able to get several 3D printed models made of Violet’s skull. By handling and slicing up the models, he got a better sense of what had gone wrong and how best to fix it.

Such 3D-printing is becoming more commonplace in complex surgeries, allowing doctors views and knowledge they can’t get on their screens.

Continue reading

Frostbite, Hypothermia And Other Fun Facts To Remember On Blizzard Day

It’s going to be a long, long day. If you’re like us, you’ve already cooked some kind of elaborate breakfast, chosen the morning movie lineup, and set up the “Let’s Dance” Wii. And it’s not even 8 a.m.

When you’re ready to venture outside and “play,” remember it’s freezing, with ferocious winds. No doubt you’re familiar with this kind of extreme weather, but there are a few health tips worth repeating. Here’s the Boston Public Health Commission with a cute video reminder:

Listen: How Health Care Facilities Are Preparing For The Blizzard

Most of us will be hunkered down at home over the next 24 hours, as a blizzard bears down on the state. But police, firefighters, hospital staff and workers at hundreds of nursing homes will be working. Listen above to a report from WBUR’s Martha Bebinger about how hospitals and senior care facilities are preparing to ride out the storm.

Related:

5 Reasons You Should Worry Way More About Flu Than Ebola

(CDC)

(CDC)

By Veronica Thomas
Guest Contributor

A deadly virus is sweeping America, putting nearly 10,000 people in the hospital so far. No, it’s not Ebola. We’re talking about the common seasonal flu that shows up every fall and lingers on until spring.

Every year, 5 to 20 percent of Americans get the flu and, depending on the strain, anywhere from 4,000 to 49,000 people die from the virus or its complications, like pneumonia. And this season’s flu virus is shaping up to be pretty nasty — so nasty that the CDC declared a national flu epidemic at the end of December.

As a graduate student at the Harvard School of Public Health, I’m baffled by this: A couple months ago, I couldn’t step on a subway car or flip through Facebook without being bombarded by panicked comments about Ebola spreading to the U.S. But when it comes to the real and immediate threat of the flu: radio silence.

“Ebola is exotic. It has a very high mortality rate that people are very much aware of. It seems like you can be exposed to it without your control,” says Dr. Alfred DeMaria, medical director for the Bureau of Infectious Disease at the Massachusetts Department of Public Health. “All of those [factors] contribute to a higher perception of risk than the flu.”

In reality, far, far more people die from flu-related complications than from Ebola, but it’s a very small proportion of the millions who get sick each year. That’s one reason we should be more concerned about the flu than Ebola, Dr. DeMaria says. Here’s why else:

1) The flu is next door, not across the Atlantic.

Ebola has tragically claimed over 8,600 lives in West Africa, largely because many countries don’t have the capacity to contain the outbreak or treat infected patients. And though the news cycles have moved on, Ebola hasn’t. As the virus continues to spread, Ebola remains a real threat for some West African countries.

But for ordinary Americans: “The risk of getting Ebola is somewhere in the order of magnitude of getting personally hit by a meteorite,” Dr. DeMaria says. Just four people have been treated for Ebola in the U.S., and only one has died. No new cases have been reported since October. Continue reading

AG Healey Weighs In Against Partners Acquisition Of South Shore Hospital

Attorney General Maura Healey, at WBUR (Robin Lubbock/WBUR)

Attorney General Maura Healey, at WBUR (Robin Lubbock/WBUR)

Updated 7:15 p.m.

BOSTON — On her first Monday morning as Massachusetts attorney general, Maura Healey stepped into a fight that may well continue through her first term. Healey said, in short, that Partners HealthCare should not be allowed to acquire South Shore Hospital and that she would sue to block the acquisition.

Her predecessor, Martha Coakley, had the option of suing Partners, but chose instead to negotiate concessions. In a deal filed in court by Coakley, Partners would be able to add at least three more hospitals — South Shore and two owned by Hallmark Health — but would have to keep price increases in line with inflation for six and half years and cap the size of its physician group for five years.

Healey raised several concerns about the agreement in a brief filed in court Monday. She suggests that the physician cap is too lax and that the terms of the deal are too short. When the deal expires, “Partners may wield market leverage that is greater than its current, already significant market leverage,” Healey said.

Healey said she wants proof that Partners has figured out how to use its size to save money.

Continue reading

Hundreds Mourn Surgeon Fatally Shot At Boston’s Brigham And Women’s Hospital

A woman wears a button honoring Michael Davidson at his funeral service Friday. (Jesse Costa/WBUR)

A woman wears a button honoring Michael Davidson at his funeral service Friday. (Jesse Costa/WBUR)

The cardiac surgeon killed inside Brigham and Women’s Hospital in Boston this week was laid to rest on Friday.

More than a thousand people gathered at Temple Beth Elohim in Wellesley Friday to pay their respects to Dr. Michael Davidson, who was fatally shot by a patient’s son on Tuesday.

Some wore buttons with Davidson’s initials, MJD, in a heart. Six buses brought people from Brigham and Women’s, and when Rabbi Joel Sisenwine asked all the doctors and caregivers to rise, at least half the room stood.

Several colleagues and friends of Davidson’s spoke, as did Davidson’s father, Robert, a well-known cardiologist at Cedars-Sinai Medical Center in Los Angeles. He spoke of the hopeful flight he and his wife took to Boston Tuesday after they received news that their son had been shot — hopeful because Davidson’s parents thought when they boarded the plane that he would live.

Continue reading

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How Are We Today? Study Lets Patients Help Write Medical Notes, Google Doc Style

(Life Mental Health/Flickr via Compfight)

(Life Mental Health/Flickr via Compfight)

First, beginning about five years ago, came the OpenNotes study. Researchers found that when they gave patients access to their primary care doctors’ written notes, the patients said they got better at taking care of themselves, particularly at taking medications correctly. And contrary to some doctors’ fears, the notes did not tend to cause offense or avalanches of questions.

“OpenNotes” caught on; Some 5 million patients’ records around the country now use it.

Then came the next bold move: The researchers, centered at Beth Israel Deaconess Medical Center, launched a pilot program to open some psychiatric notes to selected patients. (The journal headline: Let’s Show Patients Their Mental Health Records. Our headline: What Your Shrink Thinks.)

And now, the open records movement is moving beyond transparent, to interactive. That is, what if you could not just see your doctor’s medical notes but actually comment on them and contribute to them? As you do, say, when you collaborate online with colleagues on a project in Google Docs?

That’s the next step, says Jan Walker, co-director of the “OpenNotes” project and a researcher at Beth Israel Deaconess and Harvard Medical School. With a new $450,000 grant from The Commonwealth Fund, researchers plan to develop and test “OurNotes,” an interface that will invite patients to contribute to their own medical notes.

Our conversation, edited:

Given the self-obsessive behavior of some people I know who use Fitbits and other health trackers, I think if I were a doctor I’d fear a huge deluge of data into my patients’ health records: “I took 6,000 steps and slept 6:27 hours…” How do you address that?

Jan Walker: One of the frontiers here is making decisions about what data is really paid attention to. As we invite patients to contribute to their records, as we invite patients to upload data from home devices into their records, there are going to be many new inputs of data into the medical records, from technologies that probably don’t even exist yet.

For clinicians, this can look like such a flood of data coming toward them that it’s impossible to pay attention to, to distill it and act on it, and be responsible for understanding everything that’s coming in. So one of the interesting parts of this research is figuring out how to highlight important things for clinicians, and let the rest just be stored.

We will face some of that with this project; perhaps we will be able to have patients flag things they think are important for doctors to see right away, versus just things that are reminders to themselves or things they want to have in the documents.

So will it be kind of like editing with someone on a Google doc, where you can see who did what?

We don’t know yet but we’re thinking about things exactly like that.

What are some examples of uses you imagine?

OpenNotes co-director Jan Walker (courtesy)

OpenNotes co-director Jan Walker (courtesy)

If you’re a patient, you might have gone to the doctor with an infection and been given antibiotics. So you might write down in this record when your symptoms abated or how you did with the antibiotics.

Similarly, you might read in your notes that the doctor reminded you to exercise, and you might keep track of your exercise regime to discuss that with your doctor at the next visit.

Or, in between visits, you may think of things that you want to talk to your doctor about on the next visit, and you would, in essence, set an agenda for yourself so that when you get to that visit, everything gets covered.

And the doctor could look at your agenda beforehand and be more informed, instead of looking things up on the fly?

Exactly. If you can set an agenda before you get to the visit, it gives the doctor a chance to prepare.

Another possibility would be to work with the clinician actually during the visit to write this note. Perhaps the clinician starts the note while you are still sitting there in the office, and you look at what’s being written, you comment, you add, and so it becomes almost a co-authored note.

Yet another use of this interactive feature would be to raise questions about things you think might possibly be in error. Continue reading

Laughing Gas For Labor Pain May Be Regaining Popularity In U.S.

ABC News reports a resurgence in the use of laughing gas for labor pain. (Not to toot our own horn, but we reported this back in 2010 here at CommonHealth and did a podcast on it in 2013.)

ABC suggests the practice may be gaining popularity since 2011, when “the U.S. Food and Drug Administration approved new nitrous oxide equipment for delivery room use.”

Quoting Dr. William Camann, director of obstetric anesthetics at Brigham and Women’s Hospital in Boston, the ABC piece continues:

labor pain

“Maybe 10 years ago, less than five or 10 hospitals used it [for women in labor],” Camann…told ABC News. “Now, probably several hundred. It’s really exploded. Many more hospitals are expressing interest.”

He added the gas popular in dentists’ offices has an “extraordinary safety record” in delivery rooms outside the U.S. But more studies are needed to confirm its safety, other doctors say. Continue reading

Trouble With State Health Connector’s Call Centers Frustrates Insurance Seekers

Update at 9:17 p.m.: Gov. Charlie Baker has extended the deadline for signing up for coverage:

Original post:

Frustration with the state’s Health Connector is mounting.

Today (Friday) is the deadline for coverage that begins Feb. 1, but an untold number of residents say they’ve hit roadblocks while trying to enroll and pay for a plan. The problem at this stage is not so much the new website — it’s the call centers. Continue reading

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