Hi again -
This one is for a little bit of fun again. I do love watching my medical shows. This week they fared much better.
I watched two different shows - Mercy and Three Rivers. I do love both of them.
I only found one mistake between the two of them this past week.
On Mercy, they were very busy saving a young Asian man who had an injury and became septic. When his heart stopped, the team was doing everything they could to save him - which they eventually did. They were doing CPR, ordering and giving all the correct medications - and then .............. placed a pacemaker - which was a last ditch effort to save him. Well, they placed the pacemaker, captured the rhythm and voiced all of these actions out loud. Too bad when they showed the monitor, it didn't show a paced rhythm like they said. Oh well - good job anyway.
On the other side, no errors this week at all on Three Rivers that I saw. But I do need and want to say one thing. Can any one say EMMY for Mandy Patinkin? Wow - he was amazing - although I guess he usually is. He played an ALS guy who was in an automobile accident. Post recovery, he found out he was going to have to be bed bound on a ventilator. He decided to make himself a DNR and remove himself from life support so he could donate his organs to other people and die a respectable death. He had it all down - even the voice and the movements. I must say I cried multiple times due to interactions with his daughter, the staff and the other patients vying for his organs. This show had a lot of ethical issues that were addressed and they handled them all well as far as I could tell.
Anyway - off this thing for today. I hope everyone is having or will have a Safe, Great and Happy Thanksgiving. I hope everyone is either spending their week with family or friends - or in our case, treating the ill and spending the day with co-workers. Keep the less fortunate in your thoughts.
Thursday, November 26, 2009
New Study shows Uninsured Trauma Patients 80% More Likely to Die than Insured
Hi there everyone -
As I walked into work the other day, I was surprised to find an article posted on the board with the above headline. Wow - Uninsured Trauma Patients 80% more likely to die than the Insured.
The study was conducted by Harvard University and Brigham and Women's Hospital in Boston and the information was extrapolated from the National Trauma Data Bank. They looked at 2.7 million patients from 900 different trauma centers across the US.
This surprised many trauma hospitals, physicians and staff because of the EMTALA laws. These laws are supposed to protect patients without insurance. Anyone presenting to an emergency room is supposed to be treated equally without regard to insurance coverage.
The study seems to conclude otherwise. Patients with private insurance, HMOs and Medicaid all seems to fair equally. Medicare patients died 56% more often and the Uninsured patients died 80% more often.
The researchers thought that the Medicare population was adversely affected by their chronic medical conditions and age. So, they next decided to remove the age and chronic condition criteria - they concentrated on 200,000 + patients from 18 - 30 years of age. Surprisingly the numbers got worse, those uninsured individuals died 89% more often than their insured counterparts.
So why is this happening???? I work in an ER and I still think that we treat anyone that walks through our doors - I don't believe that we withhold care from the uninsured. Anyone else experiencing anything different?
Some studies do show that the uninsured do wait longer to go to the hospital for treatment, maybe too late. Others don't seek care for their chronic conditions so this could make recovery from a trauma more complicated. Studies do show that uninsured individuals do get less testing done and are transferred to rehab. facilities less frequently.
I believe it could also have to do with the type of traumatic injuries these patients are suffering. The age range seems to indicate that maybe the high risk behaviors they participate in and the injuries they suffer from them attribute to these numbers. But then again, why are the insured in this age group surviving more?
I also believe it may have something to do with the course of the treatment of the uninsured. I believe that the uninsured do get the same treatment in the ER or trauma center- but I do believe at some point after stabilization, these patients may get transferred to some other hospital or rehab centers. Post -stabilization care, treatments, tests and maybe even staffing or after discharge followup and compliance may also be hidden factors in these outcomes.
So I hate to sound like a broken record - but how much money do we sink into these bad outcomes? Would it change if we insured everyone? Would it cost less to save them? Maybe they would get out of the hospital sooner if we were already treating their chronic conditions.
Are we proving that we give sub maximal care to the uninsured?
What do you think?
As I walked into work the other day, I was surprised to find an article posted on the board with the above headline. Wow - Uninsured Trauma Patients 80% more likely to die than the Insured.
The study was conducted by Harvard University and Brigham and Women's Hospital in Boston and the information was extrapolated from the National Trauma Data Bank. They looked at 2.7 million patients from 900 different trauma centers across the US.
This surprised many trauma hospitals, physicians and staff because of the EMTALA laws. These laws are supposed to protect patients without insurance. Anyone presenting to an emergency room is supposed to be treated equally without regard to insurance coverage.
The study seems to conclude otherwise. Patients with private insurance, HMOs and Medicaid all seems to fair equally. Medicare patients died 56% more often and the Uninsured patients died 80% more often.
The researchers thought that the Medicare population was adversely affected by their chronic medical conditions and age. So, they next decided to remove the age and chronic condition criteria - they concentrated on 200,000 + patients from 18 - 30 years of age. Surprisingly the numbers got worse, those uninsured individuals died 89% more often than their insured counterparts.
So why is this happening???? I work in an ER and I still think that we treat anyone that walks through our doors - I don't believe that we withhold care from the uninsured. Anyone else experiencing anything different?
Some studies do show that the uninsured do wait longer to go to the hospital for treatment, maybe too late. Others don't seek care for their chronic conditions so this could make recovery from a trauma more complicated. Studies do show that uninsured individuals do get less testing done and are transferred to rehab. facilities less frequently.
I believe it could also have to do with the type of traumatic injuries these patients are suffering. The age range seems to indicate that maybe the high risk behaviors they participate in and the injuries they suffer from them attribute to these numbers. But then again, why are the insured in this age group surviving more?
I also believe it may have something to do with the course of the treatment of the uninsured. I believe that the uninsured do get the same treatment in the ER or trauma center- but I do believe at some point after stabilization, these patients may get transferred to some other hospital or rehab centers. Post -stabilization care, treatments, tests and maybe even staffing or after discharge followup and compliance may also be hidden factors in these outcomes.
So I hate to sound like a broken record - but how much money do we sink into these bad outcomes? Would it change if we insured everyone? Would it cost less to save them? Maybe they would get out of the hospital sooner if we were already treating their chronic conditions.
Are we proving that we give sub maximal care to the uninsured?
What do you think?
Monday, November 16, 2009
This Week in Medical Show Critique - I Play a Doctor on TV - BUT Do I ever Wear a Mask????
Hi everyone -
I thought I'd once again do a little critique on the medical mistakes we see on TV. Maybe you've seen some as well - if so feel free to post them here.
It's kind of funny to think we live this every day and some of the shows do a really good job, others not so much. But I still love to watch them - for me, it's more about escapism - I love it when they make me laugh and cry. I still do have the urge to scream though when they're doing a great job and then mess up - medically speaking.
So the theme of the last week or so shows seem to be their ability to screw up the use of masks - any kind of masks.
First I was watching Three Rivers - which I love. The medical consultants were doing such a great job with all medical aspects of the show. I was very impressed with their portrayal of the "John Ritter syndrome" case. The patient was having chest pain and had ST elevation on his EKG. The star of the show wanted to wait for the CXR results - but oh no, the other doctor just wanted to give TNK and head to the cath. lab. Oops - guess what - dissecting aneurysm and now the thought of this patient dying on the table.
After a lot of show casing - first they tried a balloon expandable stent graft - which I must say was pretty amazing to watch. I've never seen one in person - but they used fluoroscopy and it showed it in real time which was way cool. Of course, it didn't really work.
A few hours later when the patient was ready to crash, they cut him open and repaired it surgically - of course after giving him lots of FFP to reverse the thrombolytics they had pumped him full of earlier. And success, the patient lived. All in all, pretty impressive.
So it was with great dismay that they could pull something off this complicated, and they can't put a nonrebreather mask on correctly - it was flat as a pancake. The whole scene was killing me - I was saying, "could you please blow that darn bag up just a little so the patient doesn't suffocate?"
Then the next show was Mercy. Again, loving this show. Love all the drama - all the dysfunctional family dynamics and all the whackiness of some of the characters.
I also think they do pretty good with the nursing aspects - they're not too over the top. They do just basic medical things so far, a lot of bedside stuff and stay away from portraying complicated medical practices.
So this show was about a chemo patient who was going to get a bone marrow transplant. They were sooo good in portraying the cleanness of the room - the patient's kids had given her a teddy bear and it was in plastic. The staff all had on gowns and hats and shoe covers and MASKS - but they were around their necks. Now, why oh why go to so much trouble to show the white room but make it not so white. lol. Now, I know they're actors and we want and need to see their faces - but ...... oh well.
And one more thought on last week's Mercy. I don't think we needed to give the family another blow to deal with - they're already dysfunctional enough - they didn't have to give the dad Alzheimers too.
And by the way - can you say hot fireman-nurse sex in the storage closet? Oh yes they did.
Of course, they hit the nail on the head about the whole firemen thing. They made him a hot dog - and what I mean by that - he's hot - but he's a dog - he's married and the nurse he's having sex with in the closet doesn't know. And all her nurse friends told her not to fall for him - "he's just to play with, not to get hooked on." lol
Anyway, off this thing for now. Just having some fun. Got a diamond today !
I thought I'd once again do a little critique on the medical mistakes we see on TV. Maybe you've seen some as well - if so feel free to post them here.
It's kind of funny to think we live this every day and some of the shows do a really good job, others not so much. But I still love to watch them - for me, it's more about escapism - I love it when they make me laugh and cry. I still do have the urge to scream though when they're doing a great job and then mess up - medically speaking.
So the theme of the last week or so shows seem to be their ability to screw up the use of masks - any kind of masks.
First I was watching Three Rivers - which I love. The medical consultants were doing such a great job with all medical aspects of the show. I was very impressed with their portrayal of the "John Ritter syndrome" case. The patient was having chest pain and had ST elevation on his EKG. The star of the show wanted to wait for the CXR results - but oh no, the other doctor just wanted to give TNK and head to the cath. lab. Oops - guess what - dissecting aneurysm and now the thought of this patient dying on the table.
After a lot of show casing - first they tried a balloon expandable stent graft - which I must say was pretty amazing to watch. I've never seen one in person - but they used fluoroscopy and it showed it in real time which was way cool. Of course, it didn't really work.
A few hours later when the patient was ready to crash, they cut him open and repaired it surgically - of course after giving him lots of FFP to reverse the thrombolytics they had pumped him full of earlier. And success, the patient lived. All in all, pretty impressive.
So it was with great dismay that they could pull something off this complicated, and they can't put a nonrebreather mask on correctly - it was flat as a pancake. The whole scene was killing me - I was saying, "could you please blow that darn bag up just a little so the patient doesn't suffocate?"
Then the next show was Mercy. Again, loving this show. Love all the drama - all the dysfunctional family dynamics and all the whackiness of some of the characters.
I also think they do pretty good with the nursing aspects - they're not too over the top. They do just basic medical things so far, a lot of bedside stuff and stay away from portraying complicated medical practices.
So this show was about a chemo patient who was going to get a bone marrow transplant. They were sooo good in portraying the cleanness of the room - the patient's kids had given her a teddy bear and it was in plastic. The staff all had on gowns and hats and shoe covers and MASKS - but they were around their necks. Now, why oh why go to so much trouble to show the white room but make it not so white. lol. Now, I know they're actors and we want and need to see their faces - but ...... oh well.
And one more thought on last week's Mercy. I don't think we needed to give the family another blow to deal with - they're already dysfunctional enough - they didn't have to give the dad Alzheimers too.
And by the way - can you say hot fireman-nurse sex in the storage closet? Oh yes they did.
Of course, they hit the nail on the head about the whole firemen thing. They made him a hot dog - and what I mean by that - he's hot - but he's a dog - he's married and the nurse he's having sex with in the closet doesn't know. And all her nurse friends told her not to fall for him - "he's just to play with, not to get hooked on." lol
Anyway, off this thing for now. Just having some fun. Got a diamond today !
Monday, November 9, 2009
The Military and the Ball and Chain that Holds Their Members
Hi everyone -
Just a little note today - curious about what every one's thoughts are on the military contract with it's members.
In light of the tragedy at Fort Hood this week, I'm questioning the responsibility that a member of the Armed Forces has with the establishment. I'm wondering if things could have been different if they had just left this person out of the military. What do you think? Is there a way they could have discharged him? Is there another way he could have repaid his financial obligation?
Being an ex-military wife, I'm fully aware of the adage "If the military wanted you to have a wife, they would have issued you one." They've always been known for their bold and brass techniques to keep you in their fold, to beat you down so you can't really think for yourself, to stay loyal to the beast, to be strong in hard times.
Now, be clear, I'm not saying the Military isn't a wonderful place for a special kind of person. I totally respect and honor every member of the service that is there due to their personal beliefs and desires, those that are loyal - those who fight for our freedoms and country - those who love this tight knit community. But I do think, it's not for everyone. And I do feel that a great many people of my generation joined the military for the wrong reasons.
At the very least, in the 70s and 80s, it was a time of peace. It still remains a time of opportunity to escape the high unemployment rates of our small home towns, the towns where blue collar jobs are disappearing. It is still a time of educational opportunities where most young people will never be able to afford to continue their education, learn a skill, climb the ladder, move away from their small towns. And maybe it is even a time of opportunity to escape the violence of our towns and cities - either in our own families or a life of crime and violence that we have chosen. It used to be the only choice young people had - when the local law enforcement said you had to join the military or go to jail.
Obviously this person who shot many co-workers was in a lot of turmoil and for years. He apparently tried many times to get out of the military. He even offered to pay back the money he felt he used to get his education. I'm guessing, and I do mean just that, as I didn't know him, that there were moral and religious beliefs that were involved. And I truly believe there were a lot of emotional problems - both personally and also because of the travesties that he heard day in and day out from the soldiers returning from battle. If I recall correctly, some of the most affected people from times of war are the mental health professionals and the chaplains. Both have to hear people struggling everyday because of what they'd been through and their problems with reintegrating into society. And I do believe no one took him seriously. He had been investigated and nothing happened. Maybe he was calling out for help?
So what do we do now? Times are different. We're at war. Some people don't believe in war.
Why do we not question some people's internal conflicts when their own religious beliefs or cultural background are in play? In World War II, some of the Japanese men who were in internment camps fought for our Country - but our Country was sensitive to them - either because they didn't trust them or they didn't want them to have to kill their own people. They didn't ask them to fight against their own - they fought in other countries instead and proved their loyalty without this internal conflict.
Do we change the way we handle these situations in the future? Does the military determine how much money they spend on a members education so that if this same situation happens in the future, these members can be discharged? Can they repay the military in a dollar amount instead of a "years due" manner?
Why does the Military actually want to keep someone who isn't there 100% mentally and physically? Why would they want to keep someone who is bad for other soldiers' morale? Why would they want to keep someone who then chooses to open fire on innocent victims.
Will anything change? Well, I think I know the answer - they'll apologize to the families of the innocent victims for missing the tell tale signs. But unfortunately nothing will really change. Members won't be discharged. This man's mental health will be blamed. The government will need to step up their commitment in addressing the mental health toll it's taking on it's members.
What a shame - so many lives lost on our own ground. What is the price of war - a war that may or may not even be ours to fight???
At some point, I'd like to visit a subject close to this one - requiring young people to actually volunteer for a Country's welfare - something like a mandatory draft - but not all on a military scale. I think it would help with the unemployment rate. It would help these young people find their way when they aren't sure what they want to do. It could help them see the world, get an education, learn a skill and give back. What do you think?
See you soon.
Just a little note today - curious about what every one's thoughts are on the military contract with it's members.
In light of the tragedy at Fort Hood this week, I'm questioning the responsibility that a member of the Armed Forces has with the establishment. I'm wondering if things could have been different if they had just left this person out of the military. What do you think? Is there a way they could have discharged him? Is there another way he could have repaid his financial obligation?
Being an ex-military wife, I'm fully aware of the adage "If the military wanted you to have a wife, they would have issued you one." They've always been known for their bold and brass techniques to keep you in their fold, to beat you down so you can't really think for yourself, to stay loyal to the beast, to be strong in hard times.
Now, be clear, I'm not saying the Military isn't a wonderful place for a special kind of person. I totally respect and honor every member of the service that is there due to their personal beliefs and desires, those that are loyal - those who fight for our freedoms and country - those who love this tight knit community. But I do think, it's not for everyone. And I do feel that a great many people of my generation joined the military for the wrong reasons.
At the very least, in the 70s and 80s, it was a time of peace. It still remains a time of opportunity to escape the high unemployment rates of our small home towns, the towns where blue collar jobs are disappearing. It is still a time of educational opportunities where most young people will never be able to afford to continue their education, learn a skill, climb the ladder, move away from their small towns. And maybe it is even a time of opportunity to escape the violence of our towns and cities - either in our own families or a life of crime and violence that we have chosen. It used to be the only choice young people had - when the local law enforcement said you had to join the military or go to jail.
Obviously this person who shot many co-workers was in a lot of turmoil and for years. He apparently tried many times to get out of the military. He even offered to pay back the money he felt he used to get his education. I'm guessing, and I do mean just that, as I didn't know him, that there were moral and religious beliefs that were involved. And I truly believe there were a lot of emotional problems - both personally and also because of the travesties that he heard day in and day out from the soldiers returning from battle. If I recall correctly, some of the most affected people from times of war are the mental health professionals and the chaplains. Both have to hear people struggling everyday because of what they'd been through and their problems with reintegrating into society. And I do believe no one took him seriously. He had been investigated and nothing happened. Maybe he was calling out for help?
So what do we do now? Times are different. We're at war. Some people don't believe in war.
Why do we not question some people's internal conflicts when their own religious beliefs or cultural background are in play? In World War II, some of the Japanese men who were in internment camps fought for our Country - but our Country was sensitive to them - either because they didn't trust them or they didn't want them to have to kill their own people. They didn't ask them to fight against their own - they fought in other countries instead and proved their loyalty without this internal conflict.
Do we change the way we handle these situations in the future? Does the military determine how much money they spend on a members education so that if this same situation happens in the future, these members can be discharged? Can they repay the military in a dollar amount instead of a "years due" manner?
Why does the Military actually want to keep someone who isn't there 100% mentally and physically? Why would they want to keep someone who is bad for other soldiers' morale? Why would they want to keep someone who then chooses to open fire on innocent victims.
Will anything change? Well, I think I know the answer - they'll apologize to the families of the innocent victims for missing the tell tale signs. But unfortunately nothing will really change. Members won't be discharged. This man's mental health will be blamed. The government will need to step up their commitment in addressing the mental health toll it's taking on it's members.
What a shame - so many lives lost on our own ground. What is the price of war - a war that may or may not even be ours to fight???
At some point, I'd like to visit a subject close to this one - requiring young people to actually volunteer for a Country's welfare - something like a mandatory draft - but not all on a military scale. I think it would help with the unemployment rate. It would help these young people find their way when they aren't sure what they want to do. It could help them see the world, get an education, learn a skill and give back. What do you think?
See you soon.
Sunday, November 8, 2009
Inching Towards Health Care Reform
Hi it's me again.
I'm writing just a little update on the Health Care Reform Topic. Good news - ever so slow, but inching towards a bill being passed.
Last night, the House passed their Health Care Reform Bill by a narrow margin. They got 220 votes, needed 218. Yikes!
Anyway, it's good news because it means now the Senate can call for their vote as well. The House Bill was pretty wide and all encompassing, so expect the Senate Bill to be more conservative so that in negotiations, they can meet somewhere in the middle. Politics, politics, my pretties!
I'd like to urge everyone to actually read this bill. It's huge, a lot of verbage. But if you really want to know what's actually there, please feel free. And it's a lot better than listening to all the negative talking points and little snippets out of context that everyone has. Yes there are some regulations, OK a lot of them - but they are there to protect the citizens. There is also a lot of reform and change in this bill.
Stayed tuned here for updates and talking points. I'm going to try to read a little each day so that I can keep everyone informed on what's actually in the final bill.
I think it's important to remember that this is all a slow process. I know a majority of Americans voted for President Obama wanting change. If you remember, he always said it in his speeches - he said that things may not be different for years, some things wouldn't get accomplished even in his first 4 years. Change is slow, a lot slower than we'd all like. We're a generation of instant gratification. And it's hard to ask people who aren't working or who are drowning in debt, to be patient. But we all need to do just that.
Once we get past this big hurdle and I sure hope we do - at least in some effective form, we can all move on to other important issues that will get our economy back on track.
So if you want to check out the bill, click here. It's not a great copy. You have to click back and forth on all the sections. I'm guessing in a few days, there will be a complete copy online. Or you can go to this link - this is a copy of the 1990 page bill without the amendments.
Anyway, take care and keep checking back.
I'm writing just a little update on the Health Care Reform Topic. Good news - ever so slow, but inching towards a bill being passed.
Last night, the House passed their Health Care Reform Bill by a narrow margin. They got 220 votes, needed 218. Yikes!
Anyway, it's good news because it means now the Senate can call for their vote as well. The House Bill was pretty wide and all encompassing, so expect the Senate Bill to be more conservative so that in negotiations, they can meet somewhere in the middle. Politics, politics, my pretties!
I'd like to urge everyone to actually read this bill. It's huge, a lot of verbage. But if you really want to know what's actually there, please feel free. And it's a lot better than listening to all the negative talking points and little snippets out of context that everyone has. Yes there are some regulations, OK a lot of them - but they are there to protect the citizens. There is also a lot of reform and change in this bill.
Stayed tuned here for updates and talking points. I'm going to try to read a little each day so that I can keep everyone informed on what's actually in the final bill.
I think it's important to remember that this is all a slow process. I know a majority of Americans voted for President Obama wanting change. If you remember, he always said it in his speeches - he said that things may not be different for years, some things wouldn't get accomplished even in his first 4 years. Change is slow, a lot slower than we'd all like. We're a generation of instant gratification. And it's hard to ask people who aren't working or who are drowning in debt, to be patient. But we all need to do just that.
Once we get past this big hurdle and I sure hope we do - at least in some effective form, we can all move on to other important issues that will get our economy back on track.
So if you want to check out the bill, click here. It's not a great copy. You have to click back and forth on all the sections. I'm guessing in a few days, there will be a complete copy online. Or you can go to this link - this is a copy of the 1990 page bill without the amendments.
Anyway, take care and keep checking back.
Thursday, November 5, 2009
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