Cell 2 Soul: The Humane Health Care Blog

Silver Dragons by Phil Delrosario

Stanford undergraduate, Phil Delrosario, does an amazing job of getting into the mind of a four year-old at a doctor's office.

"Momma, why is she hurting me? Momma wouldn't say anything. She just held me there. The lady stabbed me again with another silver dragon. Stop I yelled out. I was still crying. Why are you hurting me I screamed. She said she needed to give me two more and then she'd be done. She came closer and closer. I kicked her in her face. That's what Aladdin would have done..."  Download Silver Dragons

 

Author Bio:  Phil Delrosario is a junior in Human Biology with a concentration in Psychological Development in Children and Adolescents at Stanford University in California.  He enjoys writing, making short films, and playing his violin/piano/ukulele. He can be reached at pdel@stanford.edu.

Pediatric practitioner Brian Maurer has this comment:  "This unfortunate scenario is repeated daily in pediatric primary care practice.  An interesting twist: told through the eyes of a 4-year-old as imagined by a pre-medical student. see Brian's full comment"  Download Maurer
 

To Screen or Not To Screen?

"The basic strategy behind early diagnosis is to encourage the well to get examined — to determine if they are not, in fact, sick. But is looking hard for things to be wrong a good way to promote health? The truth is, the fastest way to get heart disease, autism, glaucoma, diabetes, vascular problems, osteoporosis or cancer ... is to be screened for it. In other words, the problem is overdiagnosis and overtreatment.

Screening the apparently healthy potentially saves a few lives (although the National Cancer Institute couldn’t find any evidence for this in recent large studies of prostate and ovarian cancer screening). But it definitely drags many others into the system needlessly — into needless appointments, needless tests, needless drugs and needless operations (not to mention all the accompanying needless insurance forms)."

This is an excerpt from an important editorial in the NYT by H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, and an author of “Overdiagnosed: Making People Sick in the Pursuit of Health.”

A Patient Request

by Zena David

The night my brother, Steve, a long-time resident of a nursing center, was sent to the emergency ward, I expected him to be admitted to the psyche ward of a Chicago hospital.  It wouldn't have been the first time.  Occasionally, the medication he took to stabilize his schizoaffective behavior didn't hold. Medicare hadn't approved the new medication that might have helped in a timely fashion.   He walked the halls, refused to eat, had difficulty urinating, descended into a deep depression and heard voices.  This time, he would be a patient on the medical floor until his prerenal azotemia (impending kidney failure) and a blockage in the bladder could be treated surgically. He could not, in this state, enter the psyche ward. 

By the time I flew to Chicago from California, I saw my brother pulling out the IV's before being physically restrained. The psyche ward did not have the capability to handle patients with certain medical conditions so even though Steve's  doctors tried to get him into the ward, they were unable to do so. Never having been operated on, confused as to what was happening to him, and often being addressed in the third person, my gentle and gentlemanly brother became uncooperative and at times belligerent, ripping off the bandages protecting the fistula. Two operations later, my brother left the hospital having taught the staff that a smile and a kind word are as crucial to the healing process as the medicines that were injected into his veins.

“Whoever survives a test, whatever it may be, must tell a story.  That is his {her} duty,” said Nobel Peace Prize winner and Holocaust survivor Elie Wiesel.  My brother, Steve, never won a prize, but he is noble. And his story must be shared.  Within his living nightmare, he found his voice sounding it out so that it could make a difference to those who heard him.  I wanted him to know what he went through. I wanted him to know how proud I was of him.  I wanted him to know what he taught me.

 Robert Frost said, “The only way out is in.” Steve orbited in and out of consciousness and sanity and into traumas that frightened me.  Then he surfaced to a place where our words could meet and be understood not only by me but also by the medical staff.  This is our story.  See: Download A Patient Request

My Brother Steve

Author Bio: Zena David, a former public school educator, was awarded several Los Angeles Educational Partnership Grants which enabled her to develop interdisciplinary projects  and publish articles about the programs for middle school students.   She encouraged her English and drama students to share her philosophy, “love what you do and feel that you matter.”  The English Council of Los Angeles honored her for her achievements as outstanding English classroom teacher in 1986.  The next year, she received a Global Teaching Award for her children's Museum exhibit and her production of  The Diary of Anne Frank led to a correspondence and an invitation to visit Miep Gies at her home in Amsterdam. She became an assistant producer for a Dramalogue award winning theater and an associate director for the UCLA extension musical production about the second half of life.  Zena also has also written plays  and acted in several small theater as well as community productions.  She has facilitated a creative writing workshop in a women's prison. Her most recent speaking engagement was this year at the Yom HaShoah Observance and Photo Exhibition, “Through Your Eyes:  Holocaust Memorials Around the World.” As a writer, actress, and director, she is most interested in using the creative arts to integrate issues and heal traumas. Email:  Zena

Gambling with Your Life and Health

If you have questions about the value of screening (especially for breast and prostate cancer) here is a link to an important article by one of the most respected workers in the field.

You Have to Gamble on Your Health
by H. Gilbert Welch
NY Times, October 11, 2011

Concierge Medicine

There is an old Yiddish saying:  "If the rich could pay the poor to die for them, the poor would make a very good living."  Well, it is coming to pass.

Concierge medicine is a relationship between a patient and a physician in which the patient pays an annual fee or retainer. In exchange for the retainer, doctors provide enhanced care. Other terms in use include boutique medicine, retainer-based medicine, and innovative medical practice design.

The NY Times had an eye-opening article on this topic on April 30, 2011:  Putting Your Doctor, or a Whole Team of Them, on Retainer.  It is worth reading to see where this trend is going.  The rich are, in this case, co-opting physicians' time that might better be spent with poor suffering humanity. 

Osler wrote:  "The practice of medicine is a calling not a business."  Clearly, some arrogant, greedy physicians do not adhere to his sentiment.

 

Knaves and Pawns

In their seminal essay, Societal Perceptions of Physicians: Knights, Knaves, or Pawns?, Christine Cassell and Sachin Jain, refer to three kinds of physicians: knights, knaves and pawns.  The knights are motivated by virtue and service.  The knaves by rigid self-interest, and the pawns are passive victims of their circumstances (employers and corporate masters).

It is clear, that most U.S. psychiatrists these days are Knaves and/or Pawns.  They don't have time to listen to their patients, but rather, adjust their medicatons in short visits and depend on psychologists and social workers to listen and counsel. We have a a new specialty, "psychopharmacologists" whose knaves and pawns generate the income they want at the expense of their patients.

See a recent article in the NY Times: "Talk Therapy Doesn't Pay."   "A 2005 government survey found that just 11 percent of psychiatrists provided talk therapy to all patients, a share that had been falling for years and has most likely fallen more since. Psychiatric hospitals that once offered patients months of talk therapy now discharge them within days with only pills."

If you agree or if you are outraged, please let us know.

 

Health Care Quality in the U.S.

June 24, 2010

According to new annual report from the Commonwealth Fund, a private foundation that focuses on health care, the U.S. health system presents a rather dismal picture in terms of overall quality of health care.

The analysis comparing the nations spending and health outcomes with seven other industrialized nations, found that despite outspending the other competitors, the Americans are getting less for their money and are languishing behind in common health issues.

The Commonwealth Fund's president, Karen Davis, stated, "On many measures of health system performance, the U.S. has a long way to go to perform as well as other countries that spend far less than we do on healthcare, yet cover everyone.

"It is disappointing, but not surprising, that despite our significant investment in health care, the U.S. continues to lag behind other countries.”

America scored poorly in most of the five key areas of health service in comparison to the other six competitors despite the country’s healthcare system being the most expensive in the world.

The rankings of the 7 countries
The Commonwealth Fund report was based on a survey of both patients and primary care doctors for the years 2007, 2008 and 2009 in Australia, Canada, Germany, the Netherlands, New Zealand and the United Kingdom.

The focus of the report was five essential measures of health care- access to care, equity, quality, efficiency and the ability to live long, healthy, productive lives.

The overall winner was Netherlands scoring the highest in the list. The country topped in access and in equity, and ranked second in quality of care.
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The Dutch were closely followed by UK and Australia while Canada ranked sixth and America fared the worst in the list.
                                                                                                                                                                                                                                                             
US healthcare system the most expensive in the world
The United States scored poorly in most of the five key areas of health service despite the country’s healthcare system being the most expensive in the world.

The other six countries spend approximately half that of the United States yet are able to provide better universal care to its citizens.

In 2007, the nation spent $7290 per person which was more than double that of Canada, three times more than New Zealand and also much higher compared to the $3800 per person, spent in the Netherlands.

Some specific findings In areas of providing safe care, the United States ranks last and second last on coordinated care.

Patients with a chronic condition in the nation are most likely to be given the wrong medication and the wrong dose and delays in being informed about abnormal test results.

Another major problem is efficiency. The nation also ranks last on spending on administrative costs, use of information technology, duplicate medical testing and re-hospitalization.

In addition, the nation fared the worst in infant mortality and healthy life expectancy among older adults.

A large number of Americans go without care because of the cost. The report pointed out that the United States was the only country on the list that does not give all citizens healthcare coverage.

The authors of the report stated, "For all countries, responses indicate room for improvement. Yet, the other six countries spend considerably less on health care per person and as a percent of gross domestic product than does the United States.

“These findings indicate that, from the perspectives of both physicians and patients, the US health care system could do much better in achieving value for the nation's substantial investment in health."

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One More Unfortunate

This woman is one of the 13.2 million uninsured young adults in the U.S.  That is more than the population of Cuba and many other countries.

Alanna Boyd [pictured above] is an uninsured 28-year-old receptionist in New York City. She had the misfortune to wind up in a NYC hospital with a bout of diverticulitis.  This fine article was on the front page of the NY Times on Wednesday, February 18, 2009.  Boyd's bill was $17,398 after spending just 46 hours in hospital last October. “My first reaction was to start laughing — I just kept saying, ‘No way, no way,’ I could have gone to a major university for a year. Instead, I went to the hospital for two days.”

Open your heart and read this important article: For Uninsured Americans -- Do It Yourself Health Care.

What if she were your kid?  Your sister?  What if this were you?. 

Extraordinary Nutty Delusions

Sometimes, the title of a book is all one needs to read:  Extraordinary Popular Delusions and the Madness of Crowds is a popular history of popular folly by Charles Mackay, first published in 1841.

Mass hysteria is a universal phenomenon for our species (and perhaps others as well). Nicholas A Christakis, professor of medical sociology, Harvard Medical School, and attending physician, Mt Auburn Hospital, Cambridge, Massachusetts has an important piece in this week's BMJ, This allergies hysteria is just nuts.

He writes: The issue is not whether nut allergies exist or whether they can occasionally be serious. Nor is the issue whether reasonable accommodation should be made for the few children who have documented serious allergies. The issue is what accounts for the extreme responses to nut allergies and what to do about the responses and the allergies themselves.

Espousing his views will not make you popular with certain people; yet this piece is in the Mackay tradition and will be valuable to read. If you have trouble accessing the BMJ site, here is a pdf: Download Nut Allergy Nuts

Engage with Grace

"The One Slide Project was designed to help get the conversation about end of life experience started. The idea is simple: Create a tool to help get people talking. One Slide, with just five questions on it.  We're asking people to share this One Slide – wherever and whenever they can… Just One Slide, just five questions to get us talking."

This is an important, well-conceived project.  For more information go to web site: