I've followed Dr. Don Berwick since my 1999 awakening to the forces at work to improve the quality and safety of our healthcare system. Long before the healthcare reform act was a glimmer in Obama's eye, Dr. Berwick's organization, the Institute for Healthcare Improvement (IHI), was working to change the system from within. He is a revolutionary pediatrician with a gift for vision and insight who has successfully applied these qualities toward concerted action.  

As the founding CEO for the Institute for Healthcare Improvement, others like me have learned both from him and with him on the journey toward helping our healthcare systems deliver more on its promises.  The substance of that "more" includes making it:

• Safe
  
• Timely
• Equitable
• Efficient
• Effective
• Patient Centered

These are the Six Aims of the Institute of Medicine.

He will now leave his IHI post to serve as Director for the Centers for Medicaid and Medicare.
So what will he do in this new job?

"Do you have a rubberband", Paul asked the barmaid. She plopped it down on the bar in front of us and looked up at me.  My hair, plastered with sweat against my face and neck, prompted her "Is this for your hair?"

I nodded.

She shook her head then took the elastic hair band off her wrist, handed it to me and returned the wretched rubberband to its resting place.   

I had just come off the dance floor after communing with the Anointed Vessel Gospel Choir.

There's a lot of excitement around the nation about medical marijuana. In one of my prior posts I talked about it's health benefits.Illinois has even proposed such a pilot program. So how are those that seek medical marijuana consuming the stuff?  Well, most are going the traditional route of smoking it a la Cheech and Chong. Now, last I checked my lungs were generally opposed to the whole concept of smoking. So what are the specific health hazards of consuming marijuana in this fashion?

Well I gave it a go recently myself.  See, I've developed a back problem.  That's not supposed to happen, right? I take care of myself, exercise regularly, enjoy the sins of consumption in

moderation...nonetheless, here I was 6 months and counting, left leg going numb, cramping in my calf, aching in my lower back. What should I do??!?

Hello again!

 

I've been quite the slacker lately, leaving Dr. Carrie to shoulder our blog alone.

 

Nope, I wasn't on an extended vacation on a remote island, although it does look inviting, doesn't it? 

 

 

 

I've been busy rearranging my new fish bowl and rocks. Dr. Carrie actually taught me the concept, but I'll give you the gist of it. (I know you're wondering what a fish bowl and rocks has to do with medicine...be patient...you'll see...)

I'm back! Took a little break--went on a wonderful trip to the tropics and am busy making the rounds of holiday parties.  Last night I made this really wonderful baked brie topped with cranberry relish and nuts, then there were those outstanding stuffed mushrooms my neighbor made... then came dessert.  But before I started singing this new take on a Colbie Caillet song, I remembered to be mindful with my eating like Dr. Michelle May tells us.  

I've got it!  I called the Borders and they had just one book left so I asked them to hold it for me and I got right over there.  Dr. Michelle May's book: Eat What You Love, Love What You Eat--How to Break Your Eat-Repent-Repeat Cycle.  You won't find many "diet" books with a luscious piece of chocolate pictured on the cover.  I like it already.

 

I put the word "diet" in quotations because as Dr. May tells us in the introduction: "...this book is really different.  In fact it may seem a bit too different. ... No dieting? How's that going to help?

 

Well, I think we may just be witnessing a true diet revolution between the pages of this book.  

I wrote a piece on "mindfulness" a while back.  It turns out that there are many many applications for this valuable skill.  As it relates to eating, I can't possible cover this topic as well as my friend, Michelle May, MD can. Michelle is a fellow Family Physician who has conquered her obsession with food through a program of mindful eating. She now shares this acquired wisdom through her website, educational programs and books. You can learn more about her programs here with some great tips on how to avoid the "eat-repent-repeat cycle".

I have this wonderful new toy, a Kindle, and I tried to download Michelle's latest book but it's not yet available on Kindle.  So I'm going to have to break down, treck to the book store and buy it.  If you're interested, join me in reading it and we'll digest her pearls of wisdom together.  I plan a series of posts on the topic.  For now, I'll tell you what I understand so far about her approach to "mindful eating".

Sorry, I've been keeping you waiting but this is a BIG DEAL.  I'm sure you feel the same. It was really important to me to think it through. First a recap of the controversial new breast cancer screening guidelines released by the United States Preventive Services Task Force (USPSTF) earlier this week--the USPSTF (say that 6 times fast):

 

1. recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms
2. recommends biennial [every other year] screening mammography for women aged 50 to 74 years.
3. concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older.
4. recommends against teaching breast self-examination (BSE).
5. concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older.
6. concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer.

Who are these people?!?

I was only a third year medical student when I heard someone yell that. Luckily, I was already at church, which meant I didn't think I'd have to wait in line for my prayers to be answered. I began praying more fervently, "Please, God, let there be a real doctor here. Please. A real doctor who knows what to do."

 

No one responded. I glared at others to STOP praying so my prayer would be heard loud and clear. "Look, I know I'm only a third year medical student. Don't know anything yet. Please send real help. And, uh, this kinda urgent." Still no one responded.

 

The United States Preventive Services Task Force released this report today. 

I know...hard to take isn't it?

I'm figuring since you've landed on this webpage, you may be interested in my opinion on the topic. 

I'm sure I have one....

I'll have to get back to you on that.  I'm still absorbing the shock...and thinking...

 

But don't worry, I will get back to you on this.  I promise.

It's the $100,000 question on One Vs One Hundred.  Player, Eric Smart, is growing more emotional as he ascends the greenback ladder.  "What does the Mayo Clinic consider a normal blood pressure?"  I'm sitting there watching with my son and I burst out "Well who doesn't know that?!"  Now my kids do many things for me. Aside from roping me into meaningless television shows, getting me hooked and derailing  my quest to live a productive life, they also keep me connected to the real world.  With just a slight bit of sarcasm, I'm told "Mom--I wouldn't know that, most people wouldn't know that."  Sure enough when the results come in some 15 people in the audience are eliminated. 

 

High blood pressure is THE most common chronic illness in the U.S.  Many of you out there have it, in fact one in three adults has it!  If you're not one of them yourself, a lot of people in your life are. Ergo...you need to know what a normal blood pressure is. Do you even know what your own blood pressure is?  The next time you're at the doctor, make sure you ask. 

 

So what's the answer to the $100,000 question?  What's a normal blood pressure? 

Come on, take a guess.

A study about physician burnout found that mindfulness meditation can be a helpful remedy. This University of Rochester study, published in the Sept. 23/30 issue of The Journal of the American Medical Association, found that as many as 60 percent of practicing physicians describe symptoms of burnout. The study defined such symptoms as "emotional exhaustion, depersonalization, treating persons as objects, and low sense of accomplishment."

 

Do you want to see a doctor like that?

The health department in my county ran out of the H1N1 vaccine after the first vaccination clinic. On one hand, this is a good sign because people showed up for the vaccination. On the other hand, there are still some high-risk folks who aren't yet vaccinated.

 

The originally scheduled fifteen additional clinics were cancelled until more H1N1 vaccine is received.

 

Why isn't there more H1N1 vaccine available?

I got my first black eye last weekend. It actually looks pretty good in this picture - it was already starting to fade.

I feel uncomfortable when I see someone with a black eye. How did it happen? Was it a bar brawl? Was is a street fight? Was it a mugging? Was it domestic violence?

Domestic violence is a really uncomfortable topic. After all, what do you say to the lady with a black eye next to you in line at the store? Don't you try to avoid looking at her, and especially try to avoid looking at her bruised eye?

My black eye and I had a busy week. Together, we went to work at the hospital. We saw patients, rode in the elevator, had lunch in the cafeteria, and went to meetings. I even took my black eye on a plane trip! We went to the airport, took a cab, checked into a hotel, and ate out at restaurants.

Yes, Gardasil has been approved by the FDA for use in boys ages 9-26 years for the prevention of genital warts. However, this approval needed to pass another hurdle in order to gain widespread use.

I'll give you a hint, here's what our trophy looks like. 

I don't know if only two tweets is an accurate sign of interest or not but it seems my posting last week entitled, How Do You Know if You're Getting Quality Medical Care, didn't interest too many of you.  Maybe my spider web story reminded you that you didn't yet have your Halloween costume together and you ran off before sending the courteous "tweet". If that's not the case, then why would we care so little about the quality of our medical care?

Reading that last sentence over again, I realize how ridiculous it sounds.  Of course we care about the quality of medical care we receive!  So why do the websites I referenced in that post see so little use from the public?  Do we think that we are already equipped to judge whether we're getting good quality?  Is this like some adults-only content a la "we know it when we see it"? 

Surveys of perception of medical care among the public tell us a few things. I should have read these studies before sitting down to write that post.

How in the world are you to judge the quality of the medical care you're getting or not getting?  For most people, the only things we have to go on fall into the categories of communication skills, appearance of the facility and service quality. Is the place clean?  Did I get a smile from the receptionist? Did the doctor introduce herself?

Do any of these things tell you anything about whether your healthcare team is adhering to best-practice standards in the treatment of your pneumonia?  Or that they follow protocols to prevent medication or surgical errors?  Or whether the nursing home you reluctantly placed your dad in adheres to quality standards set forth by the Center for Medicaid and Medicare Services, The Joint Commission and all the other regulatory bodies that have something to say in the matter? 

Uh... no! In this post, I will guide you to some valuable resources so you can base your medical decisions on good information as you travel with your loved ones through the healthcare morass. 

Kane County Health Department started their H1N1 vaccinations yesterday. Last night, my family and I went to St. Charles North High School for our immunizations.

Yes, the lines were long. Yes, the wait was literally several hours. I didn't mind one bit though, because it meant the community was showing up for the vaccine and I couldn't have been happier about that. (You've probably gotten the idea by now that Dr. Carrie and I recommend getting both the H1N1 and seasonal flu vaccinations.)

I was impressed by the organization of this public vaccination campaign. The Kane County Health Department did an incredible job planning and preparing for the evening. I'm sure the St. Charles Police Department had extra officers working that night to direct traffic around the school. There were hundreds of volunteers assisting with patient flow and administering the vaccines. They were working for hours and every single person there was pleasant and with a smile. They did a tremendous job and everyone involved deserves a great big thank you!

Is it true?  Healthcare doesn't make you healthier?  Why that's blasphemy!

And alas... true it is.  Julie Deardorff and Judy Graham had an eloquent piece in today's Chicago Tribune that discussed just that point.  Truth be told, health is in fact influenced by factors in five areas of our lives. 

Yeah, I've got a complaint. The only thing worse than having a complaint is having no one to listen to the complaint. Boy, am I glad we have this blog now because at least I know you are listening.

I don't complain much. In general, I'm a roll-with-the-flow, easy going kind of person. (Dr. Carrie knows me well and I'm 100% positive she would agree with that self-assessment.)

But, I am going to complain now and here's my complaint:

The CDC is now calling H1N1 a disease of children.  This information combined with what I already know about H1N1 caused me to call that 24 hour health department line to make appointments for my kids to get the nasal vaccine.  Since only the nasal spray is currently being offered at the health departments and since H1N1 has already infiltrated, and it will take about two weeks for the vaccine to take effect, I'm moving ahead...

Sounds like a fantasy, doesn't it? Well, here's a concept that could make it a reality - it's called the Patient Centered Medical Home (PCMH). There's an article in yesterday's Trib about it.

To put it simply, the PCMH is a medical home built on a strong foundation of primary care that is a comprehensive, team-based, coordinated, and cost-effective approach to improving healthcare. And it works.

But let's talk money first. We know that the US spends more per capita on healthcare than any other country and our outcomes are horrible. We're certainly not getting our money's worth. But consider this...

The hazards of concussions have been hitting the airwaves in recent weeks.  As a mother of three boys, each of whom have played football and one that still does, being reminded about the risks of contact sports rattles me.  My boys have always loved playing positions that get them right in the thick of the brutality.  I've envied that mother who watches her son gallop onto the field--pristine white jersey, not a single scuff on the helmet... he lobs a field goal into the endzone and everyone cheers! 

Then I look over at my own son with that piece of sod hanging off his facemask, muddied and loving it. Don't get me wrong, I'm a loyal Bears fan and have been seen pacing the sidelines at my sons' games, screaming "get 'im!" with the other maniacs.  Consistent with their general reaction to me, the boys find this very embarrassing.   

While concussions can be sustained in many different sports, football is the most notorious of them.  New studies have been coming out about the long-term impact of concussions, especially multiple concussions. And we're realizing that concussions often go unreported. So how can you keep your child's brain safe from harm?

 

Last week, I was talking to a nurse who is looking forward to a new grandchild in about a month or so. The obstetrician had told her pregnant daughter-in-law that "by protocol, he has to tell her that she is supposed to get the vaccine, but to tell her the truth, if it was his wife or daughter who was pregnant, he wouldn't let them get the vaccine."

 

 

And after a personal endorsement like that from an obstetrician, who would get the vaccine? 

So

 what's the real scoop? Is he right? Or is the CDC right?

(Let me give you a hint...if you're a betting person, put all your money on the CDC.)

Yes, pregnant women really should get the H1N1 vaccine.

Oh, hold on a minute, I think I hear something...yep, it's that obstetrician wondering how he just lost his money on that bet.