One in a continuing series about emails you get when you are CEO of a hospital. Somehow these get through our spam filter. I'm still relatively new to health care, but I marvel to think that a consulting company has a "director of medical spa services." Look, America is a great country, and I love the entrepreneurial spirit demonstrated by these folks, but isn't it a better idea for hospitals just to get really good at what they are supposed to do rather than be distracted by people from the hospitality business to create health spas? If anything, let's use the experience these folks have from that sector to help us improve the quality of service for sick, nervous, and anxious people visiting our hospitals. There is plenty to do to make sure we are delivering our core business in a proper fashion before jumping off for the latest fad.
7 Secrets to Running a Successful Hospital Owned Medical Spa
Is your hospital contemplating a Medical Spa? Is this a million dollar opportunity or a million dollar boondoggle? Attend a free webinar on "Hospital Owned Medical Spas" to be held on Tuesday, October 9th at 12:00 pm EDT and see if a medical spa is right for your healthcare organization.
This webinar will share with you the 7 Secrets of Running a Successful Medical Spa.
Hospitals across the country are considering whether a Medical Spa is right for them. Join us and get the facts on this fast-growing industry. Some of the reasons hospitals are opening Medical Spas at a record pace are:
Physician partnerships
Drives additional business to core hospital services
New high-margin, non-reimbursed revenue stream
Enhanced focus on well-care instead of acute care
Benefit to employees, patients, and families
Brand building throughout your market
Competitive advantage
This short webinar will cover the specifics of how to properly analyze your market for a Medical Spa, how to avoid the most common mistakes, getting started, physician partnership opportunities, and financing options.
Starting a Medical Spa can be the best - or worst - action you can take this year. Spend 45 minutes with the experts.
Contact me via email or call me directly and I will send you the details on how to join us on this free webinar.
Best regards,
[name omitted]
Director of Medical Spa Services
Sunday, September 23, 2007
Friday, September 21, 2007
Thursday, September 20, 2007
Teamwork wins against VAP
Back in March, I gave an update on our efforts to eliminate ventilator associated pneumonia in our ICUs. This requires implementing a five-part "bundle" of steps every day with every patient. You measure compliance in this program by the percentage of time you do all five steps. There is no partial credit.An additional item is to perform dental hygiene on patients every four hours. The bugs that can cause pneumonia often originate in the mouth.
The goal is to reduce the number of cases of VAP, which statistically have a 30% mortality rate.
The goal is to reduce the number of cases of VAP, which statistically have a 30% mortality rate.
We report on this item on our company website, but I wanted to give you a secret advanced preview. The charts above show our improvement with the bundle and with dental hygiene.
I don't want to brag too much -- well, actually I do! -- because these results are spectacular. They are the result of terrific teamwork among several departments of nurses, doctors, and other health care professionals. Our best estimate is that the reduction in VAP from these efforts is amounting to about 320 cases per year at BIDMC. While it is risky to extrapolate to relatively small numbers by applying broad statistics, if the 30% mortality figure is applied to this number of cases, it means that our folks saved 96 lives per year.
For those interested in costs, a case of VAP is estimated to increase hospital costs by about $40,000 per patient. Once again, applying this broad average figure to our specific number of avoided cases (320) means cost savings to the hospital of about $12 million. Hmm, saving lives and saving money by teamwork and rigorous attention to detail. Any lessons here?
Wednesday, September 19, 2007
Tie one on
Much has been made of a decision in the United Kingdom to forbid the wearing of neckties in hospitals, claiming that these are a source of infections. Here's one such article.
Of course, I immediately asked our infection control people about this, seeing a potential opportunity to improve patient care and make life more comfortable for male doctors. Excerpts from their response:
The focus should remain on good hand hygiene and cleaning of equipment (especially stethoscopes) – all of which actually touch the patient. If health care workers cleaned their hands well immediately before touching a patient, it wouldn’t matter if their ties, white coats, palm pilots or pagers were colonized, since these things presumably have minimal contact with the patient, if any. Although all of these fomites have been shown in studies to become colonized, there has never been data proving transmission of infection to a patient. This topic comes up every year – it is a big distraction from the real issues. The CDC and SHEA (Society of Healthcare Epidemiology of America) agree with this stance.
Here is a quote I found about the CDC's view on the matter that supports this view, but I note that the 2004 article in which it is cited seems to head the other direction:
The Centers for Disease Control and Prevention (CDC)’s Guidelines for Environmental Infection Control in Health-Care Facilities state that, “although microbiologically contaminated surfaces can serve as reservoirs of potential pathogens, these surfaces generally are not directly associated with transmission of infections either to staff or patients. The transferal of microorganisms from environmental surfaces to patients is largely via hand contact with the surface.”
Sounds like some disagreement among the experts. Well, who knows? We started one revolution. Maybe the British will start another.
Of course, I immediately asked our infection control people about this, seeing a potential opportunity to improve patient care and make life more comfortable for male doctors. Excerpts from their response:
The focus should remain on good hand hygiene and cleaning of equipment (especially stethoscopes) – all of which actually touch the patient. If health care workers cleaned their hands well immediately before touching a patient, it wouldn’t matter if their ties, white coats, palm pilots or pagers were colonized, since these things presumably have minimal contact with the patient, if any. Although all of these fomites have been shown in studies to become colonized, there has never been data proving transmission of infection to a patient. This topic comes up every year – it is a big distraction from the real issues. The CDC and SHEA (Society of Healthcare Epidemiology of America) agree with this stance.
Here is a quote I found about the CDC's view on the matter that supports this view, but I note that the 2004 article in which it is cited seems to head the other direction:
The Centers for Disease Control and Prevention (CDC)’s Guidelines for Environmental Infection Control in Health-Care Facilities state that, “although microbiologically contaminated surfaces can serve as reservoirs of potential pathogens, these surfaces generally are not directly associated with transmission of infections either to staff or patients. The transferal of microorganisms from environmental surfaces to patients is largely via hand contact with the surface.”
Sounds like some disagreement among the experts. Well, who knows? We started one revolution. Maybe the British will start another.
Leapfrog recognition, too
And, another recognition, this one from Leapfrog. Suzanne Delbanco, who has been heading this group for many years, is stepping down. Congratulations to her for her thoughtful approach to the issues and leadership of this important organization. I remember when they first came to Boston to explain their program: It was considered so cutting edge and controversial!
A lot has changed during her seven year tenure in health care, in part because of Leapfrog. The question now is whether Leapfrog has lost importance by actions and programs and disclosure efforts that have hopped over its own approach. That needs to be resolved by its Board as it conducts a search for a replacement to Suzanne.
A lot has changed during her seven year tenure in health care, in part because of Leapfrog. The question now is whether Leapfrog has lost importance by actions and programs and disclosure efforts that have hopped over its own approach. That needs to be resolved by its Board as it conducts a search for a replacement to Suzanne.
More kudos to Ben and the team
Congratulations again for another award to Dr. Ben Sachs and his team in our OB/GYN Department. This one is national is scope, jointly from the National Quality Forum (NQF) and the Joint Commission. It is called the John M. Eisenberg Patient Safety and Quality Awards. Here's a summary from StreetInsider:
This organization is being recognized for the adaptation and application of the military and commercial aviation Crew Resource Management (CRM) principles to the field of obstetrics. After the CRM curriculum was modified for clinical application, 220 staff received training to incorporate the CRM principles and concepts into their daily work processes. The result was a dramatic reduction in major adverse obstetric events, which reduced malpractice liability exposure and improved overall patient safety and the quality of obstetric care. Specifically, a 25.4 percent reduction in the Adverse Outcomes Index (a measure developed for the project) was realized, and the severity of adverse events was reduced by 13.4 percent. The success of this work has been broadly recognized and has driven or influenced similar initiatives, including those of the Harvard Risk Management Foundation, the Commonwealth of Massachusetts, the State of Maryland, and the District of Columbia, among others.
This organization is being recognized for the adaptation and application of the military and commercial aviation Crew Resource Management (CRM) principles to the field of obstetrics. After the CRM curriculum was modified for clinical application, 220 staff received training to incorporate the CRM principles and concepts into their daily work processes. The result was a dramatic reduction in major adverse obstetric events, which reduced malpractice liability exposure and improved overall patient safety and the quality of obstetric care. Specifically, a 25.4 percent reduction in the Adverse Outcomes Index (a measure developed for the project) was realized, and the severity of adverse events was reduced by 13.4 percent. The success of this work has been broadly recognized and has driven or influenced similar initiatives, including those of the Harvard Risk Management Foundation, the Commonwealth of Massachusetts, the State of Maryland, and the District of Columbia, among others.
"Ethically and medically, we felt justified in keeping him"
Please check out this story by Joseph Kahn in today's Boston Globe. Here's a case where the rewards to the caregivers were as meaningful as to the patient.
Monday, September 17, 2007
Simple questions? Simple answers?
"Simple questions" looking for answers:
If medical costs experienced by insurance carriers in Massachusetts are rising at a pretty constant 12 percent per year, driving premium increases of similar magnitude, but economic activity is rising at a rate of 3-4%, at what point does the situation become untenable for the businesses in the state?
If the medical cost increases are caused about 50% by unit cost increases for providers and 50% from increases in utilization (especially utilization of tertiary care) by residents of the state, what countervailing forces might come into play to help alleviate the situation?
If the unit cost increases for providers are driven in great measure by salary pressures from health care workers, what might offset those increases?
Some possible "simple answers":
Self-driven and/or payer-stimulated structural changes by providers to increase efficiency and productivity, i.e., reduce dollars per episode of care delivered.
Decoupling of insurance payments from volume to reduce providers' incentives to increase volume.
Support by insurers to enhance the primary care portion of the system, to enable better preventative care and early diagnoses and intervention (aka, attempt to shift the delivery of services away from high end tertiary care back towards the primary end).
Enforced rationalization of care by insurers based on actual outcomes data (including financial incentives to patients) to encourage patients to go to higher quality providers.
Exclusion by insurers of providers who do not offer sufficiently high quality service, either overall or in particular specialties.
Creation of a strong consumer movement to demand disclosure of outcomes data to help drive process improvement.
Creation of a strong employer movement to demand disclosure of outcomes data to help drive process improvement and to create demand for insurers to offer new networks of high performance providers.
What are your questions and answers? If we narrow these down, maybe we can help set the agenda.
If medical costs experienced by insurance carriers in Massachusetts are rising at a pretty constant 12 percent per year, driving premium increases of similar magnitude, but economic activity is rising at a rate of 3-4%, at what point does the situation become untenable for the businesses in the state?
If the medical cost increases are caused about 50% by unit cost increases for providers and 50% from increases in utilization (especially utilization of tertiary care) by residents of the state, what countervailing forces might come into play to help alleviate the situation?
If the unit cost increases for providers are driven in great measure by salary pressures from health care workers, what might offset those increases?
Some possible "simple answers":
Self-driven and/or payer-stimulated structural changes by providers to increase efficiency and productivity, i.e., reduce dollars per episode of care delivered.
Decoupling of insurance payments from volume to reduce providers' incentives to increase volume.
Support by insurers to enhance the primary care portion of the system, to enable better preventative care and early diagnoses and intervention (aka, attempt to shift the delivery of services away from high end tertiary care back towards the primary end).
Enforced rationalization of care by insurers based on actual outcomes data (including financial incentives to patients) to encourage patients to go to higher quality providers.
Exclusion by insurers of providers who do not offer sufficiently high quality service, either overall or in particular specialties.
Creation of a strong consumer movement to demand disclosure of outcomes data to help drive process improvement.
Creation of a strong employer movement to demand disclosure of outcomes data to help drive process improvement and to create demand for insurers to offer new networks of high performance providers.
What are your questions and answers? If we narrow these down, maybe we can help set the agenda.
Thanks to Business Week
Many thanks to Business Week for inviting me to submit an article to the online edition. Here it is. The topic will be no surprise to readers of this blog.
Sunday, September 16, 2007
Do we need Storrow Drive?
Apologies to those from other cities or who are just reading this blog for health care items, but every now and then I like to dive back into the infrastructure arena. It is actually the field I am trained in, worked in for many years, and taught at MIT. So sometimes I can't resist. One of my colleagues in this field is Fred Salvucci, former MA secretary of transportation. We worked together in state government and also at MIT. We were gabbing about a bunch of topics, and both of us had been thinking about this one, and it just bubbled up. I don't know if he wanted me to make it public, but if you like the idea, give him credit. If you don't, give me the blame.
The topic is Storrow Drive, a road that began in the days of "parkways", pleasure roads that were off-limits to trucks. From the beginning, this one was controversial, in that it was built on state parkland bordering the Charles River. The Charles River basin was itself an early, successful example of regional planning, envisioned by Charles Eliot in the 1890's as a unique combination of urban parkland, flood control, and improved sanitation.
Today, Storrow Drive is a main arterial road, leading traffic to various points of downtown Boston. Most of the time, you are too busy driving around odd curves and on ramps and off ramps and avoiding aggressive Boston drivers to remember that you are on a pleasure vehicle parkway. The physical components of the road have deteriorated over the last 70 years and require major rebuilding. The current controversy is how to carry out the construction and maintain the traffic flow. A plan floated by the state is to take existing parkland -- the Esplanade -- as a temporary route during this construction period. This has raised objections from a variety of quarters. Here is an example published yesterday by two former highly respected parks commissioners, John Sears and Bill Geary.
Opportunities like this come along but rarely, and I think we should ask the question: Do we need Storrow Drive? Please understand that I have not done a detailed technical analysis -- and this idea might be all wet -- but would the City of Boston and the region be better off without a commuters' highway alongside one of the most beautiful portions of the city?
Imagine Boston without Storrow Drive, say from the BU Bridge to the Longfellow Bridge. The horrible gash isolating the Back Bay from the Charles River would be gone. There could be a walk to the river from every street between Charles and St. Mary's.
Impossible, you say? Look at San Francisco, where the Central Freeway was taken down after it was damaged in an earthquake -- or the West Side Highway in New York, which was likewise eliminated when a portion collapsed.
How to do it here? Let's say that a new BU Bridge -- and yes, the BU Bridge will have to be replaced soon because it is in terrible shape -- were connected directly to exit and on ramps from the Mass. Turnpike and then repositioned on the Cambridge side to align with Vassar Street instead of bumping into the Reid Overpass on Memorial Drive so that Turnpike drivers could go directly to their destinations at MIT and Kendall Square. Let's say the Grand Junction railroad bridge were reconfigured as an express bus and pedestrian route from Cambridge to Boston to enhance mass transit, walking, and biking between Cambridge and BU and the Longwood Area. Let's say the Longfellow Bridge -- and yes, this bridge will be rebuilt also -- had revised approaches on the Boston side. You get the idea.
The lesson from San Francisco and New York is that highways like this generate their own traffic. When they are eliminated, the traffic can be directed more rationally, and urban amenities like access to the water, walking, biking, and parklands can be enhanced. Maybe Storrow Drive is really needed. But maybe it isn't. Before we spend millions of dollars duplicating its design flaws, let's ask the question with an open mind and consider the alternatives.
The topic is Storrow Drive, a road that began in the days of "parkways", pleasure roads that were off-limits to trucks. From the beginning, this one was controversial, in that it was built on state parkland bordering the Charles River. The Charles River basin was itself an early, successful example of regional planning, envisioned by Charles Eliot in the 1890's as a unique combination of urban parkland, flood control, and improved sanitation.
Today, Storrow Drive is a main arterial road, leading traffic to various points of downtown Boston. Most of the time, you are too busy driving around odd curves and on ramps and off ramps and avoiding aggressive Boston drivers to remember that you are on a pleasure vehicle parkway. The physical components of the road have deteriorated over the last 70 years and require major rebuilding. The current controversy is how to carry out the construction and maintain the traffic flow. A plan floated by the state is to take existing parkland -- the Esplanade -- as a temporary route during this construction period. This has raised objections from a variety of quarters. Here is an example published yesterday by two former highly respected parks commissioners, John Sears and Bill Geary.
Opportunities like this come along but rarely, and I think we should ask the question: Do we need Storrow Drive? Please understand that I have not done a detailed technical analysis -- and this idea might be all wet -- but would the City of Boston and the region be better off without a commuters' highway alongside one of the most beautiful portions of the city?
Imagine Boston without Storrow Drive, say from the BU Bridge to the Longfellow Bridge. The horrible gash isolating the Back Bay from the Charles River would be gone. There could be a walk to the river from every street between Charles and St. Mary's.
Impossible, you say? Look at San Francisco, where the Central Freeway was taken down after it was damaged in an earthquake -- or the West Side Highway in New York, which was likewise eliminated when a portion collapsed.
How to do it here? Let's say that a new BU Bridge -- and yes, the BU Bridge will have to be replaced soon because it is in terrible shape -- were connected directly to exit and on ramps from the Mass. Turnpike and then repositioned on the Cambridge side to align with Vassar Street instead of bumping into the Reid Overpass on Memorial Drive so that Turnpike drivers could go directly to their destinations at MIT and Kendall Square. Let's say the Grand Junction railroad bridge were reconfigured as an express bus and pedestrian route from Cambridge to Boston to enhance mass transit, walking, and biking between Cambridge and BU and the Longwood Area. Let's say the Longfellow Bridge -- and yes, this bridge will be rebuilt also -- had revised approaches on the Boston side. You get the idea.
The lesson from San Francisco and New York is that highways like this generate their own traffic. When they are eliminated, the traffic can be directed more rationally, and urban amenities like access to the water, walking, biking, and parklands can be enhanced. Maybe Storrow Drive is really needed. But maybe it isn't. Before we spend millions of dollars duplicating its design flaws, let's ask the question with an open mind and consider the alternatives.
Saturday, September 15, 2007
(B)ring those cowbells again
Back in April, I related the story of the cowbells on Boston's river roads that are used to signal truckers that their rigs are too high for the underpasses. The theme is revived in a story by Michael Levenson in today's Boston Globe.
But note this contrary view:
But some specialists said the use of cowbells could be dangerous.
"I don't like it at all," said Thomas Hicks, director of the office of traffic and safety at the Maryland Department of Transportation who serves on a national panel of highway engineers. "It might fly off and run into somebody's windshield and a cowbell is usually pretty substantial steel."
There is not an iota of evidence from the past 20+ years that the cowbells are dangerous. Instead, there are 20+ years of experience that the bells and signs together reduced the danger of trucks crashing into overpasses. You want "substantial steel"? Try a multi-ton steel truck smashing into a steel overpass. That's substantial steel.
Dear Commissioner of DCR, please just put back and maintain what is proven to work.
But note this contrary view:
But some specialists said the use of cowbells could be dangerous.
"I don't like it at all," said Thomas Hicks, director of the office of traffic and safety at the Maryland Department of Transportation who serves on a national panel of highway engineers. "It might fly off and run into somebody's windshield and a cowbell is usually pretty substantial steel."
There is not an iota of evidence from the past 20+ years that the cowbells are dangerous. Instead, there are 20+ years of experience that the bells and signs together reduced the danger of trucks crashing into overpasses. You want "substantial steel"? Try a multi-ton steel truck smashing into a steel overpass. That's substantial steel.
Dear Commissioner of DCR, please just put back and maintain what is proven to work.
Congratulations, Jerry!
Bravo to Doctor Jerome Groopman (Chief of Experimental Medicine at BIDMC) for being awarded a Quill Award in the Health/Self-Improvement category for his book How Doctors Think.(The picture has nothing to do with the book, but I really like it. It was sent to me by my sister, Sita Likuski, after she took it along the Alameda shoreline in California.)
Thursday, September 13, 2007
Something in their water?
Should I install a new filter in the water supply system serving our IS department? Notwithstanding the picture below of our CIO, John Halamka, I had been able to push back any worries of unorthodox or risky behavior on behalf of our IS staff. Now, John reports the following news and sends the pictures above: "One of my IS Managers, Bill Gillis, just set the new world record for the land speed record on a motorcycle (250cc class) of 214.775 miles per hour at Bonneville Salt Flats!" Here's more information.Wednesday, September 12, 2007
Notes from Gaza and Boston
From a physician friend in Gaza:
This week Jews are celebrating the New Year -- Rosh Hashana -- and Muslems are celebrating Ramadan.
On this occasion of Rosh Hashana, I wish you a peaceful and happy days and have our world become a better place to live in peace and harmony. I wish you and your family health , happiness and gratification.
May this year be a better than the previous one, a year of peace, safety, health and freedom from oppression and fear, and I pray that our dreams and aspirations come true.
And similar thoughts from a colleague here in Boston:
As you prepare your minds, bodies and spirits for a time of celebration and reflection, I wanted to send you warm greetings. In solidarity, I will be praying for peace in Israel and throughout the world. In solidarity, I will reflect on ways that I may treat fellow beings with greater love and respect, not turning a blind eye to the suffering of others. In solidarity I will give thanks for all my blessings, most notably that each of you is part of my life.
And warm wishes to all of my loyal readers as well.
This week Jews are celebrating the New Year -- Rosh Hashana -- and Muslems are celebrating Ramadan.
On this occasion of Rosh Hashana, I wish you a peaceful and happy days and have our world become a better place to live in peace and harmony. I wish you and your family health , happiness and gratification.
May this year be a better than the previous one, a year of peace, safety, health and freedom from oppression and fear, and I pray that our dreams and aspirations come true.
And similar thoughts from a colleague here in Boston:
As you prepare your minds, bodies and spirits for a time of celebration and reflection, I wanted to send you warm greetings. In solidarity, I will be praying for peace in Israel and throughout the world. In solidarity, I will reflect on ways that I may treat fellow beings with greater love and respect, not turning a blind eye to the suffering of others. In solidarity I will give thanks for all my blessings, most notably that each of you is part of my life.
And warm wishes to all of my loyal readers as well.
Patient generosity of spirit
It is a well recognized phenomenon, but it still brings me up short when I see it. The issue is that when life support is removed or a patient dies for other reasons, family members often want to make sure that the attending physician does not feel too upset by the event. Perhaps this is some kind of transference reaction, but I think it is more a case of generosity of spirit emerging from the particularly close relationship that develops during these end-of-life cases.
I recently received a note from a colleague whose relative had died after a difficult hospital procedure. He wrote to tell me about the case and said about the physician: "He seemed very upset. He is a good and conscientious man. Please check in on him and make sure he is OK."
I recently received a note from a colleague whose relative had died after a difficult hospital procedure. He wrote to tell me about the case and said about the physician: "He seemed very upset. He is a good and conscientious man. Please check in on him and make sure he is OK."
Can you believe this one?
Another in my occasional series on email solicitations that really make you wonder. I've left the link so you can get all the details. Does anyone really sign up for this one?
Dear Paul Levy,
If you'd like to learn strategies to effectively handle dreaded conversations with your most stubborn doctors, this is your last chance to register for a live, 60-minute Audio Conference:
"Dealing with Difficult Doctors: Eliminate Power Struggles & Bad Behavior"
Wednesday, September 19, 2007 1:00-2:00 p.m. ET
http://www.pbconferences.com/diffdoc4C?ID=-1108971932
Getting into a power struggle with a difficult doctor is a bad idea.
Listen to proven strategies to conduct difficult conversations and improve your department’s culture. Save your hospital valuable time and money by nipping potential problems in the bud. During this 60-minute conference, you and your staff can clear the air, deal with problems quickly and build a culture of excellence.
***
Hosted by Progressive Business Publications, a leader in fast-read actionable advice on workplace issues, the audio conference gives you the opportunity to add immediate, impact to your marketing efforts in a manner that is:
FAST - No wasted time here. Get right to the heart of the matter in a 1-hour block designed to easily fit into your busy schedule.
CONVENIENT - No airlines. No travel. No time out of the office.
Listen from the comfort and convenience of your desk.
EASY - A telephone is all the equipment you need. Just dial in, punch in your access code, and you're in. That's it. Follow along with the audio conference handouts provided in advance.
ACTIONABLE - Our audio conferences provide money-saving tactics you can start using right when you hang up the phone.
IDEAL FOR MULTIPLE LISTENERS - Use a speakerphone and as many people as you want can listen in - at no extra cost to you. Many professionals use these sessions as a cost-efficient, time-efficient means of training supervisors, managers, and staff and reinforcing key issues in a fresh new manner that they will remember and act on.
AFFORDABLE - Priced at $199, it is a fraction of the cost of travel and attendance fees for other high-priced conferences or seminars.
Dear Paul Levy,
If you'd like to learn strategies to effectively handle dreaded conversations with your most stubborn doctors, this is your last chance to register for a live, 60-minute Audio Conference:
"Dealing with Difficult Doctors: Eliminate Power Struggles & Bad Behavior"
Wednesday, September 19, 2007 1:00-2:00 p.m. ET
http://www.pbconferences.com/diffdoc4C?ID=-1108971932
Getting into a power struggle with a difficult doctor is a bad idea.
Listen to proven strategies to conduct difficult conversations and improve your department’s culture. Save your hospital valuable time and money by nipping potential problems in the bud. During this 60-minute conference, you and your staff can clear the air, deal with problems quickly and build a culture of excellence.
***
Hosted by Progressive Business Publications, a leader in fast-read actionable advice on workplace issues, the audio conference gives you the opportunity to add immediate, impact to your marketing efforts in a manner that is:
FAST - No wasted time here. Get right to the heart of the matter in a 1-hour block designed to easily fit into your busy schedule.
CONVENIENT - No airlines. No travel. No time out of the office.
Listen from the comfort and convenience of your desk.
EASY - A telephone is all the equipment you need. Just dial in, punch in your access code, and you're in. That's it. Follow along with the audio conference handouts provided in advance.
ACTIONABLE - Our audio conferences provide money-saving tactics you can start using right when you hang up the phone.
IDEAL FOR MULTIPLE LISTENERS - Use a speakerphone and as many people as you want can listen in - at no extra cost to you. Many professionals use these sessions as a cost-efficient, time-efficient means of training supervisors, managers, and staff and reinforcing key issues in a fresh new manner that they will remember and act on.
AFFORDABLE - Priced at $199, it is a fraction of the cost of travel and attendance fees for other high-priced conferences or seminars.
Tuesday, September 11, 2007
HBS on the IT Case
For those of you with a detailed interest in our information systems, Richard Bohmer, F. Warren Mcfarlan, and Julia Adler-Milstein have just published a case study entitled "Information Technology and Clinical Operations at Beth Israel Deaconess Medical Center". It is available from Harvard Business Online for purchase. Here is the link.Meanwhile, please see the picture above of our intrepid CIO, John Halamka, who recently climbed the Eaglet in Franconia Notch -- the tallest rock pillar east of the Mississippi. The Eaglet is located in Franconia Notch, just across Highway 93 from the former Old Man of the Mountain. Look closely and note John's body position and posture. He explains:
We were doing a data center electrical cutover, so I was checking in via Blackberry.
Monday, September 10, 2007
SEIU response
The Boston Globe's White Coat Notes contains the following, after citing my post below:
The union responded this afternoon, saying Levy "continues to parrot the Bush Administration's talking points in the way he mischaracterizes Senator Kennedy's ... bill, which was not the subject of our letter."
"Despite Mr. Levy's attempts to obfuscate what many hospital workers throughout Boston are actually asking for, our message is clear," SEIU executive vice president Mike Fadel said in an e-mail. "Hospital workers across the city are calling for free and fair union secret ballot elections, which include a code of conduct agreed to by employers to ensure their right to vote is not interfered with by hospital management."
This is really something. It appears that the nastiest thing you can say about someone in Massachusetts is that (1) they they may have said something similar to what a Republican administration has said and (2) that they might disagree with our senior Senator. In our overwhelmingly single party state, this is a way of trying to isolate (and watch for this next -- demonize) someone who disagrees with you.
For the record, I have tremendous regard and affection for Senator Kennedy and what he has done for this state, this country, and the world and -- how shall I say this politely? -- much less regard and affection for the Bush administration.
But that is not really the point, is it? These issues ultimately rise or fall on their own merit. As I mentioned below, I have seen no public reports that any person in authority at any of the hospitals in Boston has agreed with the SEIU's proposed code of conduct. Are all the hospital CEOs pseudo-Democrat anti-incumbent apologists for the Republican party? Or are there substantive and legitimate reasons for the lack of traction for the union's proposal in this city? Or perhaps someone has agreed to the code of conduct but has not made it public. If so, now would be a good time to speak up and explain the reasons for your agreement.
The union responded this afternoon, saying Levy "continues to parrot the Bush Administration's talking points in the way he mischaracterizes Senator Kennedy's ... bill, which was not the subject of our letter."
"Despite Mr. Levy's attempts to obfuscate what many hospital workers throughout Boston are actually asking for, our message is clear," SEIU executive vice president Mike Fadel said in an e-mail. "Hospital workers across the city are calling for free and fair union secret ballot elections, which include a code of conduct agreed to by employers to ensure their right to vote is not interfered with by hospital management."
This is really something. It appears that the nastiest thing you can say about someone in Massachusetts is that (1) they they may have said something similar to what a Republican administration has said and (2) that they might disagree with our senior Senator. In our overwhelmingly single party state, this is a way of trying to isolate (and watch for this next -- demonize) someone who disagrees with you.
For the record, I have tremendous regard and affection for Senator Kennedy and what he has done for this state, this country, and the world and -- how shall I say this politely? -- much less regard and affection for the Bush administration.
But that is not really the point, is it? These issues ultimately rise or fall on their own merit. As I mentioned below, I have seen no public reports that any person in authority at any of the hospitals in Boston has agreed with the SEIU's proposed code of conduct. Are all the hospital CEOs pseudo-Democrat anti-incumbent apologists for the Republican party? Or are there substantive and legitimate reasons for the lack of traction for the union's proposal in this city? Or perhaps someone has agreed to the code of conduct but has not made it public. If so, now would be a good time to speak up and explain the reasons for your agreement.
Friday, September 07, 2007
Another page from the playbook
Several weeks ago, I gave an update on the tactics that have been used by the Service Employees International Union in its attempt to organize unions at hospitals. Here is another page from the playbook.
Recently, many of our doctors received a letter from the union in which the following points were made: (1) that the BIDMC's administration has mischaracterized its position; and (2) that the SEIU has asked that the management of Boston's not-yet-union hospitals agree to a "free and fair election code of conduct", "free for workers to make up their own minds under fair secret ballot voting conditions." This code would include "a commitment by hospital executives to neither devote patient care funds toward disruptive anti-union campaigns, nor divert health care workers' time from their patient care duties to attend mandatory anti-union meetings." The code of conduct would "call on all parties to allow workers to make their own decisions in an environment free of coercion and to honor the outcome of a secret ballot election." The union says, "The secret ballot point is noteworthy, given that one CEO has been publicly arguing against a code of conduct by asserting that he supports secret ballot elections."
While it is awkward to impute another's motivation, it appears that the letter has three purposes. First, to obfuscate the statements made by management of hospitals about this issue. Second, to present a revisionist view of what the union itself has said in other forums -- like in the US Congress, where it has strenuously argued for an elimination of elections. Third, to attempt to drive a wedge between the management and a hospital's physicians by using these mischaracterizations and appealing to the doctors' underlying sense of fairness and fondness for the workers in the hospital.
Beth Israel Deaconess Medical Center
General Code of Conduct Regarding Organizing Activities
BIDMC has a strong commitment to its mission of community service in providing excellent clinical care, conducting medical research, and training future generations of medical professionals. As an academic medical center and prominent member of the corporate and civic communities, BIDMC is committed to an environment of respectful and open discourse and debate among its management, employees and physicians. It is of the utmost concern to the Board of Directors that this fair and unhindered exchange of points of view is maintained and supported during all times, including any attempt by unions to organize staff at BIDMC. Therefore the Board of Directors adopts this General Code of Conduct.
Conduct Standards
BIDMC has long believed that managers, supervisors and employees best serve the interests of patients by working together. Further, it is imperative that everyone in the work environment remain focused on patient care while continuing to have open communication and professional interaction respecting everyone's freedom of belief.
Managerial and Supervisory Employees of BIDMC
When communicating with employees, including regarding union activities, managers and supervisors are encouraged to promote an open and robust dialogue and share with employees factual information. Managers and supervisors also should feel free to express their opinions and encourage employees to ask questions. On the other hand, in any discussions with employees, respect is paramount. Specifically in the union activities context, managers and supervisors must not threaten or interrogate employees about their union activities, nor may managers or supervisors make promises to employees to induce them to be against the union. Finally, managers and supervisors must not conduct surveillance of union activities.
Non-Managerial/Supervisory Employees of BIDMC
Non-managerial and non-supervisory employees may engage in union organizing activities only on non-working time and only in non-patient care areas. BIDMC’s “No Solicitation and No Distribution” policy, “Use of Public Space Policy” and the Human Resources Department are available as resources to answer questions in this regard.
Non-Employees
Finally, individuals not employed by BIDMC may not engage in union organizing activities on BIDMC property.
Additional Information
Anyone with questions or concerns regarding this General Code of Conduct is urged to contact the Beth Israel Deaconess Human Resources Department or the Beth Israel Deaconess Office of Business Conduct.
Now, I know this may not be what the SEIU has in mind. But what it has in mind is not consistent with the balanced approach adopted by the Congress and the courts under the National Labor Relations Act.
Let me give just one example that is problematic in the approach suggested by the SEIU, its point of not using patient care funds for anti-union activities. The term "patient care funds" is highly ambiguous. All hospitals have multiple sources of revenues -- Medicare, Medicaid, private insurance companies, philanthropy, interest, dividends, intellectual property, sales of real estate -- and these dollars are indistinguishable once they are received. Some of these sources contribute to the hospital's margin, i.e, excess of revenues over costs. But in other cases, like Medicaid, the state underpays hospitals relative to patient care costs, and so those services are subsidized by a number of other sources. To prove that "patient care funds" were not being used, say, for legal counsel during a unionization drive would be a CPA's dream, in terms of billable hours, because there is no methodology for an auditable resolution to this matter.
I don't know if the SEIU has indeed asked any hospitals in Boston to adopt its proposed code of conduct, but I do know that there are no public reports of a hospital having agreed to do so. If one of them has, please submit a comment on this blog so we will all know that you have. The union's attempt to suggest that there is only one CEO in this city who believes along these lines has not been supported in any way whatsoever. If there is a CEO out there who agrees with the SEIU's proposal, please publish the code you have adopted and speak up so we can all understand why you have agreed to such a code.
Recently, many of our doctors received a letter from the union in which the following points were made: (1) that the BIDMC's administration has mischaracterized its position; and (2) that the SEIU has asked that the management of Boston's not-yet-union hospitals agree to a "free and fair election code of conduct", "free for workers to make up their own minds under fair secret ballot voting conditions." This code would include "a commitment by hospital executives to neither devote patient care funds toward disruptive anti-union campaigns, nor divert health care workers' time from their patient care duties to attend mandatory anti-union meetings." The code of conduct would "call on all parties to allow workers to make their own decisions in an environment free of coercion and to honor the outcome of a secret ballot election." The union says, "The secret ballot point is noteworthy, given that one CEO has been publicly arguing against a code of conduct by asserting that he supports secret ballot elections."
While it is awkward to impute another's motivation, it appears that the letter has three purposes. First, to obfuscate the statements made by management of hospitals about this issue. Second, to present a revisionist view of what the union itself has said in other forums -- like in the US Congress, where it has strenuously argued for an elimination of elections. Third, to attempt to drive a wedge between the management and a hospital's physicians by using these mischaracterizations and appealing to the doctors' underlying sense of fairness and fondness for the workers in the hospital.
I am not sure to which CEO the SEIU is referring. On the off chance it refers to me, you can judge for yourself in that the statements I have made are clear and available here for you to see in many of these blog postings. At BIDMC, we surely support a free and fair election, and our Board of Directors has adopted and published a code of conduct on this matter that properly reflects the federal rules and regulations governing such matters. Here it is:
Beth Israel Deaconess Medical Center
General Code of Conduct Regarding Organizing Activities
BIDMC has a strong commitment to its mission of community service in providing excellent clinical care, conducting medical research, and training future generations of medical professionals. As an academic medical center and prominent member of the corporate and civic communities, BIDMC is committed to an environment of respectful and open discourse and debate among its management, employees and physicians. It is of the utmost concern to the Board of Directors that this fair and unhindered exchange of points of view is maintained and supported during all times, including any attempt by unions to organize staff at BIDMC. Therefore the Board of Directors adopts this General Code of Conduct.
Conduct Standards
BIDMC has long believed that managers, supervisors and employees best serve the interests of patients by working together. Further, it is imperative that everyone in the work environment remain focused on patient care while continuing to have open communication and professional interaction respecting everyone's freedom of belief.
Managerial and Supervisory Employees of BIDMC
When communicating with employees, including regarding union activities, managers and supervisors are encouraged to promote an open and robust dialogue and share with employees factual information. Managers and supervisors also should feel free to express their opinions and encourage employees to ask questions. On the other hand, in any discussions with employees, respect is paramount. Specifically in the union activities context, managers and supervisors must not threaten or interrogate employees about their union activities, nor may managers or supervisors make promises to employees to induce them to be against the union. Finally, managers and supervisors must not conduct surveillance of union activities.
Non-Managerial/Supervisory Employees of BIDMC
Non-managerial and non-supervisory employees may engage in union organizing activities only on non-working time and only in non-patient care areas. BIDMC’s “No Solicitation and No Distribution” policy, “Use of Public Space Policy” and the Human Resources Department are available as resources to answer questions in this regard.
Non-Employees
Finally, individuals not employed by BIDMC may not engage in union organizing activities on BIDMC property.
Additional Information
Anyone with questions or concerns regarding this General Code of Conduct is urged to contact the Beth Israel Deaconess Human Resources Department or the Beth Israel Deaconess Office of Business Conduct.
Now, I know this may not be what the SEIU has in mind. But what it has in mind is not consistent with the balanced approach adopted by the Congress and the courts under the National Labor Relations Act.
Let me give just one example that is problematic in the approach suggested by the SEIU, its point of not using patient care funds for anti-union activities. The term "patient care funds" is highly ambiguous. All hospitals have multiple sources of revenues -- Medicare, Medicaid, private insurance companies, philanthropy, interest, dividends, intellectual property, sales of real estate -- and these dollars are indistinguishable once they are received. Some of these sources contribute to the hospital's margin, i.e, excess of revenues over costs. But in other cases, like Medicaid, the state underpays hospitals relative to patient care costs, and so those services are subsidized by a number of other sources. To prove that "patient care funds" were not being used, say, for legal counsel during a unionization drive would be a CPA's dream, in terms of billable hours, because there is no methodology for an auditable resolution to this matter.
I don't know if the SEIU has indeed asked any hospitals in Boston to adopt its proposed code of conduct, but I do know that there are no public reports of a hospital having agreed to do so. If one of them has, please submit a comment on this blog so we will all know that you have. The union's attempt to suggest that there is only one CEO in this city who believes along these lines has not been supported in any way whatsoever. If there is a CEO out there who agrees with the SEIU's proposal, please publish the code you have adopted and speak up so we can all understand why you have agreed to such a code.
Thursday, September 06, 2007
Lesson from Missoula
One of the most moving speeches I have read is one given by Don Berwick, the head of the Institute for Healthcare Improvement, at his 1999 annual symposium. It was entitled Escape Fire, and it drew lessons from a tragic fire at Mann Gulch in Montana.
Here is a summary from the link above: "When fire surrounded more than a dozen firefighters on the hillside, their leader had an unusual idea for survival. He burned an area of pasture around him and lay down in the dead grass in hopes the fire would pass over him (an escape fire). His team found the method too risky and refused to join him. Most of them perished in the inferno, while their leader survived. Dr. Berwick's message to health care professionals is that rejecting innovative ideas will have grave consequences on the industry."
I had occasion recently to visit the smokejumpers headquarters in Missoula, Montana. You would be hard-pressed to imagine a more dedicated group of people, who risk their lives by parachuting into remote areas to snuff out forest fires. As you can imagine, too, this is a group that pays a lot of attention to safety and that has a terrific record on that front. By any measure, we in health care have a lot to learn from them.
Imagine my surprise then, when I conversed with one of the crew and asked a simple question based a picture in the wall of the HQ. It showed a jumper leaving a plane in a "sitting" position, legs out front. I simply asked, "Is that the expected body position?" The man I asked said that it was a generally good position in that the aerodynamics tended to twist the person's body in the right direction to avoid tangling up in the airplane or other problems.
But then he said that for a tall person, the position could be problematic in that some percentage of the time, the aerodynamics would actually twist you in the wrong way, leaving the jumper a bit disoriented and his parachute apparatus in an uncomfortable position. So, he said, he learned to bend his legs up under his butt and take a more cannonball position leaving the plane. This would avoid the unexpected twist after leaving the airplane. Later, in talking with other jumpers, he learned that some of them did the same thing. So, there was an informal "rule of thumb" that was in play for some of the jumpers for many years.
Here was the interesting punch line: Notwithstanding the long-standing existence of this helpful informal knowledge, it has only been recently that this alternate form of jumping position was formally included in the smokejumpers' training curriculum.
The lesson for the rest of us: If an absolutely superb, tight-knit, highly focused, and disciplined organization like the smokejumpers occasionally experiences informal work-arounds to safety and quality issues -- with inherent delays in systemic education and improvement -- imagine the degree to which this occurs in complicated places like hospitals.
Here is a summary from the link above: "When fire surrounded more than a dozen firefighters on the hillside, their leader had an unusual idea for survival. He burned an area of pasture around him and lay down in the dead grass in hopes the fire would pass over him (an escape fire). His team found the method too risky and refused to join him. Most of them perished in the inferno, while their leader survived. Dr. Berwick's message to health care professionals is that rejecting innovative ideas will have grave consequences on the industry."
I had occasion recently to visit the smokejumpers headquarters in Missoula, Montana. You would be hard-pressed to imagine a more dedicated group of people, who risk their lives by parachuting into remote areas to snuff out forest fires. As you can imagine, too, this is a group that pays a lot of attention to safety and that has a terrific record on that front. By any measure, we in health care have a lot to learn from them.
Imagine my surprise then, when I conversed with one of the crew and asked a simple question based a picture in the wall of the HQ. It showed a jumper leaving a plane in a "sitting" position, legs out front. I simply asked, "Is that the expected body position?" The man I asked said that it was a generally good position in that the aerodynamics tended to twist the person's body in the right direction to avoid tangling up in the airplane or other problems.
But then he said that for a tall person, the position could be problematic in that some percentage of the time, the aerodynamics would actually twist you in the wrong way, leaving the jumper a bit disoriented and his parachute apparatus in an uncomfortable position. So, he said, he learned to bend his legs up under his butt and take a more cannonball position leaving the plane. This would avoid the unexpected twist after leaving the airplane. Later, in talking with other jumpers, he learned that some of them did the same thing. So, there was an informal "rule of thumb" that was in play for some of the jumpers for many years.
Here was the interesting punch line: Notwithstanding the long-standing existence of this helpful informal knowledge, it has only been recently that this alternate form of jumping position was formally included in the smokejumpers' training curriculum.
The lesson for the rest of us: If an absolutely superb, tight-knit, highly focused, and disciplined organization like the smokejumpers occasionally experiences informal work-arounds to safety and quality issues -- with inherent delays in systemic education and improvement -- imagine the degree to which this occurs in complicated places like hospitals.
Wednesday, September 05, 2007
Why do policemen like doughnuts?
A very much lighter note from the New York Daily News of September 4. In a special kids section, the question is asked, "Why do policemen like doughnuts?" The answer given by John F. Timoney, chief of the Miami Police Department:
It's because doughnut stores, especially in New York City, are everywhere. The ethnic foods can change from neighborhood to neighborhood, but the one staple is coffee and donuts. It's quick and easy; if while you are eating in the car you happen to get an emergency call, you can discard them easily . . . you throw them out of the window and you are gone.
Call to my readers. Does this ring true? And, how would a NYC cop answer the question? And is the answer different for Boston, home to Dunkin' Donuts? How about other cities?
Come on folks. Take a break from health care and give us your answer, but don't spill the coffee on your keyboard.
It's because doughnut stores, especially in New York City, are everywhere. The ethnic foods can change from neighborhood to neighborhood, but the one staple is coffee and donuts. It's quick and easy; if while you are eating in the car you happen to get an emergency call, you can discard them easily . . . you throw them out of the window and you are gone.
Call to my readers. Does this ring true? And, how would a NYC cop answer the question? And is the answer different for Boston, home to Dunkin' Donuts? How about other cities?
Come on folks. Take a break from health care and give us your answer, but don't spill the coffee on your keyboard.
Tuesday, September 04, 2007
Poetry from nurses and doctors -- Part II
Here are some pieces of prose and some more poems written by doctors and nurses here that were presented at one of our Schwartz Center Rounds several weeks ago. Warning: Some of these will hurt to read.
---
A Job
By Grace Campbell-Dupont
A job is a job, but it is what you bring to it which makes the difference
your job should bring out the best in you, no matter the situation or circumstance.
Experience comes in many ways and comes in handy when applied to every day situations. It does not matter what you do, as long as it is done with pride deriving satisfaction at the end of the day.
High values and great expectations come with the job sometimes
that expectation fall short when there is no connection between self and job.
To listen is to learn and to learn is to give your very best, to observe is to be diligent
To see and to do without being asked, Give your best as is expected.
Never short change your giving because you will compromise what you believe in. There is Satisfaction to be gained in knowing that you give not only of what is expected, but of your very best.
My work is very important to the smooth running of the UNIT
I may not have all the answers to many question asked but there is resource
just a phone call away, and just knowing that you have tried makes a difference. Smile while you can, no matter the outcome let your eyes brings hope, your voice sooth the caller, the one who is grieving and hope to those who need to see that the person at the desk gives respect and understand their anxiety.
Finding a job that you like is not easy or one that brings satisfaction
but when you do, it brings out the best in you, even though it is not about you
but what you can do and how well you can do it.
Working in the UNIT gives a clear and sober understanding of how important
and precious life is. Each day brings new experience and new appreciation for the smallest things in life, nothing is taken for granted as it can be taken away in just one breath...
Behind each drawn curtain excellent care is given to which I may not be a part but when that curtain is drawn with urgency and there is no time to waste it is time For action you must ready.
With humility I take my chair and give the best of my self performing
Just like the day before. As you look and see, listen and learn a whole new world unfolds of endurance, strength and dedication of those on whose shoulders rest the responsibility of making health and Safety their priority and the true spirit of TEAM coming together for the purpose of caring.
---
Ownership
By Matthew Hitron, MD
During my third year of medical school one of my patients died. It was a medical error that killed her, and I have been told to feel that the responsibility for it is shared, as a system and as a team. I didn’t feel that way then, and I don’t feel that way now. She died not only because of a screw up, but because no one really cared. I live with the fact that I could have stopped it. She needed someone to care, and I failed her in that. She was an elderly woman with many problems and a dementia that made her difficult to interview and examine. She was uncooperative and at times combative. She had no family, with a court appointed legal guardian and HCP. She arrived from her nursing home with mucus stains on her face and two necrotic toes. She swore at you, and even spat at you when you tried to speak with her. There are ways to break down the story into its components, and analyze the systems that failed; the cracks that she fell through. But it is smoke clouding the picture of a patient who was going to challenge all her care givers by requiring of them a true and exhausting commitment to her humanity; a humanity that was easily forgotten after a few seconds in the room. She was passed off from person to person, service to service, consult to consult; and I was complicit in this.
It was two weeks into my third year medicine clerkship. At times it felt like a show and I was painfully aware of the need to impress. I was not about to back down from any task, and was constantly negotiating the third year paradox of needing to learn everything while hiding the fact that you know nothing. My resident warned me she would be tough, but I had to prove I was good. She was admitted that night uneventfully, numerous consults were called, and the day was over.
The next day she was the last patient on rounds, kept NPO and on maintenance fluids while she sat in her room like that was the curative measure. Nothing happened. The team would wait for the consults to do something and the consults would wait for the team to tell them what to do. The removal of her dead toes was at least some sort of plan, but her strangely elevated INR, her ominous acidosis, and her altered mental status were just glossed over before lunch, with vitamin K, bicarb, and olanzapine given to make everybody feel better.
I came in the next morning, and as I flubbed my way through the note jotting down a K+ value of 2.0, it never occurred to me to be sure someone else knew about it. I remember thinking “wow; that sure is low…” if it were a test question I would have gotten it right. With all the nurses, consultants, and residents milling around her, someone must have seen it too and acted with purpose. No one did that morning. Instead of taking ownership, I was just another in a long line who passed the responsibility off, with no one left after me to pick it up.
Late that afternoon potassium was finally hung on her IV. The patient was alive, and I had dodged a bullet. I walked to the stairwell, stopped on a landing and leaned against the wall, “Take ownership” I said to myself, “you may be the only one left.” I remember feeling like I learned a huge lesson without a patient having to pay with her life.
I also remember moments later, and will never forget; the panic, the disbelief, and the grim realization that a patient had fallen through the cracks to her death, while I ran up the stairs to the sounds of the code alarm.
---
Sharing My Body
By Janet Greene, RN
Before I knew it,
I was sharing my body with a stranger.
No love binds us, but my whispers go unheard.
I cannot get away.
A cancer has crept in.
Motionless, I dance with this intruder.
My feet are numb.
I struggle for balance.
I am sharing my flesh with a partner
Who touches private parts in me
And leaves me nothing.
---
A Smile
By Sally Dennett RN
Why do we do what we do?
Long days, tired legs,
Families stressed,
100 things in our heads,
Trying to mend,
Trying to heal,
Mind, body and spirit thrown into one day,
Hoping our efforts pay,
Sometimes feeling helpless,
What else can we do?
A beautiful young woman in her prime,
Came to us just hanging to life,
Mother distraught wanting answers and hope,
Time would tell, is all we could say,
Head injuries have their own game play.
A daughter lying dormant in a hospital bed,
Mom and family while they are there,
Helping paint nails and wash hair,
Small gestures make strong bonds grow,
In a situation where nobody knows,
Will she wake up?
Talk again?
Walk again?
Be my beautiful daughter again?
Three months pass,
A phone call received,
You’ll ever guess the voice said,
She jogged today,
Speechless, Wow, what could I say?
Weeks pass and a visitor arrives,
The beautiful young woman, is before my eyes,
Walking and talking, incredible to see.
Mom has a grin that could light up the sky,
Her beautiful daughter looking strangely at me,
My eyes filling with tears of delight,
Why is she crying Mom?
Who is she?
I was your nurse,
Seemed all I could say,
Still in awe of what I saw,
Hours and hours of multiple tasks,
Hoping to make it all good at last,
Rollercoaster emotions for all concerned.
Then months of not knowing just what happened,
(often the norm in hospital land)
The emotion I felt at the sight that I saw,
Makes every long day mean so much more.
Every day struggles are put into place,
And all I see is a smiling face.
So, why do we do what we do?
Long days, tired legs?
Families stressed,
100 things in our heads?????????????????
Life is special………………
---
JM’s God.
By Glenn Bubley, MD
Entering JM’s room I find him where I always do,
Pouring over his large print Bible as if its all brand new.
Before I can ask him how is today,
He looks me in the eye and asks if I’m ok. I marvel at how important my answer is to him
As he lies on his hospital bed, tubes in every limb.
If there is an ultimate justice of genuine worth,
Surely JM and his kind will inherit the earth.
In JM’s time he was a victim of segregation,
With no chance to rise above his station.
He working loading boxes with his back and hands,
Acceding for years to his bosses demands.
And now even with cancer he’s neither bitter nor angry,
His struggle comported with the utmost dignity.
This man of sorrow, acquainted with grief,
Only by his release will he find ultimate relief.
Although there may be a balm in Gilead,
On this ward, IV morphine is the best we have.
Although the pain of cancer gnaws at his bones
He’s apt to laugh more often than groan.
His smiles leave lines etched on his old black face
Reflecting an inner peace that cancer can’t erase.
His strength seems to be emanate from a glimpse of God,
A glance that may be as close as men are ever allowed.
Now hobbling through the valley of the shadow without moorings,
Will he soon “mount up on the wings of eagles” up soaring?
As for me, I have much more than my daily bread.
So I wonder what it is about the future I dread.
If I could embrace the mystery of his faith might I break free,
If I could quash my doubts could JM’s God touch me?
If I could genuinely consider the lilies of the field,
Might I find a faith that feels strong and real?
Then would vain-glory and self promotion,
Fall away in favor of more genuine emotions?
Would everything change if I could begin to ponder
If it really possible that He walked on water?
Did Moses really hear the Lord from the bush?
Does JM’s bible verses contain seeds of truth? Can a book learning cynic be taught by an unschooled man,
That some things are controlled by an unseen hand?
I had thought that JM’s God was only a useful superstition,
But his life bears witness that the Holy Ghost’s not just an apparition.
If he’s found a lasting faith and true hope that abides,
Then nothing else matters on this mortal side.
His pain and the cancer is just a brief bother,
Before he finally stands before his Father.
And on that last journey that we all take alone,
Will a redeemed JM stand before the throne?
And will he hear these words now that his race is run,
“My good and faithful servant, well done, well done.
Walk up right into this new Jerusalem, it’s not a dream
Here justice pours down like water, righteous a never-failing stream”
---
INSENSITIVITY
By Christina Ho
As a medical interpreter in the hospital, the target group I encounter daily is mainly Chinese. They are mostly from China, Southeast Asia or even other parts of the world. Their education and cultural backgrounds are so diverse that I sometimes have difficulties to interpret the way to make them understand thoroughly. Moreover, there are even some miscommunications or misinterpretations in between that I am
totally unaware of due to my insensitivity until they speak up to let me know. One day, I was told by a doctor to call a patient at home for an immediate blood work which was very important for the adjustment of the dosage of the medication that he had been taking. At the time I called, I got the patient's mother (an elderly) on the phone. She told me that his son was at work and wouldn't be home until midnight and she didn't have his work phone number. The best way that I could think of to contact him was to leave my phone number for him to call me back. So, I tried to have her to take down my phone number. Without hesitation, she refused. No matter how hard I explained and stressed on the importance of getting this message across, she refused. It sounded weird to me. I got so frustrated and talked to myself, “That’s your son! What is the reason that you are not willing to help at all? How difficult is it for you to take down numbers?"
As I calmed down a little bit, I asked," What is your difficulties? Is there anything that I can help you with? She hesitated and stuttered, “To be honest, I am totally illiterate. I couldn't write, not even numbers." I was awakened and apologized, “I’m sorry for being insensitive. How do you usually do if you want to write numbers?" She answered, “Using strokes.” ”Great! What a good idea! Let us try." I then gave out my number slowly. During the process, we had a lot of fun though. When she finally got the number and repeated to me, I was so happy that she got it all right.
Before I hanged up, I praised her for doing a great job and thank her for the help. She was so happy for what she did and promised me that she would definitely pass the message to her son.
In my job, I learn something new everyday. Not just I can be sharpened on the skill of the language but the sensitivity to people which is the most rewarding part. The more I asked myself this question -- How often do I put my feet in someone's shoes to try to understand them better? -- the more I understand Jesus's love for being a mankind on earth.
---
What it Means to Care (Vol IV/2007)
By P.T.S.
It can make an impression
not so many years after you are born
the calming influence
in the midst of a storm
Your first one more often
is a mom or a dad
as they share the good
along with the dad
It might be a mom
a cousin or a friend
who inspires you also
to follow the trend
It may be a noun
It can be a verb
There can be negatives
well deserved
It can be one who is there
during your years in school
a friend and a teacher
who helps you with the tools
It might be something
better than any other
because the person cares
and helps another
It is something that
will probably never be given its due
but in its ideal is an example
for more than just a few
It should command respect not only from others but from those who perform its tasks as it recipients often
do not have the words to ask
It can have horizons that know no bounds It may stumble
and have its ups and downs
It may cause all of us to pause and remember what makes a job a profession with rewards that can't be measured. It is not always about the money or the red that is often seen
that can make it held
with well deserved esteem
It might be an extra moment
to listen to one's concern
or studying a little harder
to help and to learn
by anticipating a need
or giving a med'
or just by helping one
to get out of bed
It may be speaking up
when no one else will
I am worried
This person is ill
It is the giving of one's time
a most valuble gift
which makes it so unique
with each continuous shift
It may be actions performed today
that are remembered long after tomorrow
which help others overcome
their fear, their pain, their sorrow
This is Nursing
if you don't know by now
a job, a profession? that asks
the why, the when, the how
This is Nursing
if you want to know more
knowledge, organization, respect
enthusiam and more
This is Nursing
as observed through the years
or a synonym
for what it means to care
---
The Destruction of Urban-Day Market
Dagan Coppock, MD
The market was open, the market of sand,
Of dust blowing down with harmattan wind
Over pulp of a mango, pulp of a hand.
Fingers of smoke and ashes had fanned
Over bodies of people, burnt and pinned
By the market when opened, the market of sand.
Two tribes of Yoruba, claiming the same land
Of dry season fruit, desiccated and thinned.
The pulp of a mango. The pulp of a hand.
The soldiers had guarded, the Ife had manned
The gates of Urban-Day, its corrugated tin,
And opened the market, the market of sand.
Armed Modakekes with a list of demands
Entered the tension, an explosion of limbs,
The pulp of a mango, the pulp of a hand.
It must have been stirring, it must have been damned,
That obsession with volume, the splitting of skin
As markets when opened and salted with sand,
The pulp of a mango, the pulp of a hand.
---
Remembering Walter
By Janet Fantasia
I approach your portal, weathered wood of snakeskin amber and brown.
Through the film of gray lace, a shaft of light and you emerged,
a short, hunched figure scuffing towards me down the hall, your
withered hands, one melded to the other, straining to heave
open the door so I could give you the weekly shot to oil your joints.
I trailed behind, the nurse’s bag digging in my shoulder.
“How are you doing?” I asked.
“SOS” you said and smiled that mischievous smirk unless you were worried about your health or money
which I could tell by your downturned mouth and monotone.
In the spare room stood columns of boxes, a stockpile of saline, gauze pads, sterile gloves and ointment.
“Walter, this medicine is expired.
You cannot use it to treat your wound,” I cautioned.
Worn oilcloth covered the large kitchen table hidden by medication inserts, papers, coins, novelties
a coffee mug, napkin holder and an outdated Pill Bible.
I sat in the dinette chair, but yours was the office swivel with a cushion of five inch yellowed foam.
You filled tiny paper cups with your daily pills. Using both hands
to lift the Princess phone,
a recorder attached for fading memory,
you called the pharmacy and doctors’ offices.
Clever contraptions you devised made it easier to get through the day-from the window-shade puller-upper to
the angled piece of tin on the air-conditioner to deliver the coolest blast on a scorching day.
The stove and fridge were on borrowed time.A dented saucepan sat tilted on the burner, steam escaping from the crinkled tin foil cover.
Boiling water crackled for instant coffee to have with your soft-boiled egg, hemorrhaging yellow on the plate.
I examined you and peered at your feet,
two squishy water balloons, dusky and cool, your toes, gnarled and overlapping, then a foray into your ancient icebox for the Tin Man’s injection.
Sometimes, I asked you to lie in your bed for a dressing.. In slow motion, you removed the tattered blue terry robe.
Hiking up each hip, knobby fists with shriveled claws
pressing downward into the mattress, you reached the precipice and I vaulted your legs to supine.
We commiserated about your latest doctor’s visit, the news or something on your mind like the time your coronary artery was blocked and the doctor said “That was almost it.”
“He shouldn’t have said that. I was scared.”
A hard binder on the shelf bulged with files kept of so many admissions, dubbing you a “frequent flier.”
Grinning, you showed me an image of your coronary arteries before and after the stent. On the left, a hazy cluster of
branches and the right, a blossoming tree of blood flow.
You trusted me with your life, my pager screeching when your heart pounded double-time and for the pain in your neck, a cervical fracture.
You returned home, an erector set from the shoulders up and handed me a
camera to capture a miniature astronaut.
You had my number on Caller ID and called the night your bag broke and you were alone and frightened.
My phone rang at 3 a.m. I heard the anxiety and embarrassment in your voice. Dressing quickly,
I splashed cold water on my face for the long drive.
I gave you the “bad” news I was
promoted and moving to another office.
Later, I learned you had died
in the hospital where the nurses knew you by name. I took this hard, having been your nurse so long.
Since you left, I slow my car while passing your home half expecting to see your oversized Buick tipped
into the tiny driveway. There is a BMW there now. I wonder how much has changed inside and how much of you remains.
---
A Job
By Grace Campbell-Dupont
A job is a job, but it is what you bring to it which makes the difference
your job should bring out the best in you, no matter the situation or circumstance.
Experience comes in many ways and comes in handy when applied to every day situations. It does not matter what you do, as long as it is done with pride deriving satisfaction at the end of the day.
High values and great expectations come with the job sometimes
that expectation fall short when there is no connection between self and job.
To listen is to learn and to learn is to give your very best, to observe is to be diligent
To see and to do without being asked, Give your best as is expected.
Never short change your giving because you will compromise what you believe in. There is Satisfaction to be gained in knowing that you give not only of what is expected, but of your very best.
My work is very important to the smooth running of the UNIT
I may not have all the answers to many question asked but there is resource
just a phone call away, and just knowing that you have tried makes a difference. Smile while you can, no matter the outcome let your eyes brings hope, your voice sooth the caller, the one who is grieving and hope to those who need to see that the person at the desk gives respect and understand their anxiety.
Finding a job that you like is not easy or one that brings satisfaction
but when you do, it brings out the best in you, even though it is not about you
but what you can do and how well you can do it.
Working in the UNIT gives a clear and sober understanding of how important
and precious life is. Each day brings new experience and new appreciation for the smallest things in life, nothing is taken for granted as it can be taken away in just one breath...
Behind each drawn curtain excellent care is given to which I may not be a part but when that curtain is drawn with urgency and there is no time to waste it is time For action you must ready.
With humility I take my chair and give the best of my self performing
Just like the day before. As you look and see, listen and learn a whole new world unfolds of endurance, strength and dedication of those on whose shoulders rest the responsibility of making health and Safety their priority and the true spirit of TEAM coming together for the purpose of caring.
---
Ownership
By Matthew Hitron, MD
During my third year of medical school one of my patients died. It was a medical error that killed her, and I have been told to feel that the responsibility for it is shared, as a system and as a team. I didn’t feel that way then, and I don’t feel that way now. She died not only because of a screw up, but because no one really cared. I live with the fact that I could have stopped it. She needed someone to care, and I failed her in that. She was an elderly woman with many problems and a dementia that made her difficult to interview and examine. She was uncooperative and at times combative. She had no family, with a court appointed legal guardian and HCP. She arrived from her nursing home with mucus stains on her face and two necrotic toes. She swore at you, and even spat at you when you tried to speak with her. There are ways to break down the story into its components, and analyze the systems that failed; the cracks that she fell through. But it is smoke clouding the picture of a patient who was going to challenge all her care givers by requiring of them a true and exhausting commitment to her humanity; a humanity that was easily forgotten after a few seconds in the room. She was passed off from person to person, service to service, consult to consult; and I was complicit in this.
It was two weeks into my third year medicine clerkship. At times it felt like a show and I was painfully aware of the need to impress. I was not about to back down from any task, and was constantly negotiating the third year paradox of needing to learn everything while hiding the fact that you know nothing. My resident warned me she would be tough, but I had to prove I was good. She was admitted that night uneventfully, numerous consults were called, and the day was over.
The next day she was the last patient on rounds, kept NPO and on maintenance fluids while she sat in her room like that was the curative measure. Nothing happened. The team would wait for the consults to do something and the consults would wait for the team to tell them what to do. The removal of her dead toes was at least some sort of plan, but her strangely elevated INR, her ominous acidosis, and her altered mental status were just glossed over before lunch, with vitamin K, bicarb, and olanzapine given to make everybody feel better.
I came in the next morning, and as I flubbed my way through the note jotting down a K+ value of 2.0, it never occurred to me to be sure someone else knew about it. I remember thinking “wow; that sure is low…” if it were a test question I would have gotten it right. With all the nurses, consultants, and residents milling around her, someone must have seen it too and acted with purpose. No one did that morning. Instead of taking ownership, I was just another in a long line who passed the responsibility off, with no one left after me to pick it up.
Late that afternoon potassium was finally hung on her IV. The patient was alive, and I had dodged a bullet. I walked to the stairwell, stopped on a landing and leaned against the wall, “Take ownership” I said to myself, “you may be the only one left.” I remember feeling like I learned a huge lesson without a patient having to pay with her life.
I also remember moments later, and will never forget; the panic, the disbelief, and the grim realization that a patient had fallen through the cracks to her death, while I ran up the stairs to the sounds of the code alarm.
---
Sharing My Body
By Janet Greene, RN
Before I knew it,
I was sharing my body with a stranger.
No love binds us, but my whispers go unheard.
I cannot get away.
A cancer has crept in.
Motionless, I dance with this intruder.
My feet are numb.
I struggle for balance.
I am sharing my flesh with a partner
Who touches private parts in me
And leaves me nothing.
---
A Smile
By Sally Dennett RN
Why do we do what we do?
Long days, tired legs,
Families stressed,
100 things in our heads,
Trying to mend,
Trying to heal,
Mind, body and spirit thrown into one day,
Hoping our efforts pay,
Sometimes feeling helpless,
What else can we do?
A beautiful young woman in her prime,
Came to us just hanging to life,
Mother distraught wanting answers and hope,
Time would tell, is all we could say,
Head injuries have their own game play.
A daughter lying dormant in a hospital bed,
Mom and family while they are there,
Helping paint nails and wash hair,
Small gestures make strong bonds grow,
In a situation where nobody knows,
Will she wake up?
Talk again?
Walk again?
Be my beautiful daughter again?
Three months pass,
A phone call received,
You’ll ever guess the voice said,
She jogged today,
Speechless, Wow, what could I say?
Weeks pass and a visitor arrives,
The beautiful young woman, is before my eyes,
Walking and talking, incredible to see.
Mom has a grin that could light up the sky,
Her beautiful daughter looking strangely at me,
My eyes filling with tears of delight,
Why is she crying Mom?
Who is she?
I was your nurse,
Seemed all I could say,
Still in awe of what I saw,
Hours and hours of multiple tasks,
Hoping to make it all good at last,
Rollercoaster emotions for all concerned.
Then months of not knowing just what happened,
(often the norm in hospital land)
The emotion I felt at the sight that I saw,
Makes every long day mean so much more.
Every day struggles are put into place,
And all I see is a smiling face.
So, why do we do what we do?
Long days, tired legs?
Families stressed,
100 things in our heads?????????????????
Life is special………………
---
JM’s God.
By Glenn Bubley, MD
Entering JM’s room I find him where I always do,
Pouring over his large print Bible as if its all brand new.
Before I can ask him how is today,
He looks me in the eye and asks if I’m ok. I marvel at how important my answer is to him
As he lies on his hospital bed, tubes in every limb.
If there is an ultimate justice of genuine worth,
Surely JM and his kind will inherit the earth.
In JM’s time he was a victim of segregation,
With no chance to rise above his station.
He working loading boxes with his back and hands,
Acceding for years to his bosses demands.
And now even with cancer he’s neither bitter nor angry,
His struggle comported with the utmost dignity.
This man of sorrow, acquainted with grief,
Only by his release will he find ultimate relief.
Although there may be a balm in Gilead,
On this ward, IV morphine is the best we have.
Although the pain of cancer gnaws at his bones
He’s apt to laugh more often than groan.
His smiles leave lines etched on his old black face
Reflecting an inner peace that cancer can’t erase.
His strength seems to be emanate from a glimpse of God,
A glance that may be as close as men are ever allowed.
Now hobbling through the valley of the shadow without moorings,
Will he soon “mount up on the wings of eagles” up soaring?
As for me, I have much more than my daily bread.
So I wonder what it is about the future I dread.
If I could embrace the mystery of his faith might I break free,
If I could quash my doubts could JM’s God touch me?
If I could genuinely consider the lilies of the field,
Might I find a faith that feels strong and real?
Then would vain-glory and self promotion,
Fall away in favor of more genuine emotions?
Would everything change if I could begin to ponder
If it really possible that He walked on water?
Did Moses really hear the Lord from the bush?
Does JM’s bible verses contain seeds of truth? Can a book learning cynic be taught by an unschooled man,
That some things are controlled by an unseen hand?
I had thought that JM’s God was only a useful superstition,
But his life bears witness that the Holy Ghost’s not just an apparition.
If he’s found a lasting faith and true hope that abides,
Then nothing else matters on this mortal side.
His pain and the cancer is just a brief bother,
Before he finally stands before his Father.
And on that last journey that we all take alone,
Will a redeemed JM stand before the throne?
And will he hear these words now that his race is run,
“My good and faithful servant, well done, well done.
Walk up right into this new Jerusalem, it’s not a dream
Here justice pours down like water, righteous a never-failing stream”
---
INSENSITIVITY
By Christina Ho
As a medical interpreter in the hospital, the target group I encounter daily is mainly Chinese. They are mostly from China, Southeast Asia or even other parts of the world. Their education and cultural backgrounds are so diverse that I sometimes have difficulties to interpret the way to make them understand thoroughly. Moreover, there are even some miscommunications or misinterpretations in between that I am
totally unaware of due to my insensitivity until they speak up to let me know. One day, I was told by a doctor to call a patient at home for an immediate blood work which was very important for the adjustment of the dosage of the medication that he had been taking. At the time I called, I got the patient's mother (an elderly) on the phone. She told me that his son was at work and wouldn't be home until midnight and she didn't have his work phone number. The best way that I could think of to contact him was to leave my phone number for him to call me back. So, I tried to have her to take down my phone number. Without hesitation, she refused. No matter how hard I explained and stressed on the importance of getting this message across, she refused. It sounded weird to me. I got so frustrated and talked to myself, “That’s your son! What is the reason that you are not willing to help at all? How difficult is it for you to take down numbers?"
As I calmed down a little bit, I asked," What is your difficulties? Is there anything that I can help you with? She hesitated and stuttered, “To be honest, I am totally illiterate. I couldn't write, not even numbers." I was awakened and apologized, “I’m sorry for being insensitive. How do you usually do if you want to write numbers?" She answered, “Using strokes.” ”Great! What a good idea! Let us try." I then gave out my number slowly. During the process, we had a lot of fun though. When she finally got the number and repeated to me, I was so happy that she got it all right.
Before I hanged up, I praised her for doing a great job and thank her for the help. She was so happy for what she did and promised me that she would definitely pass the message to her son.
In my job, I learn something new everyday. Not just I can be sharpened on the skill of the language but the sensitivity to people which is the most rewarding part. The more I asked myself this question -- How often do I put my feet in someone's shoes to try to understand them better? -- the more I understand Jesus's love for being a mankind on earth.
---
What it Means to Care (Vol IV/2007)
By P.T.S.
It can make an impression
not so many years after you are born
the calming influence
in the midst of a storm
Your first one more often
is a mom or a dad
as they share the good
along with the dad
It might be a mom
a cousin or a friend
who inspires you also
to follow the trend
It may be a noun
It can be a verb
There can be negatives
well deserved
It can be one who is there
during your years in school
a friend and a teacher
who helps you with the tools
It might be something
better than any other
because the person cares
and helps another
It is something that
will probably never be given its due
but in its ideal is an example
for more than just a few
It should command respect not only from others but from those who perform its tasks as it recipients often
do not have the words to ask
It can have horizons that know no bounds It may stumble
and have its ups and downs
It may cause all of us to pause and remember what makes a job a profession with rewards that can't be measured. It is not always about the money or the red that is often seen
that can make it held
with well deserved esteem
It might be an extra moment
to listen to one's concern
or studying a little harder
to help and to learn
by anticipating a need
or giving a med'
or just by helping one
to get out of bed
It may be speaking up
when no one else will
I am worried
This person is ill
It is the giving of one's time
a most valuble gift
which makes it so unique
with each continuous shift
It may be actions performed today
that are remembered long after tomorrow
which help others overcome
their fear, their pain, their sorrow
This is Nursing
if you don't know by now
a job, a profession? that asks
the why, the when, the how
This is Nursing
if you want to know more
knowledge, organization, respect
enthusiam and more
This is Nursing
as observed through the years
or a synonym
for what it means to care
---
The Destruction of Urban-Day Market
Dagan Coppock, MD
The market was open, the market of sand,
Of dust blowing down with harmattan wind
Over pulp of a mango, pulp of a hand.
Fingers of smoke and ashes had fanned
Over bodies of people, burnt and pinned
By the market when opened, the market of sand.
Two tribes of Yoruba, claiming the same land
Of dry season fruit, desiccated and thinned.
The pulp of a mango. The pulp of a hand.
The soldiers had guarded, the Ife had manned
The gates of Urban-Day, its corrugated tin,
And opened the market, the market of sand.
Armed Modakekes with a list of demands
Entered the tension, an explosion of limbs,
The pulp of a mango, the pulp of a hand.
It must have been stirring, it must have been damned,
That obsession with volume, the splitting of skin
As markets when opened and salted with sand,
The pulp of a mango, the pulp of a hand.
---
Remembering Walter
By Janet Fantasia
I approach your portal, weathered wood of snakeskin amber and brown.
Through the film of gray lace, a shaft of light and you emerged,
a short, hunched figure scuffing towards me down the hall, your
withered hands, one melded to the other, straining to heave
open the door so I could give you the weekly shot to oil your joints.
I trailed behind, the nurse’s bag digging in my shoulder.
“How are you doing?” I asked.
“SOS” you said and smiled that mischievous smirk unless you were worried about your health or money
which I could tell by your downturned mouth and monotone.
In the spare room stood columns of boxes, a stockpile of saline, gauze pads, sterile gloves and ointment.
“Walter, this medicine is expired.
You cannot use it to treat your wound,” I cautioned.
Worn oilcloth covered the large kitchen table hidden by medication inserts, papers, coins, novelties
a coffee mug, napkin holder and an outdated Pill Bible.
I sat in the dinette chair, but yours was the office swivel with a cushion of five inch yellowed foam.
You filled tiny paper cups with your daily pills. Using both hands
to lift the Princess phone,
a recorder attached for fading memory,
you called the pharmacy and doctors’ offices.
Clever contraptions you devised made it easier to get through the day-from the window-shade puller-upper to
the angled piece of tin on the air-conditioner to deliver the coolest blast on a scorching day.
The stove and fridge were on borrowed time.A dented saucepan sat tilted on the burner, steam escaping from the crinkled tin foil cover.
Boiling water crackled for instant coffee to have with your soft-boiled egg, hemorrhaging yellow on the plate.
I examined you and peered at your feet,
two squishy water balloons, dusky and cool, your toes, gnarled and overlapping, then a foray into your ancient icebox for the Tin Man’s injection.
Sometimes, I asked you to lie in your bed for a dressing.. In slow motion, you removed the tattered blue terry robe.
Hiking up each hip, knobby fists with shriveled claws
pressing downward into the mattress, you reached the precipice and I vaulted your legs to supine.
We commiserated about your latest doctor’s visit, the news or something on your mind like the time your coronary artery was blocked and the doctor said “That was almost it.”
“He shouldn’t have said that. I was scared.”
A hard binder on the shelf bulged with files kept of so many admissions, dubbing you a “frequent flier.”
Grinning, you showed me an image of your coronary arteries before and after the stent. On the left, a hazy cluster of
branches and the right, a blossoming tree of blood flow.
You trusted me with your life, my pager screeching when your heart pounded double-time and for the pain in your neck, a cervical fracture.
You returned home, an erector set from the shoulders up and handed me a
camera to capture a miniature astronaut.
You had my number on Caller ID and called the night your bag broke and you were alone and frightened.
My phone rang at 3 a.m. I heard the anxiety and embarrassment in your voice. Dressing quickly,
I splashed cold water on my face for the long drive.
I gave you the “bad” news I was
promoted and moving to another office.
Later, I learned you had died
in the hospital where the nurses knew you by name. I took this hard, having been your nurse so long.
Since you left, I slow my car while passing your home half expecting to see your oversized Buick tipped
into the tiny driveway. There is a BMW there now. I wonder how much has changed inside and how much of you remains.
Tuesday, August 28, 2007
Poetry from nurses and doctors -- Part I
I'm taking a blogging break for several days and leave you with some poems written by doctors and nurses here that were presented at one of our Schwartz Center Rounds several weeks ago. They appear with the permission of the authors, and I will present others in the future. (Apologies to the poets if I made formatting errors.)
With all the talk on this blog and elsewhere about the business aspects of running a hospital, these poems and poets provide a fine reminder of the intensely personal aspects of health care. I hope you appreciate them and the sentiments presented.
---
ENCOUNTER ON THE STAIRS
By Warner V. Slack, MD
Next to Children’s Hospital, in a hurry
Down the stairs, two at a time
Slowed down by a family, moving slowly
Blocking the stairway, I’m in a hurry
I stop, annoyed, I’m in a hurry
Seeing me, they move to the side
A woman says softly, “sorry” in Spanish
I look down in passing, there’s a little boy
Unsteady in gait, holding onto an arm
Head shaved, stitches in scalp
Patch over eye, thin and pale
He catches my eye and gives me a smile
My walk is slower for the rest of the day
---
Silent Burial
By Janet Greene, RN
Loving in secret takes its toll.
Afraid to discover my twisted soul
which loves things without beauty,
I close the door hoping to find shelter.
Feeling the chill from the wind of people’s voices,
I wrap my sweater to me,
And tuck my hands carefully in the cuffs.
Quietly I cherish someone others loathed to touch.
Her mind grew like a crooked branch,
And her laugh had a silly shrill.
Restless eyes betrayed her childish spirit
That earned no wisdom over time.
Distance keeps my secret even in death.
May the earth
Gently bury my untidy companion,
And let me mourn in peace.
In Memory of Bertha Ann, 1984
---
EVENING OF LIFE
By Anupama Gangavati, MD
Inside the nursing home
In a small corner
There…I saw her
Eyes dark and dried of tears
Wrinkled face
Reflecting fatigue
Her gray hair in a total mess
Like the evening of her life.
“I lost my best friend…of eighty years”
She said
“I hope my time will come soon”
Overwhelmed, I got confused
Didn’t know how to react
I even lost my own smile
And now,
In my solitude,
The silence of the night
Seems to be telling me something
That I hate to believe
Perhaps a sheer reality
And now,
Those dark eyes haunt me
As I close my eyes
And ask myself
“Does old age bring miseries?”
And now,
The silence of the night
Leaves me wondering
And just wondering….
---
The Baby Killer
Susan Lane, RN, MSN, MBA
Pain… searing
Belly… throbbing
There is no baby.
There will be no baby.
Endometriosis.
---
Finding meaning while on call in early daily light savings time…..
By Booker T. Bush, MD
I remember teaching some of you
How to be on call
‘Not an architect, but a fireman be’.
Round early
Before the family
Who will
Express their need and wanting
Their time usually after noon
You must grant, but can avoid
By,
Rounding early
And the white cloud
Granted’on Friday an easy evening
With no calls,
So much so that you tested your beeper,
And Saturday evening and night,
Shortened
By an act of a cowardly congress,
Made you arise early, to meet
A woman
Admitted with delirium
Perhaps due to too much medication for pain
Who said
While tearing at her hair,
(there is a witness, an intern enthralled)
I am in pain and you withhold it from me,
isn’t there an imbetween place with the medications…?
Something between pain and confusion
And we stood barriered,
For she had this before done.
But while tearing at her hair
(straightened though
Black but now returned to not)
said I have my lung cancer,
And my breast disfigured
But one of my daughters, has just been told
She also, has a breast that must be removed,
And another, who has been told,
That both breasts must
Be removed
And another who also must
Sacrifice her uterus…
And perhaps her breasts also
Finding meaning…
I raised them
As best I could
I gave them
My all, and now there is this
Only tears
And pain,
And no imbetween
Daughters with
No breasts,
No uterus
And you withhold
My pain medication
And we can only listen
And listen
And she becomes more calm
And she apologizes
And she becomes calm
And we listen.
And she begins to heal
And because of the white cloud, and
Because of the easy evening,
And because of a cowardly congress.
I go to church to sing
Corelli
And I have time to think,
Before seeing more patients.
This is what we do,
We listen, we take the time
And the Corelli.
So I won’t write of the call
About the cats, biting toes
That 2 Percoset
Every 4 hours
Can’t heal
It is the time,
Un imbursed that the architect, nor the Fireman
Wishes to offer.
Thank God,
For the time
For the Corelli
---
Emotions
By Nagma KC, RN
With an inspiration to heal
Eyes open up without much sleep
Rushing, off I go towards my journey
Heart full of love and care
hands full of devine touch
less load, alas! no
much work there is,
and so is hope
I try my best to heal
Lessen the sorrow and erase
the inner soul with pain
Easy work it ain't,
Emotionally drenching it is,
My heart is filled with pain
Seeing the moans, and the groans
helplessness and shrill cries
Oh Lord! I whisper
Please Help Him/ Help Her
Dear God, I say
take away their sorrow,
Oh Please! take away their pain
Doctors are called, medicines are given
Eyes become teary and my heart heavy
Why is there so much pain, I ask
Everyday, every hour, every second
Hazy my view becomes
I quit! I say
A hand on my shoulder
A smiling face, it's my colleague
It's the Nurse
It's okay she says,
You can do it
With a new vision, off I go
Helping again, the sick
8 hours are gone, now is the time
Mercy Lord, I survived I say
And, I healed and spread love
Tired, sad, happy
I leave for home
Will be back tomorrow, I say
Will do a better job, I dream
Help us all, I pray
Dear God! Dear Lord
take away all sorrow and pain!
With all the talk on this blog and elsewhere about the business aspects of running a hospital, these poems and poets provide a fine reminder of the intensely personal aspects of health care. I hope you appreciate them and the sentiments presented.
---
ENCOUNTER ON THE STAIRS
By Warner V. Slack, MD
Next to Children’s Hospital, in a hurry
Down the stairs, two at a time
Slowed down by a family, moving slowly
Blocking the stairway, I’m in a hurry
I stop, annoyed, I’m in a hurry
Seeing me, they move to the side
A woman says softly, “sorry” in Spanish
I look down in passing, there’s a little boy
Unsteady in gait, holding onto an arm
Head shaved, stitches in scalp
Patch over eye, thin and pale
He catches my eye and gives me a smile
My walk is slower for the rest of the day
---
Silent Burial
By Janet Greene, RN
Loving in secret takes its toll.
Afraid to discover my twisted soul
which loves things without beauty,
I close the door hoping to find shelter.
Feeling the chill from the wind of people’s voices,
I wrap my sweater to me,
And tuck my hands carefully in the cuffs.
Quietly I cherish someone others loathed to touch.
Her mind grew like a crooked branch,
And her laugh had a silly shrill.
Restless eyes betrayed her childish spirit
That earned no wisdom over time.
Distance keeps my secret even in death.
May the earth
Gently bury my untidy companion,
And let me mourn in peace.
In Memory of Bertha Ann, 1984
---
EVENING OF LIFE
By Anupama Gangavati, MD
Inside the nursing home
In a small corner
There…I saw her
Eyes dark and dried of tears
Wrinkled face
Reflecting fatigue
Her gray hair in a total mess
Like the evening of her life.
“I lost my best friend…of eighty years”
She said
“I hope my time will come soon”
Overwhelmed, I got confused
Didn’t know how to react
I even lost my own smile
And now,
In my solitude,
The silence of the night
Seems to be telling me something
That I hate to believe
Perhaps a sheer reality
And now,
Those dark eyes haunt me
As I close my eyes
And ask myself
“Does old age bring miseries?”
And now,
The silence of the night
Leaves me wondering
And just wondering….
---
The Baby Killer
Susan Lane, RN, MSN, MBA
Pain… searing
Belly… throbbing
There is no baby.
There will be no baby.
Endometriosis.
---
Finding meaning while on call in early daily light savings time…..
By Booker T. Bush, MD
I remember teaching some of you
How to be on call
‘Not an architect, but a fireman be’.
Round early
Before the family
Who will
Express their need and wanting
Their time usually after noon
You must grant, but can avoid
By,
Rounding early
And the white cloud
Granted’on Friday an easy evening
With no calls,
So much so that you tested your beeper,
And Saturday evening and night,
Shortened
By an act of a cowardly congress,
Made you arise early, to meet
A woman
Admitted with delirium
Perhaps due to too much medication for pain
Who said
While tearing at her hair,
(there is a witness, an intern enthralled)
I am in pain and you withhold it from me,
isn’t there an imbetween place with the medications…?
Something between pain and confusion
And we stood barriered,
For she had this before done.
But while tearing at her hair
(straightened though
Black but now returned to not)
said I have my lung cancer,
And my breast disfigured
But one of my daughters, has just been told
She also, has a breast that must be removed,
And another, who has been told,
That both breasts must
Be removed
And another who also must
Sacrifice her uterus…
And perhaps her breasts also
Finding meaning…
I raised them
As best I could
I gave them
My all, and now there is this
Only tears
And pain,
And no imbetween
Daughters with
No breasts,
No uterus
And you withhold
My pain medication
And we can only listen
And listen
And she becomes more calm
And she apologizes
And she becomes calm
And we listen.
And she begins to heal
And because of the white cloud, and
Because of the easy evening,
And because of a cowardly congress.
I go to church to sing
Corelli
And I have time to think,
Before seeing more patients.
This is what we do,
We listen, we take the time
And the Corelli.
So I won’t write of the call
About the cats, biting toes
That 2 Percoset
Every 4 hours
Can’t heal
It is the time,
Un imbursed that the architect, nor the Fireman
Wishes to offer.
Thank God,
For the time
For the Corelli
---
Emotions
By Nagma KC, RN
With an inspiration to heal
Eyes open up without much sleep
Rushing, off I go towards my journey
Heart full of love and care
hands full of devine touch
less load, alas! no
much work there is,
and so is hope
I try my best to heal
Lessen the sorrow and erase
the inner soul with pain
Easy work it ain't,
Emotionally drenching it is,
My heart is filled with pain
Seeing the moans, and the groans
helplessness and shrill cries
Oh Lord! I whisper
Please Help Him/ Help Her
Dear God, I say
take away their sorrow,
Oh Please! take away their pain
Doctors are called, medicines are given
Eyes become teary and my heart heavy
Why is there so much pain, I ask
Everyday, every hour, every second
Hazy my view becomes
I quit! I say
A hand on my shoulder
A smiling face, it's my colleague
It's the Nurse
It's okay she says,
You can do it
With a new vision, off I go
Helping again, the sick
8 hours are gone, now is the time
Mercy Lord, I survived I say
And, I healed and spread love
Tired, sad, happy
I leave for home
Will be back tomorrow, I say
Will do a better job, I dream
Help us all, I pray
Dear God! Dear Lord
take away all sorrow and pain!
Monday, August 27, 2007
Observations from Iceland
As noted below, I had a chance last week to attend a very informative conference in Iceland with representatives from the major hospitals and medical schools of the Nordic countries (Iceland, Sweden, Denmark, Norway, and Finland). The health systems in these countries are owned and financed by the government and are often appropriately cited for the quality of care offered to the public. Indeed, in debates here in the US, they are often called out as examples of what we might strive for in terms of universal coverage and a greater emphasis on primary care than we have.
An advantage of actually meeting with people who run such systems is that you get to hear some of the details that do not make it into the public discussions here. I thought I would share just one aspect with you. In so doing, please recognize that I make no apologies for or denials about the inadequacies of our own approach. I am just trying to relate aspects of theirs that might be overlooked.
So, the simple question I asked was this: When the parliament sets the national budget for health care, how does it decide how to much to allot? Here in the US, the "budget" that we set for health care is partially set by Congress (for Medicare) and by state legislatures (for Medicaid), but well over half of our health care budget is not set centrally, but results from thousands of decisions and transactions by multiple players in the system. I was curious to learn, in contrast, how a welfare state decides on the appropriate amount.
I did not get answers about each country, but a pattern began to emerge. Using Iceland as an example, the answer seems to be that the parliament uses, as a rough guide, a desire to maintain overall health care costs at a certain percentage -- 10 or 11% -- of GNP. The US, at 15% is viewed as too high. Other European countries, at under 10%, are viewed as too low.
I pursued the question further. Is this percentage based on a quantified assessment of the actual health care needs of the public, i.e., is it driven by public demand (e.g., a growing aging population)? No. Does it take into account the government's expectation for certain quantifiable levels of service quality, medical quality, or operational efficiency of hospitals and other parts of the system? No.
In essence, this appropriation by the parliament is a politically derived decision, just as it would be for any appropriation for a program of important national priority, and it therefore competes with other worthy national programs for resources.
I offer this not in criticism, but just as a useful reminder to those of us in the US. The managers of the Nordic hospital systems, once their single annual appropriation is handed down, make important decisions about what services to offer to the public and what services not to offer. They also respond to appropriation levels by determining service quality levels. In the face of inevitable limitations on the ability of the nation hospital system to offer all services demanded by the public, a growing parallel system is emerging, in which private practitioners offer elective therapies and procedures outside of those supported by the national system.
Of course, we make similar managerial choices here when we run hospitals. The difference is that we do so in response to a variety of price signals set forth by a meld of public and private payers. Also, we have the advantage of one factor not really present in Europe, philanthropy from generous donors who help us provide advanced diagnoses and treatments that would not otherwise be available to the public.
As I note above, I am not saying one is better than the other. Just different. I predict, though, that the systems will start to look more and more alike over time. Pressure in the US for a more nationally-determined approach. Pressure in Europe for more of a private market approach. It shouldn't surprise us to see this convergence. After all, the countries are dealing with the same organisms, both biologically and politically.
An advantage of actually meeting with people who run such systems is that you get to hear some of the details that do not make it into the public discussions here. I thought I would share just one aspect with you. In so doing, please recognize that I make no apologies for or denials about the inadequacies of our own approach. I am just trying to relate aspects of theirs that might be overlooked.
So, the simple question I asked was this: When the parliament sets the national budget for health care, how does it decide how to much to allot? Here in the US, the "budget" that we set for health care is partially set by Congress (for Medicare) and by state legislatures (for Medicaid), but well over half of our health care budget is not set centrally, but results from thousands of decisions and transactions by multiple players in the system. I was curious to learn, in contrast, how a welfare state decides on the appropriate amount.
I did not get answers about each country, but a pattern began to emerge. Using Iceland as an example, the answer seems to be that the parliament uses, as a rough guide, a desire to maintain overall health care costs at a certain percentage -- 10 or 11% -- of GNP. The US, at 15% is viewed as too high. Other European countries, at under 10%, are viewed as too low.
I pursued the question further. Is this percentage based on a quantified assessment of the actual health care needs of the public, i.e., is it driven by public demand (e.g., a growing aging population)? No. Does it take into account the government's expectation for certain quantifiable levels of service quality, medical quality, or operational efficiency of hospitals and other parts of the system? No.
In essence, this appropriation by the parliament is a politically derived decision, just as it would be for any appropriation for a program of important national priority, and it therefore competes with other worthy national programs for resources.
I offer this not in criticism, but just as a useful reminder to those of us in the US. The managers of the Nordic hospital systems, once their single annual appropriation is handed down, make important decisions about what services to offer to the public and what services not to offer. They also respond to appropriation levels by determining service quality levels. In the face of inevitable limitations on the ability of the nation hospital system to offer all services demanded by the public, a growing parallel system is emerging, in which private practitioners offer elective therapies and procedures outside of those supported by the national system.
Of course, we make similar managerial choices here when we run hospitals. The difference is that we do so in response to a variety of price signals set forth by a meld of public and private payers. Also, we have the advantage of one factor not really present in Europe, philanthropy from generous donors who help us provide advanced diagnoses and treatments that would not otherwise be available to the public.
As I note above, I am not saying one is better than the other. Just different. I predict, though, that the systems will start to look more and more alike over time. Pressure in the US for a more nationally-determined approach. Pressure in Europe for more of a private market approach. It shouldn't surprise us to see this convergence. After all, the countries are dealing with the same organisms, both biologically and politically.
The Shock Doc
It is always heartening when one of our trainees moves along to a higher calling. Several years ago, Dr. Jeremy Weiss was a fellow in interventional radiology at BIDMC. He now has a highly regarded practice on the West Coast, but he also has a sidelight as a magician. Check out his site here, and watch some of the videos in the "gallery" section in particular. Also, read the provocative posting on his blog about the late Dr. Ofey.
Friday, August 24, 2007
Iceland scenes
A few pictures for those of you who are unlikely to get here.--One of many outdoor sculptures in Reykjavik, this one by Ásmundur Sveinsson.
--Evidence of the direction of lava flow, seen on rocks throughout the country.
--A grave marker from years ago: To this date, each Icelander has a first name and then a last name based on his or her father´s first name. There are no last names. Phone books list people alphabetically by their first names.
--The side of a glacial valley, cut through volcanic rock. (All the rock here is volcanic.)
--Road and pipe leading from the geothermal energy plant that serves the capital city. Bore holes produce steam and hot water. The steam drives a turbine to produce electricity. The leftover steam and hot water then pass through a heat exchanger to heat cool water taken from a lake, which is then transported about 30 kilometers to Reykjavik, losing only 2 degrees Celsius en route. Geothermal energy is a key asset in Iceland´s economy.
Outpatient clinic of innovation
An interesting idea from Ulleval University Hospital in Oslo. (There are some similar concepts that I know of from the US, like MIT´s Center for Biomedical Innovation and Entrepreneurship Center, but this one has its own unique features.) Here´s a summary from Andreas Moan, Director of Research and Education:
The Clinic of Innovation is run like any traditional out-patient clinic with one major difference: The purpose of this Clinic is to facilitate the conversion of ideas from research and medical practice into new services or products to the benefit of both patients and society. We also want to offer the same kind of service to ideas generated outside the hospital, offering our medical and research expertise. The Clinic of Innovation is organized as any other out-patient clinic, offering diagnostic work-ups, treatment and follow-up.
It is a joint venture between the Ulleval University Hospital and Medinnova, a Technology Transfer Office with 20 years of experience in innovation. The Clinic has two main customers: First, people working within the health system with new ideas on how services, treatment, organization or products can be improved or developed. Secondly, the Clinic acts as a bridge into the health system for people, commercial parties, biotech and other research-intensive businesses who may be looking for an initial point of contact to the public health sector.
Culture and language is quite different in the public health system and in private enterprise, and our goal is that the Clinic of Innovation may serve as a meeting point and as translators. Our employees have experience from both the private and public sectors.
Although this Clinic is organized as any other out-patient clinic, there is one major difference: To this Clinic you can refer yourself – please see below.
The Clinic of Innovation offers:
Diagnostic work-ups entailing evaluating your idea’s potential in both research and commercial context, or calling external competence as needed to do so. Depending on the diagnosis, the idea (and its owner) will be offered treatment that may entail
- direct problem solving
- development as a joint venture/active project
- establishment of contact with new networks that we believe will help develop the idea
- referral to group therapy with other innovators facing similar problems
Follow-up means seeing you and your idea back for follow-up and additional referral or problems solving as the idea evolves.
The Clinic of Innovation is also a tool to inform about the importance, possible economical impact and sheer pleasure of innovation. The tools for this activity include media coverage, advertising and visiting relevant people and communities inside and outside of the hospital.
How do you find the Clinic of Innovation?
Physically located at the Ulleval University Hospital in Oslo, Norway.
On the Internet: at www.ulleval.no “Idépoliklinikken” in our rather remote language and at www.medinnova.no
E-mail: idepoliklinkken@uus.noPhone: +47 23 02 70 23
Point of contact: Eli Margrethe Walseth
What can you expect?
New ideas are best submitted by a webform located here Medinnova or by email or phone.
The Clinic of Innovations has weekly intake meetings, so you can expect an answer within no more than two weeks. We may want to contact you ahead of the intake meeting to better understand your concept. Your referral is guaranteed full confidentiality, confirmed on the return receipt you get on our referral form. We will also sign a confidentiality agreement at the first appointment.
The Clinic of Innovation is run like any traditional out-patient clinic with one major difference: The purpose of this Clinic is to facilitate the conversion of ideas from research and medical practice into new services or products to the benefit of both patients and society. We also want to offer the same kind of service to ideas generated outside the hospital, offering our medical and research expertise. The Clinic of Innovation is organized as any other out-patient clinic, offering diagnostic work-ups, treatment and follow-up.
It is a joint venture between the Ulleval University Hospital and Medinnova, a Technology Transfer Office with 20 years of experience in innovation. The Clinic has two main customers: First, people working within the health system with new ideas on how services, treatment, organization or products can be improved or developed. Secondly, the Clinic acts as a bridge into the health system for people, commercial parties, biotech and other research-intensive businesses who may be looking for an initial point of contact to the public health sector.
Culture and language is quite different in the public health system and in private enterprise, and our goal is that the Clinic of Innovation may serve as a meeting point and as translators. Our employees have experience from both the private and public sectors.
Although this Clinic is organized as any other out-patient clinic, there is one major difference: To this Clinic you can refer yourself – please see below.
The Clinic of Innovation offers:
Diagnostic work-ups entailing evaluating your idea’s potential in both research and commercial context, or calling external competence as needed to do so. Depending on the diagnosis, the idea (and its owner) will be offered treatment that may entail
- direct problem solving
- development as a joint venture/active project
- establishment of contact with new networks that we believe will help develop the idea
- referral to group therapy with other innovators facing similar problems
Follow-up means seeing you and your idea back for follow-up and additional referral or problems solving as the idea evolves.
The Clinic of Innovation is also a tool to inform about the importance, possible economical impact and sheer pleasure of innovation. The tools for this activity include media coverage, advertising and visiting relevant people and communities inside and outside of the hospital.
How do you find the Clinic of Innovation?
Physically located at the Ulleval University Hospital in Oslo, Norway.
On the Internet: at www.ulleval.no “Idépoliklinikken” in our rather remote language and at www.medinnova.no
E-mail: idepoliklinkken@uus.noPhone: +47 23 02 70 23
Point of contact: Eli Margrethe Walseth
What can you expect?
New ideas are best submitted by a webform located here Medinnova or by email or phone.
The Clinic of Innovations has weekly intake meetings, so you can expect an answer within no more than two weeks. We may want to contact you ahead of the intake meeting to better understand your concept. Your referral is guaranteed full confidentiality, confirmed on the return receipt you get on our referral form. We will also sign a confidentiality agreement at the first appointment.
Thursday, August 23, 2007
Nokia power
A quick progress note about the local scene. More on the conference later.In Iceland, when you go to the pool for your morning swim and bath in "hot pots", you can rent a small locker, in which you can securely charge up your cell phone during your swim. You can pay for it with a coin or by text messaging to a certain number, after which the rental and charging fee will be deducted from your bank account. The locker has built into it three power cords with different connector attachments for the most popular cell phones, especially Nokia´s.
(Cell phones can also be used to pay for parking in municipal lots by text messaging.)
By the way, the pools are public and are considered an essential public service, right after schools, so every municipality has a least one. The water is heated geothermally, and people swim outdoors all year long, and it is a regular routine for many. The pool was comfortably warmer than the air on a cool 50 degree Farenheit morning. The hot tubs are ranked by temperature, starting at 38 degrees Celsius and rising in two degree increments from there. I felt a bit like the proverbial frog in a slowly heated pot of water as I went from one to the next. At 42 degrees, you really are fully cooked.
Wednesday, August 22, 2007
Shrimp Cocktail
I am in Iceland (yes, Iceland) for a couple of days to give a talk at a conference -- more on that in a moment -- and I was reading an article about Icelandic shrimp in Atlantica, the Icelandic Air airplane magazine. I ripped it out at the time because I thought it was interesting but didn´t think about it again until tonight when I was eating some of those exact shrimp at a reception.It appears that there is a carbohydrate -- chitosan -- derived from the exoskeletons of Icelandic shrimp that is applied to bandages that have a high success rate in external hemorrhage control in combat operations. According to this article, the company that makes them is based in Oregon and is called HemCon and has apparently sold more than 400,000 bandages to the US Army.
The good news is that the bandages help. The bad news, of course, is that they are needed by our armed forces and by civilians in war zones. (Before anyone asks, I do not know if BIDMC or any of our faculty ever have had any financial relationship with this company -- and I have not had a chance to check with our folks in Boston, so I can´t find out right now -- but I doubt it. There is a very large trauma service in Seattle, and I would bet that clinical trials would have taken place there.)
By the way, the local shrimp are delicious and are served peeled (maybe to send the exoskeletons to work as bandages.)
The conference I am attending is called the Nordic Conference for University Hospitals and Faculty Deans, with attendees from Iceland, Denmark, Sweden, Norway, and Finland, and three of us guest speakers from Calgary, Manchester (UK) and Boston. I always worry a bit when I am invited to speak at these things because I have so little knowledge of the field compared to others, but I liked the topic I was assigned. It is "Never let the practice of medicine be replaced by the business of medicine." Of course I agree with that, but I also think part of the topic has to be "Never forget that the business of medicine can affect the practice of medicine."
What´s really interesting is that these countries, which have national health insurance systems, are feeling the pinch more and more from their legislative bodies. Members of parliament are upset with the rising costs of health care and want to see more efficiency and higher quality. The underlying system is not likely to change, but hospital CEOs are expected to deliver more for less, and they look towards our US experience for ideas and suggestions.
I can´t wait to see what I am going to say during my talk tomorrow. If I come back wearing lots of shrimp-laced bandages, you will know that it didn´t go very well.
P.S. I took this picture of a waterfall east of Reykjavik at a World Heritage Site called Þingvellir National Park.
Tuesday, August 21, 2007
Roll-back of insurer rating systems?
On my favorite topic, reporting of clinical results, Theo Francis at the Wall Street Journal talks about ranking of physicians by insurance companies:
Doctors and regulators are pushing back against rating systems that some health insurers have developed to guide consumers in choosing physicians. New York Attorney General Andrew Cuomo demanded last week a "full justification" of the rankings that Aetna Inc. and Cigna Corp. have rolled out in the state. He warned the companies that the ratings are confusing and potentially deceptive, in part because insurers don't disclose how prone to error their rankings are. The move follows rankings lawsuits by doctors accusing insurers of libel, unfair business practices and breach of contract in other states.
A number of insurance company people here in Massachusetts had raised similar concerns with me, stating that any ratings they produced would be viewed as self-serving by members of the public. So, I guess this throws the ball back into the court of the public agencies. (Or, of course, providers could self-report on an insurance company website that was open to all.)
Doctors and regulators are pushing back against rating systems that some health insurers have developed to guide consumers in choosing physicians. New York Attorney General Andrew Cuomo demanded last week a "full justification" of the rankings that Aetna Inc. and Cigna Corp. have rolled out in the state. He warned the companies that the ratings are confusing and potentially deceptive, in part because insurers don't disclose how prone to error their rankings are. The move follows rankings lawsuits by doctors accusing insurers of libel, unfair business practices and breach of contract in other states.
A number of insurance company people here in Massachusetts had raised similar concerns with me, stating that any ratings they produced would be viewed as self-serving by members of the public. So, I guess this throws the ball back into the court of the public agencies. (Or, of course, providers could self-report on an insurance company website that was open to all.)
Odd survey
I picked up the telephone last night at home to find one of those electronic surveys on the line. Once I heard the introduction, I stuck with it all the way through just to see what it was about. I´ll describe it, and then people can respond if they know why it was done and whether it is what it says it is.
It started by saying that it was a survey for the state Department of Public Health. There were about two minutes worth of questions, all answerable by pushing a button. It seemed to be about health insurance, and whether I had insurance through my employer or through the new Connector Authority (set up under the new MA health insurance/access law). But then it asked a weird question: Did either of my parents smoke? If so, which, the male and/or the female? It also asked the usual question about my level of education and my age. And then it concluded by saying again that it was a survey for the state DPH.
Of course, I realize that all these surveys, supposedly anonymous, really are not likely to be. After all, they know your phone number, and from that they know your name and address. But that is not what had me wondering.
If it really was the DPH, why are they doing a survey about health insurance? The responsibility for that lies with the Connector Authority, a completely different state agency. And the Connector Authority is already collecting data on how many people in different categories have insurance through their employer or through the plans made available by the Connector. And why ask about smoking in my family history? And, finally, the way the survey announced it was being done for the DPH was just a little off-kilter: It just did not sound like a state agency. Finally, in all the articles about the state budget this year, I never read any coverage about a DPH appropriation for this kind of survey.
So, I wonder if this was really a survey for some company trying to sell insurance or some broker trying to broker insurance sales? As a result of these calls, they could easily segment respondents by age, address (and therefore likely income), family health history -- just what you would want if you were selling health insurance.
Am I too cynical? Maybe someone out there from the DPH will read this and comment. If you are doing the survey, what is it for? If you are not, perhaps you could notify some law enforcement officials that someone is appropriating your name for other purposes.
It started by saying that it was a survey for the state Department of Public Health. There were about two minutes worth of questions, all answerable by pushing a button. It seemed to be about health insurance, and whether I had insurance through my employer or through the new Connector Authority (set up under the new MA health insurance/access law). But then it asked a weird question: Did either of my parents smoke? If so, which, the male and/or the female? It also asked the usual question about my level of education and my age. And then it concluded by saying again that it was a survey for the state DPH.
Of course, I realize that all these surveys, supposedly anonymous, really are not likely to be. After all, they know your phone number, and from that they know your name and address. But that is not what had me wondering.
If it really was the DPH, why are they doing a survey about health insurance? The responsibility for that lies with the Connector Authority, a completely different state agency. And the Connector Authority is already collecting data on how many people in different categories have insurance through their employer or through the plans made available by the Connector. And why ask about smoking in my family history? And, finally, the way the survey announced it was being done for the DPH was just a little off-kilter: It just did not sound like a state agency. Finally, in all the articles about the state budget this year, I never read any coverage about a DPH appropriation for this kind of survey.
So, I wonder if this was really a survey for some company trying to sell insurance or some broker trying to broker insurance sales? As a result of these calls, they could easily segment respondents by age, address (and therefore likely income), family health history -- just what you would want if you were selling health insurance.
Am I too cynical? Maybe someone out there from the DPH will read this and comment. If you are doing the survey, what is it for? If you are not, perhaps you could notify some law enforcement officials that someone is appropriating your name for other purposes.
Monday, August 20, 2007
Way to go, Stacey
A recent email, from Stacey, one of our great ICU nurses, about a doctor with visiting privileges from an affiliated institution:
Paul,
I have been encouraging and supporting the hospital’s policy regarding hand hygiene. My understanding is that all personnel are to use Calstat when entering or exiting a patient’s room, even if they are not going to give direct patient care. I happened to notice Dr. X entering a room without using the Calstat. I went and politely reminded Dr. X to use the Calstat. Dr. X appeared quite annoyed that I requested him to do so as he said he had already examined the patient and was just looking at the monitor. This is not the first time I have had such encounters. How would you like this type of situation handled in the future?
My reply:
Thank you, Stacey,
You did EXACTLY the right thing, and I appreciate how uncomfortable that can be.
We have indeed asked everybody to remind everybody else about the importance of this matter. As you know, it is very easy to pick up germs from equipment and material near the patients and then pass those along to other patients and staff, even when the doctor or nurse has not actually touched the patient.
I am copying Dr. Sands, our SVP of Health Care Quality, who will now follow up with Dr. X.
Sincerely,
Paul
Paul,
I have been encouraging and supporting the hospital’s policy regarding hand hygiene. My understanding is that all personnel are to use Calstat when entering or exiting a patient’s room, even if they are not going to give direct patient care. I happened to notice Dr. X entering a room without using the Calstat. I went and politely reminded Dr. X to use the Calstat. Dr. X appeared quite annoyed that I requested him to do so as he said he had already examined the patient and was just looking at the monitor. This is not the first time I have had such encounters. How would you like this type of situation handled in the future?
My reply:
Thank you, Stacey,
You did EXACTLY the right thing, and I appreciate how uncomfortable that can be.
We have indeed asked everybody to remind everybody else about the importance of this matter. As you know, it is very easy to pick up germs from equipment and material near the patients and then pass those along to other patients and staff, even when the doctor or nurse has not actually touched the patient.
I am copying Dr. Sands, our SVP of Health Care Quality, who will now follow up with Dr. X.
Sincerely,
Paul
Sunday, August 19, 2007
It's official: Infections are bad
Emily DeVoto has a nice summary of the issues (and the link to the New York Times article) surrounding a possible Medicare rule that would withhold payments to hospitals when hospital-acquired infections occur. Zagreus Ammon also pitches in on the topic, as does John McDonough at Health Care for All.
Drive Calmly
Turning now to the infrastructure crisis, please read this hilarious -- and totally accurate -- column written by Monique Spencer. She writes about the "traffic calming" measures installed on Beacon Street in her home town of Brookline, MA. An excerpt:You put a red light on every block. You get rid of parking in order to kill the retailers. You make new pedestrian crossings appear overnight, in between the red lights. Special bike lanes appear on one block, then disappear, with nanny signs that say "Share the Road." Meander the side streets and you'll find giant mounds in the road that are supposed to make you slow down. The traffic engineers call these "vertical deflections." Their real function is to eject the newcomer. At night, he does not see the mound, because it is not lit. He hits the takeoff ramp at 30 miles per hour, and by the time his car touches ground again he is in the next town.
I do not feel calmed.
In a more serious vein, part of the reconfiguration was to remove one lane of traffic to create a protected area for on-street parkers along the median island of Beacon Street -- accompanied by a "bulb-out" or "neckdown" at each intersection (see picture above). Let's please recall that the Brookline section of Beacon Street is one of the evacuation routes from downtown Boston in the event of civil emergency or natural disaster. Now that three outgoing lanes have been transformed into two, it seems that we have a 50% reduction in traffic capacity. Were the emergency preparedness people from Boston notified before this happened?
Saturday, August 18, 2007
Now it's the ADL of New England board's turn
The next chapter in the ADL story is splayed on the front page of the Boston Globe today. Keith O'Brien reports: "The national Anti-Defamation League fired its New England regional director yesterday, one day after he broke ranks with national ADL leadership and said the human rights organization should acknowledge the Armenian genocide that began in 1915."
Andy Tarsy, the regional director who did the right thing, has now taught the public an additional lesson: Sometimes doing the right thing costs you personally, at least in the short run. But I predict and hope that Andy will not have to worry for long.
The action by the national ADL organization now turns the focus on the board members of the local ADL affiliate. Presumably Andy had the support of his local board in taking the action he did. A former board member commented to the Globe: "I predict that [these] actions will precipitate wholesale resignations from the regional board, a meaningful reduction in ADL's regional fund-raising, and will further exacerbate the [national] ADL's relationship with the non-Jewish community coming out of this crisis around the Armenian genocide."
Local board members really have no choice but to resign over the firing of their hand-picked executive director. But these are highly committed volunteers and community leaders who strongly believe in the mission of the ADL. What's for them do to in support of that mission?
The clear answer is to resign, rescind any philanthropic commitments they have made to the national ADL, immediately create a new regional organization with precisely the same mission, hire Andy back, and go to work rebuilding support throughout New England for the important programs they have been running.
[Disclosure: Andy's father is a member of the faculty at BIDMC, but I have not consulted with him on any of these blog postings.]
Addendum on August 19. In writing this, I didn't mean to suggest that local board members who choose to stay on the board and try to work changes in the national ADL should be faulted at all. That is an alternative approach that deserves a lot of credit. It is, however, a long row to hoe -- and until it all gets worked out, I am guessing it will be hard to find a person willing to be a successor for Andy at the New England regional branch.
Andy Tarsy, the regional director who did the right thing, has now taught the public an additional lesson: Sometimes doing the right thing costs you personally, at least in the short run. But I predict and hope that Andy will not have to worry for long.
The action by the national ADL organization now turns the focus on the board members of the local ADL affiliate. Presumably Andy had the support of his local board in taking the action he did. A former board member commented to the Globe: "I predict that [these] actions will precipitate wholesale resignations from the regional board, a meaningful reduction in ADL's regional fund-raising, and will further exacerbate the [national] ADL's relationship with the non-Jewish community coming out of this crisis around the Armenian genocide."
Local board members really have no choice but to resign over the firing of their hand-picked executive director. But these are highly committed volunteers and community leaders who strongly believe in the mission of the ADL. What's for them do to in support of that mission?
The clear answer is to resign, rescind any philanthropic commitments they have made to the national ADL, immediately create a new regional organization with precisely the same mission, hire Andy back, and go to work rebuilding support throughout New England for the important programs they have been running.
[Disclosure: Andy's father is a member of the faculty at BIDMC, but I have not consulted with him on any of these blog postings.]
Addendum on August 19. In writing this, I didn't mean to suggest that local board members who choose to stay on the board and try to work changes in the national ADL should be faulted at all. That is an alternative approach that deserves a lot of credit. It is, however, a long row to hoe -- and until it all gets worked out, I am guessing it will be hard to find a person willing to be a successor for Andy at the New England regional branch.
Friday, August 17, 2007
In sickness and in health
My friend Dave sent me notice of a new blog, called In Sickness and In Health, "a place for couples going though an illness experience - to share stories, advice, resources, and to learn from each other." It's by Barbara Kivowitz. Dave says, "She writes well, has a lot to talk about, and ought to attract an audience, I think." Let's help her along.
Thursday, August 16, 2007
Stand firm and clear, ADL
I am prompted to write on this issue after being awakened to it by a stirring talk I recently heard by Rabbi Ronne Friedman at Boston's Temple Israel.
Back in May, I wrote a post congratulating the Anti-Defamation League on their World of Difference program. This is a thoughtful and well-intentioned program to teach schoolchildren ways of avoiding prejudice.
Recently, the ADL has been involved in a major controversy about the genocide of Armenians by the Ottoman Empire in the early part of the last century. There is a good description of the dispute on Blue Mass Group.
I fear that ADL has lost its way on this issue, refusing to support a Congressional resolution that calls the massacre what it was, genocide. Now they try to rationalize their failure. See these words of their local civil rights counsel:
The Jewish community in Turkey has clearly expressed to us and other major American Jewish organizations its concerns about the impact of Congressional action on them, and we cannot ignore those concerns. We are also keenly aware that Turkey is a key strategic ally and friend of the United States and a staunch friend of Israel, and that in the struggle between Islamic extremists and moderate Islam, Turkey is the most critical country in the world.
Compare that to the pledge students are asked to take at the end of the ADL's World of Difference Program:
I pledge from this day onward to do my best to be aware of my own biases against people who are different from me. I will ask questions about cultures, religions, and races and other individual differences that I don't understand. I will interrupt prejudice and speak out against those who initiate it. I will reach out to support those who are targets of harassment. I will identify specific ways that my peers, my school, and my community can promote greater respect for people and create a prejudice-fee zone. I firmly believe that one person can make a world of difference and that no person can be an "innocent bystander" when it comes to opposing hate.
I know this pledge is not exactly on the point of the current dispute, but its message is close enough. The pledge does not say that I will stand up against prejudice only when it is politically convenient to do so or only when it is risk-free to do so. Or that I will shy away from controversy for fear of offending an important constituency.
Rabbi Friedman reminded me that Adolf Hitler used the genocide of the Armenians as part of his rationale for destroying other groups. Here's the quote he read.
Our strength consists in our speed and in our brutality. Genghis Khan led millions of women and children to slaughter — with premeditation and a happy heart. History sees in him solely the founder of a state. It's a matter of indifference to me what a weak western European civilization will say about me.
I have issued the command — and I'll have anybody who utters but one word of criticism executed by a firing squad — that our war aim does not consist in reaching certain lines, but in the physical destruction of the enemy. Accordingly, I have placed my death-head formations in readiness — for the present only in the East — with orders to them to send to death mercilessly and without compassion, men, women, and children of Polish derivation and language. Only thus shall we gain the living space (Lebensraum) which we need. Who, after all, speaks today of the annihilation of the Armenians?
In simple language "annihilation" of a particular ethnic, religious, or social group is "genocide." Hitler knew exactly what he was saying.
Nothing can bring back those who died. The government that was in power at the time is long gone, too. But the surviving people of Armenian descent -- along with every other group that could possibly be the target of genocide -- deserve the support of the ADL in validating what really happened in 1915.
If the national office of the ADL remains recalcitrant on this issue, the New England Region should break ranks and make an alternate position clear.
(By the way, here's the text of the disputed Congressional resolution: Calling upon the President to ensure that the foreign policy of the United States reflects appropriate understanding and sensitivity concerning issues related to human rights, ethnic cleansing, and genocide documented in the United States record relating to the Armenian Genocide, and for other purposes.)
Addendum. Breaking news on August 17: The New England chapter did indeed break ranks. Bravo to them!
Back in May, I wrote a post congratulating the Anti-Defamation League on their World of Difference program. This is a thoughtful and well-intentioned program to teach schoolchildren ways of avoiding prejudice.
Recently, the ADL has been involved in a major controversy about the genocide of Armenians by the Ottoman Empire in the early part of the last century. There is a good description of the dispute on Blue Mass Group.
I fear that ADL has lost its way on this issue, refusing to support a Congressional resolution that calls the massacre what it was, genocide. Now they try to rationalize their failure. See these words of their local civil rights counsel:
The Jewish community in Turkey has clearly expressed to us and other major American Jewish organizations its concerns about the impact of Congressional action on them, and we cannot ignore those concerns. We are also keenly aware that Turkey is a key strategic ally and friend of the United States and a staunch friend of Israel, and that in the struggle between Islamic extremists and moderate Islam, Turkey is the most critical country in the world.
Compare that to the pledge students are asked to take at the end of the ADL's World of Difference Program:
I pledge from this day onward to do my best to be aware of my own biases against people who are different from me. I will ask questions about cultures, religions, and races and other individual differences that I don't understand. I will interrupt prejudice and speak out against those who initiate it. I will reach out to support those who are targets of harassment. I will identify specific ways that my peers, my school, and my community can promote greater respect for people and create a prejudice-fee zone. I firmly believe that one person can make a world of difference and that no person can be an "innocent bystander" when it comes to opposing hate.
I know this pledge is not exactly on the point of the current dispute, but its message is close enough. The pledge does not say that I will stand up against prejudice only when it is politically convenient to do so or only when it is risk-free to do so. Or that I will shy away from controversy for fear of offending an important constituency.
Rabbi Friedman reminded me that Adolf Hitler used the genocide of the Armenians as part of his rationale for destroying other groups. Here's the quote he read.
Our strength consists in our speed and in our brutality. Genghis Khan led millions of women and children to slaughter — with premeditation and a happy heart. History sees in him solely the founder of a state. It's a matter of indifference to me what a weak western European civilization will say about me.
I have issued the command — and I'll have anybody who utters but one word of criticism executed by a firing squad — that our war aim does not consist in reaching certain lines, but in the physical destruction of the enemy. Accordingly, I have placed my death-head formations in readiness — for the present only in the East — with orders to them to send to death mercilessly and without compassion, men, women, and children of Polish derivation and language. Only thus shall we gain the living space (Lebensraum) which we need. Who, after all, speaks today of the annihilation of the Armenians?
In simple language "annihilation" of a particular ethnic, religious, or social group is "genocide." Hitler knew exactly what he was saying.
Nothing can bring back those who died. The government that was in power at the time is long gone, too. But the surviving people of Armenian descent -- along with every other group that could possibly be the target of genocide -- deserve the support of the ADL in validating what really happened in 1915.
If the national office of the ADL remains recalcitrant on this issue, the New England Region should break ranks and make an alternate position clear.
(By the way, here's the text of the disputed Congressional resolution: Calling upon the President to ensure that the foreign policy of the United States reflects appropriate understanding and sensitivity concerning issues related to human rights, ethnic cleansing, and genocide documented in the United States record relating to the Armenian Genocide, and for other purposes.)
Addendum. Breaking news on August 17: The New England chapter did indeed break ranks. Bravo to them!
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