GlassHospital

Demystifying Medicine One Month at a Time

Category: global health (page 1 of 2)

Reducing Harm in Health Care

Gary Cohen, Co-Founder and President Health Care Without Harm, photographed in Charlestown, Mass., Friday, Sept 18, 2015, at The Spaulding Rehabilitation Hospital, one of the first hospitals built embracing Cohen's advocacy of self-sustaining, environmentally responsible healthcare networks. (Credit: John D. & Catherine T. MacArthur Foundation)

credit: MacArthur Foundation

When we talk about harm in the world of health care, we’re usually referring to patients and the facilities in which we provide care. These are the ‘typical’ things we hope to avoid, not only because they are bad outcomes, but because they now carry the specter of financial penalties when they occur:

  • medication errors
  • wrong side surgeries
  • hospital mishaps, like falls
  • missing a diagnosis
  • hospital-acquired infections and those induced by medical hardware

But Gary Cohen of the advocacy coalition Health Care Without Harm takes a much broader view of the harms that health enterprises can cause. Founded in 1996, HCWH is now a multi-national coalition of health care enterprises, governmental and non-governmental agencies, and other advocacy groups.

Cohen and HCWH have had some amazing successes. In less than two decades, HCWH has been able to reduce the number of medical waste incinerators in the U.S from more than 5000 to fewer than 100. Why should we care? It turns out that burning medical waste pours tons of the harmful chemical dioxin into the environment.

Another example: The formerly ubiquitous mercury thermometer. They used to break all the time. Fun to play with the drops of mercury, but highly toxic. Neurotoxic, in fact. And when mercury gets in our water supply, the fatty fish we eat (salmon, swordfish, tuna, mackerel, even shark) slowly poison us — which is why pregnant women and children are advised to avoid eating fresh fish in more than minute quantities.

HCWH was able to make the case that there are technological alternatives to mercury thermometers — that work just as well and are much, much safer. And they’ve been successful. When’s the last time you saw or used a mercury thermometer?

For this tireless advocacy, which also includes making hospital food supplies safer and hospital buildings themselves green and super safe (think natural disasters), Cohen was awarded a MacArthur Foundation Fellowship (think ‘genius grant’) last Fall.

You can hear an interview with Cohen here — give a listen and broaden your perspective on reducing harm in health care.

Contagion of Yesteryear

Ebola seems to have taken up a significant portion of the news stream as of late.

sars-2003_custom-1ec2de788947040b25f2065b83f3b0e087fe0768-s40-c85

NPR–>Kevin Frayer/AP

It’s understandable, given the breadth of the epidemic (largest ever), the fact that it’s hit our shores, and that it’s so frightening: hemorrhage! death!

I wrote a first-person account of the time I was asked to evaluate someone for SARS, a 2002-2003 novel disease outbreak that originated in China and spread quickly to the West (in the end, only 27 U.S cases and no deaths; in Canada, 251 cases and 44 deaths).

SARS is a descriptive name: Severe Acute Respiratory Syndrome. We subsequently learned that it’s caused by a corona virus and that it’s spread by contact and respiratory droplets.

The outbreak died down as quickly as it flared up, and it’s nary been heard from since.

Here’s the concluding graf from the story–as true for Ebola as it was for SARS:

Today’s Ebola crisis makes clear what the many of us were slow to accept in 2003. It takes clear thinking, painstaking preparation, flawless execution and clear communication to protect the public health.

We can only hope that Ebola recedes and becomes a distant memory, also.

From the Mailbag

Yes, we’re baaaa-aack. Here’s a letter from one of our readers:

Dear GlassHospital,

media hysteriaWhile I am a firm believer in the infallibility of doctors and modern medicine, I am desperately struggling with the Dallas handling of an Ebola patient. Sure, sometimes there’s that perfect storm of things gone wrong, opportunities missed, etc (think about the assassination story of Archduke Franz Ferdinand – seems it was destined to happen) but the spread of infectious diseases need not be history-making-world-changing-events in today’s “modern” era, should it? Is there that much of a divide between the knowledgeable and the uninformed – a gap that rivals our economic disparity? Is politics playing a role here, like [Texas Gov. Rick] Perry won’t allow any federal coordinated oversight/CDC management?

I used to watch silly action movies (“Whitehouse Down” for example) and think, “that would never happen! there’d never be such a dumb-ass breach of security like that!” Now I question if I’m the silly dumb-ass who believed there was a working system in place.

So tell me Dr. Glass: while I retain confidence in individuals and continue to hold doctors in high esteem, should I/can I trust hospitals?

Sincerely,

A Lost Patient

Hospital of Horror

photo credit: Times of India

Every once in a while, a tragic news story pierces though the emotional wall we set up to handle the endless torrent.

The news of a hospital fire in Kolkata [formerly Calcutta], India is one such story for me.

The name of the hospital is the “Advanced Medical Research Institute,” known locally as AMRI.

It seems that any place wanting to call itself advanced would consider basics like a fire safety plan and how to execute it.

I was particularly horrified by the utter abandonment of patients by the medical professionals. From a NY Times article on the blaze:

The doctors on duty fled the hospital almost immediately, leaving patients stuck in their wards and at the mercy of the billowing black smoke, witnesses and patients told reporters.

I was reminded of Hurricane Katrina and the brave docs who stuck around tending to those so critically ill that they couldn’t be moved out of the storm’s path.

The Kolkata fire tragedy was compounded by inept administration, security, and rescue response. From the same article:

Local people who tried to get inside the hospital to help rescue patients said they were turned away by security guards who assured them it was only a small kitchen fire.

Hospital officials were slow to call the Fire Department, and then fire trucks were slow to arrive, hospital officials said.

In fact, it took firefighters more than 12 hours to subdue the blaze, Fire Department officials said. The hospital’s fire detection and suppression system did not function…

Who bears responsibility for such a tragedy?

Six senior hospital officials were charged with culpable homicide in connection with the fire, according to government officials.

Goodness.

Thank you for Not Smoking

How well does e-smoking approximate the real thing?

Hope you had a pleasant Thanksgiving. GlassHospital was on the road again, taking the kids to visit the hometown of Cleveland, health mecca of the eastern Midwest.

E-cig smoked by a stunt double for my Uncle Ron.

Had Thanksgiving dinner at my aunt and uncle’s. My aunt is a culinary master; she loves to pull out all the stops, including the homemade apple pie that helped define my youth.

I came away feeling a bit gluttonous. Fitting, I suppose, for the holiday.

But gluttony is not the sin for today. No, today’s sin is smoking.

There has been a convergence of recent news stories regarding the nasty habit that have grabbed my attention:

First, a Lancet article (subscription required) claiming that secondhand smoke kills–to the tune of six hundred thousand lives per year worldwide. The study was done by the World Health Organization (WHO?), and compiled statistics from 192 countries. A data set that broad is not too shabby. [Readers from almost that many countries have enjoyed reading GlassHospital, if we’re to believe Google Analytics.]

Secondly, a recent commentary written under the heading “Ideas and Opinion” in the Annals of Internal Medicine introduced me to something that I’d never seen before Thanksgiving: the electronic cigarette (the “e-cig”).

Oddly enough, in our post-Thanksgiving stupor, what do you think I saw? My Uncle Ron, a longtime smoker, proceeded to sit in the comfy TV room chair and “light up” cigarette after cigarette.

I was surprised, because Uncle Ron’s smoking has been shunned by the rest of the family to the point where he’ll usually go outside or hide in his room if he’s going to light one up. I was also surprised since even though he’s an inveterate smoker, I’d never seen him chain smoke one after the other like that.

And with kids in the room!

Then I noticed the strange glow from the tip of the cigarette. Orange. Bright orange. Perfectly bright orange with a blue halo. And the way the smoke seemed to come out in a consistent volume whether he was puffing on it or not.

Uncle “Smoke” (as my niece and nephews affectionately used to refer to him) was smoking an e-cig!

Coincidence? I think not.

My cousin had introduced his Dad to the e-cig in the hope that he’d use the device(s) to help himself quit.

The e-cig is an aerosolized nicotine delivery device that uses a battery to deliver the “medicine” and create the “vapor” that emanates from the cigarette’s tip to simulate the controlled burn of tobacco and paper in a real cigarette.

As the title of the Annals piece states, e-cigarettes are “a rapidly growing internet phenomenon.” As such, it behooves us to treat this phenomenon with a healthy degree of skepticism. The Annals piece concludes by making the unsurprising claim that more research needs to be done into the products, their effects, and their unintended consequences. For example, just how “safe” is that vapor for non-users in the vicinity of an e-cigarette? And, is there any compelling evidence that absorbing nicotine in this way really helps hard core smokers to cut down or quit?

My first impression was that my uncle was actually “smoking” more, since he no longer was leaving the room to smoke.

After Thanksgiving, my curiosity about e-cigarettes grew. If they’re so “safe,” could they be smoked in hospitals so that addicts could get their fix of nicotine in a way non-harmful to others?

Indeed, a quick internet search turns up this. But take it with a boulder of salt, since it’s a press release from a manufacturer. They do not identify the Tampa hospital that purportedly permits this, nor do they give other examples of accommodating hospitals, even though the headline boasts of e-cigarettes being accepted in “many hospitals.”

For his part, Uncle Ron seems to like the products. He’s “present” more at work, since he now doesn’t need to go outside to smoke. As to whether the e-cigs are helping him quit his tobacco habit, he (and those around him) remain uncertain.

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