GlassHospital

Demystifying Medicine One Month at a Time

Category: medical innovation (page 2 of 10)

I Floated for NPR — To Achieve Some Inner Calm.

We Used To Sell Cigarettes in Hospitals

nurse_1471846fNice article in STAT, a relatively new Boston Globe-affiliated publication devoted entirely to health care. Melissa Bailey reminds us that ‘candystripers’ used to sell cigarettes to patients to comfort them while hospitalized.

How quaint.

She goes on to point out 5 practices that will seem just as antiquated. Soon, we hope.

  1. Advising doctors NOT to say, “I’m sorry.” Hospitals still do this. It can be seen as an admission of guilt, the thinking goes.
  2. Have prescription labels that don’t indicate what the medicine is for. How smart. And not even close to standard at present.
  3. Not washing our hands in front of you every time. ‘Nuff said.
  4. Spending more time typing than talking and listening to you. We can hope, can’t we?
  5. Easily getting your medical records, without your having to pay, wait, fill out forms, or just be hassled like you’re asking for state secrets.

I think this is an excellent list. There are no doubt dozens more. (Why do we awaken people in the hospital so often?) What are your ideas for health care pet peeves you’d like to see abolished?

Stomach Draining?

FDARecently the US Food & Drug Administration (FDA) approved a device for market called “AspireAssist.”

The device is hooked up to an incision in your abdominal wall after each meal that allows you to drain 30% of your stomach contents directly into the toilet.

Harder to gain weight (and easier to lose it!) when you’re diverting a third of caloric intake from your body into the sewer system.

It works like a “G-tube” in reverse — the kind of tube that puts liquid calories INTO your stomach in the event you can’t swallow (i.e. you’ve had a stroke or some kind of oral surgical issue that won’t let you chew and swallow). Therefore it was deemed ‘safe enough’ because SO FAR it has a low complication rate.

But keep in mind to get FDA approval the manufacturers only had to show efficacy and safety in two small trials totaling less than 200 patients. This is a lower barrier to market than would occur if the new product were a medication. [Devices and medications are held to different approval standards at the FDA.]

As for whether AspireAssist is ‘ready for prime time,’ I share the healthy skepticism of my friends over at “Updates in Slow Medicine,” who wrote:

From the Slow Medicine perspective, removing food after eating directly from the stomach using an A-tube remains an experimental approach to weight loss, and we would only recommend an AspireAssist device to a patient of ours enrolled in an appropriate clinical trial.

With more clinical experience it’s possible this could be a solution for many folks struggling with obesity. But only when we know more.

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.

Game Changer.

Well, 2016 is off and running. Though the markets seem in peril due to China’s economic cooling, the health care arena in the U.S continues to burn like a hot stove.

For one thing, a now-unified Republican Congress passed the 62nd or so attempted repeal of ObamaCare, which the President unsurprisingly vetoed. The new year will likely decide the fate of the Affordable Care Act — and whether it continues its evolution and improvement in providing coverage to more Americans and helping control health care costs, or whether it is substantially rolled back.

Whatever your position on the law, here are some incontestable facts about it:

  • marmotsdhThe law has survived two (2) different Supreme Court challenges.
  • More than 20 million Americans previously without insurance coverage now have it.
  • The percentage of uninsured Americans is the lowest since the government began tracking the statistic in 1972. [Percentages were much higher in the early 1960s before the passage of Medicare and Medicaid in 1965.]
  • Millions more are eligible to gain insurance through the law’s mechanisms, provided those people elect to sign up rather than pay a tax penalty.

But here’s what I find really interesting:

More than just a coverage law, the Affordable Care Act is also a health care delivery law. Parts of the statute are directed at improving how health care is delivered and how our menu(s) of options are developed and prioritized. Fundamentally, it’s reasonable to ask: If the U.S. spends the most in health care (both per capita and in aggregate), and our outcomes are worse than other nations (in measures like life expectancy, infant mortality, etc.), shouldn’t we seriously reconsider how we prioritize our health care spending?

CMS, the federal agency that administers Medicare and Medicaid announced this week its first ever pilot initiative to fund programs addressing social determinants of health: housing, food security, utilities, transportation. [Other key determinants not covered under this pilot are education and employment.]

This is a game changer because it’s the first time the biggest driver of health care services and innovation is directly attempting to address issues that undergird our collective poor health attainment. Rather than just continuing to pour money into “sick care” (i.e. where most of the spending in health care occurs), this initiative provides dollars “upstream” to see if together we can find ways to prevent both major and chronic illnesses.

Couple new initiatives like this with ongoing efforts to reform medical education, and one gets hopeful that we can change health care to become smarter, more compassionate, and achieve better results.

« Older posts Newer posts »

© 2019 GlassHospital

Theme by Anders NorenUp ↑