Posts Tagged ‘medicine’

Lessons from Ernest Shackleton’s Medical Kit

Tuesday, October 2nd, 2012
“Men wanted for hazardous journey. Low wages, bitter cold, long hours of complete darkness. Safe return doubtful. Honour and recognition in event of success.”

That is the ad that was allegedly posted to attract crew to Sir Ernest Shackelton’s Arctic Expedition on the Nimrod in 1907-09. There’s been a lot written about this adventure to one of the then-most remote corners of the earth. It is still among the most remote wilderness locations today – contemporary workers who agree to stint at Antarctic bases have to prepare for a long haul since some locations only afford a two to three month window when bases are reachable.
A few years ago, when Gavin Francis accepted the position as a medical doctor ‘wintering’ at Halley Base, a profoundly isolated research station on the Caird Coast of Antarctica, he had to plan accordingly since the base is unreachable for ten months of the year. He’s written a pretty fascinating article in Granta magazine comparing the preparations he took in terms of supplying a medical kit with the list of supplies in Shackleton’s Medical Kit.

“In the well-stocked polar section of the little base library I unearthed the packing list for Shackleton’s medical kit – the drugs and dressings he took on the sledge trips of his Nimrod Expedition of 1907, the one that turned back only ninety-seven miles from the South Pole. It added up to a weight of about three kilos, less than a sixth of the modern kit, and to my technomedical mind read more like a witch’s grimoire than the best medical advice of just a century ago.”

It’s a pretty fascinating read, one that we think might tickle the fancy of occupational physicians. We enjoyed the author’s observations about how the practice of medicine has changed, particularly in regards to the challenges of caring for a workforce in a remote location.
Chances are, no matter how remote your workplace, planning for employee health and safety program doesn’t have quite the same extremes in parameters. But one thing remains true: advance planning can still mean the difference between life and death; knowing how to respond quickly can be the difference between a relatively minor event and a life-changing tragedy.
What’s the status of your workplace first aid kit?
In Fundamentals of a Workplace First-Aid Program (PDF), OSHA suggests:

“Employers should make an effort to obtain estimates of EMS response times for all permanent and temporary locations and for all times of the day and night at which they have workers on duty, and they should use that information when planning their first-aid program. When developing a workplace first-aid program, consultation
with the local fire and rescue service or emergency medical professionals may be helpful for response time information and other program issues.”

The booklet outlines OSHA Requirements, recommended First-Aid Supplies, including Automated External Defibrillators, guidance on First-Aid Courses and Elements of a First-Aid Training Program. In addition to evaluating their own organization’s risk factors, employers should be aware of any state laws governing workplace first aid.
ANSI/ISEA Z308.1-2009 is the current minimum performance requirements for first aid kits and their supplies that are intended for use in various work environments. You can purchase these through the American National Standards Institute (ANSI) or the International Safety Equipment Association (ISEA). If you want to save a few dollars, you may be able to find a free copy, such as the one we found minimum contents list from the Minnesota Department of Labor and Industry.
Automated external defibrillators (AEDs) programs are an increasingly common component in a workplace health and safety program to address sudden cardiac arrest. These programs require some medical guidance and training to put in place.
Arguably, one of the most parts of your emergency planning should be to prepare your employees and your supervisors about what to do in the case of a medical emergency. Put your policies and protocols writing and communicate them to your employees frequently. Don’t forget to include solitary and remote workers in your emergency planning.

How Doctors Die: It’s Not Like the Rest of Us, But It Should Be

Monday, January 9th, 2012

We’ve bringing you something a bit peripheral to our normal topics today, but it deals with the business of medicine. Plus, it is excellent.
How Doctors Die by Ken Murray, MD talks about how doctors face end of life issues. Many might assume that when faced with a terminal condition, physicians would leverage their expertise and access to the max, harnessing all the latest treatments and technologies. But the picture that Murry paints is a very different one. Armed with the knowledge of just how grueling and terrible the “do everything possible” model can be, many doctors choose to forgo chemo, radiation, surgery, and other life-prolonging treatments entirely.

“What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.”

Some physicians who have participated in or witnessed extraordinary and extreme measures to prolong life – what Murray calls “futile care” – wear “No Code” medallions or tattoos.
Why, if they don’t want this treatment themselves, do they inflict it on patients? Murray explores the many often human reasons why family members and physicians make these choices and points to a system that encourages and rewards excessive treatment and unrealistic expectations about what medicine can do. Plus, as a society, we have a cultural bias against accepting death. Perhaps it was ever so – no one want to die. But advertising, a stay-young-forever culture, pharmacology, and the miracles of technology all conspire to make us think we perhaps can live forever. When someone facing a terminal illness chooses acceptance of the natural order, they are often pressured by family and friends for not being a fighter.
The comments in the article are also well worth reading. Other people — doctors, medical professionals, and “civilians”– offer their thoughts, opinions, and touching real life experiences with family members, friends, and even their own terminal circumstances.

Battlefield medicine: technologies that may yield benefits for injured workers

Monday, November 15th, 2010

Last week, our nation honored its veterans for service rendered to the country. Although belatedly, we join in offering thanks. One could make the case that our nation’s gratitude should be a 365-day-a-year tribute rather than largely confined to a single celebratory day. On returning home, many veterans face an enormous hurdle, the day-in-day-out battle of finding employment, a formidable challenge for any vet but made even more difficult in the current economy. Beyond an expression of appreciation, there are many good reasons why employers should hire vets. The U.S. Department of Labor has collaborated with Office of Disability Employment Policy (ODEP), the Veterans’ Employment and Training Service (VETS), and other federal agencies to offer a Step-by-Step Employer Toolkit for Hiring Veterans.

In addition to their military service, there is another debt that we owe to our vets, particularly those who have been wounded physically or psychologically. It is one of life’s great ironies that war, which is responsible for so much death and destruction, is also a catalyst for the advance of medicine and medical technologies.

Just as weapons become more sophisticated, so too do the medical technologies designed treat the wounds that these weapons exact. From wars in ancient times to the present, civilian medicine has been advanced by battlefield medicine, first practiced on wounded warriors.
advanced-prosthetics
Wired Magazine has been one of the ongoing sources we turn to get our fix about battlefield advances in medical technology. A recent article – Military’s Freakiest Medical Projects – is a fascinating case in point, highlighting advances in prosthetic limbs, skin grafts, burn repair, bone cement, suspended animation, and more. The article’s intro explains that “Some of the Pentagon’s extreme medical innovations have already debuted in the war zone. And with myriad applications outside of combat, these advances in military medicine mean that revolutionary changes for civilian care aren’t far behind.”
Another recent article – Exoskeletons, Robo Rats and Synthetic Skin: The Pentagon’s Cyborg Army – focuses on technologies that foster recovery, such as neurally controlled prosthetics, or that enhance performance, such as wearable exoskeletons that amplify amplify troop strength and endurance.

As exciting as these developments are, not all effective treatments rely on advanced technology – some are reassuringly “old-school.” A case in point is this heartwarming story about vets with PTSD who train service dogs as companions for vets in wheelchairs. The dogs do double duty, serving as therapy dogs for those with PTSD while they are being trained, and later as helper dogs for those confined in wheelchairs. You can learn more about this most excellent program at Paws for Purple Hearts.
And if you doubt the healing and restorative power of dogs, we leave you with this evidence: an incredible compilation of clips of dogs welcoming home soldiers. One warning: have a box of tissues nearby!

Atul Gawande’s The Cost Conundrum – Why haven’t you read it yet?

Monday, July 6th, 2009

Over the last twenty years, medical costs have gradually, but steadily, replaced indemnity wage replacement as the engine driving the workers’ compensation train. This is the same period during which our nation’s health care costs have grown from average among OECD countries (Organization for Economic Cooperation and Economic Development) to double the average (PDF). In other words, workers’ compensation medical cost increases reflect similar increases within the general public. The only surprising thing here is that during the last decade or so, the steady increase in workers’ compensation medical costs has happened at twice the rate of those eye-popping group health increases.
The National Council on Compensation Insurance (NCCI) has convincingly demonstrated that the rise in workers’ compensation medical costs is due primarily to over-utilization of physical medicine services, especially those for chronic, soft tissue claims. (See here (PDF) and here (PDF ). And now, Atul Gawande, writing in the June 1, 2009 issue of The New Yorker, has demonstrated even more convincingly that over-utilization of medical services, including testing, surgery and hospitalization, is the metastasizing cancer in America’s health care system.
Dr. Gawande’s lengthy article, The Cost Conundrum, for which he should win the Pulitzer Prize, is the most trenchant argument yet for why costs in America are so appallingly high, but outcomes merely mediocre. He reduces the problem to its simplest terms. In essence, our American health care house that Jack built has turned the once noble profession of medicine into nothing more than assembly line piecemeal work, and our physicians both in primary care and the specialties, have been economically incentivized to over-prescribe in all areas. And, as Gawande’s article clearly shows, the areas of the country that produce the highest costs with all that over-prescribing also produce the poorest health care results.
Dr. Gawande examines health care in McAllen, Texas, a town within Hidalgo County, the County with the lowest household income in the country, but, after Miami, the second most expensive health care costs. He wanted to know why. He also wanted to know why health care costs in El Paso County, eight hundred miles to the north with similar demographics to Hidalgo’s, were 50% lower.
He wanted to know why the Mayo Clinic, in Rochester, Minnesota, with the best medical technology on the planet, produced some of the highest quality medical care in the nation, but with costs that rank in the lowest fifteen percent of the nation. And why the Mayo was able to replicate that achievement when it opened its hospital medical center in Florida, one of the country’s highest cost states for health care?
His answer? Because in the pockets of excellence he found around the country doctors work together in teams, peer-reviewing each other’s work. In these low-cost, high-quality areas, physician income is neutralized. At the Mayo, for example, the doctors are all on salary. Whether they order ten procedures or none, they get paid the same. This is central to understanding how to fix the problem. As Gawande writes:

“Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coordination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country’s best electrician on the job (he trained at Harvard, somebody tells you) isn’t going to solve this problem. Nor will changing the person who writes him the check.
This last point is vital. Activists and policymakers spend an inordinate amount of time arguing about whether the solution to high medical costs is to have government or private insurance companies write the checks. Here’s how this whole debate goes. Advocates of a public option say government financing would save the most money by having leaner administrative costs and forcing doctors and hospitals to take lower payments than they get from private insurance. Opponents say doctors would skimp, quit, or game the system, and make us wait in line for our care; they maintain that private insurers are better at policing doctors. No, the skeptics say: all insurance companies do is reject applicants who need health care and stall on paying their bills. Then we have the economists who say that the people who should pay the doctors are the ones who use them. Have consumers pay with their own dollars, make sure that they have some “skin in the game,” and then they’ll get the care they deserve. These arguments miss the main issue. When it comes to making care better and cheaper, changing who pays the doctor will make no more difference than changing who pays the electrician. The lesson of the high-quality, low-cost communities is that someone has to be accountable for the totality of care.”

The Cost Conundrum, by Atul Gawande, should be required reading for anyone interested in understanding and participating in American health care reform. And that should be all of us.

Health Wonk Review: the biweekly smorgasbord of the best fare in the health care policy blogs

Thursday, May 14th, 2009

smorgasbord.jpg Welcome to Health Wonk Review, our bi-weekly smorgasbord of the best that the policy wonks have dished out on some of the most noteworthy healthcare blogs over the prior fortnight. We have an extensive sampling of tasty and nutritious treats, with lots of brain food among the fare – so without further ado, we offer this week’s buffet.

  • The love fest at the White House with health care providers generated great headlines, but, where’s the beef? Merrill Goozner at GoozNews points out that the promises made by the trade associations and physicians held not a few ironies: Just Don’t Ask CBO To Score It.
  • To say that Joe Paduda of Managed Care Matters is skeptical about said love fest is an understatement. He is shocked and blown away that the politicians in Washington actually believe the health care-insurance industry’s self regulation will reduce the nation’s health care costs.
  • Will the consortium of private sector stakeholders be able to cut $2 trillion in healthcare costs as they claim? Jason Shafrin of Healthcare Economist casts a critical eye on this in his post Letter to Obama: We’re gonna save $2 trillion .
  • When it comes to financing health care reform, Anthony Wright of Health Access WeBlog suggests that policymakers take a two birds with one stone approach by seeking options that not only raise funds but also help the health system.
  • Are hospitals really taking a hit from the current health care system? That’s a question posed by InsureBlog’s Henry Stern, who deconstructs the latest survey results from the American Hospital Association in his post, Economy Tanks; Hospitals, Patients Hardest Hit.
  • Brady Augustine of MedicaidFrontPage posts about Wellcare being taken to the woodshed for the sins of its prior executives who lived high on the hog while shortchanging vulnerable citizens. He discusses lessons learned, offering his thoughts on how to avoid such a scenario in the future.
  • How Hard Can It Be To Coordinate Care? Rich Elmore of Health Technology News interviews Dr. Mai Pham, who turned up some startling results in a study of the number of physicians and practices that are linked to a primary care provider for coordination of care.
  • Jeffrey Seguritan looks at a study of Medicare’s unplanned hospital readmissions at nuts for healthcare, noting that readmissions seem to indicate low quality of hospital care and drive health spending. He suggests that hospitals should be incentivized to cut readmissions, but current
    policy proposals should be wary of system-gaming and should consider illness severity.
  • Yikes. David Harlow of HealthBlawg posts about the Virginia prescription record security breach, in which millions of prescription records were lifted from a state government website and replaced with a $10m ransom note. He suggests that organizations that hold electronic protected health information should use this incident as a learning experience for planning and executing programs yo increase data security, as well as preparing for communications both to prevent breaches and to respond to any breaches that do occur.
  • Roy M. Poses of Health Care Renewal has frequently tackled the topic of conflicts of interest in health care, offering examples of published defenses based on logical fallacies. Most examples were written by people who had their own ties to health care corporations and appeared mainly in the op-ed pages of newspapers, but in his post Attacking “Crusaders” Against Conflicts of Interest with Logical Fallacies, he offers an example in a scholarly journal, published as an anonymous editorial. He says we can expect to see more accusations of witch-hunting, prudery, moralism, lack of realism, and the like leveled against those who oppose such lucrative financial
    relationships.
  • Louise of Colorado Health Insurance Insider posts about how Reid is absent in Sick Around America, apparently fallout with Frontline after last year’s acclaimed Sick Around the World. Louise offers the scoop on the controversy.
  • At Disease Management Care Blog, Jaan Sidorov examines the ugly politics that emerged around the issue of using gender in health insurance underwriting in his post Snatching Humiliation From the Jaws of Compromise.
  • President Obama recently spoke about his grandmother’s death and the questions it raises about end of life care in an interview published in the New York Times Magazine. Joanne Kenen of New Health Dialogue discusses Obama’s Grandmother and the National Conversation on Healthcare, adding her own patient-centric questions that need to be part of the dialogue.
  • Jocelyn Guyer of Say Ahhh! tells us that there was mostly good news for children in the Senate Finance Committee’s Health Reform Proposal.
  • Glenn Laffel of Pizaazz discusses a particularly vexing clinical and policy problem involving a defective defibrillator produced by Medtronic, that is currently in the bodies of a quarter of a million people. Leaving the failing device in place may kill patients, but removing it may do the same.
  • Pop goes the health care bubble? At the Health Care Blog, George Lundberg looks at Enron, the dot.com era, and the real estate-financial collapse, all recent examples of growth and expectations far exceeding substance, and makes the case that the health care bubble will be soon to follow.
  • David Williams of Health Business Blog asks why employees should be penalized for smoking or being overweight but not for having unprotected sex with multiple partners in his post on the ethical considerations of financial penalties for unhealthy behaviors.
  • Eric Turkewitz of New York Personal Injury Law Blog notes that doctors still top our the pay charts, but complain about malpractice premiums anyway. He cites a survey which states that out of the ten top paying jobs, nine go to medical professionals.
  • Tinker Ready of Boston Health News posts about a new Partners/Harvard HIT blog on clinical informatics. Incidentally, Tinker will host the next issue of Health Wonk Review.
  • In his post Even more ‘Fierce’, Neil Versel of Healthcare IT Blog discusses a new publication FierceEMR, which includes one of his articles about live video links from ambulances to a trauma center in Tucson, Arizona.
  • Although the influenza A (H1N1) or swine flu outbreak is gradually falling out of U.S. news headlines, Kara Rogers of Britannica Blog notes that the full extent of the outbreak may not be known for some time because other countries are only now experiencing their first cases or are experiencing an increase in confirmed cases as their backlogs of samples are tested.
  • Is our food policy behind the current swine flu pandemic? Eric Michael Johnson discusses how we can best promote national health by changing how our food production policies at The Primate Diaries.
  • And here at Workers Comp Insider, we’ve noted that there’s a new OSHA sheriff in town. Long-time worker safety advocate and former safety blogger extraordinaire Jordan Barab is serving as Acting OSHA Administrator.