It Is In Your Backyard

It was 2 a.m., 22 years ago, when I answered the phone.  My friend’s brother, barely audible, asked if I wanted to buy his parents’ silverware or maybe a saltwater fish tank setup.  He would be over in less than an hour, and we could settle on the price then.  Another close friend was distraught, having just been informed that her daughter, a freshman in college 3,000 miles away, had been found unresponsive on the floor and taken to the emergency department.

MLPs – Current State vs. Future State: What to do with mid-level providers?

While I was recently speaking with a group of physicians, a comment was made regarding mid-level providers.  Somewhat succinctly and pointedly, it was mentioned that the direction of health care is such that patients are more frequently unable to see a physician in primary care settings, specialty clinics and emergency departments.  This is not a new circumstance, but a growing and developing integral transformation in health care occurring over several decades.  Interestingly, the same physician’s practice has MLPs as part of the staffing model, with a very large patient base and a well-regarded reputation.  What is paradoxical is that over the years many patients have commented that they have not seen their PCP at all within that practice, they are seen exclusively by a midlevel in the office who they have come to accept as the provider who knows them better than anyone else in the group, and they are quite satisfied with their PA-C/APRN relationships. 

CO Toxicity

In support of Gov. Maggie Hassan’s recently signed proclamation naming November as Carbon Monoxide Awareness Month, it is appropriate to share the importance of this timely public health message in my first NHMS blog. 

Many years ago as an undergraduate student at UNH, I volunteered as an EMT for a newly installed hyperbaric oxygen chamber.   A donation from a New York university, the chamber was unusually large in comparison to other chambers and could contain four adults and a patient during a treatment.  I recall some of the distinct differences to the patients, really challenging cases, we treated in the chamber to those I have treated in emergency departments in large inner cities and communities as well.  The one striking commonality is not the severity of any given patient nor the tragedy for those who did not wake up or fully recover from an acute high concentrated exposure, but rather those who had presented after sustained, lower concentration exposures.

Desiderata

So this is it.  The Final Blog.  Election Night 2014.  No pressure.  Why is this night different from all other nights I remember reciting as a kid? Now I know what was meant.  Will our country be realigned politically by the time you read this Wednesday afternoon?  Yup, as the Senate and House of Representatives are now under Republican control.  How will health care fare when the new Congress convenes in 2015?  Could the Affordable Care Act be turned inside out, upside down or overturned?

Stop the Madness

Columbine.  Santana High.  Rocori.  Red Lake.  Chardon.  Sandy Hook.  Reynolds High.  Arapahoe.  Marysville-Pilchuck.  Kids killing kids in school.  15 years.  More than 75 deaths.  More than 100 wounded.  Communities all over this country wondering if they are next.  Americans are 20 times more likely to die via a shooting than any other developed country in the world, and children between the ages 5 of 14 are 17 times more likely to suffer this fate.

Ezekiel's Run

In 1976, a futuristic cinema experience promised a life full of pleasure with just one catch — when you turned 30 years old, the life-clock crystal in your palm turned red, you were on your last day, and unless you wanted to head to the “Carrousel” for vaporization and “renewal,” you had to run.  While “Logan’s Run” may not have been the greatest sci-fi film ever made (“The Empire Strikes Back,” anyone?) it possibly is the reason that no one wants to admit they are a day over 29.  Recently, a new number has been thrust into the medical consciousness as another option for the last year of enjoyable life.  That number is 75, which has been proposed by Dr. Ezekiel Emanuel as his choice for leaving planet Earth for good or refusing further medical care.  See the article in The Atlantic.

The Unthinkable

An American nurse is infected with a deadly disease while working in her own hospital.  Accusations of breached protocols and changing guidelines.  Too much of a hazmat suit is not a good thing.  Taking off the personal protective equipment the wrong way may kill you.  The virus is the enemy, people, don’t forget that.  What a crazy three days it has been.  Now a second healthcare worker has tested positive for Ebola.  When the executive director of a national nurses union says that she and her members are deeply alarmed about the lack of protocols at Texas Health Presbyterian Hospital, a new day has truly dawned.

The Stand

By the time you read this blog, there will already have been a webinar put on by the New Hampshire Department of Health and Human Services on Ebola virus disease titled “Moving Clinicians from Panic to Prepared.”  As some of you may know, I wrote about EVD a few months ago for the bimonthly NHMS newsletter and asked the question about how the spread of disease could be stopped, when healthcare workers were one of the most at-risk populations.  How could a clinician not panic, seeing how egalitarian this virus has been, having complete disregard for social or professional status as it has claimed victim after victim, spreading across continents at will.

For Subcutaneous Use Only

If you were asked to name the best-selling medication in the United States last year, what would your guess be?  Not the most prescribed drug, but the medication with the most revenue, mind you.  I know what you are thinking — it must be a cardiac drug, due to the prevalence of heart disease.  Lipitor?  Close, but that would be the lifetime sales king ($141 billion).  Maybe a diabetic drug?  There are obese people with diabetes everywhere.  No, wait, an opioid — that has been in the news all over the place in the last year.  Well, the answer is not exactly clear cut, depending on what source you quote.  However, it does appear that between July 2013 and June 2014 the best-selling medication in this country was aripiprazole (Abilify), with sales of $7.2 billion, and the most prescribed medication was levothyroxine (Synthroid), with 22.6 million prescriptions written.

Who's Afraid of the Boogeyman?

Toothpaste grenades.  Bombs in iPads?  Exploding clothing!  How scared I am.  Not the typical Dr. Seuss rhyme we grew up reading.  U.S. officials announced on Tuesday, Sept. 23, that one of the reasons for the recent bombing on Islamic State (ISIS) and Khorasan Group member locations in Syria and Iraq was because of intelligence that indicated these groups had obtained materials for improvised explosive devices (IEDs) that could be concealed in handheld devices such as smart phones and tablets as well as clothing dipped in explosive material.  These could then be used in coordinated, multiple “lone wolf” attacks.  See the story on CNN.

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