Thursday February 27, 2014
I live in California. As you may or may not have heard, we have a tendency to shake out here. Big earthquakes can be kind of scary when you take time to think about them, but we hardly ever do. Most of the time we just go about our business and every once in a while we hear that San-something-or-other had a five-point-whatever quake last night around midnight. Occasionally, we get a doozy.
It's no different in other parts of the country, but we must get used to our own brand of disaster. I laughed out loud when in Mississippi -- after hurricane Katrina -- a patient I was treating asked where I was from.
"California," I said, with an air of pride in my voice.
"Oh goodness," came the reply. "I don't know how y'all can live out there with them earthquakes."
Storms don't have to have names for them to be a big deal. Tornado alley cranks up a show every year like clockwork and lightning does a pretty good job of setting the western states on fire whether the weather is more el Niño or la Niña. Superstorm Sandy--part named storm and part Frankenstein's monster--shut down New York in October of 2012. Floods occur somewhere just about every month of the year.
Mother Nature doesn't even have to put the hammer down for us to run into trouble; a simple power failure can be devastating.
Wherever you live, it's a good idea to be prepared in the case of disaster. At a minimum, it's recommended to have at least 3 days worth of supplies on hand in case the grocery store gets demolished. Since the drug store might take even longer to get back in the game, you should have at least a week's worth of medications.
Monday February 24, 2014
I've always advised against seeing your doctor when you have chest pain, just in case it could be a heart attack. Seeing your doctor is an unnecessary delay. Chest pain should always go first to the emergency room -- preferably by ambulance.
Two studies in 2008 confirmed that calling your doctor with stroke symptoms may delay treatment. The treatment that can possibly reverse the symptoms has to be started within 3 hours of the first symptoms.
In one study, conducted in West Virginia, researchers randomly called doctors' offices and described stroke symptoms. Nearly a third of all the receptionists suggested a wait-and-see response. They advised the callers to call back if symptoms persisted. What they should have done was tell the caller to hang up and dial 911.
Another study in Australia looked at almost 200 stroke patients in 3 different hospitals. The patients were asked if they contacted their primary physicians before coming to the hospital. About a fifth of the patients called the doctor before going to the hospital. Of those who called the doc, less than half were told to call an ambulance; and even though they were correctly told to call, the extra step of calling the doctor delayed their care by an average of 92 minutes. That's a lot of time when you only get a 3 hour window.
Of course, that delay is nothing compared to the more than 7 hours it took for the wait-and-see crowd to get to the emergency department. If the doc suggests that you wait or schedules an appointment for you later today or tomorrow, the chance of treating your stroke and reversing some of the symptoms simply vanishes.
The American Stroke Association wants you to call 911 when you have any of the following symptoms of a stroke:
- Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
- Sudden confusion, trouble speaking or understanding
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, dizziness, loss of balance or coordination
- Sudden, severe headache with no known cause.
Sunday February 23, 2014
The short answer is, nothing. It's all in how we got here.
First came hospitals, collections of beds where patients could be cared for by doctors and nurses. Pretty soon, hospitals started grouping their beds and equipment into wards. Babies were born in the obstetrical ward, with a separate delivery room if it was a big enough hospital, and after an operation -- which happened in the operating room -- patients would be placed in the surgical ward. Those in need of medications but not surgery were treated in the medical ward.
See the trend?
Saturday February 22, 2014
Harvard researchers recently published a study in the British Medical Journal that showed 30% of Medicare patients were getting pain meds from more than one doc.
First of all, opioids (which are what we're all talking about when we're fired up about painkillers) are addictive. It's not a secret. Plus, when you take them, you develop a tolerance and must increase your dose pretty regularly to maintain the same effects.
I'm not sure why we might have thought that a certain population of Medicare patients wouldn't manipulate the system for extra painkillers just like other patients do. I've been in ambulances for a long time and I can attest to the fact that opioid overuse is a common problem. Some patients use multiple physicians to obtain pain medications. I have no way of telling you how many patients do it (in ambulances and emergency departments, we see a disproportionately large cross section of these folks) but 30% sounds a little high.
I'm sure some of the Medicare patients identified in the study were perfectly innocent situations. Patient goes for a root canal and gets a script from the dentist, then is seen for a sprained ankle two months later and gets one from the ER doc--boom, there are two providers doling out painkillers. On the other hand, there is definitely manipulation, even though some of it isn't exactly on purpose.
There are two distinct camps in the medical professions. Either you think that all pain should be treated, regardless how minor. Or, you believe that we are relying too much on pain control, to the detriment of our patients.
I'm in the second category. Pain is a natural response. It serves a purpose of letting us know when the body is in trouble or in danger of going past its limits and causing damage. We have to learn to deal with pain on some level without masking it.
That doesn't mean there isn't a need for painkillers to help mitigate severe pain, like that after surgery. It just means that we have to make sure that our patients are not getting hooked, a real and serious concern.
Even for Medicare patients.