Grand Rounds Vol 8 No 25: Super Tuesday Edition

Welcome to grand rounds, the best around the world of medical blogging!  
For those expecting a silly recitation of today\’s posts in rhyme, this post will let you down.  But don\’t be sad, as I have provided with an alternate version of grand rounds on my other blog, Llamaricks, which (if you hadn\’t guessed) is not quite as dedicated to the serious side of things.  

Since today is \”Super Tuesday\” (whoever associated the word \”super\” with politicians should explain this to us now), I thought I would use today\’s posts as a means of communicating to those who would represent us just what they are getting in to.  Unfortunately, it seems that the people in Washington and those who are trying to get there pay more attention to the polls than they do the people.  They want to get elected more than they want to solve our problems, and the problems in health care are huge.  These posts do a far better job of underlining that reality than I could do on my own.

My apologies to those living outside of the US…wait…you aren\’t really offended at not being part of our system, are you?

Thanks to all who contributed and to the fine folks who run this whole grand rounds thing!

Enjoy.

Dear Politicians:

I have heard something startling: you want me to vote for you.  While I greatly respect people dedicated to public service, I must say that I have lost trust in you and in the political system.  I share this mistrust with the majority of Americans.

The bottom line is this: you have all lost touch.  It seems that you are more connected to the votes than to the voters, more aware of the polls than the needs of the people being polled, and more set on political battles than fixing the mess our country is in.  In no area is this more plain than our health care system.

The following articles are written by real people from all ends of the political spectrum. Some of the writers are wealthy, others are poor.  Some are doctors, some nurses, some are patients.  Some of the people are healthy, some are sick, and some are dying.  Some are thoughtful and introspective, while others are silly and sarcastic.  Some are from this country, while others are not.

What do all of these writers have in common?  They deal with health care.  They are the end-result of policy, the pawns in political battles, the \”consumers\” pandered to by profiteers, the sob-stories told to prove political points, and the statistics that are twisted to political ends.

They are all real.  Here are their stories:

The patients who would rather not be sick.  Walking the Walk – Life is a Many Zebra\’d Thing

This article is written by a person has been through cancer, heart problems, endocrine problems, infections, and now has to face being a diabetic.  She tells of the struggle to admit the reality of the diabetes.

Yep, I\’m going to have to start acting like a diabetic and carry a rescue kit of juice and candy with me. Sad to think that while I know that sugar is not my friend, from time to time I\’m going to have to rely on it. Fun times ahead, I can already see.

People who get advice that is motivated by money, not what\’s best for them.  The Challenge of Shopping Around for Healthcare – from the Colorado Insurance Insider

This article discusses the perils of trusting advice from others without knowing their motivation.

Given the difficulty of comparing something as basic as prices for medical procedures – much less things like long-term safety and efficacy – it’s unlikely that patients can really be informed healthcare consumers unless things become a lot more transparent. 

Doctors who don\’t want to recklessly spend money  –  Friday Reflection: The risks of looking and doing so much – Dr. John M

Doctors are put in a difficult situation: they are handsomely paid to do things that may not help, and may even hurt patients.  This article talks about a doctor\’s struggle between doing the job and caring for people.

I love this doctoring thing. Using hard-won skills, smartly applied modern technology, teamwork and compassion to make sick people better feels really damn good. But with such fine sensations comes the heartbreak of failure.

And one such failure that haunts me is…

Making a well person sick.

That my friends should be a never event!

 

People who get drunk to avoid societal stupidity –  UCEM Position Statement On Alcohol And Idiocy – Life in the Fast Lane

This is a very clever (and fictional) post that proves that it\’s easier to face society\’s stupidity with elevated blood alcohol levels.  This is the world in which you are wanting to govern.

Upon completing measurement of baseline neuronal density, participants were exposed to three hours of conversation topics associated with neuronal death. These conversations covered the Kardashians, Jersey Shore, Lady Gaga’s newest costume monstrosity and popular culture.

 

Doctors who are not motivated to give good care – Swedish Meatball Surgery, Part XVI – Insureblog

This post points out that bad care is not unique to the US, raising the issue that simply paying for care won\’t fix it.

When Swedish health care \”professionals\” aren\’t out trying to score hot nurses, they\’re apparently turning away fellow citizens who\’ve suffered broken necks:

 

Rich people who pay for good care they cannot get from our system – Yacht Medicine – Glasshospital

File this one under: \”signs of the apocalypse.\”  Being rich has its rewards, the greatest of which is: avoiding our health care system.  By the way,just by running for office you are lumped in with these people (in the minds of most voters).

I’ve been having trouble finding quality medial care aboard my yacht lately.

Thank goodness Guardian 24/7 is working tirelessly to fill this vital niche.

 

People getting care that is not equal.  – Study Finds Wide Variation in Reoperation Rates after Lumpectomy – Medical Lessons

This post, written by a physician, details the huge variation in the quality of care for breast cancer as witnessed by re-operation rates for lump removal.  To call our health care a \”system\” is quite a stretch at times.

All of this meshes with my experience – knowing women who’ve had breast-conserving surgery and then got mixed infor­mation about the results and what to do next. You’d think lumpectomy would be a standard pro­cedure by now, and that deci­sions about what to do after the pro­cedure, sur­gi­cally speaking (let alone deci­sions about chemo, hor­monal treat­ments and radi­ation) would be straight­forward in most cases.

 

People who go to extremes to avoid care they don\’t want. – “Do Not Resuscitate” Orders as Body Art – ACP Internist

Some people are afraid of dying, while others are afraid of being kept alive.  These are the people who want to control their own destiny, those who don\’t want insurance companies, lawyers, or politicians saying when and how they should die.

Along with tattooing comes body piercing, a review article considers all the issues that surround pierced body parts that the primary care physicians should be aware of. Body piercing is on the cusp of entering mainstream acceptance, and a host of issues follow.

 

People who feel ignored by providers. –  Channeling Your Inner Aretha Franklin – Advoconnection Blog

Our system doesn\’t excel in being respectful of people, especially the elderly.  This post is advice to the care advocates for the elderly to demand respect.  It\’s a sad thing that getting respect often requires a demand.

I’m going to guess you have witnessed this, too. In fact, some of you have done the same thing. In particular with an elderly person, or a patient with dementia, or certainly a young child, it’s so easy to have a conversation with a spouse or adult child or some other caregiver, and discuss the patient as if he or she isn’t present.

But, when it comes to any adult patient who is conscious and able to comprehend the discussion, it is highly disrespectful. These patients are not objects to be discussed. They are living, breathing, intelligent human beings. You are discussing THEIR bodies, THEIR health, THEIR diagnoses, THEIR treatment needs, THEIR lifestyle changes – and those questions and discussions need to include and embrace them as contributors to the conversation.

 

People who feel they are being shafted and mistreated by insurance companies –  Letter to an Uncaring Entity – Northwest Transplant

This is a letter written by a very angry patient, who happens to also be a nurse.  Regardless of the specifics of the case, this encapsulates the emotion most people feel toward those trying to \”manage care:\” fury.

Obviously this letter is written from an emotional and personal perspective; it\’s long and a bit messy and imperfect.  My dual roles as a provider and a patient in need of care has brought the issues of our for-profit (and broken) health care system right into my living room.  I fear that, with the new Affordable Care Act requirements that insurance companies cut their overhead costs and actually spend 85% of our premiums in providing care for us, that we as patients and providers alike will be hearing stories like mine more and more often.  Money has to be made somewhere otherwise the insurers (or the drug companies or us providers) would just give up entirely and then where would we be?

 

People who care for the dying  – Mindfulness in Palliative Care – ACP Hospitalist

What does it take to care for dying people?  What does it take to care for dying children?  It\’s not about politics, law, insurance, or technology; it\’s about being a human being.  That is the essence of health care.  It\’s well worth the listen.

Palliative care is an emotionally tough field for physicians and even more so for pediatricians. One coping mechanism is mindfulness, a way of remaining involved and aware of interacting with patients, yet detached just enough to allow for proper decision-making.

The goal of mindfulness is to act and be aware of acting at the same time, which creates a slight mental space that allows the physician to choose how he or she responds, instead of reacting, judging or lashing out.

 

People who inspire – The Soundtrack of Loss – MS Renegade

What do a British composer during WWI, a cellist in the 1960\’s, and a blogger disabled by MS have in common?  The ability to rise above the tragedies of life and inspire others.

There are, sadly, all sorts of tragedies in our world.  Huge, global events like wars.  Public losses of talents like Jacqueline du Pré’s.  And millions of anonymous, small (in the scheme of things) losses like that of the life I used to lead.  All cause grieving.  And now when I think of loss, in my head, I hear the eloquent, elegiac melody created by Edward Elgar out of his own pain almost one hundred years ago.   Played by Jackie in her youthful prime, conducted by Daniel Barenboim, knowing how their stories will play out, makes this performance heartbreakingly poignant.   For me, it is the soundtrack of loss.

So, my dear vote-seeker, you see that this is a very real game you are entering.  It\’s not about winning or losing an election.  It\’s not about playing the political game to defeat your rivals.  It\’s not about raising enough money to smear others on television.  It\’s about people.  It\’s about helping others.  It\’s about life.

Happy \”Super\” Tuesday.

Next week\’s host: Health in 30