Tuesday, May 24, 2011

NYT: "When Doctors Are Called to the Rescue in Midflight"

Bring your stethoscope, carry-on, this summer!

"Dr. Matthew Rhoa is still haunted by one of his lowest moments as a physician. Several years ago, on the first leg of an international flight, he was just settling in for a nap when a flight attendant came on the public address system to ask, “Is there a doctor on the plane?”
Leif Parsons

Dr. Rhoa, who lives in San Francisco, didn’t push his call button. “As a gynecologist, I always waited for another doctor,” he said. “There’s never a need for a Pap smear at 30,000 feet.”

He fell asleep, only to be awakened an hour later by a second call for medical help. This time he answered, and at the back of the plane he found two anxious parents with their 18-month-old toddler, who had a cast on her broken leg and was crying inconsolably.
The girl’s toes were blue. Limbs can often swell in flight, and it was clear that the cast was much too tight. Dr. Rhoa slit the cast and pried it open. The girl stopped crying at once.

“I have been riddled by guilt to this day,” said Dr. Rhoa, who now promptly answers every call for medical help on a plane. “I never want that feeling again of a kid suffering like that when I could have done something sooner.”
Since the earliest days of commercial aviation, airlines have coped with medical emergencies in flight by calling on physicians who happen to be passengers. And as more people travel by air, the number of emergencies has risen accordingly.

“Passenger health is becoming more and more of an issue, because of increased life expectancy and more people flying with pre-existing conditions..."

[To see full article at the New York Times, click here:
"When Doctors Are Called to the Rescue in Midflight"
Published: May 23, 2011]


Tuesday, April 12, 2011

Multimedia NYT: "Patient Voices"

A recent discovery--a late one--of this New York Times feature from 2009 called "Patient Voices," with personal audiovisual narratives from people sharing their experiences living with various well-known, and very un-well-known illnesses.  38 illnesses are included, to be exact, of everything from A.D.H.D., Tourette's syndrome, and stroke, to Lou Gehrig's disease, Charcot-Marie-Tooth disease, and sleep apnea. 

Couldn't resist passing along this must-see feature for med students, patients, caretakers, friends, family members--everyone, really.  NYT: Patient Voices


Friday, March 25, 2011

Health Care Reform Has Begun! So how does it benefit you and yours?

Democrats.org has a cool quick-tool to find out how Health Reform now specifically helps you and the people you know: "Right now, the Affordable Care Act is helping millions of Americans like you, your friends, and family. Take a minute to answer the questions below and find out how health reform helps you and your nearest and dearest."

Also, here is a pointed summary from Doctors for America--spread the word!:

Moving Forward: 10 Ways Health Reform is Helping America

Here are 10 ways health reform is moving forward. Please share this far and wide! 
1. Patients are no longer threatened with lifetime caps on coverage.  Families no longer have to make the hard choices of delaying care or facing bankruptcy.
2. Children with pre-existing conditions are no longer being denied coverage.  Insurance companies can no longer deny coverage to children under the age of 19 because of a pre-existing condition or disability.
3. Young adults are getting covered on their parents’ insurance.  Many medical students in Doctors for America are now covered thanks to this provision.  Over 1.2 million people age 19-26 are eligible!    
4. Medicare fraud prevention is getting ratcheted up!  $350 million was invested in 2010 for enhanced efforts to prevent criminals from defrauding Medicare, Medicaid, and CHIP – contributing to a record $4 billion recovered in 2010.
5. People and communities are focusing efforts on preventing disease.  $750 million in 2010 and $500 million in 2011 have already gone to programs in tobacco cessation, obesity prevention, care coordination, behavioral health, and more in all 50 states.
6. Seniors (4 million of them!) are getting help with prescription drugs.   Seniors in every state got rebate checks in 2010.  In 2011, they get a 50% discount on brand-name drugs in the Medicare prescription drug coverage gap – so they don’t have to cut pills to make them last longer!
7. Hospitals are gearing up to improve quality and safety.  Medicare reimbursement changes in 2012 are getting hospitals around the country to step up efforts to prevent hospital-acquired infections and to keep people from landing back in the hospital within 30 days of going home.
8. Small businesses are getting help covering employees.  Up to 4 million small businesses that employ 16 million people are eligible for 35% tax credits on health insurance premiums right now.  Note: small businesses will not be required to buy insurance under the law.
9. Insurance companies have a new cap on profits.  As of January 1, insurance companies have to spend at least 80% of premium dollars on health care. In the large-group market (big employers), they must spend at least 85% on health care -- so more of our premium dollars go to health instead of corporate vacations and CEO bonuses.
10. We are training thousands more health care providers to take care of the population.  $320 million in grants is already boosting primary care residency programs, training physician assistants, and helping states create innovative plans for their unique health care workforce needs.

Are you a doctor or medical student?  Sign our pledge to Return to Core Values as we work together to build a patient-centered health care system that puts justice, integrity, and compassion first!


Wednesday, January 19, 2011

Doctors for America: Take action TODAY and "Tell Congress To Vote No On Repeal"

"On Wed, January 19th, the House of Representatives is voting on a bill to repeal the Patient Protection and Affordable Care Act (PPACA), just as many of the new provisions take effect. As physicians and medical students, we see firsthand the need for health reform. Already, many of our patient's lives are improving because of reform.

Thousands of doctors have stood up to tell Congress to let health reform move forward.  Congress needs to hear your voice again!  Take a look below for the phone number and sample script.  Then call your Representative today and tell to vote NO on repealing health reform.

Note: if you are not a doctor or medical student, you're welcome to use our call Congress tool for the general public!

Fill out the form below so we can find your congress members' phone numbers for you to call..."  [Go to webpage]


Wednesday, November 17, 2010

Health Information Technology - join the train!

"Dear fellow students & faculty,

With major changes in healthcare underway--in particular, the arrival of the era of implementing Health Information Technology (HIT)/Electronic Health Records (EHR) as a tool to make our healthcare coordination and delivery more effective--there is a new frontier for all of us to learn, and much for us to discuss as well.  As I came across an exciting opportunity (email below) on Thursday to hear from and discuss these issues with our country's National Coordinator for HIT, I thought it would be of interest to many here as well so I am passing the invitation along to the larger Downstate medical community. 
For those interested, there are also many readily available resources--compiled on DownstateCafe.blogspot.com--which are great introductions to the topic of HIT/EHR.  Among them are
  • Link to the website for the Department of Health's Office for the National Coordinator for HIT - great background on HIT, events, blogs, etc.: healthit.hhs.gov/
  • Links to videos & materials from the Institute for Family Health, which has been a pioneer in meaningful & effective use of HIT in New York City for the past decade - the link includes a video of the Introductory remarks to this year's "HIT Workshop," given by Dr. Neil Calman: http://institute2000.org/HIT/information%20technology.html
  • Forums at DownstateCafe.blogspot.com where anyone can share in discussion/thoughts/ideas/experiences regarding our own electronic health records (at Kings County, and *hopefully* sometime soon at Downstate UHB as well...)
If anyone has any other good resources to share, please email me, or post them under "Comments" at DownstateCafe.blogspot.com.

Best Regards,


"The head of National Health IT takes questions from doctors"

"...We've been getting lots of questions about reforms related to Health Information Technology (HIT).  Many of our colleagues want to know what the national strategy is and how it's taking into account the concerns of physicians and patients.
To answer these questions, we've asked Dr. David Blumenthal, the National Coordinator for Health Information Technology (and a primary care physician) to join physicians and medical students for a conference call on Thursday, November 18th at 8pm EDT/5pm PDT.
Please join us for a call with Dr. Blumenthal on Thursday, November 18 at 8pm EST.  
The American Recovery and Reinvestment Act (ARRA) and Affordable Care Act (ACA) have many provisions supporting Health Information Technology (HIT).  We know that many of our colleagues want to move to a more modern system but many are concerned about the expense and difficulty of doing so.
Dr. Blumenthal is spearheading the HIT effort and he will share his perspective on:
  • The role of HIT in promoting high-quality, cost-effective care.
  • Provisions supporting HIT in the American Recovery and Reinvestment Act (ARRA) and in health reform.
  • "Meaningful use" and HIT incentive payments.
  • The timeline of HIT implementation moving forward.
  • The role of physicians in developing the national HIT strategy.
...Sign me up for the call with Dr. Blumenthal on Thursday 11/18/10 at 8pm EST.

Thank you for your continued support.

Alice Chen, MD,
Doctors for America
P.S.  Come participate in our online discussion where you can share your ideas, thoughts, stories, and experiences on health IT.  Visit the Health IT Discussion Board."


Friday, October 1, 2010

"Health Reform Hits Main Street" (incredible, & INCREDIBLY educational short animated movie featuring the "YouToons")

Pssssst... Pass this on to at least 10 friends--and help this amazing, short, animated movie go viral!!!
"Confused about how the new health reform law really works? This short, animated movie -- featuring the "YouToons" -- explains the problems with the current health care system, the changes that are happening now, and the big changes coming in 2014."


Wednesday, June 2, 2010

Knowing & sharing (Part 2): "How Does Health Reform Impact Physicians?"

Last week, in reference to my prior post of Doctors for America's "one page handout for your patients explaining how Health Reform will affect them," a savvy reader of DownstateCafe asked me:

"Could you find one of these for how it will affect doctors?"  
Why certainly!  DFA comes to the rescue (their name indeed sounds like a superhero's, doesn't it?), with the following earlier today in their newsletter: 

"Need an easy way to teach your colleagues and your patients about the new health reform law? Download our new resources [How Does Health Reform Impact Physicians?]. Hand them out to your colleagues at a noon time talk or print copies to keep in the office..."


Thursday, May 27, 2010

NYT: Hospitalists & Health Reform

New Breed of Specialist Steps In for Family Doctor

PHILADELPHIA — By the time Djigui Keita left the hospital for home, his follow-up appointment had been scheduled. Emergency health insurance was arranged until he could apply for public assistance. He knew about changes in his medication — his doctor had found less expensive brands at local pharmacy chains. And Mr. Keita, 35, who had passed out from dehydration, was cautioned to carry spare water bottles in the taxi he drove for a living.

The hourlong briefing the home-bound patient received here at the Hospital of the University of Pennsylvania was orchestrated by a hospitalist, a member of America’s fastest-growing medical specialty. Over a decade, this breed of physician-administrator has increasingly taken over the care of the hospitalized patient from overburdened family doctors with less and less time to make hospital rounds — or, as in Mr. Keita’s case, when there is no family doctor at all.

Because hospitalists are on top of everything that happens to a patient — from entry through treatment and discharge — they are largely credited with reducing the length of hospital stays by anywhere from 17 to 30 percent, and reducing costs by 13 to 20 percent, according to studies in The Journal of the American Medical Association. As their numbers have grown, from 800 in the 1990s to 30,000 today, medical experts have come to see hospitalists as potential leaders in the transition to the Obama administration’s health care reforms, to be phased in by 2014.

Under the new legislation, hospitals will be penalized for readmissions, medical errors and inefficient operating systems. Avoidable readmissions are the costliest mistakes for the government and the taxpayer, and they now occur for one in five patients, gobbling $17.4 billion of Medicare’s current $102.6 billion budget.

Dr. Subha Airan-Javia, Mr. Keita’s hospitalist, splits her time between clinical care and designing computer programs to contain costs and manage staff workflow. The discharge process she walked Mr. Keita and his wife through can work well, or badly, with very different results. Do it safely and the patient gets better. Do it wrong, and he’s back on the hospital doorstep — with a second set of bills.
“Where we were headed was not a mystery to anyone immersed in health care,” said P. J. Brennan, the chief medical officer for the University of Pennsylvania’s hospitals. “We were getting paid to have people in the hospital and the part of that which was waste was under the gun. These young doctors, coming into a highly dysfunctional environment, had an affinity for working on processes and redesigning systems.”...

...The most compelling argument in favor of hospitalists, who are now in 5,000 institutions, from academic giants like the Hospital of the University of Pennsylvania to small community hospitals to innovators like the Mayo and Cleveland Clinics — is that they are there all the time. Another is that they are more comfortable than their predecessors with technology and cost-cutting decision-making. One day in April, Dr. Airan-Javia was in and out of the rooms of a dozen patients, toggling between clinical work and designing a computer system for the safe handoff of patients between residents whose hours are now limited by law.

Bad discharges generally result from hurried instructions to patients and families and little thought to where they are headed. One such situation was the centerpiece of a class taught for doctors at Mount Sinai Medical Center in New York. The patient, an elderly woman in the hospital for scoliosis, a spinal condition, was discharged by a hospitalist on a Friday night, with a prescription for a narcotic pain reliever that her pharmacy, as it turned out, did not stock. No one explained how her new medication differed from the old, or gave her a contact number for help. Without medication, by Tuesday, her ankles swollen and her breathing irregular, the woman was back in the hospital.

In 2008, the hospitalists’ organization decided to invent better discharge systems rather than respond defensively to criticism, not unlike the simple operating room checklist, made famous by the physician and author Atul Gawande, which reduced accidents and deaths.

In 65 participating hospitals around the country, the Society of Hospital Medicine identifies patients at high risk for readmission, provides staff mentoring, and designs user-friendly discharge forms listing follow-up appointments, potential signs of trouble and phone numbers for the hospital team.  Peer-reviewed research on the reforms in the system is expected in a year or two.

Even experts who were initially skeptical agree that the hospitalists’ skill set is timely. They are young and thus not entrenched in the current order. They enjoy working in teams, when older doctors tend to be hierarchical. And, like Dr. Airan-Javia, who has a 16-month-old baby, they appreciate the regular hours and a paycheck of, say, $190,000 — higher by $30,000 than community-based peers.

Dr. Airan-Javia says she made an inspired career choice. Forty percent of her time is spent on the floor, treating diseases and helping patients and families though complex life events, like deciding when it is time to suspend medical care and let life end. Sixty percent of the time she is designing systems to improve workflow and advising the hospital’s chief medical officer. At meetings with her fellow hospitalists, phrases seldom spoken by most doctors, like “cost-effective delivery of care,” and “preventable adverse events,” flow off everyone’s tongue: The language of health care reform.

“The tools have never been better,” she said, “for finally getting all of this right."

[Read the full article here.]


Thursday, May 20, 2010

Knowing & sharing: "How Does Health Reform Affect You?"

This week, Doctors for America, a non-profit organization of physicians and medical students who advocate for changes in the health care system to ensure affordable access to quality care for all, says:

"Need a one page handout for your patients explaining how Health Reform will affect them? Look no further. Keep copies of the handout in the reception area, or print off a copy if someone asks you about reform during a visit."

Check it out...