Saturday, October 29, 2011

Sobering Statistics

Haiti: A History of Poverty and Poor Health

Haiti has extremely poor health indices. The life expectancy at birth is 61 years (9), and the estimated IMR (Infant Mortality Rate) is 64 per 1,000 live births, the highest in the Western Hemisphere. An estimated 87 of every 1,000 children born die by the age of 5 years (9), and >25% of surviving children experience chronic undernutrition or stunted growth (10). Maternal mortality rate is 630 per 100,000 live births (10).

Haitians are at risk of spreading vaccine-preventable diseases, such as polio and measles, because childhood vaccination coverage is low (59%) for polio, measles-rubella, and diphtheria-tetanus-pertussis vaccines (9). Prevalence of adult HIV infection (1.9%) and tuberculosis (312 cases per 100,000 population) in the Western Hemisphere is also highest in Haiti (11,12), and Hispaniola, which Haiti shares with the Dominican Republic, is the only Caribbean island where malaria remains endemic (13).

Only half of the Haitian population has access to health care because of poverty and a shortage of health care professionals (1 physician and 1.8 nurses per 10,000 population), and only one fourth of seriously ill persons are taken to a health facility (14). Before the earthquake hit Haiti in January 2010, only 63% of Haiti’s population had access to an improved drinking water source (e.g., water from a well or pipe), and only 17% had access to a latrine (15).

Emerging Infectious Diseases

Thursday, October 20, 2011

Monday, October 17, 2011

The Emergency Room Reflects Your Hospital and Community

New England Journal of Medicine
June 16, 2011

"The ER is more than a hospital department. It's a “room with a view” of our health care system.5 The quickest way to assess the strength of a community's public health, primary care, and hospital systems is to spend a few hours in the emergency department. If public health is under-resourced, you will see more patients with vaccine-preventable illnesses, smoking-related health problems, preventable injuries, and foodborne diseases than you otherwise would.

If primary care is fragmented or weak, the ER's waiting room will be full of patients with problems that should have been prevented or treated by primary care providers.

If the hospital's administration is not adept at managing the flow of patients, the ER's exam rooms, resuscitation bays, and hallways will be packed with ill and injured patients, many of whom were stabilized and admitted hours earlier but now have nowhere to go."

Hospitals Put Emergency Department Patients at Risk

Ten years ago at OSF-SFMC in Peoria I thought my Emergency Room (ER) patients were at risk. I thought the system was stacked with elective admissions who were trumping my sick patients waiting in the ER.

See this article from Emergency Medicine News.

I thought that medicine had become more about business than taking care of patients.

This article, written by an academic surgeon in California, states the same. He lost his mother to the "system".

Friday, October 14, 2011

When You are Sick, Do You Want to be Checked by Your Provider or Your Doctor? And do you want to be the Consumer or the Patient?

See the paragraphs below from this weeks New England Journal of Medicine.

The words we use to explain our roles are powerful. They set expectations and shape behavior. This change in the language of medicine has important and deleterious consequences. The relationships between doctors, nurses, or any other medical professionals and the patients they care for are now cast primarily in terms of a commercial transaction. The consumer or customer is the buyer, and the provider is the vendor or seller. To be sure, there is a financial aspect to clinical care. But that is only a small part of a much larger whole, and to people who are sick, it's the least important part.

The words “consumer” and “provider” are reductionist; they ignore the essential psychological, spiritual, and humanistic dimensions of the relationship — the aspects that traditionally made medicine a “calling,” in which altruism overshadowed personal gain. Furthermore, the term “provider” is deliberately and strikingly generic, designating no specific role or type or level of expertise.

Each medical professional — doctor, nurse, physical therapist, social worker, and more — has specialized training and skills that are not recognized by the all-purpose term “provider,” which carries no resonance of professionalism. There is no hint of the role of doctor as teacher with special knowledge to help the patient understand the reasons for his or her malady and the possible ways of remedying it, no honoring of the work of the nurse as a nurturer with unique expertise whose close care is essential to healing. Rather, the generic term “provider” suggests that doctors and nurses and all other medical professionals are interchangeable. “Provider” also signals that care is fundamentally a prepackaged commodity on a shelf that is “provided” to the “consumer,” rather than something personalized and dynamic, crafted by skilled professionals and tailored to the individual patient.

When we ourselves are ill, we want someone to care about us as people, not as paying customers, and to individualize our treatment according to our values. Despite the lip service paid to “patient-centered care” by the forces promulgating the new language of medicine, their discourse shifts the focus from the good of the individual to the exigencies of the system and its costs. Marketplace and industrial terms may be useful to economists, but this vocabulary should not redefine our profession. “Customer,” “consumer,” and “provider” are words that do not belong in teaching rounds and the clinic. We believe doctors, nurses, and others engaged in care should eschew the use of such terms that demean patient and professional alike and dangerously neglect the essence of medicine.