That's Not What I Said

i noticed recently that when my family members and friends are having health crises and are retelling the stories or asking my opinion, they will tell me VERBATIM what their doctor said. like, "he says it's not an exact science" or "he said we'll have to wait and see." and then they'll reflect on what the doctor meant when he said that, what he might be missing or withholding, and what might be hidden in the message.

so the words we practitioners use matter. a lot.

this is why, when we were trained to do the female gyn exam, we were told to use only the words "healthy and normal." stick with those adjectives, less you worry them ("uh, huh, hmmm") or creep them out ("your labia looks nice" is not a good thing to say).

and know that they are hanging on every word you say. so be cautious. be wise. and be equally aware of non-verbals. a simple glance toward the door or out the window might tell a patient you are impatient to leave them and don't care about their plight. or, it might tell them that you're hiding something or nervous to share bad news with them. when in fact it might actually mean that you thought you heard the tow truck leaving with your double-parked car. on the flip side, when giving bad news, you have to be direct and sympathetic without giving false hope or no hope. it's a very tricky thing to do.

and i'm the same way with my MD's, by the way. when i'm pregnant and my ob/gyn says things are "perfect" (his favorite word), my heart beats a little more evenly.

words matter. which is why accents or unmatching dialects are challenging for both practitioner and patient. and why you have to try to unload your own personal stressors before encountering your patients. they might just pick up on them and think your mood has something to do with them. not easy. but important.

Should We Have to Pay for Our Decisions?

some companies give health insurance credits/premium reductions to those who make healthy choices. not smoking, not drinking in excess, exercising enough, normal BMI and healthy food choices, wearing seat belts, etc.

but what if our government, once they are the even more dominant insurance carrier in the country, does the same? are we ok with them knowing how fat we are? if we smoke? choices we make for ourselves and our children? hmmmm....

and, how far will we go in encouraging preventative measures? an interesting op ed piece on cnn.com today questioned just that, in reference to vaccinating from diseases. they use the example of an unvaccinated child traveling to europe and bringing back the measles in 2008, causing an outbreak of measles in san diego. you should read it, but the gist is, vaccines are cheap, illnesses are expensive. and you have to consider the cost not only of the unvaccinated patient with the illness but also all those who catch the illness from said child and need to be treated themselves, or those in quarantine away from said child. all this medical care and time off work for the parents could have been prevented with a simple, cheap vaccine.

so should those parents not be charged more for health insurance if they're deliberately electing to go against medical advice and to put their family (and others) at greater risk of health issues/cost? this is assuming that we're looking at a future where you get perks for being healthy, conscientious families and get penalties for being families who smoke or are obese, or are otherwise at increased risk by their own choice.

food for thought.

More Sad Outcomes

busy hospitals, understaffed, undercaring...who knows. but this article today on how a serious bacterial infection grew across a child's face as her parents watched in horror while sitting in an ER waiting room...sickening.

is it imperfect? hell yes. is it an outrage? absolutely. is the system broken? obviously. but does it mean you should stop seeking medical help when you/your family is sick? no. she needed iv antibiotics and aggressive management in a hospital. she just needed it sooner.

so...if you're blocked or dismissed by a medical practitioner when you are certain something is wrong- what should you do? my advice- (and i know full well what i'm saying here, since i might be on the other end of this) go nuts on them. give them a comprehensive and emotionally neutral description of the severity of the situation first and then if you are continually pushed aside, have a shit fit. be a squeakier wheel. sometimes that's what it takes to get things done in this world. sometimes rattling the cage one more time makes us give a quicker or more complete review that might show something crucial.

and your instincts are important. and i know parents are always worried that they're over/under reacting, but if it just feels off and your kid is not acting like your kid, make your voice heard.

also, i would recommend choosing your facilities carefully. this article says you should go online and find which ER has the shortest wait time, but i would say, if it's something that doesn't appear to be life or death, go to an urgent care first. they will a) see you sooner and b) if it's really something bad, will call ahead to the ER and have an MD lined up to see you when you arrive and meanstwhile they can be giving you some treatment.

it is extremely awful that this little girl ended up with so much debility when the parents did the right thing by bringing her in and it could have been stopped sooner. i know that after this story got released today, all triage units in ER's and urgent cares across the country are evaluating their process. let's hope that makes a difference and saves another family this tragedy.

Did Y'all See This in the News Today??

once AGAIN. vaccines do not cause autism. amen.

and, make the right decision! and even if you have, there's a chance your kids are being exposed to kids who have not been vaccinated and are carrying around scary, archaic diseases and you don't even know it. find out (daycares are a little different than schools, ask yours if they allow for personal/religious exemptions).

Happy Almost Christmas

Times is Tough

there is a lot of worry lately as hospitals in our area are cutting more staff and slashing department budgets. often time PA's (and NP's, CRNA's, midwives) are the first ones cut, since we work directly for the hospital and cost a lot, but don't actually bring in our own clients like the MD's do.

most of the local hospitals that i know who have cut their PA depts end up hiring them all back because the MD's and other staff find that life is difficult without them. but the short-sightedness and new administration constantly coming in and reinventing the wheel and the frightening amount of red on the budget sheet is making all of us a bit nervous these days.

my plan is to ride it out. keep my head down and hope for the best. i think we're vital to the integrity of the surgical dept and that they'll figure it out, i just don't know how many casualties there will be between now and then. (gulp).

i have felt a little insulated from this economic crisis the country has been suffering for years. now i'm starting to look around my house and wonder what i can sell or burn or put into a soup. :)

What is On the BHE's Mind? Cow Farts.

sorry, sports fans. i've been super busy lately. so in light of my hectic schedule, the BHE has agreed to write a post about what he's been into lately.

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so i've been thinking a lot lately about what we eat and how it gets to our table. frankly, the research i've done shows some very significant issues in our food supply. and since 2/3 of all americans are overweight or obese, i think it's a good discussion for us to have.

the topic is wide-ranging, so while we can make good arguments about the safety and sanitation in the meat supply or the damage that pesticides can cause in our bodies, i'll narrow it down to cow farts. i don't know if you know this, but global warming is kind of a big deal. and we spend a lot of time discussing the impact of carbon dioxide and different ways we can reduce our carbon footprint. and that's all well and good. however, if you really want to have an impact in reducing carbon footprint, you don't have to become a smug hippie who drives a prius 10mph below the speed limit. you have to worry about cow farts.

why?

because cow farts are made of methane, and methane is made of carbon. and what's worse, methane traps twenty times more heat than carbon dioxide. the average cow emits as much greenhouse gas as the average car, and worldwide production of beef and dairy are expected to double in the next 30 years. you can see the numbers problem.

so what does this have to do with our food supply? the vast majority of meat sold in the american marketplace is grain fed. even if you reject the resources consumed in producing the grain as food for our food, consider that it gives our cows indigestion. and that makes them burp and fart all over the place. if we fed our food grass rather than grain, or even just a grain diet that mimics natural grass, we can reduce their methane production by nearly 20%. there are health reasons why grass fed beef is much better for you, too. you can read up if you get off on omega-3 to omega-6 ratios.

food for thought.