The Medical Marijuana Debate or Do You Need a Reefer?

The debate rages on in the media about the benefits and complications of legalizing medical marijuana. We have seen the long lines in Colorado already for those buying for recreational use. I have never used medically or recreationally but many of my friends and acquaintances have done so. I recently lost my sister-in-law to stage IV breast cancer and I tried to convince her to use it to increase her appetite and promote a feeling of well being. She refused as she could not change her attitudes either toward it’s use as amarijuana leaf and gavel medicinal herb. When you are dying, no one has the right to tell you what you should do or what you should use to medicate against the end result. One of my BFF’s from high school is now using it during her chemotherapy for bladder cancer. It is illegal in our state and she has a friend that sends it to her from one of those states where it is legal. How could I deprive her of that as she says it is what keeps her going with the nausea. I never asked her if she has a continual craving for Twinkies.

However, it was not ok for my children to self medicate for feelings they could not handle or other excuses they had. My opinion is vested in the 60’s and all that Cheech and Chong imprinted in all of us. Drugs, sex, and rock and roll was not my cup of tea. There is legislation pending in 15 states for 2014 concerning the utilization of medical marijuana. Will we or won’t we be facing this conundrum? If it were a cure or help for Alzheimer’s would we give to our parents who need it? My problem is the past…literally the past. I need to stop the 1960’s tape from playing in my head and move ahead. So, all I can do at this point is sit back and see what happens. But I have my Twinkies ready.

HealthGrades Report to the Nation for 2014

ImageI received my notice that the HealthGrades Report on hospital quality outcomes for 2014 was online.  If you are not well versed in the HealthGrades ratings, it may come as a shock that your hospital is not as good as you think it is.  Their hospital rating reports for specific procedures and diagnoses are compiled primarily from Medicare claim data, and it includes all hospitals that are Medicare participants.

Our nation generally agrees (97%) that having the correct information about our healthcare is paramount in making good healthcare decisions. According to a recent Harris Interactive Research survey, we are more likely to choose our hospital based on convenience/location (58%) and amount of co-pay (45%) than on quality outcome information (10%).

This year the Centers for Medicare and Medicaid Services (CMS) reported that expenditures for healthcare in the U.S. were $2.6 trillion and 17.9% of the gross domestic product. Of that expenditure, $814 billion went to hospitals and $515.5 billion went to physicians and clinical services.  We have been told that health reform will reduce healthcare spending over the next 10 years and lower our premiums.  If healthcare costs continue to rise why doesn’t the consumer shop for better, more affordable care?

HealthGrades was founded in 1998 and ever since they have been reporting on the quality and safety of our nation’s hospitals. The most recent survey just posted online at their website claims that in the time period 2010-2012 , an additional 234,252 lives could have been saved if all hospitals had operated at their highest rating level of 5 stars. HealthGrades rates the performance of hospitals on multiple procedures and diseases within the same institution.

The first thing I did was to go to their website and look up the hospital in my home town. What I found was frightening. My chances of survival in my hometown hospital with a heart attack were only a 2.  However, if I were a patient in the same hospital with pneumonia, my chances of a good outcome were a 4.  My hometown hospital only rated a 3 on the overall scale.  Not a very comforting thought. HealthGrades states that patients treated at a hospital receiving 5-stars in a particular procedure or condition have a lower risk of experiencing complications during a hospital stay than if they were treated at a hospital receiving a 1-star in that procedure or condition.  There also is a lower risk of dying during a hospital stay in a 5-star hospital than in a 1-star hospital. They also cite the national ratings average for procedures and conditions for comparison.

You should visit the website and find your healthcare facility. It is imperative that we, as consumers, must take charge of our own health,  and make informed choices on where and from whom we purchase our care.

Influences and Perceptions: How our intuitions deceive us

Why is it that I believe certain truisms? Did I learn them as a child or was I taught by the television ad?
We are much more likely to believe an anecdote or story than we are to believe the scientific evidence. Mothers that believe they know the cause of a child’s illness are unlikely to be swayed by hundreds of scientific studies that say otherwise. If a friend tells you they tried a new herbal remedy or other alternative medicine and it cured their migraine, you are likely to make the connection that the cause is the new alternative medicine. An example of this phenomenon is found with many sufferers of migraines using acupuncture who swear to its effectiveness in spite of evidence to the contrary.
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How our mind functions and the assumptions we make often are connected to our perceptions. The condition of “perceptual blindness” was aptly demonstrated by researchers Christopher Chabris and Daniel Simons at Harvard University. Their experiment involved a group of students wearing white shirts passing a basketball among the group members. The reviewers of the group were asked to count the number of passes the basketball made between the players. In the middle of the exercise a person in a gorilla suit wanders through the center of the ballplayers. Most of the participant reviewers never see the gorilla. They are focused on the task of counting the passes of the basketball. Another way of expressing this is “looking without seeing”. This is a literal meaning saying that you can look right at an object and if you do not expect to see it, you will not see it. This is the reason that lifeguards at swimming pools must change stations often because they become blind to seeing the body floating in the bottom of the pool. In military training operations, the team can become so focused on the object, such as a bomb, that they lose sight of the other dangers present.

The premise of how our intuitions deceive us is not limited to physical objects. Our brain is conditioned to expect certain responses. We either do not catalog the “out of the ordinary” response our brain is conditioned to expect or it leads to overconfident decisions. A good example of this phenomenon is what happens to the automobile driver who never sees the motorcycle rider. After the accident, the driver usually says “I was looking right there and they came out of nowhere. I never saw them.” The driver of the car is looking for another car, not a motorcycle. This is so frequent that it has led to the redesign of the motorcycle to look more like a car with two headlights, a bigger body, and wider frame.

Another group of social psychologists coined the term flashbulb memory to explain what happens to people when asked to describe what happened in a singular important event. Where were you on September 11, 2001 when our country was attacked? We all have our individual memories, but over time, our mind has embellished those memories to make them stand out. If someone was standing next to you when it happened, their recounting of the event is probably different from yours. And if you answered a questionnaire ten years after the event, your memory would not remember the very same story.

In recent years, psychologists have categorized our thought process into two types: those that are fast and automatic and those that are slow and reflective. The fast and automatic involves perceptions, memory, and causal interference. The fast and automatic decisions are usually low level brain actions and the slow and reflective include tasks which require abstract reasoning. A fast and automatic decision is stopping for a red light. It does not require conscious thought. If I asked you to add 87 + 64, you would have to stop and think about it. This type of thinking allows for correction if we are not on the right track. Intuition influences our decisions automatically and without reflection. It allows us to jump to conclusions and make untrue assumptions. This can cause us trouble and affect our health, wealth, and welfare if we follow blindly. Try your best to slow down, relax, and examine your assumptions before you jump to conclusions based on intuition. When you think about your behaviors with an awareness of everyday illusions, you will have an insight into how the mind works. And it may even lead to understanding why people act the way they do!

Walking Beneficial in Cancer Prevention and Risk Reduction

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Diagnosis: Breast cancer, Colorectal cancer, Endometrial cancer

RX: Physical Exercise: Get yourself a dog

    Many of the latest studies show a direct relationship between physical exercise and the prevention or reduction of risk with breast cancer, colorectal cancer, endometrial cancer and other cancers. One study in 2011 showed that 3-4% of all bowel, breast and uterine cancers are linked to physical inactivity.

The correlation of body mass index and inactivity with the type of cancer you get suggests the possibility of a metabolic reason or gene pathway linking being overweight and inactivity.  The Harvard’s Nurses’ Health Study and the Health Professionals Follow-Up Study included about 150,000 people.  In this study we can assume that the subjects reporting did a pretty good job of it since they were health professionals. The study asked the participants to record their diet, exercise, weight and other responses for a year. In the participant population, 861 (0.574%) developed colon cancer. This group has been studied several times. In this group, the study identified that the body mass index (BMI) and physical activity correlated with the kind of cancer you got.

In a second study published in the Journal of Clinical Oncology, January 2013, investigators identified 2300 individuals with invasive, nonmetastatic colorectal cancer and measured how much exercise they got before and after their diagnosis. The study showed those participants who were more physically active, both before and after diagnosis, had much better outcomes.

How much exercise was or is necessary to get these better outcomes?  Moderate physical activity of 30 minutes, five times a week, can reduce your cancer risk. If you can get more than 30 minutes, you can get more reduction in risk.  Therefore, a good prescription for both treatment and prevention: Get Yourself a Dog and Walk the Dog, twice a day for 30 minutes. But don’t expect your insurance to cover it.

“Never-Events” and Medical Mistakes are Common in Surgery

The April issue of Surgery magazine reports a new patient safety study from John Hopkins University School of Medicine concerning medical mistakes in surgery. These “Never-Events” are things that should never happen and in some cases a never-event can trigger many additional issues. It becomes a tsunami of preventable situations including malpractice litigation. The study used data from the National Practitioner Data Bank which is a repository of medical malpractice claim data.  Both malpractice judgments and out-of-court settlements were included in the data search. The researchers using the data estimated that there are more than four thousand never-events in the United States each year.

To be more specific the study estimated “a surgeon in the United States leaves a foreign object such as a sponge or towel inside a patient’s body after an operation 39 times a week, performs the wrong procedure on a patient 20 times a week, and operates on the wrong body site 20 times a week.”

No wonder the JCAHO is so concerned about patient safety. The study also stated that the most likely surgeon to commit these errors would be between 40 and 49 years old. Older surgeons over 60 were less likely. It could be there are less surgeons over 60 doing less complicated cases attributing to the difference.

This study re-emphasizes that the implementation of “time outs” in surgery where all the parameters of the patient’s surgery are reviewed before the beginning of the case are vitally important. Many sites are requiring that the surgical site be outlined with magic marker. Counts of towels and sponges have been around a long time, but obviously need to be reconfirmed.

We are all responsible for the patient’s safety. Speak up if you see something that could be improved.

Ultrasound Corner

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AHEC is pleased to announce the great reception we have had with our Scan With the Experts product line.  All of the attendees have expressed basically the same feelings; one on one attention with leading experts in the area of your choice is a rare and welcome venue for education.  Across the board they have found this environment a rich and open educational opportunity they could experience nowhere else.  Consider the fact that everyone has an area of ultrasound where they are not the most confident in their skills.  We give them the opportunity to choose the topic, and then we provide the expert.  During the day they get to pick that experts brain for everything they can extract, diagnostic criteria, scanning tips and unique approaches for difficult to scan cases, or help with protocols.  Topics can include but are not limited to echocardiography, vascular, OB/Gyn, abdomen, and point of care ultrasound for the emergency room, intensive care, or physician office settings.  If you would like an opportunity to fine tune your skills in a one on one setting give us a call and a topic and see just how much you can learn in a day.