Archive for the 'Patient Safety' Category
May 3rd, 2012 by Trisha Torrey
Story One: When I was a child (and we’re talking a lo-o-o-ng time ago – when doctors made house calls)… if I got an earache, I would suffer. REALLY suffer. Mom would drip some warm oil into my ear, and then stuff some cotton in behind it. She’d give me an orange flavored baby aspirin or two. And I would just lie in bed, or on the couch, miserable. MISERABLE. Seems like I would sleep a lot. Two days later, my earache would be gone, and because I was a kid, and resilient, I would be back on my feet.
Story Two: When I was a kid, I fell off my bike as I flew around a corner near my house. My bike flew off in one direction and I flew in the other, and landed smack on my elbow. OH THE PAIN! I pulled the cinders out of my arm, and cried all the way home as I dragged my bike with me. That evening my dad walked me across the street to see a doctor who lived in our neighborhood. He felt along my arm, moved it around a little, declared that I had sprained it, then put my arm in a sling where I was expected to keep it for the next few weeks.
Perhaps it’s miraculous that I survived childhood! But I don’t think so. I think any of us over a “certain age” had very similar experiences as a child. We all had sore throats and earaches, we all sprained and broke bones – and we didn’t have the miracles of modern medical care to help.
Fast forward to today. Today when we go to the doctor, no matter what the complaint, we are met with a barrage of tests, procedures and treatments. If I had a sore throat and an earache in 2012, I would likely be given a strep test (chi-ching!) and prescribed an antibiotic (chi-ching!) If I fell off my bike in 2012, I would be given at least an X-ray (chi-ching!), but more likely a CT scan. I’d be prescribed an antibiotic (chi-ching!) and maybe even a pain killer (chi-ching!) I’d need follow up testing to see how well everything was healing (chi-ching!)…
Bottom line – healthcare is so much more expensive today because we do things that we don’t necessarily need to do. We are herded into services that we don’t necessarily need. And (shame on us) we ASK for things we don’t necessarily need and probably shouldn’t get.
Don’t need? Shouldn’t get?
Antibiotics, the miracle drug of the 80s and 90s, were so overprescribed that today the bugs they were intended to kill have evolved into superbugs. People die from acquiring infections that didn’t become problematic until the overuse of antibiotics. Yet – mom takes her child to the doctor with an earache and insists an antibiotic be prescribed for her child. Two days later, the child is no longer in pain. (But is that any improvement over the two days it took me to get past my earache 50+ years ago?)
The existence of CT scanners, MRI scanners and PET scanners, and the need to pay for them, compel doctors to order those tests, even in cases when they may not be necessary. Of course there are times when they are very necessary – but not always, and not as often as they are used now. When it comes to so much extra scanning, it can create big problems for our health (too much radiation exposure from x-rays or CTs) AND our wallets – imaging is expensive, even when we have insurance.
So how can we know the difference? How can we be a bit more savvy when it comes to test and treatments, whether or not they are suggested by our doctors?
Last month, a consortium of nine different medical specialties – the very doctors who make money when we have tests and treatments – came out with their lists of tests, treatments and procedures we patients don’t need. They listed them all on a website, called Choosing Wisely.
If these doctors don’t think we should take these tests, then why would we have them?
What we know is that this elite group has made these recommendations. What we don’t know is that those recommendations will filter down to the doctors who order these tests, treatments and procedures – because that’s how they make their money, and (they think) that’s how they can defend against lawsuits. (We can only imagine how unhappy that orthopedist who makes his living running CT scans is with his own peers that tell patients not to get so many CT scans.)
So, knowing that our doctors may not be aware of the lists, or may have chosen to ignore the lists, it’s up to us patients to ask questions. “Doctor, If I take this antibiotic, how soon will I feel better? How soon will I feel better if I don’t take it?” — or — “Doctor, I know an X-ray is much less expensive than a CT scan. What will a CT scan tell you that an x-ray won’t? Can I have just the x-ray?”
So yes, fellow empowered patients, it’s time for us to begin making smarter choices, both for our wallets and for our health. Make yourself generally aware of the new recommendations of tests, procedures and treatments you just don’t need. Understand that leaders in healthcare who understand about reining in costs, even if they are the ones who lose income, are calling out to their peers to make changes in their recommendations….
Unfortunately, anything in medical care takes a LOT time to implement. But this is something we patients can do – and do with no detriment to our health OR our wallets.
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February 16th, 2012 by Trisha Torrey
Want to make millions of dollars quickly while risking only a few months in prison if (and that’s a big IF) you’re caught? It’s not difficult at all. Just set yourself up as a distributor of counterfeit drugs in the United States.
This week’s announcement by the FDA that a counterfeit version of Avastin, a chemotherapy drug that is used for several kinds of cancers and tumors (lung cancer, kidney cancer, colon and rectum cancers – but no longer for breast cancer since approval was removed last year) has been found across the country, infused into the national drug supply, raises plenty of questions about how that could possibly happen.
It was followed by an interesting article in USA Today which partially answers the question. Counterfeiting is a multi-billion dollar business that is on the rise because it’s so lucrative, and because the penalties are so… well… inconsequential. I mean – would you be willing to spend no more than six months in jail if you could make millions of dollars for use when you got out? (Even if you would answer no! I don’t want to go to jail!… I’ll ask you this…. what if your child had treatable cancer and you had no insurance? Just sayin’ …)
Avastin isn’t the only drug that may be counterfeited. Any high cost drug that can be watered down, or manufactured to “look” right even if it is manufactured without its expensive ingredients, is a target for counterfeiters. Lipitor and Viagra are probably the most apt to be counterfeit, but others like drugs used to treat HIV and AIDs, or diabetic drugs, or weight loss drugs, are likely targets for counterfeiters, too.
So what happens if you are somehow treated using a counterfeit instead of the real drug? Maybe nothing. Or maybe you die. Or anything in between. The problem is, for the most part, we patients have very few ways we can detect whether a drug is real or fake.
Katherine Eban, in her book, Dangerous Doses, tells the stories of people who died from receiving infusions of counterfeit Procrit. The conventional wisdom on this most recent discovery of fake Avastin is that there was nothing in the counterfeit version that was dangerous, and it’s difficult to tell within a regimen of 18-20 doses a cancer patient might receive over six months whether one “missed” infusion of the active ingredients has a long-term effect.
The bigger picture problem is that our drug supply is not being well enough protected by the FDA, which is tasked with protecting us. The FDA has no backbone when it comes to protecting us from bogus, counterfeit drug distributors who appear to be selling “real” drugs, but target greedy doctors, pharmacies and hospitals that are so willing to buy “discounted” drugs for their patients, knowing that there will be more profit in their reimbursements. Experts estimate that about 1% of our drug supply is counterfeit. That means that 1 out of every 100 administered drugs may be counterfeit, too.
One answer to this is an electronic pedigree system, meaning, from the time the drug is manufactured, until it is given to the patient, it is followed and logged using a bar code type system. If such a system was in place, then even us patients would have a way to double check that the drugs being given to us are the real drugs they are supposed to be.
So why doesn’t the FDA insist on the development of such a system? Well, actually, they have. But again, they have no teeth, and so far, no backbone. Every time they raise the issue, the drug companies and drug distributors begin to wail about the added cost to the system. (Surprise! Follow the money!) And so, nothing gets done.
Like other issues in healthcare, it looks like little will happen to improve this system until something horrible befalls someone famous; someone who can actually override the special interests in Washington and insist on development of this electronic pedigree system.
Until then, here is information to help us patients do what we can to protect ourselves from counterfeit drugs.
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February 2nd, 2012 by Trisha Torrey
The information center in many homes is the refrigerator door. From family photos, to postcards to magnets from pizza shops, to phone numbers and kids’ artwork – the important ephemera of our lives can be found on refrigerator doors.
So today I thought I would share some advice that is worth cutting out and sticking to your refrigerator door – 10 empowerment tips that will keep you healthier and help you get the great medical care you deserve.
And if you like them, I invite you to download them (in the form of a small poster) to stick on your refrigerator door! (although – maybe you prefer to stick them on your bathroom mirror or medicine cabinet? That’s OK too.)
- Become the expert in your own medical challenges. Read everything you can about your symptoms or diagnosis, ask questions, study anatomy, acquire and review copies of all your medical records. Be the authority on YOU.
- Using your YOU expertise, partner with your doctors and other providers. While they may have a medical education and experience, YOU are the one who has lived in your body your entire life. Be an active participant on your own healthcare team. If your provider won’t listen to you, or share in your decision-making, then find one who will.
- Pursue a second opinionwhenever you are diagnosed with a difficult disease or condition, or surgery, chemo, or long term treatment are prescribed. And if they disagree? Then seek a third.
- Don’t be afraid to say NO. Sometimes less is more. As the authority on YOU, you’ll know when NO is the right answer.
- Thank your doctors and their staff members when they have been collaborative and helpful. They work in a tough environment. Appreciation, when appropriate, can go a long way toward strengthening your partnership.
- Read and listen past the headlines. Get the whole story, then pursue additional, objective resources to confirm their veracity and to determine how well they apply to YOU. In particular, be sure Internet health information is credible.
- Review your medical bills. Experts tell us that up to 80 percent of medical bills contain errors. Incorrect bills will eventually cost us all in higher premiums and taxes.
- Provide support to others. Shared experiences can help others who suffer the same medical challenges you do. Refer them to good doctors, and support groups, and offer an ear when they want to share their joys, or need to vent.
- Accept support from others. Whether it’s a loved one, or a professional, sometimes it’s imperative to have an advocate by your side to keep YOU safe, or keep you from being railroaded.
- Finally, wash your hands regularly and cough or sneeze into your elbow. Infections are dangerous and deadly whether acquired during a hospital stay, or brought home from school by the kids. Hygiene can go a long way toward keeping infection at bay and keeping YOU healthy.
Don’t forget – if you like these tips, you can print them out as a small refrigerator poster – here they are.
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November 23rd, 2011 by Trisha Torrey
This column first appeared
in the Syracuse Post Standard
November 22, 2011
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You may be among the millions of Americans who will travel during the upcoming holidays. Travel takes you out of your normal environment and disturbs your routine. If you have health issues, like a chronic disease, an injury, or even a short-term illness, it’s smart to prepare ahead of time for those changes and accommodate for them where possible. You’ll want to be sure your travel doesn’t upset your health, and your health doesn’t upset your travel.
Drugs, supplements and supplies: Pack enough to cover the days you’ll be away, plus extra, in case flights are delayed or a blizzard closes the roads. If you fly, remember that airlines can lose checked bags, so keep all medical supplies with you in your carry-on bag. Any time difference at your destination may require an adjustment of your drug routine. Make yourself a chart ahead of time to keep your regimen on schedule.
Airport security: The TSA has strict rules about what can, or cannot go through security. Medications, oxygen, inhalers and other medical items must be packed in certain ways, and will be screened through x-ray machines. Go online before you fly to learn to learn how to get your medical equipment or materials through security. http://1.usa.gov/TSAMedical
Foods: Alert your host ahead of time if you have special dietary requirements, or if certain foods upset your digestion. Mention any food allergies you have or conflicts with drugs you take. Plans can be made to accommodate your needs when they are discussed ahead of time.
Contagious diseases: Of course, holiday time is often cold and flu time, too. Get your flu shot prior to travel. Wash or sanitize your hands as often as possible, and keep them away from your mouth, nose or eyes. If you are highly susceptible or your immune system is compromised, consider wearing a face mask to protect yourself from others who might be contagious. If you have a cold, then cough or sneeze into your elbow, not your hands, to prevent infecting others.
Long Distance Travel: If you’ll be sitting for great lengths of time in a car or plane, you risk potentially deadly blood clots in your legs called DVT (deep vein thrombosis.). Keep your blood circulating by taking hourly breaks to walk around and stretch.
These travel preparations will keep you healthier and will make your visit more enjoyable, too.
Here are some additional resources for
making sure you stay healthy while traveling:
• Tips for Healthy Travel
Before You Go, As You Travel, and At Your Destination
• Tips for Healthy International Travel
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Want More Patient Empowerment?
Find Hundreds of Articles at:
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About.com Patient Empowerment
…and…
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Patient Empowerment Tips
