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                    Thanks to Karen for permission to use this Photo.

An aspect of injuries that’s often overlooked by inexperienced veterinary assistants is the animals’ response to injury.  This area of animal behavior fascinates me.  Over the years, I’ve noticed that animals deal with injuries and pain differently from humans.  No one is sure if they feel pain the same way we do or if they simply respond to it differently.  However, it’s a fact that most injured animals appear to be in less pain than we think they should be.  I’ve seen dogs with multiple gunshot wounds walk into the clinic, tails wagging and acting as if nothing were wrong!  Sometimes, this apparent immunity to pain can get in the way of successful treatment of the animal’s injuries. 

Let me give you an example that stands out in my memory.  One afternoon a client rushed into the clinic carrying his young female coonhound.  A large alligator had just attacked and almost killed it.  The ‘gator had ripped open the dog’s throat and had broken the right foreleg so badly that the limb literally hung by a thin piece of skin.  Even though she’d been seriously injured and was losing a tremendous amount of blood, she calmly wagged her tail as her owner carried her into the treatment area.  The owner begged us to save his dog’s leg, because she had the potential to become an excellent hunting dog. 

Extensive surgery on the leg followed, involving insertion of a series of pins and wires to hold broken bone fragments together.  The surgery was a success; the vet heavily bandaged and padded the leg to prevent further injury before the limb could fully heal.  She spent two weeks in the hospital, during which time we closely monitored her progress.  Despite the extent of her injury, the dog didn’t exhibit nearly the amount of pain that we expected.  Instead, she kept trying to walk on the injured leg.  Normally, the pain of this kind of injury would have prevented her from applying any weight at all to her leg.  As a result of her behavior, we discharged the dog with instructions to the owner not to let her walk on the leg. 

A week later, the man returned with his coonhound.  He’d been unable to prevent this active young dog from bearing weight on the leg.  In fact, she’d tried to run on it just that morning.  The veterinarian prescribed sedatives, hoping they would keep her calm enough to let the bones heal.  To make a long story short, we had to amputate the leg two months later.  Her repeated use of the injured leg never allowed the bone fragments to mend.  To make matters worse, many of those fragments had broken through her skin.  Essentially, we had no other option than to remove the leg.  I’m happy to report that this story has an upbeat ending.  The coonhound recovered so well that she did return to the fields as a good hunting dog, just as her owner had hoped.

Ken Roberts
Veterinary Assisting Program Instructor
Ashworth University

          Thanks to Lorianne DiSabato for permission to use this Photo. 

It is time, I think, to face the realpolitik of health care reform. That means asking a question few reformers dare to discuss:  How will we win the Congressional votes needed to pass serious health care reform? The American Prospect’s Ezra Klein put this question on the table at the “Take Back America” conference last week.  A pragmatic progressive (in the best sense), Klein pulled no punches:  “There are so many people in this town [D.C.] who do such smart policy thinking,” he observed. But “what we don’t give enough thought to is the politics of reform. This is a political problem. Until we have the votes in the Senate, we can’t get anything done.”Without the votes, Klein told reformers, “you don’t have a plan; you have a position.”

Some assume that, if we elect a progressive president, he will “put the votes together” to achieve reform. But the fact is that even an optimistic, charismatic JFK wasn’t able to persuade Congress to unite behind healthcare for the elderly in the early 1960s—a time when seniors were the poorest group in America. It was only after Kennedy was assassinated that a wily LBJ (who had grown up in Congress and knew where all of the bodies were buried on the Hill) was able to leverage a martyred president’s last wishes to help pass Medicare in 1965. The fact that LBJ had won by a landslide sealed the deal.

This time around, nailing the votes that would secure something like “Medicare for Everyone Who Wants It” will be much tougher. As I noted in my first post in this series, “Obstacles to Health Care Reform,” the lobbyists representing the for-profit health care industry enjoy enormous power. The money at stake in the health care industry has grown exponentially since 1965. And thanks to generous campaign contributions, the industry’s lobbyists wield great influence, even among liberal politicians.                  

Who can counter that kind of power?  Citizens who vote.  Lobbyists have dollars, but a billion dollars won’t help a politician if his constituency has made it clear that it won’t re-elect him unless he passes a particular piece of legislation that voters want. Nevertheless, any hope that pressure from voters will give Congressmen the spine to stand up to the lobbyists turns on the assumption that voters share common goals. With that assumption in mind, I decided to take a hard look at where most voters stand on health care reform. Polls show that the majority of Americans say that they want universal healthcare—but drill a little deeper, and you’ll find that different groups have very different priorities.

(more…)

Photo courtesy of sarah

I am visiting GMU. Yesterday, as I was answering email, I heard a class in progress on the other side of the partition by my desk. It was Robin Hanson lecturing about the economics of health care to 20 undergraduates. It was so interesting I ended up listening to about 90 minutes of it. “Do your students know what a great class they’re getting?” I asked Robin during a break. “I don’t know myself,” Robin replied.

I have heard hundreds of professors lecture. I had never heard anything like this. It wasn’t the usual stuff. It wasn’t the usual stuff made entertaining with cartoons or demonstrations or jokes or war stories. Instead, it was a straightforward look at how the medical profession operates, and a lot of it was about how it operates to empower doctors, reduce the power of patients, and reduce health care innovation. Robin traced the history of the profession from the 1800s until today. “What separates a trade from a profession?” he asked his class. Professionals have ethics, he said. Doctors devised a code of ethics. At the top was “first, do no harm.” What does this mean in practice, he asked his class. If a patient dies, does the doctor feel shame? No. If a patient wants a medical procedure that isn’t recommended, does this mean the doctor doesn’t do it? Apparently not. In contrast to the remarkable vagueness of “first do no harm” the rest of the doctors’ ethics code was quite clear: no practice without a license, no advertising, and so on — each item with clear economic implications.

Robin also discussed how little doctors are supervised. A British doctor managed to kill over 200 people before anyone noticed; he was finally caught only because he forged a will. A nurse at a local hospital was assigned measure how often doctors wash their hands. They’re supposed to always wash their hands but many do not. The nurse did the survey, and, as requested, correlated hand washing compliance with death rates. It turned out that the doctor who washed his hands the least had the highest death rate. The nurse reported this. The exceptional doctor had her fired. (more…)

Photo courtesy of Greg_Reser

Google announced the launch of a pilot project in collaboration with the Cleveland Clinic to provide select patients access to their medical record using the Google health platform.

According to the Associated Press, Google will:

begin storing the medical records of a few thousand people as it tests a long-awaited health service that’s likely to raise more concerns about the volume of sensitive information entrusted to the Internet search leader.

The pilot project to be announced Thursday will involve 1,500 to 10,000 patients at the Cleveland Clinic who volunteered to an electronic transfer of their personal health records so they can be retrieved through Google’s new service, which won’t be open to the general public.

Each health profile, including information about prescriptions, allergies and medical histories, will be protected by a password that’s also required to use other Google services such as e-mail and personalized search tools. (more…)

              Thanks to Tahoe Sunsets for permission to use this Photo.

The Center for Public Integrity, a public interest investigative journalism organization, has obtained copies of a Centers for Disease Control and Prevention (CDC) study of environmental and health data in eight Great Lakes states that was scheduled for publication in July 2007.

The report, which pointed to elevated rates of lung, colon, and breast cancer; low birth weight; and infant mortality in several of the geographical areas of concern has not yet been made public. A few days before the report was slated to be released, it was pulled. Meanwhile, at precisely the same time, its lead author, Christopher De Rosa, has been removed from the position he held since 1992.  The Center for Public Integrity is asking why.

The study, “Public Health Implications of Hazardous Substances in Twenty-Six U.S. Great Lakes Areas of Concern” was developed by the CDC’s Agency for Toxic Substances and Disease Registry (ATSDR) at the request of the International Joint Commission, an independent U.S-Canadian organization that monitors and advises both governments on the use and quality of boundary waters. The CDC report brings together two sets of data: environmental data on known “areas of concern” — including superfund sites and hazardous waste dumps — and separate health data collected by county or, in some cases, smaller geographical regions. The study does not try to prove cause and effect. Instead, it outlines areas for further study and data collection on the link between pollution and health.”Let’s say we have a superfund site and we also find elevated risk of leukemia in the county — is that related? We don’t know, but people living in the area can logically argue that we ought to find out,” Dr. Peter Orris, a professor at the University of Illinois School of Public Health and one of the peer reviewers of the study told Oneworld.net. (more…)

 
             Thanks to Scarlett Q  for permission to use this Photo.

Many physicians have the medical assistant write out the prescription, and then the physician signs it.  This practice places a significant responsibility on the medical assistant.  My opinion is that it is not good policy to have the medical assistant write out prescriptions.  If the physician in your office does follow this procedure, be absolutely sure that the physician reads what you have written prior to signing the prescription.  This applies especially to prescriptions that are called into the pharmacy.  If the physician has not reviewed the prescription and signed it, then you have just prescribed medications on your own.  Such a situation would have drastic legal and ethical implications for both you and the physician.  Always follow procedures carefully.  If you have concerns about procedures in your office, discuss them with your physician. 

Loretta Maples
Medical Office Assisting Instructor
Ashworth University

                 Thanks to Corey for permission to use this Photo.

At one point in time, a long time ago (around 2000), I wondered if centralized, government maintained electronic health records was the way to go.  In defense of this position, my arguments revolved around the notions of efficiency and control, in that it was easier for systems to be monitored, maintained, and updated if they were all in one place.  But, as anyone with a technical background could point out, there are significant technical issues behind such a strategy.  It would seem that some people agree: “German doctors say no to centrally stored patient records“.

What I find interesting is the proposed “counter” solution:

As an alternative, the German private doctors’ body is suggesting the use of encrypted USB-sticks. These could be handed over to patients and would carry all relevant patient data, including digital images such as radiographs or CT-scansWow.  I haven’t heard a call for the use of physical based media in quite some time.  Personally, I thought that this line of thinking was disappearing as the feasibility of cloud computing increases and slowly becomes a realistic option.  In all fairness, there are a few other very interesting points raised by the group representing the German physicians. 

Allow hackers to try to and crack the USB system in order to prove that it can be made safe.

Make patients more aware of what information is collected and stored. (more…)