Public Health

What’s on Your Nightstand?

Before going to sleep read for half an hour, and in the morning have a book open on your dressing table. -Osler What is on your nightstand? I'm not asking about the NEJM issue from 2013 that you still haven't gotten to; or the gadgets glowing or dinging through the night; or the accumulating used tissue pile since you and all your patients now have the flu. What books are on your nightstand? As Osler would ask, what are you reading the last 30 minutes of the day? I'll tell you some of my list from 2014, and then a preview of what's ahead for 2015. (Not all of these books were published in this past year. Like that 2013 NEJM article that sits unread, I’m a bit behind on my reading). The Anatomy Lesson, by Nina Siegal I was in Philly this past year, and stopped in the Philadelphia…

The CDC Must Do Better

The USPTF got schooled in 2009 when they released their guidelines for breast cancer screening.  They did not prepare for the backlash nor did they have media personnel or training to deal with the public’s ire.  The task force learned a lesson, and guideline release and dissemination has changed as a result.  The USPTF has become less forthcoming with information related to pending reviews--mostly due to politics. Last year, the CDC had its own imbroglio over Ebola: The Centers for Disease Control and Prevention (CDC) has been widely criticized for projecting overconfidence in U.S. hospitals' capacity to manage Ebola. When two nurses at Texas Health Presbyterian Hospital Dallas became infected after caring for Thomas Duncan, critics cited the CDC's assurance that “U.S. hospitals can safely manage patients with Ebola disease.”2 When the CDC said the nurses probably became infected because of a protocol breach and it turned out there was no protocol, things got…

Waiting to Inhale: Hospitalists, Marijuana, and Legalization

by Dr. Jason Persoff MD, SFHM Welcome to Friday night as a hospitalist in the ultimate Green State, Colorado: time to gear up for some marijuana-facilitated paranoia, memory loss, nausea and vomiting, and memory loss. I’m not a teetotaler but I do find the new surge in cases of preventable disease a bit disheartening if not occasionally humorous. Prior to this past year, it wasn’t uncommon for me to encounter an occasional marijuana medical problem, but since ringing in the New Year and the new law, it’s become a bit of a habit to admit folks with marijuana-associated illnesses. Take Mr. L, my first marijuana-associated admission of the night. He presents for his 10th consecutive month of recurrent nausea and vomiting. Stating that these symptoms began roughly about the time that he had a stomach virus in January; his friends suggested a cure for his upset stomach: cue the marijuana.…

Ethics and Ebola

by Dr. Bartho Caponi MD, FHM The Ebola panic has died down; while many are under monitoring, there have been no further de novo U.S. cases since October 15, and only two more "imported" cases. Travelers are being screened and resources are heading to areas where they are needed. At my institution, Hospitalists have led the way; over half my division volunteered up-front to provide necessary care. I ended up in a lot of planning and policy meetings, where we internally crafted a comprehensive plan to deal with any Ebola-related eventuality. Nationally, the Centers for Disease Control and Prevention (CDC) have created many useful resources for people and institutions needing them. We now have guidelines for speaking to our children about Ebola and for taking care of Ebola-exposed pets, in addition to more trenchant issues. We now have "Ebola centers," hospitals capable of caring for suspected or confirmed Ebola patients…

2013: Did we pay more for inpatient care, or did we use more?

  The Health Care Cost Institute is not just another consulting firm or think tank.  They are a a non-partisan, non-profit clearinghouse for all things health care payment.  They obtain commercial and government data and generate reports on health spending direction. Their 2014 release analyzing 2013 commercial trends (think age 18-64 yo)  came out last week. The report has oodles of data and fun graphics covering many domains--but since we live on the inpatient side, you might also want to  take a look at the hospital end of things.  After all, hospital bottom lines live and die by employer sponsored insurance and the rates they pay (or hospitals accept). The verdict?  Inpatient use down, with care intensity and prices up (average price of a stay equals ~$18K). Have a look (page 7 of the report): (more…)
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