Pat McNees, writer, editor,
personal historian

Useful health care and medicine websites, blogs, and stories

• Medical links for smart patients and smart parents--information about health care and medical conditions
• Reducing preventable medical errors
• A reading list of books on medicine, health care, and caregiving
• For your medical reference shelf
• You are what you eat...
• Understanding the debate on health care reform and health policy

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Grand Rounds at Dartmouth-Hitchcock Medical Center (talks and slide shows available free online)

NIH Research. CRISP replaced by NIH RePORTer (NIH Research Portfolio Online Reporting), a searchable database on federally funded biomedical research projects and programs. News updates here.

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REDUCING PREVENTABLE MEDICAL ERRORS

In 1999 the Institute of Medicine published its report, To Err Is Human:Building a Safer Health System, which presented a strategy by which government, health care providers, industry, and consumers could reduce preventable medical errors. This report led to several others, which an educated consumer could use as a checklist on how not to be the victim of hospital-caused medical problems (above all, make sure whoever does a procedure on you washes their hands first).

In February 2000, the Quality Interagency Coordination Task Force (QuIC) issued a report, Doing What Counts for Patient Safety: Federal Action to Reduce Medical Errors and Their Impact, listing more than 100 activities needed to:
1. Create a national focus on reducing errors.
2. Develop a knowledge base for learning about errors' causes and effective error prevention.
3. Ensure accountability for safe health care delivery.
4. Guarantee that patient safety practices are implemented.

The Institute for Healthcare Improvement (IHI) announced the 100k lives Campaign, through which healthcare organizations, by implementing one or more of six specific evidence-based practices, could join a campaign to potentially prevent 100,000 avoidable deaths. Six interventional measures were identified as crucial to improving patient safety:
* Deploying rapid response teams at the first sign of patient decline.
* Delivering reliable, evidence-based care for acute myocardial infarction (AMI) to prevent deaths from heart attack (for example, give patient an aspirin).
* Preventing adverse drug events (ADE) by implementing medication reconciliation.
* Preventing central line infections by implementing a series of scientifically grounded interdependent interventions.
* Preventing surgical site infections by reliably delivering appropriate antibiotics and other specific steps.
* Preventing ventilator-associated pneumonia by implementing a series of scientifically grounded interdependent interventions.

Following are links to websites and reports that deal with improving patient safety and hospital staff performance.

The Checklist

"Intensive care succeeds only when we hold the odds of doing harm low enough for the odds of doing good to prevail. This is hard. There are dangers simply in lying unconscious in bed for a few days. Muscles atrophy. Bones lose mass. Pressure ulcers form. Veins begin to clot off. You have to stretch and exercise patients’ flaccid limbs daily to avoid contractures, give subcutaneous injections of blood thinners at least twice a day, turn patients in bed every few hours, bathe them and change their sheets without knocking out a tube or a line, brush their teeth twice a day to avoid pneumonia from bacterial buildup in their mouths. Add a ventilator, dialysis, and open wounds to care for, and the difficulties only accumulate....

But consider: there are hundreds, perhaps thousands, of things doctors do that are at least as dangerous and prone to human failure as putting central lines into I.C.U. patients. It’s true of cardiac care, stroke treatment, H.I.V. treatment, and surgery of all kinds. It’s also true of diagnosis, whether one is trying to identify cancer or infection or a heart attack. All have steps that are worth putting on a checklist and testing in routine care. The question — still unanswered — is whether medical culture will embrace the opportunity."
~ Atul Gawande, "The Checklist," in The New Yorker

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A READING LIST OF BOOKS ON MEDICINE, HEALTH CARE, AND CAREGIVING -- FOR PATIENTS AND CAREGIVERS

An Uncertain Inheritance: Writers on Caring for Family edited by Nell Casey. Wonderful writing, excellent insights into the complexities both of caring and of being cared for, during an illness.

An Unquiet Mind: A Memoir of Moods and Madness by Kay Redfield Jamison (about manic depression).

Better: A Surgeon's Notes on Performance by Atul Gawande

Brain Surgeon: A Doctor's Inspiring Encounters with Mortality and Miracles by Keith Black

Complications: A Surgeon’s Notes on an Imperfect Science by Atul Gawande

Emergency!: True Stories From The Nation's ERs by Mark Brown

Hot Lights, Cold Steel: Life, Death and Sleepless Nights in a Surgeon's First Years, Michael J. Collins memoir of his grueling surgical residency at the Mayo Clinic

How Doctors Think by Jerome Groopman

How We Die by Sherwin Nuland (excellent descriptions of exactly how the various body systems fail, when they fail -- a primer even for healthy readers)

Illness as Metaphor: AIDS and Its Metaphors by Susan Sontag

Intern: A Doctor's Initiation by Sandeep Jauhar

In the Country of Hearts: Journeys in the Art of Medicine by John Stone

Just Here Trying to Save a Few Lives: Tales of Life and Death in the ER by Pamela Grim

Life Disrupted: Getting Real About Chronic Illness in Your Twenties and Thirties, by Laurie Edwards

Life Support: Three Nurses on the Front Lines (The Culture and Politics of Health Care Work) by Suzanne Gordon, author of Nursing Against the Odds: How Health Care Cost Cutting, Media Stereotypes, And Medical Hubris Undermine Nurses And Patient Care.

The Man Who Mistook His Wife for a Hat and Other Clinical Tales, by Oliver Sachs

The Measure of Our Days: New Beginnings at Life's End by Jerome Groopman

Medical Detectives, by Berton Roueche

My Own Country: A Doctor's Story , Abraham Verghese's memoir of being a doctor during the early years of AIDS.

On Call: A Doctor's Days and Nights in Residency by Emily R. Transue

Second Opinions: Stories of Intuition and Choice in the Changing World of Medicine by Jerome Groopman

Silence Kills: Speaking Out and Saving Lives , edited by Lee Gutkind (essays about communication failures that lead to potentially lethal medical error)

Unholy Ghost: Writers on Depression, ed. Nell Casey

When the Air Hits Your Brain: Tales from Neurosurgery by Frank Vertosick Jr.

You: The Smart Patient, An Insider's Handbook for Getting the Best Treatment, by Drs. Michael F. Roizen and Mehmet C. Oz, with the Joint Commission (one of a series by the charismatic Oprah favorite, Dr. Oz, and the knowledgeable Dr. Roizen)

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FOR YOUR MEDICAL REFERENCE SHELF
Although you can learn a lot online through Medline Plus and WebHealth.com (links above), you may want to have a good general reference book at home, too. Here are a few possibilities:

The Body Clock Guide to Better Health by Michael Smolensky and Lynne Lamberg

The Cornell Illustrated Medical Encyclopedia: The Definitive Medical Home Reference Guide (Weill Cornell Health Series) by Antonio Gotto

The Johns Hopkins Complete Home Guide to Symptoms & Remedies by Editors of The Johns Hopkins Medical Letter Health After 50

The Johns Hopkins Consumer Guide to Medical Tests: What You Can Expect, How You Should Prepare, What Your Results Mean by Simeon Margolis

Know Your Body: The Atlas of Anatomy by Emmet B. Keefe

Mayo Clinic Family Health Book, 3rd edition, by the Mayo Clinic

Mosby's Manual of Diagnostic and Laboratory Tests, by Kathleen Pagana and Timothy Pagana (helpful in interpreting lab test results)

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IF YOU ARE WHAT YOU EAT, LOOK AT THESE, TOO:

The New American Plate Cookbook, a good-for-you cookbook filled with delicious recipes from the American Institute for Cancer Research

Fast Food Nation: The Dark Side of the All-American Meal, by Eric Schlosser (read this and then start cooking from The New American Plate)

The Omnivore’s Dilemma: A Natural History of Four Meals, by Michael Pollan

Bottom line: Shop the periphery of the supermarket. All the natural foods are there. The center of the market is full of the processed foods that are stripped of some nutrients and loaded with garbage that increases profits for stores and manufacturers while burdening you with extra calories and weight.
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In the Mood for Chocolate. Joanne Silberner, NPR, 4-26-10, on the connection between depression and chocolate. Chocolate-lovers, check out Joanne's favorite website, Cnocolate and Zucchini (especially the forums).

For Three Years, Every Bite Organic
(an excerpt)

"Dr. Greene said he was inspired to go all-organic after talking to a dairy farmer who noted that livestock got sick less after a switch to organic practices. He wondered if becoming 100 percent organic might improve his own health.

Three years later, he says he has more energy and wakes up earlier. As a pediatrician regularly exposed to sick children, he was accustomed to several illnesses a year. Now, he says, he is rarely ill. His urine is a brighter yellow, a sign that he is ingesting more vitamins and nutrients....

In corporate cafeterias and convenience stores, he looked for stickers that began with the number 9 to signify organic; stickers on conventionally grown produce begin with 4."

Tara Parker-Pope,in her Well column, The New York Times

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Understanding the debate on health care reform and health policy

• Whitehouse.gov The eight basic consumer protections the White House wants health care reform to cover: (1) No discrimination for pre-existing conditions, (2) No exorbitant out-of-pocket expenses, deductibles or co-pays, (3)No cost-sharing for preventive care, (4) No dropping of coverage if you become seriously ill, (5) No gender discrimination, (6) No annual or lifetime caps on coverage, (7) Extended coverage for young adults, (8) Guaranteed insurance renewal so long as premiums are paid. Learn more about these consumer protections at http:/​/​www.whitehouse.gov/​
• Excluded Voices. Trudy Lieberman's penetrating series of interviews on health care reform, in Columbia Journalism Review. Start with her interview with Wendell Potter, who "didn’t want to be part of another health insurance industry effort to shape reform that would benefit the industry at the expense of the public." You can also listen to Bill Moyers interview Potter or read the transcript and Potter's testimony before Congress.
• C-Span's Health Care Hub is a good place to find various town hall discussions, hearings, wonderful links. C-Span, you're wonderful!
• The Cost Conundrum: What a Texas town can teach us about health care (Atul Gawande, The New Yorker, 6-1-09)
• A consumer guide to handling disputes with your employer or private health plan, 2005 update, Kaiser Family Foundation
• C-Span's Health Care Hub is a good place to find various town hall discussions, hearings, wonderful links. C-Span, you're wonderful!
• DrSteveB's blogroll (helpful Daily Kos blogger--and check his blogroll for other resources)
• Find Help (HRSA links to free and inexpensive care)
• Guaranteed Health Care (National Nurses Organizing Committee, California Nurses Association)
• Health Affairs (the policy journal of the health sphere)
• HELP Is on the Way (Paul Krugman on why universal health coverage is affordable)
Health Insurance Consumer Information (news you can use), with blogs that follow the health care debate and discuss news of health insurance coverage around the country, and a Consumer Guide for Getting and Keeping Health Insurance for each state and the District of Columbia. The American Cancer Society and the Robert Wood Johnson Foundation and other organizations provide support for this research by The Georgetown University Health Policy Institute. Worth checking out.
• Health Insurance Woes: My $22,000 Bill for Having a Baby (And I had coverage for maternity care! Sarah Wildman, DoubleX, 8-3-09). "Our insurer, CareFirst BlueCross BlueShield, sold us exactly the type of flawed policy—riddled with holes and exceptions—that the health care reform bills in Congress should try to do away with. The “maternity” coverage we purchased didn’t cover my labor, delivery, or hospital stay. It was a sham."..."The individual insurance market is like that old joke about the food being terrible and the portions too small; it’s expensive, shoddy, and deeply unsatisfying. Those of us who buy into it are not protected by the federal and state laws that govern employer-based health care. In fact, there’s no one looking out for us at all."
• Physicians for a National Health Program (supports single-payer national health insurance)
• Reach of Subsidies Is Critical Issue for Health Plan (Robert Pear, NY Times, 7-26-09—on another important issue: where the money comes from to cover the costs of the formerly uninsured)
• Science Blogs (Health)
• SurveyUSA News Poll on Health Care Data (showing public opinion on various aspects of the health care debate, by gender, race, party affiliation, ideology, level of college education, income,region, and age)
• Why markets can’t cure healthcare by Paul Krugman (The Conscience of a Liberal, NY Times, 7-25-09).
You can watch Michael Moore's documentary, Sicko online. You can hear on Bill Moyers' interview with Wendell Potter how the insurance industry planned to defuse reactions to Moore's documentary. As Potter states: "The industry has always tried to make Americans think that government-run systems are the worst thing that could possibly happen to them, that if you even consider that, you're heading down on the slippery slope towards socialism. So they have used scare tactics for years and years and years, to keep that from happening. If there were a broader program like our Medicare program, it could potentially reduce the profits of these big companies. So that is their biggest concern." Potter himself says of the documentary, "I thought that he hit the nail on the head with his movie. But the industry, from the moment that the industry learned that Michael Moore was taking on the health care industry, it was really concerned."

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Godwin's Law: ""As a Usenet discussion grows longer, the probability of a comparison involving Nazis or Hitler approaches"
~ Mike Godwin, creator of Godwin's Rule of Nazi Analogies, fearing glib use of the term will dilute the meaning of "Never Again"

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