1. Featured Article: The American
Thoracic Society International Conference, San Francisco
Some of the most popular issues of
our MedicalTuesday newsletters seem to be our report on medical conferences.
The interest may be primarily from non-physicians such as medical writers,
nurses, administrators and health care executives.
The feedback on the World Health
Care Congress, which we reported last month, is the most prestigious meeting of
all sectors of the health care industry. We appreciate the $400 discount offered
to all MedicalTuesday members. This is an important meeting for all physicians
to attend.
In addition, physicians should also
attend a physician-oriented practice meeting. Unfortunately, the AMA and the
CMA (California Medical Association) no longer hold annual meetings of this
nature. They offered physicians an opportunity to be in the same city, to get
to know one another, and to select from a large variety of presentations in
dozens of specialties. Wouldn't it be great if 100,000 physicians descended on
Chicago (or some large city on a relatively neutral weekend such as Columbus
Day weekend in October) every other year? And on the alternate years, the state
societies could gather on the same weekend. The CMA could have 50,000
physicians from California together at one time? What a message that would send
to our critics. At the present time, the only pro-physician meeting is the
annual assembly of the American Association of Physicians and Surgeons, which
meets on the second weekend of October. Be sure to put that on your calendar.
The third type of meeting
physicians should attend on a yearly basis is the major clinical meeting of the
various medical specialties. Some are very large, such as the 20,000 oncology
or the 35,000 cardiology or large family doctor meetings. Many that attend
these meetings are primary or personal physicians with special interests. I
attend the International Conference of the American Thoracic Society, which was
held in San Francisco this year. Next year it is in Toronto. It generally
alternates between the two coasts inasmuch as nearly 40 percent of our 18,000
members are from other countries. This makes travel easier, at least from
Europe and Asia where large membership exists. This year we had 16,400
registrants. Essentially all of the countries of the continents of Europe, Asia
and Australia were represented. Most of the countries of South America and
Africa were also represented. It also seemed like more of the Mid East was
represented. The World Health Care Congress recognizes this interest in
scheduling a meeting in Dubai, United Arab Emirates this fall.
The specialty of Lung Medicine has
had various names during its 100-year history. (We are the second oldest
specialty after Eye.) In addition to Lung, we are Pulmonary Physicians, or
Respiratory or Chest Physicians. The lung surgeons are generally known as
Thoracic Surgeons. Hence, the membership of the ATS is largely composed of the
clinical specialties of Pulmonologists, both Internists and Pediatricians,
Thoracic Surgeons, Respiratory Nurse Clinical Specialists, Respiratory
Therapist, and Pulmonary Function Technologists. The research arms in academia
are primarily respiratory physiologists, lung anatomist, pulmonary
pathologists, and now respiratory cell biologists and geneticists.
In the early 1900s, tuberculosis or
TB was the plague that was the primary interest of our organization, then known
as the American Trudeau Society, named after its founder in 1905. With no drugs
to fight TB, and with millions dying from it, the Sanatorium movement began to
isolate TB and provide "healing" rest in pastoral surroundings. They
also sponsored research in why TB reactivated so frequently. In the early days,
removing a diseased or destroyed lung was the basis for Thoracic Surgery training.
When I trained in Michigan, there was a van of TB patients from the various
sanatoriums around the state that arrived at the University of Michigan Medical
Center every Monday for lung surgery and returned to the sanatoriums usually by
Friday. This trained some of the best Thoracic Surgeons for many years.
The annual meetings enlarged over
the years to include many chest diseases and the lay organization was called TB
& Health, and later the Lung Association. The medical arm changed its name
form Trudeau to the American Thoracic Society.
There was increasing friction
between the two organizations over the years, and the doctors felt that lung
research was not emphasized enough comprising about 25 percent of the donated
income. The local lung associations gave even less to research. About 1999,
there was a divorce and the American Thoracic Society had to pay the American
Lung Association for the American Thoracic Society name and to acquire
ownership of the medical Journal, which was The American Review of Respiratory
Disease. This evolved into The American Journal of Respiratory and Critical
Care Medicine; the new name incorporated Critical Care medicine since much of
critical care in the ICUs was done by pulmonologists. There is now a similar
movement to incorporate Sleep Medicine since most of Sleep Medicine, such as
Obstructive Sleep Apnea, is done by Pulmonologists. This journal comes out
twice a month.
There is a second journal, The
American Journal of Respiratory Cell and Molecular Biology, which is published
monthly or two volumes a year. A third journal was recently added, The
Proceedings of the American Thoracic Society, which publishes Reviews and
Symposia.
The ATS is making all the required
payments for the 10-year buyout , has
greatly enlarged its research funding,
and expanded internationally, more
than tripling in size. It has become the Premier organization for all aspects
of lung disease. The societies in many of the other continents, such as the
European Respiratory Society and Asian Societies, are establishing alliances
with the ATS. Joint memberships are being established with a number of them.
Joint sponsorship of the World Chest Conferences is beginning to occur. (It was
of interest that Google noted my attendance and reportage of the Pan American
Chest Conference in Lima, Peru.)
The international conference
consisted of sessions from 7 AM to 9 PM. There were twenty concurrent sessions
each day and 60 concurrent poster sessions. Frequently, a speaker would mention
the time and date that his researchers would be stationed at the posters
related to his presentation; one could then speak with these researches in such
great detail that an hour could be spent studying with the presenters. It was
good to see aggressive Pulmonary Fellows still scheduling themselves 14 hours
of sessions daily. This could add up to more than 50 hours of Continued Medical
Education credit for attending the conference. (Twenty-five hours per year are
required to maintain a medical license in California.) There were some fellows
who purchased hundreds of tapes to listen to the other 19 sessions that they
couldn't attend. (Will they have time to listen to hundreds of hours of
lectures after their normal 80-hour work week? This must truly be a genuine
love for excellence in medicine realizing that most of them will never make
more than $30 to $50 an hour for their 80-hour work week.)
The concurrent sessions covered
every aspect of clinical lung disease. The most popular session every morning
was the two-hour review of the latest progress in all aspects of pulmonary
medicine. This popular session was held in conference halls that seated three
to four thousand attendees with standing room only in all side aisles and the
back.
Although daily journal reading is
important for all practicing physicians, one would be hard pressed to obtain as
much information as is packed into such a four-day conference. In addition,
there were two full days of 26 post-graduate courses that include intense
training in one particular field such as sleep medicine, respiratory physiology
during mechanical ventilation, pharmacogenetics, lung transplantation, and
chest imaging to name a few of the 26.
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2.
In the News: Lung Fibrosis; Life After Critical Care; How Doctors
Think
After the morning review sessions on the
first afternoon of the conference, I attended
the "Controversies in Interstitial Pulmonary Fibrosis - A
Pro/Con Debate." It has always been an interest of my mine how
hospitals and experts can rank physicians, who, after following algorithms for
managing patients, still can't decide on a unified approach to a disease that
has been studied since the first paper published by the Mayo Clinic in 1935 and
the second published in 1944. My interest was also peaked since two such patients
floated into my practice this past year. I saw the first one shortly after I
entered practice and was able to make the pathologic diagnosis with a
fiberoptic bronchoscope doing a transbronchial lung biopsy. We introduced this
procedure into Sacramento in the early 1970s: the biopsy forceps is pushed
through the bronchial wall ideally snaring 50 to 100 alveoli in order to study
the alveolar wall under a microscope and view the fibrosis present. I kept this
patient alive for more than twenty years, knowing that some of the first
patients described in 1935 only lived six months to a year. Now we know that
IPF is a multitude of diseases all with different prognosis. And the experts
are still debating what should be the treatment of choice for each.
The series of sessions on the "Metabolic
Dysfunction in Critical Care Illness," "Emerging issues in
Drug Induced and Iatrogenic Lung Disease," and "Life after
Critical Care" were all very popular sessions with standing room only.
Admission to an ICU or Critical Care Unit carries a very ominous prognosis.
Patients become anemic starting on the second day. The generally accepted
standard is to give a blood transfusion when the Hemoglobin drops to 10 grams
percent from the usual 14-16 Gm%. However, alveolar injury can be demonstrated
within six hours of a transfusion and up to 85 percent of ICU patients are
transfused. Hence, the large number of complicated "Acute Respiratory
Distress Syndromes" (ARDS) in the ICUs which accounts for a significant
mortality. One presenter suggested that transfusion should be held off until
the Hemoglobin drops to 7 Gm% or half normal. Most patients will survive better
if not transfused, thus many transfusions will be eliminated. (Be sure to
follow Jerome Groopman's suggestion of asking your doctor the right questions
and being aware of your loved one's hemoglobin levels every day in the ICU.)
Many patients develop neuropathy and myopathy in the ICU. It is so common that
they are now lumped as neuromyopathies. This is a significant barrier for
patient's return to work after an ICU admission. Fifty percent are unable to
return to work for a year after an ICU admission. Up to 75 percent are able to
return to work within five years with appropriate physical therapy. A new and
surprising finding is that 43 percent of patients have sexual dysfunction after
a critical care admission. There are a number of neuropsychological problems
that are just beginning to be recognized.
The highlight of
the Annual Membership Meeting was the President's Lecture given this year by
Jerome Groopman, MD. Dr. Groopman is the Chief of Experimental Medicine at Beth
Israel Deaconess Medical Center, one the world's leading researchers in cancer
and AIDS. He is a staff writer for The New Yorker and author of four
thoughtful books on healthcare including "The Measure of Our Days,"
"Second Opinion" and "The Anatomy of Hope." His current
best seller is "How Doctors Think" which is available in book
and audiodisc and hit the bookstores on the third day of this meeting. We will
be reviewing his book over the next month or two to bring you the wisdom of a
consummate physician who is comfortable at the research bench, the bedside and
the consultation room. This week, we bring you a review of his first book
below: The Measure of our Days - New Beginnings at Life's End.
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3.
International Medicine: NHS Cancer Patients Are Denied New
Drug
Patients
suffering from head and neck cancer are to be denied a new drug on the National
Health Service because it is claimed it is no more effective than existing
drugs.
The
National Institute for Health and Clinical Excellence (Nice) has rejected
Erbitux, also known as cetuximab, for cancer sufferers in England and Wales.
The drug is available in Scotland.
Nice
said the drug, when used in conjunction with radiotherapy, did not offer
"better therapeutic value" than existing treatments for locally
advanced head and neck cancer.
However,
according to clinical trials carried out by Merck Serono UK, the drug's
manufacturer, patients treated with Erbitux plus radiotherapy survive for an
average of 49 months, compared with 29 months for those treated with
radiotherapy alone.
Campaigners
said the move was a blow to patients as the drug is the first licensed in the
past 40 years for treating locally advanced head and neck cancer. . .
More
than 7,800 people are diagnosed with head and neck cancer in the UK every year.
Dr
Vinod Joshi, of the Mouth Cancer Foundation, said: "Nice has effectively
denied [head and neck cancer patients] this new treatment option for a chance
to live longer.
"There
is now a postcode lottery as the Scottish Medicines Consortium has approved not
only cetuximab but also docetaxel [another head and neck cancer drug] for
Scottish patients."
Christine
Piff, the chief executive of the head and neck cancer support group Let's Face
It, said: "I am devastated by the news. Head and neck cancer continues to
be the Cinderella cancer, receiving little or no attention from the NHS. . .
Dr
Nick Slevin, a consultant oncologist at the Christie Hospital in Manchester,
added: "The decision from Nice ignores the complexities and pragmatism of
clinical practice.
"I
have no doubt that cetuximab with radiotherapy is the correct treatment option
for some patients.
"Head
and neck cancer management is not black and white and I believe this decision
is discriminatory against a group of patients who don't carry the same
political influence as others."
A Swedish study published earlier this
month showed that the UK has one of the worst records over access to new cancer
drugs. Experts ranked the UK in the bottom group for its "slow and
low" uptake of drugs after analysing sales in 25 countries.
www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/05/14/ndrugs14.xml
The NHS does
not give access to appropriate healthcare, but only access to a waiting or wish
list.
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4. Medicare: Correct CPT Coding,
Billing and Documentation for Pulmonary, Critical Care and Sleep Medicine
An entire day post-graduate course was
devoted to Current Procedural Terminology codes. These are ever-changing codes
used by physicians in an attempt to get paid for the practice of medicine.
These have gotten more complicate and more extensive by the year. I did not
waste eight hours attending this. It would not lead to any professional
enhancement or improve quality of care. It only allows one to play the
government games. Even though these codes are a requirement for Medicare
Billing, they are carefully guarded and copyrighted by the AMA and cannot be
acquired without purchase.
https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp?checkXwho=done
Government is not the solution to our
problems, government is the problem.
-
Ronald Reagan
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5.
Medical Gluttony: Hospital Care
The high-tech hospital is
extremely important for the complicated and seriously ill patient. However, as
this conference repeatedly pointed out from acquired infections to simple blood
transfusion, it is an increasingly hazardous environment. The consequences
extend far beyond the hospitalization into the ambulatory care arena. As
hospitals lose much of their volume from inpatients, they have increasingly
resorted to outpatient medicine. However, it has repeatedly been shown that
outpatient hospital medicine is far more expensive than similar treatment in a
doctor's office - sometimes on the order of two or three-fold. It also depends
on the system and reimbursement mechanisms.
In the average hospital, the goal
is increasing revenue, which is how they stay in business. But it is
increasingly costly and maybe gluttonous. A recent example surfaced.
There is a great emphasis on
pulmonary rehabilitation in recent years. Medicare reimburses for this. I had a
patient that enrolled at the local hospital and he stated that Medicare was
billed about $2500 for the two-week program. There were about 20 COPD patients
in his group and he figured that the hospital revenue for providing one
respiratory therapist for two hours a day to lead this group netted the
hospital well over $50,000 for what he estimated at 25 hours of work.
I also had some Kaiser Permanente
patients in my research group that went to pulmonary rehabilitation at KP three
days a week for 10 or 15 years. There was no charge in this integrated health
care system. I made a visit to the rehab unit and spoke with the respiratory
therapist. He stated that KP provides these facilities and saves considerable
moneys by preventing hospitalizations. He had the figures to prove that when
patients dropped out of the program, they were more likely to go to the
emergency room and be admitted.
The key difference is that the
private hospitals make money on such programs and also make money on the
failure of such programs, which then requires admission to their high-cost
center.
KP, being an integrated health
care system with the three arms of Kaiser Foundation Hospitals, Kaiser
Foundation Health Plans, and The Permanente Medical Group, work in concert with
each other to reduce health care costs. They are connected through electronic
medical records that allow any Permanente physician to access a patient's
medical record from any computer terminal within the system. It appears to be a
winning combination. They feel that this is the answer to the insurance
dilemma.
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6.
Medical Myths: My Doctor Doesn't Know. Therefore, He
Doesn't Care.
Inside Medicine:
Reassurance may hurt more than help patients: By Dr. Michael Wilkes – Sacramento Bee, May
12, 2007
One morning, Bernie woke up with stiff joints in his
knees and hands. Thinking he might have pulled some muscles, he took ibuprofen
and went about his daily routine. After three of four days of the same pain, he
went to the doctor and explained to her that the pain was debilitating and
keeping him from doing his ordinary activities.
The doctor asked a series of questions and conducted a
careful physical exam.
The doctor said, "Well, the good news is, I've
not found any signs of a serious disease like rheumatoid arthritis. I've
ordered some blood tests, but I think the results will come back negative. So I
think we can assume that you just have a touch of mild ordinary arthritis. Some
mild pain relievers are all you need."
So Bernie feels better, right? Well, not exactly.
According to a recent study in the British Medical Journal, when doctors try to
reassure patients, they may actually cause them more worry. Several studies
have shown that after doctors reassure patients that their chest pain is
nothing serious -- even after they've been scanned and tested and found to be
normal -- they continue to fret and limit their physical activity. The same is
true with patients who have headaches: They continue to be concerned even after
being told everything is fine.
The problem may be a difference in perspective,
communication style, language and understanding of risk.
What did the patient with the arthritis hear?
"I heard the doctor tell me she couldn't find
anything -- that my arthritis wasn't very serious. Well, that's easy for her to
say. She doesn't see me in the evenings when the pain is worse. I think she
thinks I am faking all of this."
The doctor never heard what Bernie thought because she
never asked. The doctor thought she did a good job providing reassurance, but
we now know that simply saying that everything is all right doesn't seem to
comfort very many people. They interpret the doctor's words in the context of
their illness and in relationship to their own stories and experiences. . .
By the same token, patients need to understand that
"I don't know" doesn't mean "I don't care" or "I am a
bad doctor." Most of medicine remains an art -- far too little of medicine
is scientific despite our constant talk of "studies" and
"research."
To read the entire article, go to www.sacbee.com/107/v-print/story/176177.html.
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7.
Overheard in the Medical Staff Lounge: The Hazards of Doctoring
Dr. Rosen: The Washington Conference by the Whistleblowers
certainly raised the consciousness in this country concerning the hostility to
many segments of the health care industry.
Dr. Milton: I certainly hope so. I don't think the public has any
concept of how a doctor's efforts to improve care by pointing out inferior care
are thwarted by hospitals, whether private, military, VA, or public.
Dr. Michelle: I have a friend who provided care to the military
service and did such a good job that she was ultimately subjected to PEER
REVIEW and after a Kangaroo trial, lost her job and nearly her medical license.
Dr. Ruth: She must have done something egregious.
Dr. Michelle: Nothing of the sort. Although they tried to take
issue with her care, she had outside physicians that supported her clinical
decisions in each and every case. Every case withstood scrutiny. But facts
don't matter in a Kangaroo Court.
Dr. Dave: Another hostility we face is women alleging sexual
misconduct. Goodness, we're in the business of examining human bodies and half
of them happen to be female.
Dr. Milton: I overheard some women at a table in a restaurant
discuss that when their job was in jeopardy or they just needed money, they
could always consider filing a complaint for sexual misconduct because it's so
hard for the defense to win and they always settle for a goodly sum, usually it
beats several years of earned income.
Dr. Michelle: I've heard women discuss the same. If they ever got
pushed against a wall financially, they would always have the option of filing
a complaint against an employer or even a physician since that is open sesame.
Dr. Rosen: There was an internist in California who had a
patient that made sexual advances to him. He was a devoutly religious man and
rebuffed her several attempts. This incensed her and she vowed to get even. She
alleged that he took a little longer to do a pelvic exam on her than was
necessary and so he was a sexual pervert. She was a medical assistant in
another practice and monitored the internist's practice and contacted every
female he examined. It took five years for her to find one other patient that
agreed that perhaps the doctor took a bit longer to do a pelvic exam than was
absolutely necessary. She found the third and fourth much faster and then she
had a case and sued.
Dr. Ruth: Didn't he have a chaperone in the room with him?
Dr. Rosen: Yes he did. But the court alleged that since she
worked for the doctor, she couldn't be objective for fear of losing her job.
And he went to jail for this trumped-up charge.
Dr. Ruth: Was it a short jail sentence?
Dr. Rosen: I think he spent five years in prison before he was
paroled. But his medical license was not restored. So the authorities set up a
trap. They found a former patient who called him for an urgent medical problem.
He responded and gave her some medications and immediately the police came out
of his former patient's closet and arrested him for practicing without a
license.
Dr. Ruth: So was it back to prison?
Dr. Rosen: Yes, pronto. And he hasn't been paroled in ten years.
It was very hard on his family and his son committed suicide.
Dr. Dave: So why is this all happening to us? What can we do
about it?
Dr. Yancy: We need to counter sue. In fact, I have a special
malpractice policy that requires an additional premium. If I'm every sued for
any reason, they will promptly counter sue any patient for any reason - whether
it's a misdiagnosis, an alleged therapeutic misadventure, Peer Review,
Whistleblower, or even Sexual Misconduct. They just believe that nearly all
physicians are basically very honest and probably have the highest standard of
any profession and all suits are nuisance suits and should be stopped in their
tracks.
Dr. Rosen: The tragedy of all this is that our profession runs
scarred and we don't help each other. When one doctor is named in an allegation
of Peer Review or sexual misconduct, many are afraid to come to his defense
because they know these are trumped up charges and they can turn on anyone
interfering with a hospital or medical board's attempt to destroy a physician's
license, which then eliminates his livelihood and generally destroys his
family.
*
* * * *
8.
Voices of Medicine: The Doctors Journal
Modern Day Paul Revere's Ride to Washington, By James J.
Murtagh, M.D.
(James Murtagh spent 20 years as an
Intensive Care Unit physician. Dr. Murtagh is the founder of Doctors for Open
Government and is a co-chair of Washington Whistleblower Week.)
So through the night rode Paul Revere;
And so through the night went his cry of alarm
To every Middlesex village and farm.
A cry of defiance, and not of fear,
A voice in the darkness, a knock at the door.
Paul Revere is America's
most well known whistleblower. Present day patriots who sound the alarm when
danger threatens our society rightly believe Paul Revere to be the founding
father of whistleblowing. Like modern day patriots, he called on the Sons of
Liberty to oppose the grave, immediate dangers posed by redcoat troops sent to
impose the will of an unresponsive king and parliament.
Last week, a conference as
unique as Paul Revere's ride took place in our nation's capital.
Whistleblower's Week in Washington (WWW) alerted the countryside of the grave
dangers threatening our nation's security and well being. Modern patriots from
a broad spectrum of government and private employers - health, environment,
national security, civil rights, veterans, and more - have all banded together
in a single meeting. The program was initiated and organized by the
whistleblowers themselves. They were joined by more than 50 eminent public
interest organizations in Washington to sound the alarm on dangers proven too
real to be ignored. Hundreds of citizens took part.
Whistleblower's Week in
Washington provided the time, place and voice for whistleblower patriots to
band together for the first time to speak out against fraud, waste and
corruption. These heroes and heroines represent a broad spectrum of government
and private employees - national security, veterans, healthcare, environment,
civil rights and justice.
Activities included
congressional forums and hearings, an award ceremony for Senator Charles
Grassley, rallies, and a film screening and book signings by eminent
whistleblowers. Participants visited legislative offices to alert individual
members of Congress of grave concerns.
Speakers and participants
included both well-known figures and unfamiliar but important whistleblowers
such as:
·
Republican Senator
Charles Grassley who was the keynote speaker. He was given a lifetime
achievement award for his fight against waste, fraud and corruption in
government. The award, like the conference, is completely bipartisan and has
been endorsed by both blue-chip conservatives and liberals.
·
Mahatma Gandhi's
grandson Dr. Kanubhai R. Gandhi and EPA whistleblower and civil rights activist
Dr. Marsha Coleman-Adebayo asked to keep America beautiful and safe from
"Sea to Shining Sea.
·
Religious leaders,
including Rev. Walter E. Fauntroy, stressed the role of speaking the truth and
the role of faith based initiatives in America's civil rights heritage.
·
Climate Change
Whistleblower Rick Piltz who suffered numerous retaliations after
reporting that White House officials with no scientific training tampered with
critical reports.
·
Susan Wood who resigned
in protest against the FDA's delaying of a ruling on whether the Plan B pill
would be made more accessible to patients. She charged that then-acting FDA
Commissioner Lester Crawford interfered in FDA decisions.
·
Physicians Dr. Helen
Salisbury and Dr. Larry Poliner who put their careers on the line to protect
quality patient care. Dr. Janet Chandler battled to protect the humane
treatment of her patients, and after more than a decade of legal appeals won a
Supreme Court verdict upholding her stand for integrity in medical decisions
for patient care.
·
Coleen Rowley who blew
the whistle on the FBI's negligence preceding the September 11 terrorist
attack. Ms. Rowley was named as one of Time Magazine's Person's of the
Year, along with conference supporter and Enron whistleblower Sherron Watkins.
Patriotic commitment united
this band of whistleblowers who oppose hazardous, illegal and unsafe
conditions, waste, fraud and abuse. They unite in order to maintain an open
society, and to protect the rights of U.S. citizens to speak without reprisal
on matters threatening the general welfare and defense of our nation.
In true Jeffersonian
tradition, America's truth-tellers invited the press, Congress, and the
American people to take part, to hear their stories, and to judge for
themselves. Like Paul Revere, they rode to Washington to be heard throughout
the land. New Sons and Daughters of Liberty must rise to defend our safety, our
national defense and our honor.
The
joint task force of WWW urges you to write your congressman, your senator, the
media, and your friends to support the goal of a safer, freer America.
www.commondreams.org/news2007/0510-11.htm
http://www.commondreams.org/news2007/0510-11.htm
http://makeitsafecampaign.org/www/
http://whistle-week-in-dc.org/Jim.htm
http://en.wikipedia.org/wiki/Whistleblower_week
http://en.wikipedia.org/wiki/Whistleblower
http://whistle-week-in-dc.org/Jim.htm
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9.
Book Review: THE MEASURE OF OUR DAYS - New Beginnings at
Life's End, by Jerome Groopman,
MD
Our profession has recently focused on pain management
and end-of-life care since a law enacted in July 2001, that become effective on
January 1, 2002, requires us to take continuing medical education on this
topic. What our legislature has reduced to legalese, needs to be seen in a
medical perspective. I believe this book does that.
Jerome Groopman, Professor of Immunology at Harvard
and Chief of Experiment Medicine at Beth Israel Deaconess, explores life's
lessons as he describes eight patients with life-threatening illnesses gazing
into the face of death. He is able to transform medical case studies into
spiritual journeys to help us understand why some are ennobled by it, others
defeated.
During his second year as a medical student at
Columbia, he experienced a major confrontation with death. He rushed home from
his dormitory to find his father in the final throes of cardiogenic shock. He watched
him die. Groopman feels that his father died before his time and before he, his
family and friends could prepare for his passing. The family physician offered
no medical expertise or emotional comfort. This experience committed Groopman
to caring for his patients and their loved ones with compassion and scientific
excellence. . .
After discussing the eight patient stories, Groopman
gives a final epilogue. While writing this book, his mother developed breast
cancer. The death of his father gave him the impetus and strength to do his
life's work; looking to the future, he continues to seek lessons from his
patients on how he and his mother should live. This is not something that can
be learned in a classroom, forced upon us by lawmakers. Or, as Dr Mark Skousen,
President of the Foundation for Economic Education says, "The triumph of
persuasion over force is the sign of a civilized society." When we arrive
in such a society, our lawmakers will have little to do.
To read the entire review, please go to http://healthcarecom.net/bkrev_MeasureOfOurDays.htm.
To read other book reviews,
please go to www.delmeyer.net/PhysicianPatientBookshelf.htm.
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10.
Hippocrates & His Kin: Reviewing the SF Chronicle While in San
Francisco
A San Francisco supervisor was
targeted by the FBI because of a $40,000 cash payment he received from two men
who sought his help with city permit problems for fast food restaurants. He
immediately received a vote of confidence from supporters who say he is a man
of character.
Only
in SF does $40K seem to fall under the $25 limit for not having receipts for
cash donations.
For the
first time in history, the state of California will spend more on incarcerating
inmates than on educating students in its public universities.
Just wait until Health Care is in the same budget
soup. Will we be third? Or after roads?
Reminds
me of when I was a visiting consultant to the San Juan Hospital in Lima, Peru.
They had no fiberoptic bronchoscopes to make a diagnosis on a cancer patient
they presented to me when every hospital in Sacramento, even an 80-bed
hospital, had one. The chief of Thoracic Surgery told me that the anchovy trade
to Eastern Europe exceeded the health care priority for the seventh straight
year. Romania had no bronchoscopes to use as payment. They only had cardiac
monitoring equipment, which he pointed out in his ICU. None of the units were functional.
At least Romania had anchovies while Peruvians died
of an unrecognized arrhythmia.
Husband: What is this
Environmental mouthwash? Wife: It doesn't kill germs that cause bad breath - it
rehabilitates them and releases them into the wild. (after Piraro)
When
your teeth fall out, just put them under your pillow for the fairy godmother.
Maybe she has magical powers to counteract the environmentalist.
*
* * * *
11.
Organizations Restoring Accountability in HealthCare, Government and
Society: