Life Planning Fail

In preparing for battle I have always found that plans are useless, but planning is indispensable. Dwight D. Eisenhower

Life happens, but that’s no excuse for not knowing where you want to go. That’s a particular issue in healthcare.

People don’t like to think about negative events that are going to happen in the future. They’ll still happen, just the same. For Americans, the difference between life expectancy and “healthy life expectancy” is nine years.  They won’t necessarily come as a block toward the end of life. If fact, you don’t know when they’ll come.

A new study points out that people are often faced with making snap decisions about healthcare without adequate information. (1) That’s due to the failure to anticipate something that’s actually rather likely to happen.

People get hurt and sick. The roughly 320 million Americans generated 130.4 million visits to Emergency Rooms in 2016.(3) What are the odds you’re going to need one?

If you don’t know where you want to go in an emergency, you may get stuck someplace you don’t want to be.

Even if you’ve never had an illness in your life, you will. Nothing on this planet is immortal.

Like it or not, here are some questions for which you need to have answers.

• Financial
  • How do I cover sudden and potentially large medical bills? What does my insurance not cover that I’m going to have to pay?
  • How do I cover normal bills if I’m out of work for a few months? Or longer?
• Medical
  • In an emergency, where do I want to go for care? (Related: is my doctor affiliated with where I want to go?)
  • If I’m hurt and need rehab therapy, where do I want to go for care?
  • Does someone have access to my Living Will if I can’t speak for myself? (Having one isn’t a question.)
  • Who will advocate for me with medical personnel if I can’t speak for myself?
• Living
  • Whose going to care for me if (temporarily or permanently) I can’t care for myself?

Seriously, this matters. We have several local hospitals, two of which are problems.

• The ER department at one of them has misdiagnosed my wife twice out of two visits. That’s a 100% rate of being wrong. Do we want to test them a third time?
• The nurses at another consistently ignore a severe allergy that causes anaphylatic shock. Breathing is really nice, but you don’t really appreciate it until you can’t do it. It turns out, the nurses don’t pay attention to wristbands. (One nurse at that facility told us that they assume the allergy bands refer to drugs and not to more mundane and potentially lethal issues like iodine and latex allergies.) Going to that facility is like going to a casino. You might get fixed and you might die. How lucky are you?

As you age, where you go matters more. With seniors, for example, if taken to an ER for a serious fall, there’s a 50% chance of additional problems within six months of the initial injury, including death. Some of that risk is the result of decisions doctors make about medication.(4)

There’s no need to overthink this. Do your homework, ask questions, make decisions, and then get on with the rest of your life. Just get it done.

Aristotle was  right. Anything taken to excess turns bad. That includes both planning and lack of planning.

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Sources:

1. Emily A. Gadbois, Denise A. Tyler, Vincent Mor. Selecting a Skilled Nursing Facility for Postacute Care: Individual and Family Perspectives. Journal of the American Geriatrics Society, 2017; DOI: 10.1111/jgs.14988
2. American Geriatrics Society. “Hospitalized older adults may need more help selecting skilled nursing facilities.” ScienceDaily. ScienceDaily, 7 July 2017. <www.sciencedaily.com/releases/2017/07/170707211128.htm>.
3. Centers for Disease Control and Prevention, “Emergency Department Visits.” https://www.cdc.gov/nchs/fastats/emergency-department.htm
4. Jiraporn Sri-on, Gregory P. Tirrell, Jonathan F. Bean, Lewis A. Lipsitz, Shan W. Liu. Revisit, Subsequent Hospitalization, Recurrent Fall, and Death Within 6 Months After a Fall Among Elderly Emergency Department Patients. Annals of Emergency Medicine, 2017; DOI: 10.1016/j.annemergmed.2017.05.023

Only in New Jersey?

Unfortunately, probably not.

From the local news today:

A New Jersey man wasn’t really a doctor, but he treated area patients – including a man having a seizure – anyway for 28 years. (1)

Ooops!

I’ve made the case on several occasions that if you have anything about which you are seriously concerned, you need to get a second opinion from an unrelated physician. You really do!

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Sources:

1. https://patch.com/new-jersey/middletown-nj/monmouth-county-man-wasnt-doctor-treated-people-anyway-28-years

Your Health: The Right to Life?

The US was founded on the promise of “the Right to Life, Liberty and the Pursuit of Happiness” in Jefferson’s Declaration of Independence.

From the start, the relationship between the country and this promise has been at best inconsistent and sometimes ironic. After all, the principal writer of the Declaration, Jefferson, was a slave-owner.  So for whom was this promise made? Everyone? Or the wealthy, the planters, the slave-owners and the merchants? (Remember, there were no factories — that was before the industrial revolution.)

The inconsistency continues to this day.

We have groups concerned with whether babies or born, but not with what happens to them after they are born. How long do they live? What’s their quality of life? As Ed Cara notes, in some areas of the US, children will now have shorter lives than their parents. (2)

A new study in the Journal of the American Medical Association talks about discrepancies in life expectancy. I’ve blogged about this before, but it’s nice to see authoritative sources recognizing the issue.

The new statistical analysis shows that there is a difference in life expectancy of up to 20 years based on the county in which you live. In this analysis, the issues affecting life expectancy are

• Income and poverty
  • The wealthy live longer
• Race/ethnicity
  • Both Native Americans and African Americans have a shorter life expectancy
• Regular exercise
  • Those who do live longer
• Obesity, Diabetes and Hypertension
  • Shorten life expectancy
• Education
  • Each level completed adds to life expectancy
• Quality of health care
  • Higher quality is associated with living longer
• Having health insurance
  • Having health insurance promotes longer life
• Access to physicians
  • Having more physicians in an area helps

These factors translate into differences in life expectancy in the US based on where one lives:

• Residents of central Colorado, coastal California and the New York Metro area live longer
• Residents of eastern Kentucky and much of the Old South, especially along the lower Mississippi River, have a shorter life expectancy
  • The Old South in this case includes Alabama, Arkansas, Georgia (outside of Atlanta), Louisiana, Mississippi, Oklahoma and Tennessee (outside of Nashville)
  • The two metro areas, Nashville and Atlanta, offer much better life expectancy than the rest of their states

The states with the lowest life expectancy are those with the lowest spending on public health and health education.

One limitation of this study is that the analysis is at a county level, and there is only selected data available at that level regarding health. In particular, suicide is now one of the top 10 causes of death in the US. Suicide isn’t reported accurately or consistently, and there is limited data available on the causes of suicide.

A second limitation is the inter-relationships between some of the factors measured. For example, wealth is associated with having health insurance, with less use of cigarettes, and with living in an area with better access to medical professionals. By breaking the analysis into this much detail, does the report understate the role of wealth in life expectancy?

By the way, I use the image of Ben Franklin on some of these posts for the following reasons:

• His brilliance
• His common sense
• His skill at negotiation
• And among the Founding Fathers of the US, he became a profound opponent to slavery

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Sources:

1. Laura Dywer-Lindgren, et. al., “Inequalities in Life Expectancy Among US Counties,1980 to 2014,” JAMA Intern Med. Published online May 8, 2017. doi:10.1001/jamainternmed.2017.0918. http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2626194
2. Ed Cara, “Kids Will Die Younger than Their Parents in Some Parts of the US,” Vocativ. 9 May 2017. https://www.aol.com/article/news/2017/05/09/kids-will-die-younger-than-their-parents-in-some-parts-of-us/22077174/

 

 

Candida auris

Neurotic? Need something new to keep you up at night?

CDC photo, Candida auris

Here come’s Candida auris. Just as we have had the “Mother of All Bombs,” this may be the “mother of all fungal infections.”

• It’s drug-resistant.
• It can exist on surfaces in hospitals, clinics and doctors offices.
• It can spread between patients without direct contact.
• Specialized laboratory methods are needed to accurately identify C. auris. Conventional lab techniques could lead to misidentification and inappropriate treatment, making it difficult to control the spread of C. auris in healthcare settings. (2)

The disease is just emerging globally.  The hot spots in the US are New York and New Jersey, probably related to international travel. However, once here, it’s here, and cases have been identified in Illinois, Indiana, Maryland and Massachusetts.

Right now it’s minor, but it becomes another reason to avoid hospitals unless you really need to be there.

And you thought yeast infections were nasty.

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Sources:

1. Centers for Disease Control and Prevention, “Candida auris.” https://www.cdc.gov/fungal/diseases/candidiasis/candida-auris.html
2. Centers for Disease Control and Prevention, “Candida auris — questions and answers.” https://www.cdc.gov/fungal/diseases/candidiasis/candida-auris-qanda.html

Early surgery for hip fractures can save lives

This is something that any senior or anyone caring for a senior should see.

Researchers at Southmead Hospital (UK) report that surgery within 24 hours of injury save lives among elderly patients with hip fractures.

They analyzed data from 241,446 British patients, measuring the death rate in the 30 days after admission. They found that if surgery were delayed past 24 hours, the death rate increased by 8%. The death rate increased by 20% if surgery were delayed 48 hours.

The concern with elderly patients is whether they need time to stabilize after an injury. It turns out that taking that time can add to their risk.

Has your doctor seen that report?

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Sources:

1. BBC News, “Early Hip Fracture Surgery Will Save Hundreds of Lives,” 20 April 2017. http://www.bbc.com/news/uk-england-bristol-39655669

 

Surgical Safety

This finding appeared today, and it raises all sorts of questions about the quality of care in some hospitals in the US:

South Carolina saw a 22 percent reduction in post-surgical deaths in hospitals that completed a voluntary, statewide program to implement the World Health Organization Surgical Safety Checklist. (1)

In the South Carolina test, 14 hospitals volunteered to use the checklist, and saw a decline in deaths within the thirty days following surgery. Other hospitals in the state saw a slight increase in deaths during the same period. The trial program was run in these hospitals between 2010 and 2013.

The writers make a point that hospitals need to truly commit to the procedure, not treat it  as “a checkbox.”

There are two items that are shocking about this:

• That the country with the most expensive healthcare in the world needs to learn this from others, and
• The checklist has been in existence since 2008. (2)
  

Has your hospital adopted this checklist? If not, do you want to find one that has?

 

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Sources:

1. Alex B. Haynes, Lizabeth Edmondson, Stuart R. Lipsitz, George Molina, Bridget A. Neville, Sara J. Singer, Aunyika T. Moonan, Ashley Kay Childers, Richard Foster, Lorri R. Gibbons, Atul A. Gawande, William R. Berry. Mortality Trends After a Voluntary Checklist-based Surgical Safety Collaborative. Annals of Surgery, 2017; 1 DOI: 10.1097/SLA.0000000000002249
2. Institute for Healthcare Improvement, “World Health Organization (WHO) Surgical Safety Checklist and Getting Started Kit.” http://www.ihi.org/resources/Pages/Tools/WHOSurgicalSafetyChecklistGettingStartedKit.aspx

More on Diabetes

The US is seeing modest, steady growth in the incidence of diabetes among children and teens. A new analysis of data from 2012 to 2012 shows

• An increase in Type 1 Diabetes of 1.8% per year and
• An increase in Type 2 Diabetes of 4.8% per year.

While there’s a genetic component, diabetes risk is associated with

• Family history
• Immune system issues
• Diet and weight (and exercise)
• Blood pressure

Europeans understand that how you care for yourself affects health care costs and health insurance rates for everyone around you. It’s not just about you. Teaching a child to veg in front of a computer or TV simply shortens the child’s life.

However, one of the frustrations with public health data is lack of currency. Has the situation gotten better or worse in the last five years?  My guess is worse, but we simply don’t know.

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Sources:

1. Elizabeth J. Mayer-Davis, Jean M. Lawrence, Dana Dabelea, Jasmin Divers, Scott Isom, Lawrence Dolan, Giuseppina Imperatore, Barbara Linder, Santica Marcovina, David J. Pettitt, Catherine Pihoker, Sharon Saydah, Lynne Wagenknecht. Incidence Trends of Type 1 and Type 2 Diabetes among Youths, 2002–2012. New England Journal of Medicine, 2017; 376 (15): 1419 DOI: 10.1056/NEJMoa1610187
2. NIH/National Institute of Diabetes and Digestive and Kidney Diseases. “Rates of new diagnosed cases of type 1 and 2 diabetes on the rise among children, teens: Fastest rise seen among racial/ethnic minority groups.” ScienceDaily. ScienceDaily, 14 April 2017. <www.sciencedaily.com/releases/2017/04/170414105821.htm>.
3. International Diabetes Foundation, “Risk Factors.” http://www.idf.org/about-diabetes/risk-factors
4. Mayo Clinic, “Diabetes.” http://www.mayoclinic.org/diseases-conditions/diabetes/basics/risk-factors/con-20033091