ROXIE IS GOOD FOR MY HEART, but she knew that already. Roxie is my 8-year-old Schnoodle, and in the September Harvard Heart Letter, Elizabeth Frates, M.D., says “ … people who have a dog are far more likely to get the recommended 150 minutes of moderate physical activity each week.” So I guess there’s something good to be said about those three-times-a-day walks come rain or shine or driving snowstorm. The Letter also points to research finding that “people with dogs appear to have less cardiovascular reactivity when they are mentally stressed, meaning their heart rate and blood pressure go up less and return to normal more quickly.” And, among older folks, “dog ownership seems to confer a sense of well-being.” OK, cat lovers, top that.
TALK IS CHEAP: OH WAIT, IT’S NOT … That’s part of the headline on a commentary by Robert E. Johnstone, M.D., in the August issue of Anesthesiology News. Johnstone refers to the outpouring of disgust against an anesthesiologist who mocked a patient undergoing surgery. As I noted in Weekly Reading back in June, her words were recorded on the patient’s cellphone and he ended up winning a $500,000 jury award. Johnstone, a professor of anesthesiology at West Virginia University, notes that he's heard unprofessional conversations in the OR ranging from “flirtatious banter to gallows humor, personal gossip to pointless maundering, observations about patients to criticisms about administrators.” Now, he writes, “the new standard is to only say something if it can be played on National Public Radio.” Some people want to require video and audio recording in the surgical suite, as noted here last week. Johnstone said recording OR talk “would change discussions, perhaps to the detriment of patients and medical education. Some clinicians might keep case questions or concerns to themselves rather than ask and have them permanently recorded.” And everyone would be reluctant to talk among themselves about specific patients and information that should be protected from inappropriate ears.
I’LL PROBABLY GET PLENTY OF PUSHBACK from certain readers for even mentioning Ezekiel Emanuel’s op ed piece in Wednesday’s New York Times, which calls for the U.S. government to do more to control spiraling drug prices. “Almost all developed countries — including those run by very conservative governments — have an effective solution for drug prices, which is why these countries often pay less than half of what people in the United States pay for drugs.” As one example, he cites Australia’s single-payer system for drugs, which makes drugs available at fixed prices and posts those prices online. Emanuel calls the pharmaceutical industry’s contention that drug development carries high risks and that research and development is extremely costly “fatuous” and names companies with profit margins ranging from 18 to 50 percent. Even if you vehemently disagree, Emanuel's ideas for what our government should do are worth the read.
“WHEN IN DOUBT, LAND THE DRONE.” A couple of minor incidents prompted Carilion Clinic’s air ambulance team to issue that public safety announcement Tuesday. As reported by Jeff Sturgeon for the Roanoke Times, a drone hovered near a helicopter pickup of a patient at a West Virginia hospital, apparently to take pictures. In another case, a drone flew over the scene of a traffic accident where a medevac team had landed while an injured person was being extracted from a vehicle. The pilot wanted to take a short flight to burn fuel and reduce the aircraft’s weight before transporting the patient. “But,” Sturgeon reports, “he judged the drone was too close and stayed on the ground, missing an opportunity to shave a few minutes off the pickup.” In the Aug. 7, Weekly Reading, I cited a Los Angeles Times report about drones delivering medications to remote locations, so it certainly isn’t that the little buggers are all bad. But one drone advocate agreed with Carilion’s insistence that “owners put the safety and privacy of medical pilots and their patients first.”
THE BIG CHANGES TAKING PLACE IN HEALTH CARE are causing a lot of pain for a lot of providers but, perhaps, none more so than rural hospitals. Arizona Public Media did a good job of explaining how painful the closing of a hospital can be for a small community and the ripple effect it can have, including lost jobs, overwhelmed emergency services and people worried about their safety — especially if the nearest hospital is now 20 minutes or more away. While a large percentage of rural hospitals are operating at a loss, the report quotes CEO Jim Dickson on how his Copper Queen Community Hospital dramatically — and successfully — rethought what it could be to stay out of the red.