Should Police Officers Be First Responders For 911 Medical Calls

Mental Illness vs Terrorism

These days medical problems are  morphing into “national security” risks.

Muslims with mental illness, who commit violent acts, are diagnosed as ‘terrorists’ and their mental illness ignored. Black people with mental illness, who are a threat to themselves, maybe suicide, are now being killed by first responder cops who feel threatened by their color and illness.

So as more medical problems are misdiagnosed as national security risks, negative health outcomes increase.

What do we physicians do to honor the oath of doing no harm? By permitting first responders to harm mentally ill patients, we abandon our oath and add to poor outcomes and the mounting expense of healthcare.

Aren’t we the gatekeepers of healthcare? Shouldn’t we intervene when harm is done by those who are supposed to transport and help keep our patients healthy?

{I believe} There are no official statistics on the number of deaths or injuries caused by first responders.

Given the current environment, where cops ‘shoot to kill’ suicidal patients and those with flare ups of their mental illness, isn’t it time we track such?

If the medical community remains silent and blind to these egregious deviations in the standard of care, we will herald in a new era of medicine where harm is normal. A situation where medical error is the number one leading cause of death instead of a close third.

Lack of responsible oversight or statistics on LEO (Law Enforcement Officer) encounters with patients experiencing flare ups, or severe mental illness, has put patients at risk for death and worsening of their mental and physical ailments.

Simple interventions can go a long way. Straightforward respectful communication, on the part of first responders, can go a long way to averting bad outcomes.

Unfortunately, in most cases with bad outcomes, communication is poor. Attempts to get family members or friends involved, to de-escalate the situation, are now rarely sought.

Why? Is it better to just kill these patients who are in need of help?

Cops are first responders in the healthcare delivery system and as such should attempt to do no harm at all cost.  They chose to be police officers and are paid well for the service they are hired to perform.

Has the principle of mental illness care changed such that death by first responders is a more cost effective mode? Has imprisonment become a more secure environment for patients with mental illness? Where have all the State mental hospitals gone?

These are all problematic questions. We have a rise in mental and physical illnesses with poorer medical outcomes. And are we planning to exclude these patients from government statistics to make our health outcomes sound better than they actually are?

Misdiagnosing those with severe mental illness as terrorists, or threats to police security, leads to an escalation in problems. More power and money spent on law enforcement and less on effective treatment that could improve health outcomes.

Over 55 cents of each dollar goes to the DoD instead of money spent to better understand and treat people with mental illness humanely. We could target effective approaches to treat and de-escalate flare-ups so common in patients with severe mental illness.

Much debate has gone into First and Second Amendment rights. Let’s now face in earnest the reality around us.  A reality for which we have no metric or indicator to guide us when police officers administer inappropriate first responder care. A reality that unnecessarily mislabels patients and does harm when patients are treated as criminals.

I leave the reader with this last question: Should Police Officers be first responders for 911  medical calls?

Leave me your answer in the comments…

 

 

Finding Work Using Social Media

Out with the traditional, in with the new!

With social media everything is hashtags, viz.

  • #Overseasjobs
  • #Freelance
  • #Healthcarejobs
  • #Jobseekers
  • #Patientsafety
  • #Medicalerrors
  • #Malpractice
  • # PatientAdvocates

Let’s see if any of them is worth ($ literally!) the effort.

So I decided to advertise my services through the social media.

If employers are truly seeking talent and not cronies, then why not give all qualified, skilled and talented people a chance?

Armed with my LinkedIn profile and the Buffer app, I took the non-traditional path to finding paid work.

This is my second day. So far no bites, but it’s too early to call it quits.

Follow me as I explore social media as a viable option for job seekers.

Please chime in with your experiences and suggestions. Appreciated!

Freelancer Looking For Opportunities

Angela Crane, MD

Are Hospitals Deadly For Your Health?

MEDICAL ERRORS

Going to the doctor may be deadly for your health!

Recently published findings show medical errors are the third leading cause of death in the USA.

Rising medical errors are symptomatic of our ageing community. A culture where health care providers are chronically overworked and understaffed. A culture where working while ill is a sign of strength, responsibility and dedication. A culture where most of the work done for patients is not reimbursable.

Such is the culture of health care that contributes to medical error despite advances in technology and knowledge.

In 2013 medical errors caused 440,000 deaths in the USA: [ http://www.hospitalsafetyscore.org/newsroom/display/hospitalerrors-thirdleading-causeofdeathinus-improvementstooslow ] Medical error, defined as [ https://en.m.wikipedia.org/wiki/Medical_error ],  appears to be on the rise.

In 1999, the publication ‘First Do No Harm’ [ https://www.healthdesign.org/chd/research/first-do-no-harm ] did much shine a light on fundamental problems in medicine. Each year, medication errors alone harm 1.5 million American patients.

Tired, overworked health care providers often dismiss patient’s problems and  become magnets for medical errors. The problem of fatigue contributes to high burn out and suicide rates among doctors: [ http://www.thehappymd.com/blog/physician-burnout-rates-top-50-percent-in-usa / http://www.ncbi.nlm.nih.gov/pubmed/24448053 / http://www.medscape.com/viewarticle/838437 ]

Also, with the billing for services rendered, health care providers perform many services that are not renumerated. Many of these services are essential to the patient and require much time. Services such as communication with other providers involved in that patient’s care.

Reviewing of old records, lab tests and X-rays are not billable. Even the refill of medications, or advocating for patients to insurance companies, are not reimbursing, despite their necessity and the fact that these are done daily. Often several times throughout the day.

Unlike lawyers, doctors do not bill on an hourly rate. They are compensated only for the time spent directly face-to-face in patient care. This underestimates the numbers of hours physicians and nurses spend caring for their patients.

Finding coverage for sick healthcare providers is difficult and often results in rescheduling of patients.  That means fitting patients in already booked and hectic physician schedules. Other contributors to medical errors  include lack of communication and access to information. Another is incompetence, plus poorly supervised residents and interns performing the work of senior doctors.

Many reprimanded physicians continue in practice. Eighty percent of malpractice, and adverse or sentinel events, are committed by 20% of physicians. 80/20. Yet only a fraction ever lose their license, and if they do, they simply go next door.

Medical personnel are treated as super humans, expected to go without sleep plus care for patients with complex medical problems. Medical errors are the end result of this. This finding is no surprise and nothing new since the publication of ‘First Do No Harm’.

A medical team is responsible for your care. An error by one person can cause catastrophic problems.

Lack of communication, and lack of access to information, are two. And lack of coordination makes three elements that contribute greatly to medical errors.

Errors will always occur, of course, but they will be much more likely when one is tired and there are no mechanisms in place to intercept errors.

Again unlike lawyers, doctors are not paid to call patients or to do research on patient problems. That needs to change.  We need to stop discounting the time doctors spend doing non-direct care.  Doctors should be compensated for all work done caring.

Just changes in the above will go a long way in reducing medical error.

To close, a very sad read of six physicians who felt so overwhelmed they took their own lives:

https://www.idealmedicalcare.org/blog/physician-suicide-letters-answered-a-sneak-peek-inside-my-new-book/

&nb

Zika Virus May Have Crossed Over to Common Mosquitos 

The Zika Virus may have already crossed over to the common mosquito. Scientists in Brazil are about a month away of confirming whether the Zeka Virus is also carried and transmitted by the more common Culex Mosquito.

Culex mosquitoes are 20 times the population of Aedes aegypti, and more widespread in most of America, parts of Africa and Asia.

Little is known of the Zika Virus that is linked to over 3,000 babies born with microcephaly. Zika was first isolated in African monkeys in 1947. It is a flavivirus (a genus of viruses), in the same family as dengue and chikungunya.

The Zika Virus is linked to the startling outbreak in Brazil, with 3-4 million people infected in fewer than 12 months. Plus a 20 to 30 fold surge in the birth of children with microcephaly.

In many of these cases, the RNA (acid) from the virus was isolated both in mother and child. Currently, there are no cures, antivirals or vaccines available. The CDC (Centers for Disease Control) recommend serial ultrasounds of high risk pregnant women.

The risk of microcephaly in women infected during pregnancy is up to 1%. The pregnancy is usually normal and newborns may appear like uninfected babies. However, in the first year, the baby will develop the features of microcephaly. Also part of the clinical picture are hearing and visual impairments, mental retardation and diminished life expectancy.

To-date 22 countries are currently affected and that number is increasing. The virus crossing over to the Common Mosquito will see an explosion in those infected, once the warmer weather gets here.

What is Microcephaly?



Simply stated, microcephaly is a small head. The head circumference is abnormally low (in the bottom 3% for age and sex). A small head means a small brain! Children with microcephaly have cognitive dysfunction and are at risk of seizures. In addition to the very unpleasant symptoms mentioned already.

According to the CDC, normally 2 to 12 out of 10,000 live births develop microcephaly. It is an extremely rare disease.

The possibility of this virus crossing over to other, more widespread mosquitoes, presents a global public health emergency.

With regards to North America, the colder weather in Canada makes the virus less likely to spread that far north. However climate change may change all that.

Why now?

In 2014 Brazil, Tdap (Tetenus-Diphtheria-Pertussis) was recommended for all pregnant women in Brazil. Further details are scant.

Of note for the conspiracy theorists, Tdap was used in pregnant women throughout the world for a number of years withOUT a surge in children born with microcephaly.

Brazil started deploying GMO mosquitos to reduce the natural mosquitoe population. Scientists in Brazil have focused on the Zika virus as being linked to microcephaly.  If so, then the cross over to the common mosquito puts the rest of the World at risk.

Until we know more, exercise caution.

Any readers with more information are most welcomed to share…

Zika Virus May Have Spread To Common Mosquito:

http://news.sky.com/story/1631065/zika-virus-may-have-spread-to-common-mosquito

Zika virus in Brazil may be mutated strain:

http://www.hsph.harvard.edu/news/features/zika-virus-in-brazil-may-be-mutated-strain/?utm_source=Twitter&utm_medium=Social&utm_campaign=Chan-Twitter-General

UN health agency convenes emergency meeting to address ‘dramatic’ spread of Zika virus:

http://www.un.org/apps/news/story.asp?NewsID=53112#.VqtpRvA8KrX

The Conspiracy Theory:

https://brazilianshrunkenheadbabies.wordpress.com/2016/01/17/the-story/

A Mosquito Net Descends Across the Americas:

http://www.huffingtonpost.com/bill-mckibben/a-mosquito-net-descends-across-the-americas_b_9102864.html

 

Is Zika Virus A Genetically Modified Virus? 

Is the Zika virus now a bio-weapon?

Using genetically-modified mosquitoes?

Imagine the weaponry.

Demographically Zika is unusual. While originating as a known virus after WWII (where scientists worked on eugenics and other forms of warfare), isolated in Africa and Asia, it has suddenly shifted continent. Since last year its changed its pattern of distribution. The countries now affected are in the Caribbean, Central America and South America.

Is Zika already a weapon? An environmental weapon to wage biowarfare. A mosquito-borne virus that damages the brain of unborn fetuses, possibly producing brain-damaged children.

Why?  

UTMB’s Scott Weaver On the Zika Outbreak

Please tell me your opinions…

 

Zika Virus Targets The Fetus

The virus known as Zika was first isolated shortly after World War II, in 1947 Uganda. The first human case was reported in Nigeria in 1954.

Since, the virus spread across Africa and into the Pacific. It was detected in Malaysia in 1966. In 2007 the virus spread to the Island of Yap in Micronesia, with the first reported outbreak:  73% of the population aged 3 and above being infected.

In 2009, after a field trip to Senegal in Africa, American scientist Brian Foy may have transmitted the infection to his wife (the first known suspected case of sexually transmitted Zika).

In 2013 French Polynesia there were 28,000 infections in one outbreak. In 2015 the first reported local transmissions of the virus were seen in South America, Central America and the Caribbean.  Presently, there are reports of 3 cases involving New Yorkers.

Since 2015 there has been a Zika outbreak in Brazil. It is believed the virus was spread during the 2014 FIFA World Cup. Now there is serious concern with the pending Rio 2016 Olympic Games! The American CDC authority estimates there were 1.3 million suspected cases in Brazil in 2015.

Transmission Methods

The primary mode of transmission is from mosquitoes, the Aedes aegypti, to humans. These are the same insects known to transmit other viral infections such as Dengue Fever, Yellow Fever and West Nile Virus.   With many infected, concerns of humans transmitting the  Zika virus to local mosquitoes is mounting.

Several reports of secondary transmission, from human males, via sexually transmitted infections opens the possibility of Zika becoming a sexually transmitted virus.   In affected areas in Brazil, a 20-30 fold surge in babies born with microcephaly is  linked to Zika virus.   The virus isolated in amniotic fluid, breast milk and semen, raised concerns that it could be transmitted by blood transfusions, laboratory exposure, sex and intrauterine (uterus), prompting  more investigation into its mode of transmission.

Symptoms

Zeka has an incubation period of about 10 days. Travelers returning from infected areas may develop the infection after an incubation period of about 10 days.

Symptoms  are usually none at all in 80% of those infected or at most a very mild headache, fever, maculopapular rash, conjunctivitis and joint pains. Symptoms are self-limited and there are presently no antibiotic or antiviral treatments available.

Infection in the first trimester of pregnancy is linked to microcephaly (tiny heads) and other brain damage in newborns.

Brazil:
In 2013 there were 167 cases of microcephaly; in 2014 there were 147 cases; and in 2015 there were  at least 2,782 cases.

RNA (an acid) from the Zika virus was isolated in mothers and babies with microcephaly. In addition, some patients have developed Guillain-Barre Syndrome (muscle weakness), which caused transient paralysis following infection.

Prevention


Protection from mosquitoes is the best prevention.   Use mosquito repellent and cover up exposed skin. These mosquitoes bite during the daytime. There are no vaccines available.

Currently the CDC-issued travel guidance advises pregnant women not to travel to affected countries.  Some South American and Caribbean countries advised women to postpone pregnancy until 2018. 

Healthcare providers should report Zeka cases to their state or local health departments.

Why now?

There are reports of genetically-modified mosquitoes being used in Brazil to reduce the mosquito population. Such produces deformed mosquitoes. These may be eaten by birds, other insects and humans. The long-term effect unknown.

Imagine the weaponry of GMO mosquitos.  Zika???  It targets our future generation and may reduce birth rates in affected countries.


 

Links to referenced material below…

http://microbepost.org/2016/01/13/what-is-zika-virus/

Zika Virus Spreads to New Areas — Region of the Americas, May 2015–January 2016 | MMWR
http://www.cdc.gov/mmwr/volumes/65/wr/mm6503e1er.htm?s_cid=mm6503e1er.htm_w

Zika virus: Outbreak ‘likely to spread across Americas’ says WHO – BBC News

http://www.bbc.com/news/health-35399403

Brazilian City Tries Fighting Viruses With GMO Mosquitoes
http://www.nbcnews.com/health/health-news/gmo-mosquitoes-may-battle-zika-dengue-brazil-n499576

IT’S NOT ALWAYS DEPRESSION!

IT’S NOT ALWAYS DEPRESSION!

Diminished activity, fatigue, weight gain and little interest in activities that once brought delight.

With normal laboratory findings, most doctors would diagnose depression.

It’s not always depression!

Other physical ailments presenting similarly make the history and physical pertinent, as well as understanding culture and the differences in the clinical narrative due to culture.

To simply say it is depression, without a thorough review of all symptoms, is to jeopardize the health of patients. Plus not appreciate the impact of culture on health outcomes.

Unfortunately, nowadays, that is the case. Most doctors don’t dig deeper and many have forgotten the relevance of a good history and physical. The latter now relegated to cursory scope on the chest and back.

Such is the state of medicine today in the United States! I know because I have been a physician for all my career.

The above symptoms are actually due to visual problems. Mine!

Diminished vision can affect ones ability to function. Presenting similar to depression as well as leading to secondary complications of depression.

[ Link to Visual problems http://www.health.harvard.edu/newsletter_article/the-quirky-brain-how-depression-may-alter-visual-perception ]

By not recognizing the primary problem as visual, misdiagnosis and unnecessary medications follow, as well as deterioration in vision and functional capacity.

Unfortunately, the medical textbooks do not tell doctors this. Many lazily believe those symptoms signal depression until stated otherwise, despite the fact that depression is a diagnosis made after other illnesses are excluded. This is not done, hence the massive over-prescribing of antidepressants.

[ Link with data http://www.drugwatch.com/2015/07/29/drug-abuse-in-america/ ]

Patients typically tell their stories to non-doctors at least 2 to 4 times before they see an actual physician. (And in many poor communities patients will not visit or see their doctor.) Still the narrative and details charted rarely reflect the patient’s complaints, leading to misdiagnosis. Here repetition of the patient’s history does not breed knowledge or accuracy.

Why does this happen?

In a nutshell, over reliance on technology to make the diagnosis compounded by a bureaucratic and arcane workflow. Also treating symptoms while ignoring the root cause.

Medical staff are often under-trained and over-worked. The importance of accurate charting (of the patient’s narrative) lost in time, ignorance and even arrogance.

The end result is this: many patients are over medicated and misdiagnosed.

The recent epidemic of opioid overdoses is an example where doctors treat symptoms without making diagnoses. Opioids were over prescribed, especially in Emergency Departments where toothaches were routinely treated with Penicillin and 15-30 pills of Percoset. Doctors became legalized drug dealers! One study showed in 2012, doctors prescribed enough narcotics for every person in the United States to have a 30 day supply.

Now the pendulum has swung in the opposite direction: pain is treated suspiciously. Everyone is an addict until proven otherwise.

What is the solution?

One solution is Community Medicine. Studies demonstrate that medical outcomes, or health outcomes, are determined in the community.

Over 50% of outcomes are determined in the community. That means lifestyle or culture is very important as well as the environment (which actually has a great impact on lifestyle) to managing diseases. Genetics accounted for 30% of health outcomes and a doctor’s office visit 15%.

Using technology to facilitate accurate diagnosis is good, but technology should not be the gold standard alone for diagnosing. The history and physical still remain pertinent and relevant. The absence of radiographic or laboratory findings does not exclude pathology.

Most importantly, doctors need to know the patient’s community, and be engaged with that circle, to understand and improve the health outcomes of their patients.

What do you think?

Do you have any other solutions?