Well-Being: Strategies To Adjust To Other People

Feeling stronger makes me more productive.  Soon I will want to be around people again. That means adjusting to other people. Last summer’s attempt without a transition after years of solitude was a lesson that to live among other people, I need strategies.

Those years of medically induced PTSD make me fear the prospect of entering the world again will cause much stress, it did last summer. Despite this fear, ongoing obstacles, and unexpected medical speed bumps, I’m ready…I think.

At birth, we naturally adjust to our environment so why am I fearful of a  naturally acquired trait? After years of withdrawing from the world and cutting people out of my life to reduce stress, returning to the outside world to socialize and network with other people is challenging especially without the masks acquired over the years.

To help me adjust, I developed a short list of strategies that thus far seem to work.  While using these strategies, I noticed staying out longer, going out multiple times in one day and a desire to be with people.   This is enormous and a sign that I am indeed on the road to recovery.

The strategies are:

1. Stop, Look and Listen
2. Be Kind or Avoid
3. My Time Is Valuable, spend it wisely
4. Take Breaks

1. Stop, Look And Listen

Don’t be in a rush, slow down and take time to look around. Observe with all my senses to understand the surroundings.

A good doctor is an excellent observer. Doctors learn to Stop, Look and Listen and touch (medical term palpate). That is the basis of a physical exam. Outside of the physical exam touch is a no-no.

#StopLookAndListen forces me to observe, be cautious and learn the lay of the land.

2. Be Kind Or Avoid

I catch more flies with honey than vinegar. In person, always be kind, a smile helps. If I can’t be kind:

-Delay the interaction until I am well rested or if possible avoid altogether,
-Ask someone to be an intermediary,
-Set and stick with an agenda

It’s a good principle to be kind to everyone even those who seem insignificant.  If they are in my life, keep it civil.

The outside world is full of evil people.  Based on the  Iceberg theory, evil cannot be seen.   Avoid or reduce contact with people who make me uncomfortable or who bring out the negative side of me.

#BeKindOrAvoid lets me develop strategic friendships with uplifting or inspiring people.

3. Time Is Valuable

Time is often overlooked and undervalued. If someone takes time to give directions or be civil, show appreciation or carry it forward. I have to remember my time is valuable too, spend it wisely. With a limited amount of time, spend time with people who bring out the best side of me and avoid people who bring out the worst.  In the past, the latter was a telltale sign of a bad relationship.

#TimeIsValuable reminds me of my value and that my time matters.

4. Take Breaks

Take regularly scheduled time away from people. I live in an area where I don’t belong or fit in. No one is coming to rescue me. I have little in common with the people around me.  As a single working mom with young children, I was too busy to notice. Now my children are older, when I #StopLookAndListen the difference is glaring. I don’t belong here yet I can appreciate the environment.

Having time alone is crucial to my sanity.  I know I already have too much time alone yet that seems better than the alternatives.

#TakeBreaks for time alone keeps me balanced in my environment.

 

Adjusting to other people is no cakewalk but the above strategies work to reduce my stress levels.   If you can think of different ways to adapt while keeping stress levels low, please share in the comment section.

XXX

This section of Well-being is new. I will write about adjusting to a missed diagnosis of head trauma at Tufts Medical Center.  That missed diagnosis changed my life forever with subsequent medical and cognitive issues living nightmares.  My road to recovery will be shared in this section.  

Source of Image:  Pinterest

Personal Story of Head Injury: A Story Without A Title

Lately, I question everything I do because I forget. You see, in 2012, I suffered severe head trauma that doctors missed. Since then, I had several hypertensive crises and mini-strokes with residual weakness. The first stroke, two months  after the head injury was because doctors continued the meds that raised my blood pressure and caused the head injury.

In 2017, a neurologist finally diagnosed my symptoms as  classic head trauma.  Before that, I carried a diagnosis of “abnormal behavior,” PTSD and HTN. Little mention of the hypertensive crisis or stroke which I think my PCP at that time did not believe was real. I had to change doctors to get the care I needed. In July, I will meet with a brain trauma specialist who I hope will help me.

What was it like to live with undiagnosed brain injury? Painful, very traumatic and destructive to my life and relationships. In the early days after the head injury, I woke up and often forgot to get out of bed. Or I would get out of bed and sit in a chair by the window for hours without moving. I would forget to wash my face, bath, get dressed and even eat. Activities of daily living (ADLs) were challenging, and I was alone without help. Took me 3-5 times as long to do simple tasks.

I also dreaded going out in public because I didn’t want anyone to know I was different. Living in my head and overwhelming fatigue made me an invalid.

I knew something was wrong but couldn’t figure it out. Deep down I suspected brain injury but didn’t want it known. I feared it would be the end of my career and it was.

This post has no title because I’m not sure where it’s going. Maybe it’s an explanation for why I haven’t followed through on many stories or why I have imprisoned myself. Or perhaps it’s the beginning of my recovery.

Be patient  as this story slowly unfolds.  Last year, I was in an extremely dark place when I found a flashlight.

flashlight

Source of Images: Pinterest

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…