What's right in healthcare

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A couple weekends ago, my husband and I made a half-day trip down to Rochester from Minneapolis. The newly warmed air and sunny sky - hopes of spring! - made us long to get out of town and take a drive. You probably know that Rochester, Minnesota is home to the sprawl of Mayo Clinic, the original Mayo Clinic. What we learned on that short excursion is that it is also home to the only Dunkin’ Donuts in the entire state of Minnesota! We paid a visit to both.

The visit to Mayo was only a stroll around a small fraction of its buildings. The picture at the top of this post is of a decorative carving on the outside wall of one of the Clinic’s historic buildings, the Plummer Building, built in 1928. I love that image of the man (probably a physician but not necessarily a physician) curled around the microscope.

The day after that excursion, my mother-in-law went into the emergency room with what we learned was a heart attack. She’s fine now, and home, thanks to the work of the physicians and nurses there. I witnessed such kindness and gentleness from them. Proficiency also.

I work with physicians all the time in my medical writing work. There are a few that I especially admire, and I’ve labeled them in my head as the doctor I would want to go to should I ever develop the disease they treat - although I hope to never develop the diseases they treat and don’t live in their area anyway. The last couple weeks I’ve been pushing through a project with one of these doctors, a doctor that approaches her work with great skill and earnestness. I once heard her say, in response to a question about whether she could make such and such a decision based on a phone call or email from a patient, that she needs to actually touch a patient. I loved that she said that.

There’s another doctor I’ve worked with, also with the label of “physician of choice,” who during a blackout in his city mentioned that he was visiting his hospitalized patients with a flashlight while his colleagues were waiting it out. I wrote about another such doctor nearly 10 years ago here on this blog. I’m thinking also about a doctor who saw my mother this winter when she was admitted to the hospital for pneumonia. The doctor heard my father coughing next to her bed and unwrapped the stethoscope from around his neck and took a listen to his lungs. No concern about liability or billing or coding. Such kindness! I’m thinking also of my own primary care doctor who is retiring this spring. I’ve gone to him since he was a young doctor and I was newly graduated from college - but for a couple short bursts due to moves or insurance changes - and I’m so grateful for that continuity and care.

There’s a lot wrong with our health care system, and patients and physicians are all taking a hit. But there’s a lot right with the people working in that system. I just wanted to take a moment to shine the light on that.

Practicing walking with a broken arm

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I’ve been off this page for a couple weeks; I'm not the "good" kind of blogger that has a library of prewritten scheduled posts. I broke my arm and it has set me behind in many things. It wasn’t a bad break, not the kind that requires surgery and pins and weeks of physical therapy. It didn’t even require a cast. But I didn’t know that when I fell. The degree that it hurt and the way it wouldn’t move gave me the message that this indeed could be bad.

In the spirit of being vulnerable with readers of this blog, I’ll tell you I felt scared as I walked home with the fresh break, the arm that was whole cradling the arm that was wounded; scared as my husband drove me to the emergency room; scared as the radiology technician positioned my arm for X-rays. It wasn’t so much that I was afraid of a broken arm as I was afraid of what I imagined lurked behind the broken arm: the weeks of not being able to work, which mean for a freelancer no sick days and no income, missing deadlines and failing clients; the potential for another crisis to come on the heels of the break, which I'd be less able to handle given the break-related limitations. An Ebola outbreak, for example! While waiting for Vicodin to take effect, why not imagine the worst? I could fall again and break the other arm. I remembered my son’s wrist break that required three surgeries to fix. Irrational fears but fears nonetheless.

I’m old enough that I’ve gone through plenty of other difficult times that more reasonably warranted fear and from which I’ve learned the lessons of coping. I’m grounded sufficiently in faith and experience that I should long ago have learned the basis of courage for every situation. But the arm broke and I felt overwhelmed with potential consequence and became afraid.

The next day, assured of no surgery and with the arm neatly immobilized in a fiberglass splint and that oh-so-effective painkiller in my bloodstream, I felt more relaxed. I dipped into a book on my reading stack. Learning to Walk in the Dark by Barbara Brown Taylor. I didn’t make it far into the book (painkillers make you sleepy), but the part I read was enormously helpful and made me feel not so bad about the fear I had felt. It linked “practice” with fear.

Taylor describes how fearful actual darkness can be to walk in, literally, and how for many of us, in our current lifestyles and neighborhoods, we have little experience walking in the pitch dark. She asks, “How do we develop the courage to walk in the dark if we are never asked to practice?” Here, of course, is her transition to darkness as metaphor for the feared unknown. We need to practice walking where we feel fear, practice walking into the unknown.

Practice implies imperfection. There is no requirement to be brave at every turn. We are broken and get afraid, and it is time again to practice walking anyway.

Reading labels

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A commercial has been on television lately advertising the perks program of a certain drug, and it compels me to put on my medical writing hat. With every box of this drug that you buy there’s a perk inside that apparently makes the drug worth buying in case you had any doubt about buying it for its ability to alleviate the troubling condition from which you sought relief in the first place. I know the power of perk programs. I recently succumbed to the pull of one for another type of product, a nonpharmaceutical, and admit its effect is to make me choose that product preferentially rather than others in its genre when I run out and need to restock. 

The problem with the commercial’s advertisement of this specific drug’s perk program is that this drug should never be taken for more than 14 days or more often than every four months. Mr. or Ms Consumer should not be going back and back to the drugstore, this time trying for the steak dinner with a purchase, and two weeks later trying for a free spa appointment. If the condition that this drug addresses doesn’t go away in 14 days, you are supposed to stop taking it and see your clinician. Reading the box will tell you this but it’s not what the commercial or even the existence of a perk program implies.

Your clinician and pharmacist should tell you the full story of any drug you’re taking or considering taking; in addition or alternatively, as in all areas of life, you can educate yourself to a large degree. Everything about how and why a drug is supposed to be taken is included in the drug’s product “label” (also called prescribing or product information). It’s not really a label, like one that is glued to a box or bottle, but a multi-page document that details everything about the drug, including its chemical makeup, relevant clinical trial data, dosing instructions, known and potential side effects, and more. (For over-the-counter drugs, the label is not as detailed.) Every word in the label is carefully controlled and must be approved by the Food and Drug Administration. As an addendum to the label, there is often a patient medication guide that reiterates what consumers most need to know in easy-to-understand terms. 

Anyone can access these drug labels; you don’t have to be a healthcare professional. Go to this advertising-free site operated  by the National Library of Medicine: DailyMed. Enter the generic or trade name of the drug in question in the search box and go from there.

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