PGY 39, Day 178
The Christmas Holiday Vortex was pulling hard this past week, but despite that and the skeleton crew, we were able to stay on TARGET and on task in the ICU. Patients and families were well cared for, and they always appreciate the good care. How can we do it? Focus on the mission ... mission integrity and mission adhesion, facilitated by our team development tools. The message to the team is simple, Sick Patients Take no holidays and there is no room to cut corners on the Critical Care Mission ... EVER ... not for one second of any day ... NEVER cut corners on patient care or patient safety!
A message for PATIENTS & FAMILIES and INEXPERIENCED CARE GIVERS ... before I get into the meat of our work discussion ...
Please, I beg PATIENTS and FAMILIES to make sure their wishes are known, because this work is very intense ... and it requires our dedication to PRESERVATION of LIFE and limb. It is shameful to waste resources on people who do not want us to do our best to fix what we can fix. If you don't want critical care ... PLEASE don't let yourself, get to the ICU. Make sure your family knows you DON'T WANT the hospital and especially ICU care. There is nothing worse from THIS experienced intensivist's point of view than to have families start to waffle on a care plan before a proper therapeutic trial has been carried out. Advanced directives are useful, but they are rare, and they are VERY RARELY SPECIFIC. IF in our best judgment we are carrying out the patient's wishes, let us carry on until we are sure ... absolutely certain that we are doing what is in accordance with our Critical Care Mission. Please don't undermine our mission.
And ... as for inexperienced care givers ... plaese stay out of it. In other words, please leave these decisions to the EXPERIENCED MEMBERS OF THE TEAM. Let the Experienced Providers determine what is a proper trial of care. If you don't know what you are doing, do nothing and get help. If you don't know what you are talking about, say nothing and get help.
This is a reiteration of my big picture teaching this week.
What is the Critical Care Mission?
Preservation of Life, Limb, Organ and Vital Human Functions in accordance with the wishes of the patient, and with the intent to serve the best interest of the patient at all times.
In that context, and in the context of the family, the Intensivist and his team of care givers, must include the family in the team, and should relentlessly strive to achieve the following Goals and Objectives as soon as is possible:
A. GOALS: NOW = UPON ARRIVAL
SIMULTANEOUS and RAPID (within seconds to minutes)
-Resuscitation,
-Preservation and Restoration of
-Perfusion, Oxygenation and Ventilation to
-Optimize preservation of Life, Limb and Organ function
-Recognize and treat coexisting diseases, precipitating illnesses and/or injuries
B. OBJECTIVES:
SIMULTANEOUS and RAPID (within seconds to minutes) EVALUATION & TREATMENT to
1. Optimize cardiac output and end organ perfusion
2. Oxygenate the blood
3. Remove carbon dioxide from the blood
4. Deliver oxygen to Tissues, Organs/cells
5. Remove carbon dioxide, metabolites and toxins from Tissues, Organs/Cells
(organ priorites are a. Heart, Brain/CNS, Lung b. Kidneys c. All others)
6. Diagnose and Treat the Precipitating Illness/Injury
7. Restore Vital Functions and Optimal Physiology (total organism) ASAP (within minutes to hours) to Prevent and Limit Limb and Organ Damage As Much as is possible and as rapidly as possible (minutes to hours)
8. Prevent complications of Illness, Injury and Treatment as much as is possible (from start to finish)
9. Promote optimal recovery and restoration of normal function through rapid mobilization and rehabilitation as soon as is possible.
10. Restore patient to normal, productive and creative life, as much as is possible (To srart As soon as is possible ... and to continue as long as is necessary for days to weeks to months to years), and to help the family throughout this process.
Toward these ends, we have developed a comprehensive set of check lists designed to help facilitate team care of the sickest patients in the care of teams with varying levels of knowledge, skill and experience. Our Check Lists, all part of the StepWisely(R) System include STOMPP(TM) & STOMPPIT(TM) The Strategic Targeted Operations Management for Patient Protection Integration Tools to promote Optimal Patient Care Through Teamwork. This
Comprehensive checklists includes:
TARGETS and GUIDELINES to Promote
1. Family Integrity, Participation, and Protection - FIPPs(TM)
2. Patient Integrity Protection & Preservation - PIPPs(TM)
3. Patient Organ Specific Protection & Preservation Guidelines POPPs(TM)
4. Targets for Organ Specific Protection, Preservation & Treatment Strategies (Generic and Disease Specific) - TOPPs(TM)
5. General for ALL Pateints Prophylaxis - GAPPs(TM)
I have been using these check lists to help keep the care teams on Target for the last few years. The less experienced find them particularly helpful in light of the many distractions that are rampant and increasingly complex. Focus on the patient and on patient safety. When in doubt go see the patient ... don't rely on the record, or the documentation for decision making, but rely on reevaluation of the patient. The less stable the patient, the more time you should spend at the patient's bedside.
If you have questions, or want more details, respond to this blog, or email me @ Dr.Mike@ihealsolutions.com and I will get back to you as soon as I can.
Buona Fortuna!
Enjoy!
Dr. Mike
Monday, December 26, 2011
Tuesday, December 20, 2011
Mission: Healing December 20, 2011
PGY 39, Day # 172
ICU Rounds details will follow as the week emerges. A few thoughts will have to suffice for now.
Perfusion is the MASTER of Critical Care ... the MASTER of organ preservation, protection and resuscitation ... the MASTER of healing.
STOP THE MADNESS(TM) Rational Cost Containment
StepWisely(R)
STOMPP(TM) & STOMPPPIT(TM) tools to promote mission adhesion, team development and optimal patient care.
More on the blog as soon as I can get to it.
Think about it and have a great day!
Dr. Mike
ICU Rounds details will follow as the week emerges. A few thoughts will have to suffice for now.
Perfusion is the MASTER of Critical Care ... the MASTER of organ preservation, protection and resuscitation ... the MASTER of healing.
STOP THE MADNESS(TM) Rational Cost Containment
StepWisely(R)
STOMPP(TM) & STOMPPPIT(TM) tools to promote mission adhesion, team development and optimal patient care.
More on the blog as soon as I can get to it.
Think about it and have a great day!
Dr. Mike
Monday, December 12, 2011
Mission: Healing December 12, 2011
PGY 39, Day 164
Ask the survivor?
It has been know for decades that patients can't survive after traumatic cardiac arrest "in the field" despite the best of care. In other words, if you have an accident or significant injury from any cause, if it is severe enough to cause your heart to stop, and to require cardiopulmonary resuscitation, you are probably dead. And, then there are the exceptions ... the occasional patient who survives, despite the fact that they "should have been dead."
Recently, an article published in one of our medical journals looked at the cost and outcome of treating patients who "should die" as a result of their trauma.
http://www.ncbi.nlm.nih.gov/m/pubmed/21986740/
According to this study, which involved the authors examination of trauma patients' CHARTS retrospectively (after the care was given), of the 294 trauma patients who should have died, only one survived despite treatment (0.3%) and required "long term care". The TOTAL cost of treating these patients was stated to be $3,852,446.65, or $13,103.50 per patient. They considered treatment of these patients to be a "violation" of guidelines and conclude that "no loss of neurologically intact survivors would have resulted had strict adherence to the guidelines been maintained."
Wow ... pretty harsh and rigid conclusions, but are they correct? Not so fast!
Here are my recommendations:
1. Ask the survivor! What is his or her current status?
2. Examine all trauma registries with regard to similar data?
3. Examine all survivors who "should have died" and see how they differ from the group at large?
4. Do a prospective randomized trial?
5. Examine the details of each case identified in the study and determine weather or not any of the care provided could have been improved?
6. What else? I always forget something. Please comment
Medical care should not be wasted on dead patients, but it is precision early care that dictates survival. How many patients were saved and are doing well, because VERY AGGRESSIVE CARE was provided in the field? Scoop and run is probably the best once an airway is established. Despite this "study" my opinion stands: When in doubt, err on the side of life & when you are dead, you are dead. So ... the problem remains ... how to determine death ... and especially how to determine who of the critically injured will die despite the best of care? In the meantime ... until we can answer these questions properly, err on the side of life, so people who have the potential to survive and live a good life don't die unnecessarily.
StepWisely(R) and have a nice day!
Dr. Mike
Ask the survivor?
It has been know for decades that patients can't survive after traumatic cardiac arrest "in the field" despite the best of care. In other words, if you have an accident or significant injury from any cause, if it is severe enough to cause your heart to stop, and to require cardiopulmonary resuscitation, you are probably dead. And, then there are the exceptions ... the occasional patient who survives, despite the fact that they "should have been dead."
Recently, an article published in one of our medical journals looked at the cost and outcome of treating patients who "should die" as a result of their trauma.
http://www.ncbi.nlm.nih.gov/m/pubmed/21986740/
According to this study, which involved the authors examination of trauma patients' CHARTS retrospectively (after the care was given), of the 294 trauma patients who should have died, only one survived despite treatment (0.3%) and required "long term care". The TOTAL cost of treating these patients was stated to be $3,852,446.65, or $13,103.50 per patient. They considered treatment of these patients to be a "violation" of guidelines and conclude that "no loss of neurologically intact survivors would have resulted had strict adherence to the guidelines been maintained."
Wow ... pretty harsh and rigid conclusions, but are they correct? Not so fast!
Here are my recommendations:
1. Ask the survivor! What is his or her current status?
2. Examine all trauma registries with regard to similar data?
3. Examine all survivors who "should have died" and see how they differ from the group at large?
4. Do a prospective randomized trial?
5. Examine the details of each case identified in the study and determine weather or not any of the care provided could have been improved?
6. What else? I always forget something. Please comment
Medical care should not be wasted on dead patients, but it is precision early care that dictates survival. How many patients were saved and are doing well, because VERY AGGRESSIVE CARE was provided in the field? Scoop and run is probably the best once an airway is established. Despite this "study" my opinion stands: When in doubt, err on the side of life & when you are dead, you are dead. So ... the problem remains ... how to determine death ... and especially how to determine who of the critically injured will die despite the best of care? In the meantime ... until we can answer these questions properly, err on the side of life, so people who have the potential to survive and live a good life don't die unnecessarily.
StepWisely(R) and have a nice day!
Dr. Mike
Monday, December 5, 2011
Mission: Healing December 5, 2011
PGY # 39, Day 157
During my Family Medicine years, I noticed that a small percentage of the population (5-10%) is HIGHLY motivated to TAKE CHARGE OF THEIR PERSONAL and FAMILY HEALTH & WELL BEING. The Stress Management Workbook was written for these people in 1981 and originally published by Appleton Century Crofts. Since then, many have copied our work (some plagerism, I am sure), but none have made it better. NOW, you can get The ORIGINAL Stress Management Workbook by Aronson and Mascia in electronic format through Kindle books @ Amazon.com for less than half the original purchase price. This is very exciting to me ... to think that this book is now readily available to a world wide audience ... is truly phenomenal.
http://www.amazon.com/The-STRESS-Management-Workbook-ebook/dp/B006BIR5TO/ref=sr_1_2?ie=UTF8&qid=1323101547&sr=8-2
Also, I am happy to announce that David, at Voltage Design
http://voltagenj.com/
is helping to set up chats for those who buy the book. Wow, the wonders of modern technology! To think that you can get this book and support for use anywhere in the world is truly amazing.
If you have questions about the book, or any of my blog posts, feel free to contact me through this blog, or by email @ Dr.Mike@ihealsolutions.com.
Have fun and be careful.
Ciao for now and have a great day.
Dr. Mike
During my Family Medicine years, I noticed that a small percentage of the population (5-10%) is HIGHLY motivated to TAKE CHARGE OF THEIR PERSONAL and FAMILY HEALTH & WELL BEING. The Stress Management Workbook was written for these people in 1981 and originally published by Appleton Century Crofts. Since then, many have copied our work (some plagerism, I am sure), but none have made it better. NOW, you can get The ORIGINAL Stress Management Workbook by Aronson and Mascia in electronic format through Kindle books @ Amazon.com for less than half the original purchase price. This is very exciting to me ... to think that this book is now readily available to a world wide audience ... is truly phenomenal.
http://www.amazon.com/The-STRESS-Management-Workbook-ebook/dp/B006BIR5TO/ref=sr_1_2?ie=UTF8&qid=1323101547&sr=8-2
Also, I am happy to announce that David, at Voltage Design
http://voltagenj.com/
is helping to set up chats for those who buy the book. Wow, the wonders of modern technology! To think that you can get this book and support for use anywhere in the world is truly amazing.
If you have questions about the book, or any of my blog posts, feel free to contact me through this blog, or by email @ Dr.Mike@ihealsolutions.com.
Have fun and be careful.
Ciao for now and have a great day.
Dr. Mike
Monday, November 28, 2011
Mission: Healing November 28, 2011
PGY 39, Day #150
This was a moderately busy week in the ICU. As usual, the tug of the "holiday vortex" and the "game vortex" made it more difficult to get things accomplished. But, let us not dwell on skeleton crews and limited surge capacity. We got the job done, and I am now, again,recovering from lack of sleep for a few days.
Topics discussed on ICU rounds this week included:
1. If you don't know what you are doing, STOP & ask for help.
2. If you don't know what you are talking about, STOP your mouth & ask for help.
3. If you don't know your limits you are dangerous.
4. When dealing with families on matters of life and death, always err on the side of life. "When you put the right things on the menu, patients and families are more likely to make the right choices." You can quote me on that!
5. Hypotension and Shock: Diagnosis and Treatment
6. Supraventricular Tachycardia management in the critically ill patient
7. Traumatic Intraparenchymal Hemorrhage
8. Acute Respiratory Failure from upper airway obstruction: Diagnosis and Treatment
9. Intractable Seizures: Diagnosis and Treatment
10. Brain Protection Strategies and Targets
11. Subarachnoid hemorrhage: Diagnosis,classification, prognosis, Hunt & Hess, HHH Rx
12. Criteria for Nosocomial Pneumonia & Diagnosis of Pneumonia in General
13. Thorazine for fever
14. Breathing & Circulation: Oxygen Content, Oxygen Delivery, Oxygen Consumption, CO2 Production, CO2 Clearance. "Oxygen is overrated & Perfusion is underrated: The importance of perfusion in critical care" you can quote me on that one too.
15. Acute Respiratory Failure: Diagnosis, Treatment, Non invasive therapies, invasive therapies, endotracheal intubation, sedation, analgesia, neuromuscular junction blockade, initial ventilator settings.
Please contact me if you have any questions.
Enjoy!
Dr. Mike
This was a moderately busy week in the ICU. As usual, the tug of the "holiday vortex" and the "game vortex" made it more difficult to get things accomplished. But, let us not dwell on skeleton crews and limited surge capacity. We got the job done, and I am now, again,recovering from lack of sleep for a few days.
Topics discussed on ICU rounds this week included:
1. If you don't know what you are doing, STOP & ask for help.
2. If you don't know what you are talking about, STOP your mouth & ask for help.
3. If you don't know your limits you are dangerous.
4. When dealing with families on matters of life and death, always err on the side of life. "When you put the right things on the menu, patients and families are more likely to make the right choices." You can quote me on that!
5. Hypotension and Shock: Diagnosis and Treatment
6. Supraventricular Tachycardia management in the critically ill patient
7. Traumatic Intraparenchymal Hemorrhage
8. Acute Respiratory Failure from upper airway obstruction: Diagnosis and Treatment
9. Intractable Seizures: Diagnosis and Treatment
10. Brain Protection Strategies and Targets
11. Subarachnoid hemorrhage: Diagnosis,classification, prognosis, Hunt & Hess, HHH Rx
12. Criteria for Nosocomial Pneumonia & Diagnosis of Pneumonia in General
13. Thorazine for fever
14. Breathing & Circulation: Oxygen Content, Oxygen Delivery, Oxygen Consumption, CO2 Production, CO2 Clearance. "Oxygen is overrated & Perfusion is underrated: The importance of perfusion in critical care" you can quote me on that one too.
15. Acute Respiratory Failure: Diagnosis, Treatment, Non invasive therapies, invasive therapies, endotracheal intubation, sedation, analgesia, neuromuscular junction blockade, initial ventilator settings.
Please contact me if you have any questions.
Enjoy!
Dr. Mike
Wednesday, November 23, 2011
Mission: Healing November 23, 2011
PGY # 39, Day 145
GOOD NEWS!
FYI
The ORIGINAL Stress Management Workbook by Aronson and Mascia is now available in electronic format through Amazon.
This book, that we originally wrote and published in 1981 is still useful and relevant. The electronic version is a useful addition by making it readily available to a world audience at a low price. I will be working on a New Edition of The ORIGINAL Stress Management Workbook this year.
http://www.amazon.com/dp/B006BIR5TO
Enjoy & Contact me if you have any questions.
Later today, or tomorrow, I will update on discussion topics in the ICU for this week.
Dr. Mike
GOOD NEWS!
FYI
The ORIGINAL Stress Management Workbook by Aronson and Mascia is now available in electronic format through Amazon.
This book, that we originally wrote and published in 1981 is still useful and relevant. The electronic version is a useful addition by making it readily available to a world audience at a low price. I will be working on a New Edition of The ORIGINAL Stress Management Workbook this year.
http://www.amazon.com/dp/B006BIR5TO
Enjoy & Contact me if you have any questions.
Later today, or tomorrow, I will update on discussion topics in the ICU for this week.
Dr. Mike
Friday, November 18, 2011
Mission Healing: November 18, 2011, Children & Their Parents
PGY 39, Day # 140
My goal for today? Post this DRAFT OF Children and Their Parents for review, comments and criticism. In that regard, I will do what I can do ... as I work through this technology ... bit by bit. And, I do need other eyes to look at this critically and to give me feedback. But, IT as it is in my LOW TECH ZONE does not allow me to post the whole book for reasons that are explained in the PS below.
Nevertheless, if, perchance, people want to BUY this book, I will make it available for purchase ASAP with all proceeds going toward the New Health Development Institute. What is the Health Development Institute? A Non Profit Health Care Organization that I set up more than 20 years ago. Alas, it is time for HDI to be reborn ... perhaps as a Health Care COOPERATIVE?
Ultimately, I expect (with the help of as many people as I can find) we can resume operation of the Non Profit Health Development Institute; originally started as a teaching arm for Patients and Families I served while running my private Family Medicine Practice in Bridgton, Maine before 1989. Always looking for help with to take care of the enormous needs of The People, and the Non Profit COOPERATIVE model is the only one that makes sense to me.
Buona Fortuna e ciao per ora!
Enjoy!
Dr. Mike
PS. OMG, this is much more difficult than I thought it would be. The only way I can put this up here is by going from PDF to JPEG and loading one page at a time as JPEG files. Uggggg! It is painfully slow.
PPS. Maybe some IT people out there can help me figure out a better way.
PPPS. HELP!
PPPPS. Until I get some help it will go up just a few pages at a time ... as I get the time to do this from the LOW TECH ZONE.
© Michael F. Mascia, MD, MPH
My goal for today? Post this DRAFT OF Children and Their Parents for review, comments and criticism. In that regard, I will do what I can do ... as I work through this technology ... bit by bit. And, I do need other eyes to look at this critically and to give me feedback. But, IT as it is in my LOW TECH ZONE does not allow me to post the whole book for reasons that are explained in the PS below.
Nevertheless, if, perchance, people want to BUY this book, I will make it available for purchase ASAP with all proceeds going toward the New Health Development Institute. What is the Health Development Institute? A Non Profit Health Care Organization that I set up more than 20 years ago. Alas, it is time for HDI to be reborn ... perhaps as a Health Care COOPERATIVE?
Ultimately, I expect (with the help of as many people as I can find) we can resume operation of the Non Profit Health Development Institute; originally started as a teaching arm for Patients and Families I served while running my private Family Medicine Practice in Bridgton, Maine before 1989. Always looking for help with to take care of the enormous needs of The People, and the Non Profit COOPERATIVE model is the only one that makes sense to me.
Buona Fortuna e ciao per ora!
Enjoy!
Dr. Mike
PS. OMG, this is much more difficult than I thought it would be. The only way I can put this up here is by going from PDF to JPEG and loading one page at a time as JPEG files. Uggggg! It is painfully slow.
PPS. Maybe some IT people out there can help me figure out a better way.
PPPS. HELP!
PPPPS. Until I get some help it will go up just a few pages at a time ... as I get the time to do this from the LOW TECH ZONE.
Children and Their Parents: A Parenting Guide to the First Six Years
V 1988 Update 2011
Revised 2011
© Michael F. Mascia, MD, MPH© Michael F. Mascia, MD, MPHA MESSAGE FROM THE AUTHOR FOR PARENTS & OTHERS WHO CARE FOR
CHILDREN
This book is designed to be used in conjunction with your baby's personal physician.
In other words, we do no want you to rely on this text without guidance from a
licensed medical doctor. Also, the author expects that you will seek immediate
medical attention for all emergencies through your local doctor or local emergency
medical services.
With that in mind, it would be wise for the users of this book to:
1. Find a personal physician whom you trust, and who can help guide you and your
baby through this journey called life. Check his/her credentials and qualifications!
2. Know when to get help for an emergency
3. When in doubt, if your baby is sick, assume you are dealing with an emergency
4. Learn the signs and symptoms of a medical emergency
5. Know how to contact and get help for an emergency
6. Further instructions with regard to "Finding and Using Your Personal Physician"
will be found in several locations including, but not limited to:
a. Future editions of CHILDREN AND THEIR PARENTS
b. The NEW Stress Management Workbook
c. drmikeihs.blogspot.com/
d. Other electronic and paper publications based upon & included in the StepWisely
®System from Infinity Health Solutions & Michael F. Mascia, MD, MPH
ALSO, WE WELCOME ALL FEEDBACK OF ANY KIND ... COMMENTS, CORRECTIONS
AND CRITICISM FROM OUR READERS ARE WELCOME, AS THIS IS A WORK IN
PROGRESS, & IS NOT A FINISIHED PRODUCT.
Thanks for your help,
Dr. Mike
Michael F. Mascia, MD, MPH
Children and Their Parents: A Parenting Guide to the First Six Years
V 1988 Update 2011
Contact: For EMERGENCIES CALL 911, or your local EMS
For information, comments & questions, go to
ATTENZIONE!
REITERATION
DO NOT SKIP THIS PAGE!
Just in case you skipped this message the last time
READ IT THIS TIME!
YES, IT IS IMPORTANT
DO YOU HAVE A TRUSTED MEDICAL DOCTOR FOR YOUR BABY YET?
Monday, November 7, 2011
Mission: Healing November 7, 2011 Inexperienced Provider Tips
PGY 39, Day 129
For INEXPERIENCED PROVIDERS
If you are new in the ICU, no matter what level of training, medical student, nursing student, new graduate, intern, resident, or just a neophite in the ICU, here are a few pointers that will keep you and your patients out of trouble.
Based upon the following rule: "PRIMUM NON NOCERE" (First Do No Harm) here are your top three rules
1. If you don't know what you are doing, STOP!!!! ... DO NOTHING and ask for help.
2. If you don't know what you are talking about, STOP!!!! ... SAY NOTHING and ask for help.
3. If it is an emergency, CALL FOR HELP, use FIRST AID, ACLS, ATLS and PALS till help gets there.
Ciao e buona fortuna!
Have a nice day.
Dr. Mike
For INEXPERIENCED PROVIDERS
If you are new in the ICU, no matter what level of training, medical student, nursing student, new graduate, intern, resident, or just a neophite in the ICU, here are a few pointers that will keep you and your patients out of trouble.
Based upon the following rule: "PRIMUM NON NOCERE" (First Do No Harm) here are your top three rules
1. If you don't know what you are doing, STOP!!!! ... DO NOTHING and ask for help.
2. If you don't know what you are talking about, STOP!!!! ... SAY NOTHING and ask for help.
3. If it is an emergency, CALL FOR HELP, use FIRST AID, ACLS, ATLS and PALS till help gets there.
Ciao e buona fortuna!
Have a nice day.
Dr. Mike
Mission: Healing November 7, 2011 Messing With The Clock
PGY 39, Day 129
THEY ARE MESSING WITH MY (BIOLOGICAL) CLOCK AGAIN:
AKA, I am Falling Behind Again
There is a natural rhythm to life and the universe, and that rhythm is synchronized. As a part of that system, animals (yes, including humans) have day-night cycles called circadian rhythm. This rhythim dictates many fundamental physiologic functions ... most notable of which are the day-night/sleep wake cycle.
(Reference link: http://www.nigms.nih.gov/Education/Factsheet_CircadianRhythms.htm)
(For Detailed Scientific Evidence see:The Clocks That Time Us by Moore-Ede, Sulzman and Fuller)
In other words, our natural rhythm, or biological clock is dictated by day and night, light and dark, or, in other words, SUNSHINE! Every time we arbitrarily "change the clock", we are "messing with" COUNTLESS HUMAN BIOLOGICAL CLOCKS, because our CLOCK TIME is NOT SYNCHRONIZED with SUN TiME. That is CRAZY! Why ON EARTH (:-)) would we not synchronize our MECHANICAL CLOCKS with the SUN? Stupid!(?) We have always done it that way? NO ... that is not at all true.
Disregard of facts about our circadian rhythm and the sun might have been excusable 100 years ago, but today, it is absolute nonsense. What effort would it take to keep the clocks all around the world synchronized with the sun? Very little extra effort. What would the cost be? I have no idea, but the benefit, I am certain, would be enormous with regard to human well being and performance.
Who benefits by maintaining the status quo? Frankly, I don't know. It seems as if this clock changing nonsense is just one of those "we have always done it that way" sort of things. Isn't it TIME for us to be SMART about Clocks, Sun rhythm and circadian rhythm? Let's start a move to synchronize mechanical clocks with the sun ... it would be good for our natural rhythm. I think the music would sound better, and, besides, what do we have to loose?
StepWisely(R) and have a good day.
Dr. Mike
PS. IF, there is some reason why machine time MUST be different from SUN TIME, or EARTH ROTATION TIME, then, at least give us both times on every clock.
PPS. And, for the advocates of this clock change nonsense, explain yourself, please!
THEY ARE MESSING WITH MY (BIOLOGICAL) CLOCK AGAIN:
AKA, I am Falling Behind Again
There is a natural rhythm to life and the universe, and that rhythm is synchronized. As a part of that system, animals (yes, including humans) have day-night cycles called circadian rhythm. This rhythim dictates many fundamental physiologic functions ... most notable of which are the day-night/sleep wake cycle.
(Reference link: http://www.nigms.nih.gov/Education/Factsheet_CircadianRhythms.htm)
(For Detailed Scientific Evidence see:The Clocks That Time Us by Moore-Ede, Sulzman and Fuller)
In other words, our natural rhythm, or biological clock is dictated by day and night, light and dark, or, in other words, SUNSHINE! Every time we arbitrarily "change the clock", we are "messing with" COUNTLESS HUMAN BIOLOGICAL CLOCKS, because our CLOCK TIME is NOT SYNCHRONIZED with SUN TiME. That is CRAZY! Why ON EARTH (:-)) would we not synchronize our MECHANICAL CLOCKS with the SUN? Stupid!(?) We have always done it that way? NO ... that is not at all true.
Disregard of facts about our circadian rhythm and the sun might have been excusable 100 years ago, but today, it is absolute nonsense. What effort would it take to keep the clocks all around the world synchronized with the sun? Very little extra effort. What would the cost be? I have no idea, but the benefit, I am certain, would be enormous with regard to human well being and performance.
Who benefits by maintaining the status quo? Frankly, I don't know. It seems as if this clock changing nonsense is just one of those "we have always done it that way" sort of things. Isn't it TIME for us to be SMART about Clocks, Sun rhythm and circadian rhythm? Let's start a move to synchronize mechanical clocks with the sun ... it would be good for our natural rhythm. I think the music would sound better, and, besides, what do we have to loose?
StepWisely(R) and have a good day.
Dr. Mike
PS. IF, there is some reason why machine time MUST be different from SUN TIME, or EARTH ROTATION TIME, then, at least give us both times on every clock.
PPS. And, for the advocates of this clock change nonsense, explain yourself, please!
Friday, November 4, 2011
Mission: Healing November 4, 2011 Business of FLU SHOTS
PGY 39, Day 125
Yesterday I wrote about Flu Shots in my piece about the Business of Medicine
http://drmikeihs.blogspot.com/2011/11/mission-healing-november-3-2011.hthtml
Today, a few more comments on the Busines of Flu Shots
PICKING THE RIPE & LOW LYING FRUIT
Today, I asked Mr. Google a few more questions and this is what I found. It appears as if Walgreens, CVS and Target are all in the BUSINESS OF FLU SHOTS. Walgreens and CVS claim to provide them "every day" with some variation on the language regarding every store.
This looks like an effort to select and pick bits of $$$ (fruit) from the $$$ tree called THE BUSINESS OF MEDICNE. These are the "lowest lying & ripest of fruit" available from third party payers. Of course, the patients would be expected to pay the difference between what is covered and what is charged, except for Medicare.
Think about it, and tell me if I am wrong.
Have a great day!
Dr. Mike
Yesterday I wrote about Flu Shots in my piece about the Business of Medicine
http://drmikeihs.blogspot.com/2011/11/mission-healing-november-3-2011.hthtml
Today, a few more comments on the Busines of Flu Shots
PICKING THE RIPE & LOW LYING FRUIT
Today, I asked Mr. Google a few more questions and this is what I found. It appears as if Walgreens, CVS and Target are all in the BUSINESS OF FLU SHOTS. Walgreens and CVS claim to provide them "every day" with some variation on the language regarding every store.
This looks like an effort to select and pick bits of $$$ (fruit) from the $$$ tree called THE BUSINESS OF MEDICNE. These are the "lowest lying & ripest of fruit" available from third party payers. Of course, the patients would be expected to pay the difference between what is covered and what is charged, except for Medicare.
Think about it, and tell me if I am wrong.
Have a great day!
Dr. Mike
Thursday, November 3, 2011
Mission: Healing November 3, 2011 Business of Medicine
PGY 39, Day 125
Today, I stopped at Walgreens to pick up a few things. As I pulled into the parking lot, I noticed several flimsy signs reading something like ... Free Flu Shots ... in bold. As for the fine print ... if you have Medicare Part B. So, being the curious guy that I am and seeing that I just put the blog up on "FLU SHOTS" yesterday, and, since I had a few minutes, I commenced an investigation ... follow the $$$ and report for the blog. Little did I know that this would end up being quite an exercise. Who am I kidding ... it is exactly the bumbling third party nonsense that I would expect.
First, I buy my stuff and pay for it ... 10 minutes ... a few items ... no problem. Then I go to the pharmacy and ask them about the flu shot. Specifically, I asked for a brochure, which the pleasant cash register lady and asked her how much they cost. She asked, "Do you have medicare?", I said, "No" (do I look that old?) and she sheepishly told me $31.99 while she went to the Walgreen website to find and print the scoop on the inactivated vaccine that they offer.
So, I come home and continue my snooping on the COST of the vaccine and the reimbursement from Medicare part B. First, I ask MR. Google, "What is the cost of influenza vaccine?" and this is what I get ... PERFECTION from CDC! It is the current price list for all vaccines.
http://www.cdc.gov/vaccines/programs/vfc/cdc-vac-price-list.htm
So, the cost for the inactivated Influenza vaccine is a max of about $14/dose in the private sector, but the range is from less than $8/dose to about $14/dose.
Then I check with Medicare to see what the reimbursement rate is for the Flu Vaccine. Good luck with that ... it is a wild goose chase. Check for yourself, and see if you can find what they pay. Let me know if you find it.
http://www.medicareinteractive.org/frames.php?URL=http://www.cms.hhs.gov/AdultImmunizations/Downloads/0506vaccreimburs033006.pdf
Here again, multiple third parties are involved ... $, $$, and $$$ ... caching!
Then I check the Walgreen website for fine print about other insurance. There, availability and co-payments apply and I find that they work with some other third party with regard to the administration of the vaccine. So, let's guess they make $5 - $ 10 for each dose given on their turf. How much is that? LOTS of money! I would like to know exactly what they make on the draw and the immunization itself.
So, in the process, they draw people away from their Docs and into the BIG BUSINESS MACHINE ... THIRD PARTY ... party $ after $$ party $$$, Business of Medicine makes money on the BACK OF THE DOCTOR-PATIENT relationship.
Sickening!
When I started in practice, the immunizations were generally given as a part of a well visit or follow up visit for a chronic medical problem, and they were a part of a comprehensive & individualized health care plan for each patient. Cost of the vaccine and the administration would have been perhaps double the cost to us. But, more importantly, it would have been part of a larger effort to address each patient individually with regard to their total health care needs. In the current scenario, each thrid party contributes to the fragmentation of care, the "disintegration" of care and the cost of care. It is a pathetic and unnecessary state of affairs. That's why I am an advocate for Non Profit Doctor Patient Cooperatives to CAP the BUSINESS OF MEDICINE take all third parties out of the picture and return to the DOCTOR-PATIENT RELATIONSHIP to the realm of OPTIMAL PATIENT CARE and PATIENTS FIRST.
Let's fix it!
Do the right thing and enjoy!
Dr. Mike
Today, I stopped at Walgreens to pick up a few things. As I pulled into the parking lot, I noticed several flimsy signs reading something like ... Free Flu Shots ... in bold. As for the fine print ... if you have Medicare Part B. So, being the curious guy that I am and seeing that I just put the blog up on "FLU SHOTS" yesterday, and, since I had a few minutes, I commenced an investigation ... follow the $$$ and report for the blog. Little did I know that this would end up being quite an exercise. Who am I kidding ... it is exactly the bumbling third party nonsense that I would expect.
First, I buy my stuff and pay for it ... 10 minutes ... a few items ... no problem. Then I go to the pharmacy and ask them about the flu shot. Specifically, I asked for a brochure, which the pleasant cash register lady and asked her how much they cost. She asked, "Do you have medicare?", I said, "No" (do I look that old?) and she sheepishly told me $31.99 while she went to the Walgreen website to find and print the scoop on the inactivated vaccine that they offer.
So, I come home and continue my snooping on the COST of the vaccine and the reimbursement from Medicare part B. First, I ask MR. Google, "What is the cost of influenza vaccine?" and this is what I get ... PERFECTION from CDC! It is the current price list for all vaccines.
http://www.cdc.gov/vaccines/programs/vfc/cdc-vac-price-list.htm
So, the cost for the inactivated Influenza vaccine is a max of about $14/dose in the private sector, but the range is from less than $8/dose to about $14/dose.
Then I check with Medicare to see what the reimbursement rate is for the Flu Vaccine. Good luck with that ... it is a wild goose chase. Check for yourself, and see if you can find what they pay. Let me know if you find it.
http://www.medicareinteractive.org/frames.php?URL=http://www.cms.hhs.gov/AdultImmunizations/Downloads/0506vaccreimburs033006.pdf
Here again, multiple third parties are involved ... $, $$, and $$$ ... caching!
Then I check the Walgreen website for fine print about other insurance. There, availability and co-payments apply and I find that they work with some other third party with regard to the administration of the vaccine. So, let's guess they make $5 - $ 10 for each dose given on their turf. How much is that? LOTS of money! I would like to know exactly what they make on the draw and the immunization itself.
So, in the process, they draw people away from their Docs and into the BIG BUSINESS MACHINE ... THIRD PARTY ... party $ after $$ party $$$, Business of Medicine makes money on the BACK OF THE DOCTOR-PATIENT relationship.
Sickening!
When I started in practice, the immunizations were generally given as a part of a well visit or follow up visit for a chronic medical problem, and they were a part of a comprehensive & individualized health care plan for each patient. Cost of the vaccine and the administration would have been perhaps double the cost to us. But, more importantly, it would have been part of a larger effort to address each patient individually with regard to their total health care needs. In the current scenario, each thrid party contributes to the fragmentation of care, the "disintegration" of care and the cost of care. It is a pathetic and unnecessary state of affairs. That's why I am an advocate for Non Profit Doctor Patient Cooperatives to CAP the BUSINESS OF MEDICINE take all third parties out of the picture and return to the DOCTOR-PATIENT RELATIONSHIP to the realm of OPTIMAL PATIENT CARE and PATIENTS FIRST.
Let's fix it!
Do the right thing and enjoy!
Dr. Mike
Wednesday, November 2, 2011
Mission: Healing November 2, 2011 on Influenza
PGY 39, Day 124
FIRST OF ALL
If you don't have a Doctor whom you trust, get one! If you don't know how, contact me and I will give you guidance. She or He should be able to guide you in the right direction.
AFTER YOU HAVE YOUR DOCTOR, CHECK THIS OUT with your DOC!
There seems to be a bit of confusion regarding "the flu" and the influenza vaccine, and that is quite easy to understand. It is very confusing, because the bug confuses everyone ... it keeps changing.
BUT ... there are some fundamental rules that have not changed over the years. This CDC document
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr59e0729a1.htm
covers the whole story, and the recommendations have not changed since last year. Their reasoning for expanding the population to be immunized is covered in this document. I recommend that you study it, if you are NOT high risk and you need to decide weather or not to get immunized. If you ARE HIGH RISK, and have NO CONTRAINDICATIONS, you should be immunized for sure. Keep in mind that my conclusion is based upon the fact that I see the casualties who end up in the Intensive Care Unit ... not a good way to spend your days, if avoidable, eh?
TWO TYPES OF VACCINE: INACTIVATED & LIVE ATTENUATED
From the CDC DOCUMENT
"TIV contains inactivated viruses and thus cannot cause influenza. LAIV contains live attenuated influenza viruses that have the potential to cause mild signs or symptoms related to vaccine virus infection (e.g., rhinorrhea, nasal congestion, fever, or sore throat). LAIV is administered intranasally by sprayer, whereas TIV is administered intramuscularly by injection. LAIV is licensed for use among nonpregnant persons aged 2--49 years; safety has not been established in persons with underlying medical conditions that confer a higher risk for influenza complications. TIV is licensed for use among persons aged ≥6 months, including those who are healthy and those with chronic medical conditions (Table 1). During the preparation of TIV, the vaccine viruses are made noninfectious (i.e., inactivated or killed) (8). Only subvirion and purified surface antigen preparations of TIV (often referred to as "split" and subunit vaccines, respectively) are available in the United States. Standard-dose TIV preparations contain 7.5 mcg HA antigen per vaccine strain (for children aged <36 months) or 15 mcg of HA antigen (for persons aged ≥36 months) per vaccine strain (i.e., 22.5 mcg or 45 mcg total HA antigen). A newly licensed higher dose TIV (60 mcg per vaccine strain or 180 mcg total HA antigen) was approved recently for persons aged ≥65 years (Fluzone High-Dose, Sanofi pasteur)."
WHO IS HIGH RISK:
FROM THE CDC DOCUMENT
"Vaccination to prevent influenza is particularly important for persons who are at increased risk for severe complications from influenza or at higher risk for influenza-related outpatient, ED, or hospital visits. When vaccine supply is limited, vaccination efforts should focus on delivering vaccination to the following persons:
all children aged 6 months--4 years (59 months);
all persons aged ≥50 years;
adults and children who have chronic pulmonary (including asthma) or cardiovascular (except isolated hypertension), renal, hepatic, neurological, hematologic, or metabolic disorders (including diabetes mellitus);
persons who have immunosuppression (including immunosuppression caused by medications or by HIV);
women who are or will be pregnant during the influenza season;
children and adolescents (aged 6 months--18 years) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye syndrome after influenza virus infection;
residents of nursing homes and other long-term--care facilities;
American Indians/Alaska Natives;
persons who are morbidly obese (BMI ≥40);
HCP;
household contacts and caregivers of children aged <5 years and adults aged ≥50 years, with particular emphasis on vaccinating contacts of children aged <6 months; and
household contacts and caregivers of persons with medical conditions that put them at higher risk for severe complications from influenza."
STILL CONFUSED?
You will have to study the whole document and ask for guidance. Feel free to ask me questions and send your comments.
Buona Fortuna & Ciao for now,
Dr. Mike
FIRST OF ALL
If you don't have a Doctor whom you trust, get one! If you don't know how, contact me and I will give you guidance. She or He should be able to guide you in the right direction.
AFTER YOU HAVE YOUR DOCTOR, CHECK THIS OUT with your DOC!
There seems to be a bit of confusion regarding "the flu" and the influenza vaccine, and that is quite easy to understand. It is very confusing, because the bug confuses everyone ... it keeps changing.
BUT ... there are some fundamental rules that have not changed over the years. This CDC document
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr59e0729a1.htm
covers the whole story, and the recommendations have not changed since last year. Their reasoning for expanding the population to be immunized is covered in this document. I recommend that you study it, if you are NOT high risk and you need to decide weather or not to get immunized. If you ARE HIGH RISK, and have NO CONTRAINDICATIONS, you should be immunized for sure. Keep in mind that my conclusion is based upon the fact that I see the casualties who end up in the Intensive Care Unit ... not a good way to spend your days, if avoidable, eh?
TWO TYPES OF VACCINE: INACTIVATED & LIVE ATTENUATED
From the CDC DOCUMENT
"TIV contains inactivated viruses and thus cannot cause influenza. LAIV contains live attenuated influenza viruses that have the potential to cause mild signs or symptoms related to vaccine virus infection (e.g., rhinorrhea, nasal congestion, fever, or sore throat). LAIV is administered intranasally by sprayer, whereas TIV is administered intramuscularly by injection. LAIV is licensed for use among nonpregnant persons aged 2--49 years; safety has not been established in persons with underlying medical conditions that confer a higher risk for influenza complications. TIV is licensed for use among persons aged ≥6 months, including those who are healthy and those with chronic medical conditions (Table 1). During the preparation of TIV, the vaccine viruses are made noninfectious (i.e., inactivated or killed) (8). Only subvirion and purified surface antigen preparations of TIV (often referred to as "split" and subunit vaccines, respectively) are available in the United States. Standard-dose TIV preparations contain 7.5 mcg HA antigen per vaccine strain (for children aged <36 months) or 15 mcg of HA antigen (for persons aged ≥36 months) per vaccine strain (i.e., 22.5 mcg or 45 mcg total HA antigen). A newly licensed higher dose TIV (60 mcg per vaccine strain or 180 mcg total HA antigen) was approved recently for persons aged ≥65 years (Fluzone High-Dose, Sanofi pasteur)."
WHO IS HIGH RISK:
FROM THE CDC DOCUMENT
"Vaccination to prevent influenza is particularly important for persons who are at increased risk for severe complications from influenza or at higher risk for influenza-related outpatient, ED, or hospital visits. When vaccine supply is limited, vaccination efforts should focus on delivering vaccination to the following persons:
all children aged 6 months--4 years (59 months);
all persons aged ≥50 years;
adults and children who have chronic pulmonary (including asthma) or cardiovascular (except isolated hypertension), renal, hepatic, neurological, hematologic, or metabolic disorders (including diabetes mellitus);
persons who have immunosuppression (including immunosuppression caused by medications or by HIV);
women who are or will be pregnant during the influenza season;
children and adolescents (aged 6 months--18 years) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye syndrome after influenza virus infection;
residents of nursing homes and other long-term--care facilities;
American Indians/Alaska Natives;
persons who are morbidly obese (BMI ≥40);
HCP;
household contacts and caregivers of children aged <5 years and adults aged ≥50 years, with particular emphasis on vaccinating contacts of children aged <6 months; and
household contacts and caregivers of persons with medical conditions that put them at higher risk for severe complications from influenza."
STILL CONFUSED?
You will have to study the whole document and ask for guidance. Feel free to ask me questions and send your comments.
Buona Fortuna & Ciao for now,
Dr. Mike
Mission: Healing November 2, 2011
PGY 39, Day 124
StepWisely(R)
Improve Quality First = IQ First(TM)
The First Ten Steps To Rational Cost Containment = provide the Best Possible Care that will fresult in the best possible outcome.
for PROVIDERS in the Intensive Care Units
These tips are based upon my years of experience taking care of critically ill patients. They are especially designed for inexperienced doctors, medical students, nurses, patients and their families, and to help promote Integrated Quality Team Based Care ... STAY ON TARGET to optimize patient outcome and minimize adverse impact on families and loved ones.
1. Engage the Family: The Family is an ESSENTIAL Part of the Care Team
2. DEFINE ADVANCED DIRECTIVES based upon the PATIENT'S Wishes and in conjunction with the Family ASAP (When there is no family, whomever is responsible for the patient needs to be involved, if possible)
3. Use STOMPP*(TM) and the STOMPPIT*(TM) ATM Team Development Tools to help engage ALL Team Members in the definition & clarification of goals and objectives.
4. Restore ALL end organ perfusion RAPIDLY
5. Restore perfusion to organs at risk ASAP by all means necessary
6. Optimize ALL end Organ and Organ System preservation strategies using STOPs*(TM) (Specific Targest for Organ Preservation)
7. Enable Damage Control, if necessary
8. Enable Specific & Definitive therapy ASAP
9. Check END POINTS & STOPs for ALL therapies FREQUENTLY**, especially with regard to restoration of PERFUSION and achievement of DEFINITIVE THERAPY
10. Change the CARE PLAN/TREATMENT PLAN FREQUENTLY on the basis of weather or not your current plan is working & KEEP ALL TEAM MEMBERS in the loop.
*STOMPP, STOMPPIT & STOPS are familiar to the medical students, interns and residents I teach regularly. Contact me, if you want further information about these Patient Care Tools.
**FREQUENTLY in the ICU means at least hourly and sometimes continuously
Do the right thing and ENJOY!
Dr. Mike
StepWisely(R)
Improve Quality First = IQ First(TM)
The First Ten Steps To Rational Cost Containment = provide the Best Possible Care that will fresult in the best possible outcome.
for PROVIDERS in the Intensive Care Units
These tips are based upon my years of experience taking care of critically ill patients. They are especially designed for inexperienced doctors, medical students, nurses, patients and their families, and to help promote Integrated Quality Team Based Care ... STAY ON TARGET to optimize patient outcome and minimize adverse impact on families and loved ones.
1. Engage the Family: The Family is an ESSENTIAL Part of the Care Team
2. DEFINE ADVANCED DIRECTIVES based upon the PATIENT'S Wishes and in conjunction with the Family ASAP (When there is no family, whomever is responsible for the patient needs to be involved, if possible)
3. Use STOMPP*(TM) and the STOMPPIT*(TM) ATM Team Development Tools to help engage ALL Team Members in the definition & clarification of goals and objectives.
4. Restore ALL end organ perfusion RAPIDLY
5. Restore perfusion to organs at risk ASAP by all means necessary
6. Optimize ALL end Organ and Organ System preservation strategies using STOPs*(TM) (Specific Targest for Organ Preservation)
7. Enable Damage Control, if necessary
8. Enable Specific & Definitive therapy ASAP
9. Check END POINTS & STOPs for ALL therapies FREQUENTLY**, especially with regard to restoration of PERFUSION and achievement of DEFINITIVE THERAPY
10. Change the CARE PLAN/TREATMENT PLAN FREQUENTLY on the basis of weather or not your current plan is working & KEEP ALL TEAM MEMBERS in the loop.
*STOMPP, STOMPPIT & STOPS are familiar to the medical students, interns and residents I teach regularly. Contact me, if you want further information about these Patient Care Tools.
**FREQUENTLY in the ICU means at least hourly and sometimes continuously
Do the right thing and ENJOY!
Dr. Mike
Mission: Healing November 2, 2011
PGY 39, Day 124
For FAMILIES of Patients In the Intensive Care Unit
Here are a few pointers based upon my observations while caring for patients in the ICU over the years.
First, For Families and Loved Ones
StepWisely(R)
Improve Quality First = IQ First(TM)= Best Outcome = Best Care = Most Cost Effective Care = Best Practices
The First Ten Steps to Rational Cost Containment(TM) (RCC)
For Families of Patients In the Intensive Care Unit
1. Trusted Doctor: You must have Faith and Confidence in the physician(s) who take care of your family member, friend, or significant other. If you do not trust the people you are dealing with, arrange for a transfer of care to another facility, or doctor, or both.
2. CARRY OUT THE WISHES OF THE PATIENT: Make sure you have advanced directives that are based upon the wishes of the PATIENT, not your wishes, or the wishes of another family member. Do not impose your beliefs upon the patient. Do the RIGHT THING for the patient.
3. TEAMWORK: You are a member of the team. Find out how you can help. Ask what you can do to help. It is NOT HELPFUL for you to interfere in the care of the patient by spending too much time at the bedside. Ask the Doctor and the Bedside Nurse, what you can do to help when you are at the bedside.
4. Take Care of Yourself. You can't help if you are exhausted or in the way. Get some sleep. Identify your preference (if any) for religion and religious support. When the situation is critical get these folks involved.
5. Designate one or two members of the Family who are the primary representatives and spokespeople for the family. You will be responsible to coordinate information sharing with Family and Friends
6. Do not disrupt care: It is not helpful to have any DRAMA at the bedside
7. Write down your questions and the names of the people who are members of the care team
8. Make sure you understand the care plan
9. Review the care plan with the Critical Care Team Every Day and whenever changes are made
10. CONTACT INFORMATION: Give your contact information and GET the contact information for your care team.
Let me know if you want me to elaborate on any of this. Next will come a piece for PROVIDERS and I promised some guidance regarding influenza.
Questions or comments, contact me.
Dr. Mike
For FAMILIES of Patients In the Intensive Care Unit
Here are a few pointers based upon my observations while caring for patients in the ICU over the years.
First, For Families and Loved Ones
StepWisely(R)
Improve Quality First = IQ First(TM)= Best Outcome = Best Care = Most Cost Effective Care = Best Practices
The First Ten Steps to Rational Cost Containment(TM) (RCC)
For Families of Patients In the Intensive Care Unit
1. Trusted Doctor: You must have Faith and Confidence in the physician(s) who take care of your family member, friend, or significant other. If you do not trust the people you are dealing with, arrange for a transfer of care to another facility, or doctor, or both.
2. CARRY OUT THE WISHES OF THE PATIENT: Make sure you have advanced directives that are based upon the wishes of the PATIENT, not your wishes, or the wishes of another family member. Do not impose your beliefs upon the patient. Do the RIGHT THING for the patient.
3. TEAMWORK: You are a member of the team. Find out how you can help. Ask what you can do to help. It is NOT HELPFUL for you to interfere in the care of the patient by spending too much time at the bedside. Ask the Doctor and the Bedside Nurse, what you can do to help when you are at the bedside.
4. Take Care of Yourself. You can't help if you are exhausted or in the way. Get some sleep. Identify your preference (if any) for religion and religious support. When the situation is critical get these folks involved.
5. Designate one or two members of the Family who are the primary representatives and spokespeople for the family. You will be responsible to coordinate information sharing with Family and Friends
6. Do not disrupt care: It is not helpful to have any DRAMA at the bedside
7. Write down your questions and the names of the people who are members of the care team
8. Make sure you understand the care plan
9. Review the care plan with the Critical Care Team Every Day and whenever changes are made
10. CONTACT INFORMATION: Give your contact information and GET the contact information for your care team.
Let me know if you want me to elaborate on any of this. Next will come a piece for PROVIDERS and I promised some guidance regarding influenza.
Questions or comments, contact me.
Dr. Mike
Tuesday, October 18, 2011
Mission: Healing October 18, 2011
PGY 39, Day 110
Children and Their Parents
This book was originally composed and written by me in 1985, for CHILDREN AND THEIR PARENTS as part of our Non Profit Child Development Project, run by our Non Profit Health Development Insititute in conjunction with Northern Cumberland Memorial Hospital (at the time, a Non Profit Hospital in the town of Bridgton) and partly funded by the State of Maine. Although the book was never comnpleted for widespread distribution, it is available @ cost of production. Again, I will put Bits By Bit up on the blog for commentary and to facilitate development of a NEW Edition. Forgive the CRUDE Draft and recognize the value of the content, if you will.
Thanks for your help.
Enjoy!
Dr. Mike
Children and Their Parents
This book was originally composed and written by me in 1985, for CHILDREN AND THEIR PARENTS as part of our Non Profit Child Development Project, run by our Non Profit Health Development Insititute in conjunction with Northern Cumberland Memorial Hospital (at the time, a Non Profit Hospital in the town of Bridgton) and partly funded by the State of Maine. Although the book was never comnpleted for widespread distribution, it is available @ cost of production. Again, I will put Bits By Bit up on the blog for commentary and to facilitate development of a NEW Edition. Forgive the CRUDE Draft and recognize the value of the content, if you will.
Thanks for your help.
Enjoy!
Dr. Mike
Fundamentally, nothing has changed since the book was written. Think about what you read here and send feedback. Remember, it was originally written as a Child Development Guide for Children and Parents, under the assumption that Parents are not born with optimal Parenting Skills. Therefore, we saw it as our goal at the time to work with parents as a team ... to help them develop their parenting skills. Our target was reduction of child abuse and neglect, which is still, and I suspect will always be a worthy cause ...
Mission: Healing October 18, 2011
PGY 39, Day 110
Relaxation is one of fundamentals of Stress Management.
This video, if you focus on the sound and the falling water, is very relaxing. Although brief, it will help most to relax and it can be repeated. Try it, you might like it.
http://youtu.be/zrIwQlri07A
Enjoy & Happy Tuesday!
Dr. Mike
Relaxation is one of fundamentals of Stress Management.
This video, if you focus on the sound and the falling water, is very relaxing. Although brief, it will help most to relax and it can be repeated. Try it, you might like it.
http://youtu.be/zrIwQlri07A
Enjoy & Happy Tuesday!
Dr. Mike
Monday, October 17, 2011
Mission: Healing October 17, 2011
PGY 39, Day 109
More words from The NEW Stress Management Workbook
from Dr. Mike. The latest (electronic) version is designed for use with The Original Stress Management Workbook and will be put up here BIT BY BIT ... in pieces for your review. New stuff will be in parentheses, in order to distinguish between NEW additions and the ORIGINAL version.
*Designed for use in conjunction with your family doctor and The Original Stress Management Workbook
(Maybe in the new version, we will use "she" instead of "he" for "economy of language"?:)
Ciao for now.
Dr. Mike
More words from The NEW Stress Management Workbook
from Dr. Mike. The latest (electronic) version is designed for use with The Original Stress Management Workbook and will be put up here BIT BY BIT ... in pieces for your review. New stuff will be in parentheses, in order to distinguish between NEW additions and the ORIGINAL version.
The NEW* STRESS Management Workbook |
A new & revised action plan for taking control of your life and health |
*Designed for use in conjunction with your family doctor and The Original Stress Management Workbook
by Michael F. Mascia, MD, MPH |
Preface (from our Original Stress Management Workbook, published in 1980. These words were carefully chosen at the time of our original writing. They ring true today, in a New Millennium... more than 30 years after they were written ... and I dare say, these words will likely remain true ... into the foreseeable future. I will expand on this preface for the New edition, but for now, to avoid confusion, I leave it as it was written and published in 1981. Keep in mind, that, if you are an individual who wants to TAKE CHARGE OF YOUR LIFE AND HEALTH, think carefully about these words, StepWisely(R) and join me ... walk with me ... as I create, Bit by Bit ... The NEW Stress Managment Workbook. I welcome your participation and feedback. Enjoy! Dr. Mike Michael Frank Mascia, MD, MPH October 17, 2011) The twentieth century has been marked by tremendous advances in the theory and practice of medicine. Phenomenal scientific and tech- nological discoveries have found their way into medical practice. Peo- ple have grown to expect certain seemingly miraculous results from the institutions and providers of medical care, and often, the expec- tation is that the "impossible" can be achieved. There is, however, increasing popular awareness that modern med- icine cannot perform miracles despite the available science and tech- nology. Professionals and laymen alike are learning that advances in medicine, however dazzling, cannot make up for life styles that breed pathology. Life style is now being recognized as a major factor in the development of many of our modern medical problems. General atti- tude and behavior are clearly linked to the individual's health status. Moreover, most medical problems seem to occur more frequently with increasing stress, and environmental exposure appears to be a factor in most illnesses. Expectations appear to have an effect on health and well-being. Such varied problems as cancer, cirrhosis of the liver, mal- nutrition, pancreatitis, ulcers, high blood pressure, headache, food poi- soning, voodoo deaths, and others appear to be influenced by both internal and environmental factors, both emotional and physical. Professionals and laymen are beginning to realize and teach that the individual has a great responsibility in the promotion of his own health and the prevention of his own disease. The concept of self-care is steadily gaining acceptance. People are beginning to realize that they have control over certain factors that affect their health and well- being. But although these concepts are being accepted more readily, the methods for their application and general use have not been widely available. THE STRESS MANAGEMENT WORKBOOK is designed for the individual who takes the concept of self-care seriously and wants to do whatever he* can to promote his own health and well-being, as well as take advantage of the best that modem medicine has to offer. Although the book can be read rather quickly, the material is de- signed to be implemented gradually and thoughtfully in conjunction with advice from your personal physician. It is expected that your initial planned changes may take up to two years or more to institute. ""Throughout the book we have used such constructions as "the individual... he" solely for the economy of language. Our usage of personal pronouns is not, in any way, intended to imply any connotation of sexual role discrimination. |
(Maybe in the new version, we will use "she" instead of "he" for "economy of language"?:)
Ciao for now.
Dr. Mike
Mission: Healing October 17, 2011
PGY 39, Day 109
A "poem" ... probably just better called a "few words reflecting the dawn" promised and started several days ago ... when Fall was Dawning on Me ... written in Maine.
The photographs below are from New Orleans and Florida. Have a happy day.
Dr. Mike
Fall Dawning on Me
Out of Darkness,
This Morning Dawns with Cotton Candy Skies ...
Magical
Fluorescent Trees Glow ...
Mesmerize
Shouting in silence ...
First shades of red, then yellow and green
Scream,
"Look at me", "No, me", No, me. I am the brightest!",
they "say", shouting in loudest colors,
fighting for attention against eternal pink-blue skies.
She called me out for this glowing feast,
into the cool crisp air, morning dew, soft moss and grass
cold ... feet ...
glide slowly down to earth
Eyes ... and up again
now drifting slowly ... "ahh" ... "apple tree",
red, ripe fruit gently bending branches,
easy reach, yes, "pick the ripest one"
Wet, cold ... "rub to dry ...
and shine"
"bite" a crunching sweetness ...
deeply chilling thoughts
Awaken ... chilled ... shaken ...
I
quickly go inside.
Happy Monday!
Dr. Mike
A "poem" ... probably just better called a "few words reflecting the dawn" promised and started several days ago ... when Fall was Dawning on Me ... written in Maine.
The photographs below are from New Orleans and Florida. Have a happy day.
Dr. Mike
Out of Darkness,
This Morning Dawns with Cotton Candy Skies ...
Magical
Fluorescent Trees Glow ...
Mesmerize
Shouting in silence ...
First shades of red, then yellow and green
Scream,
"Look at me", "No, me", No, me. I am the brightest!",
they "say", shouting in loudest colors,
fighting for attention against eternal pink-blue skies.
She called me out for this glowing feast,
into the cool crisp air, morning dew, soft moss and grass
cold ... feet ...
glide slowly down to earth
Eyes ... and up again
now drifting slowly ... "ahh" ... "apple tree",
red, ripe fruit gently bending branches,
easy reach, yes, "pick the ripest one"
Wet, cold ... "rub to dry ...
and shine"
"bite" a crunching sweetness ...
deeply chilling thoughts
Awaken ... chilled ... shaken ...
I
quickly go inside.
Happy Monday!
Dr. Mike
Thursday, October 13, 2011
Mission: Healing October 13, 2011
The Stress Management Workbook
Bit By Bit: The NEW Stress Management Workbook
Click the link above to View a free Introduction posted via Twitter.
Eventually, I will figure out how to go live with it.
Give me feedback and I will do my best to make sure that your questions are answered in the NEW edition.
Dr. Mike
Bit By Bit: The NEW Stress Management Workbook
Click the link above to View a free Introduction posted via Twitter.
Eventually, I will figure out how to go live with it.
Give me feedback and I will do my best to make sure that your questions are answered in the NEW edition.
Dr. Mike
Mission: Healing October 12, 2011
The Stress Management Workbook
An action plan for taking control of your life and health
http://www.ihealsolutions.com/thestressmanagementworkbook.php
As promised, I am starting to post bits and pieces of the book, as I see the needs are great and the book is available and ... why not? Enjoy and contact me via my website, or email at dr.mike@ihealsolutions.com,
if you want a copy of the book. Electronic copies are not yet available "officially", but I do have paper copies & can put electronic copies on a disc for those who want it that way.
So, this will be a work in progress on the blog ... with The NEW Stress Management Workbook taking shape as I put pieces of the original Stress Management Workbook out here on my blog, with additions, links and commentary on the Original.
Ciao for now,
Dr. Mike
From the original cover published by Appleton Century Crofts.
Drs. Aronson and Mascia retained the copyrights.
New Comments will be put in parentheses
(from the front cover)
An Appleton Book
The
• An "Integrated Model of Health and Disease" - which helps you to pinpoint the physical and
• Diet guidelines - You'll learn which common foods can ease or increase the symptoms of
• Practical stress management exercises that you can fit into your busy schedule.
The stress Management Workbook combines the best of modern medical information with
Appleton-Century-Crofts / $8.95 0-8385-8696-1 (the original price from 1981)
(*Drs Aronson and Mascia worked together in Bridgton, Maine for 14 years and continue to collaborate on this work.)
An action plan for taking control of your life and health
http://www.ihealsolutions.com/thestressmanagementworkbook.php
As promised, I am starting to post bits and pieces of the book, as I see the needs are great and the book is available and ... why not? Enjoy and contact me via my website, or email at dr.mike@ihealsolutions.com,
if you want a copy of the book. Electronic copies are not yet available "officially", but I do have paper copies & can put electronic copies on a disc for those who want it that way.
So, this will be a work in progress on the blog ... with The NEW Stress Management Workbook taking shape as I put pieces of the original Stress Management Workbook out here on my blog, with additions, links and commentary on the Original.
Ciao for now,
Dr. Mike
PS. Always remember that I expect you will use this guidance in conjunction with your personal physician.
PPS. For emergencies, go through 911 or your local Emergency Room/Emergency Services.
PPPS. Over time, I will help you figure out how to
a. establish a relationship with a good doc &
b. figure out how to get the care you need when and where you need it.
a. establish a relationship with a good doc &
b. figure out how to get the care you need when and where you need it.
From the original cover published by Appleton Century Crofts.
Drs. Aronson and Mascia retained the copyrights.
New Comments will be put in parentheses
(from the front cover)
An Appleton Book
The
STRESS
Management
Workbook
Workbook
An
action plan for taking control of your
life and health
StephenAronson, PhD
&
Michael F. Mascia, MD, MPH
(From the back cover)
(From the back cover)
The STRESS
Management Workbook
numerous and varied as its causes. The Stress Management Workbook is a unique, complete
guide to recognizing the factors that are evoking stress - at home, at work, in school, and in
your relationships with family and friends. Once you've identified what's causing you to
experience stress, you've taken the first big step toward overcoming it!
The questionnaires, checklists, and self-evalution tools you'll find throughout the book will
helpyou to measure your personal reactions to stress and to develop a stress management plan
that is tailored to your day-to-day needs. The authors teach you how to use such time-proven
stress management techniques as meditation, exercise, deep muscle relaxation, diet, and
self-hypnosis.
Other features include:
STRESS - You're bound to experience it at some point in your life. Its symptoms are as • An "Integrated Model of Health and Disease" - which helps you to pinpoint the physical and
emotional effects stress can have on your well-being.
• Diet guidelines - You'll learn which common foods can ease or increase the symptoms of
stress.
• Practical stress management exercises that you can fit into your busy schedule.
The stress Management Workbook combines the best of modern medical information with
realistic self-help techniques. As the authors emphasize, a certain amount of stress in your life
is normal and healthy. This book simply shows you how to find and keep the perfect balance for
you - so you can enjoy life to its fullest!
About the Authors*(see updates below each author)
Stephen Aronson, Ph.D. is a licensed psychologist with more than 10 years' experience as an
organizational development and training consultant - to schools, summer camps, corporations,
and government groups. He has taught psychology at the university level throughout the
country. His professional interests include the development of communication skills, and
team management.
(*Dr. Aronson has continued his work in Portland, Maine for the many years since this book was originally published, and he will be invited to help me with certain sections of The NEW Stress Management Workbook.)
(*Dr. Aronson has continued his work in Portland, Maine for the many years since this book was originally published, and he will be invited to help me with certain sections of The NEW Stress Management Workbook.)
Michael F. Mascia, M.D., M.P.H. is a Board Certified Family Practitioner with a private medical
practice in Bridgton, Maine. He has taught Family Medicine in major medical schools, and is
actively involved in the research and development of stress management techniques. Dr.
Mascia is a diplomate of the American Board ofFamily Practice, and a member of the American
College of Preventive Medicine and the American Academy of Family Practice. He received his
M.D. and M.P.H. degrees in 1972 from Tulane University.
(*After 14 years of rural Family Medicine, Dr. Mascia returned to the University of Maryland and The Maryland Institute for Emergency Medical Services Systems for further training in Anesthesiology, Critical Care and Hyperbaric Medicine. Since then, he has taken teaching and leadership positions in several academic institutions including SUNY in Syracuse, New York; Tulane University, in New Orleans, Louisiana; and West Virginia University, in Morgantown, West Virginia. While caring for, teaching about and researching the sickest of patients, Dr. Mascia has continued his interest in and use of Team Development & Stress Management principles and strategies to optimize teaching and patient care.)
(*After 14 years of rural Family Medicine, Dr. Mascia returned to the University of Maryland and The Maryland Institute for Emergency Medical Services Systems for further training in Anesthesiology, Critical Care and Hyperbaric Medicine. Since then, he has taken teaching and leadership positions in several academic institutions including SUNY in Syracuse, New York; Tulane University, in New Orleans, Louisiana; and West Virginia University, in Morgantown, West Virginia. While caring for, teaching about and researching the sickest of patients, Dr. Mascia has continued his interest in and use of Team Development & Stress Management principles and strategies to optimize teaching and patient care.)
Drs. Aronson and Mascia have worked together, conducting stress management workshops for
corporations, government groups, and individuals.Appleton-Century-Crofts / $8.95 0-8385-8696-1 (the original price from 1981)
(*Drs Aronson and Mascia worked together in Bridgton, Maine for 14 years and continue to collaborate on this work.)
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