COVID-19 Update and Thoughts

As of 8am est today, March 26, these are the statistics of where the most effected countries stand.  I've listed them in order of the most number of cases (China).  I've also included the reported number of deaths for each country at this time, and what percent of total diagnosed cases resulted in death.

I thought it would be interesting to see how these percentages compare to the World Health Organization rankings of best overall health systems.  It would make sense (to me) that the higher ranked healthcare systems would fair better than the lower ranked systems in regards to percentage of deaths.  Right?  In the words of Lee Corso, "Not so fast my friend!"

Statistically, the numbers are skewed significantly as the top four countries are definitely on another level of diagnosed number of cases.  In my opinion its clear there are three different tiers in regards to number of cases.  Also, population demographics and other co-morbities need to be taken into account.  Nevertheless, viewing percent of cases resulting in deaths and the WHO rankings is an interesting finding.

Despite what the politicians, "experts" or the WHO says, there is no other place in the world I'd rather have care, especially life saving care, than the United States of America.  Stay safe and well!

Country Cases Deaths % Deaths WHO Ranking China 81285 3287 4 144 Italy 74383 7503 10.1 2 USA 68594 1036 1.5 37 Spain 56188 4089 7.3 7 Germany 39502 222 0.6 25 Iran 29406 2234 7.6 93 France 25233 1331 5.3 1 Switzerland 11435 165 1.4 20 UK 9529 465 4.9 18 S Korea 9241 131 1.4 58 Netherlands 6412 356 5.6 17 Belgium 6235 220 3.5 21

Are non-profit hospitals the biggest ripoff in America?

I came across an interesting read about the fleecing of our system and communities by non-profit hospitals..  My words in a nutshell...How the non-profit designation is sort of phony and allows benefits and advantages over those hospitals and healthcare systems that actually do pay taxes. I  believe it sheds much light on how many, if not all, of these "non-profits" operate.   Many in the community are not familiar with healthcare business and healthcare economics and should be aware.

Click the link below for the article.

https://www.medicaleconomics.com/med-ec-blog/how-nonprofit-hospitals-get-away-biggest-rip-america

Gratitude

With the sad breaking news of Kate Spade committing suicide it has me thinking about mental health and depression this morning. I’m currently on a family vacation with more “quiet time” than usual. It has been awhile since I have been able to unplug with my wife and kids. In fact, this has been our first true family vacation since getting married 2 1/2 years ago. We have taken numerous trips but usually for events or football games etc. Has it been a perfect start?  Honestly , no it hasn’t. But has it been worth it?  Absolutely!

What does all this have to do with depression?  Without a doubt neurotransmitters and neurobiology play an important role in depression. Substance abuse is another large player. I don’t want to talk about that though. Those issues without a doubt need medical and professional help. But there is something that not only assists with those conditions but can assist all of us in every day life. GRATITUDE.

First of all, nothing in life is or will ever be perfect. We will all have our ups and downs. Our mountains and valleys.  I’ve had my share of valleys. More than I care to count. But even in my not so perfect times I have had so much to be grateful for. Even in my lowest place there was much to be grateful for and that helped to persevere.

For me, gratitude is all about perspective. It’s a choice. For instance, I woke up this morning to look out at the pool and notice that my 12 year old left his slides down by the pool while swimming last night. I could choose to be angry that he left them or that I need to walk down there and get them before they “walk off” with someone. Or I can choose to be grateful that I get to wake up overlooking the Atlantic Ocean and sip on my coffee while I stroll to grab his slides and bring them back upstairs while they are still asleep.  After all, I could be getting ready to head into work instead. I can be grateful I have 2 pretty awesome boys....not perfect by any means but still pretty awesome.  I can be grateful I have a wonderful wife that has taken on the huge responsibility of not only dealing with me and my imperfections but has also chosen to be a step-mom to those 2 awesome boys who are still two teenagers and have many not so awesome moments.

Gratitude helps me to be less likely to take anything for granted. Gratitude helps me stay grounded. Gratitude helps me keep my priorities in check. Gratitude reminds me that life is pretty amazing. Now, I by no means do this perfectly but I do have so much to be grateful for. In fact we all do....no matter the current situation.

What are you grateful for today?

Back to Blogging

Blogging Again!!!!

I started this page well over five years ago.  The intent was to create a fun, informative avenue to attempt to begin blogging.  It lasted a short while.  However,  I never took it too seriously nor did I put in the time and/or effort to make it something of value.  Once again I have the urge!!!!

Without a doubt healthcare and medicine has changed drastically since my last post.  This trend will not stop.  Whether we are in a better place now can be debated on both sides.  However, the one thing I believe all will agree on is that changes have occurred and will continue to occur.

We shall see how long my attempt at blogging lasts this time.  I'm planning on posting regularly.  I'm also planning on the subject matter being extremely variable.  I intend to incorporate my personal life and experiences frequently, helping you to get to know me.  Often times expressing opinions where I'd love to hear feedback and your opinions (both in agreement and disagreement).  Hopefully, this will create an informative and entertaining dialogue for everyone involved.

Hope you will enjoy and engage!!

Patient Receptivity to Spiritual Subjects

How do patients feel about the subject? Not surprisingly, it depends. World War II Army Chaplain William T. Cummings famously declared, "there are no atheists in fox holes." Patients seem to have the same sentiment when it comes to talking to physicians about their spirituality.

In a survey published in 2003 in the Journal of General Internal Medicine, researchers asked 456 outpatients in North Carolina, Florida, and Vermont whether they wanted their doctor to ask them about their spirituality. Only one third of respondents interviewed in a clinic setting liked the idea, but the number climbed to 40% in a hospital setting and 70% in hospice.^[2]

"Should we do this in every primary care practice and patient interaction?" asks Drew Rosielle, MD, director of the University of Minnesota's Hospice and Palliative Medicine Fellowship. "Realistically, of course not."

But when a doctor has a little more time, such as during an annual physical, or when a patient is faced with a major diagnosis, working a question or two about spirituality into the conversation can help a physician better understand and support a patient, he says. Rosielle routinely asks a couple of questions about spirituality as part of his initial palliative care consultation with patients so he can refer them to the chaplain on his care team if necessary.

"For patients who are not interested, it's a non-issue," he says. "You just move on. I've never had a patient get offended about being asked."

But for patients with spiritual concerns, the conversation helps him connect them with the support they need. "When you get sick -- especially when you're facing a terminal illness or a life-changing situation, it affects your entire being emotionally, spiritually, existentially," he says. "Patients are hungry for any support they can get."

Puchalski sites an example from her own experience. Several years ago her father, a devout Catholic, underwent surgery for colon cancer. Prior to the procedure, the nurse asked him whether he was spiritual and what that meant to him. A retired opera singer, he responded that he couldn't live without music. Intrigued, she asked him to sing and he responded with a heart-felt aria. Afterward he felt more relaxed and uplifted. The nurse noted his love of singing on his chart. After the operation, other clinicians read her notation and encouraged her father to sing as a way of exercising his lungs.

For her father, Puchalski says, bringing music into the hospital was a profoundly positive experience, "but how would the doctors and nurses have known that if the nurse hadn't asked the question?" she asks.

Assessing Spiritual Outlook

Still, fitting spiritual assessments into practice is a hodgepodge. "From what we've seen in our research almost nobody is using those acronyms," says Farr Curlin, MD, co-director of the Program on Medicine and Religion at the University of Chicago. "It's the rare physician who uses these pneumonic tools. Rather they try to pay attention to signs from the patient and then they try to query them to bring those issues out and connect the patient with spiritual resources in the community or their organization's pastoral care department."

Taylor, says clinicians are caught in a theory-practice gap.

"The problem is we say, 'spiritual care matters,' but we haven't gotten to the point where clinicians can identify spiritual need," she says.

Should Physicians Be Involved With Patient's Spiritual Care?

Science and religion have always had a complicated relationship, so it's not surprising that, as interest in holistic care grows, physicians are trying to come to grips with whether they should play a role in patients' spiritual care.

"We've always talked about the limitations of the biomedical model that would reduce people to our physiology," says Carol Taylor, PhD, director of the Center for Clinical Bioethics at Georgetown University. "When we talk about holistic health, we talk about biological, psychological, and social needs and now we're talking about spiritual needs as well. They're all interrelated."

More than half of physicians believe that religion and spirituality affect patient health in some way, according to research conducted by the University of Chicago. In a survey of 2000 physicians, 56% believed that religion and spirituality have much or very much influence on health, but only 6% believed they often changed "hard" medical outcomes.  Rather, respondents suggested that religion and spirituality help patients cope, give them a positive state of mind, or provide emotional and practical support via the religious community.

While doctors might believe religion and spirituality influence health, acknowledging a connection raises some fundamental and tricky questions. The American College of Physicians' ethics manual encourages physicians to explore a patient's religion and spirituality as part of an overall physical. But how are they to do that? What does it mean, and what are they to do with the information?

Stethoscope and Spiritual Care?

Spirituality, broadly defined, is what gives a person's life meaning. Religion may or may not factor into the picture. In asking about spirituality, clinicians are seeking to identify a patient's source of hope, strength, and values, not their dogma or doctrine.

Research indicates that roughly 80% of medical schools now offer spiritual care courses or integrate spirituality into their curricula, according to Christina Puchalski, MD, an internist at George Washington University and director of the George Washington Institute for Spirituality and Health. But what's included and how it's taught differs tremendously from one institution to the next. In an effort to bring consistency to the spiritual history and assessment process, various proponents have development of myriad tools represented by apropos acronyms such as FAITH, SPIRIT, and HOPE as well as the slightly less catchy FICA and FACT.

Assessing a patient's spiritual health is important, because spiritual issues can not only impact a patient's health, but they can impact a patient's medical compliance and treatment choices as well, says Puchalski.

"What if they don't want to take medicines because they believe God will heal them? What if they're very nature-centric and don't want to put medications in their body? What if they don't believe in blood transfusions?" she asks. "Physicians need to know these concerns if they're going to treat a patient."

However, not everybody believes spiritual care belongs in the examination room. Indeed, those who oppose the idea present a litany of arguments: Spirituality is a private matter. Over-zealous physicians might abuse their position and proselytize to their patients. Pragmatically, many note that in the real world of 15-minute office visits, taking the time to ask questions about spirituality would come at the expense of addressing clinical issues.

Most worrisome says Richard Sloan, professor of behavioral medicine at Columbia University Medical Center and author of Blind Faith: The Unholy Alliance of Religion and Medicine, taking a spiritual history sets a doctor up to be a spiritual guide, "which they are completely untrained and unequipped to do."

"Nobody should deny that spirituality is important to a great many people, but I don't think it's grist for the physician's mill," he says. Doctors need to know about all facets of their patients' lives, he says, but shouldn't ask more than "Is spirituality important to you?" A simple "yes" or "no" answer suffices, he says.

As for the possibility that patients' spirituality might impact their care, Sloan notes that spiritual, financial, transportation, and other potential barriers to care are more likely to surface if a doctor asks, "Is there anything that would keep you from taking this medication?"

Has your physician ever asked you about your spirituality??

My next blog will be how this is recieved/percieved by the patient.  Please make comments.  I'd love to hear your thoughts.

Big Physician Pay Cut in 2012

In the category of not exactly good news, the Centers for Medicare and Medicaid Services (CMS) yesterday announced that it would cut Medicare reimbursement for physicians by 27.4% on January 1, 2012, instead of 29.5% as previously planned

To physicians, this resembles telling a condemned man that his firing squad will consist of 5 riflemen instead of 6.

The slightly lower reduction in reimbursement appears in the final regulations that CMS released yesterday regarding the 2012 Medicare Physician Fee Schedule. Medicare sets these fees using the so-called sustainable growth rate (SGR) formula, which organized medicine wants to abolish. The SGR formula establishes an annual target for Medicare spending on physician services based in part on annual growth of the gross domestic product. If actual spending exceeds the target, the difference is taken out of next year's outlays for physician services.

In March 2011, CMS estimated that physicians would be subject to a 29.5% reduction in reimbursement. The change to 27.4% reflects the fact that Medicare costs this year have grown more slowly than expected, according to the agency's announcement.

The SGR has triggered annual pay cuts for physicians since 2002, but starting in 2003, each one has been postponed by an act of Congress. The postponed cuts then accumulate, leading to the deep one scheduled for January 1. Organized medicine has warned that such a steep drop in revenue would cause droves of physicians to stop seeing new Medicare patients or drop out of the program altogether.

The slightly lower reduction announced yesterday is not changing anybody's tune. Robert Doherty, senior vice president of governmental affairs and public policy for the American College of Physicians, told Medscape Medical News that "27.4% isn't going to make doctors any happier than nearly 30%."

Glen Stream, MD, president of the American Academy of Family Physicians, said in a written statement that the 27.4% reduction "poses a serious threat to the financial viability of physician practices." He cited a survey showing that even a 25% cut would put nearly 13% of family physicians at risk of shutting their doors.

The American College of Physicians, American Academy of Family Physicians, and other medical societies have pressed the new Congressional Joint Select Committee on Deficit Reduction, known as the "super committee," for short, to include a repeal of the SGR formula in its recommendations to Congress.