health care

Tinker Ready reports on a meeting yesterday of the Association of Clinical Researchers and Educators at Brigham and Women's. The group was formed to fight the state's new ban on Big Pharma gifts to doctors and researchers.

Dr. T recalls the time she was about to anesthetize a patient for routine surgery when she was called down to the ER for a trauma patient on the verge of death:

... Someone handed me a smaller endotracheal tube to see if I would have any luck with one last attempt at an intubation. By this time there was barely any use even looking into the airway; the tongue was enormous, and the blood kept collecting.

"You're starting to get some runs of v-tach," said one of the nurses.

I maneuvered the tip of the tube toward the trachea, or what I thought would be the trachea, advanced it a little, then advanced it some more while an assistant removed the stylet. The physician applying pressure to the cricoid cartilage raised his eyebrows and said, "You know, that actually felt like it went in." ...

The New York Times reports.

The Dorchester Reporter reports that Gov. Patrick says that if the legislature overrides his veto of some funding for the Franklin Park and Stoneham zoos, he might have to cut money from a program that subsidizes health insurance for legal immigrants.

Anastamosis reports on some of the brain surgeries she's seen of late, including:

... i also saw a trans-sphenoidal surgery, which basically involves taking a brain tumor out from the nose! it's one of those times where all you can say is whoaaaaa, that is so cool.

Anastamosis, a third-year medical resident, is in the operating room as part of a surgical team trying to save the life of a man shot in the abdomen. All of a sudden, music starts playing:

... this isn't uncommon - surgeons often bring their own iPod, or the scrub nurse will turn on Pandora - but as the first notes came streaming out from the speakers, my ears perked up. was this U2's "bloody sunday"?

indeed it was. i glanced at the clock. it was just past midnight, making it sunday, and our hands, the surgical field, and the patient were covered in blood. i looked around, wondering which circulating nurse had the ironic sense of humor to play this, but they were all sitting around, faces impassive.

the lyrics struck me as they have in the past, though more physically now, as i had my hands in the abdomen of a guy who had been shot ...

Cardinal O'Malley pulls the plug over abortion issue.

Charley on the MTA explains why it's far too premature to bury a system that, in fact, has dramatically, if not perfectly, expanded health coverage.

Charlie Baker at Harvard Pilgrim writes people have figured out how to game the state's mandatory insurance system: Buy insurance for a few months, run up massive bills, then cancel insurance and pay the relatively low penalties for going without:

... Between April of 2008 and March of 2009, about 40% of the people who purchased individual insurance from Harvard Pilgrim stayed covered by us for less than 5 months. Even more amazing, they incurred, on average, about $2,400 per person in monthly medical expenses - roughly 600% higher than what we would have expected. It wouldn't surprise me if other health plans have the same problem. ...

His proposed answer: Let insurers reinstate the waiting periods and pre-existing exclusions for new subscribers that was eliminated with the health-care reform law. He doesn't say what people who have pre-existing conditions would do, but presumably they'd still go to hospitals, which would then have to eat the cost or pass it along to insurers - just like in the days before mandated insurance.

Unfortunately, John Cass has had to take his son to the MGH emergency room twice. But he reports the facility no longer feels like something out of Dickens:

... Instead of Victorian brick, we visited a newly designed 21st century facility, where triage happened within minutes at an individual nursing station, then registration with a clerk, before waiting in the children's waiting room for half an hour. The whole experience took 2-3 hours, and though could not be contrasted with our earlier visit which really was life threatening, was a whole lot better because of the new facilities and to me better organization. ...

Cleary Squared thinks they're wonderful, after getting into one in Porter Square right away to get his ears cleared out of wax:

... It doesn't make sense for people with minor injuries have to wait for care from their PCP, especially on the weekends, or have to shell out a much higher copay at the ER. The "continuum of care" will still be there; it just took the urgency of the situation and the ambition of the patient to take action.

That is why I made the choice to have my earwax situation taken care of now, rather than waiting two weeks for my PCP to do the same thing and have my ears plug up worse. This is why I had to go to Cambridge to do it, and I'd do it again above Mayor Menino's (and my PCP's) objections. ...

The Boston Public Health Commission is out with its Health of Boston 2009 report.

Via Tinker Ready, who pulls out some interesting factoids.

Beth Israel Deaconess Medical Center CEO Paul Levy says he was offered a chance to buy Landmark Medical Center in Woonsocket, declined it faster than you could say "State of Rhode Island and Providence Plantations" and wonders what the deal really is with the financially troubled Caritas Christi buying the financially trouble Landmark.

Sharon Machlis finds it pretty ironic that the for-profit owners of MetroWest Medical Center are howling about Newton-Wellesley Hospital wanting to open an orthopedics center on their turf even as they expand their own physical-therapy services in Milford Regional Medical Center's coverage area:

... Certainly, Framingham Union Hospital is an important employer and service for downtown Framingham. But that still doesn't make it right to ask the government to create a non-compete protected service area for an investor-owned, for-profit corporation. ...

Xconomy reports Partners HealthCare, which owns Mass. General and Brigham and Womens, is launching a startup to get into the burgeoning home-testing market.

The spinoff's first product is a system that lets users connect a blood-pressure cuff to a computer, which then uploads the results to a server on which users can track how their blood pressure is doing. The new company says a trial run with hypertensive employees at EMC showed the system helped them better control their numbers.

Two days after major surgery, the patient seemed to be doing fine medically, and yet, he was cracking up. Anastamosis, a medical student at one of our world-class teaching hospitals, describes why, for want of some simple sleep aids, the patient was nearly lost - despite near constant visits from seemingly endless teams of specialists.

Granted, Charlie Baker runs a private (albeit non-profit) health insurer. Still, he makes the argument that before government begins competing with providers like his, it first needs to deal with the fact that America is getting older and figure out how to be less ridiculously complicated. He cites as just one example a recently enacted subsidy for unemployed workers on COBRA:

... [I]t's really not administered as an individual benefit. Instead, the employer and the health plan are required to figure out who's eligible and for how much over that period of time, to pay out the benefit/subsidy to the eligible individual, and to then claim credit for that payment on subsequent employer payments into Social Security. That's right - the employer and the health plan figure out who's eligible, for how long, and for how much. We then deduct the value of the subsidy from what would be someone's full COBRA payment, we then get reimbursed by the feds through a reduction in our FICA contribution. If this sounds complicated to you, it should - because it is. We spent a lot of money (like hundreds of thousands of dollars) just putting in the technology to keep track of all the moving parts.

And by the way, the form the feds developed for beneficiaries to fill out to claim eligibility is, ah, about 11 pages long and has so many "if /thens," "and/ors," and "must/must nots" associated with it, I wondered when I first read it about how many people would be able to determine if they were eligible or not. I didn't have to wait long to get the answer to that one. To date, we've sent out almost 4,000 letters, answered tons of questions and only enrolled a little over 100 people. Sheesshh. ...

USA Today says Boston has the nation's longest wait times to get an appointment for a specialist. Beth Israel Deaconess CEO Paul Levy discusses the medical center's efforts to cut wait times for its clinics:

Over one year, the average wait time for all of our medicine clinics has dropped from 13 days to 4.4 days.

The hospital is trying to cut that to 3 days. Levy says part of the drop is due to the use of "mystery shoppers," who file detailed reports on their experiences as "patients."

According to a new study, a mobile health clinic run by Harvard Medical School to serve Boston's low-income neighborhoods has substantially improved public health as well as saved the healthcare system millions, the Globe reports.

Channel 5 reports: A Boston woman who defied the medical odds against her to live long enough to see her baby born lost her battle with cancer Saturday.

Tammy Donroe, who normally writes about food, reports she's been diagnosed with breast cancer:

... I've struggled with whether or not to bring this up on the blog. This is a food blog, after all, not a cancer blog. And I don't want this to become a cancer blog (not that there's anything wrong with that). But this blog is about my life through food, and if I censor my life too much, then it doesn't feel honest. Plus, logistically speaking, it was going to be tricky to hide it. Sooner or later you were going to wonder why all of my dinners of late have been composed of 50% potato chips and 50% tequila. The increased unexplained absences might seem suspicious given my previously consistent blogging schedule. And the mood swings. My god, the mood swings. PMS is dreadfully boring by comparison. ...

The Sunday Globe has a well-researched report on the value of tax exemptions and other financial breaks enjoyed by area hospital companies.

The piece gives context, and raises the question of whether hospitals should be paying more to the local government.

In addition to shutting Boston Latin School, the Boston Public Health Commission says it is also closing the Winsor School, a private girls school on Pilgrim Road, for seven days starting tomorrow.

As at Latin, the cause is "unusually high levels of influenza-like illness in recent days." The commission says 34 students - out of 430 - were out sick today.

Boston Public Health Commission statement on Boston Latin and the Winsor School.

Ed. question: Given that the two schools are right in the Longwood Medical Area, are we soon going to hear about a hospital suffering an outbreak?

The Urban Paramedic recounts one of his runs from start in a Blue Line station to finish in an ER staffed by the world's crankiest doctor.

Mass. High Tech reports a Concord start-up has come up with a new way to treat inflamed tonsils: Heat them up.

gRadiant says heating tonsils causes their cells to die, reducing the need to surgery to snip the organs out.