Archive for the 'healthcare' Category

20
May
10

my new best buds

So my new best buds are the guys from ARCHI- these Australian mates have been very helpful- I’m tempted to fly over. Scratch that- I want my vacation.

Seriously though, they have taught us a thing or two on care management that would have blind-sided us because our healthcare systems are set up quite differently. And this new health reform in the US is one humdinger of a loop- with some strange holes. But the bottom line is that our healthcare is too fragmented at the core- doctors don’t communicate across the continuum of care in a patient. Administration easily misses the quality indicators that are ringing warning bells- until CMS and/or IPRO deny the case and we don’t get paid for anything- and even at appeal it gets dicey- if the documentation is spotty and unjustifiable- no reason to appeal; and those cases that we take to appeal -the percentage upheld tells us that at the beginning of the process- when our patients enter the ER is where our first major mistake occurs…

I won’t rattle on- but every meeting adds more tasks that drill deeper- we know it will be a monster endeavor- we just not sure what to call it!

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18
May
10

work…

In the past few weeks, or maybe even months, at work, there was an intensity that I was hard pressed to define properly, or even find a source for.

Well the news is out (and I’m not surprised); our Corporation is going to do major overhaul. And I mean MAJOR! In the midst of this impacting news- lost jobs, redesign of jobs for those who stay (or are left behind), new labor and affiliate contracts; a few of us have been charged with being the ones to map out the path that will put us smack into the middle of the storm.

Even as I prepare to go on an extended leave, I have been charged with being part of the project’s Steering Committee to create a full and robust, evidence-based, patient centered Care Management program for the major hospital not only of the network I work for, but also the largest of the hospitals in the corporation.

My husband’s look when I broke the news spoke volumes…”You’ll be on overdrive right up until we leave!” Yep! Sure will. And honestly it scares me a bit. Not because I don’t think I can do it. Its what I do to myself when I’m handed a loaded package like this one. I’m, I must admit, an OCD workaholic. I truly forget to sleep and I seem to thrive on walking- running actually on that ‘edge’. That means here come the migraines that are my flags of stress.

So what am I to do? I’ve recruited the teams, I’ve sat with my research assistant and done the homework. We speak Care Management fluently now. We’ve just finished a two and a half day value stream and gap analysis for the financial end (health reforms won’t make things any easier); and are about to do the vertical value stream for the whole Care Management program… The very tip of the iceberg!

Oy Vey! I can forecast a very intense month. Already my office is full of clinical, diagnostic, and administrative guidelines, protocols, pathways, policies and data enough to launch a shuttle! NASA would be proud!

My husband? He just bought the biggest packages he could find of Linden, Chamomille, and Olive Vinegar teas. They will be my life-line when I get home at night. And because I am a night owl, I will NOT start my work day until 10 am. I come alive after noon time. So my folks at home will probably not see or hear from me any time before 8:00 pm! I did promise hubby I would stick to at least 8 hours of sleep. The only thing I can’t promise is the total length of work hours. (My doctors are threatening to write me up if I don’t stick to the plan!) Yes, some of my staff have already volunteered to rotate their tours to be in the office later. They’re the best! I tell them all the time!

What probably ‘saves’ us in a sense is the climate. The season is turning so the sun goes down much later- giving us at least four more hours of daylight. One leg up!

So here we go… T -minus…

17
Apr
10

nursing…a misunderstood and maligned profession in KSA

Recently in Arab News there was a short article on nurses in KSA and how many Saudi nurses (women in this case) had to resign their posts, and maybe even the profession (though not explicitly stated it seems by the article that for some that’s how it ends). I read the comments and as always the ‘mixing’ of genders was a natural argument for some. For others it was equating nurses to medical maids.

The nursing profession has evolved during the last century into a hard-wired niche in the healthcare system. It has become in many countries much more than taking temperature, blood pressure, administering medicine, and washing of sick bodies. The nurses of today dictate surgical practice as seen by the Association of periOperative Registered Nurses (AORN), they are leaders in data collection for a variety of diseases, drivers of medical guidelines and policies, and staunch mediators for the sick and ‘unhealthy’. As nurse practitioners they have acquired an autonomy not envisioned by Florence Nightingale and her contemporaries.

So why is nursing viewed as a ‘humiliating’, ‘degrading’ profession in places like Saudi Arabia? Why are women discouraged from being part of one of the most satisfying and productive professions? Is the concept of sickness so repugnant to Saudis that the best they will want to do is visit the sick and maybe in some unconscious way show off their health to the one who at the moment lacks it? Is a sick person equated with unclean, and therefore untouchable?

I have a problem with that. I also have a problem with certain people who view caring for the sick beneath them. In my nuclear family my eldest daughter is studying to be a nurse. My youngest daughter is studying very hard to be able to enter medical school to become a surgeon. In my extended Muslim family already one of my sister-in-laws is certified to take blood, administer IVs and care for a bed bound person. We applaud and encourage these professions. What could possibly be wrong with keeping a life as healthy as possible or help to bring it back to health?

Should trends like the one in KSA continue, the only healthcare providers will be foreigners. Is this what Saudis want? Do they want the responsibility of caring for their own flesh and blood only in the hands of those who are not Saudi? Is it because they don’t care for their own? Is it because they feel as long as they are healthy they don’t have to look at those who are not? Is it because as long as a foreigner does it its ok? This all seems heartless and unfair for the one who is sick in need of assistance.

I would prefer for Saudis to ‘one up’ everyone around the world and produce not only the best Saudi doctors, but also the best Saudi nurses to rival the rest of the world. Now that would be something I would write in their books a thousand times over as a best deed for Allah to review.

But in the meantime all we hear is men and women spouting idiotic excuses and so called Islamic pronouncements on mixing, on men not bearing the touch of their women after they have touched a sick person. So start with male nurses in male hospitals with male doctors. Start at the same time female hospitals with female doctors and female nurses all so good the world would flock to your doors for medical help. But then again that in itself would only hold until the first boy is born in a female hospital.

Because the Prophet SAW brought the women to the battle field to tend to the wounded and probably the dead; and because there was a time in Islamic Civilization when hospices and hospitals were their forte; and because the Qur’an reminds us life is precious – I hope Muslim countries turn towards their own and build their people up, both genders, and be proud of the work they do, honoring their dedication.

From CMIO.net : http://www.cmio.net/index.php?option=com_articles&division=cmio
And their article on Nurses as Power Users: http://epubs.democratprinting.com/publication/?i=34906

AORN: http://www.aorn.org/

28
Mar
10

Rainy Days and Sundays…

Like the Song – “rainy Days and Mondays” today has been a cold and dreary day in NYC. Even our dog Caesar was not up for a long run; probably still tired from yesterday. We’ve spent it in pyjamas watching movies and eating just about everything. That waistline isn’t going to go down at this rate. We have also basically congregated around the television our laptops, magazines , and newspapers as complementary fare. Reading blogs and answering in them during commercials, or parts of the movie we have already seen and want to skip over. Interrupting each other as we come across something of note. 

I have been worried about Susie back in Saudi Arabia, because her husband has undergone by-pass surgery. A frightening episode to go through by all means. Please send some good vibes and prayers her way. Her blog has always been of interest to me. She is not at the moment a high-powered multi-tasking woman, but stay at home like many of her counterparts in KSA – Arab or otherwise, after living most of her life in the States. And I can see the things that can delight or irk you when living in places like KSA. Her latest ‘moment’ with an interaction between her husband and his physician an example of when profession, culture and gender meet at the boxing ring. My husband certainly didn’t approve of the physician’s behavior, regardless of long-standing friendship. The ‘joke’ was in bad form. I agree and am truly sorry Susie had to face an issue that was unnecessary considering the outcome resulting in her husband’s subsequent surgery. 

At times I wonder if our world is less tactful because we see and know too much and can voice it; or because we have weathered down our parameters of what is prudent to say. Thought is free, but spoken words pay and demand a price. 

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Earth Hour has come and gone. We didn’t even get ‘a blink-out moment’. But we did decide to have a late ‘candle lit’ dinner for the family, once our guest had left. We peppered our conversations with the day’s moments, basking in some quiet time. Candles can make that happen, guess the glow is mesmerizing enough to put you in another mood, time, and place. 

Bottom Fish

 

Western view of the valley below us

 

Since we like to watch those eco-documentaries, ‘Life’ the Discovery Channel’s latest mini-series has been scheduled for tonight. We’ve been talking more about the environment, especially thinking of the diminishing water tables in Yemen. All of which is in direct proportion to the increase in Qat planting and population growth. More of the first than the latter. We have seen how the eco-system in Yemen has been depleted and scared not only by increased Qat production, but by garbage that can’t be contained properly – cascading down once beautiful mountains. Or by the inability of Yemeni to come up with recycling companies to keep the plastic bags from choking the few trees that are left! My husband and I agree that when a population ‘forgets’ how to deal with waste, subsequent health issues, and uncontrolled or regulated farming practices – all goes to pot real fast. 

The Manhattan of the Desert

 

But the literacy level in Yemen has not reached a ‘tipping point’ where old reliable and traditional methods can be recovered and used, nor where newer ecologically friendly ones can be used to their advantage. Wind mills is one I would like to see some entrepreneurial person take on. There is enough wind blowing at good speed to keep them going to power up the country. But the society has been high-jacked by commodities and Qat their population sorely spends on. Not to mention its political atmosphere, too complicated chameleon – like to make sense of at times. Though Tariq Ali tries to make some sense of it in his article this weekend in the London Review of Books review called “Unhappy Yemen”. Please read it and let me know what you think. 

Rainy days and Sundays. How was your day like?

24
Mar
10

throwback…

The good stuff. Cane Sugar. Recently we watched the show ‘the Doctors’ where the topic of conversation was cane sugar versus high-fructose corn syrup. The doctors were discussing the probability of plain sugar being better for you than the now ever present corn fructose substitute we find in just about everything. They proposed HFCS would actually make you crave more of it, making you fatter in the process. Well with most Americans being about 33% heavier than the rest of the world’s population, it does give you pause.

The book, ‘Omnivore’s Dilemma’ states that drinking, and eating products with HFCS is like ‘sipping petroleum’! If it could make chicks and calves triple their weight in half the time, then something was up. All those commercials assuring us this sweetener being equally good as plain sugar were now ringing untrue to my ears. It gave me enough reason to take a look at our food at home especially the juices and sodas, as well as those zero calorie sweeteners. I calculated, in about five month’s time, eating the same diet but using ‘Splenda’, I had actually gained way too many pounds. Oh, the exercise was not at the same level, but the extra pounds could not all be from it. So on a hunch I stopped the ‘Splenda’ and reverted to plain sugar while keeping everything else equal.

My research assistant then recently brought me a ‘Throwback Pepsi’ which contains natural sugar. She asked me what was the difference from the ‘regular’ Pepsi. ‘Well that one’ pointing to her Pepsi, ‘has HFCS.’ She didn’t believe me, yet sure enough there it was on the label. That got her thinking. Today she comes into my office smiling with a ‘Eureka’! She had come across an article from the journal of Pharmacology, Biochemistry and Behavior. The title? ‘High-fructose corn syrup causes characteristics of obesity in rats: Increased body weight, body fat and triglyceride levels,’ published february 12, 2010 by Bocarsly, Powell, Avena, and Hoebel.

Me, I felt kind of vindicated! Because the change back to sugar had shown some results, I was losing weight, I didn’t crave sweets and my body was better processing my food- less fat deposits. Like when I travel over-seas. I tend to eat more, in smaller portions, drink much more water, and only sweeten my tea with regular cane or brown sugar. I always come back a good ten pounds lighter. And this is especially true with trips to Spain and Yemen, locations which obviously have different diets.

Take a look at the article, and if you get a chance read the ‘Omnivore’s Dilemma’, you’ll really never look at your food the same way.

I feel lighter already!

15
Mar
10

a miss match?

Today, like any other day, at a hospital people are born, come in sick, leave stabilized, die. Like in any teaching hospital, today is a day when many find out if they have been accepted, or not, into a residency program.

According to “On Becoming a Doctor” by Tania Heller, MD a Fellow of the American Academy of Pediatrics, the process for Medical Students and for Foreign Medical School graduates is based on applications whereby you are reviewed for qualifications and those “wow” factors like fluency in more than one language, projects completed both domestically and internationally, extra-curricular activities such as summers at a clinic in poor or crisis ridden areas, career goals, etc., all depending on the program’s criteria and the hospital’s ‘culture’. “Residency programs review each applicant and may invite an applicant for an interview. After completing interviews, the student [and foreign graduate] ranks his choices and submits a rank-order list to a central service, the National Residency Matching Program (Match). The residency program also submits a list to the same service. A computer matches students to programs based on the submissions, and on a specific day in March, the results are announced.”

Having experienced by proxy the anxiety that-certain-day in March can provoke, I can honestly express the turmoil that can result when you get the news. My husband was literally paralyzed that day. The man couldn’t even have bite to eat, he was so nervous. The million and one thoughts crashing against each other: Did I put down all my choices? Did I rank them properly? Were my interviews as great as I thought they were? What ever compelled me to want to become a doctor in the first place?!

Then the moment comes- and you hear those words- your selection or your failure. Those who are matched run the gamut from ecstatic to miffed because they did or didn’t rank where they thought. Those who are not matched, however, are faced with some deep, heart wrenching decisions to make. Their lives are now defined by it in some ways, and they have to calmly (something easily said, never done) assess their options and hopefully move forward.

My husband got matched to the program he had ranked second. He had put his hopes on four programs and was actually surprised in getting his second choice. He, until that moment, believed he would probably get into the fourth choice. So for us it was a cause for celebration. It would be the beginning of many sleepless nights for me- my husband being the bigger insomniac didn’t feel it as much. I kept pumping him with lots of energy rich food to keep up his stamina.

During the first two years we set up the routine that we still maintain to this day. The ‘Friday night’ not followed by an on call the next day was our night out for movies and dinner- with no shop-talk, no exceptions. Being a couple who dealt with healthcare from two different sides can have tremendous disadvantages- all we talk about IS healthcare. We understood it and promised each other that we would create a space where the term would be left out so we could enjoy other things. Going to the opera, the ballet, going for walks, dining out, playing a sport were all activities that we did in that space. It helped us survive residency as a married couple.

The other disadvantage in our case was my husband going to medical school when others his age were half way through their residency or in a Fellowship program. That added an additional burden. As well as being a Yemeni immigrant during a time when education was the least of the priorities for many of his compatriots. The men he knew from his village would go into factories or stores. Not much has changed since. Everyday more come to be those seasonal immigrants- living with one foot here and everything else in Yemen. It continues to be a topic of conversation that invariably makes my husband upset because of the “yemeni group-think” so prevalent across their country and more so in the mountains. He has “bucked” their version of traditional work and social roles. You should see the thunder cloud that descends upon his face when he is introduced to fellow Yemeni and they ask him what store he works in. Now that, is not a pretty scene.

For those that find themselves without a residency program match, that-certain-day in March can spell doom for them, depending what was riding on the outcome. This happened today with one of our volunteers. Educated in the Philippines this volunteer came to New York with her husband. He was chosen for a residency program from the-get-go last March. She applied this year. The outcome was not what she expected. My boss wrote to me, when I gave him the news, that a few things may have affected her chances and now she would have to regroup and build strategies for the road ahead. But, he said, he was not surprised: She should not have taken “the year” off. My husband echoed the same.

She was too upset to talk beyond saying that she was not matched. We told her to come in and we would help her plan next steps. But somewhere in there I wonder if being “the doctor’s wife” took some wind out of her sails.

It is not exactly easy being the doctor’s wife when your chosen career is the same as your spouse. Heck, its not easy even if you’re your spouse’s opposite. But it is less competitive. There is more room to maneuver within your relationship. Other professions, obviously, can be just as competitive or more so, but my opinion comes from experiencing two different professions in my husband alongside mine.

I hope she will be open to suggestions from our medical staff and from our administrators, whatever they may be in whatever ranges are proposed. There are options, I hope she sees them for what they are.

01
Mar
10

when you don’t prepare for the unexpected

Lately, with hearing from American Bedu’s recurring illness and the loss of her beloved Prince, our recent encounter with death of a patient and his refusal to notify his family prior to his demise; I can only see certain parallels of my boss’ and my battle with diseases that are anything but gracious. All unexpected and filled with tribulation; some to end with disastrous consequences beyond the death or survival of the loved one.

My boss was not prepared for the news that his non-smoking, well exercised, well cared for body would betray him with two different cancers- one around his carotid artery in his throat and the other in his thigh. At his absolute best in his career, with a loving wife of more than thirty years- my boss was not prepared for what turned out to be the most aggressive chemo and radiation therapy, a cracked skull, a pacemaker, three surgeries, and a year where he so changed my heart broke the day his wife called me and said “come”- so thin was he I couldn’t find him in my arms. When I stepped outside to recover some balance, all I could say in his beloved Diana’s arms was “Please, where is my jefe? Please bring him back”.

Those were hard months, but in the shadows loomed something that would rock my family to its very foundations and all but ruin my boss’ recovery. One day I fell into a coma.

That time for me was a void- a nothing within nothing- no realization of being. For my husband and my daughters it would be the worst eight days of their lives. Because upon them descended my maternal AND paternal clan. A mixture of Spaniards, Dominicans, Lebanese, Jordanian, and God knows what else stormed the hospital. My youngest used that term- she felt like it was an invasion! And it was; everything was second guessed, quarreled over, broken, parceled; this one blaming the other. My husband thought for a moment, a long one at that, he and the girls were no longer my family- they felt as outsiders and all plans- what few we had ever made were swept away under a barrage of demands from both sides.

My husband was not prepared to feel and see the until then hidden feelings of my non muslim familiars- their disparaging remarks of even my hijab that my spouse knew even in death I would never relinquish willingly, and astonished at the depth of festering anger on the muslim familiars-who believed they had more right over me than any one- I was an object. He was blown away by the callousness at one point when someone- never did want to tell who- suggested “we go to plan B”- my inevitable death! In front of my girls (my son was being shipped back from his post) and my husband they would divide my belongings, my legacy like buyers at the market square.

Then I was told would come the recriminations the “why did/didn’t you two plan this that or the other”- those would end on the day my son arrived to find his father had aged eons and he summarily threw everyone out- I think it had been the uniform and his “assess and take command” stance- my husband willingly let him take charge, because all he really wanted was to be by my side no matter what came.

This would teach us all a great lesson- we had not envisioned such a storm in the middle of a life or death disaster- we would pay high prices for not truly planning for the worst. That sense that in the end things will work out- never did we in our wildest dreams believe our faith in our family could be shattered so utterly in an instant.

After all was said and done; after the relapse and the up hill battle to recovery, I was left with a dark and potent understanding that we truly must have those conversations Bedu spoke of*, we must look at death and point to it and say- this is what we will do when the time approaches or has come to an end. But most of all we must prepare our most precious for strength and determination to carry out our will.

Unfortunately, something broke in my clan- the deep seeded wrongs blossomed to the surface opened by the chasm that was my coma. And all I can say is that, while few ever return to hear of the horrors a family can commit when in preparation for a family member’s death, I was able to return from that void and learn to protect MY family- my adoring husband, my son and my daughters- from this ever happening again.

The Health Care Proxies are now firmly written and legalized, the last will and testaments written, the documentation of our lives secured and known to us five. Our every last wish discussed and put to legal size parchment.

Better safe than sorry is one adage I will never forget.

Today unfortunately the news is not good. After a year and a half we were told my boss’ cancer is back- we step upon the roller-coaster once more. He will have an operation on Thursday and will start again the chemo and radiation he so dreads. I could only give him hugs as I left for my own appointment- devastated and sick to the core. My results are in- I have two clots that need to be dealt with now, the Coumadin cycle begins anew, the scans, the x-rays, and again I become reacquainted with those hurtful arterial blood draws! God those hurt- Alhamdulillah the clots were found before they could do more damage or create the havoc of last summer.

Please pray for my boss- these roller-coasters are always scarier the second time around…

*http://americanbedu.com/2010/03/01/saudi-arabia-preparing-for-emergencies-and-contingencies/




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