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Most would agree with the idea that music can have a powerful hold over us—our thoughts, feelings, and movements. Given this, how might music help measure thoughts, feelings, and movements in a way that allows professionals in healthcare improve client treatment? The music therapy profession seems to be experiencing a surge in developing data-measuring tools that incorporate music in the client assessment.

The post A new (musical) direction for healthcare? appeared first on OUPblog.

While myriad forces are changing the face of contemporary healthcare, one could argue that nothing will change the way medicine is practiced, more than current advances in technology. Indeed, technology is changing the entire world at a remarkable rate – with mobile phones, music players, emails, databases, laptop computers, and tablets transforming the way we work, play, and relax.

The post Simulation technology – a new frontier for healthcare? appeared first on OUPblog.

In the late 1960s, an ugly little rhyme circulated in Britain’s declining industrial towns. At the time, seemingly unstoppable mass migration from Britain’s former colonies had triggered a succession of new laws aimed at restricting entry to Britain, followed by a new political emphasis on ‘race relations’ intended to quell international dismay and reduce internal racial tensions.

The post Migrants and medicine in modern Britain appeared first on OUPblog.

At the dawn of the children’s hospital movement in Europe and the West (best epitomised and exemplified by the opening of London’s Great Ormond Street Hospital for Sick Children (GOSH) on 14 February 1852), the plight of sick children was precarious at all levels of society. After a long campaign by Dr Charles West, Great Ormond Street hospital was the first establishment to provide in-patient beds specifically for children in England.

The post Charles West and Florence Nightingale: Children’s healthcare in context appeared first on OUPblog.

I can honestly say, these past three months have been the most exhausting, frustrating, rewarding and fulfilling months in my life. Well, maybe not my life, but they certainly rank in the top five.

1. We moved offices.

It was a confusing, whirlwind mass of chaotic activity. We all knew we were going to move to our new office at the hospital, it was inevitable, but we were told it wouldn’t be until closer to Thanksgiving, so though we knew we were moving, we weren’t really PSYCHED to move. Suddenly, our new office was done and the CEO of the company didn’t see the need to delay the inevitable so we got the green light to move.

It wasn’t a slow, organized move, it was a crazy, throw everything in boxes and load up our cars move.

We moved on a Friday but we didn’t close up shop to move. It was business as usual and we packed our crap up in between patient phone calls. Each team was allotted about two hours to pack our crap, load it up and drop it off at the new office. Then, once the phones shut off at 4:30, we all went into frenzy mode and moved the rest of our stuff. We unloaded just the stuff we knew we would need for clinic on Monday and the rest stayed in boxes.

It was a crazy, disorganized but sort of fun time. And we survived our first clinic in our new place. My doctor was pretty patient, (what choice did he have?) and when we explained the situation to the patients, they were pretty understanding and patient, too. (Again, what choice did they have?)

I love this office. I truly do. It’s spacious and still has that NEW smell. We’re located on the 7th floor and we have a spectacular view of the city. We are the only specialty on our floor so we have the place to ourselves. I’m proud to work here. I know it’s impressive and people are impressed when they get to us.

We’ve had issues. We’ve had doors that wouldn’t open and doors that opened so fast that they were seriously a hazard to anyone within slapping distance. We have been unable to locate light switches and we still have problems with light-motion sensors that are too sensitive and often shut off leaving us in the dark and either having to wave our arms to bring the lights back on or we have to work in the dark until we physically get up to turn the damn things on again.

The toilets flush so loudly they are seriously damaging our eardrums and everyone has to hold their ears when they go off to protect ourselves. At least we won’t have to worry overly much about clogging them as I’m pretty sure they have so much suction they would suck a small child down the pipes if given the chance.

Our docs don’t have offices. Instead, we have collaboration spaces within each “pod.” We have five pods total. In fact, I’m using a collaboration space right now to write this. (More on that later). These collab spaces are intended to allow the physicians to sort of disappear whenever they need a break or want someplace private to eat their lunch. These collab spaces also double as meeting rooms or in my case, study spaces. Since the doctors are only in the clinic two times a week, they are in surgery the rest of the week, they didn’t see the need to have permanent spaces for temporary occupancy.

We’ve been in our space now for three months. Three months, in some ways, it feels a lot longer. We still don’t have enough stools to sit on in the exam rooms and supplies to supply 55 exam rooms. (Each pod has five exam rooms each – we also have one large procedure room in case the doctors need to treat wounds or more complicated issues). For several weeks, we didn’t have enough scales and we had to routinely share and move scales around in order to work our clinics.

Even though we are the only specialty on our floor, we still have room to grow. The front part of our floor is undeveloped and locked off. I have no idea what the hospital plans on doing with this undeveloped space and can only guess that it’s intended to add on more doctors, but we’ll see. So that’s exciting, knowing that at some point, there are likely more changes in our future.

If you can count on anything in business, it’s change.

Let me see if I can explain this set up for you …

When you get off the elevators, you can only go one way and that way is to a centralized podium. The person at the podium then “blues” you in on the schedule so that people like me will know you’re on the floor. The podium person will then direct you to the pod where your doctor is located. I work out of pod 5. Patients will then settle into our waiting room and wait for me to call them back to a room where I start their charts and get their vitals.

On Wednesdays, we share the waiting room with another doctor and last week it was so crowded it was literally standing room only. It’s so weird how the patient flow works out – we will be an hour ahead of schedule and suddenly, we have an influx of patients and we’re an hour behind.

I think this week, I’m going to ask my doctor if he would mind if we used the main waiting area – the area that people see when they first get off the elevators. It’s just too confusing for patients and awkward for me to try and keep track of everyone.

I’m all about efficiency. In fact, I’ve sort of developed a reputation for being “on top of it.” I probably over plan clinics but in my mind, a little preparation goes A LONG WAY towards a more organized clinic. In fact, I’m pretty sure my doctor has come to expect this preparation from me now so there is no way I would NOT plan my clinics, I wouldn’t want to disappoint him.

Which leads me to the second big work change ..

2. We finally switched over to the hospital charting software program in August.

The hospital has been “warning” us for years this change was going to happen so it’s not surprising that it happened once we moved onto the hospital campus.

We spent weeks staying after work transferring people over on to the new schedule program and into the new charting system. It was exhausting but it allowed us to make extra money and to familiarize ourselves with the new program so that ultimately, we taught ourselves how to get around it faster than if we hadn’t stayed to do data entry.

The first week we went live, we had software representatives available for questions. Which sounds awesome on the surface, but wasn’t really awesome in reality. Though they knew their way around the program, they were unfamiliar with our specialty and our specific needs. I can’t tell you the number of times I heard, “well, this is the way it’s supposed to work, but the feature is not working now.” After a time, they were just in the way and became super annoying to have around.

You could FEEL the tension emanating off our bodies that first week we went live. IT. WAS. FRUSTRATING. to say the least. And it’s still frustrating to this day. It’s hard to find anything, let alone quickly. Everything is filed into folders, each doc has a folder, I have a folder for all of the documents I put into the patient’s chart, every type of document has a folder, days have folders, it’s pretty insane, quite frankly.

And the programs, the charting program and the scheduling programs, are GLITCHY. Things will disappear, or we get error messages, or the program will just shut down. And our servers SUCK. They are SO SLOW. In fact, these programs are SO glitchy and slow that our ER finally put their foot down and refused to use it. They use something different.

It’s not unusual for me to completely shut down my computer, several times a day because it just locks up.

AARGH.

I think our docs had the most trouble with the program. They were definitely not set up the way our physicians wanted them to be set up and we’re constantly coming up with ways to get around restrictions. The hospital will likely figure out some of the workarounds we’re doing but that’s the only way our physicians can get their work done so I’m sure the hospital, at some point, will no choice but to make those changes. In the interim, we make do.

So. We moved on July 17th and went to a new software system one month later.

I was working 60 hour weeks for WEEKS during this process. I’m just NOW getting to a point where I’m now going home at 6:00 instead of 8:00. I haven’t seen my family in three months. Truly, I haven’t been home to have dinner with Kevin or the boys, during the week, in three months. I haven’t had time to stop. It’s been crazy.

Some of that crazy came from our phones.

3. We FINALLY went back to voicemails.

Some knucklehead had the bright idea that answering all of our calls live was the way to go. And for a while, it seemed to work. We answered live calls and did our best to help the patient with his/her questions/requests. But after a while, that’s ALL we did. Let me break it down for you.

Monday – I was in clinic. So I didn’t answer calls. I focused primarily on making sure the clinic ran smoothly.

Tuesday – I needed to schedule the Monday clinic patients for testing, but I didn’t have time to do that because I was in the pit answering live calls. So, I was taking calls for other doctor patients who had to tell their stories, from the beginning, to me because I was not familiar with their background. And then, being on a new system, it look three times as long to look anything up because we couldn’t find the damn information. AND/OR we had (still have to) access our old system – so in essence, we were working out of four systems, our old charting/scheduling programs and our new charting/scheduling programs. And when you answered live calls, you had to stop what you were doing before the call, to take the call, and when you hung up, you didn’t have time to start your own work because the damn phone would instantly ring.

Can you tell I LOATHE the phones??

Wednesday – I’m back in clinic. And I haven’t had a chance to touch my Monday clinic.

Thursday/Friday – I’m back on the damn phones. And again, I do not have a chance to get my clinic work done because I”m now forced to take care of patients for all of the docs. So the ONLY time I had a chance to clean up my week’s clinics AND prepare for my upcoming clinics, was after hours.

It was an insane process.

And to top it off, I started having chest pains. I don’t know if it was because I was under so much stress and working 60 hours weeks, or if it due to gas from starting to take Coconut supplements, or maybe a combination of both, but I ended up in the ER one night.

I was working clinic on a Wednesday and I just couldn’t breathe. I felt like I had to continuously take large breaths in order to function. I made several trips to the restroom just so I could pause, close my eyes and force my body to settle down. I took my blood pressure and it was way high. And my heart rate was over 100. I had chest pain but no arm/jaw pain so I really didn’t think I was having a heart attack but something was OFF.

Then that night, I just couldn’t sleep. My heart was racing double time and I was laying down!! I started hyperventilating and text Kevin (because he was at band practice) and he rushed home and took me to the ER. They hooked me up to an EKG machine and luckily, I wasn’t have a heart attack. They put me into a room and gave me liquid Ativan. Liquid GOLD, I say. That calmed me right down and my blood pressure went back down to normal. They didn’t give me an explanation for my crazy, but I’m pretty sure I had a panic attack. I think the pressure just got to me and I snapped.

I haven’t had an attack since then. I’ve adapted and learned to cope with this stress.

We had another person in the office break out into a rash because of the stress. When the director of our department found out about our physical manifestations to all of this stress, he put his foot down – it was time for changes.

We narrowed down that the phone situation just wasn’t working for us. So, we called our communications department in and they set it up so that each doctor has a voicemail now. Now, I can get to phones on MY time. And I’m already familiar with my doctor’s patients so that cuts down on response time. And I can return phone calls all at once so it’s way more efficient for everyone.

We’ve been back on voicemails for several weeks now and everyone is WAY more relaxed. We have time to BREATHE. We can all go to lunch together, if we want. We’re more in control of our processes and time. And that has left more time for me to pursue my next goal …

4. I’m studying for my CMA test

The CMA test is the Certified Medical Assistant test. The hospital has put together a pretty sweet incentive package for the medical assistants to become certified. It’s better for us, for the doctors and of course, for the hospital. So that has motivated all of us to study for the thing. A few of use have been staying late, or coming in on the weekend (like today – but I’m writing to you instead because I was feeling it today), to prepare for this. It costs $150 dollars to take the 3 hours test so I’m also motivated to take this pretty seriously because I don’t want to blow $150.

I’ve purchased study materials and I plan on purchasing a practice test so that I can focus my studies on the sections that will be on the test. I’ve only really been studying seriously for the past several weeks and I already feel like I’ve learned a lot. It’s stressful though – I feel like I’m cramming four years of medical school into about six weeks. I’m not going to tell you, or anyone I work with, the actual date I plan on taking this test, that way, if I fail, no harm, no foul. My goal is to just announce to everyone that I passed. If I told everyone my plans, took the test and then failed, I’m pretty sure I would be too mortified to show my face again. Everyone is wanting to go take it on the same day, but I simply can’t do that – I will be a bundle of nerves anyway, let alone taking the test with a bunch of people I work with.

The hospital is not only offering a bonus for becoming certified, but they’re also offering an hourly pay increase. And it’s a pretty sweet jump, let me tell ya.

So yes. I’m focusing my energies onto passing this thing now. I’ve been staying after work not only to finish my work, but on collaborating with my fellow co-workers on studying for the CMA.

I’m looking forward to the day when things get back to normal. Our entire worlds, and not just working worlds, but personal worlds, have been turned upside down these past several months.

But then I’ll have continuing education requirements after I pass the CMA in order to KEEP my CMA status.

It just never ends, does it.

An unacceptably large proportion of mentally ill individuals do not receive any care. Reasons vary but include the dearth of providers, the cost of treatment and stigma. Telemental health, which uses digital technology for the remote delivery of mental health services, may help toward finding a solution.

The post Telemental health: Are we there yet? appeared first on OUPblog.

World Blood Donor Day 2015 is celebrated on 14 June each year. This Sunday, the theme is "Thank you for saving my life," a chance for everyone who has benefited from a blood donation to thank the donors that selflessly donated to the cause. The demand for blood is always high as the shelf life of donated blood is only 42 days.

The post World Blood Donor Day 2015: blood types [infographic] appeared first on OUPblog.

So, I get to work (side note – it was freaking COLD last week!! Wednesday’s high was 13!), reach out to grab the door handle to go into the clinic and I hear it – the faint sound of an alarm.

Was the alarm our clinic? Was the alarm coming from the apartments behind the clinic?

Feeling cold and not really caring overly much, (I’m curious – but not THAT curious), I enter the clinic. I head back to the pit (side note – did I tell you guys that we call the nursing area where we answer phones – we don’t have voicemail – the pit? Because it is … the pits. Get it?) when the medical secretary asks, “Did you hear the alarms when you came in?”

“Yes. But I couldn’t tell where it was coming from.”

“It’s us,” she says.

“Wait. How is it us? Wouldn’t we hear it in here?” Which I didn’t.

“It’s coming from the back, something to do with the sprinkler system, I think.”

“Humph,” I shoot back, because honestly, I don’t care overly much. I’m very choosy what I expend energy on – just ask any of my co-workers. lol

I go out into the clinic area, grab some clean gloves and Sani-wipes and begin to clean my exam rooms. (Because I forgot to do it the day before). As I’m nearing the last room, I hear dripping water – like several drips. I round the corner and see this …

I hunt down management (they’re in a huddle near the door trying to figure out why the alarm is going off because OF COURSE).

“Um, guys? Did you happen to see exam room 15?”

Apparently, we had some pipes burst. But not because of the cold but because the pipe threads, on several pipes over exam room 15, had rusted through, weakened and with the cold weather expanding them, they broke, spilling A LOT of water. I don’t if you can see it or not, but the white chunks on the floor? Is ceiling tile. A big section fell into the room. Management put trash cans out to catch the dripping water and started making calls.

Luckily, that didn’t happen the day before, because there was a doctor USING that exam room yesterday. And I remember that doctor’s team commenting on how HOT the room had been – a precursor to today’s disaster, I suppose.

And luckily, it wasn’t one of my clinic days. Because the MA’s who were in clinic that day had to re-direct their patient traffic in order to avoid wading through ankle-deep water.

And that was the start of my day that day.

If there is one thing you can count on in healthcare, you can’t count on anything in healthcare. It’s constantly changing from day-to-day. Sometimes, from hour-to-hour.

I truly love the people I work with. Everyone has a sense of humor. Everyone takes her job seriously. We all work as a team.

I couldn’t ask for a better work family, truly.

Tell us about your first day at something — your first day of school, first day of work, first day living on your own, first day blogging, first day as a parent, whatever.

It’s Obama’s fault that I work in healthcare.

I never, in a million years, even TOSSED the idea around of working in healthcare before our glorious dictator, erhm, leader, (*said with sarcasm*) started the current nightmare we’re living in right now. (Have you guessed that I DESPISE the man?)

It never even occurred to me to attempt it. I knew I could never be a nurse. Not so much for the gross factor (though there is that – KUDOS to nurses!), but I get so impatient with people who are sick or in pain. (Just ask my family). My first reaction is to say, “suck it up, buttercup.”

Not exactly stellar bedside manner, right?

This attitude applies to me, too. It drives me CRAZY to be sick or have some pain I can’t seem to control or get rid of.

But when Obama waved his scepter and deemed Obamacare to be the law of the land (*snicker* – yes, I’m being bitchy), I knew I had to DO something to protect my family. I had been a stay-at-home mom for the past seven years – the kids were old enough to take care of themselves and it was time to get back to work. But where to work? I could try and use my degree (I graduated from college in 2003 with a Technical Writing degree – more on why I didn’t pursue this later), but what if it took me forever to FIND a local job in that field? Time was of the essence, who knew how Obamacare would screw everything up for us?

Kevin was (is) self-employed. And with me not working, we were paying ASTRONOMICAL fees for family health insurance. And we were looking at even higher fees once Obamacare passed.

What were my options? I could go back to retail, banking or even the restaurant business. I have a lot of experience in all of those fields, but even then, how much would it ultimately cost us for health insurance?

I admit, the main reason I applied at the hospital was because I wanted to thumb my nose at Obama and his stupidity. How ironic would it be to have health insurance through a healthcare facility? Oh sure, I know that Obama will never know, nor care, about my decision to work in healthcare simply because of his God-like complex to ultimately control his minions (again with the bitchy), but I figured, on some level, that it might be the safest option in order to protect my family.

So. I applied and to my utter astonishment, I got the job.

Actually, that’s not true. I applied first to the insurance processing center and made it to my second interview. I sat at a table with four other women, the women I would be ultimately working with, interviewing me and I guess they didn’t like me because I didn’t get the job. I didn’t give up though. There was a scheduler’s position at the neurosurgery center that I went for and got. I was now responsible for scheduling testing for two neurosurgeons.

I was both excited and terrified. I bought my required scrubs (at that time we were wearing a different color every day so it was quite expensive initially) and my first day on the job consisted of all-day training, becoming familiar with the hospital rules and regulations, signing up for benefits, etc. We were allowed to wear business attire for my first two days of training.

There were a handful of us – maybe around 20? I remember feeling VERY THANKFUL because the economy was tanking at that time and I was just grateful to have ANY job, let alone the job I landed. I felt extremely grateful to be there.

That feeling quickly dissipated when I started my first day at the clinic. It was on Wednesday and after my boss took me around the clinic and introduced me, I began to fully appreciate what I had gotten myself into.

I knew nothing, NOTHING, about the medical field. In essence, I had to learn a whole new language. I had to learn new software; I had to learn how to be what they wanted me to be by constantly adjusting and readjusting my expectations and my personality. I was absolutely terrified and I wondered, on more than one occasion, just what the hell I was doing there.

I also came very, very close, to walking out several times. (Even recently).

I was so stressed. Just when I thought I had “gotten it,” something, or someone, would throw me a curve ball and I was left floundering. I suppose I did a good job of hiding my terror because months later, when I had become comfortable with my position and the people I worked with, I told them how I felt when I first started and my co-workers were shocked – they had no idea, they said.

I guess that was something, at least.

I could BS my way through patient interactions. I’m telling you, the most helpful class I took in college was communication. It taught me to understand different personalities and how to get along with those personalities. It taught me patience and how to word things so that people didn’t take offense but at the same time, it allowed me to maintain control over the situation.

I think everyone should be required to take a communications class like that (and I’m talking about the art of communication – studying Aristotle and the likes. It sounds boring, and it was, for the most part, it was also difficult to digest, but once that light bulb went off in my head, I feel like I can pretty much handle any personality now).

What stressed me out the most, and still does on many levels, was interacting with the doctors. As if rubbing elbows with doctors in general is not nerve-wracking enough, I’m rubbing elbows with BRAIN SURGEONS. To become a brain surgeon, you have to be the top 1% – these guys are SCARY SMART. Human, but Einstein smart.

I would feel nauseous anytime I had to speak directly with a doctor. Did I ask my question plainly? Should I have been able to answer my question without going to the doctor? Did I present myself in a professional manner? Will they like me or ask management to get rid of me?

(Hey – that’s actually happened before).

The doctors TERRIFIED me. I drove home, on many, many occasions when I first started working for the hospital, crying because I was so stressed out from trying to learn everything. Thank God I’m a fast learner. I tend to catch on quickly.

Looking back, I’m pretty proud of myself. I stepped into a world I knew little to nothing about and conquered it, somewhat. I’m currently working on educating myself so that I can take a certification test and become a CMA (certified medical assistant) which will lead to a raise and more responsibility. I’m feeling more comfortable in my duties and I’ve been told by both management, and the doctors (EEK!) that I’m doing a good job.

It sort of blows my mind, to be honest.

Oh – one more first to tell you about – the first time I had to take staples out. It was a PLIF (posterior lumbar interbody fusion). The nurse showed me how to use the tool and I got down on my knees, swallowed the bile back down my throat and took those suckers out. It’s actually sort of fun, to be honest. Unless they’ve been in for a while and they’re starting to scab over. Then you have to dig into the flesh a bit and that hurts the patient. I’m still not 100% confident on removing staples, but I just swallow my apprehension, grit my teeth and force myself to do it and appear confident while doing it. (Which is key – my lead nurse told me that patients will never know that you haven’t done something very often, as long as you sound confident while doing it).

I watched a carpal tunnel suture removal the other day. I haven’t done one of those yet. My doctor doesn’t do very many carpal tunnels. That’s pretty cool. You first don a pair of clean gloves, swab the stitches with rubbing alcohol to remove germs/bacteria, then you take your scissors and snip the stitch while pulling it by the knot with the tweezers. I’ve yet to see one long continuous stitch removed – I’ve put the word out if anyone gets one of those to come get me so I can watch how they do it.

So those are some of my firsts. Without sounding like a braggart (too late, I’m sure), I have to admit, this job is one of the things I’m most proud of in my life. I have grabbed this medical monster by the tail and conquered it. Not bad for someone who didn’t go to any sort of medical school. The other girls I started out with? The other schedulers? Didn’t last. They couldn’t hack it and transferred to other departments.

I’m the last scheduler standing.

I bought this scrub top for work – and then actually wore it.

Once.

I felt like a fool and won’t wear it again.

I do that. I get bored. Buy/wear something and then promptly regret it.

(I actually bought four pairs of reading glasses from Coastal.com. Why? Because they’re cheap, for one thing. And two, because they tend to change my look with very little effort on my part).

I mean. I wear scrubs to work every day. Basically, pajamas. Which one one hand – COMFY! On the other hand, they’re dangerous. Because we’re talking elastic waists and polyester, which easily expand to allow for expanding waistlines.

Overall, I LOVE wearing scrubs to work. The biggest reason is because I don’t have to rummage through my closet every day trying to figure out what to wear. My biggest challenge is choosing which color I’m going to wear that day and I only have three colors to choose from: Navy, Black and Pewter.

I HATE dressing up. I HATE trying to color coordinate my clothes then finally picking an outfit only to find out that it’s too tight because I ate one too many cookies the week before. Then I have to rummage further in my closet for an alternative which takes more time, frustrates me even more and makes me long for the days where I could eat what I wanted and not have to worry about adding an extra fleshy roll.

And then, there’s another 15 minutes trying to figure out what accessories to wear.

I spend my days in scrubs and my nights in t-shirts and sweats, or shorts if it’s summer time.

I’m so sexy.

I know Kevin probably gets sick to death of seeing me in lounge wear but honestly, if I’m comfortable, then I’m happy. And since we never go anywhere anyway …

I bought the Hello Kitty scrub top because I’m a child at heart. I’ve always loved Hello Kitty and I don’t know, I thought it was cute. It IS cute. But probably not appropriate attire for a nearly-50-year old woman.

Scrubs are not cheap. I wear cargo-style pants (which are super cute, are somewhat fitted and don’t look like something out of an MC Hammer video) and those suckers cost $30 bucks. Scrub tops are about $20 bucks a piece. I guess they figure you aren’t going to buy scrubs very often so they might as well gouge you while they have the chance.

I work with a gal who is a double zero ….. *pause* …… (just letting you soak that CRAZY fact for a minute). I kid you not, she’s a double zero. She’s TINY. Not just in size but she’s not very tall – I don’t think she’s even five feet tall. I call her my pocket MA … but I digress.

This poor girl has to have her scrubs ALTERED because even the smallest size is too big for her. So, not only does she have to pay about $50 bucks for a pair of scrubs, she in essence has to pay twice in order to get them altered to fit her teeny-tiny frame.

I guess that’s one advantage to being an Amazon – my size is pretty typical and completely average so I never have to worry about that sort of thing. My biggest challenge is finding pants that are long enough. But even that’s not that big of a deal anymore since they have tall sizes.

Since I wear scrubs all day every day, I like to mix things up with different hairstyles, earrings and shoes. My favorite hairstyle at the moment is the hairstyle in my profile pic in the right-hand column. And my favorite shoes at the moment are my uber-cool Sketchers – I blame my mom for this latest obsession. I saw her wearing a similar pair the other day and I HAD TO HAVE A PAIR. I’m currently on a mission to find the same style in blue. And they’re so comfortable! I don’t even feel like I’m wearing shoes, it feels like I’m walking barefoot.

My favorite brand of scrubs are Dickies, though WonderWinks are cute and comfy, too. I used to wear Cherokee, but they are boxy and tend to fit poorly, at least, in my opinion.

I won’t even tell you how much I’ve spent on scrubs in the three years I’ve been working for the hospital – it’s downright embarrassing. I buy everything online, so I’m never quite sure how something is going to fit. But I’m tossing the blame on to the people I work with because of the styles they wear – I had no idea there were so many CUTE scrub styles! Who knew!

Sometimes I miss dressing up for work. Who am I kidding – no I don’t.

Good Lord, it’s 2015.

The last time I wrote/posted anything of substance was back in June.

JUNE, PEOPLE!

Six whole months I’ve neglected this blog.

UNACCEPTABLE!

To be fair, there really hasn’t been a whole lot to write about. I get up, go to work, come home, get through dinner (I’m finding that I hate to cook ANYTHING more and more), then collapse into bed, physically and mentally exhausted.

And the things that do happen, I can’t really talk about, or am cautious about writing about, because it’s work related and though no one I work with knows about this blog, I have crossed that fine line and accepted people I work with on Facebook so it might be a matter of time before they find this blog so I have to be careful what I write about because I’ve already offended someone in my family with my hot-headed blabber mouth, and/or fingers in this case and I really don’t want to offend anyone I work with because I see the people I work with more than my own family.

But life. She’s passing me by. She’s not waiting around for me. She’s trudging ahead and I’m left stumbling after her. Events, thoughts, milestones (we’ve had milestones? Yeah, I guess we have) are whizzing past me so that my life is fast becoming a blur of fleeting thoughts and impressions – it’s time I put the brakes on and slow Mother Time waaay down by attempting to capture snippets and pin them on this blog.

Again.

Should I start where I left off in June? I haven’t even told you about our Cruise to Alaska ALMOST TWO YEARS AGO.

Though the boys are still living with us, they have also gone through some changes.

And there’s the rental house, which still hasn’t been rented out yet.

Did you even know I’m using a new blog template? I actually bought this one so it will be sticking around for quite some time – though I can switch up the color schemes once in a while so I don’t got completely out of my head with boredom.

Did I mention my dominant arm, (I’m left handed), has been hurting like a Mother Effer ever since I got the damn flu shot in November?? I’m beginning to think I have damaged my ulnar nerve, or maybe carpal tunnel? (*shudder* Say it ain’t so!)

Have I mentioned that I’m nearly a half a century old?! And how that both annoys and terrifies me?

Have I mentioned that I’m finally, FINALLY, comfortable in my own skin and though I’m “technially” overweight and need to lose 30 lbs, I’m sort of okay with that? (Though I AM going to start back on the treadmill soonish – okay – like tomorrow – for reals).

Did you know that our 25th wedding anniversary is THIS MAY (what?? How did that happen??) and we won’t be going on our Hawaiian Cruise because money is tight and we’re being responsible people by putting it off another year, or two? (*sigh*)

I bet you didn’t know that Brandon is 19 and on his THIRD job, did you??

Christmas was one of the low lights of our year this year. Not because it wasn’t great, it was just .. meh. Every day is Christmas in our house. Truly. (Does that sound pretentious?) Since money is a bit on the tight side right now (rental houses don’t improve themselves, don’t cha know), Kevin and I bought each other one gift each (I bought him a fancy-smancy power strip/box thing for his band – did I mention the drummer and bass player quit and they’ve been working on replacing band members) and Kevin bought me a laptop cooling tray … thing … so I don’t scorch my fleshy thighs and … yep, that was our Christmas. We bought the boys all practicable things – such as pots and pans (and may I just say, NICE pots and pans from the Food Network – I got a deal on a set, two saucepans, two skillets, both regular and deep-dish style, a big pot to boil pasta and two cookie sheets), a toaster, a fancy-smancy one cup coffee maker (because Blake drinks more coffee than I drink now), bathroom towels, kitchen gadgets and silverware. And yes, the boys were as excited to receive all of these things like you were excited to read about them.

BUT – they will appreciate said gifts when it’s time to move out BECAUSE that’s our goal, well, that’s me and Kevin’s goal, to move the boys out into their own apartment THIS YEAR.

IF Brandon can keep this job after the holidays. He was hired on as holiday help. (There’s another story for another time).

Did I tell you that I read 66 books last year?

And that my goal is to read 62 books this year?

Now that’s one thing I DID do right this year – I read my butt off. In fact, I have three gift cards to Barnes and Noble that I’m going to use on ebooks. Because I can’t even tell you the last time I’ve read an actual book – my Kindle is becoming a permanent body part. I’m trying to figure out how to convert a Nook ebook to a format that Kindle will recognize and I think I have it figured out. (Pst … I found this website that will convert it to a MOBI, which is what the Kindle recognizes. But don’t quote me on that yet. I’m buying a book tonight to see if I can make this work. If it doesn’t work, shoot the messenger, k?)

And I don’t buy books very often, either. I usually “borrow” them from the library, though I end up downloading them and transferring them to my Kindle because trying to read a library book in the two weeks the library sets up puts too much pressure on me and I don’t need anymore stress in my life, thank you very much.

Kevin is great. He still has his office and he’s still looking for “that perfect client, or five.” He’s been SUPER busy on the rental house and honestly, I couldn’t be more impressed with him. Is there nothing the man can not do?!? The house doesn’t even look the like the same house. (Note to self – brag more about the hubby).

I’m on a mission to give my professional life a kick in the butt. Either sweet talk my boss into allowing me to take the certified medical assistant certification early (will need to jump through some hoops to make that happen) and/or work on an alternative plan that quite honestly, scares the shit out of me but I think I could make it happen providing I can find the courage to actually take that first step.

Vague much?

And my nurse at work just text me (I left early today) to tell me that the CT machine is down and she had to cancel some appointments. AARGH.

It’s always something.

And that brings us up to date, sort of. Those are the highlights; I’ll see if I can’t do a better job of putting flesh on those bare bones.

Oh. I got to see a carpal tunnel suture removal today. I’ve never done the sutures, though I’ve taken quite a few staples out. It was cool. You just snip and then pull the sucker out. I’m rather spoiled on removing staples/sutures. My doctor has it set up where his post-op patients come in for their first visit two weeks after surgery, which is when they need to have their staples/sutures removed and the PA takes care of removing them so I rarely have an opportunity to remove them myself. I think that part of the job scared me the most when I first started doing this job – I would feel sick to my stomach when I had to do it. It still sort of weirds me out whenever it comes up, but I’m feeling more confident about it now.

I can admit, with all honestly, there is NEVER a dull moment in health care. NEVER.

Nurses play a huge role in hospitals, clinics, and various care facilities throughout the world. However, there are widespread misconceptions about what responsibilities nurses have. Nurses are saving lives and making a difference every day in health care with little recognition from the media or the world at large. Test your knowledge and see how much you really know about what exactly goes into the job of being a nurse.

Featured Image: USMC – 07790 by Ryan R. Jackson. Public Domain via  WikiCommons

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Since its advent in the early 1970s, bioethics has exploded, with practitioners’ thinking expressed not only in still-expanding scholarly venues but also in the gamut of popular media. Not surprisingly, bioethicists’ disputes are often linked with technological advances of relatively recent vintage, including organ transplantation and artificial-reproductive measures like preimplantation genetic diagnosis and prenatal genetic testing. It’s therefore tempting to figure that the only pertinent reflective sources are recent as well, extending back — glancingly at most — to Immanuel Kant’s groundbreaking 18^th-century reflections on autonomy. Surely Plato, who perforce could not have tackled such issues, has nothing at all to contribute to current debates.

This view is false — and dangerously so — because it deprives us of avenues and impetuses of reflection that are distinctive and could help us negotiate present quandaries. First, key topics in contemporary bioethics are richly addressed in Greek thought both within Plato’s corpus and through his critical engagement with Hippocratic medicine. This is so regarding the nature of the doctor-patient tie, medical professionalism, and medicine’s societal embedment, whose construction ineluctably concerns us all individually and as citizens irrespective of profession.

Second, the most pressing bioethical topics — whatever their identity — ultimately grip us not on technological grounds but instead for their bearing on human flourishing (in Greek, eudaimonia). Surprisingly, this foundational plane is often not singled out in bioethical discussions, which regularly tend toward circumscription. The fundamental grip obtains either way, but its neglect as a conscious focus harms our prospects for existing in a way that is most thoughtful, accountable, and holistic. Again a look at Plato can help, for his handling of all salient topics shows fruitfully expansive contextualization.

Regarding the doctor-patient tie, attempts to circumvent Scylla and Charybdis — extremes of paternalism and autonomy, both oppositional modes — are garnering significant bioethical attention. Dismayingly given the stakes, prominent attempts to reconceive the tie fail because they veer into paternalism, allegedly supplanted by autonomy’s growing preeminence in recent decades. If tweaking and reconfiguration of existing templates are insufficient, what sources not yet plumbed might offer fresh reference points for bioethical conversation?

Prima facie, invoking Plato, staunch proponent of top-down autocracy in the Republic, looks misguided. In fact, however, the trajectory of his thought — Republic to Laws via the Statesman — provides a rare look at how this profound ancient philosopher came at once to recognize core human fallibility and to stare firmly at its implications without capitulating to pessimism about human aptitudes generally. Captivated no longer by the extravagant gifts of a few — philosophers of Kallipolis, the Republic’s ideal city — Plato comes to appreciate for the first time the intellectual and ethical aptitudes of ordinary citizens and nonphilosophical professionals.

Human motivation occupies Plato in the Laws, his final dialogue. His unprecedented handling of it there and philosophical trajectory on the topic warrant our consideration. While the Republic shows Plato’s unvarnished confidence in philosophers to rule — indeed, even one would suffice (502b, 540d) — the Laws insists that human nature as such entails that no one could govern without succumbing to arrogance and injustice (713c). Even one with “adequate” theoretical understanding could not properly restrain himself should he come to be in charge: far from reliably promoting communal welfare as his paramount concern, he would be distracted by and cater to his own yearnings (875b). “Adequate” understanding is what we have at best, but only “genuine” apprehension — that of philosophers in the Republic, seen in the Laws as purely wishful — would assure incorruptibility.

The Laws’ collaborative model of the optimal doctor-patient tie in Magnesia, that dialogue’s ideal city, is one striking outcome of Plato’s recognition that even the best among us are fallible in both insight and character. Shared human aptitudes enable reciprocal exchanges of logoi (rational accounts), with patients’ contributing as equal, even superior, partners concerning eudaimonia. This doctor-patient tie is firmly rooted in society at large, which means for Plato that there is close and unveiled continuity between medicine and human existence generally in values’ application. From a contemporary standpoint, the Laws suggests a fresh approach — one that Plato himself arrived at only by pressing past the Republic’s attachment to philosophers’ profound intellectual and values-edge, whose bioethical counterpart is a persistent investment in the same regarding physicians.

If values-spheres aren’t discrete, it’s unsurprising that medicine’s quest to demarcate medical from non-medical values, which extends back to the American Medical Association’s original Code of Medical Ethics (1847), has been combined with an inability to make it stick. In addition, a tension between the medical profession’s healing mission and associated virtues, on the one side, and other goods, particularly remuneration, on the other, is present already in that code. This conflict is now more overt, with rampancy foreseeable in financial incentives’ express provision to intensify or reduce care and to improve doctors’ behavior without concern for whether relevant qualities (e.g., self-restraint, courage) belong to practitioners themselves.

Though medicine’s greater pecuniary occupation is far from an isolated event, the human import of it is great. Remuneration’s increasing use to shape doctors’ behavior is harmful not just because it sends the flawed message that health and remuneration are commensurable but for what it reveals more generally about our priorities. Plato’s nuanced account of goods (agatha), which does not orbit tangible items but covers whatever may be spoken of as good, may be helpful here, particularly its addressing of where and why goods are — or aren’t — cross-categorically translatable.

Furthermore, if Plato is right that certain appetites, including that for financial gain, are by nature insatiable — as weakly susceptible to real fulfillment as the odds of filling a sieve or leaky jar are dim (Gorgias 493a-494a) — then even as we hope to make doctors more virtuous via pecuniary incentives, we may actually be promoting vice. Engagement with Plato supports our retreat from calibrated remuneration and greater devotion to sources of inspiration that occupy the same plane of good as the features of doctors we want to promote. If the goods at issue aren’t commensurable, then the core reward for right conduct and attitudes by doctors shouldn’t be monetary but something more in keeping with the tier of good reflected thereby, such as appreciative expressions visible to the community (a Platonic example is seats of honor at athletic games, Laws 881b). Of course, this directional shift shouldn’t be sprung on doctors and medical students in a vacuum. Instead, human values-education (paideia) must be devotedly and thoughtfully instilled in educational curricula from primary school on up. From this vantage point, Plato’s vision of paideia as a lifelong endeavor is worth a fresh look.

As Plato rightly reminds us, professional and other endeavors transpire and gain their traction from their socio-political milieu: we belong first to human communities, with professions’ meaning and broader purposes rooted in that milieu. The guiding values and priorities of this human setting must be transparent and vigorously discussed by professionals and non-professionals alike, whose ability to weigh in is, as the Laws suggests, far more substantive than intra-professional standpoints usually acknowledge. This same line of thought, combined with Plato’s account of universal human fallibility, bears on the matter of medicine’s continued self-policing.

Linda Emanuel claims that “professional associations — whether national, state or county, specialty, licensing, or accrediting — are the natural parties to articulate tangible standards for professional accountability. Almost by definition, there are no other entities that have such ability and extensive responsibility to be the guardians of health care values — for the medical profession and for society” (53-54). Further, accountability “procedures” may include “a moral disposition, with only an internal conscience for monitoring accountability” (54). On grounds above all of our fallibility, which is strongly operative both with and absent malice, the Laws foregrounds reciprocal oversight of all, including high officials, not just from within but across professional and sociopolitical roles; crucially, no one venue is the arbiter in all cases. Whatever the number of intra-medical umbrellas that house the profession’s oversight, transparency operates within circumscribed bounds at most, and medicine remains the source of the very standards to which practitioners — and “good” patients — will be held. Moreover, endorsing moral self-oversight here without undergirding pedagogical and aspirational structures is less likely to be effective than to hold constant or even amplify countervailing motivations.

As can be only briefly suggested here, not only the themes but also their intertwining makes further bioethical consideration of Plato vastly promising. I’m not proposing our endorsement of Plato’s account as such. Rather, some positions themselves, alongside the rich expansiveness and trajectory of his explorations, are two of Plato’s greatest legacies to us — both of which, however, have been largely untapped to date. Not only does reflection on Plato stand to enrich current bioethical debates regarding the doctor-patient tie, medical professionalism, and medicine’s societal embedment, it offers a fresh orientation to pressing debates on other bioethical topics, prominent among them high-stakes discord over the technologically-spurred project of radical human “enhancement.”

Headline image credit: Doctor Office 1. Photo by Subconsci Productions. CC BY-SA 2.0 via Flickr

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By Paul Harriman

There is a truism in the world that quality costs, financially. There is a grain of truth in this statement especially if you think in a linear way. In healthcare this has become embedded thinking and any request for increasing quality is met with a counter-request for more money. In a cash-strapped system the lack of available money then results in behaviour that limits improvement. However, as an ex-colleague once said “we have plenty of money, we just choose to spend it in the wrong places”. This implies that if we were to un-spend it in the wrong place we would have plenty of spare cash.

The problem in healthcare, as in most service organisations, is that the system that delivers client value (in this case healthcare to patients) isn’t visible to those working in it. Indeed the only person that see’s the invisible system is the patient receiving that care. Our first task is to make the system visible and we can do this by producing a process map; a series of boxes describing the various activities all linked by one or more arrows. These maps can range from very high level to extremely detailed; the trick is to choose wisely and to look at the process from the patient’s perspective. Having produced your map the next step is to put some data onto it. Once you understand the process you can then start to hypothesise a different way of undertaking the work. Ask yourself;

• would pay your own money for a particular step; if not, then question why it exists
• are the steps in the right order?
• do they require roughly equal amounts of resource
• are there any bottlenecks?

Some four years ago, supported by a grant from the Health Foundation, we started to ask ourselves some of these questions in relation to the delivery of care to frail elderly patients. The answers were, in some cases, completely counter-intuitive. We found that some elderly patients stayed in hospital for many weeks after they could have left. There were many and varied reasons for this but none of them were related to acute hospital care. It was the wider disjointed system with its multiple hand-offs and traditional organisational rules that governed this. It was no-one’s fault, yet it was everyone’s problem.

So like eating the proverbial elephant we decided to start somewhere. It needed an individual clinician to put their hand up and take that first step. That first step was to try something different for one day; if it didn’t work then nothing was lost. The step was tried and the world didn’t end. Instead we found out that changing our normal system of “batching emergency admissions together so that they could all be seen the next day thus maximising consultant efficiency” to “let’s see them as they come in” meant that we reduced the time from arrival to senior specialty review by half. We also found opportunity to remove potential harm.

Having repeated this three times a few other consultants chose to take the trip with us and we repeated the same test over three days. That worked. So we tried for a full week. That also worked. By this time, and we were now almost six months into the journey, a range of staff including consultants, nurses, therapists, ambulance staff, managers and secretaries had all been involved in the tests and had all in their own way contributed to testing the new design and delivery.

The next steps were profound. A suggestion from the clinical director that all the consultants should change their job plans (on the same day) to deliver the new service was met with no dissent. A first in my experience. The physical manifestation of the change, the birth of the Frailty Unit then followed a few weeks later.

What was the cost of this? In terms of real life spend very little. The physical reconfiguration was largely cash neutral. Yes we spent some real money on service improvement support and staff invested their time; in the great scheme of things this was petty cash. But did it really change anything? Some hard metrics showed that we increased the number of patients who were discharged within 48 hrs from 18% to 24% and we reduced the number of total specialty beds by almost a quarter. We didn’t increase our readmissions and our biggest surprise was that we decreased our in-hospital mortality. In softer terms we now see many patients on the day that they arrive; we know how to potentially change our outpatient service and the staff on the Frailty Unit have become masters of caring for Frail Elderly patients.

Involving staff + Improvement science = Better outcomes + Lower Cost

Paul Harriman MBA, TDCR, FETC, HDCR, DCR(R).  Paul originally trained as a Diagnostic Radiographer at the Middlesex Hospital qualifying in 1977. He worked in a number of hospitals and obtained his HDCR and TDCR qualifications before coming to Sheffield in 1986. Whilst working as a Superintendent Radiographer at the Royal Hallamshire Hospital, he undertook an MBA and was also selected to join the General Management Scheme. He has since held a number of posts within the Trust working both within clinical directorates and corporate functions.

Paul has major interests in system thinking, improvement science, the use of data for decision making and has been working with Statistical Process Control charts for over 20 years. The main focus of his current work is supporting Geriatric and Stroke Medicine, to understand, analyse and challenge the current work processes.  He and Kate Silvester were part of the Flow, Cost, Quality programme sponsored by the Health foundation. He is a co-author of the paper ‘Timely care for frail older people referred to hospital improves efficiency and improves mortality without the need for extra resources‘ for the journal Age and Ageing.

Age and Ageing is an international journal publishing refereed original articles and commissioned reviews on geriatric medicine and gerontology. Its range includes research on ageing and clinical, epidemiological, and psychological aspects of later life.

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Image credit: Blue tone of beds and machines in hospital. By pxhidalgo, via iStockphoto.

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by Harvey Max Chochinov

A senior colleague recently shared with me the trials of going through a bout of cancer treatment. Physicians are not known to make the best patients and the transition he described was not an easy one. At one point he said, “I wanted to hang a sign over my bed saying ‘P.I.P.’ — Previously Important Person.” To be frank, I was astounded. This man is not only a highly respected and seasoned clinician, but an internationally lauded researcher and medical leader, whose accomplishments have garnered various recognitions and lofty acclaim. And yet, being a patient, in spite of what he described as excellent care, quickly led to feeling that “who he was” was largely overshadowed by “what he had.”

Source: New York Public Library

The word patient comes from the Latin patientem, meaning someone who is sick or suffering. The word patience — to bear or endure without complaint — shares the identical Latin etymology. Perhaps this common derivation suggests that it takes patience to be a patient. But what is it that patients must bear and endure without complaint? Think of even your most trivial recent health care encounter. Having your call put on hold; being kept waiting for an appointment; having to disrobe or expose private information; any of these might lead you to bemoan that you felt “just like a patient” — without a doubt, the most common critique of any health-care encounter. Feeling “like a patient” means feeling defined based on a problem or diagnosis. Personhood thrives on the expression of individual identity and being able to exercise freedom and choice. Patienthood is based on diagnostic specificity; it demands adherence to certain clinical or institutional conformities and routines, in return for which it provides organ or disease specific, evidence-based options.

A woman I helped look after many years ago with leukemia was admitted for treatment to our city hospital. Being young and fiercely independent, she struggled, not merely with having to face a life threatening illness, but the sudden assault on her sense of who she was. Almost overnight, she had to relinquish her freedom and submit to strict infection controls, including isolation on the bone marrow transplant unit. Like any patient, she was assigned a chart number, given a standard plastic wrist identification bracelet, and issued the usual, drab hospital garb. Her treatment, tailored according to detailed laboratory findings and genetic markers, was highly aggressive and invasive. One morning after having encountered her share of hardships, including total hair loss, nausea and various nasty complications, she emerged from her room wearing a beautiful, full-length blue satin nightgown. Those of us who worked closely with her realized immediately that this was no frivolous gesture. In fact, this was a way of asserting herself, a way of saying: “This is who I am,” “I am more than my white counts,” “Please, see me.”

Similarly, Jean Dominique Bauby, the former editor of Elle