Longer looks: When an ER doctor becomes an ER patient; visualizing end-of-life treatments; Google Glass inside operating rooms

Jun 6 2014

Every week KHN reporter Marissa Evans finds interesting reads from around the web. 

San Francisco Magazine: My State Of Emergency
If you are shot or stabbed in or around Oakland, you are likely to be sent [to Highland Hospital). Oakland has the highest violent crime rate in the nation, so I have indeed seen my fair share of victims over my long career here. ... And yet, despite our knife-and-gun-club bravado, patching people's bullet and stab wounds and dealing with drug-crazed patients is a tiny fraction of what I do. Patients everywhere suffer from pretty much the same ailments .... The poor get just as many heart attacks and broken arms as the wealthy do. The difference is that at Highland, we may be the only doctors our patients ever see. ... Because of the Affordable Care Act, many-;perhaps all-;of these patients will for the first time be able to make an appointment to visit a primary care doctor in an office, rather than spending hours waiting to see me (Dr. Eric Snoey, 6/4).

The Washington Post: Videos Aim To Inform Patients About Their Medical Options At The End Of Life
The video was direct and dramatic. In a demonstration of cardiopulmonary resuscitation, or CPR, a technician pushed down hard on the chest of a dummy. A white-coated doctor narrating the video laid out grim odds: "Most of the time, in patients with advanced disease, CPR does not work," she said. ... Rare is the person who is willing to grapple openly with death. Health-care providers often don't talk to patients about their preferences. And patients and their families often don't know their options and avoid asking about them. For patients approaching the end of life, that can mean not knowing about palliative-care alternatives, which research has shown can significantly improve patient satisfaction and quality of life. Instead, they continue to get aggressive treatment. Clinicians and others trying to improve end-of-life communication between doctors and their patient have turned for help to a set of videos (Lena Sun, 6/2).

The New York Times: Google Glass Enters The Operating Room
Before scrubbing in on a recent Tuesday morning, Dr. Selene Parekh, an orthopedic surgeon here at Duke Medical Center, slipped on a pair of sleek, black glasses -; Google Glass, the wearable computer with a built-in camera and monitor. He gave the Internet-connected glasses a voice command to start recording and turned to the middle-aged motorcycle crash victim on the operating table. He chiseled through bone, repaired a broken metatarsal and drilled a metal plate into the patient's foot. Dr. Parekh has been using Glass since last year, when Google began selling test versions of its device to thousands of handpicked "explorers" for $1,500. He now uses it to record and archive all of his surgeries at Duke, and soon he will use it to stream live feeds of his operations to hospitals in India as a way to train and educate orthopedic surgeons there (Anahad O'Connor, 6/1).

The Guardian: Talking About Mental Health: 'So Much Of This Is Behind Closed Doors'
When he was 22, Chris Gethard thought every day about killing himself. He thought about it so often that eventually it didn't even feel weird any more. Then, one day, he pulled his car over to the side of a bridge. He was ready to jump. Instead, Gethard called his ex-girlfriend, who told him he had to get help immediately, and that if he didn't by morning, she would call his mother. ... That was 11 years ago. ... He's one of the relatively lucky ones. That night on the bridge – and later, when he was diagnosed with bipolar disorder – his parents had health insurance that covered him. Now, he is able to pay out of pocket for a therapist of his choosing, though he's healthy enough that he barely feels the need for their bi-weekly meetings (Amanda Holpuch, 5/29).

The Weekly Standard: Obamacare In The Blue States
One of the ironies of the Affordable Care Act is that many of the governors who zealously supported the bill failed spectacularly in its implementation. Oregon, Maryland, and Minnesota are among the most prominent failures. The Massachusetts exchange, the primary inspiration for the ACA exchanges, collapsed entirely, and state officials lack a plan for fixing it in time for this fall's enrollments. After the passage of the ACA, the Centers for Medicare & Medicaid Services (CMS) instituted a management process to ensure accountability among states that chose to build their own exchanges instead of participating in HealthCare.gov. It involved "gate reviews," a periodic assessment of progress in seven areas; CMS designed the process to ensure that continued federal funding would lead to secure and functional exchanges (Michael Astrue, 6/9). 

Health Affairs: 'Nothing Is Broken': For An Injured Doctor, Quality-Focused Care Misses The Mark
As a medical professional who became an accident victim and then a trauma patient, I was a participant-observer in emergency care, with a big-picture window into how well our health care system does or doesn't work. There's just something about being boarded on a gurney in a hospital hallway for fifteen hours that gets one thinking about paradigm shifts. In my case, I was struck by the uneven nature of my care, marked by an overreliance on testing and a narrow focus on limited quality metrics such as pain management or catheter care processes. Looking back, I believe that this approach fostered an inattention to my overall well-being. Instead of feeling like a connected patient at the center of care, I felt processed and disengaged. This is disconcerting, especially at a time when patient-centered care-;that is, care delivered with me, not to me or for me-;is becoming the new normal (Dr. Charlotte Yeh, 6/2).