How to cure medical care

[SeaCat]

Those of us in the medical field know that one of the largest problems is Hospital Aquired Infections.

These infections are often M.R.S.A. and V.R.S.A. or antibiotic resistant strains of Staph.

Law Suits abound because of these infections, there are handouts and classes held in every facility to stop them and yet they keep happening. (Along with things like Bedsores and other problems.) The industry keeps throwing pittance money at the problem while Medicare and Medicaid have stopped paying for the treatment for these illnesses. Lawyers are slavering and posting ads about being injured by the healthcare industry. Nothing is helping.

Those of us in the field know the answers to the questions but we're not asked. If we were allowed to answer, and our answers were listened to the problem would almost completely vanish, but we aren't asked.

Now many of you here are highly intelligent. Many of you here have your views on medicine and finance. What are your answers?

Give them to me and I'll tell you how close you are.

Cat

 

[starrkers]

One question: Have the powers that be ordered the reduction in temperature of on tap hot water in the US?
They have here, to reduce scalding of kids in baths (checking the bath temp before throwing a kid in always worked for me).
Seems to me the incidence of these infections has increased since we're not allowed to boil the little buggers anymore.

 

[tickledkitty]

How about C.diff? I know someone who died from it. Scary stuff.

Are people not washing their hands adequately?

 

[epiphany65]

I don't have an answer to your question, but this article suggests a vaccine for superbugs may be on the horizon:

http://news.yahoo.com/s/nm/20080909/sc_nm/mrsa_vaccine_dc_1

 

[Just-Legal]

Its not just washing your hands, though that helps. Its perception of how these illnesses are acquired. MRSA can be found on ANYONE. The reason it shows up in hospitals is because patients already have lowered immune systems, and are therefore more likely to be succeptible to it. Its not just the nursing staff or healthcare providers who need to "clean up" - its EVERYONE and ANYONE that goes in a hospital. When I was in for my tests, a woman had her two children visit, who had COLDS. I mean, what the hell? I understand they want to see their mother, but come ON, Common sense please!

 

[epiphany65]

Another problem is that doctors have been over prescribing anti-biotics for things like colds so these anti-biotics become useless or at least less effective because other viruses mutate and become resistant to drugs that would have once killed them.

 

[amicus]

Seacat, I doubt very much you will find any agreement with my assessment and may even deem it irrelevant, however...

Two percent of this years graduating class of medical students will choose primary or family care, most will continue their education and specialize into more lucrative areas of medical service.

The large portion of general medicine physicians are foreigners who will accept the lower salaries of family doctors.

These kids are coming out of American colleges carrying as much as three quarters of a million dollars in debt as college loans and with the length of a medical education, are near thirty years of age, have held off marriage and starting a family and have a decade deep financial hole to dig out of.

The real and true problem is an ongoing and long existing conspiracy between the medical profession, the insurance companies and the various levels of government who can all purchase medical care at any price for their employees, bureaucrats, that has priced the general public out of the equasion.

The AMA and the medical education community strictly limits the number of medical students allowed each year to maintain a shortage of trained physicians to keep there services in a constant state of scarcity, which, in market terms, drives the price up.

The system is fucked, seacat and needs to be completely deregulated and the AMA and the Insurance industry stripped of all power and the market set free to supply the demand for medical service.

I said you wouldn't like it....




amicus...

 

[incubus666]

amicus

You hit a lot of the problems but missed the biggest one IMO any way.

That is the U.S. government. Today the government pay almost 50% of all medical bills.

Medicare, Medicaid, SCHIP, Tricare (for the military), and all federal enployees.

Medicare sets all of the prevailing rates for reimbursements for doctors, and hospitals.Insurance companies jumped on the band waggon and will only pay at what ever rate is set by Medicare.

Since Medicare sets the rates they by default also determine what procedures you may or may not have done. By refusing to pay for a specific procedure they may be rationing the care you receive.

Medicare is over seen by the U.S. Congress. If you do not think that is a problem think about HIPPAA. That was suppose to be a simple law that would allow you to take your health insurance from one employer to another so you would not have to worry about preexisting conditions. Today as it was enacted it affects every health care provider every where in the country. This seemingly simple law has IMO increased the paper work in the health care world by a minimum 10%.

Since everyone is complaining about health care in America and seem to want the government to provide health care for all think how bad it will be when the government provides 100% vs. only 50%.

Sorry about hijacking the thread. I just had to rant.

Mike S.

 

[amicus]

Hi, Mike s, I agree entirely.

Way back in 1966 when I was doing a television and radio talk show in Honolulu, I marched around the court house with a sign, "Medicare is Socialized Medicine and will destroy America"

I even got front page coverage, as I recall, but it was a bad photo of me.

You make excellent points...thank you.

Amicus....

 

[champagne1982]

Stop going to the ER for primary health care, sanitize your hands every time you touch a door or a button inside a health care facility, finish all medication as prescribed by your doctor, find a family physician for primary care and cover your nose and mouth with your sleeve or a tissue when you cough or sneeze, NOT your hand although, in a pinch this is better than nothing at all, be sure to wash your hands for at least one chorus of "Twinkle Twinkle Little Star" or 30 seconds, whichever is longer, afterwards.

eta: If you think your health care provider is going to touch you or any equipment that involves contact with your skin and/or bodily fluids absolutely INSIST that they wash their hands and/or don new gloves (at the very least) in your presence.

 

[Handprints]

Give them to me and I'll tell you how close you are.

Cat

I'm just guessing but, given the amount of time I spend in hospitals, I'm very interested to know the answer: make every visitor wash their hands on the way in and out of the patient's room and don't let the obviously unhygenic visitors in the building until they've had a shower and put on some clean clothes?

Re-reading this, I'm in favour of it whether it makes any difference to hospital-acquired infections or not.

Best,
H

 

[ishtat]

My guesses are clean clean and clean again, boot the patients out as fast as possible. Third and much less popular send old people home to die in dignity because prolonging life for its own sake is crazy.

 

[carrie-on]

I know this is going to sound crazy coming from a nurse, but all of those antibiotic soaps and sanitizers are a lot of the problem. Everyone has certain kinds of germs that are good for the body but too much of a good thing (soaps and stuff) is not good. The germs become resistant to these and then grow even more to where they aren't good for us anymore. Isn't it funny how all these kids still get sick despite the "germfree" environments?We didn't have all of these "germfighters" when I was a kid and we didn't get sick near as much as kids do nowadays.

 

[Emerald_Dragon]

I agree with pretty much everyone. I have worked as a Nursing Assistant and have taken care of people with MERSA. Scary buisness.

How about not understaffing hospitals and nursing homes with the people that do the most work. With more people on staff you are not running like crazy person trying to get everything done. It is amazing the difference that even one extra person will make. You can actually take just a bit more time doing everything including washing hands and wiping down handrails in the hallway and doorknobs ect.

 

[oggbashan]

Provide all staff (and preferably all visitors) with a change into hospital laundered clothing that is worn for one shift only and then laundered again.

That would need changing rooms preferably with showers for all people entering the hospital.

The change of clothing would emphasise the need for cleanliness and handwashing.

Og

PS. It might deter visitors who shouldn't visit because they have active infections.

 

[off2bed]

Those of us in the field know the answers to the questions but we're not asked.

Ok, what's the answer? And why would a bunch of porn site bloggers know?

 

[Recidiva]

This is tough because I know there are doctors that take every step of prevention and beyond. And those who won't care unless their morbidity/mortality stats and/or pay are affected.

If you implement more emphasis on morbidity/mortality in terms of "ounce of prevention" instead of "pound of cure" unfortunately you get the "no patient left behind" syndrome where doctors are paid according to results, so the results are likely not going to have real improvement - it's just that means of measurement are going to alter. Likely not in the patient's favor. The same way surgeons will no longer take on higher risk patients because it affects their mortality statistics.

Any move to discipline the practitioner will work if the practitioner is honest to begin with, but those aren't the ones you want to correct anyway. The dishonest practitioner will find a way to make it someone else's fault. Redirect blame to the patient. Which results in a lowered standard of care.

Prevention is the patient's job. A patient is somehow assumed in modern times to be caring for themselves before they reach a doctor, but this is not, and has never been, the case, except for a small percentage, who probably won't end up needing a doctor. I think the medical industry is being forced to attempt to "solve" problems that are the natural outcome of age, neglect, abuse and otherwise compromised immune systems due to many factors.

What is required is more innovation in prevention. Not more aggressive treatment with what isn't working already.

Unfortunately we don't know what that is yet. Hopefully we will soon.

I think with the current technology, we haven't really reached a clear-cut answer of how to conduct medical treatment that is reasonable in terms of resources. To cover legal considerations, doctors and legal departments have come up with ways to deny treatment to those who need it, and institutionalized it because of the legal and messy mortality backlash. And it's not entirely their fault. If you treat a hospital like a stock market, expect certain patterns to emerge.

There's still an attitude regarding "stay the course" and "full steam ahead" and that costs a great deal.

Doctors are expected to have all the answers to the problems that are created, and I'm afraid they don't.

In the end what you get is the hardest working and most dedicated physicians attempting the impossible and getting slammed the hardest for it. They will take on the portion of patients that are the least responsible in their behavior, the least able to prevent disease. And also the most likely to blame their physician no matter the outcome. The least dedicated and most weaselly physicians have already figured out how to assign blame and have no qualms about refusing care.

 

[champagne1982]

I agree that antibiotic soaps are a waste of resources and money. Studies have shown that an alcohol-based waterless hand sanitizer used for at least 30 seconds or a thorough scrub/rinse dry exercise, encompassing between fingers, the backs of hands and around the wrists works best.

A hand washing regimen I use (replace paper towel with hand towel in private homes) ... water on, dampen hands, soap in palm, wring hands together, work lather between fingers and concentrate on nail cuticles and finger tip beds, sing your ABC's, rinse thoroughly, dry hands with paper towelling and use it to line your hand as you turn off the taps and exit the lavatory.

 

[freshface]

I don't know if this is where you're aiming, but checklists have been shown to significantly decrease some hospital acquired infections. The study that I saw involved central line placement someplace in the Northeast (Michigan maybe or Minnesota?). The doctor who came up with the theory wondered if checklists for medical procedures that assured best practice would make a difference. He thought that if checklists worked for pilots who fly the same plane day after day, they might also work for medical professionals. With the central line study, he created a checklist that covered all of the things that should be routine, such as antiseptic scrub, sterile drape, hand washing, and sterile gloves. The checklist was implemented in hospitals state wide and hospital staff were made responsible for making certain that each item was checked off for each patient. He made some discoveries along the way, such as hospitals where the ICU didn't have Betadine, and encountered resistance (we don't need no sterile drapes, too busy, short staffed). In the end, the study showed marked and significant decrease in central line infections. I don't remember the numbers now and am too lazy to look them up, but I want to say that some hospitals went from a 30% infection rate before to less than 2% after.

Since MRSA infections can be traced to poor practices, I suspect that checklists might help here too.

 

[Selena_Kitt]

stay out of hospitals?

(hey, you can't hit a pregnant woman, even if she's being a smartass! )

 

[SeaCat]

I agree with pretty much everyone. I have worked as a Nursing Assistant and have taken care of people with MERSA. Scary buisness.

How about not understaffing hospitals and nursing homes with the people that do the most work. With more people on staff you are not running like crazy person trying to get everything done. It is amazing the difference that even one extra person will make. You can actually take just a bit more time doing everything including washing hands and wiping down handrails in the hallway and doorknobs ect.

We have a winner.

One of the major problems in hospitals and other medical facilites is chronic understaffing. (No need to go int the reasons behind this, we all know what they are.)

Now if we were to staff the facilities correctly then the staff would have the time to keep up with such little things like cleanliness.

Cat

 

[SeaCat]

stay out of hospitals?

(hey, you can't hit a pregnant woman, even if she's being a smartass! )

I wouldn't think of it.

However I would think about a gentle standing spanking.

Cat