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To be effective in relieving suffering, doctors must strike a balance between paucity and excess of empathy.
As a young doctor working in the E.R. my capacity for compassion, and that of my colleagues, was often stretched; this was particularly the case when my patients could be said to have brought misfortune on themselves. I saw drug addicts suffering overdose, teenagers retching after self-poisoning, thieves injured through being arrested, all treated more brusquely than other theoretically more blameless patients.
I tried hard to maintain empathy, reflecting that the overdosed, self-poisoned and criminal may no more have brought their problems on themselves than those with skiing or horse-riding injuries or heart palpitations through overwork.
But it’s complicated: I’ve stitched up many slashed wrists cut not through willfulness but as a release from intense anguish; I’ve attended alcoholics for whom alcohol was clearly a substitute for love.
I may not have always succeeded, but I always hoped that my humanity, or my professional duty to provide a high standard of care, would step in when my compassion was running low.
By GAVIN FRANCIS
Via Edwin Rutsch
Wellness addicts are getting their nutrient fix through IV drips, bypassing the digestive system and flooding their cells with vitamins. Our correspondent rolled up her sleeve…
“You have gorgeous veins,” said the woman giving me intravenous infusions of a detoxifying antioxidant which, she said, “whitens the skin from the inside out.”
My tawny complexion should look “brighter” in the next few days, she assured me, and the various B vitamins coursing through my bloodstream would give me loads of energy.
These days, health and wellness addicts are getting their nutrient fix through IV drips, bypassing the sluggish digestive system and flooding their cells with vitamins—or so they’re told.
Pop-up IV therapy spas are now widespread in New York and LA, with companies like Reviv and NutriDrip offering bespoke menus of vitamin transfusions that promise to boost everything from immunity to mood and libido.
In the spirit of Cara Delevingne and Miley Cyrus, who have Instagrammed pictures of themselves being intravenously nourished, I went to NutriDrip’s latest pop-up spa in New York’s East Village and rolled up my sleeve.
A smartly dressed man introduced himself as Alain Palinsky, “designer” of theAlchemist’s Kitchen, a new space which he describes as a “plant-based café and herbal pharmacy.” They've partnered with NutriDrip for the pop-up with the intention of offering their services permanently, along with a speakeasy space and other spa-like services downstairs (an infrared sauna and a cell-regenerating therapy that allegedly stems from Nikola Tesla's research in electromagnetic fields).
Palinsky co-founded Juice Press in 2008 but left two years later, just as the juice bar was becoming a wildly successful corporate enterprise (it now has 46 locations in New York alone, along with a handful in Massachusetts, New Jersey, and Connecticut).
He officially opened the Alchemist’s Kitchen, formerly home to the infamous Mars Bar, in June, transforming the space into a haven for wellness-obsessed, well-moneyed city dwellers.
There’s a tonic bar with Scandinavian-style stools, a plant wall, and a modern apothecary stocked with pricey tinctures, potions, lotions, tarot cards, recipe books, and other accoutrements for a bougie New Age lifestyle.
NutriDrip’s telescoping IV poles are stationed at the apothecary counter.
“I brought my Feng shui guy here and we prayed on every wall and all that crazy stuff,” said Palinsky, a salubrious salesman with an endearing lisp. He is 34 but looks ten years older, despite his strict adherence to a “karma diet” (no meat or animal products except raw sheep’s cheese on special occasions).
“You stop eating the animals once you start talking to them,” he chortled, showing me videos of his sister’s puppy while a NutriDrip nurse pumped my IV bag with fluorescent liquid transfusions: Glutathione (the so-called "mother of all antioxidants"), magnesium, theanine, vitamin C, B complex, and B12.
I had opted for “The Detoxifying Journey,” a $249 package specially designed for the pop-up.
“Reset and recharge your system with this powerful detox drip and help your body purge harmful toxins and free radicals caused by stress, chemicals and urban pollutants,” the menu promised.
J’ai quitté il y a peu la médecine de soin. Au bout de plus de 30 ans d’exercice, divers et varié, je n’ai plus envie de soigner ou du moins de soigner dans les conditions actuelles d’exercice.
Via SNJMG, Giovanna Marsico
Gianna Fregonara per “Il Corriere della Sera” Curiosità, coraggio, talento? No, per essere cooptati, nelle imprese come nelle organizzazioni e nei posti decisionali, vince il conformismo,
denuncia in un saggio il filosofo canadese Alain Deneault.
Il primo allarme era venuto dagli Stati Uniti: le prestigiose università della Ivy League, quelle da cinquantamila dollari l’anno (retta più vitto e alloggio) sfornano «pecoroni di eccellenza», un gregge di conformisti, un’élite – ci mancherebbe – preparata e competente ma incapace di «curiosità, ribellione, coraggio morale, stravaganza appassionata», aveva tuonato poco più di un anno fa in un polemicissimo pamphlet William Deresiewicz, professore scartato sì da Yale, ma appassionatamente informato di quel che succede lì.
Il conformismo vincente
Adesso a puntare il dito contro il conformismo vincente è un altro autore sempre dal continente americano. Il filosofo canadese Alain Deneault ha da poco pubblicato un saggio (non ancora tradotto in Italia) dal titolo eloquente:La Médiocratie (La Mediocrazia, edizioni Lux). Dov’è finito il genio? Il talento e il pensiero critico e scomodo sono scomparsi? Le idee luminose ma per questo anche fastidiose non sono più apprezzate. L’audacia delle scoperte sgradita, schiacciata dall’«estremismo del centro», della normalità. Se Deneault ha ragione saremmo già sprofondati in un nuovo modello socio-economico fondato sul predominio sociale e culturale dei «mediocri». O, forse sarebbe meglio chiamarli, i «mediani», nel senso di persone che sono mediamente competenti, mediamente informate e mediamente esperte. In altre parole normali. Ma proprio per questo assimilate, pigre, sbiadite. Cooptate, nelle imprese come nelle organizzazioni e nei posti decisionali, non tanto per le loro doti ma perché leali e affidabili, certamente esperte ma noiose, che fanno funzionare gli ingranaggi meglio di colleghi magari talentuosi ma fuori dagli schemi e dunque inaccettabili.
Il principio di Peter
È una rivisitazione del principio di Peter (in una gerarchia ognuno arriva svolgere il lavoro per cui è incompetente) adattata al nuovo millennio quella contenuta nel Médiocratie di Deneault, un modello che porta secondo l’autore alla corruzione e alla disintegrazione della società. Una visione poco meno catastrofica di altra letteratura sull’argomento, che va da Flaubert a Marinetti fino al filone fantascientifico con il racconto «Null-P» di William Tenn, dell’inizio degli anni Cinquanta, che comincia con l’individuazione del modello dell’uomo medio e finisce con l’estinzione — nell’indifferenza dell’Universo — dell’umanità.
Le università sono il regno della mediocrazia? Prigioniere dei finanziamenti privati, hanno rinunciato a essere il laboratorio dello “spirito critico” a tal punto che il rapporto di subordinazione nei confronti di chi le sovvenziona ha corrotto alla base l’istituzione. È ciò che scrive nel libro “La Médiocratie” (Lux Editeur), il filosofo canadese Alain Deneault, che dedica un intero capitolo a un mondo che conosce da vicino perché ne fa parte: il mondo accademico. E il ritratto che ne emerge è del tutto desolante. Un quadro capace di provocare reazioni infuriate all’interno dell’ambiente universitario per le ragioni più diverse.
Certo, si potrebbe dire che in Italia siamo abituati a tutto questo. Si potrebbe aggiungere che i casi di nepotismo e di corruzione che hanno riempito le pagine di cronaca negli ultimi anni possono averci assuefatti a un realtà da cui spesso faticano a emergere gli esempi positivi, che tuttavia ci sono e sono molti. Si potrebbero precisare tante cose. Ma l’analisi di Deneault, per quanto possa apparire troppo crudele, ha il pregio di farci riflettere sulla strada lungo la quale ci siamo incamminati.
Che cosa sia la mediocrazia e perché i mediocri abbiano preso il potere nel corso della “rivoluzione anestetizzante” avvenuta negli ultimi anni sono i temi di due precedenti post basati sul libro di Deneault.
Patient groups often shout loudly for access to drugs but are quieter about their links to industry. Sophie Arie and Chris Mahony ask whether this is acceptable given increasing demands for transparency elsewhere in medicine
Science is getting to grips with ways to slow ageing. Rejoice, as long as the side-effects can be managed
IMAGINE a world in which getting fitted with a new heart, liver or set of kidneys, all grown from your own body cells, was as commonplace as knee and hip replacements are now. Or one in which you celebrated your 94th birthday by running a marathon with your school friends. Imagine, in other words, a world in which ageing had been abolished.
That world is not yet on offer. But a semblance of it might be one day. Senescence, the general dwindling of prowess experienced by all as time takes its toll, is coming under scrutiny from doctors and biologists (see article). Suspending it is not yet on the cards. But slowing it probably is. Average lifespans have risen a lot over the past century, but that was thanks to better food, housing, public health and some medicines. The new increase would be brought about by specific anti-senescence drugs, some of which may already exist.
This, optimists claim, will extend life for many people to today’s ceiling of 120 or so. But it may be just the beginning. In the next phase not just average lifespans but maximum lifespans will rise. If a body part wears out, it will be repaired or replaced altogether. DNA will be optimised for long life. Add in anti-ageing drugs, and centenarians will become two a penny.
The following graph visualizes the relationship between life expectancy and health expenditure, for a number of OECD countries across the period 1970-2014. Two points are worth mentioning. Firstly, all countries in this graph have followed an upward trajectory (life expectancy increased as health expenditure increased), but the U.S. stands out as an exception following a much flatter trajectory; gains in life expectancy from additional health spending in the U.S. were much smaller than in the other high-income countries, particularly since the mid-1980s. And secondly, the gains for all countries (except for the U.S.) were not diminishing, as in the previous graph. This suggests that there are many other factors affecting life expectancy, that are not determined by healthcare spending. Indeed, as we have pointed out before, healthcare is just one of many inputs to produce health.here to edit the content
Why does a drug in Switzerland cost three times less than the same one here?
Humira is an injectable medication used to treat multiple autoimmune diseases ranging from rheumatoid arthritis to psoriasis to ulcerative colitis — and it’s one of the best-selling drugs in American history. In 2014 alone, millions of Americans spent a combined $6.5 billion on Humira prescriptions.
But we probably didn’t have to. While Americans paid an average price of $2,669 for Humira, the Swiss were able to buy the exact same drug for $822 — and in the United Kingdom, patients got it for $1,362. If the United States paid what the Swiss paid for the arthritis drug, we would have spent $2 billion on Humira in 2014 rather than $6.5 billion.
There’s nothing different about the Humira that we bought in the United States and the drug the Swiss bought – except that in the United States, we’re terrible at negotiating a good deal on pretty much any medical service.
“It’s exactly the same product, but, in terms of the American patient, you’re just paying double or more the price for no more health gain,” says Tom Sackville, chief executive of the International Federation of Health Plans.
Every two years, his group publishes a report that compares health care prices in different countries. And it shows that Humira isn’t some weird anomaly; nearly every procedure or drug costs way more in the United States.
Official Full-Text Publication: The Glymphatic System - A Beginner's Guide on ResearchGate, the professional network for scientists.
J Am Osteopath Assoc. 2016 Mar;116(3):170-7. doi: 10.7556/jaoa.2016.033.
The Glymphatic-Lymphatic Continuum: Opportunities for Osteopathic Manipulative Medicine.
AbstractThe brain has long been thought to lack a lymphatic drainage system. Recent studies, however, show the presence of a brain-wide paravascular system appropriately named the glymphatic system based on its similarity to the lymphatic system in function and its dependence on astroglial water flux. Besides the clearance of cerebrospinal fluid and interstitial fluid, the glymphatic system also facilitates the clearance of interstitial solutes such as amyloid-β and tau from the brain. As cerebrospinal fluid and interstitial fluid are cleared through the glymphatic system, eventually draining into the lymphatic vessels of the neck, this continuous fluid circuit offers a paradigm shift in osteopathic manipulative medicine. For instance, manipulation of the glymphatic-lymphatic continuum could be used to promote experimental initiatives for nonpharmacologic, noninvasive management of neurologic disorders. In the present review, the authors describe what is known about the glymphatic system and identify several osteopathic experimental strategies rooted in a mechanistic understanding of the glymphatic-lymphatic continuum.
Social media is fundamentally changing the PR and marketing industry, and the healthcare sector is no exception. From Facebook and Twitter pages to blogs, YouTube videos and Snapchats, these channels give healthcare organisations the opportunity to influence patients in their pursuit of healthcare. There’s even a social network dedicated to health that allows patients to seek support and advice from hundreds of health communities. Healthcare has got social.
With easy access to vast amounts of healthcare information, the patient-doctor dynamic is changing and patients are now much more informed about conditions and treatment options. With hashtags categorising conversations within social media, be it #Diabetes or#BreastCancer, patients can discuss specific conditions, in real time, accessing information from other patients and any engaged clinicians. The information patients find does have a significant impact: a survey by Adweek found that for more than 40% of consumers’ information found via social media affects the way they deal with their health.
Listen to what patients are saying
Social media allows clinician and practices the opportunity to ‘listen in’ on these conversations and many of these online communities will provide the perfect targets for information from private practices. What’s more, group members will also be more likely to take recommendations from other group members and online friends, particularly younger people. In one recent survey by Search Engine Watch, 90% of respondents from 18 to 24 years of age said they would trust medical information shared by others on their social media networks. If someone in a group or forum says good things about a private practice, other potential patients may hear about it and follow up on the recommendation.
According to Preeti John, a Baltimore-based surgeon who gathered essays, poems, and interviews from sixty women surgeons for her book, Being a Woman Surgeon, a surgeon’s life is challenging, requiring not only physical stamina but also “strength of character, balance, careful planning, and a firm commitment to what is important.” These adapted essays from four of the surgeons featured in the book calmly and proudly attest to the truth of her statement.
Based upon my own experience and many discussions over the past few years, there's one key reason why digital transformation efforts fail: a lack of communication and involvement of people who matter far more than assumed, and those who are all too often overlooked.
It happens in transformations on the level of a business function, processes, an overall business model and most certainly societal evolutions.Overlooking internal customers
We could also call it a lack of leadership, but then, in a non-traditional sense: the ability to ‘lead’ or, better, create a common purpose with a clear buy-in and involvement of all stakeholders, not just buy-in of leadership itself.
Most companies realize that there's often a link between customer-centricity and customer experience on one hand, and digital transformation on the other. However, when you start looking from the top-down, there's a distinct lack of involving, let alone informing and guiding ‘internal customers’.
We've mentioned before how many customer-facing employees feel that leadership doesn’t really care about them. In transformative projects, employees and other critical stakeholders are often left out far too much as well, amidst uncertainties, leadership changes, a lack of basic involvement and uni-directional “internal” communication and management patterns.
You've probably heard about the so-called 'Iceberg of Ignorance' concept, depicted below. Never mind the percentages but we do know there's a cost in not being close enough to those front-line employees who, in the end, need to make transformations and your customer-centric initiatives happen. And it’s exactly there – and thus close to the customer – that we need to be in digital transformation.
Large health care systems are beginning to invest core operating dollars in connecting their patients to community resources, in service of the ultimate solution to better costs and outcomes: keeping patients healthy.
Twelve-year old Anna has asthma. She lives in a low-income neighborhood and gets her care at a clinic affiliated with a major teaching hospital. Despite high-quality medical care, Anna’s asthma is not well controlled. Last year she missed almost two weeks of school, had two urgent care visits, and a brief but scary (and expensive) hospital stay. Her pediatrician believes that the old, rent-subsidized apartment where Anna’s family lives may be part of the problem: The presence of mold, moisture, rodents, and dust mites, for example, may trigger her asthma attacks but lie beyond the scope of a clinical intervention.
Situations like Anna’s (a composite illustration) are a major factor in worsening health and rising health care costs in the United States. Unhealthy living conditions, nutrition, and a host of social and environmental factors turn potentially manageable health issues into costly ones for both patient and provider. Indeed, the Robert Wood Johnson Foundation, the largest private US grantmaker focused on health, estimates that just 20 percent of a person’s health is related to health care. The rest stems from behavioral, environmental, and social factors. As highlighted by The Commonwealth Fund, asthma symptoms can be linked to where families live; frequent emergency-department visits and hospitalizations can be linked to homelessness; and diabetes-related hospital admissions and other health problems can be linked to food insecurity. In health systems like Kaiser Permanente—one of the largest managed care organizations in the United States—just one percent of the patient population accounts for approximately 25 percent of the total cost of medical services provided annually, often due to non-medical factors.
What’s the right way to pay for hospital care? Believe it or not, even in 2016, we don’t really know. In many advanced economies, hospital care is paid with a yearly budget for a given population. In other countries with advanced health care systems, hospital care is paid piecemeal; every inpatient day generates new bills for the room, the nursing staff, and the procedures.
Piecemeal was how Medicare paid for hospital care until the mid-1980s when it switched, for a large majority of hospitals, to what is known as prospective payment. Paying prospectively was simple: identify why someone was admitted and provide a lump sum for that hospitalization based on our best understanding of what it costs to care for that condition. Although the formula for payments is complex, the idea underlying it is straightforward. We pay more for more complicated conditions and for patients with more complex issues, and then let hospitals figure out how best to spend the chunk of money from an “inpatient bundle.”
Most policy makers believe prospective payment has worked well. Seen in one light, we know that bundling payments for inpatient care has reduced hospital spending growth. For example, inpatient spending on acute myocardial infarction (AMI) grew just 0.9% annually from 1997 through 2010, far below the overall growth in health care spending. However, the number and types of hospitalizations have changed, such that per capita hospital spending has grown at nearly 5% between 2000 and 2010.
But the news is worse. Much of the spending growth around inpatient care, which has grown slowly, has shifted to postacute care—long-term hospital care, rehabilitation care, and skilled nursing facility care—where spending hasskyrocketed. Inpatient bundles may appear to have successfully curtailed spending growth, but like pushing on a balloon, the spending growth bulges elsewhere.
Given these challenges, the Centers for Medicare & Medicaid Services (CMS) has experimented with 30-day bundles for the last several years, allowing hospitals to voluntarily choose which conditions they want to bundle. The hospital receives a single payment for the expected costs of a patient’s hospitalization for the condition and first 30 days after discharge. If the hospital uses fewer services, it gets to keep some of the savings; if it spends extra, it typically has to pay Medicare back. The effect of this program, which has had only modest participation, is largely unknown.
To move toward bundles that extend beyond hospital care, CMS introduced 2 new programs over the past year. TheComprehensive Care for Joint Replacement, introduced in April 2016, focuses on hip and knee replacement surgery for all acute-care hospitals in 67 metropolitan areas. On July 25th, CMS announced a substantial expansion, the Episode Payment Model (EPM) program, for 3 conditions: AMI, coronary artery bypass graft (CABG) surgery, and hip and femur fracture surgery. All health care services for these conditions that occur within 90 days of discharge, rather than within 30 days, are included in a single bundled payment that a hospital must manage. The rationale is that most of the health care services that occur soon after discharge are related to the condition for which the patient was hospitalized, and holding hospitals accountable for that care makes sense.
Ma allora, quali sono i rischi quando si utilizza un defibrillatore?
Nessuno! A ben vedere non esiste nessun rischio pratico nell’utilizzare il defibrillatore senza aver frequentato un corso BLSD, poiché le istruzioni di questo strumento sono talmente chiare e precise che nessuno potrebbe sbagliare. Ovviamente, si consiglia sempre di frequentarlo per imparare le tecniche di massaggio cardiaco, di messa in sicurezza della scena e di utilizzo del defibrillatore.
Life has definitely changed a lot in the last one hundred years.
Back in 1914, a man could follow a set life path and not have to worry too much about the slowly changing world around him. It was clear that he needed to grow up, get a job, get married, have a family and then prepare for retirement and death. Yet, for a man in 2014, life isn’t so simple and straightforward anymore.
Here are just a few of the many differences between being a man in 1914 vs. 2014
It is not enough to write monographs. It is not enough to publish. Today, scholars must understand what happens when our research is distributed, and we must write, not for rarified audiences, but for unexpected ones. New-form scholarly publishing requires new-form scholarly (digital) writing. Digital academic publishing may on the surface appear as a lateral move from print to screen, but in fact it brings with it new questions about copyright, data analysis, multimodality, curation, archiving, and how scholarly work finds an audience. The promise of digital publishing is one that begins with the entrance of the written, and one that concludes with distribution, reuse, revision, remixing — and finally, redistribution.
Digital publishing is a field worthy of rigorous research and deep discourse. In a post-print environment, for example, social media — Twitter, Facebook, Pinterest, WordPress, or Tumblr — have supplanted the static page as the primary metaphors for how we talk about the dissemination of information. Digitized words have code and algorithms behind them, and are not arrested upon the page; rather they are restive there.
Via Pierre Levy
In some workplaces, reorgs and personnel changes are constant, which means that you might be getting a new boss every few months. How do you develop an effective relationship with your manager when the person filling that role keeps shifting? How much of an investment should you make? How can you get what you need to succeed and grow in your role? And is maintaining continuity your responsibility?
The United States stands at a crossroads as it struggles with how to pay for health care. The fee-for-service system, the dominant payment model in the U.S. and many other countries, is now widely recognized as perhaps the single biggest obstacle to improving health care delivery.
Fee for service rewards the quantity but not the quality or efficiency of medical care. The most common alternative payment system today—fixed annual budgets for providers—is not much better, since the budgets are disconnected from the actual patient needs that arise during the year. Fixed budgets inevitably lead to long waits for nonemergency care and create pressure to increase budgets each year.
We need a better way to pay for health care, one that rewards providers for delivering superior value to patients: that is, for achieving better health outcomes at lower cost. The move toward “value-based reimbursement” is accelerating, which is an encouraging trend. And the Centers for Medicare & Medicaid Services (CMS), to its credit, is leading the charge in the United States.
That doesn’t mean, however, that health care is converging on a solution. The broad phrase “value-based reimbursement” encompasses two radically different payment approaches: capitation and bundled payments. In capitation, the health care organization receives a fixed payment per year per covered life and must meet all the needs of a broad patient population. In a bundled payment system, by contrast, providers are paid for the care of a patient’s medical condition across the entire care cycle—that is, all the services, procedures, tests, drugs, and devices used to treat a patient with, say, heart failure, an arthritic hip that needs replacement, or diabetes. If this sounds familiar, it’s because it is the way we usually pay for other products and services we purchase.
We need a way to pay for health care that fosters the delivery of superior value to patients.
Emerging social media sites targeting patients are increasingly playing a vital role in societal “information sharing” research announced today by the University of Warwick, Coventry, U.K.Sites such as HealthUnlocked in the U.K. allow patients to tap into a community with the same health challenges for moral support, shared information about health care providers and practical advice to manage their medical condition.