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Suicide and The Rural ER

July 6, 2017

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Underserved. We frequently talk about rural communities being medically underserved. Usually, this means underserved by PCP’s.  And usually the recommended solutions have to do with allowing PA’s and NP’s to practice unsupervised in such areas. Or designing special programs to attract PCP’s to rural communities. Educational loan forgiveness and such.

But read this piece. You will be reminded of a cruel irony. Rural communities, where closed steel mills and coal mines are contributing to soaring unemployment, in turn leading to soaring alcoholism and other mental health problems, have virtually no Psychiatrists and no mental hospitals. Leading to the kinds of train wreck situations described in this piece.

And things aren’t getting better on this front. They are getting worse. No, folks, the mines aren’t going to reopen!!!

Bottom Line. I like to close my daily blogs with a breezy little recommendation as to how bad healthcare situations can be made better. Quickly and easily.

Unfortunately, folks, today I’ve got nuthin’!

Ideas?

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How 101 Words Helped to Fuel the Opioid Crisis

June 12, 2017

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Check this out. What you will see is a fascinating analysis of how only a few sentences, under certain circumstances, can take on a life of their own and wreak major havoc.

More specifically, what you will see is the impact felt from a 1980 Letter to the Editor of NEJM. Just a few sentences summarizing the findings of an analysis that seemed to indicate that the use of opioids in the treatment of pain carried with it virtually no risk of abuse or addiction. Wrong!

As the story got spread, a couple of key factors got left by the wayside. The fact that the patients studied were in a hospital environment, for example. And the fact that patients included in the analysis were those who had taken an opioid “at least once.” Etc. Leaving out these “little details” convinced physicians that it had been demonstrated that opioids carried little risk of addiction in the treatment of chronic pain in ambulatory patients. Wrong again!

Bottom Line. This piece taught me a new term. Bibliometric Analysis. A rigorous procedure used for counting how many times this letter was cited by other scholars. Over 600 times! In articles read by untold thousands of physicians. 

 The moral of the story. When information is put “out there,” it can take on a life of its own. It can morph significantly in terms of meaning, and get (mis)quoted ludicrous numbers of times. 

 So. Be careful. As a writer. And as a reader.

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ZD, MD Strikes Again

May 23, 2017

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You all know how I love ZDoggMD. Why? Because he is a physician who knows what the important messages are today in public health, and knows how to communicate them creatively. Here is his latest offering.

As usual, his message can be taken at several levels. Cut through the rapping, and at the next level what you hear is his warning to stay away from tanning beds. Got that!

But at the next level, what he is saying is that consequences can be thought of as being immediate, intermediate or long term. As with many dangerous activities, the immediate consequence of tanning bed use is gratification. Boy, will I look great in my white prom dress with this tan! Unfortunately, it is the seeking of such short-term gratification that causes much of the behavior that has negative impacts on our health.

At the other end of the temporal spectrum is the specter that tanning beds might cause a skin cancer that will kill us. Maybe. Eventually. Unfortunately, communicating such doomsday scenarios typically does not dissuade people from participating in dangerous activities.

Ah, but then there are the intermediate consequences. Like tanning beds will, in a very short period of time, almost certainly make the user look old and wrinkled. AAAHHH!!!

Bottom Line. Things keep working out this way. Years ago, I saw a study that showed that the chance of getting lung cancer didn’t make people put down cigarettes, but the high likelihood of smoking causing significant and unattractive dental problems, after only a few years, did.

The learning? While public health campaigns often emphasize dire long terms results, people often ignore them since they see the probability of developing the problem as low and the timing distant if ever. Intermediate results, which happen sooner, with higher likelihood and often with graphic images like wrinkly skin and rotting teeth, tend to be more effective. 

Let’s learn to communicate more effectively by applying this learning!

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Prescription-Free Naloxone

May 18, 2017

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Pharmacy

Another interesting moral quandary. Check out this piece. It reports that Hy-Vee is making Naloxone, used for the treatment of opioid drug overdoses, available in 4 states without prescription.

Good news? Sure! If you or a loved one is at risk of a drug overdose, the ready availability of a drug, in injectable or even nasal inhaler form, that can save a life is a godsend. BUT. Again, I worry if this quick fix will encourage a more cavalier attitude toward drug use.

Bottom Line. As I keep saying, beware of unintended consequences. Question. In a situation like this, is there a way to get the positive benefits of an antidote’s availability without encouraging increased use of illegal opioid drugs?

Think about it!

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Ebola? Again???

May 16, 2017

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Ebola

Just a quick thought. Ever wonder what happens to those diseases that get their Andy Warhol 15 minutes of fame and then disappear? Remember when the national news was chock full of Ebola? Helicopters, patients and doctors wearing space suits?

And then it went away. Or not. Check out the “or not” part right here. At least in the Congo, Ebola seems to be back. In spades! Stuck in the middle of this piece is the report that this is the eighth outbreak of Ebola that the Congo has faced since 1976!!!

Bottom Line. Despite the thousands of people that have died of Ebola over the years, there remains no vaccine and no cure. Inquiring minds want to know . . . Do researchers continue to work on Ebola, and those other conditions that come and go (remember Sleeping Sickness, etc.???) when we are between outbreaks? How are research priorities set here? Who is in charge of all of this? 

My guess is that we will never know the answers to these questions! And if we did we would be dissatisfied.

 

Unfortunate, eh? 

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Bill Gates Takes On Donald Trump

March 30, 2017

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Bill Gates

Check this out. What you will see is a Time Magazine article in which Bill Gates challenges the reasoning behind Trump’s cutting of foreign aid related to health care. More specifically, Bill argues that by nipping epidemics like Ebola in the bud, investing in health care outside the U.S. makes Americans safer.

As an aside, Gates’ thesis here could be expanded well beyond healthcare. It might well be rational, even in an increasingly nationalistic political environment, to selectively invest dollars offshore. Makes sense!

Bottom Line. Gates and Trump are supposed to meet sometime in the near future to discuss this issue. Wouldn’t you like to be a fly on the wall for that one???

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States With The Highest And Lowest Paid Doctors???

March 17, 2017

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Go here to see a ranking of the 50 States in terms of average physician salary.

Bottom Line. Why would you care? I am guessing that you are not a physician looking for a State in which to practice. BUT. There are broader questions underlying these dollar amounts. Things like why the discrepancy? And no, it’s not cost of living. And what do these different compensation levels mean for the kinds (?) of physicians that wind up being attracted to practice in these states, etc.

Interesting stuff!

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Why Do We All Want To Die???

March 13, 2017

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That is the question posed, and elucidated, in this blog post from the Psychiatrist pictured above. Read the post at two levels. First, ponder the causes of suicidal ideation and think of the extent to which these causes are increasingly ubiquitous. Feelings of global unrest, absence of belonging, etc. Quite unfortunate, actually!!!

Second, ponder the notion that this Psychiatrist is dealing with suicidal ideation with tele-psychiatry. As I read his musings on the topic, I thought about the fact that the good news here is that I would guess that the vast majority of the patients who come to him digitally would never have gotten to the bricks and mortar office of a shrink in the old days.

All good.

Well, not quite all good. You might note that the doctor is one busy dude, often having a backlog of patients waiting for a consult. Sad if a patient does the deed while waiting to be seen!

Bottom Line. One of my favorite truisms has always been la plus ca change, plus c’est la meme chose. The more things change, the more they remain the same. But not this time, folks. In this one blog post we see a rather accurate and devastating description of changes in the world that are making us all, yes all, more prone to suicide. AND. You see the blossoming of tele-psychiatry to help us to deal with these and other mental health issues. Yup! In 2017, things really are different!

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If Legalizing Same Sex Marriages Reduces Suicide Rates Among Homosexual Adolescents, Then …

March 10, 2017

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What? A recent study found that legalization of same sex marriages has significantly reduced the rate of adolescent suicide attempts among kids who are members of  sexual minorities. As discussed in the linked video, the working assumption here is that this drop is due to the reduction in stigma experienced by kids in these groups.

While this specific outcome is no doubt a positive one, one ponders its greater meaning. At the extreme, does it mean that the legalization of other stigmatized behaviors would result in the avoidance of even more adolescent suicides? And if so, what are the legalization steps that would be instrumental in this outcome? And the unintended consequences of these steps?

We can ponder, for example, the oft discussed (and now jeopardized!) legalization of transgendered individuals using the rest room of the sex with which they “identify.” Did thus reduce stigmatization in public schools? Suicide among adolescents? I frankly don’t know!

Bottom Line. Today, spend a couple of minutes and ponder the connection between “legal” and “popularly accepted.” I’m thinking this link is going to become increasingly important in years to come.

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Prescriber Expectations

February 27, 2017

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Interesting stuff. Check out this NYT article. What you will find is that physicians who prescribe a lot of opioid medications also wind up with a greater percentage of their patients on chronic opioid use. This somewhat less than surprising statement, of course, is open to multiple interpretations. Seems like the simplest one is that physicians who are more open to opioid use are not only more likely to prescribe these drugs initially but are also more liable to allow patients to remain on the products chronically. An alternative interpretation, i.e., that the high prescribing/chronic prescribing doctors see more severe pain patients, deserves some consideration but is likely not what is happening here.

Bottom Line. Much has been written about the “opioid epidemic” in this country. The study reported in this article seems to indicate that some doctors do need to toughen up their prescribing philosophies and practices in this area. 

More generally, the article serves as a reminder that treatments and treatment outcomes are highly dependent upon the specific physicians involved in the prescribing.

Lots of reasons for us to keep that in mind!

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