Brown vs. Board of Nursing

January 21, 2010

Timothy Noah is right. I still may not  feel entirely confident that I know how to use the word ironic correctly, but I think this one’s got irony written all over it, probably in the blood of the uninsured. For those of you who don’t know, Massachusetts is the only state in the country with near-universal health coverage, which was achieved by legislation enacted in 2006. The Massachusetts legislation passed under the stewardship of then-governor Republican Mitt Romney. Jump to three years later, when Obama’s pushing health reform on a national level, and one of health reform’s champions, Democratic Senator Ted Kennedy (from… where else? Massachusetts, duh), dies a politically untimely death in  August 2009. Now here we are in the new year, and Republican  Scott Brown, a  Mass. state senator,  just won Kennedy’s vacant seat in a special election. Brown is the first Republican to occupy the seat in like a billion years or something. As a state senator, he supported health reform for Massachusetts, but now as a United States senator, he opposes national health reform. The voters of the only state with universal health coverage sent a man who opposes health reform to the Senate. The irony of the circumstances, the irony of the timing, the bizarre message this sends… well, I’m at a loss. I’m sad. The watered-down, public option-free, anti-abortion, pro-insurance company, pro-Big Pharma version of heath care reform that the Dems worked so hard to pass in both the House and the Senate may never reach the president’s desk, thanks to an unfortunate death and a fateful election. Even in its flawed state, I wanted that legislation to pass. I really did. Now it probably won’t, and I just have to be sad.

Yet some things still retain the power to make me glad. Check out this sweet article from Kaiser Health News, authored by Dr. Lavizzo-Mourey, president and CEO of the badass Robert Wood Johnson Foundation. The article argues that nurses have the clinical expertise, the patient advocacy background, and enough of the public’s trust to reshape health care for the better, but we lack positions of political influence. So, my dear nurse friends, I hope this inspires you to live up to the public’s high opinion of you. I hope this means you’ll think about organizing and bombarding your senators and representatives over the health reform issue. I hope this means you’ll run for city council, apply for Ph.D. programs, join hospital boards, join nursing organizations, go to law school, and first and foremost, take what you’ve learned at the bedside with you. I know many of you will argue against ever leaving the bedside… after all, patient care is why you became nurses in the first place. I’m not saying everyone in our field needs to start climbing the ladder and grubbing for power.  But I do think that part of patient care is lifting your gaze from the bedside, looking out the dirty hospital window and seeing inequities that either prevent millions of people from ever reaching a much-needed hospital bed or trap countless others in their hospital beds, unable to shake the chronic diseases of our civilization. So although you are desperately needed at the bedside, and much appreciated by your colleagues and your patients, I do believe that most bedsides at least come equipped with a cheap-looking hospital phone from which you can call your senators and representatives and tell them why the both the bed and the bedside are such difficult places to be these days. Don’t forget to dial 9 first.


Chemical Dependency

January 4, 2010

A most terrific Miss Diagnosis blog on commercial chemical secrecy and autism can be found here, while another update on health reform-cum-social commentary on Facebook can be found here. Keep reading, friends!

Heinrich n’ Me

December 17, 2009

Miss Diagnosis, my reporter/journalist/political whiz of an alter ego, interviews New Mexihunk representative Martin Heinrich for The Alibi.

Drugz R Us

December 11, 2009

54 children die from tainted medications, Eli Lilly pays NM $10 million in settlement fees for illegally marketing Zyprexa, and Congress considers and amendment to allow importation of FDA-approved prescription medications from abroad. Miss Dx  sure likes her drugs, baby.

In Defense of Nursing

December 11, 2009

As a family nurse practitioner student, people regularly ask me a question that I find extremely rude:

“So why didn’t you just go to medical school?”

All nurses who are labelled as achievers, as do all male nurses, get asked this question frequently. People don’t understand why anyone would choose to become a nurse rather than a doctor. They assume that this decision is evidence of the fact that you must not “measure up” or “have what it takes” in some way. These assumptions have saddled nursing with a bit of an inferiority complex (here I go with inferiority complexes again), which we cope with as best we can by fortifying our discipline with ever-improving arms of academia and clinical expertise.

Although nursing and medicine are related, they are distinct disciplines. We’ve had our own pioneers, our own theorists and researchers and clinical heroes. For me, the difference comes with how we are taught to conceptualize things like health, wellness, disease, treatment, power, and empowerment. Nurses seek to address the patient holistically, as a balanced ecosystem of body parts, chemical reactions, cultural components, social bonds, economic resources, developmental stages, and idiosyncratic quirks. A nurse practitioner aims to use not only empirical or scientific knowledge in the battle against illness, but also personal, ethical, aesthetic, and sociopolitical knowledge as well. We’re trying to improve our understanding of how broad determinants of health, such as socioeconomic status, influence the human beings that we care for. And though we seek to sharpen our clinical judgment and expand our arsenal of skills in order to keep pace with modern medicine, we keep the focus on the global picture. This is the direction that nursing leadership is and always has been pursuing.

Of course, I’m biased towards my own profession, but I didn’t start out this way. I went into nursing with a very low opinion of the field. My only plan was to use nursing as a bridge to medical school. But my time in the real world, my experiences within the healthcare system and by the bedside profoundly influenced me. Which is why I really loved this column on nursing published by the Kaiser Family Foundation. It really rings true to me by acknowledging how nurses are trying to impact the system and how nurses contribute to improved medical outcomes. The article reviews some of the progress that nurses have made in the past ten years in terms of influencing how care is delivered. The authors describe nursing as undervalued, which is a statement that’s often thrown around flippantly, but they show the sad truth behind the statement. For instance, despite the fact that nearly half of all health care workers are nurses, and despite the fact that nurses deliver the vast majority of bedside care, only 2% of hospital boards include nurses on them.

Given the current health care climate within the larger global picture, nursing’s struggle against insane policies and practices (everything from understaffing and poor utilization of human resources to global inequities and evil economic practices) is an uphill battle. But I have confidence that nurses will succeed in shaping a more humane, more sustainable health care system in the future. I hope this blog post adequately captures how honored I feel to be in such good company as we move forward with our committment to a better world. I also hope I finally put to rest all those questions why I didn’t choose medical school. And nursing, if you couldn’t already tell, I love you.

I Heart Nurses, ER edition

December 10, 2009

I’m about to tell you a deep dark secret of the medical world, so keep this on the D.L, deal? Ready? Ok. Here we go. (Deep breath.) Ok. (pause). Alright. For reals this time. Ready? Ok. 1, 2, 3, go!

Whether or not they are willing to admit it, almost every health care worker, no matter what age, what gender or what specialty, has an inferiority complex concerning emergency department folk. Even if we are happy in our own specialties, tending to premies in Newborn ICU or sullen teens at the STD clinic or emotionally-bereft family members of patients new to hospice, we all kinda secretly wish we could hop on top of the gurney and crack open the chest of a trauma patient. We want to wield that crash cart with ferocity, slam that first intraosseous needle into a veinless drug addict, and deploy enormous volumes of morphine with swagger. We want the badass ER nurses to accept us into their shit-talkin’ clique and the testosterone-pumped docs to meet us at the bar for a round of shots and dirty stories after our shift.

Of course, this is all part of a fantasy that doesn’t really exist. ED docs are not always manly, handsome superhumans–the best ED doc I know is a sweet, soft-spoken hispanic lady. And not all ED nurses are fiery redheads like my friend Lisa, although I have noticed that emergency nurses are, in general, bitchy and hilarious and a blast to hang out with. But many of them are cranky burnouts or sweet older ladies or hardworking fathers. There’s also techs and secretaries and paramedics and terrified students and lab people and pharmacists and transport guys and the people who restock the supplies and a few naked, disoriented patients from the other wards wandering around, too. But in reality, ED patients are not all gory traumas and massive MIs and outrageous injuries, and they are certainly not all quirky but lovable or touching characters. For the most part, ED patients at a big teaching hospital like ours are drunks, drug seekers, unfortunate people without insurance, and hysterical parents of children who have the sniffles. Now, I am not saying that our ER does not see some crazy shit. They have gunshot wounds and MVAs and hanta virus and bones sticking out of limbs and blown valves and all kinds of stuff. But these cases are relatively few compared to the constant onslaught of non-emergency cases and substance abusers. And this type of inappropriate usage of the ED is one of the reasons why ER waiting rooms become a holding cell for desperate people who have been waiting 6, 10, sometimes 14 hours just to see a doctor. It’s a shitty situation, and nobody’s happy. And that’s the real reality, the reality that keeps most health care workers out of the ED, mindful that the fantasy isn’t worth the stress of a system in peril.

Inappropriate usage of the emergency department is a complex problem with multiple etiologies. Many people without access to insurance are forced to use the ED for primary care. Other people cannot wait 2 months for an appointment with their own primary care provider. Plenty of people do end up going to their primary care provider’s office, at which point they are sent directly to the ER by a nervous provider who would rather take extra precautions than be sued. Plenty of people are just unaware of alternatives like urgent care. People with avoidable chronic illnesses such as diabetes or heart disease have scary flare-ups that send them to the ER on an annoyingly regular basis. And other people just don’t know that a cough and a runny nose are not life-threatening, since health education leaves much to be desired in this country. Social services also leave much to be desired in this country, which means emergency rooms get to babysit people who would be better off in a comfortable shelter or a treatment program.

All this overflow adds up to a miserable experience for people who really are experiencing severe, urgent or life-threatening problems. It adds up to waste and burnout. Even if people receive excellent medical care at the ER, they leave pissed and dissatisfied because of long waiting times, poor customer service, and high out-of-pocket expenses.

If you are unfortunate enough to wind up in a busy ER, make sure you pack a blanket and a pillow. Bring your iPod and some snacks. If you have a laptop, bring that too, since most ERs now have wireless internet and you can use the time to google your symptoms and diagnose yourself. Unless your guts are spilling out all over the place, don’t expect to be seen right away. My apologies for that. The thought of people waiting stresses me out, and that’s one of the toughest realities that ER people must constantly confront.

Even given what a hot mess the emergency department is, I still cling to the fantasy of hot doctors and kickass nurses and crazy medical cases. The reality of the situation makes these people even more remarkable, since they deal not only with the ugliest medical disasters, but also with the ugliest snags in the health care system. It’s quite a burden to shoulder, and some shoulder it more gracefully than others. In either event, I hope that political, social, cultural and economic factors eventually converge to help ease the load and restore the ER to its rightful place among the medical specialties: emergency medicine.

News updates and tips that will get you laid

December 10, 2009

Miss Dx updates you on the latest health reform and H1N1 gossip. She also turns health reform into a holiday aphrodisiac. Enjoy!