Don't Put Your Faith in Antibiotics

This time of year sees an uptick in people who present to the doctor's office for one reason, they want an antibiotic. It's amazing how people think antibiotics are the cure for all their ills, even though antibiotics are only useful in treating bacterial infections.

People don't want to hear how their viral illness won't respond to an antibiotic. They don't care that at the rate things are going, antibiotic overuse is going to make most antibiotics ineffective leading to deaths from minor bacterial infections. They certainly have no interest in treating themselves by increasing fluids, staying home and resting. No. An antibiotic prescription is the expected parting gift of the office visit and without it, well, try the Emergency Department. Maybe they'll give you one to shut you up and get you out.

I think it's a type of sickness hysteria fueled by the internet and symptom checkers. Have a sore throat? It must be strep! A stuffy nose for a week? Sinusitis! A cold that's made you tired and run down? Bronchitis!

Problem is 85%-95% of sore throats aren't strep, 90-98% of sinus infections are caused by viruses, and most upper respiratory infections aren't bacterial. Antibiotics will do nothing for these infections. The bitter truth is that it takes time to recover from an illness. Colds, bronchitis and sore throats caused by viruses may last two weeks or more, time we're not prepared to spend taking care of ourselves. It's easier to throw a pill at it.

Instead of rushing to the doctor's office (and exposing yourself to whatever germs are lurking there), the next time you're sick, stay home and take care of yourself. A tincture of time is remarkably effective in curing much of what ails us and it's safer and cheaper than an antibiotic.

Remember, antibiotics kill bacteria, not viruses.

Did You Wash Your Hands?

As part of my ongoing kitchen remodeling project, visitors to my home now have the option to relax on couches and watch me cook. I joke that it prevents me from serving anything I drop on the floor, but my real worry is that I'll forget to wash my hands appropriately (between handling meat and vegetables or the like) and someone will call into question my ability to safely prepare food.

Now I have a pretty good record in that I have no reported instances of my guests contracting a food related infection (at least not that I'm aware of). Unfortunately many hospitals can't say the same when it comes to healthcare acquired infections or HAI's. The Centers for Disease Control (CDC) reports that for every 20 patients in the hospital, one gets an infection. That's two million infections annually. The simple act of handwashing breaks the chain of infection. So why don't healthcare workers do it every time?

A quick scan of articles on the topic show handwashing rates of 37% to 77% for healthcare workers. Interventions to increase these numbers, including education, posters, and even personal hand sanitizer dispensers that monitor the number of uses, have all met with limited success. When no one's actively paying attention to handwashing compliance, handwashing rates drop and infections increase.

Some institutions have encouraged patients to ask healthcare workers whether they've washed their hands before a treatment is given. I contend that the majority of hospital rooms and outpatient exam rooms have sinks or are equipped with hand sanitizing dispensers. It's clear to most patients who has, and hasn't washed their hands, but they're too intimidated to demand only clean hands be placed on them. Since healthcare workers have shown they're unwilling or unable to consistently wash their hands, patients need to demand it whether it's comfortable or not.

No exceptions.

You can be polite:  "Did you want to wash your hands before you examined me?"
Belligerent: "Hey, I don't want the cooties from your last patient. Wash up!"
Indirect:  "Did you see that Dr. Oz episode on handwashing? Amazing how many doctors don't follow the guidelines."
Matter of fact: "I don't want to walk out of here with an infection, so please wash your hands."

It doesn't matter how you want to phrase it, if you value your health, you'd better say it. Every time. Don't wait for your healthcare worker to protect you, protect yourself.

Pray Rain

Recently I read an article about a Pray Rain Journal. Basically you write a daily page about your ideal life as if it's already happening. Here is my Pray Rain Journal for the healthcare system.

Today we were overwhelmed writing prescriptions for acupuncture, massages, and hypnotherapy. Now that insurance pays for this, our providers and patients turn to alternative medicine rather than narcotics. Not once during this entire day did a patient receive a prescription for oxycontin, vicodin, or percocet for chronic, non malignant pain.

Our diabetic patients came in armed with questions and information. They all had their blood glucose logs and their food journals. There was time to review them and work with the patient to make good choices to improve their blood sugar control. They checked their feet daily so it was another month without foot ulcers. Several of our patients had lost weight as they'd instituted an exercise program. No one gained weight today.

Our hypertension patients took their medications faithfully and monitored their blood pressure. A few of them had experimented with biofeedback and meditation as a way to control their stress.  They all knew the correct way to take a blood pressure and insisted it be done that way, politely, of course.

Our patients with mental illnesses continued to work with their therapists and psychiatrists to gain insight into their problems and work through them. Everyone who needed a referral to our therapist, got one, and got in the same day. Our patients on medication acknowledged the role of talk therapy in their recovery. None of them self medicated with tobacco, alcohol, or illicit drugs.

People with coughs, colds, and sore throats came in without the expectation of an antibiotic prescription and left armed with self care tips and the knowledge that their illness would get better with time. They all promised to take time off from work to get well, rather than return to work and sicken their coworkers. 

No one left our office today with a prescription without knowing what it was for, what the side effects were, and what they should look for in order to judge it's effectiveness.

My coworkers and I had a great day of teamwork as we tried to meet our patient's needs in a polite, respectful way. At the end of the day we all went home tired, but we felt good about the job we'd done.

Are We Safe Yet?

Sitting in a hard plastic chair, waiting for someone to show up and pat search me,  I look at the mass of people going through airport security around me and wonder if we're safe yet.

I remember what air travel used to be like.  One went to the airport with a identification and a ticket, checked in at the desk, and leisurely walked to the gate, oftentimes accompanied by family members or loved ones. I have fond memories of my grandparents waving at the window as I boarded my flight in Tuscon. I have pictures at the Manchester airport with my firstborn as she waited to board her first flight alone to college. Back then, airports were happy places. Security, if there was any, was hidden in the background.

When my mother traveled to Italy one year, she was struck by the fact that airports there had security officers that carried guns. Machine guns. My mother was a cop, so it wasn’t the guns that scared her. It was the fact that it seemed reasonable to expect an event requiring an armed response.

Something we thought would never happen here.

And then 9/11 happened and all of a sudden U.S.airports had armed men and woman. I remember the first time flying through Charlotte and seeing men, who I assumed were National Guard or the like, positioned throughout the airport with casually held machine guns and rifles.  It lent a different tenor to the trip, but deep down I was more scared of the men with guns than I was of terrorists. The guns I could see. The tension I could feel. How many times has a simple misunderstanding escalated into violence? Enough to know that men with guns frightened me and had no place in the airport.

The guns were only the first change. Suddenly only “authorized travelers,” meaning those with tickets and boarding passes, could enter the gate areas. Metal detectors and x-rayed luggage became the new standard. We all learned the ever changing rules of travel: Laptops out and turned on, shoes, jackets, and belts off.  No nail clippers, no lighters, no scissors. The area around the screening checkpoint became choked with the belongings we left behind in order to go forward.  We packed our bags and hoped the inadvertent tangle of cords and batteries didn’t get mistaken for a bomb.

We became afraid to say the word bomb in the airport terminal.

Then one sunny day I traveled back from Myrtle Beach and discovered liquids were the new enemy. Forget carrying drinks on the plane, let alone shampoo or conditioner.  Security made us dump them at the gate. Liquids in our carry-on bags were first forbidden, and then “after extensive research and understanding of current threats” (TSA website) were allowed  in 3.4 ounces containers in a ziplock bag. Security checkpoint trashes overflowed with oversized shampoo bottles, liquid foundation,  and discarded drinks.

Then full body scanner machines were introduced. Touted as a noninvasive method to detect items hidden under clothes, we learned to stand with our arms outstretched and our feet on the yellow outlines. We took off our shoes, jackets, belts, hats.  We took our laptops out and put them in a separate bin. Our liquids,  too. We watched as TSA officials scrutinized our identification cards and checked our boarding passes. At least they didn’t have guns. We endured pat downs in public. We endured pat downs in private.  Trigger the metal detector or refuse the body scanner and assume the position.

So as I waited at Charlotte airport recently on a hard black, plastic chair for someone to pat me down, I saw people pass with dogs, cats, small children, strollers and wheelchairs.  Surprisingly, none of them  went through the metal detector or the body scanner. They, and their owners were pulled aside, I assume for a pat down, but what good is patting down a cat? A dog? A stroller? A wheelchair?

If a determined person wants to get a bomb, a gun, or an airborne virus on a plane,  do we have the technology to stop them?  I don’t believe our security can keep up with human ingenuity. If someone wants to do it bad enough, they’ll find a way.

I think of all of the liberties we have given up, all of the dignity we have lost, all of the changes we have endured, and I have to ask, are we safe yet? I think not.

A Little Criticism

Taking criticism is hard. Most of us want to hear that we're special, have great taste, and rock in everything we do. Sort of like Toddlers and Tiaras without the temper tantrums. Unfortunately, life seldom gives us blanket approval for all of our actions.

We misunderstand, we misinterpret, we think we get it, but we don't.  The person that points out these truths  doesn't earn our respect and thanks (not even if our underwear is tucked into our skirt or a big piece of spinach is blighting our smile). Instead, our first response is to turn on them.

Disagree with me and you're wrong, you're stupid, and/or you don't understand.

How do we learn, though, if not by criticism? In education, there's a saying that "you don't know what you don't know."  We're all blind to our faults and our weaknesses. When someone points them out to us, of course our first reaction is a big HELL NO as we put up our guard to defend ourselves and our self image from our attacker.

But, how can we get better if we don't take advice from others?

When I went to nursing school, I knew right from the beginning that I knew nothing. It took me ten minutes to reconstitute medications. Twenty minutes to set up an I.V. Putting in a female catheter? Forever. I accepted criticism because I accepted my ignorance. I listened a lot, I read a lot, I took my lumps, and eventually I became good at my trade. But, if I had been defensive, argumentative, and convinced of my own rightness, I would have ended up a hack. I got good because of criticism.

I maintain the most dangerous people in healthcare, and the world, are those that don't understand their limitations. They will fight to the end of time to defend their rightness. And they are wrong.

I might not always agree when people tell me I'm wrong, but I'll listen, I'll think, and I'll research. Because in this big world full of information, I must accept there are people that know more than me. If I'm not willing to at least hear them out, who's the idiot?

Celebrating Labor Day

Labor Day was created as a way to pay tribute to the worker's of American, particularly those in trade and labor organizations. Today, trade organizations and labor unions are often categorized in negative terms, even while studies show these organizations save lives.

A history of the IBEW notes that: "Some statistics support the fact that one out of two men who entered the industry did not survive their first year." Currently the United States Department of Labor estimates "The annual fatality rate for power line workers is about 50 deaths per 100,000 employees."

An article reporting on a  federally backed study on the hazards of working in mines concluded,  "In the past two decades, there have been 18-33 percent fewer traumatic injuries per miner in union mines than nonunion mines and 27-68 percent fewer fatalities per miner, according to a draft of the study sponsored by the National Institute of Occupational Safety and Health."

An ILR review study purports that "After controlling for patient and hospital characteristics, the authors find that hospitals with unionized R.N.’s have 5.5% lower heart attack mortality than do non-union hospitals."

In Rhode Island "Between 1998 and 2005 there were 354 fatalities at non-union workplaces throughout New England. During those same years, there were 77 deaths at unionized locations, according to OSHA figures."

Whether you like unions or not, there's something to be said for organizations that may very well increase your chances of celebrating another Labor Day.