Category Archives: Culture

Staying away from substance abuse on campus

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Safe at home

The opioid epidemic is truly devastating. Drug overdoses (mostly opioids) are a leading cause of death in the US, topping guns and car crashes. People don’t want to become addicted to drugs or die from overdoses, so why does it happen so often?

It often starts with a doctor writing a prescription for someone complaining of chronic or acute pain or following a surgical procedure. Little thought is given to the number of pills prescribed; extra pills are either consumed by the patient or left lying around in the medicine cabinet where they may be taken by family members or house guests who have developed a habit. When prescription pills run out and the cost of buying them on the black market is too high, users shift quickly to heroin, which is cheap, potent and readily available. The downward spiral can be steep.

Thankfully, the country is starting to get a grip on the opioid crisis. Health insurers are tightening up on opioid coverage, doctors are trying alternative therapies (like massage) or being more conservative in their prescribing. TV and newspaper stories are pointing out the perils.

Awareness is spreading, including to the younger generation. I’m really pleased to see that some colleges are offering “sober dorms” for students committed to a substance-free lifestyle. The idea is not brand new –a Rutgers program dates back to 1988—but it seems to be gaining traction as more schools try out the approach.

A number of schools offer housing for people in recovery, designed to prevent relapse. New Jersey has a new law requiring any college with more than one quarter of students living on campus to offer sober housing. Other schools are starting to offer sober dorms to students who are looking for a clean lifestyle, whether they are in recovery or not.

It’s also my impression that college administrators are doing more than they used to to enforce alcohol and drug laws, regardless of a dorm’s official designation.

Image courtesy of Stuart Miles at FreeDigitalPhotos.net

By healthcare business consultant David E. Williams, president of Health Business Group.

In the future, will every job be a healthcare job?

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I’m here for your job

The US added 38,000 jobs in May, including 46,000 in healthcare. In other words, healthcare added more than 100 percent of the new jobs in the economy. That won’t happen every month, but it’s a pretty striking statistic.

What’s going on here?

I recently read The Second Machine Age: Work, Progress, and Prosperity in a Time of Brilliant Technologies, which basically argues that almost all jobs –including highly skilled ones– will be wiped out by automation, robots and artificial intelligence. Case in point: truck drivers and taxi drivers, who will be replaced by self-driving vehicles.

Job destruction is happening today on a large scale. Manual laborers have been vulnerable for a long time, but professionals are now under threat as well. There’s little opportunity in previously safe jobs like bookkeeper and paralegal. I firmly believe that a big driver of Donald Trump’s popularity is the alienation felt by many workers –including skilled ones– whom the economy no longer really needs or won’t need soon. It’s easy to blame free trade pacts, Chinese, Mexicans, and our feckless political leadership, but technology is actually the root cause.

The two big exceptions to job loss are healthcare and education, sectors that have been very slow to match the innovation pace established by the rest of the economy. That’s kept costs high and rising. As a result, Americans are getting killed by healthcare and education expenses at a time that incomes are stagnant.

Healthcare is always 10-20 years behind the rest of the economy (I’ll let someone else speak for education) so we can expect continued robust healthcare hiring for some time.

If the jobless future described in The Second Machine Age really comes to pass, society will be in serious trouble. I really don’t like the author’s idea of addressing joblessness by paying everyone a guaranteed minimum income. Sure people need an income, but they also need purpose in life, which often comes from having something productive to do on the job.

As I’ve been saying for years –for example Welcoming immigrants and robots to fill the nursing shortage and Robots are coming and they plan to treat you like a moron –I do think healthcare will eventually catch up with the rest of the economy and healthcare jobs will go by the wayside. But maybe there will be enough lag time that we will in fact preserve and invent meaningful jobs in healthcare, and that the healthcare field will lead the next wave for the re-humanization of the economy.

Image courtesy of Geerati at FreeDigitalPhotos.net

By healthcare business consultant David E. Williams, president of Health Business Group.

 

Canada is looking better and better

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O Canada!

In almost every election cycle people talk about moving to Canada if a presidential candidate they despise takes office. In practice few make the move. Things could be a little different this time around if a certain nationalist strongman comes to power.

There’s something else to fear this year: the Zika virus. According to NIH director Tony Fauci, mosquitoes with Zika are likely to arrive in the US mainland within the next month or two. One species will be all over the South, another will come up the East Coast as far as New England. Already, close to 300 pregnant women in the US are infected.

Congress is dithering with the President’s request for funds to combat Zika’s spread and is toying with the idea of canceling Ebola funds to partially support the Zika fight. It’s pretty irresponsible.

In the past I would have assumed that Congress would get it’s act together and do the right thing. But after seeing some members unconcerned about preventing a default I no longer take good intentions and common sense for granted.

Zika is serious and its spread could have a big impact on economic growth. In El Salvador, the government has advised women not to get pregnant for the next two years, lest they give birth to babies with severe birth defects. Can you imagine the impact such an advisory would have in the US?

Image courtesy of Vlado at FreeDigitalPhotos.net

By healthcare business consultant David E. Williams, president of Health Business Group.

The false link between mental illness and gun violence

It would be nice if we could eliminate mass shootings by improving the mental health system, coaxing (or forcing) potential shooters into treatment before they have a chance to wreak havoc.  As the Washington Post (Most mass shooters aren’t mentally ill. So why push better treatment as the answer?) reports:

“It would be ridiculous to hope that doing something about the mental-health system will stop these mass murders,” said Michael Stone, a forensic psychiatrist at the Columbia College of Physicians and Surgeons and author of “The Anatomy of Evil,” which examines the personalities of brutal killers. “It’s really folly.”

This seems pretty obvious, and yet Republican and Democratic leaders, along with the general public and the media seem to think mental illness is the root cause of shooting sprees and that improving the mental health system can fix the problem.

After mass shootings, reporters often jump quickly to mental illness as the cause. Remember after the Sandy Hook shooting when there was speculation that the shooter’s Asperger’s diagnosis was to blame?

Asperger’s? Are you kidding me?

The danger of our fixation on mental illness as the root cause of violence is that we end up stigmatizing people with mental illness –and developmental disorders– while ignoring more direct causes of gun violence, such as ready access to guns.

Mass shootings are rare outside the US. Is there someone who can tell me with a straight face that the difference is due to better mental health systems abroad?

Meanwhile, Australia has seen a major decrease in gun violence over the past 20 years since adopting strong gun control after a mass murder. That seems like a more evidence and logic based response than what we’ve tried here.

By healthcare business consultant David E. Williams, president of Health Business Group.

 

The decline of white women’s health

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The Washington Post (A great divide in American death: Statistics show widening urban-rural gap) examined death statistics and found that death rates for white women –especially rural white women– have been climbing fast. Key culprits? Self-destructive behavior such as over-eating, opioid abuse, heavy drinking, smoking, and suicide. White women still live longer than other groups, but the trend for them is bad.

According to the Post:

In at least 30 counties in the South, black women in midlife now have a lower mortality rate than middle-aged white women, The Post found. That’s up from a single such county in 1999.

Among them is Newton County, Ga., southeast of Atlanta, where the death rate for black women ages 35 to 54 dropped from 472 per 100,000 to 234. The rate for white women went the other way, from 255 to 472.

The article cites researchers who speculate that new sources of stress are contributing to poor health and higher death rates.

The Post also connects areas with rising white death rates to those supporting Donald Trump’s presidential bid. That makes intuitive sense to me, although I don’t know whether there’s a causal link. What I will say is that those who vote for Donald Trump are going to be disappointed that he won’t be a stress reliever, even if he is somehow elected.

Image courtesy of Ohmega1982 at FreeDigitalPhotos.net

By healthcare business consultant David E. Williams, president of Health Business Group.

Most young men don’t know about emergency contraception. Is that ok?

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About 40 percent of adolescent boys and young men know about emergency contraception, aka the “morning after pill” or Plan B according to a Journal of Adolescent Health study. Women who take the pill within a few days of unprotected sex or a condom break can avoid an unwanted pregnancy because emergency contraception prevents ovulation.

So how should we think about the 40 percent number?

The authors are pleased that the number is as high as it is, and take it as proof that educational campaigns are working. They’d also like to see the number go higher so that boys and men take responsibility for contraceptive planning. In an ideal world that’s undoubtedly true, but I wonder whether it would be better if men were less aware of emergency contraception rather than more.

After all, the possibility of pregnancy is not the only reason to avoid unprotected sex. Prevention of sexually transmitted diseases is right up there as well. If boys and men know that emergency contraception is an option, they may be less careful about protection and more likely to pressure their partners into having unprotected sex in the first place.

I’m not actually advocating for purposefully keeping people in the dark, but I’d focus the awareness message heavily on girls and women.

Image courtesy of Stuart Miles at FreeDigitalPhotos.net

By healthcare business consultant David E. Williams, president of Health Business Group.

Should patients choose doctors who are friends?

Come with me?

Can I help you?

In the social media era, it’s common to read articles discussing the blurring boundaries in the doctors/patient relationship. Usually it’s some version of, “Should a doctor accept friend requests from patients on Facebook?” or “Is it ok for doctors to Google their patients?”

The Wall Street Journal (The New Boundaries Between Doctors and Patients) explores these issues and goes on to explore what happens when patients and doctors become friendly during the course of treatment. In the midst of this there’s a throwaway paragraph:

“Some boundaries are clear. Professional medical organizations have strict rules against sex and romance with patients. Doctors are also advised not to treat family or close friends, situations that could compromise objectivity and judgment.”

I have no problem with the part about sex and romance. I also kind of understand the family issue. But the friend one is more interesting to me.

I read a few pieces that discuss this topic. (Here, here and here.) The typical scenario is a friend asking for medical advice in a casual setting, often on a topic that’s not related to the doctor’s specialty. I get why that’s a bad idea.

In my own case I know many practicing physicians socially, and most are in the prime of their careers: mid 40s to early 50s. A couple years ago when I was having trouble finding a new primary care doctor after mine retired, I asked physician friends who they went to. That was a little too clever on my part, since I forgot to account for the fact that physicians get treated differently than regular people when they go to the doctor’s office. No NPs for them!

But after some so-so experiences with a particular medical specialty, I decided to ask a specialist friend if he would be comfortable being my doctor. He said yes and I started seeing him. He’s a longtime friend but not an extremely close friend. I’ve been extremely satisfied with the experience. Partly because he’s an excellent doctor but also because I feel he understands me better and may even provide a little extra attention. He trusts me enough to exchange detailed emails. I’m not embarrassed to share personal medical details that I wouldn’t be comfortable with sharing someone who’s just a friend. Honestly, for me I don’t see the downside.

I did the same thing when I a needed a new dentist and that’s worked out well, too.

I hope I stay reasonably healthy and then die peacefully in my sleep when I turn 100, so I don’t have to spend a lot of time as a patient. But realistically it’s likely that I’ll be seeing more specialists as time moves along. I’m definitely planning to keep friends in mind when it comes time to find people to treat me.

Image courtesy of stockimages at FreeDigitalPhotos.net

By healthcare business consultant David E. Williams, president of Health Business Group.