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Resiliency: What is it anyway? And Where Can I Find Some?

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It is pretty difficult to work in the health care setting without hearing about the plague that has infested the majority of the workforce: burnout. The pressures of caregiving, budgets, bottom lines, quality scores and regulatory burden have been named as a few of the causes. As leaders in health care, we have acknowledged the illness and pinpointed the cause of burnout, but continue to struggle to find a cure.

The impact of burnout is widespread. A 2013 study by the Luican Leape Institute at the National Patient Safety Foundation found health care workforce injuries are 30 times greater than other industries, 60 percent of physicians surveyed were considering leaving practices, 70 percent knew a physician who left due to poor morale and 37 percent of newly licensed registered nurses were thinking of leaving their job. It seems that in our efforts to transform the health care system, we have neglected the very people carrying out the transformation. In the search for relief, many health care organizations have worked on building the resiliency of the workforce. Resiliency is the ability of people to cope with stress or crisis, and then rebound quickly.

Sheryl Sandburg, Facebook executive and author of Lean In, recently found herself in desperate search for resiliency when her husband died suddenly while they were vacationing out of the country. In her latest book, Option B: Facing Adversity, Building Resilience, and Finding Joy, she describes the first few fragile days and months following his death, and her quest for a way to live through the pain. She thought that “resilience was the capacity to endure pain” and wanted to know how much resilience she had. However, she discovered that our amount of resilience isn’t fixed, and we should instead ask how we can become resilient. “Resilience is the strength and speed of our response to adversity—and we can build it. It isn’t about having a backbone. It’s about strengthening the muscles around our backbone.”

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What if we run out of antibiotics?

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Antibiotics were miracle drugs in the 1930s 40s and 50s. After Scottish researcher Sir Alexander Fleming accidentally discovered penicillin in 1928, he was quoted as saying, “One sometimes finds what one is not looking for. When I woke up just after dawn on Sept. 28, 1928, I certainly didn’t plan to revolutionize all medicine by discovering the world’s first antibiotic, or bacteria killer. But I guess that was exactly what I did.” Previously life-threatening diseases became treatable and many new drugs were developed between 1950 and 1970, making this the “golden era” of antibiotics.

Unfortunately, Alexander Fleming’s warning that “overuse may cause mutant bacteria” also started to come true around this time, and, as antibiotics were used more and more both in humans and in animals, even antibiotics developed to treat resistant strains became ineffective. Coupled with the fact that drug companies may not be as focused on developing short-term medicines than those needed for life, new drug development slowed substantially, coming almost to a halt in 2010.

So, what does this mean for us? Will stories about antibiotic resistance become more typical, like one from a HealthInsight staff member who has shared about a very scary time a few years ago when she had an infection that was resistant to all oral antibiotics? This infection required two rounds of intravenous antibiotics and spurred the fear that they may not work. Are stories like the woman in Reno, Nevada, who died in early 2017 of a resistant infection that no U.S. antibiotic could treat going to be more commonplace? I truly hope not. I sincerely believe that the global effort around preserving antibiotics and reducing resistance will succeed. A national action plan was initiated in 2015 in response to an executive order from President Obama. This action plan includes goals to accelerate the development of new drugs and diagnostic tests as well as to increase surveillance of infections and work together with International partners to slow resistance.

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“Just the Facts, Ma’am”

In the 1950s, a popular, long-running TV series titled “DRAGNET” featured two, serious-as-a-heart-attack Los Angeles Police Department detectives: Sergeant Joe Friday and his partner, Officer Bill Gannon. Every week they set out to investigate and solve serious crimes in the big city. After viewing one episode, you could tell that neither of these two, steely, uber-committed police officers had a single political bone in their respective bodies. They were all about getting to and understanding the facts—the truth. And, with the facts and the full truth, they could then do the hard work to solve every otherwise difficult and confounding case.

In our modern times of partisan politics, social media and the daily news cycle, there is often very little focus on objectively examining the facts, on finding common ground and on solving many of the great problems of our day. However, the greatness of our country is demonstrated whenever we and our leaders find ways to unite and to gain principled consensus; to find the best, most practical, if imperfect, solutions to the challenging issues of our day.

So, here are some hard-to-ignore facts on an important and daunting challenge: Federal spending on entitlement programs (Social Security, Medicare, Medicaid, the Affordable Care Act) continues to grow at ever higher rates—as a percent of our gross domestic product (GDP), and as a portion of federal revenues. Also, the cost of interest payments on the national debt will rise precipitously over the coming years as large deficits continue to accrue and as artificially-low interest rates rise to market levels. Eventually, this predictable deficit spending will overwhelm the federal budget and lead to a fiscal crisis—if our national leaders fail to control the growth of spending and the cost-drivers within the system.

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The Power of Prevention

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A few years ago, I watched as a childhood friend was diagnosed with diabetes and then multiple other related co-morbidities in rapid succession. It has affected every aspect of her life and was caught much later than it should have been, exasperated by years of lacking access to health insurance and preventative care. As her friend, I knew on some level for that she was at risk of developing a chronic condition and did my best to support her, but was unsure how to help her change her circumstances. I’ve worked in a health related field for most of my career, but this experience has further driven me to want to advance prevention and understand what people truly need to stay healthy.

An alarming 1 out of 3 adults has pre-diabetes. And of those, 15-30 percent will develop Type 2 diabetes within five years. Not only is diabetes emotionally, physically and financially costly for individuals and their families, it accounts for 23 percent of total health care costs annually in the United States and is highly associated with heart disease, which is the leading cause of death worldwide.

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Cost of Medications

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Over the past year we’ve heard about terrible price increases in the EpiPen® and how horrible this skyrocketing was because it’s a lifesaving medication. There’s no doubt that the EpiPen is lifesaving, but what qualifies a medication as lifesaving? Any medication that controls an acute or chronic medical problem is lifesaving.

As an endocrinologist, to me the most common lifesaving medication is insulin. Let’s look at what has happened due to the costs of insulin. Retail costs of newer insulins can cost up to $500 or even $600 per month. Older ones can cost about half that. And copays can range from $40 to $150. Patients sometimes tell to their physicians that they’ve stopped their insulin because they can’t afford it. In fact, some have reported that they stopped their insulins and ended up in the hospital, but their hospital copay was less than their prescriptions. Older patients have said that they stopped their insulins when they hit the “doughnut hole” in Medicare.

If you go on the Good Rx website, you’ll find that you can get regular or NPH insulin (an intermediate insulin) for around $27 each. I’ve sent patients in two different states to Wal-Mart pharmacies to buy these insulins, and they have all been told that Wal-Mart doesn’t have anything comparable to these prices. Many pharmaceutical companies offer discount cards that enable patients to purchase a month’s supply for $10 to $25 for up to 12 months. But, to get these cards, you must meet eligibility requirements. And if you’re on Medicare, Medicaid, Tricare, VA, Department of Defense or similarly federally or state-funded programs, you won’t qualify. One bright spot is that Federal Employees Health Benefits Program members do qualify.

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