Tag Archives: Emergency Medicine

ED Patients Blind to Risks of Being Overweight

American tongues start wagging whenever the latest starlet puts on a few pounds, but we appear loathe to discuss our own ever-increasing waistline.

A study of 453 adults presenting to a Florida ED found that 58.5% of overweight/obese African American and Caucasian men and women feel their weight is not a health issue AND have never discussed their weight with their healthcare provider.

The average BMI in the study was 29.5 kg/m2, mean weight 184 pounds, 61% were female and the average waist circumference an undignified 39.5 inches.

Given those stats, you’d think these patients had gotten an earful from their provider, but not so.

Overall, 38% of all patients reported their weight to be unhealthy, but only 28% recalled being told so by their provider, University of Florida emergency physician Dr. Matthew Ryan reported at the recent meeting of the Society for Academic Emergency Medicine in Chicago.

It’s possible that some physicians may be afraid to bring up weight for fear their patients will scurry off to a “kinder, gentler” provider. Others may simply be short on time. Yet even when docs did start the conversation, some patients just couldn’t make the connection between obesity and health risks.

Among patients told by their provider they were overweight, 77% believe their present weight is damaging to their health, yet 23% still believe their weight is not unhealthy.

Dr. Ryan points out there’s an obvious disconnect between patients’ perceptions of their weight and their actual weight and current health, and suggests that “the first line of action toward confronting the mounting obesity epidemic in the U.S. is clear patient-provider education.”

The chaotic environment of the ED may seem like an unlikely place to help increase patient awareness about weight-related medical issues or to provide weight-loss counseling, but there may just be something to the “Willie Sutton rule” that teaches, not just bankrobbers, but medical students to focus on the obvious.

As part of the study, the investigators also measured the prevalence of obese patients presenting to their ED in order to compare it to state and national prevalence rates. It reached a whopping 38%, towering over the already hefty 26.6% obesity rate reported for the general population in Florida in 2010 by the CDC.

To their knowledge, the authors say no studies have directly measured the obesity prevalence in the ED. Thus, the ED population may be poorly represented in existing national healthcare studies, which are largely community-based. Moreover, the obesity prevalence may be higher than indicated by studies like the CDC’s that rely on self-reported height and weight.

Given the author’s findings in the ED, that’s a very real and chilling possibility.

The research was supported by a University of Florida Clinical and Translational Science Institute grant.  Dr. Ryan reported having no conflicts of interest.

– Patrice Wendling

 

Leave a comment

Filed under IMNG, Uncategorized

Fort Hood Shooting: A Cautionary Tale for Tucson

    I don’t care how many special news reports I see or read on the shootings in Tucson, I’m convinced we won’t fully understand what happened there for months, if ever. What we can be certain of is that more mass casualties will occur and that there will be missteps by both medical and journalism professionals.

I say this because of a recent post-mortem I heard on the November 2009 shootings at Fort Hood, where in a span of roughly 10 minutes, 32 people were injured and 10 died. Ultimately, 13 individuals lost their lives in that tragedy.

In the rush to report the news, two news helicopters hovered over the Scott & White Hospital, located 30 miles from Fort Hood, and the only level I trauma center in the area. The FAA was called in to clear the airspace, but not before the helicopters interfered with the transport of patients.

Back in Atlanta, CNN broadcast the Scott & White command center referral line, and over a 1-hour period, the hospital received 1,300 phone calls, which “essentially crippled our phone systems,” Dr. Jeff Wild, a surgical resident at that hospital, told his colleagues at the Western Surgical Association meeting.

The overload meant that Darnall Army Hospital in Fort Hood and nearby Metroplex Hospital, both of which were receiving shooting victims, couldn’t reach staff. Communication problems ultimately led to the transfer of two patients from Metroplex to an out-of-region hospital.

Triage was minimally organized and patients were maldistributed, with the closer facilities becoming saturated with shooting victims, he said. Darnall Army Hospital, a level III hospital, evaluated 27 patients and performed five operations on 4 patients, with one death. Scott & White prepared 6 trauma bays, made 16 of its 24 ORs available and posted one trauma surgeon in the OR and another in the ED, which proved invaluable in triaging patients, noted Dr. Wild. Over roughly a 2-hour period, they received 10 patients, of which five were taken urgently to the OR. Metroplex, which had only one emergency department physician and two general surgeons in the level IV facility at the time, received seven patients, including a civilian police officer who helped take down the perpetrator, and had no deaths. “I think we’re quite lucky that none of the patients transferred here had any adverse events,” he said.

I was beginning to squirm in my seat at this point, until Dr. Wild acknowledged the hospitals had alternative means of communication. The only problem was that personnel didn’t know how to properly work the radios and Web-based computer program.

Security was also an issue for the hospital. The alleged perpetrator, psychiatrist Maj. Nidal Hasan, was in the same ICU as six of his shooting victims and their families. The hospital elected to move Hasan to an isolated OR that served as his ICU until he was transported out of the hospital.

Since the shootings, Scott & White has hosted several disaster drills that included the army hospital, which had not been done before, Dr. Wild reported on behalf of senior author Dr. Randall Smith, Scott & White interim chief of trauma, critical and acute care surgery. Staff has been educated on various communication pathways, and twice a month, all the hospitals and EMS agencies in the area talk on the radios to make sure they’re working properly and that staff knows how to use them.

“Scott and White hospital has taken part in four mass casualty events in the past 25 years and, although these are considered somewhat a rarity, they seem to be more commonplace,” Dr. Wild said. “And if you haven’t already, it’s very likely a lot of you will take part in one of these events over your careers.”

From my own perspective, I just hope everyone knows the drill, including my colleagues at the mic.

  Patrice Wendling (on Twitter @pwendl)

Leave a comment

Filed under Emergency Medicine, Hospital and Critical Care Medicine, IMNG, Surgery, Thoracic Surgery

Family matters in cancer care

Family: can’t live with them, can’t live without them.

The upcoming holiday season calls the sanity of this adage into question, but when a member of the clan is diagnosed with cancer, there’s nothing like family to ease the way forward. Or is there?

 A team of Argentinian researchers evaluating the influence of family on the care of cancer patients found that 50% of physicians acknowledged at least one negative feeling for the relatives. Wrath, anger, rejection, and anguish were all noted, with women physicians more likely to feel anguish, and anger rising to the top of the list among male physicians. 

“Negative emotions must be considered since the above mentioned emotions may be an obstacle to the correct performance of the professional,” Luisina Ongania and colleagues reported at the European Society for Medical Oncology meeting in Milan. 

Before physicians cry foul, however, the survey showed that relatives had secrets of their own. 

"The Secret" by Edmund Blair Leighton, image in the public domain

 

 A stunning 95% of physicians said they had been asked by relatives to hide information of an adverse diagnosis or prognosis from the patient. 

Only 35% of the sample – made up of 50 oncologists, surgeons, pathologists, pulmonologists, and NIC providers – rejected this demand.  

Contrary to the image of women as chatterbox cream puffs, female physicians were more likely to snub a request for secrecy than men (40% vs. 32%), as were seasoned practitioners when compared with those with less than 10 years of clinical experience (40% vs. 32%). 

The influence of family can place doctors at an “ethical crossroads” in relation to respect for the patient’s autonomy, the researchers, from the Centro Médico Austral OMI in Buenos Aires, noted in their poster. 

Proponents of family centered care argue that engaging families in the hospital and even the ED can provide medical teams with valuable clinical and social information and calm patients who find themselves in a frightening and unfamiliar setting. Conversely, family members who witness the massive medical efforts launched to save their loved one are said to be more accepting of the outcome, even when the patient dies. (Click here for related story).

Exactly how hospitals, EDs, and clinicians should navigate these tricky waters is unclear, although all physicians in the survey argue that it’s important to receive information and training about how to work with relatives. Only 16% believed they’d received enough of this training.

Getting relatives to behave in the hospital, or even at the holiday dinner table, may be a harder nut to crack. 

By Patrice Wendling (on twitter @pwendl)

Leave a comment

Filed under Emergency Medicine, Hospice and Palliative Care, Hospital and Critical Care Medicine, IMNG, Internal Medicine, Oncology, Practice Trends, Psychiatry

Home Sweet Medical Home

Photo courtesy of Flickr user @cdharrison (CC).

Photo courtesy of Flickr user @cdharrison (CC).

from the American Academy of Pediatrics National Conference and Exhibition

 If the medical home model of health care ever comes to be, it looks like it’s the pediatricians who will get there first.  At least that’s the way it sounds based on comments of outgoing AAP president Dr. David T. Tayloe Jr., during one of the plenary sessions.

“When most of my adult friends become ill, they cannot get same-day sick appointments with their primary care physicians. They seek care from an urgent care facility or a hospital emergency department,” he noted. If these adults are very sick, they’re admitted to a hospital for care by a hospitalist team that is employed by the hospital or they are referred out of town for a higher level of care.  “None of these entities share the longitudinal health records of my adult friends. So their care is very fragmented and expensive,”  he pointed out.

“Contrast this adult medicine example, however, with the health care situation that exists in our community for the children and grandchildren of my adult friends,” Dr. Tayloe said. These children transition from the newborn nursery directly into pediatric practices, “where they DO receive comprehensive 24/7 care.”

Children “can have same-day sick appointments to avoid fragmentation of primary care.  They may be cared for in a hospital emergency department if all of our offices are closed … but the family has the opportunity to talk with one of our physicians before going to the emergency department,” he said. “If the emergency department staff needs to be seen by a pediatrician, our on-call pediatrician goes to the [ED].  If they’re sick enough to be admitted to the hospital, our staff provides hospital care such that the patient has a current, longitudinal record,” at the practice. Likewise, if pediatric patients require subspecialty care elsewhere, we make those arrangements and expect efficient communication from our subspecialty colleagues.”

“I realize that there are some underlying reasons for the failure of the adult medicine system to adopt the medical home concept,”  Dr. Tayloe conceded. These include primary care physician shortages and payment issues. “Even so, the mind-set of adult medicine is not the same as that of those of us in pediatrics. We are way ahead of them … in providing real medical homes for our patients.”

—Kerri Wachter, @knwachter on Twitter

Bookmark and Share

Leave a comment

Filed under Emergency Medicine, health reform, Pediatrics, Practice Trends, Primary care