Sunday, January 25, 2015

Vaccination Communications

Vaccinations, immunizations, shots...whatever you want to call them, they've been in the news a lot lately.  Because of the measles issue at Disneyland, there has been an abundance of media coverage.  Some factual.  Some quite logical and persuasive.  Some, like the Onion's, meant to be funny. There has also been a fair amount of news coverage related to the flu vaccine, which is not proving as effective against this year's strain as it was hoped--but which people are still encouraged to get.  And that doesn't even get into the anti-vaccine stuff, which I admit I have not bothered to read.

Bottom line:  there are a lot of vaccination communications floating around the Internet, TV, and newspapers now.  Many are well-done.

As a public health person, I am glad to see all the news media coverage around immunizations.  Aside from the fact that immunizations are among public health's great triumphs and it's nice to see them get some good primetime attention, I'm happy about the coverage for another reason.  There's no hope that it will convince the diehard antivaxers to vaccinate themselves or their kids, but maybe just maybe the attention and coverage will convince those who are on the fence, those who are debating, those who are pondering, to get immunized and/or to get their kids immunized.

I am young enough that I've never seen measles, mumps, or polio in action (chicken pox is another story--I am just old enough that I actually had it).  And I hope that in my public health career, I never do. Dealing with vaccine-preventable diseases is one thing I can do without, thank you very much.  In terms of influenza, which is different than the others because it tends to rear its ugly head each year, I have not only seen it in other people, but I have had it myself.  Suffice it to say that having it once is enough to make anyone a convert to getting the flu shot yearly for the rest of one's life (and to make one very thankful for Tamiful!).

With media coverage continuing regarding the Disneyland situation and the flu season, there are stories and columns and factual pieces aplenty that will reach lots of Americans.  I hope that people are reading and listening, considering the facts and thinking critically...and baring their arms and their kids' arms--for the shots that can save lives.  I hope that some of the carefully crafted vaccination communications are having a positive public health impact.

Monday, January 19, 2015

A Sign of Trust...

A medical/health newspaper article hasn't ticked me off for a while, but today one did.  My rant would have been too long for a Facebook post, so a blog post it will be.

Abigail Zuger MD wrote an article in the New York Times entitled Too Close to a Patient for Comfort.  The gist of the article, that sometimes physicians treat family/friends/celebrities and have difficulty remaining objective, is legit.  The example she gives in the article, however, is not.

Zuger writes about how the CEO of her clinic announced that he would be getting his medical care from one of the doctors in the clinic, and about how this made her and her colleagues uncomfortable.

I completely and totally disagree with the CEO example.  First of all, if a CEO doesn't get care from providers in his/her clinic, hospital, or health system...what a demeaning sign to those providers: that the CEO doesn't trust their clinical skills and judgment enough to see them for medical care, to let one of the doctors listen to his/her heart, diagnose and treat high cholesterol, or remove a gallbladder.  The CEO may have had something to do with hiring these doctors, and yet he/she doesn't trust them enough to see them for care?!?  And an equally demeaning sign to clinic/hospital/health system staff:  that the CEO doesn't trust the nurses, radiology techs, and phlebotomists enough to let them take blood pressures, insert IV needles, perform ultrasounds, etc.  If community members and outsiders know that the CEO doesn't get care at his/her own clinic/practice/health system, it becomes more than just a demeaning sign to providers and staff, it becomes really bad PR.

I don't disagree with Zuger's general premise about physician objectivity.  I have multiple doctors in my family, who--depending on the situation, may or may not be objective.  Which is why I have actual regular doctors, people who are more objective and whose clinical skills and judgment I trust.  But as a child of two doctors who was born and raised amidst community medicine, I think Zuger's CEO example is off base.  Zuger and her colleagues should be more than a little annoyed and upset that the CEO wasn't seeing one of them for care in the first place.  In fact, they should expect that he/she would see one of them as a basic sign of trust in the health care that they provide. 

Thursday, January 15, 2015

Deja Vu

I feel like I am back in public health grad school. In Health Policy and Managed Care class.

I just started reading Ezekiel Emanuel's new book Reinventing American Health Care.  Yes, this is the quintessential health policy nerd book.  A few nights ago I went bookstore browsing, planning to buy something light and mindless, and then I saw this.  So much for light and mindless.

I've only read a little of the book thus far, but thus far it brings back memories of classes long ago.  Emanuel's pages are filled with all of the acronyms and terms I knew and loved back then.  Flexner Report, Hill-Burton--all of my old friends appear in this book.  And Emanuel himself is familiar--I know that we read some of his health policy journal articles in grad school, because that's where I first learned his name and his importance.

In other words, Health Policy and Managed Care classes repeated.

But there's something very different now.  The ACA.  It wasn't around when I was in grad school.  Meaning that we didn't get to dissect its parts in Health Policy class, to analyze the impact on the number of uninsured, to think about the difference preventive health care benefits would make.  Wed didn't get to learn the ins and outs of this law, because it simply didn't exist.

Now, as a public health professional who continues to be fascinated with health policy, I'm discovering that I want and need to know more about the ACA. I need to go back into MPH student mode and delve into the policy details, the intricacies, the  historical issues.  My advocacy friends' Internet resources and social media posts are excellent sources of information, but the ACA is one complicated law and I want to actually see more of the writing on the page.

Hence snatching this book off the shelf. And hence feeling like once again, I am a MPH Health Policy student--a feeling I honestly didn't think would ever be repeated.  I'm glad that the ACA, as it has entered the scene and completely changed the landscape, has proven me wrong and is taking me back to my health policy roots.

Sunday, January 4, 2015

Who's Welcome...and Why?

Over the holidays, I went on a much-needed public health and health policy hiatus.  Which also meant a blogging hiatus.  Now I'm reentering the worlds of public health and health policy--and blogging again.

I'm thinking about our broad, overarching health care system, who's welcome in it--and why they're welcome.

Who's welcome in traditional, run-of-the-mill clinics and hospitals?  The answer to this is, at first glance, simple:  those with accepted insurance.  In some places, those with Medicaid and Medicare.  If we go deeper....some insurers have recently (possibly in response to the ACA) narrowed networks, meaning patients with those insurances are welcome in fewer clinics and hospitals.  As far as Medicaid and Medicare, some doctors and clinics won't accept patients with those forms of coverage, due to low reimbursement rates and bureaucracy.  Underlying all of this:  if you're not a citizen of the US, you don't have access to private insurance or Medicare. If you're pregnant or dealing with an emergency, you may have access to temporary Medicaid--but otherwise, nothing.  Without any form of coverage,  you're generally not welcome in traditional clinics, and you're only really welcome in the ERs of hospitals (which have to treat you, per EMTALA).

And we can go even deeper with this.  What about patients that are homeless, addicted to alcohol and other drugs, struggling with mental illness, dealing with multiple chronic health problems?  These types of these patients, even if they have coverage, are challenging--and thus not always welcomed in  doctors' offices or clinics.  They may be among those who are the most in need of skilled, compassionate, ongoing care---yet they are among the least welcomed.

From another angle, thinking about individual health care systems, what kinds of doctors are welcome in them?  Primary care doctors and specialists who spend lots of time with their patients and put listening before EHR documentation, who focus on health education and prevention? Or...primary care doctors who adhere rigidly to 15 minute appointment slots and who are EHR wizards?  Specialists who perform high volumes of lucrative procedures?  Who are individual health care systems recruiting, and to whom are they paying the big bucks?

Under the ACA, we'll continue to reshape our overarching health care system, and as we do this, we need to consider:  who's welcome, and why?  And who's not welcome, and why?

These questions are important if we want to build a health care system that is more responsive, more effective, and more compassionate.

Saturday, December 20, 2014

Twas the Night Before Christmas--the Public Health Version

Twas the night before Christmas, a night dark and cold,
People wanted health under their trees--people rich and poor and young and old,
But health is not merely a gift or a blessing; it is in fact a right we all deserve,
And a right we all must work to fulfill and preserve.

The Ebola epidemic clearly illustrates the many factors that affect health,
From medical care to clean water and from education to wealth,
“Social determinants” is what public health people say,
It means that health happens where we live, learn, work, and play,

Certainly Ebola is a serious disease to dread,
And part of the problem is that African nations had few meds and hospital beds,
But they also had poverty and hunger and social conditions,
Ripe for an epidemic across borders and divisions.

Closer to home, social determinants affect health too,
And how to intervene we actually have a decent clue,
If we help early we increase the chance that youngsters succeed,
Whether it’s Nurse-Family Partnership or Reach Out and Read.

This year’s health heroes include the Ebola fighters,
Their stories already detailed by journalists and writers,
We can’t forget all the others,
Not in the news as much, but still our public health sisters and brothers,

From Pakistani polio vaccinators to promotoras on the Mexico border,
These people have extremely tall orders,
Improve health with limited resources in tough situations,
For this they deserve all our wholehearted admiration.

This past year there has been much more gun violence,
And yet in Florida doctors are expected to keep their silence,
Government is interfering in the exam room taking of a history,
Why the Court ever OK’d such a thing—it’s a total mystery.

 As always the politicians continue to duke it out,
It’s often the ACA they’re fighting about,
Here’s wishing they would just get along,
So that implementation of this law could be full and strong.

We need leaders who put the health of America at the center,
Who don’t into mere Democrat-Republican battles enter,
Who move fast to confirm the Surgeon General and protect programs like CHIP,
Who know how to crack that public health whip.

May 2015 bring improved health for all nations,
And prosperity, equality, and peace in hearty rations,
May we remember that health is a human right,
Merry Christmas to all and to all a good night!