Thanksgiving

I have sooooo much to be thankful for. Volunteering at San Jose Clinic has completely opened my eyes to all of the people out there who need healthcare but can't afford it. Of course I know that it is a problem, especially in light of the new health care legislature that just passed, but at San Jose I can match faces and names to the statistics. When my grandpa was first diagnosed with Mantle Cell Lymphoma sophomore year, I was frustrated that his Medicare supplement plan was not accepted by M.D. Anderson. Of course, when you think cancer you think M.D. Anderson, but to go for preliminary testing and workups would cost ~$13,000 out of pocket. At the time, I did not realize how lucky he is that he even has access to any kind of healthcare, and thank God he is now in a partial remission. Anyhow, this thanksgiving even further indicated to me how lucky and fortunate I am as I heard on Wednesday about two young people from church who were in the hospital. One of them is a priest's four-month old daughter who (against all odds!!!) was born with trisomy-18. Most babies with this genetic disorder don't even make it to birth. Tuesday night was a rough one for her, and they decided to remove her breathing tube, but she is still going strong. Last week at San Jose, watching all of the children get helmets made me realize how much I take for granted. If I wanted/needed a bike helmet, I would just drive over to Target and pick one up. But some of these families don't even have a car, let alone the extra cash to buy something as seemingly unnecessary as a helmet. I bet most of those children do not even have bikes, which made me a little unformatable that we were putting the parents on the spot like that. I remember in health class in eighth grade, we went out to the football bleachers and watched our teacher toss two cantelopes off the backside of the bleachers: one with a helmet, and one without. The cantelopes were supposed to represent what would happen to the brain upon impact with concrete without the protection of a helmet. That image will stick with me forever, and I will never ride a bike without a helmet ever again. Anyhow, this thanksgiving truly was one of sincere gratitude thanks to my time at San Jose.

Hard Hats for Little Heads

Yesterday, Saturday the 20th, I volunteered at San Jose's partnered event with the Texas Medical Association: Hard Hats for Little Heads. Certain patients with ages ranging from 4-13 were mailed letters informing them that they were selected to recieve a free helmet from the TMA as well as a helmet sizing. Pediatricians from Texas Children's Childhood Injury Prevention Program were there to size the children with the appropriate size helmet and to offer safety tips when riding bikes, roller blading, skate boarding, or riding a scooter. The children were also filling out pledge cards that stated that they promised to wear their shiny new red and white helmets. There was also an arts and crafts table where they were coloring Christmas ornaments to put on the San Jose Tree. Some kids were even playing jump rope and hula hoops with some representatives from the American Heart Association. It is so important to get kids used to living healthy and active lifestyles from such a young age, especially in a country in which the childhood obesity rate is at an all-time high. Obesity-related illnesses such as type II diabetes have been placing a significant burden on patients as well as the healthcare system in general, and it is unfortunate because obesity is definitely preventable. It was my job to check in the families according to their letters, hand out the goody bags, and "sort" the children to the proper age-group stations. It was awesome to see how excited the children were to get their helmets. A lot of proud older siblings were proclaiming that they were going to teach their younger siblings how to ride a bike now that (in certain cases) got their first helmet. But of course, some of the parents started to roll their eyes when their kids came up to them and told them that they wanted Santa to bring them a new bike for Christmas to go along with the new helmet :)

Now for the Opposite Argument

This past Wednesday when I was at San Jose, I continued to record patient names and clinic card numbers from old files as I did last week. Again, I encountered the same issues that would lead me to highly favor a universal switch to electronic medical records, however, during this blog I want to consider some of the downsides to EMR as well. It may seem, at first, that there are no downsides especially considering all of the confusion and how computers can substantially ameliorate it. However, a physician that I have shadowed for a quite a while seems to be adamant against a switch because he believes that it will make private patient files extremely vulnerable to Internet hackers and contribute to the already rampant identity theft. Despite assurances about safety and security of electronic records you can never be certain--furthermore, what are you supposed to do if there is a power outage, or the electronic files are inadvertently deleted? When I was in high school and used to shadow physicians in the primary care clinics of the VA, I witnessed an EMR system first hand. At my interview for A&M, my interviewer mentioned that the Scott and White Health care System has been using EMR since 1989--the year I was born! I communicated to him my experience with the system at the VA, and that the only drawback that was very blatant to me was the fact that the doctors and nurses must type into the computer in order to chart, with their backs toward the patient. Not only does this create an off-putting environment in terms of a health care worker and patient relationship, but also, everything that the HCW is entering into the patient chart is clearly displayed on the computer screen for all in the room to see. Because my dad (an optometrist) has implemented the following in his own clinic, I offered the following suggestion: that instead of desktop PCs, patient files should be accessed via tablet PCs or even iPads. As soon as I said this, my interviewer agreed that they have witnessed the same problem with the backs turned to patients so they have re-oriented exam rooms as a result, and the next step is indeed to purchase tablet PCs. I was excited to see the progress that they have made from the last 21 years in utilizing EMR. Therefore, I suppose this is not necessarily "a case against EMR," rather a consideration of possible improvements to make it more palatable and feasible to be applied in the real life health care setting.

Medical Records (a case for going electronic!)

Today I was organizing files for the dental clinic with Michelle. There were large boxes of patient files that were numbered--basically all we had to do was "inventory" the files by writing down the patients' names and clinic card number. While I was working, I realized many little glitches that could cause serious problems with the administration of health care. First of all, since all the records were hand written (and often times in different handwritings) it was very difficult to read and confirm proper spellings of patient names. Also, many people had very similar names, or families who were all patients could easily have mixed-up records. For example, today there were two patients who had the exact same first and last name. Firstly, I needed to make sure that the two files did not both belong to the same person by looking at the date of birth in both files. BUT,the birthdate just offered more confusion (and a random coincidence) considering that both of the patients with the exact same name were born on the exact same day of the month of September, but one was born in 1937 and the other was born in 1995. At first, this just raised further suspiscion for me that the two files belonged to the same person and that the date in 1995 just referred to the date of an exam. But after further careful inspection, I had to accept that the files belonged to two seperate people that just happened to have the same name and be born on the same day. Such cases can really have a negative effect on health care in case these two patient files were ever mixed up, especially considering that one is an elderly lady and the other is a 16-year old girl. Also, I had many cases in which the patients were named "Jr." or had a "II" or "III" in their name, resulting in a John Smith I, John Smith II, and John Smith III. This further facilitates a recipe for chaos. For this reason, I feel like I can say firsthand what an impact electronic medical records (EMR) can have in the medical field. Computers with patient databases can quickly run searches regarding birthdate, allergies, etc. instead of having to sift through a file and trying to decipher a doctor's scrawl.