Physician Blog -- Kate Scannell, MD

By Dr. Kate Scannell, Syndicated columnist
First Published in Print: 06/08/2013

As a writer, I wish I could claim the title of this column as my own. But it rightly belongs to Dr. Michael A. LeNoir, an Oakland physician who is trying to educate patients and policymakers about approaching remedies for health disparities "from the bottom up, instead of the top down."

A "health disparity" usually refers to a higher burden of disease, disability, or mortality experienced by one subpopulation in comparison to another. In the U.S., health disparities are common, and they often reflect population differences characterized by race, ethnicity, gender, age or socioeconomic status.

For example, African-American men and women are more likely to die of heart disease and strokes than white people experiencing the same diseases. A recent study showed among preschool children hospitalized with asthma, 21 percent of white children were prescribed medications to prevent future hospitalizations, compared to only 2 percent of Hispanic and 7 percent of black children.

The troubling fact is that health disparities are many, widespread, long-standing and persistent. And studies rather consistently show that gaining access to a health care system does not necessarily ensure that patients will receive higher quality care. Racial and ethnic health disparities often persist even when insurance status is comparable -- a sobering acknowledgment as we approach near-universal coverage anticipated under the Affordable Care Act. (more…)

By Dr. Kate Scannell, Syndicated Columnist
First Published in Print: 05/26/2013

On May 14, The New York Times published a moving essay by Angelina Jolie in which the actor revealed she had undergone a double mastectomy -- even though she did not have breast cancer. However, Jolie was aware that she had inherited a genetic mutationthat increased her risk of developing breast cancer to about 87 percent. That mutation, associated with a "BRCA gene," additionally upped her chances for developing ovarian cancer to about 50 percent. Facing such grim odds, Jolie decided to be proactive and minimize those risks by having her breasts and ovaries surgically removed. (more…)

By Dr. Kate Scannell, Syndicated Columnist
First Published in Print: 05/10/2013

The news in the Cincinnati Enquirer sounded dreadful. Someone who'd been suffering from "pulmonary peritonitis" had "died suddenly of pleurisy of the brain." Equally distressing, the Chicago Record-Herald reported that a man, following six gunshots and defying anatomy, died from "shock and lumbar pneumonia."And sadly (or at least I think so), according to an Erie, Pa., newspaper, three surgeons opined that a man "would always be a sufferer from chromatic epilepsy."

These and other examples of "misinforming and even ludicrous" medical journalism were colorfully recounted fully 100 years ago in the April 19, 1913, edition of the Journal of the American Medical Association.

Clearly, the physician-editorialist was annoyed by such careless health reporting. And when it came to inaccurate or misleading news that could actually harm people, he was outright incensed. He railed against "sensational newspaper articles concerning cancer and tuberculosis cures, some of which at least soon prove to be the rankest fakes."

It's always interesting -- although often unsettling -- to look back at physicians' critical writings about media coverage of science and public health. It's interesting partly because so many of those criticisms remain unchanged well beyond a century later. And it's often unsettling because ... well, so many of those criticisms remain unchanged over so long a time. (more…)

By Dr. Kate Scannell, Syndicated columnist
First published in print: 04/14/2013

Some patients seem to lodge forever in my memory, prompted into my consciousness by happenstance cues from the outside world. And others -- those who have variously shaped my identity as a doctor -- steadfastly reside in the forefront of my awareness, routinely accompanying my thoughts and influencing my view of the world.

One of those latter patients was a young woman I met 30 years ago in a Chicago hospital's emergency room. That hospital -- Michael Reese -- no longer exists. But one room within it -- the one in which we met -- remains solidly constructed in my memory, the details of the woman's face, the room's furnishings, the floor tile and wall color all painfully clear.

It was a warm Saturday afternoon, the kind of slow summer day that typically lured Chicagoans to the lake or Navy Pier. I'd been up all night as a medical resident in training, my green scrubs wrinkled, caffeine keeping me afloat.

The young woman was to be my last patient of the day. I grabbed her chart from the ER nurse and read its sparse contents on my way to her room. I learned that she was 18 years old and living in the housing projects adjacent to our hospital. The intake nurse had recorded the patient's chief complaint as "SA" -- letters of unknown significance to me.

But their meaning became instantly clear when I entered the young woman's room. Dressed in a pale hospital gown, she sat rigidly on the edge of the gurney, her legs dangling motionless and barely contacting the floor. Her every facial muscle clenched while tears dropped unceremoniously onto her lap. She stared at a bare patch of wall a few feet away and said nothing when I introduced myself.

Evidence of prior commotion surrounded her stillness. Discarded iodine swabs. Crumpled medical supply wrappers on the desk. Blood-tinged towels beneath the gurney. And "the rape examination kit" wide opened.

On this sunny Chicago afternoon this woman was in our ER, being questioned by police and probed by strange doctors. Blood and cervical samples had been taken from her body, checking for sexually-transmitted infections. A "baseline" pregnancy test was being processed.

The woman's stunned angry silence was as diagnostic of trauma as any "kit" could ever be. Closing her chart and deciding to forgo the usual litany of medical questions, I just sat down and said, "I'm sorry." And then I waited, my chest aching, my own anger expanding.

"I was just coming home from the grocery store," she finally said. "They were waiting for me in the stairwell." (more…)

By Kate Scannell, Syndicated columnist
First published in print: 03/29/2013

The Vatican is the only place I know where evidence of smoke can signal positive job news. Instead, as paired essays in the New England Journal of Medicine attest, employers are increasingly searching for evidence of tobacco smoke in job seekers to deny them jobs.

The authors of those essays neatly lay out opposing arguments to either support or denounce hiring policies that exclude smokers from employment consideration. Their thoughtfulness, civility, and adherence to actual facts provide a refreshing break from the smoke-blowing in much of the current public debate. (more…)

By Dr. Kate Scannell, Syndicated columnist
First published in Print: 03/17/2013

Last Monday, a judge canned New York City's revolutionary plan to prohibit the sale of large, high-caloric, sugar-sweetened drinks in restaurants, movie theaters, and other food venues -- just one day before the ban was supposed to take effect. The ruling dealt a blow to the city's Board of Health and Mayor Michael Bloomberg who were promoting the ban as a means to address the obesity epidemic.

Had the deliciously-named judge -- Milton Tingling -- not overturned the so-called "soda ban," today it would be permissible in establishments under the health department's purview to celebrate St. Pat's in Manhattan with pitchers of manhattans, but nothing larger than 16-ounce servings of sugary beverages.

This has stirred much debate about the proper reach of government into our private lives. Can -- and should -- the government regulate the sipping point of our thirst for sugar, the critical ounce beyond which our intake tips toward transgression? (more…)

By Dr. Kate Scannell, Syndictaed columnist
First Published in Print: 02/17/2013

Hips. We tend not to think much about them -- until they hurt or need replacement -- even as they support our ability to walk, climb stairs, sit and dance.

With the exception of Lucille Clifton's celebratory poem, "Homage to My Hips," poetic works have largely ignored these workhorse joints in favor of hands, backs, necks -- even ankles. Hips rarely qualify as subjects of serious literary concern. In fact, entering "hip" into Amazon's book search window mostly delivers stories about American pop culture, hipsters and bunnies who hip-hop.

All this to explain why it's remarkable that hips have grabbed so many current headlines. Are we finally getting hip to hips, and all that they can teach us?

I certainly hope so.

For example, let's review two such stories which are ... well, joined at the hip, and see what we learn about money, deception, shopping hassles, and, yes -- there's more!

The first story involves an otherwise healthy, uninsured, 62-year-old grandmother seeking hip-replacement surgery for which she must pay out-of-pocket. The cost being of great concern, her dutiful granddaughter calls hospitals throughout the country, in quest of the lowest "complete bundled price" -- that is, cost inclusive of both hospital and physician fees. (more…)

By Dr. Kate Scannell, Syndicated Columnist
First Published in Print: 02/03/2013

An elderly woman hobbled into my clinic, precariously balanced with the assist of two canes. Her face had a worn and ashen look, depleted of all vitality. The seemingly simple act of getting into a chair exhausted her.

Disabling arthritis had largely restricted her to a life lived within apartment walls, one devoid of a pain-free day over many years. I tried to contain my astonishment upon hearing she had never used an analgesic stronger than aspirin or acetaminophen. Before I could ask why, she offered matter-of-factly: "Because my doctor said it would turn me into an addict." (more…)

By Dr. Kate Scannell, Syndicated Columnist
First Published in Print: 01/19/2013

Last week, while sitting in a doctor's crowded waiting room, I watched the new season of the Winter Flu Olympics.

A sneezing competition was in progress when I arrived. And within mere minutes of taking my seat, I thought I had witnessed the worst sneeze I might ever see in my entire life. It erupted without warning from a young man, slouched in his chair, tethered to an iPod, staring glassy-eyed at the ceiling. His Vesuvian sneeze rocked the room, spewed a misty cloud of viral detritus throughout our cramped quarters. It was an appallingly effortless performance -- entailing not even the slightest gesture toward covering his mouth.

I was ready to score him a perfect 10 in the category of "most obnoxious sneeze, greatest risk of public contagion." But then an older gentleman came out of nowhere and trumped him. He suddenly stood up, placed his hands on his hips, bent abruptly backward and inhaled deeply. Several of us tried to protect ourselves -- turning away or wrapping scarves across our faces. Alas, like a whipsaw, his body bent violently forward, flinging a wet and turbulent "ahhHHH-CHOooooo!" into the collective airspace.

In other events: Competitive coughing generated comparable infectious excitement within the room. And rivalry remained fierce, running nose-to-nose, for "greatest number of missed tissue-tosses into the wastebasket."

Still, as engrossing as these events may have been, I soon realized that every passing moment spent in the waiting room only increased my risk of getting sick. My hopes for leaving infection-free depleted faster than all the Purell dispensers stationed by the doors.

I derived meager consolation in considering how the experience might help inform the next revision of my best-selling book, "The Sick Person's Etiquette Guide -- How to Contain Your Own Secretions with Style and Make the World a Healthier Place." Published by the Common Sense Medical Association, it makes for a good read in front of the fireplace during a cold winter's night ... or, actually, just during a cold.
(more…)

By Dr. Kate Scannell, Syndicated columnist
First Published in Print: 01/06/2013

Last month, the country was shocked to learn that a gunman shot and killed 20 schoolchildren in Newtown, Conn. The tragedy sparked yet another so-called "national conversation" about gun control, igniting predictable passions on both sides of the heated debate. While National Rifle Association leadership recommended armed security guards in schools to enhance children's safety, gun-control advocates demanded stricter legislation to limit assault weapons and high-capacity magazines.

Locked in stark disagreement, still, both sides claimed to be aiming at the same objective: to keep children safe. How could that be?

"Keeping children safe" is always a great idea. But as an idea or abstraction, it can be easily shaped into a platitude, a moral imperative, or a political sound bite used to lure people toward wildly differing points of view. Want to keep children safe and healthy? Well, then -- do/do not have them vaccinated. Do/do not provide them with sex education. Do/do not allow contact sports. Do/do not pass legislation allowing confidential abortion counseling for teens. Do/do not tinker with school lunch menus.

A major problem with "keeping children safe" is, well ... that it is such a great "idea." It brilliantly shines as a shared concept, but is dimly seen as a collective reality. Why should that be? (more…)