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Recent Newspaper & Online Columns by Kate Scannell MD

Last Week -- Things that Saved Me

A little down last week, hearing with finality that I was not invited to the Royal wedding. What raised my spirits:
1. Watching an old Chris Rock video.
2. Reading "Bossypants" by Tina Fey.
3. Re-uniting with an old friend.
4. That great joke going around, about some wild plan to dismantle Medicare, and change it into a system where Medicare patients are instead given coupons to purchase private health insurance policies! It is a joke . . . Right? Read More 

Ingratiating yourself in the hospital, hoping for good medical care

By Dr. Kate Scannell, Syndicated Columnist
First Published in Print: 04/17/2011

I WAS able to arrive at the hospital an hour after my frail, elderly aunt had been delivered by ambulance to her local emergency department last month. I found her lying motionless in bed, moaning softly, covered only by an impossibly thin hospital gown, her eyes shut protectively against glaring overhead lights.

Without her hearing aides and distracted by pain, she had trouble communicating. I saw by the way her contorted left limbs "rested" on the bed that she most certainly had fractured her hip and arm during the fall she'd just taken.

Before attempting to track down the doctor for his medical assessment and plan, I asked my aunt what she immediately required for comfort. "Blankets," she replied, and "to urinate -- but, please, not in this bed."

I tensed immediately -- realizing that the ritual of trying to establish caring connections with complete strangers on a medical staff had begun. I would initiate the ritual by trying to broker my aunt's requests for warmth and dignity, which, on the surface, seemed easy to remedy and worthy of concern.

Still, as both an insider physician and veteran patient, I knew those requests could be otherwise perceived by the staff -- as an intrusion or annoyance, perhaps. Or a judgment about inadequate attention to my aunt. At worse, as an imperious claim of entitlement to the staff's valuable time. The stakes were high -- I feared that any staff displeasure I might inadvertently generate could jeopardize the quality of my aunt's future care.

The ER nurses were sitting at a desk 15 feet away, in direct line of sight of my aunt. I took a deep breath and approached them.

"Excuse me," I began apologetically, "but my aunt needs to urinate, and if we could please just get her a couple of blankets "... ."

The nurse barely glanced up from her computer and mechanically replied, "We're busy. Besides, we need two people to move your aunt onto the bedpan."
 Read More 

At the heart of Clinical Practice Guidelines -- at what price?

By Dr. Kate Scannell, Syndicated Columnist
First Published in Print: 04/02/2011

BY NOW, most of us know what a "GPS" is -- at least those of us who tend to get lost and require a "global positioning system" to navigate us toward our desired destination. But how many of us are familiar with the "CPGs" our doctors use to navigate our medical care?

A CPG is a "Clinical Practice Guideline," and it functions like a GPS for doctors and patients. For example, when a medical decision must be made for a diabetic patient, the doctor might consult a "CPG for diabetes" to select a course of management among several options. Depending on that course, the CPG could navigate doctors toward ordering certain tests or prescribing particular medications.

CPGs are created by a hodgepodge of private and public organizations that share some interest in the focus of the CPG. So, for example, the American Diabetes Association creates CPGs regarding diabetes management. The Academy of Ambulatory Foot and Ankle Surgery issues guidelines concerning ingrown toenails. More than 1,000 CPGs exist, spanning a vast array of medical disorders including heart disease, arthritis, thyroid problems, high blood pressure and various cancers.

Ideally, organizations volunteering to create guidelines do us a favor, because it is impossible for most doctors to keep up with the thousands of new research findings published each year in medical journals. We doctors tend to welcome CPGs that are written by groups of professionals who have expertly reviewed, analyzed, distilled, synthesized and translated complex research findings into useful clinical practice recommendations.

It's important to understand about CPGs because doctors frequently rely upon them to determine what happens to you when you're sick.  Read More