Kate Scannell, MD

By Dr. Kate Scannell, Syndicated Columnist
First Published in Print: 06/11/2011

FOOD AND health and safety issues cooked up more news within the last two weeks than Lindsay Lohan and Oprah Winfrey combined! Is the public appetite changing?

A toppled pyramid, fishy fish, killer bacteria stalking European food supplies, Ronald MacDonald's job threatened and the FDA taking heat on the back burner . . . how to digest it all?

Let's begin with the dismantling of the 2005 food pyramid --that charming but baffling icon developed by the U.S. Department of Agriculture (USDA) that was supposed to somehow guide us toward healthier nutritional habits. But few Americans could crack the mysterious code of the old-world pyramid and its six unlabeled columns, all the while our nation's obesity and diabetes epidemics swiftly expanded.

Americans puzzled over the nutritional significance of the staircase -- or escalator? -- appended to the pyramid. They were distracted by the disarticulated humanoid figure that loitered on it. Was it a mummy emerging from the pyramidal catacombs? Was its disarticulation merely metaphor for the entire icon's failure to articulate a coherent message about good nutrition? Why was it running away from "the five food groups" jumbled at the pyramid's base -- especially if they were supposed to be good for us? Sadly, in the wake of the food pyramid's recent dismantling, we may never find out. Read More 

By Dr. Kate Scannell, Syndicated columnist
First Published in Print: 05/28/2011

LAST WEEK, I visited Lainey Aldermen's fourth grade class at John Swett Elementary School in Martinez with two related goals in mind. The first was to demonstrate how writing could be fun and exciting, how it could lead to adventures and experiences in bigger worlds that existed "off the page." My second objective was to gain a better understanding of what young people think about doctors and health care -- their important perspectives are virtually absent from mainstream polls and surveys.

My overarching plan was to merge both goals by teaching the students how to write a structured essay, and asking them to focus it on their experiences with doctors or hospitals. I told them I would include their opinions in this newspaper column, hoping to provide them a concrete experience of witnessing their words being carried beyond the classroom into a larger public conversation.

And, of course, I learned many amazing things during my visit.  Read More 

By Dr. Kate Scannell, Syndicated Columnist
First Published in Print: 05/15/2011

FOR WEEKS, we've been reading about air traffic controllers falling asleep on the job. In one case, an airborne ambulance transporting a sick patient had to circle a Nevada airport for 16 minutes while the controller snoozed. In March, two jetliners inbound for Reagan National Airport were forced to land without clearance while the air controller slept.

In response to such disturbing incidents, the office of fatigue risk management at the Federal Aviation Administration (FAA) has been collaborating with the National Air Traffic Controllers Association to identify and remedy conditions fostering controller fatigue. While not an expert at such matters, I have a (grounded) hunch these agencies will discover that 99.3 percent of human beings who sit alone within a tower, staring out for hours at a yawning night sky, working irregularly staggered shifts -- will tend to feel a little sleepy.

So far, the FAA has recommended a minimum nine-hour break between controller shifts, and at least one additional buddy present on overnight shifts at 27 airports that had previously maintained only one controller.

On the runway of public opinion about aviation safety, concerns about pilot fatigue immediately preceded our current focus on air traffic controllers. An ABC News investigative report in February claimed that "despite denials from the airline industry, large numbers of pilots report to duty every day after getting only a few hours of what fatigue experts call 'destructive sleep' in crowded crew lounges and so-called 'crash pads'." More than two dozen accidents and 250 fatalities in the U.S. had been linked to pilot fatigue in the past 20 years.

Public anxiety associated with air traffic controller or pilot fatigue is soaring high, partly fueled by post-9/11 insecurities regarding flying in general. But the reality is that fatigue-related safety hazards loom even larger on the ground. Whether referring to ourselves or to others within our daily lives, being sleepless IN Seattle might be riskier overall than being sleepless over it.  Read More 

Dr. Kate Scannell, Syndicated Columnist
First Published in Print: 04/30/2011

AS A physician specializing for years in geriatric medicine, I was delighted to learn about Republican Rep. Paul Ryan's plan to dismantle Medicare and replace it with good old-fashioned, coupon-clipping, private-marketplace opportunities for elderly and disabled people seeking health insurance.

It was a brilliant idea. We all know how fun it is to comparison shop for health insurance policies in the first place. But also incorporating the prospect of applying coupons or "vouchers" to insurance purchases -- well, it sounded like a shopper's paradise for the Medicare crowd.

Besides, as a matter of principle, shouldn't the elderly and disabled be freed -- yes, freed! -- from Medicare to pursue opportunities to shop for private insurance, just like more able-bodied, freedom-loving Americans? As a matter of personal liberty, shouldn't they be allowed as many mind-boggling consumer "options" for policies?
Sure, the disabled and elderly may collectively suffer more physical, mental, financial and social limitations in multiple arenas of life -- but the Ryan plan offers them a rare taste of unfettered freedom in the private insurance marketplace.

OK, wait -- I can't satirize the Ryan plan anymore. What it threatens to do to Medicare is entirely too serious and disturbing. Read More 

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 

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 

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 

By Dr. Kate Scannell
First Published: March 24, 2011

My 20-year old patient had been suffering a slow, painful death expected to occur within the next few days. Alone in his drab room on a county hospital’s AIDS ward in California in the mid-1980s, he had been praying to see his father and mother one final time. He fantasized about them rushing into the hospital, assembling around his deathbed, holding his hands and easing his transition from this world.

He had last seen his parents several years before at the family homestead in the rural south. Standing on the front porch where he had been exiled moments after admitting his homosexuality, he saw his father’s angry face behind the slamming screen door, his mother’s piercing stare through the front window.

But, in the end, he carried those final imagesof his parents to his grave. Neither of them had responded to his pleas for a bedside visit, accepted offers of airfare to California gifted by an AIDS advocacy group, or taken opportunities to speak with their son by phone.

And yet, days before he died, he had the experience of “being saved” by Elizabeth Taylor. He had seen her on television, witnessed her embrace of a gay man with AIDS, and heard her unflinching support for AIDS research to seek cures for people who suffered with HIV infections.

Without first-hand experience of the early AIDS epidemic, it may be difficult now to appreciate Elizabeth Taylor’s heroism back then.  Read More 

By Dr. Kate Scannell, Syndicated Columnist
First Published in Print: 03/20/2011

I AM IN DETROIT visiting family, and I’ve got sports on the brain.

Last night, we watched a local news report about former Red Wing hockey star Bob Probert who died last July at age 45 with a bad heart and battered brain. His celebrity on the ice rink had derived as much from his skill with his fists as with his stick.

Earlier this month, Probert’s brain was examined and found to exhibit “chronic traumatic encephalopathy” or “CTE” – a degenerative brain disease originally noted in boxers and, more recently, football players. Caused by repetitive or severe head trauma, CTE can manifest as dementia, memory loss, depression, aggression, and suicidal behavior. According to his wife, Probert had displayed problems with short-term memory and a quick temper.

During a commercial break, one of my sisters commented upon the increasing violence she’d witnessed during her own sons’ school sports activities. “But the parents are often worse than their kids,” she said.  Read More 

The flames were slow, steady, black.
All the long while you burned in such darkness
no one saw the consuming flames.

Peace of the deep earth to you, A.