Saturday, September 22, 2012

HOW TO STOP HOSPITALS


How Fit Can You Get


From Killing Us 







Medical errors kill enough people to fill four jumbo jets a week. A surgeon 

with five simple ways to make healthcare safer.

When there is a plane crash in the U.S., even a minor one, it makes headlines. There is a thorough federal investigation, and the tragedy often yields important lessons for the aviation industry. Pilots and airlines thus learn how to do their jobs more safely.
The world of American medicine is far deadlier: Medical mistakes kill enough people each week to fill four jumbo jets. But these mistakes go largely unnoticed by the world at large, and the medical community rarely learns from them. The same preventable mistakes are made over and over again, and patients are left in the dark about which hospitals have significantly better (or worse) safety records than their peers.

WSJ's Gary Rosen talks to author and surgeon Marty Makary about his ideas for making American hospitals more transparent about their safety records and more accountable for the quality of their care.
As doctors, we swear to do no harm. But on the job we soon absorb another unspoken rule: to overlook the mistakes of our colleagues. The problem is vast. U.S. surgeons operate on the wrong body part as often as 40 times a week. Roughly a quarter of all hospitalized patients will be harmed by a medical error of some kind. If medical errors were a disease, they would be the sixth leading cause of death in America—just behind accidents and ahead of Alzheimer's. The human toll aside, medical errors cost the U.S. health-care system tens of billions a year. Some 20% to 30% of all medications, tests and procedures are unnecessary, according to research done by medical specialists, surveying their own fields. What other industry misses the mark this often?
It does not have to be this way. A new generation of doctors and patients is trying to achieve greater transparency in the health-care system, and new technology makes it more achievable than ever before.
I encountered the disturbing closed-door culture of American medicine on my very first day as a student at one of Harvard Medical School's prestigious affiliated teaching hospitals. Wearing a new white medical coat that was still creased from its packaging, I walked the halls marveling at the portraits of doctors past and present. On rounds that day, members of my resident team repeatedly referred to one well-known surgeon as "Dr. Hodad." I hadn't heard of a surgeon by that name. Finally, I inquired. "Hodad," it turned out, was a nickname. A fellow student whispered: "It stands for Hands of Death and Destruction."
Leonard Mccombe/Time Life Pictures/Getty Images; Photo Illustration/The Wall Street Journal
'Doctors absorb an unspoken rule: to overlook the mistakes of our colleagues.'
Stunned, I soon saw just how scary the works of his hands were. His operating skills were hasty and slipshod, and his patients frequently suffered complications. This was a man who simply should not have been allowed to touch patients. But his bedside manner was impeccable (in fact, I try to emulate it to this day). He was charming. Celebrities requested him for operations. His patients worshiped him. When faced with excessive surgery time and extended hospitalizations, they just chalked up their misfortunes to fate.
Dr. Hodad's popularity was no aberration. As I rotated through other hospitals during my training, I learned that many hospitals have a "Dr. Hodad" somewhere on staff (sometimes more than one). In a business where reputation is everything, doctors who call out other doctors can be targeted. I've seen whistleblowing doctors suddenly assigned to more emergency calls, given fewer resources or simply badmouthed and discredited in retaliation. For me, I knew the ramifications if I sounded the alarm over Dr. Hodad: I'd be called into the hospital chairman's office, a dread scenario if I ever wanted a job. So, as a rookie, I kept my mouth shut. Like the other trainees, I just told myself that my 120-hour weeks were about surviving to become a surgeon one day, not about fixing medicine's culture.

25%


Hospitalized patients who are harmed by medical errors

Source: New England Journal of Medicine
Hospitals as a whole also tend to escape accountability, with excessive complication rates even at institutions that the public trusts as top-notch. Very few hospitals publish statistics on their performance, so how do patients pick one? As an informal exercise throughout my career, I've asked patients how they decided to come to the hospital where I was working (Georgetown, Johns Hopkins, D.C. General Hospital, Harvard and others). Among their answers: "Because you're close to home"; "You guys treated my dad when he died"; "I figured it must be good because you have a helicopter." You wouldn't believe the number of patients who have told me that the deciding factor for them was parking.
There is no reason for patients to remain in the dark like this. Change can start with five relatively simple—but crucial—reforms.
Online Dashboards
Every hospital should have an online informational "dashboard" that includes its rates for infection, readmission (what we call "bounce back"), surgical complications and "never event" errors (mistakes that should never occur, like leaving a surgical sponge inside a patient). The dashboard should also list the hospital's annual volume for each type of surgery that it performs (including the percentage done in a minimally invasive way) and patient satisfaction scores.


Nothing makes hospitals shape up more quickly than this kind of public reporting. In 1989, the first year that New York's hospitals were required to report heart-surgery death rates, the death rate by hospital ranged from 1% to 18%—a huge gap. Consumers were finally armed with useful data. They could ask: "Why have a coronary artery bypass graft operation at a place where you have a 1-in-6 chance of dying compared with a hospital with a 1-in-100 chance of dying?"


A survey of New Yorkers found that approximately 60% look up a restaurant's "performance ratings" before going there. If you won't sit down for a meal before checking Zagat's or Yelp, why shouldn't you be able to do the same thing when your life is at stake?
Instantly, New York heart hospitals with high mortality rates scrambled to improve; death rates declined by 83% in six years. Management at these hospitals finally asked staff what they had to do to make care safer. At some hospitals, the surgeons said they needed anesthesiologists who specialized in heart surgery; at others, nurse practitioners were brought in. At one hospital, the staff reported that a particular surgeon simply wasn't fit to be operating. His mortality rate was so high that it was skewing the hospital's average. Administrators ordered him to stop doing heart surgery. Goodbye, Dr. Hodad.
Safety Culture Scores
Imagine that a surgeon is about to make an incision to remove fluid from a patient's right lung. Suddenly, a nurse breaks the silence. "Wait. Are we doing the right or the left chest? Because it says here left, but that looks like the right side." The surgery was, indeed, supposed to be on the left lung, but an intern had prepped the wrong side. I was that doctor, and that nurse saved us all from making a terrible error. It isn't every hospital where that nurse would have felt confident speaking up—but it's this sort of cultural factor that is so important to safety.

98,000


Annual deaths from medical errors in the U.S.

Source: Institute of Medicine
If anyone knows whether a hospital is safe, it's the people who work there. So my colleagues and I at Johns Hopkins, led by J. Bryan Sexton, administered an anonymous survey of doctors, nurses, technicians and other employees at 60 U.S. hospitals. We found that at one-third of them, most employees believed the teamwork was bad. These aren't hospitals where you or I want to receive care or see our family members receive care. At other hospitals, by contrast, an impressive 99% of the staff reported good teamwork.
These results correlated strongly with infection rates and patient outcomes. Good teamwork meant safer care. The public needs to have access to such information for every hospital in America.
Cameras
It may come as a surprise to patients, but doctors aren't very good at complying with well-established best practices in their fields. One New England Journal of Medicine study found that only half of all care follows evidence-based guidelines when applicable. Fortunately, there is a technology that could work wonders to improve compliance: cameras.
Corbis
You wouldn't believe the number of patients who have told me their deciding factor in choosing a hospital was parking.
Cameras are already being used in health care, but usually no video is made. Reviewing tapes of cardiac catheterizations, arthroscopic surgery and other procedures could be used for peer-based quality improvement. Video would also serve as a more substantive record for future doctors. The notes in a patient's chart are often short, and they can't capture a procedure the way a video can.
Doug Rex of Indiana University—one of the most respected gastroenterologists in the world—decided to use video recording to check the thoroughness of colonoscopies being performed by doctors in his practice. A thorough colonoscopy requires meticulous scrutiny of every nook and cranny of the colon. Doctors tend to rush through them; as a result, many cancers and precancerous polyps are missed and manifest years later—at later stages.
Without telling his partners, Dr. Rex began reviewing videotapes of their procedures, measuring the time and assigning a quality score. After assessing 100 procedures, he announced to his partners that he would be timing and scoring the videos of their future procedures (even though he had already been doing this). Overnight, things changed radically. The average length of the procedures increased by 50%, and the quality scores by 30%. The doctors performed better when they knew someone was checking their work.

The same sort of intervention has been used for hand washing. A few years ago, Long Island's North Shore University Hospital had a dismal compliance rate with hand washing—under 10%. After installing cameras at hand-washing stations, compliance rose to over 90% and stayed there.
Following Dr. Rex's camera study, he did a follow-up, asking patients if they would like a copy of their procedure video. An overwhelming 81% said yes, and 64% were willing to pay for it. Patients are hungry for transparency.
Open Notes
Sue, a young accountant, came to my office complaining of abdominal pain. She wasn't sure what was causing it. She offered various theories: "Could this be from my Bikram yoga?" "Did my late-night ice cream cause the pain?" "Does having unprotected sex have anything to do with it?" Throughout her visit, I took notes. When we were done, she looked down at them suspiciously.
"What did you write about me?" she asked.
She was concerned that I thought she was either nuts or an ice-cream addict. In the course of our conversation, I also learned that she wasn't quite sure why I was recommending an ultrasound, though I thought I had told her.
I decided to start dictating my notes with the patient listening in at the end of his or her visit. "I also have high blood pressure," was a correction one older patient blurted out. Another said, "My prior surgery was actually on the right, not the left side." Another patient interrupted me and said, "No, I said I take 20 milligrams, not 25 milligrams, of Lipitor." Being able to review your doctor's notes in writing might be even better than my method, particularly if you could add your own comments, perhaps via the Web.
Harvard doctor-researchers Jan Walker and Tom Delbanco are using "open notes" at Harvard and Beth Israel Hospital in Boston, and my hometown hospital, Geisinger Medical Center in Pennsylvania, has begun giving patients online access to their doctors' notes. So far, both patients and doctors love it.
No More Gagging
Though there are many signs that health care is moving toward increased transparency, there is also some movement backward. Increasingly, patients checking in to see doctors are being asked to sign a gag order, promising never to say anything negative about their physician online or elsewhere. In addition, if you are the victim of a medical mistake, hospital lawyers will make never speaking publicly about your injury a condition of any settlement.
We need more open dialogue about medical mistakes, not less. It wouldn't be going too far to suggest that these types of gag orders should be banned by law. They are utterly contrary to a patient's right to know and to the concept of learning from our errors.
Political partisans can debate the role of government in fixing health care, but for either public or private approaches to work, transparency is the crucial prerequisite. To make transparency effective, government must play a role in making fair and accurate reports available to the public. In doing so, it will unleash the power of the free market as patients are better able to take charge of their own care. When hospitals have to compete on measures of safety, all of them will improve how they serve their patients.
Transparency can also help to restore the public's trust. Many Americans feel that medicine has become an increasingly secretive, even arrogant, industry. With more transparency—and the accountability that it brings—we can address the cost crisis, deliver safer care and improve how we are seen by the communities we serve. To do no harm going forward, we must be able to learn from the harm we have already done.
A version of this article appeared September 22, 2012, on page C1 in the U.S. edition of The Wall Street Journal, with the headline: How to Stop Hospitals From Killing Us.

PICK THE RIGHT


How Fit Can You Get

Gym for You




Good Day Readers:
Yesterday I ran into a friend who used to workout with me at the now defunct, “Fitness Place.” Well he had one hell of a story to tell me about suffering a severe injury and his process of healing and recovery since I last saw him. His name is Tim and he is a police officer. He was responding to an officer-needs-assistance” call last year and was t-boned by another vehicle. The police cruiser was crushed and he suffered multiple injuries including severe head and back injuries. He described himself as being broken.

Our conversation soon turned to the old gym we attended and how much we both miss it. Whenever I run into former members of my old gym they all speak about how much they miss the atmosphere and support they received while working out there. The atmosphere was encouraging and most members were supportive of each other. The motto was, “Go Hard or Go Home.” If caught slacking you’d catch some grief and if you needed a spot while lifting heavy, you could trust almost anyone there to do it correctly. There was a level of expertise that I have not experienced at any other facility and I have been lifting since 1987.

I remember the first time I went there after finally finding the place I’d heard so much about. I was doing chest exercises that day and coming from another gym where I was one of the “big dogs,” I figured it would not be much different here. I was working out with someone else and after I finishing my lift; I turned to my partner for the day and asked if he wanted me to take some weight off. Well he added weight and did more repetitions than I did on my lift.

Humbled and a little surprised, I knew this was home for me. I knew it because these people were going to make me better. I was going to compete and if I did, I could only get better and I did. I started there with a maximum flat bench of 315 and by the time they closed a few years later my maximum bench press was around 420. The atmosphere was the correct one for me and many others who chose to lift very heavy and/or work very hard at whatever their niche was.

However not everything is for everyone. This was conducive for me but the question is what is conducive for you? It is important to pick a place that is comfortable for you and supports you in becoming the best you can be. Before you sign up and commit to a gym do your homework and that starts with knowing what type of atmosphere will support your goals.

This includes the type of people who attend. What is the best time to come? Do you like crowds? Is it loud and too macho driven? Are people really working out or are they sitting, texting, calling and trying to get a date. All of these things may matter and impact how often you attend and what you do when you get there. Even at the gym and maybe especially there, remember: association brings assimilation. Presently I attend a popular commercial, mass produced gym. I usually attend during the gym’s down time so that I am there when people are serious and it isn’t too crowded so I am not waiting for someone to finish a text or conversation.

It is also important to note that comfortable does not mean “Comfort Zone.” In this context it means supportive to your needs and consistent with your personality. I can remember one gym recommended to me after FP closed and I did not like it. It was macho driven with a real edge to it and although I was able to compete I did not like the idea of having to watch my back or secure my belongings. It was distracting to the point of diminishing my workout so I did not join.

Do your homework first and make sure it is a place you want to be. Not wanting to be there because of the atmosphere is definitely a deterrent to progress. Where else (besides work) do you go that you do not want to be? Do not sabotage yourself by picking the wrong gym for you. It is unlikely you will make the gains you desire even if you do attend regularly if you do not like the environment.

So let’s Get Up Get Moving and burn the fat away, and remember,
“CHIT CHAT WON’T BURN FAT”

Jay

Friday, September 21, 2012

BEGINNING LEGS

How Fit Can You Get



Legs                                                 Sets                            Repetitions

Leg extensions                                      3                                  12-15

Leg-Extensions


Leg curls                                               3                                  12-15






Dumb bell squats                                  3                                  8-12




Dumb bell lunges                                  3                                  8-12




Dumb bell Calf raises                             3                                   10-15

USDA's LIES CONTINUED


How Fit Can You Get




Money Talks and Bull.... Walks

Perhaps the most influential and interesting shortcoming of these food guides is the government’s failure to follow through with the policies it recommends. The intended purpose of these guidelines is to provide the public with information on how to eat better. How is the government persuading consumers and food producers to implement its advice? 

Has it restricted the amount of salt or sugar permitted in certain foods or reduced advertising of junk foods to young children? Does it support farmers who grow predominantly vegetables and whole grains? The government does not support its advice economically.

Clearly, America’s actual food consumption is nowhere near what the USDA is recommending. Part of the problem might come from the fact that the federal government, with an annual budget of about $3.8 trillion, spends exactly zero dollars promoting the food guides. Think about it: when was the last time you saw a government sponsored commercial, magazine ad or billboard promoting whole grains, vegetables or exercise?

The government simply develops the guidelines and leaves the advertising and education in the hands of the corporations who make money from product sales. Why would a wealthy country in the middle of an obesity epidemic not allocate resources to help its citizens with diet and nutrition? It’s a bit odd that the government has no budget for advertising their own health advice yet still finds a way to contribute resources to other food campaigns.

Perhaps you’ve seen the slogans: “Got Milk?” “Beef, It’s what’s for Dinner” and “Pork. The Other White Meat.” These campaigns, aimed at increasing Americans’ consumption of dairy, beef and pork products, are part of the federal government’s commodity promotion programs called “check off” programs. Check off programs demonstrate that what the government tells us to eat is contradictory to where it focuses its time and money. 

BEGINNERS SHOULDER ROUTINE


How Fit Can You Get


Pay attention to your form and tighten your abdomen while performing each motion. This will help to protect your lower back. It is especially important while doing any exercise with weight while standing but it is also important for many of the sitting motions as well. The lower back muscles can be very sensitive and it is important to have a strong core (abdomen, lower back, oblique). Your lower back supports your upper body’s weight and requires the support of a strong abdomen. 

Do them correctly and only increase the weight if you are able to maintain good form throughout the motion. Increasing weight is a gradual process and there may be days when you able to do more and you should do more repetitions or increase the weight. This will help you to grow more lean muscle and avoid plateaus where you are just stuck. Pay attention to the good days. What you did the day and evening before is probably the cause for your good fortune.

There will also be days when you feel sluggish and out of touch. This may be due to a lack of rest which most will contribute it to. However it is likely to be your fuel impacting you and making you sluggish the way your auto may operate if you get gas with impurities in it. Do not get discouraged, upgrade your fuel and treat yourself better and your workouts and results will improve


Have great day and even better work and remember,

"CHIT CHAT WON'T BURN FAT"





Shoulders                                      Sets                            Repetitions 

Alternating dumb bell front raise             3                                  8-12







Simultaneous dumb bell side lateral raise         3                                  8-12








Barbell seated shoulder press                3                                  8-12


Barbell Shrug                                        3                                  8-12



Seated pulley row to neck                      3                                  8-12






Reverse Fly Deltoids                                          3                                  8-12





Thursday, September 20, 2012

WHAT'S THEIR MOTIVATION


To Promote Wellness

Doctors are human too aren’t they?  Considering the BIG BUSINESS INDSUTRY that is our country’s Health Care System, I sometimes question if doctors are concerned with their patients’ wellness as much as they are concerned with increasing the size of their bank accounts. 


I do not believe there is a simple answer to this question since all human beings are complicated creatures. 

I also have to admit I am a little biased. I believe most people who do not have a genetic health condition may have the ability to stay fairly well and reduce their dependence on Doctors and medication. My goal is to support you in moving toward wellness.

In my previous job as the Director of Truancy Prevention, in the beginning stages of building this new department in human services, a high level union representative, stated, “If (we were) successful it would reduce the number of active cases thereby reducing the number of Social Workers.” Are you certain your doctor does not think that way? The more healthy people, the less doctors will be needed. 

The health care industry is slowly moving towards using natural products for health but very few physicians I’ve spoken with are willing to discuss the topic. Instead they usually reach for a prescription pad. Their unwillingness to even consider alternative treatments makes me apprehensive.

The pharmaceutical companies are a dominant component of the health care industry. Everyone is making money off of our nation’s deteriorating health and the big pharmaceutical companies are at the root. Doctors are induced to use certain drugs as they are provided incentives to do so. The more scripts they write the more money they and the drug companies as well as affiliates like marketers, researchers, and all associated with this failed system gather. We are spending more money on health than ever before.

I guess the best question is, “Are We Better Off?” The answer is a resounding NO!!! Our health is not better. As a nation we are sicker than at any time in our history and this issue needs to become a topic of ongoing public discussion and action. This is a big part of my motivation to act now. We are trusting people with our lives without asking the hard questions. What is the motivation of a person who makes their fortune by treating illnesses with high priced drugs?

When money becomes a factor, we must question the motivation. The question is… how can we take our power back? What can we do ourselves to lessen our chances of having to sit in that costly doctor’s office?

Think about that question for a minute. We are not talking about the old time doctor who came to your home and lived a modest lifestyle. No not at all, we are talking big houses, fancy expensive cars, country clubs, and the bling, bling lifestyles. To be fair, I must also mention the unbelievable debt they accumulate in order to pay for medical school. So it is a prime directive for them to make a great deal of money as soon as they are able. Does this sound like someone who is motivated to keep you well? How can they maintain their lifestyle if you do not visit regularly?


The foundation of the system is flawed and the information for you to be and stay well is available but it is usually not the physicians that share this with us. Yes there a few famous television doctors who have appeared recently and they do have some good information. The trouble is we have no relationship with these people. Experience tells me, that most people are more likely to trust and act on information provided through relationship. Who are you more likely to listen to? Someone you know or someone you do not?

The flaw can be fixed but the fear is that the flow of money will be slowed. It is faulty thinking. What if they flipped and concentrated on wellness. I believe the majority of people want to be well but do not have the knowledge and in some cases the motivation since it seems easier and quicker to take a pill. I am betting you’d probably fall off the doctor’s table if he put the pad down and handed you a pamphlet on fitness or wrote the number of a certified personal trainer rather than a prescription.

What if doctors negotiated a reduced fee contract with the gym for their customers and monitored their progress instead of sending you to the pharmacy? What if they told the truth about the food pyramid instead of keeping quiet about the politics that went into that negotiation? Question after question needs to be asked of an industry that instead of telling the truth buckled under to the food industry and negotiated which truths could be told. Think about these things and then ask your doctor these hard questions. I’d love to hear how they respond.

If the information to keep us well was not readily available this would not be an issue. But the information does exist and the biggest question of all is why isn’t your doctor sharing it readily with you? Good question and until you get a good answer you need to be an active part of your wellness. The hard and scary truth is that it does not seem like the health care industry is motivated to keep us well. The motivating factor of the healthcare industry is money.

So I encourage everyone reading this to “Get Up and Get Moving” towards a healthier lifestyle. Whether it’s me or someone else, get someone to assist and support a healthier lifestyle for you. You can do it and I will continue to provide you with information that can help.

Create a great day for yourself and those around you while remembering,

“CHIT CHAT WON’T BURN FAT.”