Ac-Cent-Tchu-Ate the Negative...

I'm sitting in the physician's lounge eavesdropping on two surgeon colleagues, who I both admire and respect, while they talk shop. But it's all about what's not working. With a heavy focus on "dumb" patients, referring physicians, admitting clerks, charge nurses.....

What's up with all the negative talk? Why don't we sit around sharing stories about all the good that surrounds us? What about the patient who asks her doctor "how are you doing?" on a day that has been visibly rough on her surgeon? The housekeeper who sees his job as making the patient environment as safe as possible for all who spend time in the hospital. The lady that works the cafeteria till that knows your name and your favourite afternoon treat. Or the charge nurse who takes the extra time to sit with his patient and her daughter to actually explore why it's difficult to take all the different pills we order without ever thinking about the complexity of compliance. And the referring physician, with limited access to diagnostics and support, who uses her clinical knowledge and expertise to make a really hard diagnosis and an appropriate, fully investigated referral.

Things are by no means perfect. But when all you can see and talk about is "what's wrong" maybe you should pause, take a look at yourself, then ask yourself the same question.

MRSA vs Lice

YUCK!  Harmless (but still yuck!)

I sat at one of my ICU’s work stations last week.  I planned on spending my time going through charts, writing notes and rechecking lab results.  Instead I sat watching the comings and goings, fascinated by our staff and our patients’ families adherence to basic infection control procedures.  Across from my work station were two adjacent patient rooms.  One patient was on isolation because he had head lice at the time of admission.  The other patient was on isolation because she was colonized with one of the “super-bugs,” methicillin-resistant staphylococcus aureus, aka MRSA. This is one of the multi-drug resistant bacteria that have emerged over the last few decades, in part to antibiotic overuse.  

Head lice elicit a visceral reaction in most of us. You are probably subconsciously scratching your head right now.  They are common in situations where people live or interact in close proximity. And while they may be gross, head lice are harmless.  

MRSA: not nearly as disgusting, but way more harmful!

MRSA is becoming increasingly common both in the community and within healthcare facilities.  But MRSA is not harmless. Patients who get a hospital-acquired MRSA infections suffer: their length of stay and death rate increase. And the cost to the healthcare system also increases. 

Unfortunately, we do not get the same visceral response when we think about MRSA.  And I think that is one of the underlying reasons I saw what I saw.

Adherence to infection control practices by families and staff for the patient with lice were universally executed with perfection.  

For the patient with MRSA: not so much.  

It is well known that MRSA transmission is primarily a healthcare worker vigilance problem.  We can prevent the transmission of the potentially deadly MRSA bacteria from one patient to another.  How?  Washing our hands before and after any contact with our patient or our patient’s environment. Gowning and gloving. Attention to cleaning the patient-care environment. It requires a level of fastidiousness that borders on OCD.  But we can do it.  

Three or four years ago we had a significant Norovirus  (aka Norwalk) outbreak in our hospitals. No one wants to catch an   infectious diarrhea: it, too, elicits (both figuratively and literally) a strong visceral reaction in all who come in contact with the virus. Our adherence to best practices was so good during the Norovirus outbreak that our Medical Director of Infection Prevention and Control was able to report to the Quality Committee that no in-hospital transmission of MRSA occurred during this time period where we are so focused on infection prevention.  She attributed this success to our staff’s strong desire to not contract such a horrible case of the runs.  

Viral diarrhea and head lice - YUCK!   

Too bad we don’t feel the same way about MRSA transmission.  

Let's Get Physical

Recently my friend Peter told me about a workout he completed at our Field House.   

Peter is crazy fit.  Right now he is on the other side of the world on a five-week hiking holiday.  He runs, skis (alpine, backcountry, cross-country, heli...), hikes, portages, canoes...  This workout wasn’t really for his benefit.  One of his friends had a heart attack.  Once the crisis was managed, Peter’s friend was referred to Saskatoon Health Region’s Livewell Cardiac Rehabilitation Program.   One of the program requirements is that you need to bring a workout partner with you.  And that’s how Peter got to the Fieldhouse the other day. 

The Saskatoon Health Region Livewell Cardiac Rehabilitation program has a long history (over forty years!) of offering supervised graduated exercise to people with active coronary artery disease.  If you live within our health region, have angina or have had a heart attack, heart surgery, or heart stents, you will be referred to the Cardiac Rehab program which is supervised by doctors, nurses and kinesiologists.  Dieticians, pharmacists, physiotherapists, social workers, physicians and, probably most importantly, other people living with heart disease will support you.  You will learn how to safely increase your activity and exercise endurance all while working out at a world class facility. 

Saskatoon Health Region also offers similar programs for people with COPD, heart failure, diabetes, and strokes. And it’s affordable: $25 a month and for that you get to go three times a week. These programs have helped hundreds, if not thousands, of patients improve their activity levels, their health, and their quality of life.  What Peter pointed out to me that we don’t offer any similar preventative programs for all those people who don’t yet have a chronic disease.  You have to develop complications of a chronic disease before we encourage and support you.  A single drop-in rate for unsupervised use of the same Field House is $8.30.  A month pass is $67.  (BTW Clopidogrel (aka Plavix) is $100 a month in Canada.  Most patients with active coronary artery disease are on clopidogrel along with at least three or four other drugs). 

What if we prescribed exercise to our patients? This approach has been proven to be effective at increasing activity levels and quality of life.  Several communities in Alberta are starting to look at this approach also.  What if we chose to pay for access to a trainer, a dietician, a yoga class?  As they say, an ounce of prevention is worth a pound of cure.  It seems like we are coming at the problem of chronic disease management more than a little too late.