(via Samantha Bee Slams Catholic Hospitals for Refusing to Provide Life-Saving Medical Care)

Full Frontal host Samantha Bee detailed all the ways Catholic hospitals are denying pregnant patients life-saving medical care. Catholic hospitals, which are the largest nonprofit health-care providers in the country, follow “Ethical and Religious Directives” requiring physicians to refuse patients contraception, sterilizations, and abortion care even in cases of life endangerment.

anonymous asked:

lawlu + innocence? or smth?

“Isn’t this where you protest your innocence?” Law asks his patient, careful of the handcuffs holding him to the bed. “Say you didn’t commit the crime?”

There’s a smile, something bright and sunny that stretches across the kid’s face, “But I did do it! They were hurting Robin!”

“So you decided to attack the building in broad daylight with a ragtag bunch of mercenaries?”

“Aw, Traffy, are you mad that I didn’t wait for you?”

“I’m mad,” Law hisses leaning closer to glance out the door, checking the police guard was distracted by Bepo. “That my idiot boyfriend launched an attack against a government agency and didn’t even wait for me to be there to help.”

Luffy laughs, “Sorry Traffy, I won’t do it again.”

“Better not,” Law warns slipping a paperclip into Luffy’s hand. “You better be home for dinner.”

“I will!”

Law shakes his head, grabbing his file and walking back out to where Bepo was starting to annoy the guard at the door. He was going to have another talk with Luffy when he got home, about how to wait for Law to help him or Law would have no choice but to handcuff Luffy to their bed.

For his own safety of course.

A doctor discovers an important question patients should be asked

This patient isn’t usually mine, but today I’m covering for my partner in our family-practice office, so he has been slipped into my schedule.

Reading his chart, I have an ominous feeling that this visit won’t be simple.

A tall, lanky man with an air of quiet dignity, he is 88. His legs are swollen, and merely talking makes him short of breath.

He suffers from both congestive heart failure and renal failure. It’s a medical Catch-22: When one condition is treated and gets better, the other condition gets worse. His past year has been an endless cycle of medication adjustments carried out by dueling specialists and punctuated by emergency-room visits and hospitalizations.

Hemodialysis would break the medical stalemate, but my patient flatly refuses it. Given his frail health, and the discomfort and inconvenience involved, I can’t blame him.

Now his cardiologist has referred him back to us, his primary-care providers. Why send him here and not to the ER? I wonder fleetingly.

With us is his daughter, who has driven from Philadelphia, an hour away. She seems dutiful but wary, awaiting the clinical wisdom of yet another doctor.

After 30 years of practice, I know that I can’t possibly solve this man’s medical conundrum.

A cardiologist and a nephrologist haven’t been able to help him, I reflect,so how can I? I’m a family doctor, not a magician. I can send him back to the ER, and they’ll admit him to the hospital. But that will just continue the cycle… .

Still, my first instinct is to do something to improve the functioning of his heart and kidneys. I start mulling over the possibilities, knowing all the while that it’s useless to try.

Then I remember a visiting palliative-care physician’s words about caring for the fragile elderly: “We forget to ask patients what they want from their care. What are their goals?”

I pause, then look this frail, dignified man in the eye.

“What are your goals for your care?” I ask. “How can I help you?”

The patient’s desire

My intuition tells me that he, like many patients in their 80s, harbors a fund of hard-won wisdom.

He won’t ask me to fix his kidneys or his heart, I think. He’ll say something noble and poignant: “I’d like to see my great-granddaughter get married next spring,” or “Help me to live long enough so that my wife and I can celebrate our 60th wedding anniversary.”

His daughter, looking tense, also faces her father and waits.

“I would like to be able to walk without falling,” he says. “Falling is horrible.”

This catches me off guard.

That’s all?

But it makes perfect sense. With challenging medical conditions commanding his caregivers’ attention, something as simple as walking is easily overlooked.

A wonderful geriatric nurse practitioner’s words come to mind: “Our goal for younger people is to help them live long and healthy lives; our goal for older patients should be to maximize their function.”

Suddenly I feel that I may be able to help, after all.

“We can order physical therapy — and there’s no need to admit you to the hospital for that,” I suggest, unsure of how this will go over.

He smiles. His daughter sighs with relief.

“He really wants to stay at home,” she says matter-of-factly.

As new as our doctor-patient relationship is, I feel emboldened to tackle the big, unspoken question looming over us.

“I know that you’ve decided against dialysis, and I can understand your decision,” I say. “And with your heart failure getting worse, your health is unlikely to improve.”

He nods.

“We have services designed to help keep you comfortable for whatever time you have left,” I venture. “And you could stay at home.”

Again, his daughter looks relieved. And he seems … well … surprisingly fine with the plan.

I call our hospice service, arranging for a nurse to visit him later today to set up physical therapy and to begin plans to help him to stay comfortable — at home.

Back home

Although I never see him again, over the next few months I sign the order forms faxed by his hospice nurses. I speak once with his granddaughter. It’s somewhat hard on his wife to have him die at home, she says, but he’s adamant that he wants to stay there.

A faxed request for sublingual morphine (used in the terminal stages of dying) prompts me to call to check up on him.

The nurse confirms that he is near death.

I feel a twinge of misgiving: Is his family happy with the process that I set in place? Does our one brief encounter qualify me to be his primary-care provider? Should I visit them all at home?

Two days later, and two months after we first met, I fill out his death certificate.

Looking back, I reflect: He didn’t go back to the hospital, he had no more falls, and he died at home, which is what he wanted. But I wonder if his wife felt the same.

Several months later, a new name appears on my patient schedule: It’s his wife.

“My family all thought I should see you,” she explains.

She, too, is in her late 80s and frail, but independent and mentally sharp. Yes, she is grieving the loss of her husband, and she’s lost some weight. No, she isn’t depressed. Her husband died peacefully at home, and it felt like the right thing for everyone.

“He liked you,” she says.

She’s suffering from fatigue and anemia. About a year ago, a hematologist diagnosed her with myelodysplasia (a bone marrow failure, often terminal). But six months back, she stopped going for medical care.

I ask why.

“They were just doing more and more tests,” she says. “And I wasn’t getting any better.”

Now I know what to do. I look her in the eye and ask:

“What are your goals for your care, and how can I help you?”

-Mitch Kaminski



Today, the U.S. Supreme Court is hearing a challenge to a buffer zone law that protects patients and staff at clinics in Massachusetts from anti-choice harassment and violence.

Across the country, extreme, often violent, anti-choice protesters physically block access to clinics and intimidate people exercising their constitutionally protected rights.  Learn more about this issue and the laws that exist to protect patients and their doctors.

If you do what needs to get done now, you won’t need to worry about your future.

Not a checklist

Psych has been a pretty sobering rotation. It’s easy to get worn out by the stories of childhood abuse, substance dependence, poverty, poor coping skills, and maladaptive behaviors. It’s easy to get frustrated with patients who look away when you come in the room, who give monosyllabic answers, who won’t help you help them, who actively fight all your efforts. Telling yourself over and over ‘they are sick, they are sick, they are sick’ only goes so far if you’re honest with yourself.

On inpatient consult service, I was sent to see A, a quadrapalegic, Hep C+, HIV+, stage 3 kidney failure patient who was just discharged last week and returned to us with a fever and 20 bed sores, one of which was very advanced. When I went to do the new patient workup, they wouldn’t look at me, barely answered my questions. It was a frustrating interview, like most consult interviews seem to be. On rounds we diagnosed them as depressed (can you blame them though?) and prescribed an SSRI. All in all my interactions with them were less than 10 minutes total. 

The next day when I went to see them our conversation was better. They were awake, spoke loud enough for me to hear, and actually answered my questions. Then they asked if I knew someone. It took me a few minutes to figure out who they were talking about, but it turns out A was referring to one of the students who was on consult before me- Sir Orthopod. Conventiently, this student was rotating on the inpatient psych floor in the same facility. I asked A if they would like me to see if Sir Orthopod can come visit today, A said they would very much like that and actually smiled. 

I immediately texted Sir Orthopod the patient’s room number, asked him to go see the patient. Sir Orthopod remembered them, and said he’d visit as soon as he could. I went on to see my next patient, write my notes, get done as soon as possible so I could eat and relax for a little bit.

A few hours later as I was eating my lunch in the doctor’s lounge, mindlessly scrolling on Facebook, when Sir Orthopod came and sat next to me. I asked, “How is A doing? I can’t get anything out of them, but they seem to really like you.“ 

He replied, "Yeah, when we had them I had a hard time getting them to talk to me too. One day I had an extra hour so I went up there and just talked to them about stuff. They’re really lonely, and nobody spends very much time with them.”

That hit me. I definitely could have spent more time with A. I mean, they are quadrapalegic and has a huge host of chronic medical conditions and very painful bed sores. They never have visitors. They lie alone in a dark ICU room, punctuated by this or that doctor or nurse or coming in for a minute, and watch TV all day- they can’t even change the channel or volume if they want. Were I in their shoes, I’d be desperate for human interaction too. Most gut wrenching of all, I had done the thing I swore up and down I’d never do: treat patients like items on a checklist, to be taken care of as quickly as possible. 

As medical students we have the immense luck of having no real responsibilites. Sure, we see patients and write notes, but our responsibilities are very superficial in reality. The residents and attendings are the ones who are so overloaded with responsibilites that they can’t spend more then 10-20 minutes with a patient in a day. But medical students? We have all the time in the world. Today, after I finish my notes and do a set of practice questions, I’m going to see if A would like some company.

Advice to Med Students: How To Impress a Resident/Attending (The Patient Care Episode)

Since a lot of you are about to start the clinical part of your training, and I’m about to get med students for the first time, I figured I’d put together a little how-to (in 3 episodes) with the help of my fellow residents.

  • Take initiative with your patients. Know all their info: what meds they’re on, their labs, their histories, etc.
  • Check back on your patients in the afternoon. Follow their labs or tests done during the day and think about what needs to be done about them. Otherwise you’ll find that a ton of stuff has happened the next day and you’ll be out of the loop. 
  • Have your notes written before the resident rounds so they can read them and hopefully give you feedback on them.
  • Always attempt to write an assessment and plan on your notes, no matter how simple it is. “Continue current management” is usually not an acceptable plan. What needs to be done before this patient can go home? 
  • In surgery, always ask permission (preferably from the attending) to scrub in. I do this still as a resident. If they say yes, get your gloves and gown for the scrub tech because they’re probably not prepared for you. 
  • Ask to do procedures, but don’t expect to get them. The residents are always first in line. If it’s a procedure they’re confident doing and they have time to teach you, they’ll probably let you do it. 
  • If we ask if you want to do a procedure, always say yes. Even if you don’t want to. 
  • In the outpatient setting, always offer to help write the note. Rarely will a resident turn you down, and you will really help them out. They will still review and change it, but it will definitely help.
  • Be available. You don’t have to be a shadow, but don’t expect your resident to call you for admissions/procedures/check out, because she will forget. If you haven’t heard from the resident in a while, check back in with them. She may have forgotten you were around and might send you home early!
… those who saw a palliative care specialist stopped chemotherapy sooner, entered hospice far earlier, experienced less suffering at the end of their lives—and they lived 25 percent longer. In other words, our decision making in medicine has failed so spectacularly that we have reached the point of actively inflicting harm on patients rather than confronting the subject of mortality. If end-of-life discussions were an experimental drug, the FDA would approve it.
A Patient-Centered Hospital - Part I

I have often wondered, while wandering the desolate halls of the hospital, “why do we round at 6 am?”  Frankly, no one has given me a good answer.  The common reply is a frightening response: “that’s how it has always been done.”  Where else in modern society do we allow such tradition to trump innovation, or  convenience?  Everywhere you look there are companies that become widely successful based on innovations that increase customer satisfaction.  The business world has even created a whole concept on this idea, termed disruptive innovation.  A disruptive innovation is an innovation that completely upends the industry it is introduced in.  Notable examples include digital books, tablet computers, and media streaming services. For some reason this mentality does not always translate to the patient care environment.

I would propose to you that the last place healing people should be is a hospital.  Little rest can occur in the alarm-ridden, ceaseless activity of most medical floors.  To satisfy the early morning rounding of the medical team, phlebotomists come in at all hours of the night ensuring labs are updated.  To meet quality measures, nurses walk in and out of patient rooms to record vitals at regular intervals.  And through all of this, various medical professionals call on patients based on their own schedule – medicine and surgery often very early in the morning, radiologists as imaging facilities allow, and subspecialists later in the day after clinic.  To sum this up, patients are brought to rest in a strange environment, with bizarre noises, and a multitude of healthcare workers flitting in and out of there room, all the while in a very uncomfortable bed.  Is it any wonder most people report being exhausted by the time they leave the hospital (Ubel, 2013)?  

The current hospital model also lends itself to the overuse of healthcare resources in the form of daily labs, readily available consultations, and unnecessarily aggressive treatments.  Perhaps worst of all, we corral sick people together, allowing for mass exposure to pathogens and creating a breeding ground for super infections like C-diff and MRSA.  Depending on the statistics you look at, hospitals could actually be classified as a leading cause of death in the U.S. (James, 2013).

So why do we use them? Because “that’s how it has always been done.”  This isn’t entirely true, but has been for the past 100 years or so.  It is astounding that after the enormous sums of money invested in making hospitals safe, quality-oriented, and patient-centered, the U.S. healthcare system is left with the same decades old complaints.  Hospitals are noisy, impersonal, error prone, and full of terrifying complications. Most service industries would not survive with such inattention to the complaints of consumers.  However, hospitals are unique in that they provide goods that individuals literally cannot live without.  More importantly, healthcare is a market in which there is little free choice – patients go where their insurance directs them and get the services that insurance will cover with no transparency about the prices and success rates of what they are purchasing.  

The careful reader will note I have highlighted many complex and theoretically unsolvable problems. But that is not how a disruptive innovator thinks, particularly one as disagreeable as I.  Over the coming weeks I hope to further tease out some of these problems and offer my potential solutions.  

Just maybe all of these words will convince you that, with some disagreeableness and disruption, we could do things better.  

Citations/Further Reading

James JT. A new, evidence-based estimate of patient harms associated with hospital care. J Patient Saf. 2013;9(3):122-8. DOI: 10.1097/PTS.0b013e3182948a69

Ubel, P. (2013, June 19). Sleep Deprivation in Hospitals Is a Real Problem. The Atlantic. Retrieved from

I knew I could go [to Planned Parenthood] and be safe. As a trans, gender non-conforming person seeking healthcare – especially abortion, which is thought of as something that only women do – the thing about Planned Parenthood is that when you go in for treatment, it’s about treating you. It’s about making sure that what you need to get done is done and that the services you need are provided to you.
—  Planned Parenthood patient Cazembe Jackson via Yahoo Health