FEBRUARY 21, 2020
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AUGUSTAMEDICALEXAMiNER
The blog spot From the Bookshelf — posted by Suneel Dhand, MD, on Feb. 9, 2020 (Edited for space)
HEALTHCARE IS LIKE LIONS FOR LAMBS I just watched the movie 1917 at the theatre. Shot in a unique way giving an immersive experience, showing the frontline reality of war through an unforgettable human story, it has to be one of the greatest war movies ever made. I’d encourage everyone to go watch it. I learned a fair bit about the First World War in high school in the UK. Its stories are often eclipsed by the much larger-scale Second World War, but many historians will argue that it was the First World War which was more horrific and shook the world to a greater degree. It was a war that became drawn out because of the sheer arrogance of the leaders. The British lost millions of brave young men, not to mention the millions wounded and maimed. There are monuments all over England, even a large one right in the middle of my small Berkshire village. There’s a famous quote by a German general who was witnessing wave after wave of brave British soldiers being sent over the top of trenches to their certain death, as they were mowed down by machine gunfire. He remarked: “Never before have I seen such lions led by such lambs.” That quote came to represent many of the catastrophic leadership decisions of the British hierarchy, who kept making miscalculations and taking needless risks with human life — all for sometimes gaining just a few feet of enemy territory. That famous quote can be applied in a multitude of different ways today, especially to modern leadership. Leadership is lacking all around us, in so many industries and sectors. And nowhere more so than health care. The consequences are right in front of our eyes: a suboptimal fragmented system, soaring costs, hidden agendas, and a demoralized group of people who work in it. If you have a leader who is not with their frontlines, an earthquake will be felt down the whole chain. As a physician who has worked in dozens of different institutions in different parts of the country, I have sadly seen some terrible examples of leadership. From mid-level managers all the way up to CEO. From what I have seen, the better places are in the minority in the health care world. There is a scene in 1917 when the soldier who is trying to deliver an important message from high command to a senior Colonel, to halt an attack, interacts with a senior British officer, who cleverly tells him: “Make sure there are witnesses when you deliver your message … because some of us just want the fight.” That was a very shrewd thing to say, because there are sadly leaders who will always be more interested in advancing their own agenda, and will gladly sacrifice others to do so. We have all seen it, and I’m sure everyone reading has their own stories. Managers who are all about numbers, targets, and the bottom line. I have personally seen many leaders gladly throw a doctor group or nursing team under the bus, to look good themselves. And all the while the clinicians know that none of them would even last a day if they ever had to do what we do. The frontline workers in health care are heroes. There’s no other word for them. They are lions. The doctors, nurses, and all other professionals. They will always do their duty no matter what. Moreover, their hearts are in the right place. Sadly, that is often taken advantage of. They could be exhausted, understaffed, or being led badly—but they will never neglect that patient in front of them and always go the extra mile. And all of this while their immediate world may be consumed by corporate greed, politics, industrial disputes, and patients who are suffering. Every day across this great nation, frontline clinical staff are let down by their leaders. Whether it’s the administrators or politicians, it’s true in health care too: Rarely will you ever see such lions led by such lambs. +
They wouldn’t last a day in our jobs.
Suneel Dhand is an internal medicine physician
Reading this book calls to mind the famous quote by Stuart Chase: “For those who believe, no proof is necessary. For those who don’t believe, no proof is possible.” We are currently rehashing issues that were hotly debated in the 1700s and even earlier: the first military defeat in American history happened when George Washington vacillated on whether or not to have his troops vaccinated against smallpox. After a forced retreat he made inoculation mandatory. That he was unsure of the safety of vaccines was not an evidence of the thinking of the day. As Eula Biss shows in this slim but well-researched volume, many centuries before George Washington vaccines were the subject of broad acceptance and pockets of entrenched skepticism. The more things change, it seems, the more they stay the same. The debate has little to do with fact, although this book is densely packed with them. Consider a little of the related history Biss reviews: the theory that AIDS is a government plot to kill
segments of the population the government supposedly views as undesirable. As one African man near AIDS’ ground zero remarked, however, wouldn’t it have been simpler to poison their Coca-Cola than to concoct a virulent disease? Another: Cotton Mather, became a proponent of variolation in the early 1700s (coincidentally, not long after losing his wife and three children to measles), and was rewarded by a firebomb thrown through his window. Consider the so-called anti-vaxxers who ignore the mountains of evidence provided by the World Health
Organization, the CDC, and countless independent studies by organizations with impeccable credentials, and instead hitch their wagons to a disgraced doctor and a former Playmate of the Year. Indeed, this debate is really not about facts. It’s about trust: of government, of the medical profession, and of the pharmaceutical industry. As Biss acknowledges, there are plenty of reasons to distrust all three. That does not mean, however, that everything they endorse or recommend is some diabolical plot. If it is, one has to wonder what’s behind government speed limits, healthful suggestions from the medical field (like encouragement to quit smoking), and aspirin tablets made by the pharmaceutical industry. The best idea may be found in the words of Biss herself, who suggests that we should “trust, but in an intelligent, skeptical way.” Her book will help readers do just that. + On Immunity: An Inoculation by Eula Biss, 205 pages, published in January 2014 by Graywolf Press
Research News Possession is 9/10ths... How does that saying go? However it’s worded, here is one of the most amazing discoveries about possession we have ever read here at Medical Examiner world headquarters. This is not about drug possession either. It’s about the exact opposite of drug possession. A study was published in Current Psychology last February which demonstrated the always-amazing power of placebo. But this is even more amazing than normal. In the study, participants were given information about a pain relieving cream. The cream was actually an inert placebo, however. Half of the study participants were given a sample of the cream. Everyone in the study did a cold-pressor test, which involves submersing one hand in ice water for a full minute. It can be quite painful. As it turned out, participants who received the cream but
did not use it reported lower levels of pain intensity during the cold-pressor task than those who did not receive the cream. Study authors say, “Our findings constitute initial evidence that simply possessing a placebo analgesic can reduce pain intensity.” Long hours = high pressure A new study by Canadian researchers published late last year in the journal Hypertension revealed a link between long hours of work and an increased risk for high blood pressure. Working between 41 and 48 hours per week was linked to a 42 percent greater likelihood of having sustained hypertension. Working 49 or more hours each week was linked to a 66 percent greater likelihood of sustained high blood pressure. High blood pressure affects nearly half of all Americans over age 18, and is considered the primary factor in more than 82,000 deaths per year.
Goodie bags that save lives You know that little bag that some dentists give you when you leave their office, the one with a new toothbrush, maybe a sampler tube of toothpaste and a small package of floss? A cancer researcher at the Medical University of South Carolina had an idea sitting in his dentist’s office watching patients leave with their bags. Why not do the same thing for patients who use tobacco? Matthew Carpenter, Ph.D., managed to roll out his idea at 22 clinics across the Palmetto State, reaching nearly 1,250 patients with parting gifts after appointments with their primary care providers. The bags included nicotine patches, lozenges and quitting information. More than a quarter of all participants achieved a full week smoke-free, and 12 percent were completely smoke-free at a 6-month follow-up appointment. +
