Skyline Happenings

Harvard surgeon and author Atul Gawande has written several books and New Yorker articles about medicine, aging, mortality, quality improvement, and philosophical musings. In many ways he reminds me of Lewis Thomas. Gawande is probably doing more than any other person to improve the quality of our health care. He looks at a problem, studies it, interviews people, then writes in a language we can understand.

In Gawande’s book  Better he has advice to doctors on how to be a “positive deviant” from the current norms in medicine. To stay engaged intellectually and connected he has the following advice:

1. Ask an unscripted question. Too often doctors are rushed, and miss this human interaction.
2. Don’t complain. This one can probably apply to us all. Do you really want to hear your colleague complain about things?
3. Count something. Gawande likes to engage in figuring out why mistakes occur. He encourages us to study and analyse.
4. Write something. By keeping a diary or journal or simply writing about any subject of interest, we clarify our thoughts.
5. Change. Be an early adopter. Avoid being a curmudgeon. Learn and apply.

From the Health Affairs Blog: “The Executive Order restricting visas for citizens of Iran, Libya, Somalia, Sudan, Syria, and Yemen has many legal, political, and moral implications. But here we will focus on the medical implications of the executive order, by considering its impact on the physician workforce in the United States and the patients that rely on these immigrant doctors. There are 14 million doctor’s appointments provided each year by physicians trained in those six countries. These doctors are working all across America, but they are especially concentrated in the Rust Belt and Appalachia, seeing many patients in communities in Ohio, Michigan, West Virginia, Indiana, and Kentucky.”

Click here to read the full article.

At the moment, I’m living about 15 minutes north of Tijuana. The wall at the border is impressive restraining movement in both directions, yet the car and foot traffic are brisk and commonly backed up – and medical care is one of the reasons folks here head south of the border.

I talk to locals here in San Diego. Some never venture into Mexico. Others go frequently especially for dental care and to buy expensive (made in the USA) medications. Likewise in Seattle I had patients who would bus to Canada where, once across the border, a Canadian MD would OK their prescriptions. The trip made great financial sense for them.

But there are more exotic places to mix vacationing and a dental implant. There’s an article about medical tourism in the NYT which talks of one family’s adventure in Thailand combining dental care with tourism. Click here to read their story.

Ed Note: “The desire to take medicine is perhaps the greatest feature which distinguishes man from animals.” William Osler. This seems to be more than obvious by walking the isles of expensive supplements and vitamins at COSTCO and any pharmacy. Some are good – but make sure your doctor knows what you’re taking. Years ago a woman suffered from lead poisoning from “natural” calcium pills. It turns out they were from a foreign source of animal bones which had lots of lead in them from contaminated food sources.

From the NYT: “Supplement makers commonly market biotin, a B vitamin, for nail health, based on two small studies published in the 1990s that found that most patients had stronger, thicker nails within several months of beginning a biotin supplement. However, neither study included a control group, so any improvements may have been a result of changes in diet or nail care.

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Oops! Someone seems to have misplaced it. Sorry, can’t seem to find it anywhere! Maybe it’s locked in drawer somewhere. But wait, there may be three or four plans, who knows? Trumpcare/Ryancare awaits the light of day.

Ed note: This web site http://www.agingkingcounty.org/advisory-council is well worth subscribing to for all kinds of health and safety tips. Below is just a taste of one of their articles on food safety for your edification and to whet your appetite.

Food safety is important for everyone, but especially older adults. The U.S. Food and Drug Administration says that as we grow older, our bodies may hold on to food longer, our internal organs don’t rid our bodies of toxins as easily as they once did, our sense of taste and/or smell may have changed, and we may have chronic conditions that weaken our immune system. So it’s good to take special care with foods at home and to know more about the health department’s restaurant ratings when we go out.

For more information about the new rating system, visit www.kingcounty.gov/foodsafetyrating. If you have a smart phone, you can also text the words “king food” to 468311 to receive information about the rating system. Information is available in eight languages.

If you have comments about the rating system, Public Health—Seattle & King County can be reached by e-mail at public.health@kingcounty.gov.

Contributor David Baker is chair of the Seattle-King County Advisory Council on Aging & Disability Services, which publishes AgeWise King County. He is mayor of the City of Kenmore and vice-chair of the King County Board of Health. Mayor Baker welcomes input from readers via e-mail (advisorychair@agewisekingcounty.org) as well as applicants for open positions on the council. For more information, visit www.agingkingcounty.org/advisory-council.