NEWSHEALTH CARE PROFESSIONALS

An emergency medical technician can face many on-the-job health threats, but pesticides seemingly aren't one of them. But an ongoing battle between union workers and a hospital service company indicates that workers are exposed to harmful pesticides inside ambulances -- and are suffering the health repercussions.

The EPA recently intervened in the ongoing battle between a local union and a New Jersey ambulance company, Monmouth-Ocean Hospital Services Company (MONOC), which uses a micro-mist system to disinfect their ambulances. The system, made by the company Zimek Technologies, sprays tiny particles of the antimicrobial pesticides Sporicidin and Zimek QD throughout the inside of ambulances.

Although Zimek claims that the chemicals leave no toxic residues, workers in these vehicles are  have suffered health problems. The local union, Professional Emergency Medical Services Association (PEMSA), says that up to 100 paramedics were sickened by exposure to the pesticides, with symptoms ranging from skin and eye irritation to asthma, headaches and ulcers.

The national health care debate may be centered on health care reform and the GOP's bogus claims of repeal, but many states are fighting a different battle. In particular, proponents of the single-payer health care system are realizing that now is their time to shine. And in Vermont, a single-payer system is getting closer than ever.

This past Wednesday, advocates packed a Vermont Statehouse to show their support for a healthcare system that promises to improve and expand care and lower costs. Among them were members of the Healthcare is a Human Right Campaign, started by Vermont Workers' Center. The advocates delivered more than 4,000 petition signatures to legislators demanding that Vermont lead the nation in the adoption of a universal healthcare system.

And the state is well-poised to do so. Last year, the state passed Act 128, the "Universal Access to Healthcare Act," which mandates the creation of a healthcare system that upholds the human rights principles of universality, equity and healthcare as a public good. In redoing their system, Vermont sought an outside consultant, Dr. William Hsiao, a Harvard health economist who was integral in implementing Taiwan's single-payer system.

It's said that there are two professionals you should always be honest with: your doctor and your lawyer.

But what if you can't be honest with your doctor, for fear of losing your livelihood? Or forgo necessary medical treatment because you don't trust that your history will be kept in confidence? That's the reality for some members of the military, says Kenneth Katz, an Associate Adjunct Professor at the Graduate School of Public Health at San Diego State University.

In a recent article published in the New England Journal of Medicine, Katz states that the military's don't ask, don't tell (DADT) policy for gay, lesbian and bisexual service members means infections go undiagnosed and members don't get the treatment they need and deserve.

Katz describes an active-duty service member who came to his clinic for treatment of a sexually transmitted disease, even though his health care is completely covered for free by the military. So why would did he come to a clinic?  The patient tells Katz that he would not be comfortable discussing his sexual practices or sexual partners with military clinicians. Doing so, the patient tells him, would "jeopardize his military career under DADT."

A lung doctor that carries a pack of Camels. An infusion nurse that smells of cigarettes. A cloud of smoke outside a cancer center. These will be scenes of the past for the Massachusetts Hospital Association (MHA), a not-for-profit organization, that announced this month that it will no longer hire individuals who use tobacco products.

"MHA and its members hospitals have long been committed to initiatives that promote the health and welfare of our patients and communities. The negative impact of tobacco use on health is well documented. In Massachusetts alone, smoking is the leading cause of preventable death and disease," they said in a statement on their website.

The move could set a precedent for hospitals -- an other organizations -- nationwide. And Lynn Nicholas, the CEO of the Association, which consists of more than 100 of hospitals in the state, wanted it that way. She decided to take the ban public as a way to raise awareness about the tobacco use, the number one cause of preventable death in the United States.

The hiring ban makes sense for a hospital, whose employees are meant to care for sick and serve, at least in some capacity, as role models for healthy living. In addition, not hiring tobacco users is a savvy way to reduce healthcare costs.

Smokers are not a protected class of workers, so the ban doesn't violate federal law. Police and fire departments in the state stopped hiring smokers in 1997 as part of a change in their pension system. But while MA state law permits the ban, 29 states do have laws discriminating against hiring smokers.

Laughter may be the best medicine, but exercise, especially when done outside, might be the closest thing we have to a miracle drug.

That's the idea behind park prescriptions, a concept driven by the Institute at the Golden Gate and the American Recreation Coalition as a way to increase the connection between public lands and health care.

Doctors and the medical community are catching on to this idea, "prescribing" nature and the great outdoors as a way to prevent and treat depression, cancer, heart disease and other medical conditions.

But it doesn't just mean a white slip of paper with the words "go outside" from your doc.

"Prescribing instructions are considerably more detailed than ones you might get with a medication; they include the location of a local green space, the name of a specific trail and, when possible, exact mileage," writes Daphne Miller, an associate clinical professor at the University of California, San Francisco in a Washington Post article.

Last week, HHS Secretary Kathleen Sebelius announced $130.8 million in grants to grow the health care workforce. The bulk of the money is going toward increasing the supply of primary care providers, including family medicine, general internal medicine and general pediatrics programs. With tens of millions of Americans entering the health care market thanks to health reform, studies project a shortage of 44,000 to 46,000 primary-care doctors by 2025 unless action is taken to lure more medical students into the field and retain experienced primary-care doctors. However, a new report from the Dartmouth Atlas Project reveals that while increased access to primary care is needed, it might not be enough.

By studying the fee-for-service Medicare population from 2003 to 2007, researchers found that where you live matters more than the ratio of physicians to patients. The first step to better health is getting in to see a doctor at least once per year. However, the relationship between the supply of primary care physicians and the percent of Medicare beneficiaries who had at least one annual visit with them during 2003-07 suggests that there is no correlation between the supply of docs and access to primary care.

You're in Chicago and wondering which deep-dish pizza is really the best ... there's a website for that.  Shopping for a car, TV, hot tub, vacation or pedicure ... there's a website for any of that. About to choose a surgeon for one of the most complex and scary medical procedures you will ever face ... now, thankfully, there is finally a website for that. This week, Consumer Reports, the venerable watchdog publisher, launched an addition to their health-related site that provides a ranking of 221 surgery groups from around the country who perform heart bypass surgery. Patient advocates are thrilled with this breakthrough transparency of clinical outcomes. Critics, including some physicians, caution that there is still much work to be done before this data can be accurate and useful.

The online accessibility of data has been heralded as the consumer revolution in health care. Second opinions have been around for years, but that only helps confirm the diagnosis. Usually, when a treatment or procedure is needed, patients just stay with their current physician or rely on a specialist referral.  But what if that physician is not the best possible choice? Now, with specialists agreeing to share performance and care data, patients can decide for themselves.

I’ve just this very moment gotten my head above the surface after spending the better part of the last week and a half navigating the waters of the federal grant process.  The good news is that I think programs like mine are particularly well-suited to the grant for which we’re applying, and I’m quite optimistic about the outcome.  The bad news is that the process, and in the case of this grant the incredibly short turn-around time, may dissuade from applying the very programs that it’s meant to benefit.

The grant to which I refer is HRSA-10-277, the Affordable Care Act Primary Care Residency Expansion Program.  Announced June 17, 2010 and due July 19, 2010, this program offers $168 million to increase the number of primary care physicians by expanding enrollment in primary care residency programs.  Priority will be given to those programs who offer a minimum of six months of the residents’ training in a rural health clinic, community health center, community hospital, critical access hospital, or other community based settings.

Which sounds great, but I can’t help but wonder how programs so heavily invested in such priority areas could have the resources to come up with a 35-page grant in such a short period of time.  Do these places have grant writers?  Because there’s no way on earth I could have completed this grant application without my grant writer Donna.  Just none.  And most community health centers that I know of are so overextended and understaffed, the mere suggestion of adding a project of this size with such a precipitous deadline would probably be met with no small measure of laughter.

In 2003 I almost died - simply because I did not have a referral.

I was in the process of moving back to my home town, when I began having a flare up of Crohn's disease: diarrhea, cramping, pain, blood in my stool, and a constant, gnawing fever. I knew exactly what the problem was, and exactly what medicine I needed, but I could only obtain the medicine from a gastroenterologist. Lucky for me, the very same gastro who diagnosed me as a kid and treated me for many years was willing to work me in. Unlucky for me: I didn't have a referral - and my insurance company wouldn't pay for any of it.

That meant I had to see a primary care physician first: I had to find a PCP that was accepting new patients, and wait for a "new patient" visit to open up. Weeks and weeks went by, and every day I grew sicker and weaker, until finally I was allowed to spend thirty minutes in a PCP's waiting room, 5 minutes in her exam room, and sent away with a referral to see my gastro. Two months after my symptoms started, I finally got the medicine I needed - but I was debilitated, wasted, and damn close to dead.

The Yahoo news headline says that Rand Paul "Isn't a Board-Certified Doc", which suggests he's basically a tribal shaman poking out people's eyes with sharpened bamboo poles. Of course, the article then makes clear that he is Board-certified, and he's licensed to practice in Kentucky, and that he got his degree from Duke.

You won't find much defense of Paul's candidacy here at Change - his libertarian zealotry makes him obnoxiously retrograde on a range of issues important to progressives, and I think we all know he's only trading on his dad's famous name. Still, the certification controversy is a bit deeper than it looks at first glance. The question everyone should be asking - and the article doesn't - is, who are these boards? And what do they do?

Board certification is an award doctors give to other doctors: it means a doctor has passed a test written by a other doctors about what doctors in that specific field ought to know. Usually, this is technical knowledge - not social or policy knowledge. For example, the test (.pdf) for the American Board of Internal Medicine includes as much as 3% questions on ethics, 2% on patient safety, and nothing on health care policy. The test (.pdf) for Family Medicine, by contrast, has 5% of questions on "patient-based systems" and another 5% on "population-based care".