Thursday, September 28, 2017
A librarian colleague just shared this film on non-binary pregnancy with me, A Womb of Their Own. I was pleased to see a reference to A.K. Summers and her graphic novel Pregnant Butch, a comic that I'm assigning in my graphic medicine class this semester.
We often think of pregnancy as a very feminine thing, but what about those who identify with a different gender, but are pregnant? As awareness of gender identity, gender fluidity, and non-binary people increases, a film like this can make a big difference in how we and health care providers understand the wide variety of experiences families trying to conceive and start a family.
I ordered it for our library and can't wait to see it and share it with the nursing and physician assistant faculty I work with. Find more on the film here: http://www.seriousplayfilms.com/.
Wednesday, September 27, 2017
A friend of mine was telling me they were having trouble remembering to take their medicine at a certain time each day. I knew that there were pill reminder apps, but I had no idea there were so many. After a little bit of Googling, I found that one of my favorite tech experts, David Pogue, set out to discover which was the best (free) app for this very thing. See what you think.
Thursday, September 21, 2017
A few years ago a geriatrician asked for my help in researching visual cues and design for patients with dementia. She was mostly concerned with hospital room and unit design, but doing that research led me to finding this product from Sha Yao, an industrial designer, who created special tableware for patients with dementia.
It's such an interesting idea, and one that would be interesting to see in action at a hospital, nursing home, or other long-term care facility.
A 2014 PBS NewsHour article looked at more ideas for assisting patients with dementia, from memory maps, to spoons that tell you if you food is sour or salty.
Tuesday, September 19, 2017
WHSLA Spotlight - Brian Finnegan at Marshfield Clinic's George E. Magnin Medical Library, Marshfield, WI
I moved to Wisconsin from Connecticut in 1993 (that’s a whole separate story) and graduated from UW-Milwaukee SLIS in December 1995.
I was not planning to become a Medical Librarian but a job opened up for a technical services librarian at Gundersen Lutheran. (Any of you remember installing the multiple SilverPlatter discs that held the Medline database?) Besides the great people I met there, helping to establish the consumer health library was one of many highlights during those years.
Thinking I wanted to be an academic librarian, I left for a position across town with UW-La Crosse library. However, soon found out that I missed the medical focus and began watching the WHSLA job listings for a new position. Reference Librarian with the Marshfield Clinic became available and I have been here since June 2003. Recently took over as Manager when Alana Ziaya retired in December 2014.
Marshfield Clinic celebrated its centennial in 2016 and as manager of the clinic archive I had the opportunity to create a number of displays around campus. That was interesting to pick out some of the older medical equipment we had in storage. Video of the display can be seen here: https://www.youtube.com/watch?v=J3ZnFyZyETc
My wife Karen and I love to travel, sometimes by motorcycle, sometimes by air. We took a dream vacation to Ireland this past summer and had a fantastic time. It was all we hoped for and would love to go back again someday.
Another hobby of mine is playing saxophone in a local jazz band – Hub City Jazz – which is a lot of fun.
Friday, September 15, 2017
I recently ran across a story on the surprise incidence of hookworm in Alabama. Hookworm was thought to be wiped out in the U.S., but a recent study found 19 out of 55 individuals in a small community tested positive for hookworm.
Here is a little more on the history of hookworm in the U.S. South and how that disease might have influenced how Southerners were thought of. You can read more from NOVA Next.
Thursday, September 14, 2017
A recent article in Kaiser Health News (included below) got me thinking more about how hard it is to find prices for health care services.
Here in Wisconsin we have PricePoint, a free database that allows comparing prices between WI hospital for the same service: http://www.wipricepoint.org/. It might not be perfect, but it's a good tool to compare prices if you, a family member, friend, or library patron is interested in shopping around.
A recent story about why Northern California is the most expensive place in the country to have a baby began as a tip from an obstetrician. Dr. Sarah Azad told me that insurers were paying her just a third of what they pay doctors employed by large hospital systems in her town of Mountain View, Calif.
Unfortunately, she explained, she could speak only in general terms. She couldn’t share her actual payment rates with me because she was barred from doing so by a gag clause in her contracts with insurers.
So, I called the insurers who pay her, and the hospital systems that employ most of the other obstetricians in Mountain View. They all had the same answer: It would be illegal for them to tell me the dollars and cents.
As it turns out, the vast majority of contracts between doctors or hospitals and insurance companies are subject to a gag clause, which prohibits either party from disclosing negotiated rates. That means it’s almost impossible for consumers, researchers or journalists to find actual, accurate numbers, despite the fact that cost differentials among doctors can be so stark. And it’s particularly problematic for the growing number of people who have insurance plans with deductibles that can run more than $10,000 for a family.
The underlying problem of our health care system — beyond the corrosive partisan politics — is its high cost. I have long understood that the lack of price transparency is one reason our system stays so expensive. It was a surprise, though, to find out that this opacity is cemented by legally binding contracts.
Think about what this would look like for a mundane purchase, say, a gallon of milk. Advertisements and price tags would disappear, so you couldn’t compare prices at different stores. And you wouldn’t even know how much you had paid for the milk until you got a bill in the mail weeks or months later. On top of that, the store and the dairy farmer would be barred from telling a journalist or an economist what you had paid.
It’s absurd, but I wasn’t going to let the absurdity kill my story.
I started by asking all of the health policy analysts, researchers and economists I could find, “How can I find these rates, by physician, for an uncomplicated vaginal delivery?” Everyone told me the same thing: You can’t get that.
I searched online, but most of the websites claiming to offer health price transparency offered only “average costs” for specific services in your area. Not much help if you’re trying to compare the costs of individual doctors.
Next, I asked Castlight, a “transparency tool” that gathers payment data and allows employees of certain companies to estimate the costs of their medical care. But Castlight told me that as a journalist, I wasn’t allowed to have access to the exact pricing information of individual providers. It, too, was subject to the gag clause.
So I turned to the consumers who might have access to those tools. I asked friends and colleagues, and put out social media requests: Would anyone be willing to share the information from the cost estimators they got from their employers or insurers? I found a few willing sources and was able to mine the results of their inquiries to find out the basic cost differentials between independent doctors and those employed by large systems, including Sutter Health.
Unfortunately, these estimators are difficult to use and often provide incomplete data. And when I tried to confirm that information, I ran up against the gag clauses again.
Finally, I found out about a health data company called Amino that was willing to send me the claims data it had been gathering. At last! The Holy Grail! It had hundreds of claims for vaginal births performed by obstetricians in the Bay Area. KHN data correspondent Sydney Lupkin helped me decipher a Medicare provider database to determine where each doctor worked. In cases where the doctor’s employment status was unclear, I called the health system or physician directly. We then calculated the median billing amount, on average, for a routine vaginal birth for each health system.
Weeks of digging and data analysis confirmed the imbalance Dr. Azad had told me about at the start of my quest. The few independent doctors left in the Bay Area receive a median amount of $2,408.45 for a routine vaginal delivery, which includes prenatal and postnatal visits. That compares with $5,238.13 for the same bundle of services provided by Stanford physicians and $8,049.84 when the doctors are employed by University of California-San Francisco — a fourfold difference.
Hard data, hard won.
The database we built gave us a strong sense of the cost variation between doctors who work at other health systems and those who have remained independent. But it did not include enough claims from the largest hospital system in the region, Sutter Health. For Sutter, I used the data from the online cost estimators, and found that obstetricians employed by the system are reimbursed about $6,452 for a vaginal delivery.
It’s no accident that data on physician costs are so hard to find. Its inaccessibility allows hospitals to keep raising their prices. It’s simply not in their interest for the public to know how much they’re charging. And insurers don’t want other doctors or hospitals to see the high prices they’ve agreed to pay, for fear they would demand the same.
In the end, all of us — through our insurance premiums and our taxes — pay a price for non-transparency.
Friday, September 8, 2017
Another video from TED-Ed this week...this time about concussions.
I know when I watch football or any contact sports now, I can't help thinking about the brains of the athletes who are playing. But as this video shows, even soccer players are at risk for brain damage from repeatedly "heading" the ball. See what you think.
Tuesday, September 5, 2017
Water...it's a basic human need, but what happens when you don't have clean water? And more importantly, how do you know when it's safe to drink?
"Water is refreshing, hydrating, and invaluable to your survival. But clean water remains a precious and often scarce commodity – there are nearly 800 million people who still don’t have regular access to it. Why is that? And how can you tell whether the water you have access to — whether from a tap or otherwise — is drinkable? Mia Nacamulli examines water contamination and treatment."