2017 Articles
By Reza Ghadimi
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12-28-2017 - A look back at 2017
We covered many issues in the past year about the need for and use of telehealth, telemedicine and tele-education and how these tools can help with the plight of the under-served and the poor in our rural and urban areas here at home or internationally. Thanks to the efforts of many, our legislators, universities, healthcare providers, managed care organizations and the insurance companies have addressed many of these issues and new rules and processes have brought telehealth into the mainstream healthcare arena.
Some of our weekly notes and editorials attracted more attention than others. We thought that you may want to revisit some of them:
Our article on "A Milestone for Burrell College of Osteopathy" (May 25), received the most attention. In part due to the interest of the students and faculty of the college. But many others were equally excited about the success of the state's second medical school.
The article "Don't regulate us out" (June 29) received the highest rate of readers, followed by "The late great Senator Pete Domenici" (Sept 21) and "Night of the Witches" (Oct 26).
News of the "Interstate Telehealth SIG" (Aug 17), was most welcomed and finally the article "apoplexy" (Apr. 20) also made the list of most read.
It is clear that we are reaching many of our readers and actions taken by telehealth organizations such as; "NM Telehealth Alliance", "American Telemedicine Association (ATA)", "UNM's Project Echo" and others are having positive, constructive, productive and beneficial results.
The coming new year with the many regulatory changes going into effect will bring us challenges that need addressing and concerns to keep in perspective and attend to. The new administrations changes to the healthcare provisions will no doubt affect many of our patients. As healthcare providers, we should be a helpful portal to their needs and not add to their confusion and uncertainty.
New Mexico Telehealth Alliance wishes you, your family and your organizations a very happy and resourceful new year.
----------------------------------------------
12-21-2017 - Ave Maria
"Ave Maria, gratia plena, Dominus tecum" goes the song in Latin. " Hail Mary, full of grace, the Lord is with thee" is the meaning of, perhaps the most widely sung religious song in the world. It is sung in many languages; including Chinese, Arabic, and by many singers from Maria Callas, to Frank Sinatra, to Pavarotti & Bono, to Celine Dion. It was originally written and composed in 1825 by Franz Schubert.
It is always sung with full passion and fervor, regardless of religious belief. I once heard a version of it sung in Hawaiian that seemed to reach deep into the soul and calm all insecurities in its path. Its collective message of prayer for peace is desired by all humanity. Today, with the many problems in the world, such a prayer seems most appropriate. If there is one individual in history who is loved and revered by all, it is Lady Mary, daughter of Anne. Her selfless devotion and silent actions of goodness have done more for mankind than most sermons and speeches of others. Which brings us to the question, If the world can love and revere one such person, why can't we follow her example and care for each other better?
People don't hurt differently, babies don't cry in different languages, and the homeless don't despair differently in the Arctic or the Sahara. All the walls and boarders of the world cannot isolate a mother's lament or a baby's hungry cry.
We can ease people's despair. Lets start by bringing peace to ourselves, our neighbors and fellow human beings. As healthcare providers, lets resolve to volunteer our services to the needy a few hours a week or a month. By using Telehealth, Telemedicine, and Tele-education, we don't even need to leave home.
We pray for peace for ALL during this holy time of the year;
Ave Maria, Full of grace ....
12-14-17
Contradiction
Among the stack of Christmas cards on my desk are many asking for donations for the needy while wishing me happy holidays. What a marvelous contradiction.
Perhaps the reason for such contradiction is that we hear and see so much of it in our daily life that we become numb and indifferent. But the danger here is that our apathy actually feeds the problem. As the world population grows, the gap between the prosperous communities and that of the poor widen and broaden exponentially. With the problems, the need for solutions become ever more dire but grim. Arguments on both sides of this divide seem to justify the position of each group. The trouble is that despite all rationalizations, the consequence and effect on individuals is personal - no matter which side they are on. Two interviews of people who lost their houses in the ongoing wild fires in California, makes my point. An affluent man whose multimillion dollar home burned, as well as a reticent man standing next to the rubles of his modest dwelling said: "I didn't lose my house, I lost my home."
Once one become homeless, whether due to fire, storm, war, politics or prejudice, he/she could become desperate and hopeless. Desperate people may do irrational things.
No other profession has to deal with desperate people more than us in healthcare. However, this is one place that no one should feel rejected, dejected or prejudiced. For those of us who find it hard to deal with the dichotomy of events, we have Telehealth, Telemedicine, and Tele-education to help us care for many from the comfort of our own home and office.
As we all wish for cheers in the coming holy days, many face it in tears. Let us ease their fears, wipe away their tears and add to their cheers. Lets all have a wonderful Christmas season.
----------------------------------------------
12-7-2017 - What Money Buys
"Salvator Mundi" ("Savior of the World") by Leonardo da Vinci sold for about $450 Million at auction last week. Let me repeat that; "Salvator Mundi" by Leonardo da Vinci sold for about $450 Million at auction last week.
I won't even try to comprehend the absurdity of this news, except to paraphrase comedian Bob Hope who once said; "People claim that I have 500 Million Dollars. When you think of it, that's really not that much. If you make one million dollars a year, it will only take 500 years to make that much money." The article for this news was written by; Leila Amineddoleh, Art and Cultural Heritage Lawyer and Professor, who wrote it for "Live Science". I will just quote a few points that she made in her article; "This exorbitant price raises the question: What exactly did the buyer purchase? It's challenging to say the buyer procured a piece depicting da Vinci's genius. That's because (this) da Vinci's masterpiece accumulated damage over the years, prompting art conservators to heavily repair and, in effect, change and diminish its brilliance. Rather, it's likely that the buyer acquired “Salvator Mundi” as a type of trophy …"This is even more significant when, she further notes that; "… The painting (had) sold at auction in 1958 in Louisiana for about $90."Ms. Amineddoleh elaborates further on the condition and authenticity of this work and at one point states; "It is interesting to consider the term "authentic." What makes a work authentic? Does heavy restoration alter the attribution? Can a painting lose its authorship? Does attribution result merely after an artist’s hand touches a work? In that case, this $450.3 million sale is the product of the "cult of the artist. …"
" What does it say about the market? … Is that what the art market has become? If this painting is a trophy, then "Salvator Mundi" has lost its meaning."
She further writes: "I think the staggering price is absurd. It is shocking to the conscience. The sum paid is difficult for most of the world’s population to grasp, and probably impossible to understand for communities lacking clean drinking water and access to health care, for people living in abject poverty, and for the starving masses. …"I think the article said all there is to say about the state of our world today. Where does that leave us, as healthcare providers though? News of such extravagance is becoming more common and that adds to the hardship many endure daily. As caring for those seeking our help becomes ever more arduous, we must reach for new ways and means of providing the needed care. Especially to those who are far and isolated from us. Fortunately Telehealth, Telemedicine, and Tele-education help us provide our services to them while trying to sort out the illogical decisions of our wealthier neighbors and politicians. Lets hope that we do not lose our resolve.
----------------------------------------------
11-30-2017 - Songs and guns
"Amado mio", sang the pretty señorita to the music of Bossa Nova. The hypnotic rhythm of the Spanish music had every one gyrating in their seats.
We were gathered for Thanksgiving and on the weekend following the feast, my son took us to hear the Latin Jazz and burn some of the extra calories we had pilled up. The lounge was crowded and the cacophony of languages being spoken added to the exotic atmosphere of the place. It was heart warming and exciting to see how the diverse cultures gathered in such a place had no differences of opinion and swayed to the music in unison.
A group of Oriental people caught my attention. My daughter who has lived in Japan and South Korea, informed us that they were businessmen from South Korea there with their wives and hosts enjoying the evening. Looking at the serenity of the mixer of cultures present made me wonder why we have fought so many wars in the world.
An absurd idea hit me, "maybe if they played this music on those battlefields, people would have put away their guns and dance their differences away." - I don't know, maybe it was the margaritas.
Differences that we try to resolve by aggression, affect our health and well-being, as well as the structure of our world. Innocent people often get caught in these struggles. When emotional or physical injuries occur, they seek our help. Healthcare providers are then caught in their own quagmire of having to deal with the problem.
A while back, I was serving with the Red Cross in response to a short civil war in a Middle Eastern country that left many injured. Although we had nothing to do with the conflict, as Americans, we were the focus of hostility by one of the groups in the conflict. So much that we could not care for them adequately. We resolved the problem by sending the injured from that side to the much smaller group of the Swedish Red Cross, and had them consult us on their care.
Today of course Telehealth, Telemedicine, and Tele-education gives us the tools we need to care for many of our friends and adversaries alike. Only if we could keep politics out of our mind while caring for the ones under our care. Is that too much wishful thinking and desire?
----------------------------------------------
11-23-2017 - From our families to yours
HAVE A WONDERFUL AND - BLESSED THANKSGIVING
In the spirit of the occasion, we leave you with this prayer from our Native American elder,
Lakota Sioux Chief Yellow Lark - circa 1850
Oh, Great Spirit
Whose voice I hear in the winds,
And whose breath gives life to all the world,
hear me, I am small and weak,
I need your strength and wisdom.
Let me walk in beauty and make my eyes ever behold
the red and purple sunset.
Make my hands respect the things you have
made and my ears sharp to hear your voice.
Make me wise so that I may understand the things
you have taught my people.
Let me learn the lessons you have
hidden in every leaf and rock.
I seek strength, not to be greater than my brother,
but to fight my greatest enemy - myself.
Make me always ready to come to you
with clean hands and straight eyes.
So when life fades, as the fading sunset,
my Spirit may come to you without shame.
Happy Thanksgiving
----------------------------------------------------
11-16-2017 - Communication is a two way street
A question on the ATA Forum caught my attention this week. "Does anyone know of clinical studies or other research on patient outcomes comparing communication with a patient who is a non-native English speaker in his/her native (first) language versus communication in English only?"
Although the question here pertains to communication with non-English speaking people, in my opinion, bad communication can result in negative outcome even when both sides speak the same language. As those of you who have been following my articles for the past several years know, communication between patients and providers has been of special interest to me.
I have written several articles on this issue, including "Understanding Each Other" and "Communication is a two way street", published in journal JOPA.
But as far as the question at hand is concerned, several colleagues responded to it with link to studies, reports and papers written on the subject.
I feel that we can all benefit by reading and referring to them:
* - Do Professional Interpreters Improve Clinical Care for Patients with Limited English Proficiency? A Systematic Review of the Literature
* - Kenison, T Cet al. (2017)Through the Veil of Language. Academic Medicine.
* - Radhakrishnan, Xie, Berkley, & Kim (2016).
* - Suurmond, J., Rosenmöller, D. L., el Mesbahi, H., Lamkaddem, M., & Essink-Bot, M.-L. (2015). International Journal of Nursing Studies.
* - Kim, W., & Keefe, R. H. (2010). Barriers to healthcare among Asian Americans.
* - Exploring the Hidden Curriculum for the Care of Patients With Limited English Proficiency
Being the start of the holiday season, I will leave you with this related entertaining story, a friend told me:
"When my son was very young, we had an old dog that he was rather found of. Then one day, that old dog passed away. My son was understandably heart broken. In an effort to console him, my wife said that God has taken Jojo (dog's name) to heaven and he now was with other dogs like him and happy.
To distract him, I asked him to give me a hand in the shop and while working on a project, I noticed him to be pensive and not his usual talkative self. "You are still thinking of Jojo aren't you?" I asked.
"Dad," he said innocently "what I don't understand is, what is God going to do with a dead dog?"
We covered many issues in the past year about the need for and use of telehealth, telemedicine and tele-education and how these tools can help with the plight of the under-served and the poor in our rural and urban areas here at home or internationally. Thanks to the efforts of many, our legislators, universities, healthcare providers, managed care organizations and the insurance companies have addressed many of these issues and new rules and processes have brought telehealth into the mainstream healthcare arena.
Some of our weekly notes and editorials attracted more attention than others. We thought that you may want to revisit some of them:
Our article on "A Milestone for Burrell College of Osteopathy" (May 25), received the most attention. In part due to the interest of the students and faculty of the college. But many others were equally excited about the success of the state's second medical school.
The article "Don't regulate us out" (June 29) received the highest rate of readers, followed by "The late great Senator Pete Domenici" (Sept 21) and "Night of the Witches" (Oct 26).
News of the "Interstate Telehealth SIG" (Aug 17), was most welcomed and finally the article "apoplexy" (Apr. 20) also made the list of most read.
It is clear that we are reaching many of our readers and actions taken by telehealth organizations such as; "NM Telehealth Alliance", "American Telemedicine Association (ATA)", "UNM's Project Echo" and others are having positive, constructive, productive and beneficial results.
The coming new year with the many regulatory changes going into effect will bring us challenges that need addressing and concerns to keep in perspective and attend to. The new administrations changes to the healthcare provisions will no doubt affect many of our patients. As healthcare providers, we should be a helpful portal to their needs and not add to their confusion and uncertainty.
New Mexico Telehealth Alliance wishes you, your family and your organizations a very happy and resourceful new year.
----------------------------------------------
12-21-2017 - Ave Maria
"Ave Maria, gratia plena, Dominus tecum" goes the song in Latin. " Hail Mary, full of grace, the Lord is with thee" is the meaning of, perhaps the most widely sung religious song in the world. It is sung in many languages; including Chinese, Arabic, and by many singers from Maria Callas, to Frank Sinatra, to Pavarotti & Bono, to Celine Dion. It was originally written and composed in 1825 by Franz Schubert.
It is always sung with full passion and fervor, regardless of religious belief. I once heard a version of it sung in Hawaiian that seemed to reach deep into the soul and calm all insecurities in its path. Its collective message of prayer for peace is desired by all humanity. Today, with the many problems in the world, such a prayer seems most appropriate. If there is one individual in history who is loved and revered by all, it is Lady Mary, daughter of Anne. Her selfless devotion and silent actions of goodness have done more for mankind than most sermons and speeches of others. Which brings us to the question, If the world can love and revere one such person, why can't we follow her example and care for each other better?
People don't hurt differently, babies don't cry in different languages, and the homeless don't despair differently in the Arctic or the Sahara. All the walls and boarders of the world cannot isolate a mother's lament or a baby's hungry cry.
We can ease people's despair. Lets start by bringing peace to ourselves, our neighbors and fellow human beings. As healthcare providers, lets resolve to volunteer our services to the needy a few hours a week or a month. By using Telehealth, Telemedicine, and Tele-education, we don't even need to leave home.
We pray for peace for ALL during this holy time of the year;
Ave Maria, Full of grace ....
12-14-17
Contradiction
Among the stack of Christmas cards on my desk are many asking for donations for the needy while wishing me happy holidays. What a marvelous contradiction.
Perhaps the reason for such contradiction is that we hear and see so much of it in our daily life that we become numb and indifferent. But the danger here is that our apathy actually feeds the problem. As the world population grows, the gap between the prosperous communities and that of the poor widen and broaden exponentially. With the problems, the need for solutions become ever more dire but grim. Arguments on both sides of this divide seem to justify the position of each group. The trouble is that despite all rationalizations, the consequence and effect on individuals is personal - no matter which side they are on. Two interviews of people who lost their houses in the ongoing wild fires in California, makes my point. An affluent man whose multimillion dollar home burned, as well as a reticent man standing next to the rubles of his modest dwelling said: "I didn't lose my house, I lost my home."
Once one become homeless, whether due to fire, storm, war, politics or prejudice, he/she could become desperate and hopeless. Desperate people may do irrational things.
No other profession has to deal with desperate people more than us in healthcare. However, this is one place that no one should feel rejected, dejected or prejudiced. For those of us who find it hard to deal with the dichotomy of events, we have Telehealth, Telemedicine, and Tele-education to help us care for many from the comfort of our own home and office.
As we all wish for cheers in the coming holy days, many face it in tears. Let us ease their fears, wipe away their tears and add to their cheers. Lets all have a wonderful Christmas season.
----------------------------------------------
12-7-2017 - What Money Buys
"Salvator Mundi" ("Savior of the World") by Leonardo da Vinci sold for about $450 Million at auction last week. Let me repeat that; "Salvator Mundi" by Leonardo da Vinci sold for about $450 Million at auction last week.
I won't even try to comprehend the absurdity of this news, except to paraphrase comedian Bob Hope who once said; "People claim that I have 500 Million Dollars. When you think of it, that's really not that much. If you make one million dollars a year, it will only take 500 years to make that much money." The article for this news was written by; Leila Amineddoleh, Art and Cultural Heritage Lawyer and Professor, who wrote it for "Live Science". I will just quote a few points that she made in her article; "This exorbitant price raises the question: What exactly did the buyer purchase? It's challenging to say the buyer procured a piece depicting da Vinci's genius. That's because (this) da Vinci's masterpiece accumulated damage over the years, prompting art conservators to heavily repair and, in effect, change and diminish its brilliance. Rather, it's likely that the buyer acquired “Salvator Mundi” as a type of trophy …"This is even more significant when, she further notes that; "… The painting (had) sold at auction in 1958 in Louisiana for about $90."Ms. Amineddoleh elaborates further on the condition and authenticity of this work and at one point states; "It is interesting to consider the term "authentic." What makes a work authentic? Does heavy restoration alter the attribution? Can a painting lose its authorship? Does attribution result merely after an artist’s hand touches a work? In that case, this $450.3 million sale is the product of the "cult of the artist. …"
" What does it say about the market? … Is that what the art market has become? If this painting is a trophy, then "Salvator Mundi" has lost its meaning."
She further writes: "I think the staggering price is absurd. It is shocking to the conscience. The sum paid is difficult for most of the world’s population to grasp, and probably impossible to understand for communities lacking clean drinking water and access to health care, for people living in abject poverty, and for the starving masses. …"I think the article said all there is to say about the state of our world today. Where does that leave us, as healthcare providers though? News of such extravagance is becoming more common and that adds to the hardship many endure daily. As caring for those seeking our help becomes ever more arduous, we must reach for new ways and means of providing the needed care. Especially to those who are far and isolated from us. Fortunately Telehealth, Telemedicine, and Tele-education help us provide our services to them while trying to sort out the illogical decisions of our wealthier neighbors and politicians. Lets hope that we do not lose our resolve.
----------------------------------------------
11-30-2017 - Songs and guns
"Amado mio", sang the pretty señorita to the music of Bossa Nova. The hypnotic rhythm of the Spanish music had every one gyrating in their seats.
We were gathered for Thanksgiving and on the weekend following the feast, my son took us to hear the Latin Jazz and burn some of the extra calories we had pilled up. The lounge was crowded and the cacophony of languages being spoken added to the exotic atmosphere of the place. It was heart warming and exciting to see how the diverse cultures gathered in such a place had no differences of opinion and swayed to the music in unison.
A group of Oriental people caught my attention. My daughter who has lived in Japan and South Korea, informed us that they were businessmen from South Korea there with their wives and hosts enjoying the evening. Looking at the serenity of the mixer of cultures present made me wonder why we have fought so many wars in the world.
An absurd idea hit me, "maybe if they played this music on those battlefields, people would have put away their guns and dance their differences away." - I don't know, maybe it was the margaritas.
Differences that we try to resolve by aggression, affect our health and well-being, as well as the structure of our world. Innocent people often get caught in these struggles. When emotional or physical injuries occur, they seek our help. Healthcare providers are then caught in their own quagmire of having to deal with the problem.
A while back, I was serving with the Red Cross in response to a short civil war in a Middle Eastern country that left many injured. Although we had nothing to do with the conflict, as Americans, we were the focus of hostility by one of the groups in the conflict. So much that we could not care for them adequately. We resolved the problem by sending the injured from that side to the much smaller group of the Swedish Red Cross, and had them consult us on their care.
Today of course Telehealth, Telemedicine, and Tele-education gives us the tools we need to care for many of our friends and adversaries alike. Only if we could keep politics out of our mind while caring for the ones under our care. Is that too much wishful thinking and desire?
----------------------------------------------
11-23-2017 - From our families to yours
HAVE A WONDERFUL AND - BLESSED THANKSGIVING
In the spirit of the occasion, we leave you with this prayer from our Native American elder,
Lakota Sioux Chief Yellow Lark - circa 1850
Oh, Great Spirit
Whose voice I hear in the winds,
And whose breath gives life to all the world,
hear me, I am small and weak,
I need your strength and wisdom.
Let me walk in beauty and make my eyes ever behold
the red and purple sunset.
Make my hands respect the things you have
made and my ears sharp to hear your voice.
Make me wise so that I may understand the things
you have taught my people.
Let me learn the lessons you have
hidden in every leaf and rock.
I seek strength, not to be greater than my brother,
but to fight my greatest enemy - myself.
Make me always ready to come to you
with clean hands and straight eyes.
So when life fades, as the fading sunset,
my Spirit may come to you without shame.
Happy Thanksgiving
----------------------------------------------------
11-16-2017 - Communication is a two way street
A question on the ATA Forum caught my attention this week. "Does anyone know of clinical studies or other research on patient outcomes comparing communication with a patient who is a non-native English speaker in his/her native (first) language versus communication in English only?"
Although the question here pertains to communication with non-English speaking people, in my opinion, bad communication can result in negative outcome even when both sides speak the same language. As those of you who have been following my articles for the past several years know, communication between patients and providers has been of special interest to me.
I have written several articles on this issue, including "Understanding Each Other" and "Communication is a two way street", published in journal JOPA.
But as far as the question at hand is concerned, several colleagues responded to it with link to studies, reports and papers written on the subject.
I feel that we can all benefit by reading and referring to them:
* - Do Professional Interpreters Improve Clinical Care for Patients with Limited English Proficiency? A Systematic Review of the Literature
* - Kenison, T Cet al. (2017)Through the Veil of Language. Academic Medicine.
* - Radhakrishnan, Xie, Berkley, & Kim (2016).
* - Suurmond, J., Rosenmöller, D. L., el Mesbahi, H., Lamkaddem, M., & Essink-Bot, M.-L. (2015). International Journal of Nursing Studies.
* - Kim, W., & Keefe, R. H. (2010). Barriers to healthcare among Asian Americans.
* - Exploring the Hidden Curriculum for the Care of Patients With Limited English Proficiency
Being the start of the holiday season, I will leave you with this related entertaining story, a friend told me:
"When my son was very young, we had an old dog that he was rather found of. Then one day, that old dog passed away. My son was understandably heart broken. In an effort to console him, my wife said that God has taken Jojo (dog's name) to heaven and he now was with other dogs like him and happy.
To distract him, I asked him to give me a hand in the shop and while working on a project, I noticed him to be pensive and not his usual talkative self. "You are still thinking of Jojo aren't you?" I asked.
"Dad," he said innocently "what I don't understand is, what is God going to do with a dead dog?"
iliency, audacity, courage and bravery set apart the can-doers from others. Its interesting how music always becomes a major healer in such events. When hurricane Katrina devastated the gulf region, returning colleagues from the area told of the musicians gathering in the evening hours and jamming in the dark and flooded streets. People would assemble and dance, chasing their fears away.
I was visiting colleagues on a reservation awhile back when a big and deadly sandstorm rolled through. Afterward I witnessed the native people finding the injured and the dead, caring for the wounded and burying the deceased. To my amazement, after grief, cries, and prayer, they took out their drums and instruments and started playing. Teary eyed men and women sang and danced well into the night. I don't remember why but I started walking away from the site and into the desert. The further I went, the more the music changed. It seemed to wrap itself around the dunes and roll down the hills, soothing the very sand and air that a few hours earlier was wrecking havoc on the desert.
After an earthquake in Central America, all the news was of devastation and death. While reporting from a hospital packed with hurting injured, I noticed a couple behind the reporter, playing their guitar - comforting the wounded.
And after the recent hurricane, an old friend called from Mayagüez, Puerto Rico to report that she and her family were OK. She further spoke of how every night the dark streets of the city come alive with music, dance and singing. Similar stories of endurance and compassion are everywhere. Music provides healing powers to our soul and spirit as physical medicine does our bodies.
In many parts of the world lacking amenities of the modern time, communities pull together and deal with the damaged lives and homes without outside help. Many smaller isolated towns or islands don't ever receive help from any government, nor do they even expect it. Our dependence on technological advances though, have handicapped us. Today lack of electricity, functioning plumbing, access to medical clinics, etc. delays recovery efforts in this twenty first century world.
Luckily, our profession has established many ways to respond to medical needs of affected areas. We may not be able to do much about electricity and plumbing but we have made great strides in providing healthcare. Today, Telehealth, Telemedicine, and Tele-education help us reach people in these areas, even if they don't have normal communication channels available to them. Fortunately telehealth organizations are moving further to the forefront of this technology. That gives us hope and adds to our resiliency and survivability.
We strive to reach those who need us as quickly as possible. In the meantime we can depend on our musician colleagues to calm the situation while we do our work - THANK YOU!
----------------------------------------------
11-2-2017 - Cultures of the past, cultures of the future
Not long ago, practitioners of different disciplines were discriminated against. The hierarchy ended with the MDs on of the pecking order. Even the graduates of different medical institutions ranked in a special roster of their own. Graduates of foreign schools were looked at with suspicion and tested rigorously. DOs were considered second class practitioners not worthy of sharing the same institutions with MDs - they had their own hospitals, boards, organizations etc. Chiropractors and Podiatrists were considered wannabe orthopedic surgeons, optometrists wannabe ophthalmologists, on and on and on.
I suppose that we have 'for profit medicine' to thank for incorporating the different disciplines into their managed care system. Though, their aspiration may have been to tap into the money being spent in those arenas.
Internet changed much of that as information of the logic, advocacy, rational, and applicability of these different disciplines became available and we learned that each doctrine has it's own value and can and does complement others. Today one can receive acupuncture treatments in the orthopedist's office, massage therapy in the chiropractor's practice and even leeches are used by some surgeons in place of lancing boils.
What has changed? Was it the capitalistic desire to keep all the healthcare money under one umbrella? Was it that we have really become that open minded or is something else at work here? Whatever it is, it is propelling us toward a new culture. As Telehealth, Telemedicine, and Tele-education further expand the boundaries of our practice, some of us take our old ideologies with us and defend them. Others take their new found attitudes and thoughts and spread them around. Chaos may pursue in arenas slow to change, and confusion where there is too much change. How to cope with it all and how to ensure the safety of our patients will be an issue that needs noticing and safeguarding. Finding the right balance may be difficult but the alternative could be pandemonium. Adding to all of this is the demands of a mobile society wanting to take everything with them. Which makes establishing a sound foundation for Telehealth and Telemedicine of paramount importance. It behooves us to build the new paradigm of healthcare on a sound and firm basis. An old saying states that; "If the first brick is placed crooked, to the stars the wall continues crooked!" In the zeal of getting on the band wagon, many are implementing dubious and even impractical models. Lets be cognizant of building a level foundation for the future culture of our healthcare system.
I was visiting colleagues on a reservation awhile back when a big and deadly sandstorm rolled through. Afterward I witnessed the native people finding the injured and the dead, caring for the wounded and burying the deceased. To my amazement, after grief, cries, and prayer, they took out their drums and instruments and started playing. Teary eyed men and women sang and danced well into the night. I don't remember why but I started walking away from the site and into the desert. The further I went, the more the music changed. It seemed to wrap itself around the dunes and roll down the hills, soothing the very sand and air that a few hours earlier was wrecking havoc on the desert.
After an earthquake in Central America, all the news was of devastation and death. While reporting from a hospital packed with hurting injured, I noticed a couple behind the reporter, playing their guitar - comforting the wounded.
And after the recent hurricane, an old friend called from Mayagüez, Puerto Rico to report that she and her family were OK. She further spoke of how every night the dark streets of the city come alive with music, dance and singing. Similar stories of endurance and compassion are everywhere. Music provides healing powers to our soul and spirit as physical medicine does our bodies.
In many parts of the world lacking amenities of the modern time, communities pull together and deal with the damaged lives and homes without outside help. Many smaller isolated towns or islands don't ever receive help from any government, nor do they even expect it. Our dependence on technological advances though, have handicapped us. Today lack of electricity, functioning plumbing, access to medical clinics, etc. delays recovery efforts in this twenty first century world.
Luckily, our profession has established many ways to respond to medical needs of affected areas. We may not be able to do much about electricity and plumbing but we have made great strides in providing healthcare. Today, Telehealth, Telemedicine, and Tele-education help us reach people in these areas, even if they don't have normal communication channels available to them. Fortunately telehealth organizations are moving further to the forefront of this technology. That gives us hope and adds to our resiliency and survivability.
We strive to reach those who need us as quickly as possible. In the meantime we can depend on our musician colleagues to calm the situation while we do our work - THANK YOU!
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11-2-2017 - Cultures of the past, cultures of the future
Not long ago, practitioners of different disciplines were discriminated against. The hierarchy ended with the MDs on of the pecking order. Even the graduates of different medical institutions ranked in a special roster of their own. Graduates of foreign schools were looked at with suspicion and tested rigorously. DOs were considered second class practitioners not worthy of sharing the same institutions with MDs - they had their own hospitals, boards, organizations etc. Chiropractors and Podiatrists were considered wannabe orthopedic surgeons, optometrists wannabe ophthalmologists, on and on and on.
I suppose that we have 'for profit medicine' to thank for incorporating the different disciplines into their managed care system. Though, their aspiration may have been to tap into the money being spent in those arenas.
Internet changed much of that as information of the logic, advocacy, rational, and applicability of these different disciplines became available and we learned that each doctrine has it's own value and can and does complement others. Today one can receive acupuncture treatments in the orthopedist's office, massage therapy in the chiropractor's practice and even leeches are used by some surgeons in place of lancing boils.
What has changed? Was it the capitalistic desire to keep all the healthcare money under one umbrella? Was it that we have really become that open minded or is something else at work here? Whatever it is, it is propelling us toward a new culture. As Telehealth, Telemedicine, and Tele-education further expand the boundaries of our practice, some of us take our old ideologies with us and defend them. Others take their new found attitudes and thoughts and spread them around. Chaos may pursue in arenas slow to change, and confusion where there is too much change. How to cope with it all and how to ensure the safety of our patients will be an issue that needs noticing and safeguarding. Finding the right balance may be difficult but the alternative could be pandemonium. Adding to all of this is the demands of a mobile society wanting to take everything with them. Which makes establishing a sound foundation for Telehealth and Telemedicine of paramount importance. It behooves us to build the new paradigm of healthcare on a sound and firm basis. An old saying states that; "If the first brick is placed crooked, to the stars the wall continues crooked!" In the zeal of getting on the band wagon, many are implementing dubious and even impractical models. Lets be cognizant of building a level foundation for the future culture of our healthcare system.
10-26-2017 - Night of the Witches
Reminiscing on the occasion of the season, awhile back I had the fortune or the misfortune of working the ER on Halloween night which happened to fall on Friday. At the time, I was living in a small but very multicultural town in Northern New Mexico. The night turned to be more wacky than any of us expected. Of-course the usual, Friday night crowd kept us busy with drunkenness, bar brawls, car accidents, sniffling noses, and the standard medical incidents. But the unusual was what made it, well, rather memorable.
It started with the usual minor accidents due to drivers watching the trick and treaters rather than the road and running into each other. Kids falling in the dark streets and bruising themselves, and so on. Then closer to midnight two very striking young ladies showed up in the ER in witch attire. Well the outfits were more risqué than witchy and that attracted some unwanted attention. The ladies were from out of town - California to be exact - visiting friends for Halloween. They were sisters with a long history of terrible asthma - yes both of them. At the friend's party, the guests got to drinking and smoking and more smoking and different kinds of smoking and before long the indoor atmosphere got too polluted and our young ladies found themselves in severe distress. Their inhalers just weren't doing the job and they were rushed to the ER by the police - ambulances were busy chasing fender benders. In their haste they didn't grab their coats and showed up in revealing witch costumes.
It was particularly cold that evening in the high country of Northern New Mexico. As it was usual for our town, several locals from the nearby Pueblo and their homeless town friends use to sneak in the waiting area of the hospital to get warm. They were regulars and generally subdued and quiet, if they got rowdy, we would asked them to leave and they usually quieted down. But that night being Halloween, they had a bit too much to drink and the arrival of two very attractive blond witches - well just got them too excited. The policeman who brought the witches was known to be a bit rough and as he too was interested in the ladies, got into an argument with the others in the waiting room. In his roughness, he turned one of the unwelcome visitors to the wall and grabbed his Mace Spray and proceeded to use it on his subject. A scuffle ensued and as the officer pressed the Mace Spray, the Indian ducked and the officer sprayed himself in the eyes. Well you can guess the chaos that followed.
The Indians and their friends dashed out into the dark night. We covered our ladies with patient gowns and rushed them to the P.T. department across the hall and locked the door. As it was the standard treatment of the day, we gave them each a shot of epinephrine and started them on a nebulizer. Much to our dismay, they told us that they had been dealing with asthma much of their lives. They were started on a new treatment by their pulmonalogist back in California but didn't know the medication they were given. Fortunately for us, it all turned out well. Our Indian friends made it back to the sanctuary of their tribal pueblo, we flushed the officer's eyes and sent him home, dressed, bandaged, and splinted other injured patients, treated the sniffling children and cared for other medical problems. It was a full and eventful night. Our out of towners responded well to our treatment and left the next day for California.
We were lucky that night, for our patients were young and did respond to the management of their acute asthmatic attack. Today of course, better treatments are available and with the help of telehealth we can access patients' medical charts from out of town and consult their providers back home - even on Halloween evening. Telehealth, Telemedicine, and Tele-education are great tools that allow us to care for this mobile generation. Still, it helps to remind ourselves of how we dealt with medical urgencies back in not so distant past.
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10-19-2017 - Tabernacles of healthcare
In the past several weeks, our world has witnessed many shocking disasters and calamities. The news media's dash to the scene along with the first responders shows the acute phase of such tragedies. The affected are rushed to the local medical centers and most of the time, the news ends there. However for us healthcare providers, that is when the work begins, though seldom are we mentioned. It is also noteworthy to point out that disasters do not always have an acute phase to them. As matter of fact some of the worst crisis start slowly but due to lack of notice by the authorities and the media, do not receive attention till they become a full blown problem. Though these incidences may go unnoticed by the masses, our profession responds and cares for the deprived. Often urgently yet quietly and calmly.
A medical boat sails up the Amazon, a hospital ship docks in the Caribbean, a MASH unit moves close to the frontlines, the Red Cross prepares shelters for refugees, and the volunteer healthcare providers travel to affected areas - often at their own expense. We see and care for the needy first hand, frequently before any news media is alerted or governments take action.
It is understandable to respond to calamities brought upon us by wars, nature, famine, disease, and economic changes. But when the cause is an individual or group's demented ideology, anger or revenge, our work is even more heartbreaking .
Healthcare providers have always been selflessly caring for the needy throughout history. At times in the most appalling environments such as during the epidemic of the black plague, numerous instances of Cholera and yellow fever outbreaks, and most recently the Ebola, Zika and the many occurrences of viral respiratory diseases (see UN WHO's list of Disease outbreaks by year).
Today, the ever increasing population and their migration - due to economics, war or natural afflictions - create new challenges for us. Fortunately though we have Telehealth, Telemedicine, and Tele-education to help us rise to the occasion and confront these problems. By doing so, we provide the solace people seek when they come to our tabernacles of healthcare. Thus we acknowledge and salute our colleagues in all corners of the world. Keep up the good work and may God bless you!
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10-12-2017 - American Dream
This week is the 46th annual Balloon Fiesta in Albuquerque, NM. The weather has been phenomenal and hundreds of balloons from around the world are putting on an unparalleled show. As I have indicated in my previous articles (10-6-16), I was involved in our annual balloon fiesta activities since the beginning when it launched from the parking lot of the local mall. Today of course the event owns its own field and museum. Hundreds of thousands of spectators from around the world are in town enjoying this spectacular event. The special shape balloons are particularly breathtaking. Many are so big they require their own time for launching as they take a large area and resources to get them aloft. A new one is in the shape of a racing motor cycle. It is as big as a multi story building. Here is a link to the time-lapse videos of this years many events. It will continue till next Sunday the 15th, so you can still make it out to some of the events and the weather is advertised to be perfect. Not every year have we been this lucky, enjoy it.
I have also been involved with Telehealth and Telemedicine since its early years as well. The 24th annual international ATA conference will be in Chicago next April 29 - May 1, 2018. Telehealth, Telemedicine, and Tele-education as well as ballooning have progressed considerably over the past few short years. Today people needing healthcare and advise can reach American institutions from every corner of the earth. Organizations such as ATA, UNM project ECHO, FSMB and others are working very hard to improve access to Telehealth, Telemedicine, and Tele-education for everyone.
These are the good news of the day and I wish the media would reflect on and concentrate on rather than all the negative and heart wrenching stories. In following the harrowing ordeal of all that has been happening in our country over the past few weeks, we must still realize how lucky we are to be living here. We have always faced challenges and have always come through by uniting and confronting them. I recall a song from 1950s by Bing Crosby called "Early American" in "You Can Change the World" that is worth listening to. If that is not enough, I recommend the book; "Did I ever tell you how Lucky You Are?" by the late Dr. Seuss. A book that I feel should be mandatory reading by all high school and college students. There are many who are working very hard to make our world a better place, lets join them! In our profession, use of Telehealth, Telemedicine, and Tele-education is a good place to start.
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10-5-2017 - People of Medicine
Among the massive news of disasters, calamities, crimes and aggressions, were tidbits of good news that should have been the focus of our attention had it not been for the great work we do dealing with the catastrophes. One such report was of the Noble Prize in Medicine, awarded jointly to three American scientists, Jeffrey C. Hall, Michael Rosbash and Michael W. Young "for their discoveries of molecular mechanisms controlling the circadian rhythm". Our sincerest congratulations and best wishes to these outstanding researchers.
Medicine is a collaborative and cooperative science. Especially in today's advanced and complicated environment. Our scientists are attempting research in areas that a few years ago would not be achievable. This is a credit to the advance technologies of our time. It must be remembered that our researchers have many supportive staff and assistants to help them accomplish their work. Much like a fine tuned orchestra conducting together, a research team also depends on each individual to perform his or her part perfectly. They too should be congratulated and saluted for their contribution. Especially when the work is shared by several schools, the number of supporters multiplies. In the case of this year's prize winners, the University of Maine, Brandeis University's Howard Hughes Medical Institute in Massachusetts, and Rockefeller University in New York, with their faculty and staff need to be applauded.
The technology of telecommunication plays a major role in the work of our researchers and scientists today. In this respect, we have even more people to be thankful to. This type of supportive and shared work will help accomplish the new and wondrous discoveries for the betterment of mankind in the twenty first century. Thus we cannot overlook the potential contribution of Telehealth, Telemedicine, and Tele-education to this endeavor. It is the cooperative work of the people of medicine that make life more challenging and interesting in a positive way in this troubled world. So we acknowledge and salute them all. It is a pride we all share and a gratifying achievement to entice our students with - in all fields of medicine.
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9-28-2017 - When disaster affects more than the disaster area
It is always heart breaking when disaster strikes a part of our nation or the world. But the recent string of calamities are definitely testing the limit of our ability to cope. Even a wealthy and powerful country such as ours feels the tremendous weight of such tragedies. More importantly though, are the far reaching effects of these events, for while everyone focuses on the center of destruction, damages to outlying infrastructures and businesses are often more long lasting and expensive and often affect places far from the disaster centers.
The healthcare industry is perhaps more effected than others. Not only by having to provide care to the needy but often in ways not envisioned. Case in point is the interruption of drug manufacturing in Puerto Rico that could cause shortages in far away places. Or the destruction of medical school infrastructures in many Caribbean Islands housing them, disturbing their students' education. Or damage done to many rural hospitals and nursing homes around Houston, having to transfer their patients to places as far away as Dallas, San Antonio, and New Orleans.
The unpredictable earthquakes in Mexico are another example. Beside all the damage that was done to many buildings, burying hundreds of people in their ruble, many small businesses were totally destroyed, forever sping the livelihood of families.
Despite all these horrendous tragedies, today, our technology of Telehealth, Telemedicine, and Tele-education provide us with plenty of tools to help our fellow human beings. Telehealth can help those on the frontlines, get help from the experts in different centers far away. Find vacancies for patients and make available, their medical records - no matter where they end up.
Telemedicine can supervise the first responders to provide the best care possible. It can help transfer the production of drugs from damaged plants to other pharmaceutical manufacturing centers through transmission of the drug formula, 3D printing and other controls. Tele-education can continue teaching the medical students - wherever they are - while their school arranges for restructuring. Small businesses can receive government oversight and financial support while they plan their future.
Organizations such as ATA, FSMB and NCSBN are at the forefront of this revolution in the medical field. We can help support their efforts by talking with our medical boards and legislators in states still resisting this important change.
Maybe our world is facing more challenges but upon closer examination, we find that the solutions are also here. The United Nations General Assembly just ended in New York. Many leaders of the world presented the challenges they were facing. But there was one clear thing present, the hope that their problems could be resolved. No one had lost hope in resolving their problems but asked that the rest of us be aware of their needs and help them work it out. No one was planning for failure but was worried that the world was failing to plan properly. The world needs to channel resources toward the constructive efforts needed to address these issues. We can help!
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9-21-2017 - The Late Great Senator Domenici
"PASSING OF A STATESMAN" read the Albuquerque Journal's Sept 14th front page headline. No truer statement could be made about New Mexico's great senator, Pete Domenici, who passed away a week ago Wednesday.
Senator Domenici was a gentlemen's gentleman. A true statesman of extraordinary compassion and talent. A politician for the people. Not many have served their constituents more caringly than he did. Highly respected by all his colleagues from all sides of the political spectrum, he illustrated the real meaning of pragmatism and common sense. We New Mexicans are especially proud that he was our senator in Washington!
As healthcare providers, of course we remember him best for all the hard work he did in the healthcare field. Especially in the mental health arena. The Mental Health Parity Act bill signed into law in 2008 was championed by him. A true long lasting gift to the most vulnerable among us.
One of his great attributes was his listening trait. No matter who was talking, he gave them his full attention. I met him once in Washington, as a visiting delegate member of our Medical Board and another time in Albuquerque regarding a bill concerning UNM. On both occasions, I was with a group of people and did not expect him to remember me. He proved me wrong when I ran into him several years later while shopping in Coronado Mall. He was standing inline to pay for a purchase he was making. I approached him to say hello. When he saw me, he smiled and greeted me warmly and when I introduced myself, he said; "Yes, I remember you from your Washington visit, you are with UNM?" I was very surprised that he did, but became even more stunned when he left his place in line to talk to me.
Whether the concern was about a clinic in Las Cruces, nuclear research in Las Alamos, or Energy Policy of national interest, he presented it with full authority and knowledge. Many politicians present a bill or support an issue without really knowing much about it. They rely on expert witnesses to make their point, giving the impression that they really don't know what they are supporting or are against. Though Senator Domenici had his own experts present, he knew the detail of the issues he was working on, reducing the need of explaining the ic at hand.
New Mexico has a history of having some very strong and savvy politicians. Senator Pete Domenici shined as one of our best. We will miss you Sir!
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9-14-2017 - Project Echo - A Global Success Story
The annual meeting of the project Echo is in progress right now in Albuquerque, NM. The four day event proceeds through Saturday Sept.16th. Hundreds of participants from around the world are in Albuquerque for the MetaECHO conference. Key sessions of the conference are available via Zoom.
Project Echo is one of the most successful Telehealth, Telemedicine, and Tele-education programs in existence. In a short few years it has reached many around the globe with more healthcare providers joining it daily. It is a resourceful stage where healthcare providers and educators from around the world gather and share their experiences, ideas, philosophy and wisdom. Listening to their stories of successes and failures is what adds to and enriches the knowledge of medicine for all of us. Such programs help many in situations where help is hard to get. And assistance comes from places not even thinkable a few short years ago. This is especially true after the very recent disasters we have had in our own country and neighborhood (and it is not over yet.) Today as many volunteers head toward ruined areas of the Caribbean, Mexico, Texas, and Florida, they take with them the security and knowledge that their colleagues back home are available at the push of a few buttons. It is calamities such as these that demonstrate that storms, earthquakes, and wild-fires do not chose whom or what they damage and hurt. Often it is the rural areas that are hit the worst. Though cities and population centers receive the most coverage by the media, rural communities may actually be more affected - an example of this was reported on CBS News. Today's technology allows us to get backup knowledge to those on the frontlines and help the people in these areas faster. But only if we fully implement it.
To a great extend, programs such as Project Echo are directly responsible in making this availability possible. These programs further prove and help organizations such as the American Telemedicine Association (ATA) and the Federation of State Medical Boards demonstrate the viability of license portability and recognition of the need for it in this global healthcare arena. We salute Doctor Sanjeev Arora's achievement in the way this program has made an impact worldwide. Project Echo's vision to "REACH A BILLION PEOPLE BY 2025!" is well on its way. The beauty of the program is that it touches a billion people individually. We hope and pray that more than a billion is reached by his venture and others learn and use the idea to truly make Telehealth, Telemedicine, and Tele-education the key to healthcare for everyone on our planet.
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8-31-2017 - Of Harvey, Katrina, Haiyan & Sandy
The emptiness in the faces of the people was a testament to the suffering they had endured - reported a colleague with the Red Cross who arrived on the island in early September. Many sat staring into a distant void. Bruises on the faces and bodies, a tribute to what was witnessed. The air reeked of death and destruction permeating all senses. A warm gentle breeze swayed the broken palm trees, many harboring bits and pieces of things thrown at them earlier. The hood of a car wrapped around one tree, thirty feet high. Sheet metal roofing and building materials replaced what was once branches, leaves and flowers.
Hurricane David hit the island of Dominica on August 29, 1979. From there it traveled north to the Dominican Republic, the Bahamas, Florida, and up the US coastline.
In 1984, Dominica was still in disarray, needing help. Direct relief International - an aid organization was asking for volunteers to the island, so I signed up. In April, I left Taos, NM and spent three months on the island. Though the hurricane had left four years earlier, the devastation was still there and the surmounting need for help very present. I got to see the damage these monster storms can do first hand and will never forget.
Since then many cyclones, typhoons, and hurricanes have ravaged our planet. Perhaps no country in the world has been more devastated than the nation of Bangladesh. The mostly low-lying terrain is divided by the Ganges, Padma, Brahmaputra and about 700 other rivers which empty into the Bay of Bengal. Of the ten deadliest storms in history, seven were in Bangladesh. The most recent was the Cyclone Mora that hit the country in May of this year.
Though the structural damages are what we see and record, it is the human toll in these instances that are lasting. The loss of a family member is exceptional. So are the damages inflicted on human bodies and souls. Our profession sees these first hand. We are the first they call on, and when we get there, expectations are overwhelming and demand often unattainable. Yet we respond, at times at the risk of our own well being. Governments answer with aide, organizations with money, people with donations of all kind, but it is the healthcare providers who will step off the boat or plane into a ruined world that just a few hours earlier was a thriving and happy community. There, standing ankle deep in flood and blood, looking into the anxious eyes of young and old, applying bandages, suturing wounds, stabilizing fractures and administering the needed medication.
In the past we were often alone or in small groups with no backup or support. When I was in Dominica, I couldn't even call my own family to report my status. So getting qualified help was non-existent. Today however we are much luckier. Technology has put instruments at our disposal that allows us to contact professional help from large centers thousands of miles away. Telehealth, Telemedicine, and Tele-education allow experts to literally look over our shoulders from afar and guide our eyes and hands. The same technology has also made it possible to alert citizens of coming catastrophes, and to get them prepared and to shelters. In 1991, when Cyclone 02B hit Bangladesh, it killed 139,000 people. In comparison, Mora killed only six.
Our world is changing. Although political and climate changes present us with ever new challenges, our technology could keep us ahead of the oncoming calamities. But only if we have the wisdom to utilize it properly.
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8-24-2017 - The Eclipse
On Monday, I, like millions of others, was twisting and stretching my neck and head skyward watching the dance of the sun and the moon as they peekabooed across the sky. At the moment when the darkness of the moon overcame the all powerful face of the sun, awestruck I watched the reaction of the nature around me, and saw how this momentary show of the universe had a profound affect on everything around us. I was reminded of the famous naturalist; John Muir's reflection: "When we try to pick out anything by itself, we find that it is bound fast by a thousand invisible cords that cannot be broken, to everything in the universe."
Lost in our human arrogance, we often forget how much a part of the universe, we all are. How we are attached and connected to one another and all that is around us. How everything that we do affects every fiber of all that surrounds us. As healthcare providers we often see the effects of the actions of our fellow men firsthand. But perhaps the most profound are the calamities and tragedies we bring upon each other through wars, neglect, protectionism, etc. Lets not forget though, that mankind is of one family and what affects one of us affects all of us.
We as healthcare providers however, are more fortunate than most others. We have at our disposal means and tools to make a difference for ourselves as well as others. Telehealth, Telemedicine, and Tele-education are three such tools. Through them we can bring positive and constructive change to many who need it, close and afar. For just as the actions of the sun and the moon, thousands of miles away in the universe can turn a day into night, our benevolence too can turn someone's life around - even miles away.
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8-17-2017 - Interstate Telehealth SIG
It is with great pleasure that we announce that the "Interstate Telehealth Discussion Group" (DG) is now the "Interstate Telehealth Special Interest Group" (SIG). As a SIG, we will have more access to ATA's resources.
We feel that a bit of history is in order. This group started as the "Four Corner Telehealth Consortium" several years ago. The four corner states of New Mexico, Colorado, Utah, and Arizona were the original members. As our concerns and membership grew, other states joined us and we decided to ask ATA to consider making us a SIG. The response was that, we first had to become a Discussion Group (DG) to see if there was enough interest. In 2015 we held our first DG meeting. Over the next months, interest grew further. In 2016, we presented an application to ATA to become a SIG at the annual meeting in Minneapolis. The ATA regulation requires that at least thirty members sign the petition, we had well over a hundred. Still ATA wanted us to remain a DG for another year, which we did.
At the ATA's annual meeting in Orlando this year, we resubmitted the application but did not secure an answer during the meeting. However, we were promised that they would work on it. A few days ago, we finally received word that ATA has approved us as their latest SIG. Amen.
Now our real work begins. We truly feel that the "Interstate Telehealth SIG" will be one of the most important in the organization. Our monthly meetings reveal that there is considerable interest as many organizations and individuals contribute to it and volunteer opinions, recommendations and assistance.
We invite everyone who is interested in interstate practice to join us. You can start by joining our monthly meetings on the third Tuesday of every month. The meetings are conducted via ZOOM and the contact information is always posted on the ATA HUB. See you there!
The Interstate Telehealth SIG is chaired by Kris Erps, Vanessa McLaughlin is Vice Chair, Dale Alverson is past Chair, and Reza Ghadimi; Secretary.
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8-10-2017 - Revamping Healthcare
The news media tells us that another attempt at revamping the healthcare system failed. But why? The argument is that the ACA is not affordable at all. That it costs too much, etc… But the anecdotal solutions seem to only add to the problem rather than solve it. For as long as the primary focus of medicine is on profits, true healthcare will take a back seat. This however is the reality of things and it is doubtful that the primary focus will be averted from profits. Attention therefore is centered on reducing cost. The problem arises when this is done in the form of cutting services to the patient. But there are other ways to cut cost if we only step back and look at the big picture. For example why does a college degree cost so much and who benefits from skyrocketing tuition and fees? Why do patients have to travel to distant hospitals for good care? Why do drugs cost so much? Why don't we have better insurance regulations? Why....?
The problem as we see it is the lack of addressing systemic problems. And when things get really bad, the head of an agency or department resigns or is fired. But if systemic problems could be resolved by replacing one or two people, they wouldn’t be considered systemic.
For years now, while the healthcare industry struggles to find ways in dealing with these issues, Telehealth, Telemedicine, and Tele-education have been moving forward with resolutions and decrees to help reduce the cost of healthcare. We have shown and proved that adaptation of telemedicine benefits regulatory agencies, government departments, hospitals, clinics, insurance companies, and above all; patients. Fortunately, more and more states and organizations are joining our efforts, but we still have a long ways to go. Every day new legislation is passed at national as well as local levels to help embrace this technology. Perhaps the naysayers need to s objecting and join others in incorporating Telehealth, Telemedicine, and Tele-education into our healthcare system, thus reducing the cost of providing care. Maybe then the system as a whole could find a way to be affordable and profitable.
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8-3-2017 - Surviving the Storm
It was amazing to see the day last so long. As we flew westward the sun just seem to hang on the horizon. Massive clouds bellow us stretched their angry arms into the sky but we soared well out of their reach. The rays of the sun penetrating their convoluted crevasses were not as fortunate. Their changing colors of light fought the shadows through the canyons in the stormy sky bellow us. Occasional openings in the clouds revealed the darkening earth bellow. Lights were coming on in the towns and hamlets foretelling the approaching night. I watched and wondered at the changing world around and bellow us.
I was returning from a medical conference. The theme of the conference was the new discoveries in antibiotics and the wonderful promises they made in fighting some of the more tenacious infections nature sends our way. Looking down, I thought of all those afflicted with them and the wonderful news me and my colleagues were bringing them from our conference. I was giddy with excitement and couldn't wait to return to work and tell my patients and coworkers the news. It was 1980 and the future looked bright. But as I watched the night overtake the diminishing light of the day, something deep within me was alarmed by the fight we were waging against nature.
Today healthcare seems to be trapped in a storm of its own. There are those of us who soar above it all and others caught in its turbulence. Problems with antibiotics, opioids and other drugs being just some of the issues. The political maelstrom seems to be overlooking the very need for a healthcare system that should be helping the sick and injured. But while the politicians, special groups and Wall Street biggies each work to serve their own interest, we the healthcare providers have our own job to do and it is much more difficult today than it has ever been. While dodging the up and down drafts of today's tempest, we still need to help those who come to us for assistance. Fortunately for us, Telehealth, Telemedicine, and Tele-education gives us a hand in navigating this storm. It is the tool we can use that not only will help us survive the gale but come out ahead no matter which way the final wind blows.
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7-27-2017 - Beating Cancer
Last Sunday, The CBS program; "Sunday Morning" was devoted entirely to cancer. Hosted by Dr. Jon LaPook, it showed the progress being made in understanding, research, and the treatment options of this dreaded disease.
One common problem is the continuous lack of true and timely communication between researchers and the application of their findings and the main hurdle seems to be the bureaucratic obstacles put in place by regulatory agencies.
The CBS report showed the advancement made by major cancer hospitals and institutions such as Memorial Sloan Kettering Cancer Center in NY, John Hopkins in Baltimore, and Seattle Cancer Care Alliance of The University of Washington Medical Center. Many others too are making groundbreaking and advanced progress in this arena here and internationally. Clearly this is a much needed yet daunting task. So it stands to reason that cooperation of all involved would benefit everyone.
Access to patients needing treatment, is always difficult. Especially in the area of rare diseases (see our 11-3-2016 Article). It is overwhelming for some patients to travel to a center away from home for treatment, since many can not afford to travel to far away cities for care. Even if the cost of treatment is covered by insurance or some grant, family members can not leave home to stay with their loved ones during the often long periods of treatment. Loss of income and family support adds to the anxiety and pain of having to deal with a loved one's fight with his/ her disease.
We all know that treating a patient in their home environment is preferable to dislocating them for the sake of an experimental method that may or may not work - as usually is the case with investigational approaches. Many local cancer centers are equipped to handle the long term hospitalization needed for these patients. If regulatory agencies allow specialists from major institutions to treat patients at their home centers without having unrealistic demands, much advancement could be made in beating cancer. Cost too, could be shared if doctors of several institutions cooperate and treat patients at other locations without having to be licensed in every state or center. This could easily be done by Telehealth, Telemedicine, and Tele-education.
American Telemedicine Association and Federation of the State Medical Boards have been working for years on resolving this issue. Progress is being made but is much too slow for many. A lot of hardship is tolerated by those stricken by cancer, bureaucratic hurdles should not be one of them.
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7-20-2017 - Telehealth Works
In our last monthly meeting of the NM Telehealth Alliance we were delighted to receive Dr. Robert Sapi?n, from the UNM Department of Pediatric Emergency Medicine.
It is heartwarming to see how telehealth is being used in the real world of patient care and the benefits everyone receives from it. Dr. Sapien introduced his UNM program. The program encourages community healthcare centers around New Mexico to signup and integrate with UNM Pediatric Department's "Regionalization of Pediatric Emergency Medicine", using telehealth.
Programs such as this and the UNM Telehealth Stroke program or the one by UNM's Mind research Institute's work on "Advancing the diagnosis and treatment of mental illness and other brain disorders" reveal the benefits of Telehealth, Telemedicine, and Tele-education. These programs have served thousands of patients, saved hundreds of thousands of dollars in patient care by keeping patients in their local communities, providing state of the art care and reducing hardship on patients and their families.
Those of us who have been at this for a while can tell stories of times when a misdiagnosis, or misunderstanding led to expensive trips and hardship for patients and right down embarrassment for the provider. A PA colleague tells a story of a patient she saw once at a resort clinic she was working at in Northern NM. A new provider in town was setting up office and trying to impress the small town populous. A visitor to the resort had developed a rather sever conjunctivitis and was seen by the PA. She started him on ophthalmic antibiotic and had him return the next day for follow-up. She was late getting to work the next day and the patient went to see the other provider, who became alarmed by the severity of the infection and being new to the area, figured that the nearest ophthalmologist must be in the nearest city, Santa Fe, 110 miles away. He patched the now alarmed patient's eye and instructed him to travel to Santa Fe for immediate care, less he might lose the eye.
The out of town visitor had come with a group on a bus. He had to find an expensive ride to take him to Santa Fe. They passed two towns on the way - one 40 miles away and another 80 miles away with an ophthalmologist on their staff. In Santa Fe, the patient - being a walk-in, had to wait a long time to be seen. When he was finally seen by the doctor, was told that he indeed had a severe conjunctivitis and to continue with the given medication by the PA and follow-up with his family doctor on returning home. The understandably irate patient returned to the resort town late that night. The next day, … well you can imagine what happened next.
A simple phone call could have lessened the trauma and had telehealth been available then, he could have saved the patient a trip all together.
Today of-course we can deal with a lot worse problems like stroke, psychiatric crisis, and cardiac incidents than conjunctivitis by Telehealth and Telemedicine. Still we have to convince the skeptics that Telehealth, Telemedicine, and Tele-education are safe and very cost effective ways to treat many problems, even serious ones. We are grateful that the University of New Mexico along with many other medical centers around the country are vigorously pursuing the use of this technology and look forward to more use of it by others.
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7-13-2017 - History is a Mirror
"All over the southwestern states, the owners of the land came onto the land, or more often, someone came for them. All of the owners told their tenants the same thing: 'You know the land's getting poorer. The bank has to have profits all the time. It can't wait for the next year's crops. One man on a tractor can take the place of twelve or fourteen families. You'll have to go.'
Then the tractors came over the roads and into the fields. They drove through fences and houses to make space for even larger fields."
We all remember the story. We read it in high school. It was required reading. It still is! It is from the "Grapes of Wrath by John Steinbeck"
These folks were pushed off their home, land, even state and country and we should recall the terrible welcome awaiting them elsewhere. Many died on their exodus and many more arrived sick and injured. And ….
Today hundreds of thousands of our citizens are destitute and homeless. Many have become so depressed and helpless they have succumbed to drugs, alcohol, even suicide. So much so that our country is facing an unprecedented tragedy.
In middle American states like Kentucky, West Virginia, Tennessee and others, the middle age white man's rate of death has increased by over three hundred percent. Most deaths are due to drugs, alcoholism, and suicide. A CDC report indicates that, the rate from suicide or unintentional death due to substance abuse has increased dramatically in recent years. The tragedy is not just the loss of these people but often that of the family they leave behind. A new increasing problem is the fate of many children left parentless. Many seniors suddenly find themselves having to care for their very young grandchildren.
A recent report from Brookings Institution by Ann Case and the Nobel laureate; Sir Angus Deaton, reveals the tremendous burden to our society, these "Deaths of despair" are creating.
But are we missing something? There are nearly seventy million displaced people around the world. The majority are in much worse predicament than any of us. Yet the suicide rate among them is much less than ours. Many Europeans too have suffered in these economic upheavals, but we don’t see them killing themselves. The refugee population shows families staying together, even in their plight of leaving their homeland. During the great depression too, families were close. When the going got bad, families coalesced and helped each other to keep moving. So, is today's family structure a problem or are we looking at something entirely different? No matter what the problem though, when depression sets in, many will turn to their family healthcare providers for help. Many of us are ill equipped and not trained to deal with this dilemma and may overlook the basic principle underlying this conundrum. How we treat them will determine whether we solve or add to the overall harm of the crisis.
One caveat is the technology at our disposal. Telehealth, Telemedicine, and Tele-education is still not adequately implemented in dealing with these problems in our society. Using Telemedicine and Tele-education to provide help can drastically reduce the burden of dealing with the intricacies of the dilemma. Especially to our colleagues in rural areas where the problem seems to be ever more acute and at times hopeless. As more information become available, we can rapidly educate ourselves and our colleagues through these tools. Maybe we can't replace the family support or resolve the underlying economical and social obstacles but we can educate ourselves properly and provide solace by showing that we care!
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7-6-2017 - It Is A Small World
Tuesday was America's independence day and our birthday. Happy birthday America! It is interesting to note that 21 other countries celebrate their independence in July as well. Yet despite the fact that many proudly commemorate their autonomy, the business world unites and tears down barriers.
A family member who has traveled extensively throughout Southeast Asia told of a time she was traveling the northern regions of Borneo in Malaysia. She was on a train to Tenom Station and passing through the jungle, marveling at the scenery and relatively simple way of life. She was hungry by the time the train reached the station and thinking of where to eat when, to her astonishment, she saw a sign for "Pizza Hut" next to the station. I was Googling the map to follow her trip and sure enough there is a Pizza Hut and a KFC in Tenom, which shows the globalization of our commerce and businesses.
Recently, we received a request from a medical student in South Korea who, enthusiastically wants to introduce Korean medicine, the complementary medicine in Korea, to the world using telemedicine. Our Chairman; Dr. Alverson informed him that there are active telemedicine programs in South Korea, commonly called “ubiquitous Health” (uHealth) and that he had the opportunity to visit with some of the key stakeholders in Seoul. Dr. Alverson further stated that the integration of traditional healing is a common theme in many countries around the world and that he would be happy to discuss it further with our student.
Dr. Alverson has traveled the world promoting telehealth and telemedicine. From the Jungles of South America to the Middle East and Southeast Asia. It is amazing how a rare disease in a remote village up the Amazon River can be treated directly by the UNM doctors, 4000 miles away. And how I can write about it while listening to Flamingo music performed in Barcelona, Spain. It is indeed a small world after all.
Our technology connects us in ways not perceivable even a few short years ago. We can reach out and touch each other across the world, help one another, treat diseases, advise on social, economic and commercial matters. Even attend scientific and trade meetings on the other side of the country or enjoy a live concert thousands of miles away, without having to leave our home base. Indeed Telehealth, Telemedicine, and Tele-education are taking the latest of sciences to the very center of the needy regions. But there are still places that lack this connection and it is remarkable that some actually resist it - on both sides. But if we can sell American style pizza and chicken around the world, we can share our knowledge of medicine and healthcare with others. Teach as well as learn from one another. Let us be one of those who remove barriers rather than raise them.
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6-29-2017 - Don't Regulate Us Out
In reading through forums on the ATA and other websites, one question keeps coming up. How should an organization or hospital handle telehealth privileges for it's providers? It seems that suddenly, organizations feel the need to regulate this age old practice. But if we step back and look at the way we have been practicing medicine forever, we see that providers have always used telecommunication and consulted with their patients and one another regarding their care. Even primitive medicine men consulted one another by smoke signals or drum beats; "Child sick, feel hot. What to do?"
I would argue that, this too is telehealth! We are just carrying this concept into the 21st century technology and exchanging drums for internet. So the idea that we need new regulations to do this is ludicrous.
It is not healthcare providers who are asking for regulations. It is our legal colleagues and their bean counter friends who …. . But once we start down this road, we will regulate ourselves out of business.
Here is Dr. Peter Yellowlees, the President of ATA's response to this; "I am concerned about this discussion, and as I have said to Tom offline, do not believe that telemedicine should be privileged in any special way as part of a credentialing process and I have been practicing teemed for many years and have never heard of this occurring previously. All that is happening in the places and ways that Brenda quotes, in my belief, is raising yet another administrative barrier to telemedicine which is the last thing we want. …!!"
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6-22-2017 - Summer Heat
Yesterday was flag day, the day (June 14, 1777 - 240 years ago) that marks the adoption of the flag of the United States by resolution of the Second Continental Congress.
And next Sunday is Father's Day, to celebrate and honor our fathers. Just as a flag raises the sense of patriotism in people, Fathers Day raises sense of responsibility, affection and devotion in all of us. These two days help us celebrate our civility and sense of belonging, to our families, country, beliefs, and our fellow men.
Unfortunately the political rhetoric of some of the world leaders have left many to believe that to be patriotic is to harm those who do not agree with us. Obviously this strategy is not working and it maybe a good time for us to rethink our approach to our problems. For, as Mahatma Gandhi said; "An eye for an eye will soon leave the whole world blind".
Sometimes, we have to go out of our way to execute the needed task. A good example of this can be seen in the work of peace activist and novelist Baroness Bertha von Suttner. Born on June 9th, 1843 in Prague. As a popular peace activist, her work was read overwhelmingly. Her book "Lay Down Your Arms (1889)" was well received. She traveled all over Europe and in her mid 30s became the secretary to the industrialist Alfred Nobel.
Nobel had made a fortune as the inventor of dynamite and later through the development of weapons. Bertha became an influencing factor on Nobel and convinced him to create what is now known as "The Nobel Peace Prize". Nobel died in 1896, and the first Nobel Prize was given in 1901. In 1905, Bertha von Suttner became the first woman to win the Nobel Peace Prize that she had helped create.
Today the need for peace and harmony is paramount. We as healthcare providers can be a catalyst in starting a spark to light the torch of hope and we have the tools to make our torch be seen far away. Telehealth, Telemedicine, and Tele-education can carry the light of our torch around the world. Lets make our flag be one of hope and peace!
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6-15-2017 - Patriotism
Yesterday was flag day, the day (June 14, 1777 - 240 years ago) that marks the adoption of the flag of the United States by resolution of the Second Continental Congress.
And next Sunday is Father's Day, to celebrate and honor our fathers. Just as a flag raises the sense of patriotism in people, Fathers Day raises sense of responsibility, affection and devotion in all of us. These two days help us celebrate our civility and sense of belonging, to our families, country, beliefs, and our fellow men.
Unfortunately the political rhetoric of some of the world leaders have left many to believe that to be patriotic is to harm those who do not agree with us. Obviously this strategy is not working and it maybe a good time for us to rethink our approach to our problems. For, as Mahatma Gandhi said; "An eye for an eye will soon leave the whole world blind".
Sometimes, we have to go out or our way to execute the needed task. A good example of this can be seen in the work of peace activist and novelist Baroness Bertha von Suttner. Born on June 9th, 1843 in Prague. As a popular peace activist, her work was read overwhelmingly. Her book "Lay Down Your Arms (1889)" was well received. She traveled all over Europe and in her mid 30s became the secretary to the industrialist Alfred Nobel.
Nobel had made a fortune as the inventor of dynamite and later through the development of weapons. Bertha became an influencing factor on Nobel and convinced him to create what is now known as "The Nobel Peace Prize". Nobel died in 1896, and the first Nobel Prize was given in 1901. In 1905, Bertha von Suttner became the first woman to win the Nobel Peace Prize that she had helped create.
Today the need for peace and harmony is paramount. We as healthcare providers can be a catalyst in starting a spark to light the torch of hope and we have the tools to make our torch be seen far away. Telehealth, Telemedicine, and Tele-education can carry the light of our torch around the world. Lets make our flag be one of hope and peace!
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6-8-2017 - Learn, Experience, Teach
Marcus Tullius Cicero(106 BC - 43 BC), the great Roman politician said; "What greater or better gift can we offer the republic than to teach our youth?"
Indeed! There is no greater way for people to remember us than as a teacher, coach or mentor. For in the practice of healthcare, every encounter teaches us something about humanity as well as medicine. Parting with that knowledge to our students and colleagues - young and old - should be the goal of us all.
I was going to write an essay about the benefits of teaching but in the interest of not sounding pedantic, I will just beg your discretion to consider passing your wisdom to others. If all of us learn from all the best of us, there will be less healthcare provider shortage. Telehealth, Telemedicine, and Tele-education provide us the tools to be that teacher, coach and mentor to many around the world. The road that has brought us to this day may have been smooth or rough, but now that we know the way, it will be easy to show it to others. As Bernard Shaw said; "I am not a teacher: only a fellow-traveler of whom you asked the way. I pointed ahead - ahead of myself as well as you."
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6-1-2017 - Experience and OJT
Our first job out of the medical school is the one we will never forget. Those of us lucky enough will land a job in a busy clinic, hospital or private practice where other experienced practitioners and providers are at hand to help, guide and mentor us. Others may find themselves in situations where such resources are limited or non-existent. Personally I feel that two years work at a large organization should be mandatory, though some argue that the residency provides that experience - I disagree.
But no matter the situation, we are all learning on the job (OJT) and the most important thing will be good communication, when needed. Successful communication occurs when others contribute meaningfully to your decision. It does not occur when you assume a despotic posture. Even if the consultation is inadequate, it may shine a light on alternative possibilities of diagnosing, deciding and treating.
As years go by, one realizes the value of knowledge. Looking back, those who were the best mentors, teachers, and counselors had the most experience. For even the best schools cannot substitute for it. Sometimes even a small familiarity can save the day. Once while working at an urgent-care, my shift started late in the morning. I arrived at work and noticed the waiting room to be full. As I walked to the back, I saw that all four of my colleagues working that day had their heads buried in different medical books searching for something. Approaching the nurses station, I saw a large canning jar with something in it on the counter. I picked it up and with astonishment called out: "Ascaris? Where did this come from?"
Four heads rose from the books and turned to me. One asked; "Is that what that is?"
"Yes" I answered "where did it come from?"
He pointed to a young man in an exam room. He was from Central America here visiting family when he got sick and started passing the parasites in his stool. Mystery solved and everyone went back to work. In my times of working in the Caribbean and Middle East, I had seen and treated many infested by the vermin. It wasn't that I was smarter than the others, I just had a bit of diversity in my experience.
Fortunately for us, today Telehealth, Telemedicine, and Tele-education make consultation with knowledgeable people so much easier and available, even across continents. They open avenues of communication not possible even a short time ago. In our May 11th issue of this newsletter, there was a link to an article; Virtual Veterinary Training that was established by Tufts University Veterinary School. It connected with veterinarians in Africa, allowing Tufts students to experience caring for large African animals. That link received some attention, not because of our readers' interest in veterinary medicine, but rather due to a knowledge it provided for Tufts' students that they would have otherwise not be able to get.
Today, more than ever, our world needs healthcare providers. Economics, natural disasters, famine, wars, political changes, all have placed average communities and people in dire situations where their health has been affected and getting care more difficult. But technology of Telemedicine, and Tele-education can close the gap. Whether novice or experienced, we can all use some help at times. Telehealth gives us the means of getting and giving that help.
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5-25-2017 - A Milestone for Burrell College of Osteopathy
The value and standing of any society is measured by the percentages of its educated citizens.
The establishment and founding of the Burrell College of Osteopathic Medicine (BCOM) last year, increased New Mexico's status among the states as a highly educated and skilled culture.
Along with UNM's well regarded Medical school (in the 20 nationwide), Burrell College is already being noticed and recognized by the work of its faculty and students. We salute the Burrell family for their support and financing of our school.
As the school's staff writer, Jessica Salopek writes:
"It has been a milestone year for Las Cruces, NM’s Burrell College of Osteopathic Medicine, which officially opened its doors in August 2016. The 162 students in the inaugural class were officially welcomed into the medical profession on August 13 at a White Coat Ceremony where Antonia Novello, MD the 14th U.S. Surgeon General and the first woman to hold the position, gave the keynote address.
Within weeks of beginning classes, the faculty, staff, and students began fulfilling the school’s mission to increase and diversify the state and region’s physician workforce, by reaching out to young students and encouraging them to pursue careers in medicine. Several programs for those interested in medicine was launched. BCOM professor Samuel Kadavakollu, Ph.D., welcomed the first group of 70 students from around the region into his community MCAT prep course and Richard Selinfreund, Ph.D., founded the Medical Explorer Post for high school students interested in health care careers.
In February, the entire inaugural class traveled to Santa Fe to visit the NM State Capitol where both the senate and the house passed a memorial to support the declaration of February 9 as 'Burrell College of Osteopathic Medicine Day at the Roundhouse.'
Many of the students and faculty received national recognition over the course of the year. The American College of Osteopathic Family Physicians named an article written by BCOM’s Chair of Family & Community Medicine, Sherri Howell, DO, as the 2016 OFP Paper of the Year. Student Katherine Vidal was selected to participate in the National Institute of Diabetes and Digestive and Kidney Diseases prestigious summer research fellowship program and student Mohan Muvalla beat out 122 applicants from across the country for a summer internship with NASA. Students John Rajala and Harris Ahmed were elected to serve on the National Board of Directors for the Student Osteopathic Medical Association, and the BCOM student chapter of the American College of Osteopathic Pediatricians was named National Student Chapter of the Year.
This first year is just the beginning for the new school. Oliver Hayes, DO, has been working diligently to establish clerkship and residency positions that will keep the students in the region after they graduate. Before BCOM was established, there were 18 medical residency positions in Las Cruces. Hayes has already increased that number by 450 percent and is continuing to establish positions around the state and region.
As Dr. Novello said in her keynote address, the BCOM team is proving that they can “walk the walk and not just talk the talk” when it comes to accomplishing their goal of improving health care for New Mexicans."
BCOM officials have met with the NM Telehealth Alliance members and we are glad to contribute and help with Telehealth, Telemedicine, and Tele-education at the school.
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5-18-2017 - Part 2-Mental Health Awareness Month
May being Mental Health Awareness Month and crisis in mental health touching all levels of our society - veterans, adolescence, executives, healthcare providers, rich and poor, all races, and nationalities are touched by this calamity - we at the Alliance feel more attention to this predicament is needed. Many still feel that telemedicine may not be the best way to address the issue and that people in need of mental health help should receive hands on care. This of course is true in most medical emergency situations. But not every psychological case is an emergency. If we attend to more routine conditions remotely, more resources could be available to those truly in need of personal attention.
Many with mental health difficulty just need an attentive ear to listen to their complaint. A phone call to a friend, relative or loved one often is sufficient enough to help someone out of a depressive mood. At some more drastic times providing a safe house for someone in crisis for a few days maybe enough to help them deal with it. A few years back, a friend of ours came home one day to find her teenage son murdered by an intruder. Even though she was a psychiatric nurse herself, she was having a great deal of difficulty dealing with it even weeks after the event. Understandably the overwhelming circumstance demanded that she get away from those surroundings. My wife and I offered her to come and stay with us for a while. We lived in the country and she readily accepted our offer. Although no one can truly forget such calamity, the interlude gave her healing time. A mental health crisis center or safe house could be all a person in distress needs to rest and heal.
A few years ago when we were trying to show the effectiveness of telehealth and telemedicine, many questioned the efficacy of physical exams done remotely. At the ATA's annual meeting in 2014, during one of the more provocative plenary sessions, the panel was drilled about the safety of “Examining, Diagnosing and Treating a patient by Telemedicine.
Later, our Chairman - Dr. Alverson who attended the meeting reported that; The importance of meeting reasonable and appropriate standards of care during a telemedicine encounter as during an in-person patient visit was of paramount importance to the audience. For example, diagnosing an “ear infection” without examining the ear was brought up. It was pointed out that technology had developed tools that can allow such an ear exam to occur with an otoscope connected to a cell phone or communication device. Thus standards of care and an appropriate evaluation could all be accomplished via Telemedicine services, even 24/7. For, it is the responsibility of the provider to insure that these principles are upheld, whether in-person or virtually through telemedicine technologies. Mental health usually does not even require any devices, just an attentive and caring professional. Day by day, the safety and adequacy of Telehealth, Telemedicine, and Tele-education is proven. Its universal acceptance will only help resolve many crisis in medicine, including mental health. Our leaders and politicians need to keep hearing our concerns about the matter and the urgency of it. For, a sound and healthy society is more productive and resourceful.
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5-11-2017 - Mental Health Awareness Month
----Much has been written about the origin, reason, diagnosis, and treatment of mental illness. From the time of Hippocrates - who first declared that mental illness has a physical and medical foundation and not a religious or evil basis, to Freud with his theory that mental disorders such as schizophrenia resulted from unconscious conflicts originating in early childhood, to today when mental disorders are primarily seen as a biological disorder of the brain. Yet even today critics call for a radical rethinking of mental disorders, not as disease processes with many diagnostic labels, but as subjective and meaningful experiences of both personal and socio-cultural reasons. Though no one can deny that psychological and social stressors play important roles in triggering episodes of illness, we have to keep in mind that definitions of mental health are at best subjective. All in all, they reveal the intricacy and complexity of the problem.
Add to this the changes our modern life has made to the family and social structures and one can appreciate the challenges of dealing with this dilemma. The complication of these stresses touches all levels of our society. Even our own profession is not immune as about 400 doctors commit suicide every year. Furthermore when our politicians downplay the importance of the problem and decide that the government is not responsible for the problem so it should not be liable for it - adds even more to the quagmire of dealing with it. The acuteness of this problem peaked in the 1980s when a large number of mental health hospitals and care centers were closed and their patients discharged into the streets. Many became homeless and out of necessity resorted to a life of petty crime just to survive and thus ending up in our prison system - costing the tax payers more than it would have cost to care for them in the mental health facilities.
To deal with this dilemma, experts like; Rachel Pruchno Ph.D. suggest that we should bring back the mental asylums. But the very negative connotations attached to the concept of an asylum, turns everyone one off. Yet the problem is not the place for mentally ill people rather the negative stigma attached to it. The enormity of the problem shows the need for more resources to treat people with mental illness. The need for more psychiatrists, psychologists, and social workers. More inpatient facilities and integrated outpatient therapies so that people with mental illness are not homeless or imprisoned. We need to overhaul these infrastructures, not to eliminate them.
In this restructuring, Telehealth, Telemedicine, and Tele-education can play an enormous role. The majority of these people can be treated effectively with simple supervision of a professional. By involving family members, many could be managed at home. With a little direction, family practitioners could care for a good percentage of them in their office. And the more serious cases could be cared for in institutions run primarily by well trained midlevel and auxiliary healthcare providers. Telehealth, and Tele-education could be the solution to a major part of mental health treatment, and as it becomes a more and more acceptable means of treating, its usage can be enhanced and communication between parties improved. The means and facilities for this technology is available. We now need to use it, evolutionize it, grow it, and popularize it for the benefit of everyone.
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5-4-2017 - ATA Annual Meeting
A friend says; "whenever we return from these annual meetings, we feel hyped up with enthusiasm, fervor and excitement. Not so much from all the lectures we listen to or new products flashed in our faces, but rather from all the interest and passion we see in others. The way they see Telehealth, Telemedicine, and Tele-education used in their community, practice and communication."
I feel that medicine is seeing a brand new way of treating patients. Practitioners and administrators are finding avenues to tackle and address age old problems of bringing care to their facilities with new and affordable tools.
Where this excitement is seen the most is in the eyes of those from the rural communities, developing countries and torn up neighborhoods - whether from natural or human caused disasters. For the first time in a long time, we find actual possibilities in affordable patient care. I feel that not since the discovery of penicillin has there been such optimistic outlook in the way we care for each other, educate each other and learn. At a meeting not long ago, a doctor from a small island told me; "I am not afraid to ask questions any more." What a wonderful feat!
Still there are skeptics and deniers - though their numbers are declining. It is therefore up to each of us to provide accurate, truthful and honest information to the interested and inquiring public. We still do have a long ways to go to make available this technology to everyone who needs it. And we have even more challenges to convince many medical centers and academic institutions to see that Telehealth, Telemedicine, and Tele-education will benefit them and not be a detriment.
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4-27-2017 - Annual Meetings
In the last week, two very important meetings took place that affect the way Telehealth and Telemedicine are practiced and promoted in the United States; The first meeting was that of the "Federation of State Medical Boards" and the other, "American Telemedicine Association".
The Federation of State Medical Boards (FSMB)' annual meeting was significant as its work on the "Interstate Medical Licensure Compact" directly affects the very practice of telemedicine (listen to the opening ceremony here). Without clear and undemanding national licensing, all efforts toward the real practice of telehealth will be difficult. The entire philosophy of Telehealth and Telemedicine is the ability to bring needed help to underserved and rural communities of our country. Many of these areas are across state lines, making the need for the 'Compact' essential.
The other, even more urgent need for telehealth is the need for specialty medicine in many parts of the globe. According to "Orpha" and "Global Genes" websites, there are approximately 7,000 different rare diseases and disorders affecting more than 300 million people worldwide with only a few centers specializing in their treatment. Many in our own country facing the dilemma (see our article in Nov. 3, 2016 issue). The Compact would help the specialists in these centers care for patients everywhere. Fortunately FSMB is making progress in advancing the "Compact'. At the last week's meeting it was announced that Washington State Legislature just approved the Compact and it is on the governor's desk for his signature.
The ATA's meeting just ended yesterday and we don't have all the latest news of what was achieved there. Although we do know that it was a very successful meeting indeed. Hopefully in next week's newsletter, we will be able to post the accomplishments.
It is important to realize that these meetings and many others bring the importance of Telehealth, Telemedicine, and Tele-education to the attention of tens of thousands of practitioners, regulators and legislatures. Our small world is getting ever more populated and despite the fact that we elect representatives to address the many shortfalls it faces, the challenges seem to mount rather than be solved. No place is this issue in more dire need of immediate attention than in healthcare. Many leaders in the field are working very hard on many fronts to resolve the problems. But they need help from all of us. Please take some time and visit the website of some of these organizations (see the link list bellow) and see where you maybe able to help. The future of our troubled world depends on what we can resolve today.
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4-20-2017 - Apoplexy
We have been talking about the use of telehealth and telemedicine in the practice of medicine for many years. Organizations such as the American Telemedicine Association (ATA), Veterans Administration, Department of Defense (DOD), UNM Project Echo, NM Telehealth Alliance and many others, have been vanguard advocates of this technology. We see the changing world, the challenges it creates, and its ever increasing need for global healthcare as major reasons for our support of this technology. That along with the ever shortage of healthcare providers, especially in the real needy areas, makes this choice clear. Still there are many skeptics of the real value of Telehealth, Telemedicine, and Tele-education. So here is one proof;
In last week's monthly Alliance meeting, Dr. Howard Yonus, along with Dr Collin Semper from UNM dept of Neurosurgery reported on the federal award they received to use telemedicine in caring for stroke patients. The enormous difference it made to get care to patients in rural areas quickly and the great savings to all involved by keeping the patients in their hometown and local care facilities. Historically stroke patients were routinely transferred to major medical centers such as UNM. The enormous cost and wasted time in transport - whether by ambulance or aircraft - has been non-productive and often at the patients peril.
The use of telemedicine to treat stroke patients has been a God send. The UNM experience reveals that it has saved 20 million dollars in airfare transfers alone and added 12 million dollars to the bottom line of rural hospitals. Converting 80% of transfers to 80% that was kept at the local facilities.
They reported that telemedicine provides 24/7 consult and second consult within 24 hours. It avoids late transfers as well by helping hospitalists and local providers decide and care for patients locally.
It is important to realize that neurosurgical telemedicine consultations have lowered transfers to 15%. Of those retained at local hospitals, none transferred later, causing substantial savings to CMS and other payers. The small percentage that were transferred, often needed surgery.
The UNM neurosurgery department is working with Medicaid leadership and CMS to develop reimbursement code so that even small consult fees are reimbursed to hospitals, further helping and encouraging the local establishments to use telehealth.
This is a good example of how the technology of Telehealth, Telemedicine, and Tele-education helps bring state of the art care to patients in the underserved and rural areas, increase revenue to the local healthcare establishments, increase savings to the overall system and reduce the burden of stroke to the patients and their families. A real win/ win for all concerned. Such scenarios abound in this new arena. The ATA annual meeting in Orlando next week will reveal the many other benefits and show how Telehealth, Telemedicine, and Tele-education can truly make a difference in our healthcare delivery system worldwide.
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4-13-2017 - So God made a medic
Tomorrow is Good Friday and Sunday is Easter. Sacred days in the Christian faith. A time to reflect on peace and health in the world, important to all monotheists religions.
Back in the later part of last century, there was a broadcaster by the name of Paul Harvey. He had a style of news reporting that left everyone happy, no matter what the news. A great conservative commentator who made his point without insulting or annoying anyone.
In 1978, he made a narrative tribute to farmers, that years later was used in the background of an agricultural commercial broadcasted during the Super Bowl and became a sensation.
It was called "So God made a farmer." RIP Mr. Harvey. You were a great American!
Picking up on that narrative, I have made this account; "So God made a medic." A medic being any healer of physical or mental illness or injury. From a medicine man, curandera, military medic, nurse, to a doctor and surgeon.
{And on the 8th day, God looked down on his planned paradise and said, "I have made a farmer, now I need a healer." So God made a medic.
God said, "I need somebody willing to get up at all hours of the night to tend to the sick and injured, deliver babies. Then work all day in the hospitals and clinics. Go home late at night and love his family still." So God made a medic.
"I need somebody with wits strong enough to go into disease stricken areas of the world to care for them and yet wise enough to distinguish the dangerous from the safe. Somebody to go out to the rural communities and make the country folks feel the most important in the world. Listen to their complaints patiently. Tend to their spouse, children, and occasionally their animals too." So God made a medic.
God said, "I need somebody willing to go out into the bush, jungle or Sahara and spend years studying herbs, roots, flowers and venomous creatures in the hope of finding a cure for a disease of the living and be satisfied even if he fails to find what he is looking for and say, 'Maybe the next person will find it.' I need somebody who can live in solitude, care for himself and not lose his focus on his work. Make notes after notes, test after test, look through the microscope till his eyes can't see anymore." So God made a medic.
God needed someone who could learn from his/her mentor on all matters of folk remedies even when he couldn't read or write and use that knowledge to care for his/her tribe, clan, people and relations without concerns for herself. So God made a medic.
God said, "I need somebody strong enough to go to war, not to harm others but to care for the wounded and sick on sea and land. Someone to see all injured as My children and care for them proper, whether they be friend or foe. Go to the orphanages behind enemy lines and help with their needs at the risk of his own, and pray for their safety." So God made a medic.
"Somebody who would tell the grandchildren that there is no inheritance left for them, because he gave it all to the needy under his care the entire of his life. And have the grandchildren be proud of that achievement in their family heritage." So God made a medic.}
Fortunately for all of us in this technological era, Telehealth, Telemedicine, and Tele-education help reduce our exposure to many of these dangers, bring more people to us from near and far, and teach us lessons learned from around the world. Let us embrace the fact that God has given us this gift to share with His people. Lets use this Holy time to appreciate all that we are, for God has said in more than one place in His holy books; "All I ask of you is to believe in me and care for each other."
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4-6-2017 - Maya Angelou at AAOS
April 4 was the birthday of poet Maya Angelou (1928).
In 1999, she was the Presidential Guest Speaker at the American Academy of Othopaedic Surgeons' annual meeting in Anaheim, California. In his introduction of Maya Angelou, Dr. James D. Heckman, President of the Academy, said he chose Angelou as speaker to put a humanistic spirit into medical education. "We are overwhelmed with new science and new technology," he said. "It has been said that we are fine technicians, but lack the sensitivity and caring touch so often desired by our patients. With those thoughts in mind I have selected Maya Angelou, who I know will bring some balance and much beauty to these proceedings."
I was an attendee at that conference and was pleasantly impressed by her speech. I was particularly tickled when she started singing on how the "Toe bone connected to the foot bone, foot bone connected to the ankle bone, ankle bone connected to the shin bone,…" on and on to the skull bone - to thousands of orthopaedic surgeons.
After her speech, I met her and upon learning my name, she began speaking Arabic to me. She was disappointed that my knowledge of that language was very limited. I recall her quoting an African divine saying encouraging the orthopaedic surgeons to inspire others by "becoming a rainbow in their clouds." She told us the story of her son, who was paralyzed in an auto accident, but recovered and was able to walk, under the care of an orthopaedic surgeon. She gratefully told the audience; "It's amazing what you are able to do, and how many lives you touch. Even at the worst time, one can see a possibility of hope."
Recalling her childhood in segregated Arkansas, she said, "Stamps, Arkansas, with its dust and hate and narrowness was as South as it was possible to get. One needs to know that others have had sad times. One survives with compassion, humor and style."
Later in her life, she lived in Egypt and Ghana, working as a journalist. She was over forty years old when, on the advise of a novelist friend; James Baldwin, began to write. Her first autobiography; "I Know Why the Caged Bird Sings (1969)" was a great success. She went on to write many more books including "Oh Pray My Wings Are Gonna Fit Me Well (1975)". She Died on May 28, 2014 in Winston-Salem, NC. She was eighty six years old.
"Since life is our most precious gift, let us dedicate all our conscious lives to liberation of the human mind and spirit," she told her avid audience. "We human beings are more alike than unalike. Everybody wants healthy children, safe streets and love. Everybody wants someplace to party on Saturday night."
In 1999 there was no usable internet. In less than twenty years from that speech, Telehealth, Telemedicine, and Tele-education have completely changed the way we communicate, interact and learn from each other. Today we are overwhelmed with new science and technology but these tools also reveal the existence of many Angelous in our world. Many of them in our own world of medicine and education. By embracing their teachings and learning of the adversities they had to overcome to be the teachers they are, we too can be liberators of human mind and spirit and serve those who need us, not for monetary gains, but for the pure joy of helping our fellow human beings. As Angelou said; "When you learn, teach. When you get, give."
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3-23-2017 - Spring winds
Spring arrived last Monday in the early hours of the day. It is said that "as the seasons form a great circle in their changing, so does the life of a person - from childhood to childhood." The spring winds are an integral driver of this circle and their stimulating powers too, bring new messages to the awaken; "Arise and start anew, for much awaits to be done. All things evolve from the creator and all must revolve to complete the circle of life!"
Thus the spring equinox is celebrated by many cultures as the beginning of their calendar year. But our troubled world makes any celebration less of a festivity these days. The overwhelming exodus of many from their distressed surroundings is overpowering the resources of what used to be sanctuaries. Unfortunately the future is unclear for refugees as well as asylums. Such uncertainties distress people to mental instabilities and illness. Spring times are usually a busy time for medical practitioners as people - sick with cabin fever - dash outdoors unprepared and fall to illness and injury. The new political, social and economical worries however, add a new level of healthcare needs that many of us are not trained for and are ill prepared for. Regardless of who is right or wrong, health practitioners must deal with the adverse outcome of the state of affairs.
At times like these, we need to embrace the power of technology at our disposal to deal with the grave needs of many seeking our help. Telehealth, Telemedicine, and Tele-education can help both sides to bring conditions under control. Telecommunication can bring needy and provider together without jeopardizing the resources of either. I hope that we can address this urgent issue at the upcoming ATA meeting. Our troubled world is looking for help. With telehealth, telemedicine, and tele-education, we can provide a great deal of assistance. Lets find ways to be helpful for after all, the great circle will change and the world of tomorrow will remember the caring people of yesterday!
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3-16-2017 - Entropy
Last Tuesday, March 14 was International Pi day. No, not pie day, rather Pi day. The mathematical constant that is the ratio of a circle's circumference to its diameter, approximated as 3.14159. Although it is believed that the Babylonians were the first to have calculated it to be about 3.125, Archimedes (287-212 BC) is considered to be the first to calculate it accurately. Thus March 14 or the fourteenth day of the third month of the year (3.14) is celebrated as Pi day by mathematicians.
It is one of the constants in the laws of the universe that control and regulate our lives. Although some laws like entropy point to chaos as being another constant, it can be argued that the chaotic changes in themselves are orderly.
In medicine too, entropy is considered by some to be the cause of genetic mutation and degradation of our life due to accumulation of bad mutation in human genome. But genetic mutation happens in all living things. The one thing however that is overlooked is the fact that - it stands to reason - at that same rate, good mutations occur as well. These good mutations too are passed on from generation to generation and maybe the reason why many of our children are smarter than we are. It is true that we are mortal but that too is a universal constant and all living things in fact are mortal - as is the universe itself. But what is mortality? The second law of thermo dynamic indicates that "energy must be spent in order to create order!" And the first law of thermo dynamic indicates that "energy can not be created or destroyed!" Then the third law of thermo dynamic (entropy) indicates that "energy must degrade to perform work." So if life is a form of energy, the mortality of it could be considered a change in its form and not necessarily the end of it.
The fact that more of us are realizing, researching, experimenting and working with this knowledge in itself is a proof of advancement of our genome in good ways. For example, our progression in computer technology is contributing to the enrichment of our understanding of the many natural laws. That comprehension too will enrich the way we will practice medicine in the future. Telehealth, Telemedicine, and Tele-education are tools that will contribute to this understanding. Maybe we should just slough off our comfortable layer of old beliefs and embrace the chaos of the new information coming our way. That however does not mean to destroy or disregard old knowledge, traditions or customs. Rather it means to built upon their foundation and establish a just and equal world for all. A healthy world encourages the good mutational changes in our genome and a weak, diseased, and contaminated one degrades those mutational changes. The real question here is, how to use the technology at our disposal to make positive changes and mold the entropic energy to perform constructive work. It is said; "The HOWs in life are easy, the WHYs are the tough ones." But today we can say that; "We know what needs to be done, HOW to do them are the tough ones." Telemedicine, and Tele-education can help us find ways to make the positive changes.
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3-9-2017 - Women's Day
Yesterday was "International Women's Day". Our congratulations to all the women in the world, in business, politics, science, education, medicine, engineering, aerospace, and all the other fields that their contributions have been important. But I would like to also recognize all the selfless ladies whose tireless work support the very fabric of families and societies. The nuns who run shelters and clinics in very rural and desolate areas of the world. The volunteer nurses and doctors who feel more rewarded helping the needy in war torn regions of the world than working in a plush urban hospital. Those female members of many societies who face the daily barrage of harassment in order to provide for their families. They are the real heroes in my book.
Working in a small town in rural Colorado, a long time ago, I had the privilege of practicing alongside a wonderful nun nurse whose name (unfortunately) I cannot recall. She and several other nuns traveled from a rectory in Walsenburg, CO. They would attend to the many people living in isolation in the Colorado mountains. Many were handicapped by age, genetic problems, illness, or other maladies. Although these ladies were all wonderful in their devotion, my colleague was truly noble in her efforts. She would drive many miles on the mountainous and dangerous roads of the area to deliver care to people who at times were not even aware of her presence. In winter, those roads were particularly treacherous, but would not s her. I learned a lot from that lady - particularly obstetrics. I helped her deliver several children. Some under extremely trying conditions. As many families lived in primitive conditions without electricity or proper plumbing. Ladies like her need real recognition.
What is noteworthy that in those days, communication was non-existent. Our small clinic was sixty miles from the nearest town and any semblance of a hospital (twelve beds, one doctor and another part time physician visiting from the nearest city 120 miles away). To make a long distance phone call, we dialed the operator and gave her the number we were trying to reach and then waited for the operator to contact that hospital, university or specialist and have them call us back. Sometimes we would not even hear from them for a day or two. Today the communication technology of Telehealth, Telemedicine, and Tele-education allows us almost immediate access to specialists anywhere. High quality cameras - even in our cell phones - eliminates the need of tediously describing patient's condition verbally.
Although these incredible technologies put us in closer contact, many of our citizens still live in isolation throughout the world and many healthcare providers - women and men - still care for them. The need however is greater than ever before which is surprising, given the ability of telehealth, and tele-education to keep us in real time contact. So our sincerest salute goes to all our colleagues - especially the women - who give so much without being rewarded or even recognized.
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3-2-2017 - Optimism
The calendar tells us that February 25 was the birthday of Idawalley Zorada Lewis Wilson (1842) an American lighthouse keeper in Newport, Rhode Island. She is noted for her heroism in rescuing people from the sea. On July 16, 1881, she was awarded the prestigious, Gold Lifesaving Medal from the United States government.
Today there is an Ida Lewis Light house, an Ida Lewis yacht Club and museum and at least two pieces of music were named for her: the Ida Lewis Waltz, and the Rescue Polka Mazurka.
There is even a Coast Guard ship named after her. She died of cancer on October 25, 1911.
Women like Ida Lewis, have always been achievers and at the forefront of their field and profession. Just this week the Albuquerque Business Journal named the UNM Health Sciences Center’s Martha Cole McGrew, MD, and Jamie Silva-Steele, RN, as Albuquerque Business First
"2017 Women of Influence." - We also learn that Ms. Lynn Gallagher has been confirmed by the NM Senate as Cabinet Secretary for the New Mexico Department of Health. Ms. Gallagher was appointed as Secretary Designate by Governor Susana Martinez following the passing of Secretary Retta Ward in March 2016.
Fortunately for us, today's communication advancements make it possible for us to learn about the many heroes of history like these great ladies. This same technology helps us bring help and our specialties to patients near and far. Telehealth, Telemedicine, and Tele-education are tools that can make heroes of all of us. At the forefront of this innovation is The American Telemedicine Association. Peter Yellowlees, MD, President-Elect and Chair of Member Groups wrote in the recent ATA Newsletter that; "No longer are we primarily focusing on telemedicine as an innovation. Instead, we are examining implementation methods and how to achieve quality and value with better patient care through the use of telemedicine. As such, we are going to depend on the work of our increasingly engaged members, with all of your expertise, to move the association and healthcare changes forward."
Such visions and foresights are what propels us into Twenty First Century medicine. March is optimism month and we at the New Mexico Telehealth Alliance are very optimistic about the role of telehealth, telemedicine, and tele-education in the future of the healthcare delivery system.
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2-23-2017 - People are beautiful
People are beautiful. My daughter was showing me a Flash Mob performance of young musicians in Sao Paulo, Brazil on You Tube. The piece was Ravel's Bolero. The musicians were very young - high school age. Their performance was with such vigor, vitality, and enthusiasm that it filled my heart with joy. I was not familiar with the concept of Flash Mobs and became thrilled by it. I surfed around and found a few more fascinating performances.
What I noticed the most however, was the goodness of the performers and the happiness they raised in the surprised and enthralled shoppers. Not a face without a smile. It shows the goodness many bring to our world.
This is noteworthy as Feb. 19 was the birthday of novelist Carson McCullers, born Lula Carson Smith in Columbus, Georgia (1917). Author of "The heart is a lonely hunter" and many others. Although her writings were often of tragedies in people's lives, they equally portrayed the kindness of many others as well.
She wrote in The Ballad of the Sad Café: “The most outlandish people can be the stimulus for love. A man may be a doddering great-grandfather and still love only a strange girl he saw in the streets of Cheehaw one afternoon two decades past. The preacher may love a fallen woman. The beloved may be treacherous, greasy-headed, and given to evil habits. Yes, and the lover may see this as clearly as anyone else — but that does not affect the evolution of his love one whit. .… It is for this reason that most of us would rather love than be loved.”
To love is to give selflessly. It is the rationale for many of us in choosing medicine as a vocation. We care and give, love and provide solace to those who seek our help. It is a satisfying service that gets more fulfilling with age. No where does this present itself better than in the heart of a country doctor. Where we know everyone by name and their relations. Where payment sometimes comes in the form of eggs, milk, and tortillas rather than cash.
Even city folks may recompense you with such gifts.
While working in a small town in Northern New Mexico, I once took care of a fisherman - up from the city for the day. He hooked himself while fishing and sought my help. I removed the hook and got to know him a bit and gave him a ride to his car. He loved fishing and the Rio Grande Gorge - close to my clinic was his favorite hole. He asked if I liked trout - well "yes" was my response. For the next couple of years, every time he came up fishing, he dropped a few of his catch for me on his way back to the city. A simple fish hook removal provided me with fresh fish for a couple of years.
Today's uncertain politics and conflicts around the world, generate many needy people. These disorders make even the most well intentioned provider, hesitant to volunteer his or her services. Fortunately technology helps us to do our share even from far distances. Telehealth, Telemedicine, and Tele-education are wonderful tools that avail to us the means of being a good Samaritan without jeopardizing our safety, security or well being. We will find that people are beautiful even when they are sick, hurt, homeless and destitute. Today's technology gives us many opportunities to help each other. All is needed is our desire to use them and help our fellow men.
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2-16-2017 - Darwin Day
February 12, 1809 was Abraham Lincoln's birthday and also Charles Darwin's birthday. Two giants of history who set our world on a new course. Different yet parallel in scope and enormity. While Lincoln's revolution forever changed our social outlook of humanity, Darwin's theory altered the very understanding of our existence. Both concepts faced enormous opposition and resistance from many levels of society. The religious groups were some of the most outspoken on both fronts. While many spiritual groups supported Lincoln's anti slavery stance, many more staunchly opposed Darwin's.
Today, while we clearly support Lincoln and Darwin's ideologies, we have vastly different philosophies on how to incorporate one or both into our own lives. But philosophical or political ideologues aside, our modern technological wonders of communication give everyone the tools to find support for their point of view - whatever that maybe.
Many of us in healthcare entered our profession with the same zeal and ideology of making a big difference in people's lives as well as our own. We have had many revolutionaries and pioneers in our own world. But here are some women medical pioneers that you probably never even heard of;
Trota Of Salerno (11th Century)
Jane Sharp (1641-71)
Mary Seacole (1805-81)
Elizabeth Blackwell (1821-1910)
Elizabeth Garrett Anderson (1836-1917)
Yoshioka Yayoi (1871-1959)
Rebecca Lee Crumpler (1831-1895)
Susan LaFlesche Picotte (1865-1915)
And then there were all those countless men and women of medicine, curanderas, and folk medicine sorts, who, although having little to no western type education, nevertheless had enormous knowledge of botany, herbs and concoctions of all kinds. Their wisdom has contributed much to our knowledge of health and medicine.
Fortunately for us today, Telehealth, Telemedicine, and Tele-education bring all this knowledge right into our home with a click of a computer key. By the same token, it can make heroes of many of us by allowing us to share our knowledge and expertise with people all around the world. Let us build bridges, share our knowledge and help those in need everywhere. Telehealth and Tele-education can take our help to every corner of the globe.
In these chaotic political and social times of uncertainty, peoples physical and mental health suffer greatly. They turn to us, the healthcare providers for help. It is important that we don't allow our own prejudices and views interfere with our work. As the newly elected President of Germany; Frank-Walter Steinmeier said: "Let's be brave and not make politics with fear, because then we don't have to be afraid of the future."
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2-9-2017 - Children's Oral Health Month
This week, Governor Susana Marinez, proclaimed the month of February 2017 as "Children's
Oral Health Month" in New Mexico.
New Mexico suffers from a shortness of dentists. According to NM Health Resources, at the present time there are openings for 23 dentists, especially in our rural communities. The majority of our dentists practice in cities, leaving the smaller towns without providers.
There is a bill (SB 264) in the legislature to create a mid-level type of provider; "Dental Therapist". The bill has the wide support of many healthcare and community leaders but has met some resistance from the organized dental groups. They have the same old and tired argument about lack of supervision, substandard care, etc. The same objections were made forty years ago when many of us approached legislators and the medical and nursing boards regarding physician assistants and nurse practitioners. Today these professionals are an integral and important part of our healthcare delivery system.
Several states have adopted dental therapists and have shown improvement to their dental care delivery system. Especially in their rural and under served areas.
Governor Susana Martinez, has proclaimed this month as "Children's Oral Health Month" but our children in many rural and under-served communities have no access to proper dental care professionals. So how are our children to have oral health without oral health care providers.
The New Mexico Telehealth Alliance strongly supports SB 264 and the concept of dental therapists. Today's Telehealth, Telemedicine, and Tele-education provide a great means of supervision, and consultation for these new professionals. The advanced technology of Telehealth and Tele-education allows for direct and proper consultation and observation of their work through high quality live video conferencing.
Please join us in supporting this bill and providing proper dental health care for our children everywhere.
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2-2-2017 - Healthcare and Our Legal System
Among the stack of mail on my desk is a letter from NM Medical Review Commission asking me to serve on a hearing of an alleged malpractice case.
The Commission was established by our legislature to provide hearings for potential malpractice cases against healthcare providers before they go to court. It consists of three providers and three attorneys sitting on the hearing where a patient and his or her lawyer are accusing a provider of negligent, wrongdoing or malpractice that has allegedly caused harm to that patient. On the other side, the provider and his or her attorney present their case, defending themselves. The majority of the cases arise from simple misunderstandings.
This experience along with my time served on the Medical Board has taught me much on the intricacies of the legal aspects of providing healthcare. Although there are a few bad apples among us, I have found that overall my colleagues do an admirable.
Although most hearings are straight forward, some are interesting for being utterly preposterous. Others maybe classified as down right stupid and some, hilarious.
There was a case a few years ago, where a patient had surgery by a very reputable surgeon. The outcome was not perfect due to the fact that the patient - an alcoholic -repeatedly damaged the surgical site. The surgeon and staff at that practice attended to that patient many more times than was needed to assure success of the case and they were successful in doing so despite the patient's total lack of concern. An attorney brought suite against the doctor claiming the doctor should have done a better job as the patient's result was not optimal. But could not show what 'optimal' in such a case was nor did he even knew anything about the case. The patient was not helpful either as it was obvious that it was past drink time.
On another case a patient, while visiting friends in a nearby town, shot himself in the leg by accident and was seen at the ER and cared for. On return home, did not seek follow up as he was suppose to. Few days later he developed chest pain and went to see his primary care provider (PCP) but did not mention the accidental gunshot wound to his leg. Many laboratory test did not reveal what the history could have told the PCP. Lack of history and normal lab tests lead the PCP to treat him for a possible bronchial infection. The next day when his condition worsened, he refused hospitalization and still did not reveal the gunshot wound to his leg. The following day an embolism killed him. His wife suede for negligence and malpractice. At the hearing we asked the wife if she was present at the visits and she said yes. “Did your husband tell your PCP about the gunshot wound?” No! was the answer. “Did you tell the PCP about it?” again no was the answer.
“Why?”
“We didn't think that the two were related and my husband was embarrassed for shooting himself in the leg.”
Then it was the time when a young female attorney, new to the job, came to the hearing dressed to kill – low , short skirt and all. Expecting to address a bunch of old retired guys. Only to find herself facing a group of very serious female professionals. She didn't do well.
Right or wrong, our society allows for lawsuits, frivolous or not. However, I feel that Telehealth, Telemedicine, and Tele-education are the tools that could avert these kind of suites. The PCP in the small town clinic could have used it to get help in the diagnosis and perhaps the records from the ER. As political atmosphere in our country turns, the chaos it creates could cause confusion that may lead to misunderstandings. Such misconceptions lead to lawsuits. Telehealth and telecommunication could help us stay clear of confusions.
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1-26-2017 - Legislatures in Session
Many state legislatures along with New Mexico are now in session and struggling with budget and monetary issues. Due to the plan to repeal the Affordable Care Act at the national level, more of the healthcare costs will fall on the shoulder of the states. With the economy being where it's at, many states look to balance their budget by reducing the budget of other departments. Education and healthcare are always on the of the list to receive cuts. Yet it is education and healthcare that contribute to the future well being of every state and our country. All the tax incentives will not help if citizens see that their families are not being educated well or receiving proper healthcare. At times like these our lawmakers need our input and help in deciding where to put the limited state money, or at least where not to cut it.
Telehealth and tele-education can help provide great education and healthcare for our people, statewide and nationwide. Our legislatures need to see the advantages of this technology and the benefits it will bring to their constituents and it is our job as healthcare providers to make them aware of it. The recent congressional approval of UNM's Project ECHO is an important proof of the viability and affordability of Telehealth, Telemedicine, and Tele-education. The ECHO Act will increase access to specialized healthcare in rural and under-served areas nationally. Let's get involved and contact our legislatures and offer them our knowledge and help. They can use our expertise and would welcome help in dealing with the opposition.
In most states, the legislative process is broadcasted or webcasted. You can watch the NM Legislature in action via their webcast as well.
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1-19-2017 - Grandma use to say
Grandma use to say: Never go to a restaurant, where the cook is not fat.
If you want something done quick, ask a busy person to help you.
Never criticize something you don't do yourself.
Look at the poor around you before putting that first spoon in your mouth.
A lot of truth to all that. The old timers spoke from experience, but today the technology of our day keeps people separate and makes criticizing things we know nothing about, easy and protects us by keeping everyone anonymous. The Chinese's vernacular that; "to know someone, walk a mile in his shoes." is sage advise. But many of us would rather criticize that person's shoes, than to walk in them.
Providing healthcare is something everyone has an opinion about. How many books have been written about the upbringing of children by those who have no children, or on losing weight by slim people. But unless you have sat next to a worried mother with a child who has a 103 fever or watch hopelessly as the life drains from the face of a fourteen year old boy who has been stabbed – despite your heroic efforts to save him, you can not appreciate the enormous responsibility carried by every healthcare provider doing his or her job. For at that moment when the eyes of a desperate mother in Albuquerque, or a dying teenager in South Bronx, or a wounded soldier in a foxhole is on you, all the politics, rationalizations, logic, excuses, and justifications will matter not.
Those who developed the wonderful technology of today's communication, did not intend for it to be a tool of evil, it was developed with the idea for us to help each other. Telehealth, Telemedicine, and Tele-education are great instruments that can be used to bring care, peace, humanity and harmony to our troubled world. Yet many feel threatened by it, criticize it and pass legislation to s it or restrict it.
Our world is in dire need of help. While many feel justified to restrict access to healthcare options, the need for medical care increases exponentially. From the plight of the homeless, whether from poverty or war, expansion of diseases caused by overpopulation or environmental effects, psychological and behavioral changes due to combat experience or daily living stresses, all place the livelihood of many at jeopardy. So maybe we should s criticizing others misfortunes and do try to walk in their shoes – if not for a mile, just around the block.
Legislating bodies start work this month – at federal as well as state levels. It behooves us all to contact our representatives and ask them to help our world by passing laws that will benefit every one. I am sure that their grandmas had similar advise. They just need to be reminded of it.
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1-12-2017 - New Year Challenges
The political atmosphere of the day demands clarity as we enter the new year. The challenge for us healthcare providers is to be able to treat our patients without prejudice and political overview. We were taught that our patients have no color, nationality, race or creed. They are all human beings needing our help. Their language is not English, Chinese, Arabic, Swahili, or Navajo, rather their communication is of pain, discomfort and malaise – of themselves or a loved one.
Nationalistic fervor, political conservatism, and xenophobic ideologies have no place in a treatment room. Our relationship with our patients must be much like that of a priest and a parishioner and our healthcare center as a church and sanctuary.
The world in 2017 will be preoccupied with all kinds of regional problems. In Europe, the Brexit shock of 2016 reverberates. Many European countries facing elections will look to the outcome of our election and may challenge their system by supporting xenophobic and nationalist parties. In the far-east, resource-rich China may fill in the economic void created by western trade and investment protectionism, creating more uncertainties for people of all nationalities.
In the middle of this chaos, live millions of homeless and refugees that, due to no fault of their own, have lost everything and are looking for a glimmer of hope and a chance to set their lives back on course. Yet the new protectionism of many is drowning that hope. In the United Nations, a new Secretary-General; Antonio Guterres of Portugal took up his position this month and in his first address to the UN, said; "I remember the times when most borders would be open and now we see borders closed, now people do not even have the right to be a refugee in many parts of the world."
In these times of uncertainties, psychological as well as physical hardships sicken people. Not to mention the deplorable conditions they live under. Often their only hope for the relief of their pain and discomfort will be a visit to a healthcare provider – if there are any among them. In our brief encounter with them, we must show mercy and unbiased concern and remain brutally neutral. With our own citizens as well as others. After all lets not forget that the epidemic of the 1918 that killed over 30 million people worldwide started out of similar chaos.
Fortunately the technology of Telehealth, Telemedicine, and Tele-education helps us reach more of the needy near and far. We can employ many of our colleagues – even those with reservation – to care for these people through telecommunication of Telehealth and Telemedicine. This technology allows us to even care for our enemies, without jeopardizing safety.
In a recent interview Mark Zuckerberg – founder of Facebook said:
"For decades, technology and globalization have made us more productive and connected. This has created many benefits, but for a lot of people it has also made life more challenging. This has contributed to a greater sense of division than I have felt in my lifetime. We need to find a way to change the game so it works for everyone. After a tumultuous last year, my hope for this challenge is to get out and talk to more people about how they're living, working and thinking about the future."
Maybe we all need to get out and communicate with more people and spread hope!
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1-5-2017 - Happy New Year
On Some New Year days, I stayed at home.
And on some, I've been far away.
Some times, far away places were home.
Other times, home; Far Away!
No matter where I was though, there were those who called it home! Celebrating the coming new year, wishing each other good health, prosperity and a resolve to be better in whatever they do. Though prosperity maybe more of a "wishful thinking", "good health" is what we all strife for. In illness, we pray for rapid recovery and hope to receive help fast. Help however, may come from unexpected and unusual places. To this, a sage healer remains wise and amenable.
Camping in the wilderness once, I observed a rather large injured lizard, chewing repeatedly on the bark of a tree by the stream. I was fascinated and curious, as I could not see any nutritional value in that bark. Years later, I learned that the tree was a White Willow and it's bark contained salicylic acid (Aspirin). The lizard knew, as I did not, where to find medicine for it's pain.
Through the many travels, I have learned that people approach problems according to the beliefs and customs of their land and time. Often I interjected my Western learned knowledge to their true and proven remedy, only to find - to my surprise - for it to be inferior to what was practiced there. On a New Year's day, long ago on a Caribbean Island, I saw a young boy rubbing mud from a hot spring into a cut on his leg. I objected but was assured by him that it will help it heal. Over the following days I saw the boy several times and he would proudly show me his healing wound. Back at the clinic, I was told by the local doctor that the mud contained Sulfur, iron and many other mineral. The acidic hot spring water thus acted as an antibiotic and had healing properties.
Today the power of our technology allows us to learn as well as teach one another around the world. There is so much knowledge that we can share for the betterment of ourselves and others. Telehealth, telemedicine and tele-education can bring this knowledge into our homes and offices. It is great that not only can we treat patients with our modern medicine, but also understand, know and learn their cultural and home remedies. For what makes home such a special place, is that beside being a safe abode, it heals us of our ills by the knowledge local to it, and that is very precious. I, for one see an immense opportunity in sharing the health of the world through these technological tools.