Real physicians discuss recent healthcare headlines.
Cleaners perform critical work in COVID ICUs
https://abcnews.go.com/Health/wireStory/sight-cleaners-perform-critical-work-covid-icus-75559448
COVID is just highlighting a group of people who are ALWAYS overlooked. When was the last time you thanked the housekeepers in your department and told them they do a good job cleaning up your trauma bay or the bathrooms or the break room? Do you know any of their names? On your next shift, seek them out and make a point of saying thanks. I will do it, too. And when all this COVID crap goes away, keep doing it.
—E. Paul DeKoning, MD, MS, FACEP, FAAEM
Public service announcement…Have you said thank you to your environmental services team? They are often the forgotten frontline workers…they show up every day for little compensation…learn their names…be sure to thank them…we could not do our jobs without them.
—Salim R. Rezaie, MD
This all day long! I always try to show appreciation for the support staff in the hospital and have doubled down on it during the pandemic. It’s amazing how far a smile (with my eyes because I am of course wearing a mask) and a hello goes in the hospital hallway. So take the time to be friendly, say hi and learn the names of those “behind the scenes” hospital workers that make the place hum.
—Andrew Kalnow, DO
Every one of the housekeeping staff at our hospital is dependable, brave and hard working. It is so sad to me that the staff in this article is embarrassed by the work they do. Medicine’s “front line” can’t do too much without a good backfield. Hope everyone uses this article as a
reminder to thank all the ancillary staff at their hospitals on a regular basis.
– William Sullivan, DO, JD
This should be a group that gets thanked always (not just in pandemic times), including the people who launder our scrubs, clean our showers and decontaminate the room after an infectious patient has occupied it.
—Evie Marcolini, MD, FAAEM, FACEP
Docs spot potentially fatal iPhone 12 problem with pacemakers, defibrillators
https://www.usatoday.com/story/tech/2021/02/04/apple-iphone-12-pacemakers-defibrillators/4389285001/
This is incredibly important for patients and physicians alike to know. I just hope it doesn’t balloon into a ban on all phone use. I can remember when families were not allowed to use cell phones in the ICU, which seemed silly because the rest of us were.
—Evie Marcolini, MD, FAAEM, FACEP
My first thought is what geriatric patient with a pacemaker/defibrillator carries their newer-than-mine iPhone in their chest pocket? My soon to be 40-year-old self is so far behind the times. On the plus side, the patients’ iWatch will pick up on the rhythm change and tell the patient to seek medical care.
—Andrew Kalnow, DO
MagSafe wireless charging…Yay…no more wires…MagSafe magnets inhibit pacemakers/defibrillators…Whoops!!!
—Salim R. Rezaie, MD
One word: oops.
—E. Paul DeKoning, MD, MS, FACEP, FAAEM
Oops is right. With technologic advances, older technology has to be updated. Unfortunately, updating a defibrillator isn’t quite as easy as upgrading your computer. The idea of shutting down someone’s pacer/defibrillator with an electromagnetic field could be the basis for a new John Grisham murder mystery.
– William Sullivan, DO, JD
Oklahoma Returning $2M Worth of Hydroxychloroquine
https://www.seattlepi.com/news/article/Oklahoma-seeking-to-return-2M-worth-of-15902236.php
OK returning Hydroxycholorquine: not sure what’s news-worthy here. Seems to me like it’s an attempt to thumb a nose at and cancel one or more individuals who dared to question a party line (“HCQ is baaaad”— it’s not. It’s safe. Ask the millions of people who take it every Sunday) that may have an underlying agenda. I’ll probably be next; don’t waste your time.
—E. Paul DeKoning, MD, MS, FACEP, FAAEM
Hoarding, stockpiling and panic buying…does this sound familiar? What exactly is the deal with everyone buying all the toilet paper? Well, I digress…this type of behavior leads to national shortages of essential items. I find it ridiculous that this behavior is allowed and then when the crisis is over, we condone this behavior by allowing the return of the purchased product. How about instead we focus on the real story here…equitable distribution of needed therapies instead of first-come, first-serve?
—Salim R. Rezaie, MD
I agree with Sal, this is more about hoarding than about betting on the wrong treatment. The big issue here is that we don’t have a coordinated federal response to supplies needed in the middle of a pandemic and the states, hospital systems, etc are left to fend for themselves. I hope this might change with the administration change and there is some indication it will, but it is a major rebuke to the state of federal pandemic response affairs.
—Andrew Kalnow, DO
Why should Oklahoma get a refund on medications it ordered in haste? On one hand, stores allow refunds. On the other hand, you don’t get a “do-over’ if you make a bad choice purchasing stocks and the value goes down. Guess it depends on what is in the purchase contract. If I was the manufacturer, I’d send the Oklahoma attorney general a thank-you note saying “caveat emptor.”
– William Sullivan, DO, JD
Fecal microbiota transplant overcomes resistance to anti–PD-1 therapy in melanoma patients
https://science.sciencemag.org/content/371/6529/595
I believe there is a lot about the gut microbiome that is not completely understood. However, getting a fecal transplant is pushing the boundaries of what I would be comfortable with and leaves me with some questions that I would like to have answered. It’s all about the details people. Is this oral transplantation or enema transplantation? Is this my feces or someone else’s feces? Does this treatment modality come in flavors?
—Salim R. Rezaie, MD
Poop transplants, the microbiome, and melanoma: I won’t begin to claim that I understand much of this, but this I do know: the microbiome is exceedingly interesting and will probably be a hot area of discovery for generations.
—E. Paul DeKoning, MD, MS, FACEP, FAAEM
Fecal transplant is nothing new, but it’s still gross. What else is stool going to be good for both detecting and treating? It’s more accurate than nasal/oral swabs for COVID, treats C. diff and now improves response to anti-PD-1 immunotherapy (whatever that is).
—Andrew Kalnow, DO
So this isn’t exactly an emergency medicine issue. I haven’t heard of stat fecal transplants. But the idea that the bacteria inside our bodies can affect the efficacy of medications we take — in this case how well chemotherapy works for malignant melanoma — should be of interest to every medical practitioner on the planet. Then I wonder about all the antibiotics we prescribe. Could they do more harm than we know?
– William Sullivan, DO, JD
OK, everyone giggles and the jokes come out when we discuss fecal transplant. But it’s a real thing! I’ve prescribed it for multi resistant c-diff in critically-ill patients. We should take off our allopathocentric hats, and our discomfort with the human exit system once in a while to consider possibilities of the GI system. I once took care of a cancer patient in the ICU who was incredibly constipated and had hypertension resistant to every medication we threw at her. Her husband finally begged us to give her a coffee enema that she had been on for years (seven years of stage 4 pancreatic cancer to be clear). Once we convinced the nurses to do it, guess what happened? Oh yes it did.
—Evie Marcolini, MD, FAAEM, FACEP