The Curious Evolution of Medicine

When you think of evolution you imagine it happening in the natural world. Simpler organisms turning into more complex life forms. As evolution unfolds plants and animals becomes more diversified and specialized. In medicine it's the same.

Recently I visited a hospital where it had a small museum. It displayed old medical equipment. Crash carts used to be wooden and the size of a cabinet. Pacemakers were chunky, huge metal devices that looked like they could barely fit into a patient's chest.

Radiology (a relatively new medical science along with anesthesiology) started out using heavy and fragile glass plates for X-rays. The exposure time was long (think of holding 45 minutes completely still while in pain) and the plates had a nasty habit of breaking. 

Enter World War I and the need to find X-ray plates that were both durable and could be developed quickly. This was the beginning of X-ray plates using film. Fast forward to the 21s century and film plates are all but obsolete and Computed Radiography is giving way to Digital Radiography. 

Now everything is becoming miniaturized. We have endoscopes and catheters, lessening the the need for invasive surgery. We have microscopes and robotic arms in the operating room. If physicians from a century ago stepped into today's hospitals they'd probably be amazed and overwhelmed.

Just like in evolution, however, medicine is becoming more specialized as it grows increasingly more complex. Whereas physicians used to have to know a little bit about everything in general medicine now it's impossible to know everything about every specialty. The need for more specialized physicians communicating and coordinating the care of patients sometimes lead to confusion and miscommunication.

Are we becoming over specialized to the point medicine is too complex, unwieldy and inefficient? Is is possible that even with the advances in medicine we don't provide the best quality care? 

While I'm not one to long of the simpler (and less effective) days of healthcare sometimes I worry we've lost the human, personal touch in medicine. We need to start focusing on being less clinical and more compassionate toward our patients. We shouldn't let the "care" in healthcare go extinct.

- Kim Schure, RRT (R)

Healthcare Copywriter

RSNA 2013 comes to Chicago

When I'm not writing I work in X-ray as a radiologic technologist. It seems pretty straightforward. You need an X-ray machine, the right technique (kilovoltage and milliamperage) and a way to move your patient so you get a good picture without causing too much patient discomfort. When you work as a technologist you aren't aware of the latest innovations in radiology occuring around you. Then I had a chance to see where the magic happened.  

I attended the Radiological Society of North America's (RSNA) conference in Chicago. It was an overwhelming experience. There were exhibitions in halls so vast you could get lost in. The big vendors are always there - GE, Toshiba, Agfa and Cerner - name brands I'm familiar with just from going to work. 

I felt like a kid in a radiology candy store. 

Every year radiology vendors display patient tables with now digital X-ray equipment and portable radiographic equipment that's lighter, smaller and calculates the correct dose just by calling up the patient's information.There are patient tables that can lower - allowing easier transfer of the patient to the table and lessening the chance of staff injury. 

More fluoroscopic equipment, CT and MRI tables are designed to accommodate heavier patients. I saw an MRI with an open bore that eliminated the problem of claustrophobia and allowed patients to sit during scanning. There also was the newest software in CT that helps eliminate the noise (graininess) on radiographic images so they are more diagnostic and drastically reduces the radiation dose to the patient.

Perhaps the greatest treat, however, was meeting entrepreneurs who came up with a novel solutions in diagnostic imaging. I saw equipment that used a computer to calculate the angle and depth of a needle in delivering steroid injections during pain management. 

I met a physician who developed a device that would lift the breasts out of the way, thereby reducing the amount of radiation to the breast tissue during an X-ray or CT scan. There even was a cream that could be applied to gloved hands that would reduce the radiation received to the extremities during a fluoroscopic procedure. 

After leaving the RSNA, I wondered why I didn't see these innovations at hospitals and clinics everywhere. How come these inventions are the exception more than the norm in treating patients? 

Part of the reason is money. New equipment and the latest software is costly, but some of these entrepreneurs are not charging the top dollar the big companies are demanding for the latest diagnostic equipment. In the end, it all comes down to marketing.

How successful were these vendors at creating a demand for their services and equipment? Often I saw brochures at the conference that truly didn't sell their products and services. Most of the marketing literature consisted of long spec sheets or densely-worded case studies. Were these effective? Did they bring in the new clients?

If not, how could they have done it differently? Is there a better way?

The short answer is Yes. And here's how.

The Hidden Risks of Patient Obesity

We all know obesity isn't healthy and comes at a high cost to your health. It may cause serious health problems such as diabetes, heart disease and skeletal fracture. Despite these risks obesity is rising in the United States. Global Data reported that in 2012 167 million Americans were obese. The growing number of obese patients also is creating additional problems in healthcare. 

One Size Doesn't Fit All

It's often assumed that obese patients are able to receive identical care and diagnostic procedures as patients at a healthy weight. As patients' weight increases more challenges occur in trying to treat them. 

Obese patients pose a special problem in obtaining diagnostic images. Patient tables designed before 2000 often are unable to hold patients exceeding 400 lbs. X-ray tubes and fluoroscopic equipment also yield poor quality images due to the increased density of obese patients. More radiation must be used to obtain diagnostic images, but put the patient at greater risk. Magnetic Resonance Imaging (MRI) also might be ruled out due to the patient's size. 

What can be done?

The only remedy to deal with the limitations of diagnostic equipment is to buy newer models that are designed to image obese patients. Some MRI tubes are now open bore. Newer computer software produces diagnostic quality images while using lower amounts of radiation.

Hospital Risk

There also are added risks associated with patient obesity. Nurses and assistants are placed at greater physical risk in caring for these patients. Staff might injure their backs as they try to move, lift and transport obese patients who are unable to move themselves. Sometimes there are not enough nurses to care for these patients.

What can be done?

Make sure there is available equipment to help your staff while treating obese patients. Patient lifts and belts are useful, but also assign enough nurses when caring for an obese patient. One nurse isn't sufficient if the patient is unable to move himself.

The High Cost of Obesity

Obese patients run a higher risk of leading unhealthier lives. While it's important to have equipment and hospital staff to care for obese patients it doesn't address the real problem of rising patient obesity. Education is important in letting the public know about obesity and the health problems associated with excessive weight.

- Kim Schure ARRT (R)

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Heartburn or Heart Attack? How can you tell?

With Thanksgiving upon us many of us are looking forward to eating lots of rich food. Almost inevitably this will lead to sleepiness and indigestion. Sometime overeating or eating the wrong food triggers a burning pain centered in our chest. 

Most likely the pain is caused by Gastroesophageal Reflux Disease (GERD). The burning sensation occurs when stomach acid travels from the stomach into the esophagus. While our stomach has a protective layer of mucus our esophagus does not. Many people mistake the burning pain of stomach acid in the esophagus with a heart attack due to the proximity of the organs.

It's important to note when the pain occurred and if its onset is close to mealtimes. Another common source of chest pain is a gallbladder attack which may cause intense chest pain and nausea. Be aware of when the pain occurred, its location and if it's triggered by eating rich food.

Here are some guidelines in determining the cause of your chest pain. 

Symptoms:

Heartburn 

• Burning sensation during or after eating

• Sour taste in the mouth

• Pain worsening when you lie down or bend over

• May be triggered by eating certain foods

• Occurs often near mealtimes

• Pain may last minutes to hours

Gallbladder attack

• Pain in the right upper abdomen

• Nausea or vomiting

• Burping or gas

• Pain may radiate to right shoulder blade

• Discomfort after a rich meal

• Attack may last minutes to an hour after eating

Heart attack

• Pain or "vise-like" pressure in your chest

• Shortness of breath

• Sweating, nausea, vomiting and/or dizziness

• Discomfort that lasts a few minutes, disappears, then returns again

Regardless of the cause of chest pain, it's important to get it checked by a physician.

If you believe you are having a heart attack you should go immediately to the Emergency Room.

Stay safe and healthy this holiday season!

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