Medical Practices of the Past QUIZ

Medicine in the 21st Century is based on scientific knowledge. Practices we use now have been reached by a wealth of knowledge gained over many years, tests and experiments and the study of data.


So, when you realize what practices were used as little as 50 or 60 years ago, it seems amazing that we’ve come so far ever since! It also makes you thank God you weren’t alive in those times, for the treatment may have been worse than the illness. Test your medical history I.Q. here.

Try our quiz and see if you can guess which practices are fact and which are fiction.



Medical Practices of the Past QUIZ Infographic

Trump Visa Changes Hit US Nursing Supply From Canada, Mexico

What !?

HENRY FORD HOSPITAL VS . NAFTA

vs.

Health care is now inextricably wound into the fabric of government. Even NAFTA's recision effects the availabllity of skilled health care professionals.  It goes something like this.

President Donald Trump's dislike of the North American Free Trade Agreement (NAFTA) is starting to affect the workforce in United States hospitals that rely on specialized nurses from Canada and Mexico to fill critical positions.

Under NAFTA, Canadian and Mexican registered nurses have for decades practiced in the United States on nonimmigrant professional TN visas, and each day many Canadian registered nurses (RNs) cross the border to work in US hospitals.

But under recent stricter interpretations by US Customs and Border Protection (CPB), advanced practice nurses and advanced clinical nurse practitioners are no longer eligible to work under the old RN category and must now apply for H-1B visas. The latter cover specialized positions for foreign workers from any country and can cost several thousand dollars per applicant for expedited processing.

Last week, a Canadian nurse practitioner working at Henry Ford Hospital in Detroit, Michigan, was denied renewal of her TN visa. "She was told by CBP that the reason for the denial was a change in interpretation of NAFTA and that advanced practice nurses, in their opinion, no longer qualified under the NAFTA registered nurse category," said immigration lawyer Marc Topoleski, who represents Henry Ford Hospital, at a March 16 new conference.  (Holy Moses, Batman !).  Nurse practitioners are no longer categorized as R.N.s.  Who makes that kind of decision ? Is it a fear of terror, or something else even more insidious and dark ? Did some negative factor for this particular person appear suspicious. In fact this policy has not been made official nor appear in any written policy documents. 

30 Canadian nurses at Detroit hospital pressured at border after policy change

The process could take as long as 3-4 weeks.

From left: Patti Kunkel, nurse practitioner, Henry Ford Health System; Marc Topoleski, principal attorney of business immigration services, Ellis Porter; Kathy Macki, vice president of human resources, Henry Ford Health System. (Dana Afana | MLive.com) (Dana Afana | MLive.com)

 HFH and others must file for a more complex and expensive H1B visa for those employees admitted on TN Visas.  Maybe an executive order from the Apprentice director would help

Trump Visa Changes Hit US Nursing Supply From Canada, Mexico

Primary Care: Some Good News Residency Match Day 2017 Sets More Records

In recent years several new medical schools have come on line.  Some of them are specifically designed to educate primary care physicians. (you know what we used to call GPs).  As a result that increase in medical school graduates along with the increasing emphasis on primary care by HHS, CMS reflected by better reimbursement rates gives hope that health care will become more accessible.





Residency Match Day 2017 Sets More Records

Common Blood Tests Can Help Predict Disease Risk :

By the time you finish reading today's Health Train Express you will be able to add one more metric to decreasing the liklihood of chronic disease.

It is not a guarrantee, nor an absolute predictor of your fate...all of these tests are readily available at you doctor's office.  Ask that they be done, when your physician asks you why....quote the following. Almost all plans now reimburse for preventive medicine.  If they deny you, appeal it to the health plan.  The squeaky wheel gets the ' oil '.

The research was presented Friday at a meeting of the American College of Cardiology and hasn't been published in a peer-reviewed journal.

"Our goal was to create a clinical tool that's useful, easily obtainable and doesn't slow the work-flow of our clinicians," said Heidi May, PhD, MSPH, principal investigator of the the study and a cardiovascular epidemiologist with the Intermountain Medical Center Heart Institute.

Dr. May and her team studied a primary care population consisting of both male and female patients who had no history of a chronic disease. ICHRON was developed among one set of primary care patients, then tested in a second, independent primary care population.

 The tests, done in Utah are not controlled and are biased heavily to the demographics of Utah, where the study was performed. ICHRON Score ( Intermountain Chronic Disease Score) is factored on several well known and routinely done lab tests.  Many of these are done annually, and are relatively inexpensive.

"It's a fascinating concept," says Wayne Dysinger, a preventive and family medicine physician and CEO of Lifestyle Medicine Solutions, a primary care practice in southern California, who wasn't involved in the study. "They may be on to something, but it's too early to say for sure." For one thing, the score would have to be shown to be accurate in a more general population outside Utah, which is largely white and has lower rates of smoking and obesity than other states.

Among women, those with a high ICHRON score were 11 times more likely to be diagnosed with a chronic disease than those with a low score. Women with a moderate score were three times more likely to be diagnosed. Men with a high score were 14 times more likely to be diagnosed than those with a low score, and those with a moderate score more than five times more likely to be diagnosed.

American Heart Association

Common Blood Tests Can Help Predict Disease Risk : Shots - Health News : NPR

Telehealth Outlook Under the Trump Administration | The National Law Review

 The Trump Administration is likely to drive telehealth advancement in a positive direction. use of telehealth technology.For example, President Trump’s plan to reform the Veteran’s Affairs Department includes improved patient care through the use of telehealth technology. There are also some indications that the newly confirmed Secretary of the Department of Health and Human There are also some indications that the newly confirmed Secretary of the Department of Health and Human Services (“HHS”), Tom Price, is “telehealth friendly.

Price also said he is interested in promoting telehealth because it “holds great promise, particularly for rural areas experiencing physician shortages and for patients with limited mobility.”

Despite the current focus in Congress on repealing and replacing the Affordable Care Act, telehealth legislation continues to gain traction and bipartisan support on the Hill. In February, a bipartisan group of 37 Senators sent a letter to Tom Price encouraging HHS to support telehealth and remote patient monitoring. Congress also has embraced telehealth advancement with a consistent stream of proposed legislation seeking to enhance the provision of telehealth services. Most recently, Rep. Joyce Beatty (OH-03) and Rep. Morgan Griffith (VA-09) reintroduced the Furthering Access to Stroke Telemedicine (“FAST”) Act that would expand access to stroke telemedicine (also called “telestroke”) treatment in Medicare. Congress also recently introduced HR 766 which would establish a pilot program to expand telehealth options under the Medicare program for individuals living in public housing. Additionally, Congress is poised to consider at least two bipartisan pieces of legislation focused on telehealth. The first is known as the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (“CHRONIC”) Care Act of 2016, which seeks to modernize Medicare payment policies focused on improving the management and treatment of chronic diseases using telehealth technologies. The second is known as the Creating Opportunities Now for Necessary and Effective Care Technologies (“CONNECT”) for Health Act, which seeks to mandate Medicare reimbursement for telehealth services (beyond the current, limited reimbursement framework). Finally, Senator Orrin Hatch (R-UT), the Chairperson of the Senate Finance Committee, recently released his “innovation agenda for the 115th Congress” which encourages the promotion of the “internet of things,” greater broadband investment, and increased device-to-device communication and cross-border data flows.

Telehealth will continue to increase in use despite proposed changes to the Affordable Care Act. Whether it will become a major player in health care will depend on studies to show if it cuts costs,improves care, or increases utilization as a redundant triage mechanism.  Telehealth does not . substitute for a visit to a physician, except for remote locations, where medical care would otherwise be lacking.

Telehealth Outlook Under the Trump Administration | The National Law Review

Seema Verma Confirmed by Senate as CMS Chief

Following a relatively benign debate about the new CMS Chief, Seema Verma is confirmed as the new head of CMS.

Seema Verma, nominee to head CMS, listens during a Senate Finance Committee confirmation hearing in Washington, DC.

Physicians seem to be  content that she is a governmental minimalist and favors voluntary participation in government programs rather than mandatory participation

Vice-President Pence was instrumental in recommending her to the position as he had worked closely with the Medicaid program in Ohio.

Verma has specialized in working with state Medicaid programs to improve care while lowering costs. The Trump administration will count on her to achieve those goals in a federal program that stands to shrink in a House Republican bill that repeals and replaces the 7-year-old Affordable Care Act (ACA). The measure would eliminate expanded Medicaid eligibility that 31 states chose under the ACA, and convert open-ended federal contributions to state programs to a fixed, per-capita amount, putting the program on a budget, as it were.

Verma's work with the Medicaid program in Indiana may be a preview of the program's future. She designed a "consumer-directed" version of Medicaid called Healthy Indiana Plan (HIP) that gives beneficiaries a Personal Wellness and Responsibility (POWER) account — similar to a health savings account — to apply toward a $2500 deductible. And while Vice President Mike Pence was governor of the Hoosier State, she helped created HIP 2.0, which expanded Medicaid coverage under the ACA. Beneficiaries who contribute a small percentage of their income to their POWER accounts are entitled to extra benefits such as dental and vision coverage.

Like the president that nominated her, the new CMS administrator espouses a small-government philosophy that many physicians may find refreshing. At her confirmation hearing, Verma said that physician participation in Medicare pilot projects for delivering and reimbursing medical care should be voluntary, not mandatory. She also decried federal regulations that might discourage physicians from participating in Medicaid and Medicare, and the burdens that electronic health records impose on clinicians in connection with the meaningful use incentive program.

Seema Verma Confirmed by Senate as CMS Chief

On Death's Door California To Permit Medically Assisted Suicide As Of June 9 :

Debbie Ziegler holds a photo of her late daughter, Brittany Maynard, while speaking to the media in September after the passage of California's End Of Life Option Act. Maynard was an advocate for the law.
Carl Costas/AP

Classic Version of the Hippocratic Oath

I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfil according to my ability and judgment this oath and this covenant: hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art - if they desire to learn it - without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.

If I fulfil this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

A Modern Version of the Hippocratic Oath

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

California will now permit assisted suicide.  

California Gov. Jerry Brown signed landmark legislation last October that would allow terminally ill people to request life-ending medication from their physicians.

But no one knew when the law would take effect, because of the unusual way in which the law was passed — in a legislative "extraordinary session" called by Brown. The bill could not go into effect until 90 days after that session adjourned.

The session closed Thursday, which means the End of Life Option Act will go into effect June 9.
If one carefully compares the classic version with the modern version the modern version contains a new phrase,  "But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

Physicians asked to . participate in legal executions have long been uncomfortable performing this function.  Physicians have quietly assisted in hastening death's approach surreptiously with medications.  Patients who are in death's grip are often sedated to diminish pain, and the use of opioids has many side effects on the cardiovascular system.  Now this can be pursued in hospital, or at home with family and/or friends in attendance.
It seems most merciful, and another evolution of medical practice.  Some physicians may refuse to participate, even if the family requests this act.  In such cases a new 'specialty' may emerge, Deathologist.  It no longer is such a horrific word.

Although physicians will be protected legally, the disconnect will remain. 

California To Permit Medically Assisted Suicide As Of June 9 : Shots - Health News : NPR