They'll be godmothers to thousands: Pulse oximetry for newborns

On Oct. 13, Kathleen Sebelius, the Secretary of the U.S. Department of Health and Human Services, sent a letter formally recommending that hospitals perform pulse oximetry screening of newborn babies. This followed the formal recommendation of the Secretary's Advisory Committee for Hereditable Disorders in Newborns and Children, which had met a month earlier. Pulse oximetry is performed via a painless clip (imagine a soft clothespin) on the baby's foot, to measure the oxygen in their blood.

Sebelius' recommendation was made on the ninth anniversary of the death of Mary Ellen Mannix’s son, James. Mary Ellen has become an influential patient advocate since then, and participates on the advisory board of the (newly born) Newborn Coalition.

The Newborn Coalition and the mission to get pulse oximetry as a recommendation on the SACHDNC were spearheaded by Annamarie Sarinaan. Annamarie's daughter, born with a heart defect, got good, error-free care, and survives.

Bravo to Annamarie and Mary Ellen, who will soon become virtual godmothers to the babies who will be healthier as a result of their work!

Advice: Forward this to your friends who are expecting a baby, and have them send this to their obstetricians.

I was one of 99: Hepatitis from injections

Evelyn McKnight's story:
In over 45 known outbreaks during the last twelve years, patients have been the victims of syringe re-use. I was one of 99 Nebraskans infected with hepatitis C in 2001 while receiving treatment for cancer. Syringes were reused, and a saline bag was misused. And ours is not an isolated incident. Over 150,000 Americans have been notified during the last decade that they have been put at risk for infection while receiving medical treatment. Infection control by ambulatory surgery centers is described by Dr. Melissa Schaefer and her colleagues in an article this month in the Journal of the American Medical Association.

Our research led me to discover inadequate level of protection for patients caused by widespread failure of health care providers to follow fundamental, basic injection safety practices. Astonishingly, these unsafe practices continue.

We started the HONOReform Foundation in 2007. Our vision is a nation in which health care providers always follow fundamental injection safety practices that are designed to protect all patients each and every time they receive an injection.

We are pleased to announce that HONOReform Foundation, along with the Southern Nevada Health District, launched our Compassionate Response Toolkit on December 1, 2010, in Las Vegas. Providers throughout the area will be able to give this helpful resource, written from the patient perspective from our year-long research, to anyone diagnosed with viral hepatitis. It is just a start for our toolkit. It will be available online to all patients…and will be offered to public health departments and other organizations.

I invite you to join us in our efforts—testifying and working with federal and state lawmakers on legislation to protect patients, helping public health officials prevent and respond to outbreaks, and providing inspirational and motivational compassion and support to people across the country who have been affected by unsafe injection practices.

Please visit our web site, HONOReform.org, and please contact me anytime, evelyn@HONOReform.org.

Read a daredevil’s hepatitis story.

The patient's decision: Data on dialysis facilities' outcomes

Roberta Wager went on dialysis in the early 1980s. "I had nothing, no frame of reference," for choosing a dialysis facility, she said.

But now, dialysis patients can have a much more informed choice. Today, ProPublica made available extensive information on the quality of dialysis facilities across the U.S., in an easily searchable database.

"It gives you a snapshot of what a clinic is about," said Roberta, a past president of the American Association of Kidney Patients who works as a nurse and patient educator at several dialysis clinics in Texas. "It should be the patient's right and the patient's decision to have [the numbers]….This is your life. Wouldn't you want to have everything in your favor?"

Almost 400,000 Americans depend on chronic dialysis to do what their failed kidneys cannot. Their number has grown swiftly over the past two decades, spurred by epidemics of obesity and diabetes.

Advice: Dialysis patients should look up the outcomes of local facilities on the database, interview current dialysis facility staff, tour the facilities, and gather information about staff members' experience level and turnover rates.

Read another dialysis story from this blog, or read ProPublica's full story by Robin Fields.

The cult that cures: Listening to stories

"It's not surprising that storytelling became so fundamental to the culture of A.A. What is more interesting is what it contributes to recovery. 'It's just confession,' you might think, or 'It's just free psychotherapy.' And that's partially right. But it's not just confession or psychotherapy when everyone in the room is doing it, and it turns out that listening to stories is just as important – and maybe more important – than telling them. Stories break through loneliness. And perhaps the worst thing about alcoholism - and the reason I tried to kill myself that night – is the conviction that you deserve your loneliness, that no one needs to be cast out more than you do."

Advice: In this holiday season, listen to and tell lots of stories with others.

Read another story about the therapeutic fellowship of A.A.. Thanks to Clancy Martin for this excerpt from his warm and poignant article in the January 2011 issue of Harper's Magazine, ”The Drunk’s Club: A.A., the cult that cures”.

Woodstock in Kissimmee: IHI's National Forum Leadership Summit

In November 2000, a very pregnant woman entered a Boston teaching hospital to have her labor induced. "Suzanne" experienced a series of medical errors that resulted in the loss of her fetus and the rupture of her uterus. This required a hysterectomy and an 18-day stay in the surgical intensive care unit.

Five months later, after the insurer, Harvard's Risk Management Foundation, had settled with the family, and after the hospital's public apology, RMF approached the hospital, asking them to adapt Crew Resource Management to safeguard obstetrics. Physician leaders did so. In fact, the medical staff was so successful at bringing this form of team communication to the Obstetrics unit that the number of high-severity adverse events fell by 62%.

This is a case in point of how tragedy can sometimes ultimately lead to improved patient safety. That may not happen often, as it requires brave and dedicated leaders at the top and middle levels of a hospital, and a particular type of dedication by clinicians. Most hospitals lack leaders like Jim Reinertsen, Paul Levy, and Stephen Pratt. Their leadership was key and their receipt of the John Eisenberg Award was well deserved.


Two weeks ago, at the National Forum of the Institute for Healthcare Improvement near Orlando in Kissimmee, Florida, I had the pleasure of meeting Paul Levy and Dr. Pratt, and seeing Dr. Reinertsen again. Along with the heads of the Cautious Patient Foundation, Paul had charmed his fellow hospital CEOs into sponsoring 50 patient activists from around the country to participate in the Forum. I was one of the lucky ones who'd been chosen to attend the Leadership Summit.

For we patient advocates, it was our Woodstock, a mass intoxicating love-in that convened widely scattered like-minded young-at-hearts who are critical of the Establishment. I expect to tell many of our intense and redemptive stories in this blog over the next few months. Many of us hope to turn our tragedies into improvements as solid, life-giving, and lasting as the use of CRM in Obstetrics.

I'd like to salute the leaders of Boston's Beth Israel Deaconess Medical Center, and the doctors who joined us in the Leadership Summit, including some who have harrowing stories as patients: Carl Flatley, Julia Hallisy, Kevin Kavanagh, Gil Mileikowsky, Cari Oliver, Kavita Patel, and Stephen Pratt.

Read another crew resource management story, or read Stephen Pratt's article of Dec. 2007 in the Joint Commission Journal on Quality and Safety.

70% don't know: Carl Flatley's story on sepsis

Watch this short video video, prepared by Carl Flatley, the founder and Chairman of the Sepsis Alliance.

Read another sepsis story, or see the Sepsis Alliance website.

Which they can take to market: The Hunger Site

Today, on Thanksgiving, I'm thinking only about food, not about patient safety. You can get food to hungry people, for free, every day. The Hunger Site, at http://www.TheHungerSite.com, enrolls advertisers who will pay for food for a starving person, in exchange for the honor of showing their ad to you briefly on the website. You can click there as often as once a day. When you click, the money generated goes directly to Mercy Corps, Feeding America, and Millennium Promise.

Here's the story of how the aid reached Zainbon in the Aceh province of Indonesia:

Zainbon is a 37-year-old rice farmer with a black baseball cap perched atop her pink headscarf. Her husband mans a desk as a temporary, low-level bureaucrat in the district transportation office nearby, but still they struggle to find the rupiahs each month to get by. She pulls at her scarf, explaining how they stretch six or seven dollars a day across the needs of cooking staples, school fees, fuel and now, in the fall planting season, fertilizer and rice seed. A Mercy Corps survey in the area recently found staple food prices climbing between ten and twenty-five percent, on top of fuel prices that jumped forty percent earlier this year.

"This is hugely important for us — the staples are rising and the salary isn't keeping pace," Zainbon says. "What about others whose husbands are just farming? They're struggling even worse."

This worldwide crisis is striking an area just starting to find its feet again after a vicious cycle of calamity. For decades, a rural separatist conflict kept many farmers out of their rice fields and fruit plantations for fear that they would be caught in the crossfire. Then in 2004, the Asian tsunami sent a wall of water up to thirty feet deep and flattened everything in the area, including the entire village of Naga Umbang.

With the houses now rebuilt, the rice paddies cleared of debris and new water buffalo roaming the yards, villagers are now teaming with Mercy Corps to strengthen their rice farming techniques and improve crop yields. And with food prices bearing down on locals, it could't come at a better time.

"We need to modernize," Zainbon said through a translator. "We're already thinking about when Mercy Corps leaves here, and this transfer of knowledge is one way we can build independence. Money from an NGO would go quickly, but knowledge and technology sticks in your mind."

The improved techniques are aimed at boosting incomes. Typically most of the rice harvest in villages like this goes to feed families. But if farmers in Naga Umbang can grow more efficiently, they will begin to see surplus rice from the same backbreaking labor they currently put into the season. And they will hopefully have the resolve to plant a second crop each year, which they can take to market in nearby cities.

Advice: Please click on The Hunger Site's "Click Here to Give – It's Free" button today, and every day. The site is run by someone I know and trust.

Thanks to the Mercy Corps for providing this story, which is reprinted here.

I thought this was an odd response: A father’s intuition on misdiagnosis

John James' story:
Early in my son's failed diagnosis I told his lead cardiologist that I could get a previous electrocardiogram [which produces graphs of the heart's electrical activity over time] done a few months before my son's non-fatal collapse. That cardiologist wasn't interested in this previous EKG. Since I carried a small card in my wallet with my EKG, I thought this was an odd response from the cardiologist if he knew what he was doing. My intuition said I need to find another hospital for my son. Unfortunately, I did not follow my intuition and my son lost his life to incompetent medical care. The changes in my son's EKG would have pointed the way to the proper diagnosis, which was acquired long QT syndrome [a rare heart condition].

John James' Advice: If I could tell patients only one thing it would be to follow your intuition. If you think there is something wrong where you or a loved one is being diagnosed or treated then take charge, get a second opinion, or just get out.

Read a happier story about the role of a patient’s intuition in choosing medical treatment. Thanks to John James for this story.

Click here to get John’s book and e-newsletter subscription.

How cool is that?: the Personal Health Record

The administrative director of Patient Always First has an 88-year-old father who lives in another state. After a lengthy hospital stay about a year and a half ago, he returned to his home but was no longer able to live alone. Different aides come in to help him as well as a physical therapist who comes to see and work with him twice a week.

Before Betsy used the PatientAlways First Health Record (PFHR), she would ask her dad, “are you taking your medicines?” and he would always say “yes.” His aide would also say “yes, I give him what he needs.”

She decided to start a PFHR for him. She called his pharmacist and got a list of his medicines, and then she called her father’s doctor, and asked if these medicines were the ones he should be taking. (She faxed the list to the doctor’s office.)

(Doctors would be glad to check a list of medicines like this because, obviously, they want you on the medicines that they want you on.)

So imagine her surprise when she learned that her father was still taking several medicines that the doctor had discontinued and replaced with different prescriptions. The doctor had no way of knowing that his patient was still taking the old medications as well as the new ones. (A real-life scenario of “medications: just plain mix-ups.”) The pharmacy continued to fill all the re-ordered prescriptions, old and new, and because so many different people were coming to the house to help, the aides weren’t exactly sure what he was supposed to be taking. The doctor was able to recognize the errors and cross out the medications that were no longer to be given.

Betsy then put her dad’s correct medications into the PFHR, and added his diagnoses, allergies, important contacts, etc. as she remembered them and as she asked him to recall. She printed out a copy of the PFHR and it sits on top of the medicine box so that anyone coming in to help can just look at the list and know what medicines to give.

(Remember, just do it. From your memory, it’s going to be better than what your doctor has had time to organize.)

Then, since the PFHR has this really neat feature where you can let other people access the record, or add to it (only with your permission), she allowed the physical therapist who visits her dad to have access to add to the record. So now, when the physical therapist comes, he types the date, vital signs, and other information about her dad’s treatment and condition that day into the record. And Betsy can see all that information when she logs on.

So Betsy can have some peace about helping her father long-distance like this- she really is checking in and helping with his health.

And if her dad should need to go to the emergency room again, then his aide could bring the printed-out PFHR, or Betsy could fax it to the ER, or the ER could even access it online themselves (if Betsy or her father gives them the username and password.)

Now, how cool is that?

Advice to Sandwich Generation women who are caring for a distant parent: Get a personal health record for them.

Read another personal health record story, or read Dr. Oliver’s blog.

Thanks to Dr. Cari Oliver for her permission to reprint this story from her book, “Cautious Care: A Guide for Patients.”

To complete the miscarriage at home: A lack of discharge instructions

Rene's story:
Years ago I was diagnosed by more than one fertility specialist as being infertile because I had only one fallopian tube that was totally blocked. I lost my other fallopian tube in 1990 when I had a tubal pregnancy. To add to the odds stacking up against us, my husband Arthur had a low sperm count. We were told our only alternative was in vitro fertilization (IVF) which was not affordable. Unfortunately most insurance companies don't pay for this procedure, so we didn't worry about it. God had blessed me with two daughters before I got married that Arthur legally adopted at a young age. Our daughters were all grown up and out of the house. We were living life to the fullest without the responsibility of being tied down to children, when suddenly after seventeen years of marriage and not using a contraceptive I became pregnant with our son, who was conceived on February 15, 2008, just one day after our seventeen year wedding anniversary. What an anniversary gift! The doctors still can't explain how we conceived our love baby.

I had prenatal care early in the pregnancy. Then in my second trimester, my water bag broke, and I went to the hospital here in Louisiana. I was sent home to complete my miscarriage with no discharge instructions. I was told I would be going home to pass tissue the size of a bar of soap. We left the E.R. at 5 am, on Arthur's birthday, and delivered our son at home 45 minutes later in the toilet. Arthur grabbed baby Trey who was still alive, breathing and gasping for air. Within minutes Trey stopped breathing and went limp in Arthur's hands. Our love baby was gone, we would have never left the E.R. if we were told it was a possibility our baby would be still alive.

It was a nightmare! They hadn't told me that could happen. There's no way they can make me believe that was normal. But that's what they said at the medical review panel, and that it was not preventable.

At the deposition, the E.R. doctor had tears in his eyes, and said, "I didn't realize this would happen," even though his lawyer was trying to tell him to shut up. But my Ob Gyn doctor could care less! She just sat there, twirling the ice in her glass, looking at me with such bitterness. If she'd said, "Rene, I'm sorry, I made a mistake," it would be different. But to pretend that I'm the one who has a problem, really irritated me. I went to this doctor because I trusted her, she was the best. She said she would take care of me and she didn't. There should be a law to prevent hospitals from discharging people without instructions when they most need them!

Rene's Advice: All week long my body was telling me something. Everybody knows their own body. If something's not right, it's not right. If you feel uncomfortable about a procedure, ask questions. Realize that the doctor is a man and not God, and ask questions about what they're doing, and why. If your body is giving you warning signs, if the doctor can't see you, get a second opinion.

Thanks to Rene McCoy for sharing her story.

Read another story on a premature birth.

I was not told of the complications: Botched Lasik Surgery

Caprice’s story:
I went to the eye center to see if I would be a candidate for Lasik. I was not told of the complications other than the obvious, I was never told of the permanent side effects (reading glasses). I was assured that I could attain 20/20 with the surgery. After my first surgery the doctor left "debris" under the flap of the right eye, and my eye became infected. I had excruciating headaches and the antibiotics did not help.
I went back in, they had to lift the flap and remove the debris, I was not told this would change the prescription of the eye. After removing the "debris" he left behind in the initial surgery my eyesight in my left eye was 20/40 and it became 20/100 in the right. I was not allowed to use any kind of corrective lenses at this time, again I was suffering severe headaches due to the disparity between the vision in both eyes. Unable to see adequately I subsequently lost my job. I went in to have the right eye corrected again.

After this surgery both eyes were 20/40 and I failed my eye exam for my drivers license. I was told I would have to wait a year before they could go back in and "enhance my vision. One year later I received a notice in the mail advising me it was time to come in and have my eyes checked. I returned to their office only to be told I would be charged for the visit. I was indignant and told them it was a follow-up from the previous surgeries, that they had not given me 20/20 and I would not pay. I was escorted back for more tests on my eyes. I was told they could get me 20/20 this time and i asked would this affect my near vision I was assured by two technicians it would not. I was scheduled for the "enhancement." After the "enhancement" surgery I discovered the doctor not only had left "debris" in the right eye he had also left some in the left eye as well. The field of vision in my right eye was greatly obstructed.

Not wanting to allow this "doctor" to touch me again I went to a specialist in Dallas only to discover not only had the doctor left "debris" in my right and left eyes, he had left creases in the flap of the right and ruined the lens in that eye as well! I got astigmatism in the left eye and I have to permanently wear reading glasses all the time. The specialist spent 45 minutes cleaning out the "debris" and "ironing" out the creases. I want to tell the world what they did to me!

Read another story about elective surgery. Thanks to Caprice for sharing her story.

When you buy a car: Inappropriate surgery

Here's an idea that should both empower consumers and nudge costs down.

When you buy a car, critical information for this major purchase decision is immediately available, and clearly and prominently displayed on key features of the product, e.g., the miles per gallon. The decision of whether to have surgery is just as important, but information as clear and objective as that is usually absent.

The National Priorities Partnership is a broad group of experts, convened by the National Quality Forum, who have agreed that certain operations are often unwarranted.

Patients who are considering a coronary artery bypass graft (CABG), hysterectomy, knee/hip replacement, prostatectomy, percutaneous transluminal coronary angioplasty (PTCA), or spinal surgery should carefully consider beforehand whether the surgery is appropriate for them. To enable them to do so, patient advocates should find out and tell them the:

Survival rate;

Identification and frequency of the most common adverse effect;

Fraction of patients who need the operation to be performed again;

Best alternative to surgery; and

Cost to be billed by the surgeon and hospital.


I wish I had this information when I considered surgery. A friend's father also would probably have wanted to know it, as it might have saved him from an ineffective operation that left him incontinent. When consumers learn this information, many will probably consider alternatives to surgery, which may well be less expensive.

Long, full and joyous: Don Berwick and the pursuit of health

On Monday, Pres. Obama formally nominated Dr. Donald Berwick to be the Administrator of the Centers for Medicare and Medicaid Services.

At a recent conference of the Institute for Healthcare Improvement, Don described health care as a means to an end. "Health care has no intrinsic value, none," he said. "Health does. Joy does. Peace does….The best health care is the very least health care we need to gain the long, full and joyous lives that we really want. The best hospital bed is empty, not full. The best CT scan is the one we don't need to take. The best doctor visit is the one we don't need to have."

This was a tough message to hear for the hospital leaders who comprised most of his audience. But Don has never shied away from delivering tough messages clearly. That quality makes him a good choice for this impossible job. Perhaps Don's greatest virtue in this context, however, is his single-minded focus on a single vital aim.

Health in its fullest sense is our goal. Health is far from the absence of disease, which is usually the way it has been defined in medical care settings.

Even early detection isn't good enough. Better is the prevention of conditions that leaves us whole, without the need for medical procedures like biopsies. That will take an enormous transformation of our healthcare system. Don, I salute you, and I'm reporting for duty!

Thanks to Robert Pear for the source story in the April 20 issue of the New York Times.

If you have a family member in the hospital: Rapid Response methods

Our Rapid Response Work Group of the Consumer Health Quality Council of Health Care for All will encourage insurers in Massachusetts to publicize an important message to their members throughout Massachusetts. We hope they'll tell people how they can call for a Rapid Response method or team in the hospital, if needed, to rescue a family member whose health is suddenly deteriorating in the hospital. We hope they'll include it in their print and e-newsletters and emails to their members.

The announcement will alert people that certain warning signs often precede, by several hours, a usually fatal heart attack or respiratory arrest in the hospital. "Failure to rescue" is one of the most common causes of in-hospital deaths, so this could save many people's lives.

The announcement reads like this:

Have a Family Member in the Hospital?



Be aware that certain signs can warn that a heart attack or respiratory arrest can occur in the next few hours:

A sustained noticeable change, either an increase or decrease, in their:

Breathing rate;

Heart rate or Pulse; or

Blood pressure;


Or if they experience Confusion.



You can ask the nurse about the specific criteria your hospital uses.

If you see that your loved one is experiencing one or more of these signs while in the hospital, you can insist that the hospital respond promptly with a "Rapid Response Method" or a "Rapid Response Team." That's a new state law (Chapter 305 of Massachusetts General Laws), and is required by the hospital's accrediting body, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).


Non-Massachusetts residents should realize that you, too, can call for a Rapid Response, per the JCAHO regulations, even if you don't have a state law requiring it.

Read another story about rapid response teams.

The paternalism is a little more kind-hearted now: Patient's participation in medical decision-making

David Leonhardt tells this story in his column today:
Dr. Dale Collins Vidal, a reconstructive breast surgeon at the Dartmouth-Hitchcock Medical Center, told me a story about a patient's husband who asked to sit in on the medical team's discussion of his wife's case. The doctors said no, because they were uncomfortable with him knowing about the uncertainty surrounding the case. "The paternalism is a little more kind-hearted than it was in the past," Dr. Collins Vidal says, "but it's still paternalism."


As a rule of thumb, Don Berwick suggests "nothing about me without me." This fails the test.

Advice: Patients and their spouses need to learn about the uncertainty that usually accompanies the decision the doctor is making. If this is impossible during a hectic, scary time in the hospital, get a professional patient advocate to help you understand your choices. The alternative is to leave key decisions to well-meaning strangers who don't know your loved one's values and preferences.

Thanks to David Leonhardt for the source story in today's New York Times.

Donald Berwick as head of CMS

Pres. Obama has just nominated Dr. Donald Berwick to lead CMS, the Federal government agency that runs the Medicaid and Medicare programs. Don has stellar qualifications. Equally important are his experiences as an advocate during his father's period of declining health, and his own experiences as a patient with a botched knee operation. Years ago, at his speech to the Institute of Healthcare Improvement's National Forum, he movingly described his frustration and inability to get the proper treatment, and an appropriate wheelchair, for his father, himself a doctor. At the most recent December Forum, he described his definition and vision of his own health, and showed the large gulf separating that from the absence of illness, as doctors usually define good health in practice. He did this by encouraging people to ask, What do you really want? Then to ask again, What do you really, really want? And to ask a third time, which elicits the true vision of one's ideal health.

What do I really, really, really want? For the Senate to confirm my friend and colleague Don, and give him the keys.

Be brave anyway: Marcelas and Tiffany Owens and the Patient Protection and Affordable Care Act

Here's what I imagine the late Tiffany Owens would say today to her 11-year-old son Marcelas, who was beside Pres. Obama at the signing of the healthcare reform bill:

To my beautiful young man Marcelas,

I'm so proud of you! Thank you so much for being brave in speaking for me to all those important men and women. I wish I could be with you.

A lot of people have been yelling at you on TV and blogs. Try not to let that bother you. When you stand up for something you believe in like you've been doing, people on the other side can get mad, especially if you're effective. Maybe, like they say, I could have done things that might have prevented my health from getting so bad, but maybe not. I don't know enough about pulmonary hypertension to know. I'm not sure anyone does. And that misses the point, anyway. The point is that sick people should still be able to be taken care of by doctors and nurses, even if they lost their job, and don't have health insurance anymore. That's what you told all those people, and that's exactly what I wanted you to tell them.

People won't always listen to you as much as they did about this. But you should still speak your mind, with respect. And, of course, you may well never get to the White House again! Don't expect that you'll always be rewarded for being brave – but be brave anyway.

There are lots of people here with stories like mine – 45,000 every year, who died because they didn't have health insurance. You helped to speak for them, too. And you helped to save the lives of lots of people like them, from now on, because of the new law.

I miss you so much, Marcelas! Give a big hug to your Grandma, and do what she tells you.

Much love,

Your mother

Advice: Remember Tiffany Owens.

Read another story.

Meghan Morris, Rep. Stephen Lynch, Healthcare Reform, and History

Legislative assistants in Congress dream of the chance to make history. That moment arrives today for Meghan Morris in Rep. Stephen Lynch's office.

Congressman Lynch is one of the few Democrats to oppose national health reform. His vote could be the decisive one, given the closeness of the vote. Will he be known as the person who tipped the balance, giving health insurance coverage to 39 million people, and banishing the "pre-existing condition" exclusion from insurance policies? Or as the one who extinguished the financial security and hope for millions of working-class people for health insurance coverage, for many more years?

Meghan, you'll soon report the count of the letters the office received, and will advise Rep. Lynch on the optics as of next week, on November 2, and in ten years. Next week, the optics of a No vote could make him the butt of late-night talk show jokes, and make him look like a disloyal black sheep, a Democrat in name only, another Democrat who snatched defeat from the jaws of victory. On Nov. 2, it won't look like much of anything, either way, for Massachusetts voters will make their decisions on other grounds. In ten years, and from then on, he'll look foolish.

The optics of a Yes vote? Next week, he'll look like one of a crowd who helped make history. On Nov. 2, it won't matter either way. In ten years, we'll all think, "He and those other Dems actually accomplished something big. We're not going back. How could we have excluded so many working class and suffering people for so long?"

Your call, Meghan. Please rise to the moment.

Advice to voters: Tell your friends in the suburban Boston towns of Brockton, Braintree, Needham, and points between to contact Meghan at Meghan.Morris@mail.house.gov or by calling Rep. Lynch's office at 617-428-2000 or 202-225-8273.

Read a story about the one-year anniversary of universal health insurance in Massachusetts.

Her uterus is intact: An alternative to hysterectomy

Shelly is an Iowa native and a 42-year-old mother of two daughters. She trained to be a schoolteacher and later worked as a pharmaceutical representative. She is savvy and understands the business of health care. Her Ob-Gyn in a three-physician office practice in her hometown diagnosed uterine fibroids. The doctor told her that her only option was a laparoscopic hysterectomy.

Shelly describes what happened next. "I didn't want a hysterectomy, so I asked about less invasive methods that would leave my uterus intact and get rid of the fibroids. The doctor made fun of me, repeating 'less invasive methods' mockingly. Then she said, 'When that fibroid grows up over your belly button, you'll come running back!' I asked her whether my ovaries and cervix would remain, and she said, 'Well, I guess we could leave them." Shelly was indignant that anyone would remove perfectly healthy organs. She thought to herself, "my ovaries and cervix are perfectly fine!"

Not satisfied, Shelly saw another doctor in the practice who came to the same conclusion. Laparoscopic hysterectomy. So did the third doctor in the same practice.

"I wanted them to know that I'm not the average cabbage that fell out of the truck, so I asked for a copy of my medical records and the ultrasound so I could search for less drastic alternatives. They said, 'We only give records to our obstetric patients.' I was floored." Shelly knows that patients have a right to a copy of their medical records. When she called her insurance company to find out how the doctor's office could withhold her medical records, the company representative put her in touch with the state medical licensing board, which gives doctors their licenses to practice medicine. Shelly spoke to a representative of the licensing board. "I don't know what this person did," she says, "but within a day I had my records."

In the records she saw that the second doctor had written that she spent 45 minutes discussing treatment alternatives to laparoscopic hysterectomy. "That was a lie," Shelly says. "She spent 10 to 15 minutes with me and didn't tell me about my options. That's because it would be money out of their pocket if I chose an alternative treatment that these doctors didn't do. All they did was laparoscopic hysterectomies, so that's what they recommended. I think it's a conflict of interest for them to steer people toward certain procedures because that's what they know and that's how they make money."

Shelly thoroughly researched treatment options and found a less drastic alternative that she believed was best for her. Her uterus is intact, and she is pleased with the results. "It's not enough for patients to know treatment options and their risks and benefits," she says. "You have to understand the business of health care." Because Shelly had worked in health care, she understood that she was led down a treatment path that might be good for the doctor's business but not for her. When asked what happens to people who don't have the skills she has, she quips, "They will have everything ripped out."

Advice: Be aware of physicians' financial incentives.

Read a story about unnecessary treatment. Thanks to Rosemary Gibson for this story, reprinted from her excellent new book, co-authored with Janardan Prasad Singh: The Treatment Trap: how the overuse of medical care is wrecking your health and what you can do to prevent it.
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Wracked with worry: Loss of insurance for a cancer patient

Natoma Canfield is a 50-year-old cancer survivor, a cleaning lady from Medina, Ohio. She had written the White House in late December about her inability to afford insurance.

 Natoma's premiums had risen 25% in 2009. She had paid $6,700 in premiums in 2009, and more in copayments, and yet received less than $1,000 in insurance benefits. In light of that, and the likely rise of 40% in her premiums in 2010, she had dropped her policy.

White House officials had reached out to her last week and asked her to introduce Pres. Obama to the stage at a speech today promoting health reform. But days after the White House made the offer for the introductory slot, Natoma collapsed. Taken to an emergency room for tests, she was diagnosed with leukemia, and hospitalized.
"The reason Natoma is not here today is that she's lying in a hospital bed, suddenly faced with this emergency - suddenly thrust into a fight for her life. She expects to face a month or more of aggressive chemotherapy. And she is wracked with worry not only about her illness but about the cost of the tests and treatments she will surely need to beat it," Obama declared.

Advice: Consider if the same thing could happen to a friend with cancer, as you make up your mind on health insurance reform.

Read a story about a loss of insurance. Thanks to David Herszenhorn for the source story in today's New York Times, and Sam Stein in today's Huffington Post.