A 28 year-old single man with type I diabetes mellitus presents to your busy Texas emergency department in diabetic ketoacidosis (DKA). This is his third hospitalization for DKA in 5 months. When you ask the patient about his current medication regimen, he admits that he frequently skips doses as a cost-savings measure. He shares that he works 45 hours a week at a small local grocery store, makes minimum wage ($15,660 pretax), and has no health insurance. His prescribed insulin regimen, consisting of Lantus at bedtime and Humalog with meals, costs approximately $600 a month. This cost estimate is based on 25 units of nightly Lantus and 25 total units of Humalog daily from GoodRx advertised list prices for the San Antonio area.
Symptomatic influenza A and B infections cause worldwide morbidity and mortality every year. Annual vaccination remains the greatest prophylactic measure, but the vaccine is not 100% effective due to mismatch between the circulating and vaccine virus strains. Although most individuals will recover from influenza without incident, some specific patient populations are at high risk for severe complications. The Infectious Disease Society of America (IDSA) recently updated their clinical practice guidelines.1 We review these key updates, including recommendations on who to test, treat, and provide chemoprophylaxis.
Rallies by white supremacists in Charlottesville, VA and the subsequent milquetoast response from the White House shocked many Americans. These events invoked a national discussion about how many of our public monuments, built to celebrate triumphs and critical moments from our country’s past, can also exhibit appalling acts of malevolence and cruelty, treatment that today is unacceptable. Similarly, our understanding of medical history has evolved. While many of us are aware of particular atrocities, such as the Tuskegee study or the nonconsensual obtaining of Hela cells from Henrietta Lacks, these stories are by no means isolated, and there are times in our country’s history in which harm was bestowed upon vulnerable populations, especially African Americans. Medical Apartheid unveils the long history of medical experimentation performed on African Americans and highlights some of the origins of our country’s health disparities. We provide a synopsis and discuss the book in greater detail on the Google Hangout below.
First and foremost, international emergency medicine (IEM) is a big tent. We’ve got clinicians with an interest in tropical medicine and trauma, systems experts, inventors, educators, missionary families, public health experts, thrill-seekers, and policymakers. A disaster response specialist who has a “go bag” packed at all times ready for deployment belongs in this tent, as does an epidemiologist based in the U.S. who analyzes data on cholera outbreaks in refugee camps. Because it’s a relatively new specialty there is the occasional squabble about what does and does not constitute IEM, but generally we agree that we are working together to improve the state of health for people in our world. Our specialty allows us to work in a multitude of settings and clinical environments, something that no other specialty can do.
My department chair recently forwarded me a provocative little video regarding how we should conceptualize “population health.” The video encapsulates a number of hot topics in public health, labeled here as “population health”. It appropriately emphasizes the importance of addressing not just prevention among healthy populations, but also improving the health outcomes of high utilizers.
Like it or not, many things that determine our daily satisfaction with our work are determined by policy. QI measures, the implementation of EMRs, the availability of cigarettes, the funding of GME positions, the strength of drunk driving laws, the availability of mental health care: these are all legislative decisions, with an intimate relationship to our work. Yet, only half of the practicing physicians in the U.S. report that they are actively involved in policy change/advocacy.
Think back to your last shift. How many of you saw someone whose chief complaint was “assault”? What did you do for the patient? If you’re like most of us, you ruled out acute life-threatening injuries, sighed loudly (especially if the person had been in the ED before for other fight-related injuries), and dispo’ed. But do you ever wonder if you should do more? Or why?