Cleveland Clinic - Past and Present (video)

Disclaimer: I was an Assistant Professor of Medicine at the Cleveland Clinic from 2005 to 2008.

Empathy and patient experience - video from Cleveland Clinic

CEO Toby Cosgrove, MD, shared this video, titled "Empathy," with the Cleveland Clinic staff during his 2013 State of the Clinic address on Feb. 27, 2013. The video relates to any person - not only patients and physicians. It's so worth it 4 minutes of your time:



Physician Communication PEARLS from Cleveland Clinic

- Establish rapport and plan an encounter with the patient

- Elicit the patient perspective using FIFE (function, ideas, fears and
expectations)

- Apply PEARLS (partnership, empathy, acknowledgment, respect,
legitimation and support) to convey empathy

- Incorporate the patient into decision making and education using ART
(ask, respond, tell)

References:

Relationship-Centered Communication for Physicians (PDF) from Cleveland Clinic Academy

Comments from Twitter:

Dr Kelly Sennholz @MtnMD: This is JUST how I see the hospital. Magic place

PracticeMatch @PracticeMatch: Wow...great video!

Wouter van Furth @wvfurth: Take 4 min to watch this video. Worth it.

Mary Maier MD @MaryMaierMD: The Cleveland Clinic - it was/is a great place to train

Snow Blower and Shoveling Safety (video)

Using a snow blower is not as physically taxing as shoveling, but its powerful blades have the potential to severely injure hands and feet. Dr. David Shapiro, an orthopaedic surgeon at Cleveland Clinic, explains the most common injuries he sees with snow blowers:



Snow shoveling injuries land thousands of people in the emergency room every year. 96 percent of them happen at home:

Credit Card Germs: 1 of 10 of cards has fecal bacteria

Here is what a Cleveland Clinic ID specialist has to say: "You know all that money you're spending over the holidays? It's jam-packed with germs. So keep your hands clean and your credit cards wiped down. Avoid touching your eyes and mouth when out shopping."



What are the 8 germiest places in the mall?

The 8 germiest places in the mall, according to CNN, are:

1. Restroom sinks
2. Food court tables
3. Escalator handrails
4. ATM keypads
5. Toy stores
6. Fitting rooms
7. Gadget shops
8. Makeup samples

The filthiest area in a restroom (and therefore in the whole mall) isn't the toilet handle or the doorknob - it's the sink. The sink area is a moist environment, so bacteria can survive longer there.

Researchers found food, E. coli, urine, mucus, feces, and blood on escalator handrails. Where there is mucus, you may also find cold and flu viruses.

Each key on an ATM contains, on average, 1,200 germs. Protect yourself: "Knuckle" ATM buttons.

References:

The 8 germiest places in the mall. CNN.
12 Germiest Places in America According to Health Magazine
Dirty Money and Credit Card Germs - Health Hub from Cleveland Clinic http://bit.ly/TRLSoQ

Physician Communication PEARLS from Cleveland Clinic

The video features my former colleagues and hospital medicine stars Drs. Moises Auron and Vj Velez:



Some key messages:

- Establish rapport and plan an encounter with the patient

- Elicit the patient perspective using FIFE (function, ideas, fears and
expectations)

- Apply PEARLS (partnership, empathy, acknowledgment, respect,
legitimation and support) to convey empathy

- Incorporate the patient into decision making and education using ART
(ask, respond, tell)

References:

Relationship-Centered Communication for Physicians (PDF) from Cleveland Clinic Academy

"We can take care of you better if you understand your disease" - Cleveland Clinic's project for visual learners

In this White Board Series, Cleveland Clinic cardiothoracic surgeon Eric Roselli, MD, takes us on a tour of the heart that simply illustrates complex problems so everyone can understand. He says, "We can take care of you better if you understand your disease", and I could not agree more. The videos are below:

Academic medical centers face shrinking profits - what to do?

Here are some suggestions from the official AMA newsletter for 5 recommendations to help academic medical centers evolve, with my comments:

1. Build a brand name by holding faculty accountable for cost and quality. Mayo Clinic has mastered that and they offer a "subscription service" allowing local hospitals to gain quick access to Mayo experts - and to advertise that in the local press.

2. Become part of a larger community network. This is part of the "spokes of a wheel" concept to generate referrals to the tertiary center from the peripheral clinics and hospitals.

3. Increase effectiveness by maximizing use of extenders such as telemedicine and simulation technology. Mayo Clinic has a TeleStroke unit. Cleveland Clinic offers an "all-electronic" second opinion for a base price of $600.

4. Become an information hub. MayoClinic.com, the online patient information portal of the Mayo organization, is a good example of that concept.

5. Align research efforts with clinical and business strategies.

Bart Demaerschalk, M.D., neurologist and medical director of Mayo Clinic Telestroke, shows us how the smartphone technology works:



References:

Academic medical centers may face shrinking profits. Amednews staff. Posted April 4, 2012.
Image source: openclipart.org, public domain.

The link between stress and heart disease

In this video from the Cleveland Clinic, Steven Nissen, MD, talks about the important lesson war has taught us about stress and its effect on the heart. One of the best ways to manage stress is regular exercise.



Tips for managing stress (watch the 2-minute BBC video embedded below)

- Take a few deep breaths
- Get plenty of exercise
- Socialize - don't stress alone, talk to someone and have a laugh
- Get out - go to the park



Read more: http://www.bbc.co.uk/scotland/brainsmart 

Participation in sport is associated with a with a 20—40% reduction in all-cause mortality compared with non-participation. Exercise might also be considered as a fifth vital sign, according to the Lancet: http://goo.gl/gyxYf

 If nothing else helps, consider this: Chewing gum may reduce stress and improve memory

Warning: Your reusable grocery bags can become contaminated with bacteria

97% of shoppers admit they never wash their reusable grocery bags. Dr. Susan Rehm from Cleveland Clinic talks about avoiding illness from contaminated grocery bags:



Another video: Viruses and Bacteria In Reusable Grocery Bags, from a local TV station, KOBITV:



Comments from Twitter:

SwoodLady @SwoodLady: Always something! RT @DrVes: Warning: Your reusable grocery bags can become contaminated with bacteria goo.gl/fb/sDOMs

More than 50% of injuries on Fourth of July are related to fireworks

The eyes are the most frequently injured body parts, followed by the fingers and hands. Here is a video from the Cleveland Clinic with some advice how to prevent these injuries:



This video discusses ways to prevent and identify heat-related illness in senior citizens:

Drowning Prevention Guidelines

Here is a video from the Cleveland Clinic:



Key risk factors for drowning are:

- male sex
- age of less than 14 years
- alcohol use
- low income
- poor education
- rural residency
- aquatic exposure
- risky behavior
- lack of supervision

For people with epilepsy, the risk of drowning is 15 to 19 times as high as the risk for those who do not have epilepsy.

For every person who dies from drowning, another four persons receive care in the emergency department for nonfatal drowning.

Drowning Doesn’t Look Like Drowning

- Except in rare circumstances, drowning people are physiologically unable to call out for help. The respiratory system was designed for breathing. Speech is the secondary or overlaid function. Breathing must be fulfilled, before speech occurs.

- Drowning people’s mouths alternately sink below and reappear above the surface of the water.

- The mouths of drowning people are not above the surface of the water long enough for them to exhale, inhale, and call out for help. When the drowning people’s mouths are above the surface, they exhale and inhale quickly as their mouths start to sink below the surface of the water.

- Drowning people cannot wave for help. Nature instinctively forces them to extend their arms laterally and press down on the water’s surface. Pressing down on the surface of the water, permits drowning people to leverage their bodies so they can lift their mouths out of the water to breathe.

- Throughout the Instinctive Drowning Response, drowning people cannot voluntarily control their arm movements. Physiologically, drowning people who are struggling on the surface of the water cannot stop drowning and perform voluntary movements such as waving for help, moving toward a rescuer, or reaching out for a piece of rescue equipment.

- From beginning to end of the Instinctive Drowning Response people’s bodies remain upright in the water, with no evidence of a supporting kick. Unless rescued by a trained lifeguard, these drowning people can only struggle on the surface of the water from 20 to 60 seconds before submersion occurs.

References:

Drowning Doesn’t Look Like Drowning. Mario Vittone.On Scene Magazine: Fall 2006 (page 14)
Drowning - free NEJM review, 2012 http://goo.gl/xSqLu

Understanding Healthcare Power of Attorney - Cleveland Clinic video

This is very important: Advance directives are legal documents that provide instructions about who should oversee your medical treatment and what your end-of-life wishes are, in case you are unable to speak for yourself.

Advance directives include:

- Health Care Power of Attorney
- Living Will



Everyone over the age of 18 should consider assigning Health Care Power of Attorney to someone.

Blood Management Summit and App - Transfuse 2012

Announcement: Blood Management Summit - Transfuse 2012 will be held on April 19-20, 2012 at the JW Marriott in Scottsdale, Arizona.

This conference has been developed with collaboration between Mayo Clinic and Hartford Hospital, building upon the success of three previous national conferences. "Transfuse 2012" is a unique multi-disciplinary conference focused on exploring the current state-of-the-art techniques and programs to reduce allogeneic blood utilization in hospitals. This international conference will feature national and international blood management experts from China, New Zealand and Australia along with a unique iPad app launch and one-of-a-kind hands-on animal lab.

Mayo Clinic's Mark H. Ereth, M.D. introduces the conference and the iPad app in this 3-minute video:



This conference is designed for all physicians, including surgeons and anesthesiologists, perfusionists, nurses and leaders in quality and patient safety. The conference is a CME accredited activity for physicians, nurses and perfusionists.

The Conference Website is: http://www.mayo.edu/cme/anesthesiology-2012r780

One of the course directors is Dr. Ajay Kumar, Chief of Division of Hospital Medicine at Hartford Hospital, and a good friend of mine. Another friend from the time I worked at Cleveland Clinic is also on faculty, Dr. Moises Auron.

It should be a great conference. Go check it out.

"Lifestyle 180": Cleveland Clinic 1-year program promises to reverse chronic disease through lifestyle modification

During the past 5 years, the Cleveland Clinic has moved aggressively to expand from illness management to wellness management. They even have a Wellness Institute. One example of its programs is Lifestyle 180 (R) which is "designed to reverse" the effects of chronic disease through lifestyle modification.

Here is a 5-minute video about the program from the Clinic YouTube channel:



The program focuses on nutrition, exercise, and stress management. The yearlong program is available at the Cleveland Clinic Wellness Institute campus located in Lyndhurst, Ohio.

References:

Lifestyle medicine

Interactive wellness guide by Cleveland Clinic

Lifestyle 180 (PDF)

Disclaimer: I was on faculty at Cleveland Clinic and Case Western Reserve University as Assistant Professor of Medicine until 2008.

Comments from Twitter:

Meenakshi Budhraja @gastromom: Like>>

Linda Pourmassina,MD @LindaP_MD: "the $3,000 fee for this program represents a fraction of the increasingly high co-pays for doctor visits and medications."

March Madness Vasectomies: Postop period is "a perfect situation for television", says Cleveland Clinic urologist

Vasectomy is a surgical procedure for male sterilization, and consequently, birth control. During the procedure, the vasa deferentia of a man are severed, and then tied/sealed. This prevents sperm from entering into the seminal stream (ejaculate). You can watch a video how the procedure is done here.



From Cleveland Clinic YouTube channel: A urologist talks about the increase in the number of vasectomies he does this time of year. "Guys get it done, then watch the NCAA Basketball tournament all weekend long." The procedure takes 5-10 minutes. Patients need to ice the area for 2-3 days.

The NCAA Men's Division I Basketball Championship is a single-elimination tournament held each spring in the United States, featuring 68 college basketball teams, to determine the national championship in the top tier of college basketball. The tournament, organized by the National Collegiate Athletic Association (NCAA), was created in 1939 by the National Association of Basketball Coaches, is held mostly in March, and it is known informally as March Madness (source: Wikipedia).



Private urology practices advertise on TV their "Vasectomy Madness" campaigns:



CNN RidicuList with Anderson Cooper: Vasectomy and free pizza (video):

Essential tremor: what are the treatment options?

Essential tremor is a common neurologic problem. It should be differentiated from secondary causes of tremor and Parkinson disease.

Impact of essential tremor

Essential tremor causes motor dysfunction (e.g. a dentist may have to quit his/her job). However, more importantly, the tremor can have a psychological impact on the patient, especially since it usually gets worse in social situations.

Diagnosis

Essential tremor is a clinical diagnosis. A thorough review of the medical history and medication exposures is a good start. Laboratory and imaging tests may be ordered to rule out a secondary cause.

Treatment

The two first-line agents in drug therapy for essential tremor are:

- nonselective beta-blocker propranolol (Inderal)
- antiepileptic primidone (Mysoline)

They can be used alone or in combination.

Severe, resistant, or atypical cases should be referred to a specialist. Botulinum toxin injection and deep brain stimulation are reserved for resistant tremor or for patients who do not tolerate drug therapy.

Dr. Young from Swedish Medical Center discusses some of the new treatments for essential tremor in this video:



References:

Essential tremor: Choosing the right management plan for your patient. CCJM, 2011.

Boxing and brain disease - Cleveland Clinic video

Boxing and Brain Health - a video from the Cleveland Clinic YouTube channel.

iPad app tests athletes for concussion - Cleveland Clinic video

An iPad app tests athletes for concussions (a Cleveland Clinic video). The players perform a series of balance, memory, vision, and reaction time experiments to obtain a baseline reading. If they receive a blow to the head during a game or practice, these tests can be redone to determine when it is safe for the athlete to return to action.

References:

Concussion Center - Cleveland Clinic.
Cleveland Clinic Treats Concussions With iPad App. Fox News.
Chronic traumatic encephalopathy (CTE): Brain bank examines athletes' hard hits - CNN, 2012.

Comments from Twitter:

@DrVes: Why are some doctors and nurses giving back their iPads? http://j.mp/Hq15aD - Easy: iPad works great for pt education, NOT for data entry. Only 10% of doctors currently use an iPad at work http://j.mp/Hq15aD - I use iPad daily to discuss these diagrams: http://j.mp/Hq1k5v

iPad is a great teaching tool @CraigCCRNCEN was able to explain to Vietnamese family AFib and clots by showing them animation from YouTube.

Brian S. McGowan PhD @BrianSMcGowan: so is the best option for docs still a touch screen laptop? teach w/ touch screen, work w/ full keyboard? #hcsm

@DrVes: iPad works well for discussing DDx, Tx options with pts. Much more portable than laptop. Full-keyboard COWs best for typing.

Jeff Bray @jeffkbray: I have been scanning all my medical reference books and store them on my iPad for quick use and no weight - great tool and mobile

The "Five Second Rule" doesn't work

In case you had any doubts, the "Five Second Rule" doesn't work, says Dr. Susan Rhem, an infectious disease specialist from the Cleveland Clinic:



A common superstition, the five-second rule states that food dropped on the ground will not be contaminated with bacteria if it is picked up within five seconds of being dropped (Wikipedia).

Comments from Twitter:

@alisha764: The "5 Second Rule" doesn't work: Food + Floor = Bacteria

Cleveland Clinic calls "Code Lavender" to improve patient satisfaction

From the WSJ:

How patients feel they were treated has always colored their opinions of a hospital. Now, those feelings are being factored into how hospitals get paid.

The Cleveland Clinic CEO, Dr. Cosgrove, says that in his own days as a top cardiac surgeon, he focused so intently on reducing complications from cardiac procedures that he gave little thought to the feelings or experiences of patients.

Times have changed dramatically since then. The Cleveland Clinic has launched a program known as HEART - for hear the concern, empathize, apologize, respond and thank—that empowers employees to handle patient concerns from the moment they arise.

It developed a Healing Services team to offer complimentary light massages, Reiki—a laying on of hands—aromatherapy, spiritual care from a clergy person or lay practitioner and other holistic services, and it will call a "Code Lavender" for patients or family members under stress who need immediate comfort.

Since 2008, the Cleveland Clinic's overall hospital ratings have increased by 89%.

"Code Lavender" has a Twitter account too (@CodeLavender), managed by the former Cleveland Clinic Chief Experience Officer who popularized the term.

From the Cleveland Clinic Twitter account: Efforts to improve patient satisfaction were featured in a NBC Nightly News story (see the video below).



References:

A Financial Incentive for Better Bedside Manner. WSJ.
Image source: Lavender Farm, Wikipedia, public domain.

Disclaimer: I was an Assistant Professor of Medicine at Cleveland Clinic from 2005 to 2008.

Comments from Twitter:

@TanyaPRpro (Tanya R. Walton): Clever and meaningful hospital care

@scottRcrawford: Brand medicine

@gruntdoc: How sad. Condolences. RT @DrVes: Cleveland Clinic calls "Code Lavender" to improve patient satisfaction goo.gl/X4Jtt

@MGastorf (Melissa Gastorf): concerns about satisfaction basis for payment- i.e. if you refuse to write narcotic and patient angry, physician payment suffers.