Curbside Consult with Dr. Jayne 8/14/23

Many physicians enjoy seeing antique medical equipment or visiting care delivery sites that aren’t your standard brick and mortar medical office building, and I’m no exception. One of my favorite museums is the Mütter Museum at The College of Physicians of Philadelphia, whose mission is to help the public “understand the mysteries and beauty of the human body and to appreciate the history of diagnosis and treatment of disease.” Its collections include items such as a surgeon’s kit from the American Civil War, which not only makes me glad to practice medicine in the current era, but also reminded me that some of the tools used during amputation of a limb haven’t changed much since that time.

I recently spent some time visiting friends in Virginia and was amused to see a 17th century ear cleaning tool found during the archeological excavations at Historic Jamestowne. Those who set out to establish the first permanent English settlement in North America may have struggled for survival, but at least they planned to maintain hygiene standards. We also spent a day at Colonial Williamsburg, which illustrates a time period where healthcare had evolved a bit.

I was looking forward to visiting the Apothecary and learning more about the apprenticeship they would go through, the medications that would have been available at the time, and more. Unfortunately, that particular living history exhibit was closed on the day I visited, so I had to settle for an online tour. Some of the treatments haven’t changed in hundreds of years, including calcium carbonate for heartburn and camphor for strained muscles.

The most modern healthcare delivery setting we visited was aboard a battleship museum, where you could see what shipboard dentistry was like. Not only was that part of the ship nicely restored, but it also featured recorded dental drill sound effects, which probably was a bit traumatic for some visitors. It was interesting to think about medical recordkeeping on a battleship, with the need to keep hundreds of sailors healthy and ready to support complex military operations on a moment’s notice. Unfortunately, the ship’s sick bay wasn’t accessible to visitors, so it will remain a bit of a mystery.

The ship I visited served from World War II to the Gulf War, so physicians aboard would likely have completed their documentation using a range of methods, from index cards to paper charts, but since it was decommissioned in the 1990s, I doubt it had much in the way of electronic recordkeeping. I chatted with some military folks at HIMSS and CHIME earlier in the year, and learned a bit about the additional complexity of military clinical informatics beyond what you would expect in a typical care delivery organization. It’s definitely a subspecialty of its own, and I am grateful for those who serve in that capacity.

One of my funniest reads this week was on the NordPass website. The solution is a password manager that I admit I hadn’t heard of until a friend pointed me to the site. Independent researchers who were examining cybersecurity practices used data from the company to look at the password habits of the C-suite, including CEOs, CMOs, CTOs, CFOs, and others. They found that passwords with sequential numbers (the proverbial “123456” that every cybersecurity training warns us about) remain as popular with executives as they do with other classes of users. Names were popular, with Tiffany leading the race.

Looking at some other articles on the site, I found some interesting statistics. In data from breaches, 20% of passwords were the name of the company or some variation thereof; “vacation” is a popular password in the healthcare industry; and “password” remains one of the most popular passwords across all sectors. In digging into the top 50  on the C-suite list, however, I found these gems:

• Welcome
• DEFAULT
• Letmein

For some of those, it’s clear that IT departments need to beef up their rules for password complexity at least a little bit. You can’t blame those entirely on the end users.

My heart goes out to the people of Hawaii given the recent wildfires and devastation. I can only imagine how taxed the healthcare resources are in the affected communities right now. I’ve heard that first responders and other critical workers are being housed at scout camps and it sounds like everyone is simply exhausted.

I was impressed by the speed at which the Department of Health and Human Services declared a Public Health Emergency. The Centers for Medicare & Medicaid Services quickly followed with an announcement of additional resources and flexibilities for hospitals and providers. Some of the supports announced include addressing the availability of dialysis services for patients needing treatment and working to ensure patients have equal access to emergency services including language access. CMS is also temporarily waiving certain limits on the replacement of durable medical equipment and supplies, which is going to be critical for people who lost their prosthetics or other devices in the fires.

In talking to some of my colleagues who have been involved in major disasters, they reminded me that it’s not just patients with fire-related needs entering an already stressed system. There are also people with everyday health events like motor vehicle accidents and heart attacks who were impacted, such as patients who might have needed helicopter transport who couldn’t be reached due to the high winds, or those who couldn’t be reached by ambulance due to downed power lines. Pharmacies burned down, medications were destroyed, and supplies will need to be brought in from other parts of the state, from the continental US, or from international sources.

Looking beyond the next month or two, there will also be long-term healthcare consequences, such as lung disease from wildfire smoke. We can’t even begin to quantify the impact on mental health, especially the trauma experienced by those who were directly impacted by the fire as victims or as first responders.

For readers who might have more inside knowledge about the needs on the island or what the healthcare IT community can do to help support those impacted, please leave a comment or email me.

Email Dr. Jayne.