EPtalk by Dr. Jayne 12/28/23

As we expected, coming out of the Thanksgiving holiday and moving towards Christmas, emergency department and hospital visits for respiratory viruses were on the rise. According to data from the Centers for Disease Control and Prevention, the most recent numbers show a 21% increase from the previous week, with influenza accounting for the majority of visits.

While seeing patients, I’m hearing a lot of stories about family drama when someone attends a gathering and they’re sick. I’m also hearing a fair number of complaints about people who are staying home when sick, depriving their relatives of the chance to see them. It’s rough for patients who can’t win either way, especially when all they want to do is take a nap and feel better. Kudos to those who stay home when sick and keep their germs to themselves.

Speaking of staying home, Uber is advertising its package service as an option to help with post-holiday gift returns. Customers selecting “Return a package” can send up to five packages to a single postal carrier for $5, with the driver sending a confirmation when the drop off is complete. Packages are limited to less than 30 pounds, need to fit in the trunk of a midsize car, and must not contain any prohibited items. I perused the list of banned items for entertainment value. As expected, you can’t send illegal items, weapons, money, or alcohol. Also making the list: recreational drugs, stolen goods, obscene materials, livestock, or animal parts.

The virtual water cooler is abuzz with a recent private equity-related article that was published in the Journal of the American Medical Association. The findings suggest poorer quality care and clinical outcomes at facilities that are owned by private equity firms. The researchers were associated with heavy-hitting organizations: Massachusetts General Hospital, Harvard Medical School, Beth Israel Deaconess Medical Center, and the University of Chicago. They looked at data on millions of hospitalizations at 300 facilities, focusing on years before and after private equity transitions. They found that private equity-acquired hospitals had higher rates of hospital-acquired conditions such as falls or central line-associated bloodstream infections. Surgical site infections also rose after acquisitions. The other interesting finding was the lower-risk demographic of patients at private equity-associated hospitals, which makes the other findings all the more striking.

As expected, more research is needed, but lots of physicians are jumping on the fact that staffing looks dramatically different at PE-owned hospitals compared to other community hospitals or even academic medical centers.

In other journal publication news, this year’s Christmas edition of the BMJ provides an “Analysis of Barbie medical and science career dolls” as a descriptive quantitative study. Among the highlights: although Barbie can be a doctor, she is usually shown caring for children and rarely meets occupational safety standards. Loose hair, heels, and exposed legs are all considered workplace hazards. Science-related Barbie dolls were also short on personal protective equipment such as gloves or full-coverage lab coats. Competitor dolls were also analyzed and had a more “clinically accurate” appearance. Of note, Dr. Ken was more compliant due to his full-length pants, flat shoes, and short hair.

The article goes into gory detail on a lot of different features, but is interesting to think about given the sheer number of Barbie dolls out there. Of note, my own childhood Barbie doll had scrubs, and although they came with a pair of white sneakers, she couldn’t wear them due to her heavily molded feet. My Ken doll was a hand-me-down and had one leg that popped out of the socket any time you tried to get him dressed, so in hindsight perhaps my own Barbie should have been an orthopedic surgeon rather than whatever specialty she was.

It was nice to take a bit of a holiday break, but my heart goes out to all the healthcare professionals who are working during the holidays. I’ve spent enough of them in the emergency department to know that it’s hard work, and the pressure just keeps increasing. One of my colleagues mentioned that the new ED mandate is “do more, do it faster, do it friendlier, with less resources, and you can never ever make one mistake.” Hospitals continue to use short staffing as an excuse for everything, and often the buck stops in the ED because they don’t turn patients away and the halls end up filling with patients who are boarding. They don’t yet have rooms elsewhere in the hospital, yet require care that is often different from what the emergency department is equipped to provide. It’s stressful for all involved, especially when there are empty beds in the hospital but not enough people to staff them.

I’m involved in an online physician support group where one of our members shared an editorial that was published this week in the Annals of Emergency Medicine. The title is certainly eye-catching: “My Suicide Blanket.” It begins with a vignette about a hospital giving out blankets to staff as part of a mental health improvement plan. It reminded me of the challenge coins and other tokens given to staff during the height of COVID and which served only to illustrate how disconnected administrators were from those who were actually delivering care on the front lines.

Emergency department physicians are often treated as if we are expendable, expected to operate under a mindset where we don’t dare call in sick because that means we’re not team players. We’re supposed to just take everything thrown at us even when we know we’re working so fast that we aren’t delivering good care. The author of the piece is a member of our group and mentioned that it had to be published anonymously due to fear of retaliation. Students have been seeing this for the last few years, and during the most recent residency program match, they ran away from the specialty of emergency medicine.

Many of your clinician colleagues are not OK. Check on them and let them know that resources are available. They can call or text 988 or visit the 988 Suicide and Crisis Lifeline for help at any time.

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