from the world's big
Medical Professor Without Borders
Dr. Ross Donaldson: When you look at errors in medicine, this is a huge issue that we've begun to address, but really it's like having airplanes crash daily. People are not addressing it. This is something that we really need to look into.
Question: Does the U.S. need a greater focus on health outcomes?
Dr. Ross Donaldson: I certainly agree that outcomes are very low part of the focus of the American system, as it were. I think that's one of the main things that we need to do, moving forward, to improve things.
I spend half my time here in the States and half my time abroad, currently in Iraq, and when I'm here in the States, what I'm working on is quality assurance and trying to improve those outcomes in our hospitals. There's been a movement towards that lately with pay-to-performance and other things that have an outcome basis.
When you look at the health care system, especially from a European perspective, whenever they talk about the American system it's almost a joke to them. They put it in quotes--"as a system"--because, in fact, it's really not so much a system here as it is a conglomeration of interest. And those interests aren't really aligned to focus on outcomes as much as on other things.
A physician gets paid based on how many things they do, how many tests did you order, how many patients did you see. Actually, it really has no connection whatsoever with how did the patients do.
Question: What new technologies are improving outcomes?
Dr. Ross Donaldson: The electronic medical record really has the potential to be very beneficial for error reduction on several levels. One is that having the information from a patient from other hospitals, or even from your own hospital right there and readily available can really reduce the amount of errors you're making. You don't have to ask the patient again if they have an allergy because it's already there.
And the newer computer technology systems can actually prevent you from making an error. For example, if the patient has an allergy to a certain medication, and you prescribe a related medication, the computer might pop up a screen and say, "Hey are you sure you really want to do that?" You always have to have the physician able to work around that, because sometimes you do actually want to do that, but it's somebody asking you the question that can really reduce the errors in the system.
Question: How important is integrated medicine?
Dr. Ross Donaldson: I think the medical record potentially is going to help a lot with integrative care. But what's happened is that because we've a very low focus on primary health care, we've put a high focus on specialization, and what happens is that a patient comes in and they go to this specialist and that specialist, and if you don't have a person coordinating everything, you really can get in a lot of potential problems as a patient.
I think it's like having 12 chefs cooking something. Each one has his own thing that they're trying to do. What you really need to do, even if you have a bunch of people make parts of your meal, make one person being in charge in taking the overall care for the patient in mind. In our current health care system, we have dropped that ball, the primary health care push. I think the specializations are important, as is access to emergency care, but you really need somebody after you're done with the emergency or to coordinate with other things to look after the patient going forward.
Question: What have you learned about preventative care?
Dr. Ross Donaldson: I think preventive health care is a big and important push, especially for the American health care system. When we look at our rates of different indices compared to other countries, our vaccination rates and other things, a lot of those are reduced from what you would think they would be for a country with so much money. It's really that kind of preventative care that can save money at a later date. We tend to focus in America on the high technology afterward. We'll come up with some great drug to treat measles after you've had it. We have cheap vaccines to treat all these disease. It's on the public health level that we're really lacking here in the States.
Question: Are mobile devices enabling safer global expeditions?
Dr. Ross Donaldson: On this trip up to Mt. Licancabur I had a pulse ox [pulse oximeter], which is a little machine that tests how much oxygen you have in the body, how much of the oxygen has bonded to hemoglobin. In the old days we didn't have them. I'm old enough to remember not having them in emergency departments. In the States they are a larger machine. Now, the new technology has a little thing that you can just snap on to your finger.
It was quite interesting because you get up to the top of this mountain, and the amount or percentage of hemoglobin that's bonded to oxygen for us is normally 98% or 99%. And when you get to the top of this mountain, I think my own pulse ox was something like 66%.
If I had that same level down here in the States, everybody would have been running around like it was quite a severe emergency. And yet for all these people up there, it was fairly normal. Being able to see that in real time, while you're on the top of a mountain in this, very desolate area, it was very beneficial as a physician to have that point-of-care testing.
Question: How are these discoveries improving health care in the developing world?
Dr. Ross Donaldson: There's a lot of new technologies that are taking very new technology approach to low-income countries. There's a bunch of work using mobile phone technology to do tests that are very expensive or difficult to do in the third world, that are taking them and automating those processes. With the very cheap technology, like a cell phone and the cell phone networks and a lot of the third world, low-income countries work quite well, and then taking the test, essentially from the patient, but doing the analysis in the cloud, as it were, and being able to provide very low cost solutions in a high technology way to low-income countries.
Recorded on: June 1, 2009.
Dr. Ross Donaldson is a physician, teacher, and author who has worked in hospitals from Los Angeles to Iraq. In this video, he shares his most important medical insights from around the world.
Sallie Krawcheck and Bob Kulhan will be talking money, jobs, and how the pandemic will disproportionally affect women's finances.
Health officials in China reported that a man was infected with bubonic plague, the infectious disease that caused the Black Death.
- The case was reported in the city of Bayannur, which has issued a level-three plague prevention warning.
- Modern antibiotics can effectively treat bubonic plague, which spreads mainly by fleas.
- Chinese health officials are also monitoring a newly discovered type of swine flu that has the potential to develop into a pandemic virus.
Bacteria under microscope
needpix.com<p>Today, bubonic plague can be treated effectively with antibiotics.</p><p style="margin-left: 20px;">"Unlike in the 14th century, we now have an understanding of how this disease is transmitted," Dr. Shanthi Kappagoda, an infectious disease physician at Stanford Health Care, told <a href="https://www.healthline.com/health-news/seriously-dont-worry-about-the-plague#Heres-how-the-plague-spreads" target="_blank">Healthline</a>. "We know how to prevent it — avoid handling sick or dead animals in areas where there is transmission. We are also able to treat patients who are infected with effective antibiotics, and can give antibiotics to people who may have been exposed to the bacteria [and] prevent them [from] getting sick."</p>
This plague patient is displaying a swollen, ruptured inguinal lymph node, or buboe.
Centers for Disease Control and Prevention<p>Still, hundreds of people develop bubonic plague every year. In the U.S., a handful of cases occur annually, particularly in New Mexico, Arizona and Colorado, <a href="https://www.cdc.gov/plague/faq/index.html" target="_blank">where habitats allow the bacteria to spread more easily among wild rodent populations</a>. But these cases are very rare, mainly because you need to be in close contact with rodents in order to get infected. And though plague can spread from human to human, this <a href="https://www.healthline.com/health-news/seriously-dont-worry-about-the-plague#Heres-how-the-plague-spreads" target="_blank">only occurs with pneumonic plague</a>, and transmission is also rare.</p>
A new swine flu in China<p>Last week, researchers in China also reported another public health concern: a new virus that has "all the essential hallmarks" of a pandemic virus.<br></p><p>In a paper published in the <a href="https://www.pnas.org/content/early/2020/06/23/1921186117" target="_blank">Proceedings of the National Academy of Sciences</a>, researchers say the virus was discovered in pigs in China, and it descended from the H1N1 virus, commonly called "swine flu." That virus was able to transmit from human to human, and it killed an estimated 151,700 to 575,400 people worldwide from 2009 to 2010, according to the Centers for Disease Control and Prevention.</p>There's no evidence showing that the new virus can spread from person to person. But the researchers did find that 10 percent of swine workers had been infected by the virus, called G4 reassortant EA H1N1. This level of infectivity raises concerns, because it "greatly enhances the opportunity for virus adaptation in humans and raises concerns for the possible generation of pandemic viruses," the researchers wrote.
The word "learning" opens up space for more people, places, and ideas.
- The terms 'education' and 'learning' are often used interchangeably, but there is a cultural connotation to the former that can be limiting. Education naturally links to schooling, which is only one form of learning.
- Gregg Behr, founder and co-chair of Remake Learning, believes that this small word shift opens up the possibilities in terms of how and where learning can happen. It also becomes a more inclusive practice, welcoming in a larger, more diverse group of thinkers.
- Post-COVID, the way we think about what learning looks like will inevitably change, so it's crucial to adjust and begin building the necessary support systems today.
Scientists uncovered the secrets of what drove some of the world's last remaining woolly mammoths to extinction.
Every summer, children on the Alaskan island of St Paul cool down in Lake Hill, a crater lake in an extinct volcano – unaware of the mysteries that lie beneath.
The coronavirus pandemic has brought out the perception of selfishness among many.
- Selfish behavior has been analyzed by philosophers and psychologists for centuries.
- New research shows people may be wired for altruistic behavior and get more benefits from it.
- Times of crisis tend to increase self-centered acts.