The Marketing of Medical Services

Increased competition in medicine is here. With nostalgia, we note a certain loss of dignity. Hospitals compete with other hospitals for patients. Health insurance plans compete with other plans. Doctors compete with doctors. There are advertisements and direct marketing to consumers (patients).

You need to be aware of these changes because once-conservative institutions are now trying to influence your choices. A new event, the hospital “chain” with facilities in many cities and national marketing practices, has developed. Payment for spectacular new technologies, such as the artificial heart, may be internally justified, at least in part, because it calls attention to the merits of particular companies. Marketing directors, or their equivalent, have been hired at many hospitals, even small ones. The hospital public relations director interacts with media, and regular press releases as well as attractive brochures are prepared.

To an extent, the marketing educates and aware of the features of the alternative choices you might make. But beware of hype and jargon. Guidelines from this blog might be more effective means of finding good-quality care than slick brochures and press releases.

Oral Poisoning and Home Treatment

Although poisons may be inhaled or absorbed through the skin, for the most part they are swallowed. The term ingestion refers to oral poisoning.

Most poisoning can be prevented. Children almost always swallow poison accidently. Keep harmful substances, such as medications, insecticides, caustic cleaners, and organic solvents like kerosene, gasoline or furniture polish out of the reach of children. The most damaging are strong alkali solutions such as drain cleaners (Drano and others), which will destroy any tissue with which they come in contact.

Treatment must be prompt to be effective, but accurate identification of the substance is as important as speed. Don’t panic. Call the doctor or poison control center immediately and get advice on what to do. Attempt to identify the substance without causing undue delay. Always bring the container with you to the emergency room. Life-support measures take precedence in the case of the unconscious victim, but the ingested substance must be identified before proper therapy can be instituted.

Suicide attempts cause many significant medication overdoses. Any suicide attempt is an indication that help is needed. Such help is needed even if the patient has “recovered” and is in no immediate danger. Most successful suicides are preceded by unsuccessful attempts.

Home Treatment

All cases of poisoning require professional help. Someone should call for help immediately. If the patient is conscious and alert and the ingredients swallowed are known, there are two types of treatment: those in which vomiting should be induced, and those in which it should not. Vomiting can be dangerous if the poison contains strong acids, alkalis or petroleum products. These substances can destroy the esophagus or damage the lungs as they are vomited. Neutralize them with milk while contacting the physician. If you don’t have milk, use water or milk of magnesia.

Vomiting is a safe way to remove medications and suspicious materials. It is more effective and safer than using a stomach pump and does not require the doctor’s help. Vomiting can sometimes can be achieved immediately by stimulating the back of the throat with a finger (don’t be squeamish!), or by giving two to four tea spoons of syrup (not extract) of ipecac, followed by as much liquid as the patient can drink. Vomiting follows usually within 20 minutes, but because time is important, using your finger to induce is sometimes quicker. Or you can try both methods. Mustard mixed with warm water also works. If there is no vomiting in 25 minutes, repeat the dose of syrup of ipecac. Collect the vomitus so that it can be examined by the doctor.

Before, after, or during first aid, contact a doctor. Many communities have established poison control centers to identify poison and give advice. These are often located in emergency rooms. Find out if such a center exists in your community, and if so, record the telephone number both on the accompanying decision chart and in front of this book. Quick first aid and fast professional advice are your best chance to avoid a tragedy.

If an accidental poisoning has occurred, make sure that it doesn’t happen again. Put poison where children cannot reach them. Flush old medications down the toilet.

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The Problem of the Multiple Problems

Most of the major diseases of our time are more common in the older patient. Diabetes, atherosclerosis, osteoarthritis, cancer, and the other major problems are more common with increasing age. And the older patient, with less organ reserve, may have several problems at once, thus creating special difficulties.

If you already have one significant medical problem, a second one is more serious than if it occurred when you were in good health. Because the simple rules do not apply as well in this situation, you have to use more judgment. In general, a combination of problems is more serious than the sum of the problems dealt with by themselves.

One problem can easily complicate another. High blood pressure can increase kidney failure, which can increase blood pressure. A problem of breathlessness caused by the heart can complicate breathlessness caused by lung disease. Arthritis can increase inactivity, which leads to promise in which all aspects of the situation are considered. You need a doctor to help you in these decisions much more often than in the uncomplicated, isolated illnesses of relative youth.

GOD Bless Pakistan - Happy 63rd Independence Day

Today is the great day in the history of Pakistan and is most important for every Pakistani. We’re having this lucky morning in the Holy Ramadan right after 63 years, when it was in the same Holy month and lucky enough to give us a separate homeland against countless sacrifices of our forefathers. In this perspective I would wish my nation a very Happy Independence Day, but truly speaking we’re not in a condition to celebrate this day as it supposed to be!



But, situation is not much different today as it was in 1947, because we’re going through a crucial time again as the nation is tackling with several situations like worst ever flood in the history of Pakistan that effected more than 150 million people and weak law and order situation. We are fighting hard to reclaim the peace and prosperousness in our lives as we did 63 years before and this is reminding us the sacrifices and hard efforts of that time. Today, I’m proud of my nation but ashamed of my president Zardari, because he is enjoying his luxurious life in Europe at the cost of flood victims. O ALLAH please forgive us and show him right path to accompany and help his poor people. I appeal to those Pakistanis who are well settled abroad to step forward and donate for their people.

I pray that ALLAH give us courage, patience and power to reunite and fight back to the normal and may ALLAH bless us all. In the end, I must say that we should all help our brothers and sisters as much as we can in this time of need and pray for all those who are not among us, may their souls rest in heaven.

Head Trauma and Treatment:

Head is the most important part of our body and the slightest trauma is to be observed carefully. It may cause severe symptoms and result. The commonest cause of the Head Trauma is Road Traffic Accident.

There are different mechanisms of Injury to Head:

· Closed Head Injury

· Impact of the brain on the skull may result in hemorrhage( collection of blood in Brain)

· Penetrating Injury

· Secondary Causes: may be due to the infections affecting brain, edema, due to poor blood supply to brain.

Clinical Presentation:

· Nausea, Vomiting, Loss of Consciousness are the most common complaints which should be acted promptly after a head trauma.

· Occurrence of Lucid Interval ( i.e. patient lose and gain consciousness which suggest hematoma)

· Amnesia ( related to the severity of the blow)

· Skull Fractures increase risk of hemorrhage and meningitis.

· On examination: We should look for the wounds and other injuries and also the neck region.

· Bleeding should be looked for- may be from eyes, from inside the ear or behind the ear, nose.

· Neurological examination should also be tested. Based mainly on the history of the level of consciousness. We must look for any abnormal signs in the patient accordingly as unable to move hand/legs; deviation of mouth; seizure; unable to speak; unable to remember the incident and serial examination of eyes/ears/nose done simultaneously.

Management:

· Initial step would be to assess the level of consciousness.

· Have to be careful regarding the neck trauma.

· Immediately at the hospital CT scan without contrast should be done as it identifies hemorrhage and contusion.

· Skull and facial X-rays

· Cervical Spine X-rays to rule out fracture or dislocation.

· Awake, alert patients are observed in the hospital for 24 hours with hourly assessment to detect deterioration.

· Surgical emergency evacuation done in cases of hemorrhage.

Constipation and Treatment

A natural diet is recommended with natural vegetable-fiber residue, to the use of any laxative. But if you must use a laxative, the most attractive alternatives are psyllium as a bulk laxative or milk of magnesia to hold water in the bowel and soften the stool.

Bulk (Psyllium Containing Laxative)

Metamucil and Effer-Syllium contain substances refined from the psyllium seed. They can help both diarrhea and constipation. Psyllium draws water into the stool, forms a gel or thick solution, and thus provides bulk. It is not absorbed by the digestive tract but only passes through; thus, it is a natural product and essentially has no contraindications or side effects. It has been recommended as a weight-reduction aid when taken before meals because it induces a feeling of fullness that may reduce appetite; however, it doesn’t seem very effective in this role.

Dosage

One teaspoonful, stirred in a glass of water, taken twice daily is a typical dose. A second glass of water or juice should also be taken. Psyllium is also available in more expensive, individual-dose packets, for times when you don’t have a teaspoon. The effervescent versions mix a bit more rapidly and taste better to some people.

Side Effects

If the bulk laxative is taken without sufficient water, the gel that is formed could conceivably lodge in the esophagus (the tube that leads from the mouth to the stomach). Sufficient liquid will prevent this problem.

Your Doctor Can Save You Money on Drugs

Your doctor plays a major role in the cost of drugs by choosing the drugs to be prescribed. For example, if you have an infection due to bacteria, you may be given tetracycline or erythromycin. Tetracycline costs about twenty cents a capsule, whereas erythromycin costs about $9. At the doctor’s option, a steroid prescription for asthma may be prednisone at 14 cents per tablet or methylprednisolone at $1 or more per tablet. Medically, such drug choices are between agents of similar effectiveness. If your doctor prescribes a drug by its trade name, in many states the pharmacist must fill the prescription with that particular brand-name product. The brand-name product frequently costs many times more than its “generic” equivalent. Does your doctor know the relative cost of alternative drugs? Many doctors do not.

The drug-prescribing habits of different doctors can be divided into two groups: the “additive” and the “substitutive.” With each visit to an “additive” doctor, you receive a medication in addition to those you already have. With a “substitutive” doctor, the medication you were previously taking is discontinued and a new medicine is substituted. Usually the “substitutive” practice is advantageous to your health as well as your pocketbook.

Most of the time, medication can be taken by mouth. Sometimes medication is given by injection because of the physician’s uncertainty that you will take the medication as prescribed; by injecting it, there is no question that the medication has been taken. However, as a thoughtful and reliable patient, you can assure your doctor that you will comply with an oral regimen. Taking medication orally is less painful, less likely to result in an allergic reaction, and far less expensive. There are exceptions, but whenever possible you should take medication by mouth rather than by injection.

If it is clear that you must take medication for a prolonged period, ask the doctor to allow refills on the prescription. With many drugs, it is not necessary to incur the expense of an additional doctor visit just to get a prescription written. However, under some circumstances, the doctor may prefer to examine you before deciding whether the drug can safely continued or is still required. Ask your doctor if refills on the prescription are permitted.

The careful doctor will ensure that you fully understand each drug that you are taking, the reasons you are taking it, the side effects that may arise, and the expected length of time that you will taking the medication. A daily medication schedule will be arranged so that it is convenient as well as medically effective. If the program is confusing, ask for written instructions. It is crucial that you understand the why and how of your drug therapy. Do not leave the doctor’s office for the pharmacy without understanding your medication.