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In My Opinion

Marijuana Seems to Be Making In-Roads
February 23, 2015 9:28 AM by Jimmy Thacker

We are at a crossroads in this country. In one direction, we move to what we think the people want. The other road moves to what is safe for the people.The question over the next several years is which road we should take.The players are marijuana and electronic cigarettes. It seemingly became more tolerable to have legal pot and less tolerable to let people "vape" in 2014, making for an interesting 2015.     

The FDA says that "vaping," the use of electronic cigarettes, brought in $1.7billion in 2013. You have no doubt driven around and seen what us old people would call "head shops" built for vapers to go into and vape with others and buy their gear so they can vape anywhere they want. That was, after all, the biggest selling point up to now; you can "vape" where ever you want. Not so any more.

Though cigarette manufacturers project the use of electronic cigarettes to increase steadily over the next 10 years, it will get harder to make that little light on the end of the stick in your mouth glow in some areas. Los Angeles, New York City, and Chicago are already banning vaping in public areas. And 172 other cities and counties across the U.S. are doing the same, making vaping unwelcome. North Dakota, New Jersey, and Utah do not allow vaping as an alternative in zones where smoking is prohibited. If you cannot smoke somewhere, you also cannot vape there. Many states are dabbling their feet in it, like Arkansas, where vaping on a school property by anyone, student, parent, or staff, is illegal.     

That other road is strange, too. Alaska, Oregon, Washington, and Colorado have legal marijuana. A legal marijuana store in Colorado, for example, generates over a million dollars in taxes for the state each year. Unlike vaping, marijuana is regulated. Some 23 other states are looking at legalization of cannibis, too, after recent elections show the majority of people in those states want to at least have the option to vote for or against it. Even in Washington, D. C., where I personally would at least like to see the do-nothing politicians mellow out with a doobie and do even less, marijuana is up for consideration as a legal recreational substance. Although I think D.C. making marijuana legal might take the edge off of some folks on Capitol Hill, it means that Cheetos and pizza parlors will become booming businesses. You do not have that situation with vaping. 

Marijuana can bring in some serious cash if it is regulated, taxed, and overseen by someone who knows Mary Jane on a personal basis, as opposed to some stuffed shirt who has been in Washington for 100 years. I'm just saying, if you want to legalize it, then let's not have Senator So-and-So regulate it, let's hire an experienced professional, somebody who admits he uses it and really does not care what you or I think about it. Drug dealers always know how much pot they have left. Let one of them run the pot regulating and I guarantee you there will be nothing to worry about.

Vaping will need a czar, too, if we continue to allow it. Like teaching a class to stop smoking, hire a smoker or a vaping user to oversee everything. Nothing dumber than teaching a smoking cessation class with a person who has never smoked, and few things are dumber than regulating something and making decisions about it without including the people who have done it and whose lives it will likely affect the most. So marijuana looks like it is making progress, while vaping is headed out the door. Seriously, would you have imagined a scenario like this?

That's just my opinion,

Jim Thacker, MBA, MHA, CRT

Wellington, MO

Sleep Deprivation in Teens
February 17, 2015 3:59 PM by Jimmy Thacker

New studies are showing that teenagers get less sleep than they may need. Many teens get less than seven hours of sleep a night. Some rate themselves as getting even less than that, and certainly less than the recommended eight to 10 hours. A lack of sleep can result in a loss of focus, pimples, mood swings, weight gain, substance abuse and trouble in school.

This opens up a field I have not heard of yet, dealing with the sleep problems specific to teenagers. Some of my sleep friends that read the blog can tell us if this is already being done, but the value of a sleep study on a teenager who cannot seem to get enough sleep seems high. Kids are under so much more pressure these days. The homework assignment of today makes the homework assignments I had in the 70s look like nothing.

Part of this, too, is the fragile nature of children and their need to be "social" 24 hours a day. This phenomenon takes even more time away. In my day, you went home and did chores, or played in a mysterious place we called "outside." These days, that doesn't happen for a lot of kids, and I bet those kids are the ones having trouble sleeping. We would wear ourselves out with work and play, and had no trouble sleeping at night. We also had little problem getting up in the morning and though we all dreaded school, once we got there, we generally enjoyed it and the task of learning. It would be interesting to have some detailed studies on why teenagers believe they are sleep-deprived and to discover what they are doing rather than sleeping.

In my opinion a big part of the problem is that we have forgotten what school is for, and that we are sending children to a building where they should be learning -- not to a factory. In preparation for this blog, I talked to some friends with school-aged children, and the schedules they are on are not conducive to achieving anything. Extra-curricular activities in the morning before school and after, groups, clubs, and functions that are school, church, and just plain social-related means that Johnnie and Jenna do not have time for sleep. Add to that some kids have an Xbox or PlayStation for a babysitter or a means to pass the time until dinner and even after, and I believe we would discover that we are turning our kids into the same robotic, work-way-too-much society that adults live in. We are merely starting them at an earlier age, not thinking about the long-term affects on the kids or our communities.

Turn the televisions and game stations off. Limit school and other activities during the school week, and pursue excellence in the classroom rather than on Facebook or Pinterest. I think if we did that, teens would sleep more and get more out of their education. The business part of me sees a great opportunity, because I know few parents will follow that advice, regardless of who it comes from. So let's exploit teenage sleep deprivation and further study the cause and effects. At least then we can earn a few new patients and possibly help some of them sleep.

That's just my opinion,

Jim Thacker, MBA, MHA, CRT

Wellington, MO


A Win for Students with Asthma
February 9, 2015 7:18 AM by Jimmy Thacker
Finally! New York has joined the rest of the United States in approving a law that allows students to carry and self-administer epinephrine auto-injectors and asthma medication. With this, now all 50 states have some kind of right for students affected by asthma and allergies to protect themselves. The next issue is allowing schools to stock epinephrine. 40 states already have those laws, but the other 10 are lagging behind. 

This has been no easy task. Schools are slow to respond because of potential liability issues. Governmental agencies are slow because they fear the overuse and abuse of the "epi-pens" that students may be allowed to carry. For those of us who have worked with people with asthma, we know that asthmatic kids are usually light years ahead in maturity when it comes to their health, and are the least likely to let a life-saving pen be abused by anyone. But I understand the concerns. It's a drug, with potentially life-threatening or even deadly results if used improperly.

Still, one must wonder why it has taken so long for schools to get on board with some kind of program that protects the kids. To me, it seems plenty of money is invested in new football uniforms and computer labs, but not in keeping the kids alive if they have an allergic reaction. As I have stated many times in this blog, I think our priorities are a little messed up.

In my opinion, now that all 50 states have these laws, it is time to look at other ways we can improve the safety of our kids with respiratory issues in the schools. It isn't easy. Local health departments, hospitals, and other "health" agencies do not welcome outsiders, even with the best ideas, and are slow to support anything that involves money, liability, accountability, responsibility, or potential headaches, even if the idea could save lives or prevent suffering. School nurses, likely our strongest allies in helping kids, are overworked, underpaid, and have to fight school board members who have no idea of the depth or breadth of the problem. As respiratory therapists, so many of us are not working in our own communities that we do not feel the obligation to help out, which may be the biggest concern of all. Even if you work in a different community than where you live, get involved. We are always looking for ways to cement our future and show our worth; you have one now. Find out what your community needs. Quit talking about how valuable you are and let your works speak for themselves.

That's just my opinion,

Jim Thacker, MBA, MHA, CRT

Wellington, MO

Patient Dignity
February 3, 2015 9:40 AM by Jimmy Thacker

After talking to a former patient of mine, I started thinking about something to which we all get exposed. It is sometimes subtle, and sometimes very obvious, but at some point in health care, all of us will have some experience with it. It is dignity; specifically preserving the dignity of those for whom we care. I can remember several situations when what I was doing, the treatment or test, seemed less than dignified for the person I was doing it to. I know there have been times when I have been the patient, and felt I had given up some dignity in the name of tests run on me, too. 

Whether you work in a hospital or clinic, a patient's home, or some other setting, please keep in mind the person you are working on. Often, we see people when they are not at their best. Let's face it; people who feel perfectly well, who need no assistance, just have no need to come see us, or have us go see them. So whether you are a therapist or nurse involved in seeing people at their homes, a doctor or healthcare worker who sees them in the hospital, or anyone else who has one-on-one contact with people, particularly those of the opposite gender or those whose age is markedly different than our own, remember the person's dignity. 

Some tests are just that way. There are only so many ways a man, who could well be the only person able to do the ECG in the hospital at the time, can perform the test. Likely, it will result in some embarrassment, some uncomfortable feelings, and maybe even anger. When I did ECG's on females, whenever possible, I asked my patient if she was OK with me doing it, or if she would like me to have an escort of her gender in the room while I was testing her. On children, particularly those younger than the years of puberty, I would ask a parent or guardian to stand by within earshot and instruct the patient to call out to the parent if I did anything to make them uncomfortable. For older girls, I insisted on a person of the same gender in the room, for her protection and for mine. I spent a lot of time explaining what I was doing and why. Often, communication is all that is needed to go from the guy with cold hands to just another person doing a test. 

People at home may have limited mobility and financial means. They may not want you in their house or feel uncomfortable about their perception that you will judge them based on what you see. They may imagine you telling your co-workers. This puts them on defense and makes it hard for you to focus on the reason you are there. Again, communication and constantly striving to preserve another person's dignity can go a long way. We have all heard the stories and those of you from small towns know that in some cases if one person sees or hears something, the whole town knows about it very quickly. By the time it comes back to you, the story, your story, has changed significantly. Do not put yourself in that situation. "Loose lips sink ships" is another saying to remember; do not sink the ship that you and your patient need to ride to good health. 

Even in the hospital, clinic, or doctor's office, dignity can suffer. We put effort into not sacrificing a patient's health information, and many of us have to take classes on the subject yearly. Few of us, however, have ever had a class on preserving the dignity of the patient.  Everyone in healthcare, everyone who deals with patients, should be able to come up with plans aimed at preserving dignity; both our patient's and our own. The old saying "treat others as you would be treated" seems to be applicable here. Think about that the next time you see a patient. It is easy to hurry, to take shortcuts, particularly when you are busy, understaffed, overwhelmed or just plain tired. You have an opportunity to be the status quo, or be the example. It's your choice. 

In my opinion, very few of us allow a patient's dignity to suffer on purpose, but it does happen, and can be prevented or minimized. Plan ahead. Think about how you would want your healthcare worker to do that test, treatment, or procedure if you were the one in the bed. Think about how you would want him or her to treat your mother. That was always my trick; I pretended everything I did I was doing to my own mother. I think that is why patients often commented on not only my skill, but my consideration. Also, you can tell a lot about how you are perceived by the people you work with. If a co-worker of the opposite gender needs a test that is sensitive or could cause embarrassment, would they come to you, or would they go somewhere else? If they cannot come to you when they need you the most, you have an issue, as does your employer. Be the "go-to" person, no matter who needs your services. Treat others like you want to be treated in all aspects. Protect your patients information absolutely, but never forget that humans need to maintain a certain level of dignity, too, in order to fully recover and return to you the next time. 

That's just my opinion,

Jim Thacker, MBA, MHA, CRT

Wellington, MO

'News' on E-Cigs Is Nothing New
January 26, 2015 9:21 AM by Jimmy Thacker
Can someone answer a question for me? What does our government do for a living? Seriously, someone needs to tell me. I consider myself reasonably intelligent, but when the government does "studies" and finds the same information, or non-information, over and over, I am baffled. I mean, just today, an article cites a study that shows that electronic cigarettes, when using a higher voltage battery, produces formaldehyde.

That's news? Really? Every asthma educator I know has known this for years. Every good respiratory therapist has known it. Every doctor and nurse has known or suspected it. So why is this news? It is sad that stuff like this is in the news, years after a trend like "vaping" catches on. I believe it is a part of our "treat symptoms" rather than "prevent disease" type of healthcare. The article had great timing; just the other day I was making fun of a woman puffing on her e-cig while driving through a small Missouri town. She puffed on it like I am sure she has never puffed on a real cigarette. It honestly made me laugh at how ridiculous she looked.

Now, under consideration is whether or not to regulate electronic cigarettes and treat them as tobacco products. Again, really? You are just now considering that? Whichever side you choose, the main benefit would be to help stem the tide of growing popularity with those too young to buy regular cigarettes, but old enough to buy the e-cigs. Other than that, I see little value in assigning rules to e-cigs because we have not yet learned how to enforce the rules for regular cigarettes. But that is what we do; we make rules without hope or a plan of enforcing them.

     My opinion is multifaceted. First, we know e-cigs contain nicotine, right? OK, then it is a drug and should be regulated, from controls over what the recipe is for the liquids used, to stopping commercials on television obviously aimed at young people. End of that discussion. Next, we do not know what effects e-cigs will have on users long term. So study that and stop rehashing information we have had for years. Give me new information. Get potential customers new information.

Do you really want to stop people from using this form of nicotine? Fund a real study and get real scientific information on the product and present it. Otherwise, we can all say it is bad for you, but as long as someone on television does not seem to have a problem with it, someone will think it is safer and buy it. I don't expect the government to pay my bills, and I don't expect them to be involved with every decision I make. But when they spend billions of dollars of our money to conduct studies, I do expect the studies to be worthwhile. I don't think that is too much to ask. Do the study. Make the determination. Tell me what you found out. Then maybe we could move on to the next problem.

 That's just my opinion,

Jim Thacker, MBA, MHA, CRT, AE-C
Windsor, Mo.

Resolve to Grow as an RT and as a Person
January 19, 2015 12:38 PM by Jimmy Thacker
This time of year, many are working on New Year's resolutions. As a respiratory therapist, one of your resolutions should be to improve yourself somehow, personally or professionally, and preferably both. It can be hard. For many, work takes up so much time. Not only do you work your regular shifts, but maybe you cover for someone else, or take overtime from time to time get a little extra cash. There is nothing wrong with that, but remember that you have a license, and maintaining that license requires getting your CEUs. Last year, I met so many therapists struggling at the last minute to get their CEUs before the cutoff. Rather than picking and choosing which meetings they wanted to go to, they ended up taking whatever they could find. This might them get through their CEU crisis for the year, but did not help them grow into the therapists they could be.

Be smarter. Make time for growth. Not only is it important to your patients and your employer, but it is equally important to you. You may discover some other need for your talents in a different sector of respiratory therapy, like home care, DME work, or moving from the floors to the ICU. Professional growth should be mapped out by you and your department director. If he or she is not involved in your professional growth, you do not have a good director.

Personally, you need to grow, too. Find outside interests to blow off some steam, help you relax, and just enjoy life. Working 24 hours a day seven days a week is fine if you need the money, but at some point, you will want to enjoy the fruits of your labor. A vacation that involves work is not a vacation. Read a book, take a dance class, do some woodworking, travel, or maybe even turn a passion of yours into a new business. This will take your mind off of work and give you some rest, improving your focus when you go back to work. Otherwise, what is the point of doing all that work if you cannot enjoy it?

In my opinion, one of your resolutions should be growth. Personal and professional growth are both important, and I think they compliment each other. I do not know of many who can grow professionally without growing personally, and vice versa. It is easy to get wrapped up in work and forget to take care of ourselves, just as it is easy to do the bare minimum at work and focus too much on our personal time, even while we are at work. Either way, you are not giving your employer or yourself all you can, and eventually, that will catch up to you. Enjoy life. Work hard and play hard. You will be much happier.

That's just my opinion,

Jim Thacker, MBA, MHA, CRT

Wellington, MO


Modern Healthcare Is All About Money
January 12, 2015 9:27 AM by Jimmy Thacker

The television show 60 Minutes is not a comedy, but I had to laugh when it aired last night. Part of the show was dedicated to the Affordable Care Act and what it has and has not accomplished. One of the subjects was that it has not reigned in rising hospital costs. In part, this is due to some chief executive officers of non-profit hospitals and their pay. One short interview was with Jeffrey Romoff, CEO of the University of Pittsburgh Medical Center, who admitted that last year his salary was $6 million. He looked out over the city of Pittsburgh from his lofty office with a 360 degree view, and it made me wonder why I wonder that healthcare costs are going up, particularly when it comes to hospitals.

You cannot blame just one source. The short answer is that healthcare costs have always gone up. Yes, but why in the hospital? I mean, most money is made in outpatient services, not overnight hospital stays. Insurance companies make millions off of us, but it is not solely their fault. Pharmaceutical companies make billions off of one of the most pill-dependent societies ever known to mankind, but you cannot blame them solely, either. Doctors, who used to be thought of as the culprits, often have their own struggles just to make ends meet between paying for their hospital work and their office time, not to mention the costs to their personal lives. But $6 million worth of administration is, in my book at least, a lot of administration, particularly for a hospital that does not make the ranks of the top 100 hospitals in the country. The problem is that our healthcare system does not work together. We sell out to the lowest bidder, then pay top price and pass those costs to the consumer. It's called making money, and in healthcare, that's really all we worry about.

The United States spends $2.6 trillion on its healthcare. That is 18% of our gross domestic product, or 18% of everything we make as a nation. That amount is expected to rise to 20% by the year 2020. For that kind of investment, you would expect our health care to be pretty good, right? Well, the World Health Organization recently ranked the U.S. #37, not #1. So how do we spend all this money and get such poor results. Because making money is more important than anything else in our healthcare system.

Other factors that lead to high health care costs include paying for doing more, not doing better. We do tests that are not needed, repeated, or even dangerous, "just in case" because our society will sue if you do not. We are also getting older, more sick, and fatter. This places stress on an already broken system. We think that new is better, so we continually update our old equipment with newer stuff that may not have even been approved except for safety.

Patients are just as bad as providers here; everyone wants only the newest stuff. We overuse our expensive healthcare plans. This trend is changing some, so there is some hope, but those with insurance have been shown to actually drive the costs of healthcare up, where most people felt it was those without insurance.

Now that we know who is really responsible, we can move (and are moving) to fix it. But we have no information. When is the last time you checked on your doctor bill to see if what he or she charged you was consistent in today's market? You haven't. You are not that smart, and no one else in America is, either. Corporate hospitals are getting increased market shares, which drives up prices because they do not have competition. When a corporation (like our aforementioned University of Pittsburgh) takes over a market, costs automatically go up 20% because of a lack of competition. Corporate takeovers rose 33% between 2000-2010, including in small towns where big corporate hospital chains make health care as easy to access as the local McDonald's, with about the same results. Last, we are still practicing defensive medicine. I have insurance in case someone sues me. You do, too, if you are smart. Nurses should, and doctors all do. Rather than treat what they know, we have to treat what could be. That is the reason for useless orders for incentive spirometry and oxygen that never gets used, but gets charged for. It's all defensive, because when money is involved, it really is "us versus them" and it always will be.

In my opinion, as I have stated before, the healthcare system is broken. Good people are leaving the hospitals for other options because responsible people with high morals and ethics simply cannot stand to watch the hospital system of yesterday implode upon itself. The only thing that matters to that CEO with his office overlooking his or her kingdom, rather than being somewhere accessible to the community, is money. That's it. You are fooling yourself if you think different. There are, of course, exceptions. CEOs involved with their staff often get much more out their employees than the typical boss does. But these types of leaders are not getting into hospitals, either, because they know what is coming. What is left is the type of leader who, though not actively involved in saving any life, not having any skills to affect customer service at the bedside, and not having any idea what you do for a living, is making decisions based on how much money can be made rather than what is best for the community, the employee, the doctor or nurse, and the patient.

Sure, they build new, shiny hospitals with spiral staircases as a testament to the power of the dollar, but if you move the same people that was in the old, crummy hospital to a new building, have you really improved anything? But hey, in the United States health care system, "that's how we roll."

That's just my opinion,

Jim Thacker, MBA, MHA, CRT

Wellington, MO

School Nurses Need Support from RTs
January 5, 2015 10:18 AM by Jimmy Thacker
Our children spend 28% of their daytime in school during the academic year, and 14% of their total time between the ages of five and 18 will be sitting at the desk learning the three R's (yes, I know they are no longer taught). Behind the scenes, someone is responding to the 18 million children estimated by the Department of Health and Human Services who have health care needs or a chronic illness. The school nurse may be the unsung hero of the nursing profession. Quietly, they sit at sports events they are not interested in, they respond like the school's version of 9-1-1 any time a child goes down on the playground, in the classroom, or in the halls, and they are responsible for making sure children get the medicines they need to succeed in class through 12 grades. That's no easy task. Yet, talking to school nurses, they feel underappreciated, misunderstood in their role, and unsupported for the herculean task they must do for every child in the school district.

School nurses have a lot to be frustrated about. Few schools have oxygen available, let alone artificial airways. AEDs are spread out to the point of being useless in an emergency. Few people other than the nurse may even know CPR or what to do if a child has an asthma attack. School nurses seldom get practice either. Though 86% of surveyed schools have an emergency medical plan, less than 35% of them have ever tested it. EMS tries to help; the average EMS response time to a school with a medical emergency is about 10 minutes. School boards tend to cut expenses through the school nurse's budget; there is little money to send a school nurse to a conference or training where he or she could improve his or her skills; skills that may save the life of a child.

Given all the hazards that exist at a school, from playground equipment to foods with allergens, to the germs of the other kids, one might think that schools would lead the way in providing clean and safe environments, but you would be wrong. Walk through your local school. Schools where I live and a couple of towns surrounding me have mold in their walls, dust everywhere, broken glass in the parking lots, and paint chips falling off the walls. It is up to the school nurse to point these things out, too, as safety hazards.

School boards are not always cooperative. Often board members do not have children in the school, or worse, they do and rely on the child to bring up potential problem areas. Non-emergent injuries or illnesses can completely bypass the school nurse, with other staff making decisions to send the sick or injured straight to the doctor without involving the one person who will be expected to know the most, the school nurse. Parents can also be a problem. Parents assume the school's job is to provide every need their child has during that eight or so hours day and are upset when there is a lack of communication, but no school nurse I know of can do that for every child. If the parent does not bring up the latest visit to the doctor, the change in medicines, or the new allergy discovered, how would the nurse know? Parental involvement would add greatly to the safety of their children and the effectiveness of the school nurse.

In my opinion, as respiratory therapists you should know that your local school needs you. If not, you either live under a rock or you simply do not care. A class on asthma, a partnership between the hospital and school where school nurses are supported keeping the CPR and even advanced training current, advising school boards on policy and procedure, and many other ways. I walked 110 miles across my county a few years back to raise money for asthma, and bought spacers for all kids in my county schools that had asthma. The appreciation I received from school nurses was wonderful. We had a county where every asthmatic child in the public school system had two spacers; one for school and one for home. A little creativity and care go a long way. Get involved with your local school. Check up on your school nurses and see if you can help them. If you are an asthma educator, get your school aged asthmatics a treatment plan on file with the school nurse and the parents. Jan. 25 is School Nurses Day. I challenge you all to support your local school nurse any way you can, make contact with him or her, acknowledge the difficult job they have with a gift or visit, and improve the lives of the children in your communities.

That's just my opinion,

Jim Thacker, MBA, MHA, CRT

Wellington, MO

Circle Conference Day on Your 2015 Calendar
December 29, 2014 9:21 AM by Jimmy Thacker

As the New Year quickly approaches, I just want to let you know about some conferences coming up so you can plan your calendar:

  • The AARC Summer Forum takes place in Phoenix this year and goes from July 13-15. The AARC Congress is in Tampa, FL and runs from November 7-10.
  • The Pulmonary Disease Education Course, which may be an extension of the COPD Educator Course, is being presented in Arlington, VA on March 16 and 17.
  • The Adult Critical Care Specialist Course will be in Winfield, IL on March 20, and Marco Island, FL on July 13-14, but is only for registered therapists.
  • The Association of Asthma Educator annual conference will be held in Anaheim, CA from July 31-August 2.

In my opinion, it's important to plan an educational event this year. Renew friendships, meet others, get out of the hospital and see others in a more relaxed mode. Hit your department manager up for it now, before the budget gets blown on the next "doo-dad" that he or she forgot to figure in, and you can lock in the best rates for rooms, flights, and fun packages that may be offered.

That's just my opinion,

Jim Thacker, MHA, MBA, CRT, Wellington, MO

Patience for Patients
December 22, 2014 9:56 AM by Jimmy Thacker

Christmas is upon us, and the New Year is not far away. After all the presents are unwrapped and travel to "grandmother's house" is done, we settle in for the rest of winter. Interrupted by New Year's Day celebrations, often, this can be a tough time of year for many. Depression seems to run rampant this time of year. Some, shut in by conditions they have acquired over the years and life experiences, can feel gloomy and even give up on life.

It's a good time of year to check in with people. Christmas cards are great, but an email, a phone call, or even a short text message to check in on family and neighbors goes a long way. We get to see people at their worst; stuck in a hospital over the holidays. Encourage visitors to stop by if possible. Give your patients a little "me" time to enjoy, as you see practical. You may even make some new friends and be able to show how important respiratory care is to the community.

With the New Year come resolutions.Some will resolve to get their lives in order. Some will resolve to make life-changing decisions like quitting smoking or getting more exercise. Sadly, by this time next year, many resolutions will still be that, promises to oneself that never quite happened for one reason or another. Soon, in early 2015, the shock of what the season costs will set in, as credit card bills come in and about the time you get used to writing 2015 instead of 2014, income tax season looms on the horizon. The first six months of any new year can be all uphill for those unprepared. Patients, now looking at increased expenses from their visit to you, can get down, even angry, at their situations. Even workers can feel the pinch, trying to balance their checkbooks and their time to have a good holiday season.

In my opinion, this time of year requires more patience than most. I get anxious for football season. Once it is here, I often wonder why I watch since my team seldom does well. Some anticipate birthdays or anniversaries. Others are looking forward to that raise they have been promised and hope this is the year it actually happens. Patience is a virtue, it is said, and frustration can be its byproduct. I often do not have much patience. I admit it, I am flawed. I am just not geared to be patient, but I am learning and you can, too. So many things going on this time of year wears a person's patience thin. Take a deep breath. Squeeze that stress ball you got at the hospital Christmas party harder than you ever have, and show some patience with your patients and each other. It may be hard and require you to bite your tongue a time or two, but in the end, you will be a better person for it. The dark, gloomy winter days that haunt us now are here for a while, so let's make the best of them.

It's a good time to get some education. Nothing passes time like writing papers or doing math equations into the wee hours of the morning. It's a good time make a list of your priorities for the coming year. It's a good time to catch up with old friends. It's a good time to rekindle old relationships that have slipped away over the years with a card or message from the heart. It's a good time to look at what happened last year and what you want to make happen next year. It's a good time to relax, give yourself a "chill pill" and enjoy the success you have had in 2014 and plan for the challenges you will face in 2015.

Merry Christmas and Happy New Year to all of you. I wish you fun times, safe travels, and a wonderful season. Remember those who are serving in our military at home and abroad, as well as their families, and those who serve our communities every day. Thank all of you for your contribution to our nation's health, to the services you provide your communities, and to your organizations. May the New Year keep you healthy, happy, and enjoying your professional and personal lives in 2015.

That's just my opinion,

Jim Thacker, MBA, MHA, CRT

Wellington, MO

What's Your 'State' of Health?
December 15, 2014 11:58 AM by Jimmy Thacker

I love this time of year. Not because of the holidays, and not because of the crispness in the air. I don't care for either of those. I love it because at this time of year, every year for the past 25 years, a new report from America's Health Rankings comes out. The report, broken down state-by-state, is available online and is hot off the press now, after it was released Dec. 10. The rankings are actually published as a cooperative by the United Health Foundation and partners at the American Public Health Association and Partnership for Prevention. Since it was first launched in 1990, we now have 25 years of progress (or not) to look at, which makes me all tingly inside.

First, life expectancy is up. At 78.8 years, you will likely live longer, but not necessarily better. Along with expectancy, also up are conditions that will plague you later in life. There are some clear cut successes: smoking prevalence is down from 2013 by 3%. Immunization coverage is up 5% in adolescents, and a 4% decrease in infant mortality has quietly slipped under the radar of your local news show. Of course, we do have challenges. Pertussis is making a comeback, increasing 154% since 2013. Obesity, which has been well covered by the media, is up 7%. Drug deaths are up 7% also, but the report does not specify if it is talking about illicit, prescription, or over-the-counter drugs. Finally, physical inactivity is up 3% when people were asked to rate their exercise programs over the last 30 days.

The report also allows us to compare today with 1990, which I find particularly useful and fun. Since the first report in 1990, smoking has decreased 36%. High school graduation rates have increased nearly 10%. Violent crimes are down 37%. Air pollution has dropped 25% and preventable hospitalizations have decreased roughly the same amount. Occupational fatalities, infant mortality, premature deaths, cancer deaths, and cardiovascular deaths have all decreased. Still, there is some work to do. Obesity, physical inactivity, the number of children living in poverty, public health funding, child (19-35 months) immunization coverage, adolescent (13-17 years) immunization coverage, low birth weights, and diabetes are all areas that have become worse since the original report in 1990.

So, who is the best and worst? The top five healthiest states are (#1) Hawaii, (#2) Vermont, (#3) Massachusetts, (#4) Connecticut, and (#5) Utah. All five states have very active programs focusing on prevention, improving air quality, and community education. The bottom five states are (#50) Mississippi, (#49) Arkansas, (#48) Louisiana, (#47) Kentucky, and (#46) Oklahoma. Biggest improvements from 2013 to 2014 were seen in Maryland, which went up eight places, while Texas and Virginia moved up five. Alabama, Rhode Island, and South Dakota all moved up four places in the reporting year.

The report is full of "fun facts" and is one you should look up to be an educated therapist, especially if your state is one of those bottom five. "U.S. health outcomes are much worse than most other developed countries despite spending a greater percentage of our resources [on] health care than all other countries. We have an opportunity to make dramatic improvements [in] health if we focus on prevention..." according to Anna Schenck, PhD, MSPH, Chair, America's Rankings Scientific Advisory Committee, Director, Public Health Leadership Program, UNC Gillings School of Global Public Health.

In my opinion, as I have stated in the past, it is hard to focus on prevention when you have to focus on pleasing your stockholders, which is what America's hospitals put their priorities on. Though some numbers have improved, you may notice that the improvements are in individual statistics and choices, and are not things influenced by the hospital or clinic. You may note that "challenges" are all community issues that require a massive education effort by communities and community-based hospitals that fail to utilize the resources they have and do not place education as a priority.

Are hospitals and clinics failing us? Maybe, but a more plausible answer is that our health system is failing us. A doctor or clinician has eight minutes to spend with you on average. After eight minutes, he or she will chart on you for 15 minutes to cover him or herself legally. And you will wait 30 minutes on your new prescription to be filled if there is no line; longer if you are not the next number on the ticker. Then you go back and repeat the process in a month or two because there is no talk of prevention, only treatment.

Seriously, who is the person that believes that system will work? I cannot tell you when the last smoking cessation class was in my community, but I can tell you it was hosted by a lady who has never smoked, so you can guess how horribly that went. I failed to get an asthma clinic going at a corporate-run hospital simply because the corporation saw that I could attract patients and wanted to bump the prices up to a point no one (who needed the clinic) could afford. My local health department and health care collaborative here in Missouri are not smart enough to use an asthma educator in their community education programs. Sadly, this is the norm. Friends in Wyoming, North Dakota, Oklahoma, Tennessee, and Florida who are respiratory therapists and asthma educators tell me the same thing happens in their communities.

Prevention does not make money, and does not please stockholders. Treatment, especially repeat treatment, does. And now, after 25 years, the proof is out in a report that this type of medicine has done very little for us. 18% of our nation's gross domestic product is spent on a healthcare system that that does not keep us healthy. If you were that ineffective at your job, you would be jobless. But it seems to be OK for the healthcare industry. Money is made hand over foot, and your hospital CEO likely has a much bigger bank account, investment portfolio, and car than you do. Do you really think he or she has your best interests in mind, or the interests of your community? Look at the report. Educate yourself. Be a change agent, because in my mind, the best thing respiratory therapists and other healthcare professionals can do according to this report is work tirelessly to change our healthcare system.

That's just my opinion,

Jim Thacker, MBA, MHA, CRT, AE-C

Wellington, MO

Simple Strategies to Avoid Flu
December 8, 2014 11:39 AM by Jimmy Thacker

Well, the flu season is almost upon us, and the CDC says that it may be a bad one. In fact, the same week we heard that this year's flu vaccine may not cover many strains of the flu we will be dealing with this year, the CDC reminded everyone that a flu shot is recommended, particularly for those at high risk. The agency is also encouraging doctors to treat flu-like symptoms as the flu sooner rather than later, to head off spread of the illness and to relieve suffering early. 

It takes us longer to make a flu vaccine than it does for the flu to mutate into other strains. This is part of the reason why we can never seem to keep up. Consider, also, that the current flu vaccine was chosen back in February, giving the flu time to mutate into strains we did not consider at the time. The flu bugs circulating then will still be around, and you will be protected from them, but since then, "drift variants" have come up, and the vaccine may not fully cover you on those. 

The flu hits about 15% of the population each year. The CDC recommends everyone over the age of six months get a vaccination, unless you are pregnant or have specific conditions such as asthma, diabetes, kidney, heart, or lung disease. So the average respiratory patient is questionable. Anti viral drugs should be started within 48 hours of initial symptoms, which presents another problem because flu patients are often not seen that quickly unless they are already in the hospital.      

In my opinion, this is another example of our poor healthcare system. We spend so much on medicine, and I believe we get treatment right more often than not, but our preventative medicine is not good. We do not focus on prevention in general. I know some doctors that do, but as a society we are content taking pills and medicines once we are already ailing, rather than making choices that prevent the illness or condition from occurring in the first place. This drives up our healthcare costs. We have to do a better job of not only "guessing" what flu bug is coming, but taking steps to prevent the flu in our own lives to start with -- outside of vaccines and medicines. Simple steps like washing hands more often, avoiding talking in people's faces or letting them talk in ours, trading the handshake for a fist bump, and keeping children and ourselves home when we do have symptoms are all effective strategies. I feel relatively certain taking these steps would do more to curtail the flu than vaccination only.

That's just my opinion,

Jim Thacker, MBA, MHA, CRT, AE-C Wellington, MO

E-Cigs May Be Worse than Tobacco
December 1, 2014 9:16 AM by Jimmy Thacker
Well, November was quite a month for electronic cigarettes and those who use them. Just as the CDC reported that smoking in the United States has decreased to an all-time low, we also heard that when users recharge their e-cigarettes, malware may be transmitted from the device into their computers. Most e-cig devices are made in China, so who knows what this does to your laptop or desktop? Later in the month, I read a team of researchers from the Japanese Health Ministry believes that e-cigarettes, which many use to stop smoking and which has attracted many others who do not look at it as smoking but a "cool" thing to do in lieu of smoking, may contain up to ten times the amount of carcinogens as regular cigarettes. The bottom line is that electronic cigarettes may not offer a viable option to quitting, and it may attract many others to smoking something they consider safe, though it may not be.

How sneaky is it that a world entity would use e-cigarettes as a way to get into your home computer? The Chinese are obviously miles ahead of us when it comes to spying and espionage. If you use one of these devices, and you've plugged it into your computer to recharge it, and if your computer started acting strangely shortly thereafter, you may have found the culprit. The safety of electronic cigarettes has been hotly debated. The fact is that they are a targeted marketing tool whose advertising has left the auspices of helping people trying to quit smoking to advertising to new clients, offering the ability to be cool as you electronically "light up" anywhere you want. I am old enough to remember the Marlboro Man, which is what I equate electronic cigarettes to now.

In my opinion, it may be time to regulate these things more. Not only from the standpoint of national security, but from the point of safety. The FDA and CDC have done a horrible job of this, and even our own colleagues in respiratory care, nursing, doctors' offices and other health supporters have not performed much better. We need to focus on quitting everything, and anyone who knows anything about quitting knows it is a change in behavior, not a substitution, that leads to ultimate success. That is what we need to explore, not putting down regular tobacco in favor of a fake, and possibly more lethal, tobacco substitute.

If you have ever tried to quit, you know the thing you need to replace the most is the action of smoking; having it in your fingers, putting it to your mouth, and relaxing as the nicotine hits your blood-brain barrier. I hear very little talk of how to do that these days, and that is our problem. I think we take some false pride and relief in our smoking rates decreasing, while our dependence on electronic cigarettes tripled between 2011 and 2013. Real change is needed, and should be demanded, by those of us in fields where the unfortunate benefactors are seen in our emergency departments, clinics and hospitals every day. Since all the established agencies have failed us, who do we look to? That is the real question.

That's just my opinion,

Jim Thacker, MBA, MHA, CRT, AE-C. Wellington, MO

Who Will Fix Healthcare?
November 24, 2014 12:58 PM by Jimmy Thacker

An interesting study on public radio said that it is the insured, not the uninsured, driving up healthcare costs. The premise was simple: If you have health insurance, you use it. If you lack health insurance, you are more selective about doctor and hospital visits. It makes sense, yet who really causes our steady increase in costs is still debatable.

The Affordable Health Care Act, or "Obamacare" as it has been dubbed, has added millions to the rolls of the insured, but has also placed limitations on those who may have already had healthcare insurance by forcing them into choices of doctors and hospitals they may not want. As an advocate of universal healthcare, which looks nothing like Obamacare, I found this new study interesting. After all this time, we simply cannot nail down who is responsible for rising health care costs in the United States. With all the brain power spent on what, to me, is simple math, we still have no clue how to control our costs.

The basis of our crisis in our healthcare system is, to me again, fairly simple. Lawyers write our healthcare laws. They do so not based on what is best for our country, but what is best for corporations from a legal standpoint. We live in a society that wats to assign blame, and assigning blame in healthcare, especially when something goes wrong, is as common as putting milk on your cereal.

We do know seven definite things that drive up our health care costs. These were identified years ago. Let's review, because your doctor does not have the time to explain healthcare to you, and your insurance company likely can not be trusted to explain it correctly in terms you can understand.

  1. Health care professionals are paid to do more. Rather than be efficient, we reward being able to do enough to protect ourselves legally. This results in unnecessary procedures that cover our healthcare professionals' tails rather than focusing on making good diagnoses, ordering appropriate tests and procedures, and minimizing time and cost.
  2. We are older, sicker, and fatter. In general, the population is living longer, has more illnesses brought about by environmental changes, is over medicated, and less active, particularly in the "golden years." Even young people spend less time riding their bicycles or playing outdoors, opting instead for the latest video option. Parent,s who spend less time supervising their kids, support this because it reduces the need to watch them. The result? We live longer, but germs that used to be common back in the days when we ate mud pies and scraped our knees on bicycles ridden without helmets and knee pads are more risky now than in the "good old days" when you walked it off and played until the porch light came on.
  3. We want more. Try to watch your television for an hour without seeing a commercial for some great drug that will solve all your problems. Not only are we a dumb enough society to believe, but we are also dumb enough to ask our healthcare providers about it. Many providers will give us what we want if there is no reason not to; a change from when doctors ran healthcare long, long ago.
  4. Relatively speaking, it costs little to seek our healthcare. We get tax breaks if we have insurance, and emergency rooms do not have a standard charge waiting for you when you walk through the door, which is probably good. We add to this by using cut rate places for our healthcare, such as the local drug stores that operate in massive chains across the country or the satellite clinics set up by corporate hospitals that offer basic services but are more than willing to refer you to their "mother ship" for anything more serious than the common cold.
  5. We have a lack of information. In the age of technology, when we all can look up our symptoms on websites to help identify what our ailments are, we are still largely a stupid nation. Whether it is a lack of time, lack of interest, or, as I suspect, a simple belief that our health care system is "supposed" to help us do this so we have no reason to do it ourselves, we are ignorant of our health, our healthcare laws, and very slow to change when something is discovered that could improve lives. It is easier to take a pill to cure us than making a change in our lifestyle. And try to compare the cost of your upcoming open heart surgery between hospitals available to you. You can spend hours and still not have the information needed for a modern consumer to make an educated decision. Instead, you are most likely to go where ever your physician wants you to go. Trust is a wonderful thing; blind ignorance is not.
  6. Hospitals are corporate now, and that means less "care" in healthcare and more care about reporting favorably to stock holders. Corporate hospitals can charge higher fees, because they have a larger market share. Especially in a rural setting, where the corporate hospital is likely to be the only choice you have, the standard 300-400% markup they charge, even if they are "non-profit," funds not only the things they tell you about like new equipment, staff, and other stuff that we all support, but also makes their CEOs a lot of money and buys a lot of favor when he or she has to report to share holders. This is how healthcare is run these days, and this is why the system no longer works.
  7. Supply and demand. The U.S. does not have enough doctors. Medical school costs somewhere around $100,000 a year. Students come out ready to save the world, but the reality is they need to go into specialties rather than care for your grandmother because caring for Gramma just does not pay well enough to pay off those student loans. We have plenty of specialists, just not every day doctors, and this is the reason why. To compensate, we have nurse practitioners who do outstanding work, but are limited as to what they can do, order, test, and sign off on. We lack nurses, a problem we have seen coming for some 50 years, yet we have done nothing about it like offering incentives or making license in Missouri also good in Kansas if Kansas needs qualified nurses. I have seen recruiters for the military in high schools, but never a nurse recruiter. Many other disciplines suffer the same way. Then there is "defensive medicine," as mentioned above. We spend (waste) more time and resources protecting ourselves from ourselves than we do healing each other. That is just the society we live and operate in. Thorough testing need not be defensive testing, but the reality is that we encourage the latter rather than the former because of the threats we all incur when providing aid to the sick.

 In my opinion, as I stated in one of my very first blogs, our healthcare system is broken. Everyone knows that, but today we will be looking at things other than fixing it in Washington, D. C. Brilliant minds and elected officials cannot even agree on what color the tile should be in their offices, and our country's healthcare system continues to increase in its cost to operate despite providing no better health care for its citizens than an average country. Mid-term elections are over and the people have spoken for an increase in corporate stature, telling me the situation will get much worse before it gets any better. Educate yourself. Educate your patients. Follow health care stories, especially as it concerns costs and dividends. Notice the environment around you. None of this is new; as I said in one of my first blogs. When do we decide to fix it? That was, and is, my question for you.

That's just my opinion,

Jim Thacker, MBA, MHA, CRT, AE-C Wellington, MO


Emphasize Personal Care
November 11, 2014 10:08 AM by Jimmy Thacker

Many of us have done it. Walked around a big chain department store and looked for things, while employees simply pass us by. No one offers to help and no one wants to be the person to end our search and make us feel better. If you have experienced this, imagine what it must feel like when it happens at a healthcare facility. You are already scared and nervous, worried about the horrible bill you will amass and you walk in and no one smiles, no one offers to help you. Even when you are in your room, there are only staff; no people. 

Personal service is as vital to making a patient feel better as the medicines and therapies we deliver. Taking pride in the service you give means you look professional, act professional, and are still a human being. A little empathy goes a long way. Way back when I was in respiratory therapy school, a teacher taught me that I should treat every patient like they were my mother or father. Doing that has often gotten me some nice comments on patient satisfaction surveys, and now that I am older, I simply treat others as I would expect them to treat me if the roles were reversed. Hmmm, where have I heard that before? 

In my opinion, it is easy to get caught up in the onslaught of hurried and stacked treatments, obligations that take you away from patients, meetings, and other things during your shift. Just remember, at one point, the role will likely be reversed, and how you treat others has a nasty way of coming back to haunt you when you are the one being treated. Call it fate, karma, or whatever you label you choose to assign, but let's always remember the "care" part of healthcare. In these days of chain hospitals owned by corporations, be the exception. Be the one who prides himself or herself on personal service. Do not follow the example, set it. You will get much more respect that way, and when you are the one in the hospital bed, you may see your example being lived out by the one saving your life. 

That's just my opinion, Jim Thacker, MBA, MHA, CRT, AE-C Wellington, MO



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