Addressing a Dysfunctional Healthcare System During a Pandemic

June 19, 2020

In the battle against the novel coronavirus (COVID-19) outbreak sweeping across the globe, healthcare workers are the frontline fighters saving countless lives with their tireless efforts. Grueling hours, equipment shortages, increasing patient needs, and dangerous working conditions on top of already demanding job requirements are contributing to unprecedented levels of physician burnout at this time.

Not only are healthcare workers facing the global pandemic head on, they are doing so without the necessary safety precautions, as part of a healthcare system that is proving more dysfunctional and ill-equipped to handle a public health emergency than would have been assumed. The precarious situation is made worse by mounting evidence of the censorship and exploitation of medical professionals, who are in some circumstances being forced to choose between their jobs and sharing accounts of what the battle within hospitals really looks like. The issues coming up as a result of the pandemic devastating healthcare systems across the globe is an extension of a greater, long-term problem within the healthcare system that must be addressed.

Growing Censorship

It has become commonplace for hospital and healthcare organization leadership to take on press and media responsibilities, while the voices of physicians tend to be largely omitted in the news landscape.

Now due to the COVID-19 pandemic, news channels and other media are actively seeking input from physicians fighting the global health crisis, giving them an unprecedented opportunity to air their concerns about the state of the healthcare system on a public platform. Unfortunately, their employers and hospital leadership are actively working to suppress their ability to speak out and provide honest depictions of working conditions.

More frequently, stories are emerging of physicians who have lost their jobs for speaking out against hospital protocols, posting their stories on social media, or releasing information to the media. Dr. Esther Choo, emergency physician at Oregon Health & Science University, revealed she has been told by many fellow healthcare providers about their fears of speaking up about the challenges they are facing due to the risks involved.

Some physicians have been taking their concerns to social media, posting about dangerous shortages of personal protective equipment, unsafe hospital protocols, a lack of communication from leadership, as well as growing censorship and restrictions on their freedoms. According to reports, hospitals across the nation have been warning, disciplining, and even terminating employees who publicize their workplace concerns about coronavirus-related challenges.

Accounts reported in The Washington Post and The New York Times, describe several instances of physicians being threatened with disciplinary action, restricted from appearing on television, reprimanded for their behaviors, and even terminated for sharing glimpses into their hospital’s conditions. While other institutions such as NYU Langone Medical Center in New York have gone so far as to forbid staff members from “contacting the media without permission under threat of termination” according to an article published in The Washington Post.

During a worldwide pandemic, the worst thing that can be done is to render clinicians inconsequential and sequester them from the rest of the world when knowledge of the realities is critical to improving population health outcomes worldwide. Their first-hand perspective from the frontline is necessary both in terms of guaranteeing freedom of speech as well as providing an accurate depiction of the handling of COVID-19 within the healthcare system.

Increased Press Access

Hospitals, while not in the business of sharing information about their patients, currently face growing pressure to provide insight into the situation at hand. Protecting the privacy and dignity of patients is paramount, however, Dr. Esther Choo told CNN she believes this unprecedented situation warrants an alternative approach to sharing healthcare information.

“In this crisis, I think it creates a barrier between what is happening inside, what our healthcare workers are seeing, and what the public needs to know in terms of how bad this disease is,” Dr. Choo commented on the lack of insight provided from within the healthcare system,  “I think without seeing it, it’s hard for people to understand what we’re trying to avoid with measures like stay-at-home.”

While for both safety and privacy reasons journalists are unable to report from emergency departments or within hospitals, media professionals are calling for more access and exposure to vital information. This makes the first-hand, honest reports from physicians and nurses essential at this time – they have the power to inspire widespread reform, motivate support and donations, and underscore the importance of staying home.

Relaxing HIPAA regulations and revisiting press restrictions at hospitals may be necessary at this time to provide the public with an honest view inside emergency rooms. “I think we need to make a decision as hospitals, as healthcare systems, we are going to be a little bit more open about the challenges we’re facing,” Dr. Esther Choo told CNN, highlighting the systemic effort needed to change the status quo.

Access to information is not only vital for preserving democracy within the nation, but it is critical for public health, keeping the population informed and aware of the devastating failures of hospital protocols as evidenced by the COVID-19 response. This can be achieved while still protecting patient privacy and anonymity, if healthcare professionals are allowed to speak out. As reporter Chandra Bozelko argues in a recent Washington Post article, “Patient care includes public advocacy, minus the personal details.”

Emotional Exploitation

Alongside the censorship of medical professionals, the exploitation of physicians is another problem emerging as a result of the dysfunctional system. Viewed as a perpetual resource, healthcare staff members, their innate professionalism, and their work ethic are what keeps the healthcare industry in operation. The system itself runs on the altruism of its practitioners; if medical professionals worked their number of allotted hours and went home at the end of their shift – instead of working endless hours overtime to preserve patient health – the healthcare system and its patients would suffer greatly.

The COVID-19 pandemic has revealed how medical staff members are treated as an endless resource, used to maximize efficiency of the system, constantly being faced with added responsibilities and a growing workload – additional patients, paperwork, and procedures. For the majority of healthcare workers, walking away without completing their job and thus, endangering patients is unthinkable. Meanwhile leadership continuously exploits this ethic.

Over the past few years, demands have escalated without an equivalent rise in time or resources. At the same time, the medical complexity of patients has increased with the number and severity of chronic conditions steadily rising in prevalence. Medical encounters are more involved than ever before with more illnesses, medications, and complications, while the duration of office or hospital visits remains the same.

In times of the COVID-19 pandemic, the demands on healthcare workers have only increased, while resources continue to decrease at alarming rates and exploitation of the workforce continues. According to data from The New York Times, physician burnout levels are at an all-time high caused in part by chronic workplace stress, as are burnout rates among nurses. Physicians and nurses on the frontline of patient care experience the highest levels of burnout, which are associated with increased medical errors and thus, present threats to patient health and safety. Data suggest that doctors and nurses commit suicide at higher rates than in almost any other profession and recent examples of medical workers taking their own lives as a result of working conditions signal an urgent need for change.

Based on an unrelenting belief in the unwavering professionalism of its workers, the current healthcare model is proving unsustainable for both providers and their patients. As such, the system must be restructured to reflect the current realities of patient care. The healthcare model is  imperfect and is only able to function due to the valiant efforts of its workers who prize patient caregiving above all else. Exploiting the altruistic ethic of healthcare professionals to keep a broken system from collapsing in on itself is not just unsustainable, it goes against its very mission.

Though limited due to censorship restrictions, reports emerging from the frontline indicate a persisting problem. The COVID-19 pandemic has revealed the unpreparedness of many healthcare systems across the world to handle unprecedented spikes in demand. However, in the United States it has also presented an ominous example of dysfunction and an extension of a greater, long-term problem within the system that must be addressed. The number of challenges facing healthcare workers will continue to grow as long as the enterprise can exploit its labor force unpenalized and the repercussions of this model will continue to emerge. Silencing staff members will only further the problem while promoting an unrealistic image of the state of healthcare thereby hindering potential efforts to help those in need – which right now are not just the patients fighting for their lives against COVID-19, they are also the physicians risking their lives to protect them.

 

6 Powerful Antibacterial Essential Oils

June 12, 2020

Commonly used in medicines across the world for their many benefits, essential oils are natural products which have strong antimicrobial, antioxidant, antiseptic activity and can provide natural protection against several types of pathogens.

As a result of their chemical composition, a large number of aromatic natural oils has been investigated for their potential antibacterial properties against bacteria, fungi, viruses, and protozoa. Most notably, the oils of oregano, tea tree, eucalyptus, and peppermint have been found to contain the strongest antibacterial and anti fungal properties. Other studies have found that lemongrass and orange are also among the oils effective against bacterial strains.

Biomedical research is increasingly focusing on a wide variety of essential oils hoping to identify novel and natural applications for the inhibition of microbial pathogens, according to a review published in Antimicrobial Compounds.

Antibacterial Essential Oils

The unique benefits and wide range of uses of essential oils can be helpful at the time of a virus outbreak by offering antibacterial properties.

1. Oregano Oil

Believed to be useful both when consumed and applied topically, oregano oil has demonstrated a spectrum of antibiotic properties as well as strong antimicrobial, antiviral, and anti-fungal activity.

Preliminary findings implicate that the oil may be helpful in fighting bacterial infections; a mice trial found that oregano oil was effective at preventing and treating Staphylococcus aureus infection, while another study found the compound was able to destroy bacteria associated with dysentery.

Oregano oil is believed to derive its power antioxidant properties and fragrance from a combination of protective compounds – carvacrol, thymol, and rosmarinic acid. Research has evidenced that carvacrol, the most abundant phenol in the oil, may stop the growth of several bacteria strains, while the natural anti-fungal thymol has been shown to boost immune functioning and protect against toxins. The powerful antioxidant rosmarinic acid also contributes to the healing properties as it protects the body against damage caused by free radicals.

2. Tea Tree Oil

For many years tea tree oil has been used as a healing agent in Australia and in recent decades, its popularity as an alternative treatment has increased across the globe.

Distilled from the leaves of the Melaleuca alternifolia plant, the essential oil is known to possess strong antibacterial, anti-inflammatory, antiviral, and anti fungal properties. It can be used in the treatment acne, athlete’s foot, contact dermatitis, and many other health conditions. Today, it can also be found in many popular cosmetics, topical medicines, and household cleaning products.

While further research is needed to conclusively determine these findings, some studies have found that tea tree oil can help in the treatment of certain viruses and that its antimicrobial activity is associated with the ability to damage bacterial cell walls.

3. Eucalyptus Oil

Similarly to tea tree oil, eucalyptus oil has been used as an antiseptic and often as an ingredient in cosmetics and household products. Many styles of medicine, including Chinese and Indian Ayurvedic, have used it to treat a variety of conditions for centuries.

Due to antioxidant flavonoids and anti-inflammatory tannins found in the plant, eucalyptus has been increasingly studied for its potential antimicrobial properties.

Serbian researchers found evidence supporting a positive interaction between eucalyptus oil and existing antibiotics, potentially reducing the need for use of the latter. Meanwhile, a study published in Clinical Microbiology & Infection reveals the oil’s possible antibacterial effects on pathogenic bacteria found in the upper respiratory tract.

4. Peppermint Oil

Peppermint essential oil is often used for aromatherapy or as a topical treatment for itching, muscle pain, and headache relief. It has demonstrated antimicrobial properties against types of bacteria and fungi, however, its effectiveness may depend on the species of bacteria as research findings have been mixed.

A study published in the Arabian Journal of Chemistry reported antibacterial activity in peppermint oil against Gram-positive and Gram-negative bacterial strains revealing that concentrations of essential oils were able to inhibit the growth of microorganisms at a rate comparable to the antibiotic gentamycin.

5. Lemongrass Oil

A popular tool for stress relief, lemongrass essential oil can be used as a natural alternative to heal wounds and help prevent infections. Prior research has found the oil to be effective against bacteria that cause skin infections, pneumonia, blood infections, as well as serious intestinal infections.

Animal studies have reported the antimicrobial benefits of lemongrass oil, which was able to effectively protect against 6 species of bacteria at higher rates than 11 antibiotics tested on the same strains.

In addition, the compound has been found to help the body fight free radical damage and reduce inflammation in mice with ear edema.

6. Orange Oil

Orange essential oil has been used to treat acne, reduce pain and inflammation, relieve stomach discomfort, and as a natural household cleaner due to its antibacterial properties.

Studies have found that orange oil can be effective at inhibiting E.coli bacteria and drug-resistant Staphylococcus aureus. Additionally, orange essential oil may have anti-fungal properties, having proven to protect against several species of fungi in clinical trials.

Orange oil has been found to be more effective than other citrus oils as an antimicrobial agent and anti-fungal, indicating not only its potential for antibacterial uses but also as a food preservative.

Despite the promise of these 6 essential oils as strong antibacterial agents, it is important to note further investigation is required as many listed benefits are derived from anecdotal evidence and animal studies. However, the risk of adverse health outcomes related to essential oil use is low. Essential oils may provide a natural alternative or complementary therapy for a variety of health conditions, helping support the body in its defense against infections while also easing stress, anxiety, and depression symptoms.

Maintaining & Building Strong Patient Relationships Through Telehealth

June 3, 2020

The recent rise in telemedicine use has taken the patient-provider relationship online, offering a platform for clinicians to continue delivering care while ensuring patient health and safety by mitigating unnecessary risk of COVID-19 exposure. For some healthcare practitioners this may be their first encounter with digital care services, and they may be wondering how social distancing guidelines are going to affect the industry as a whole and more specifically, their connection with patients. Amended regulations now allow for the offering of digital medical services without a prior established relationship with patients, leading to an influx of new patient-provider relationships and an increased need for effective telehealth communication strategies.

According to a study conducted by Public Values Research, the doctor-patient relationship is the top priority for patients and an important factor for how they value the quality of care.  Although it cannot replace in-person medical care, telehealth can be used to augment the experience by providing an opportunity for building and maintaining consistent, long-lasting relationships and expanded accessibility to care. The benefits are wide-ranging; both medical professionals and their patients can develop new lines of communication and strengthen existing ones, promote continuous care, and improve overall population health outcomes.

The Patient-Provider Relationship

In today’s healthcare environment screen-side manners are just as important as good bedside manners. As the new model of virtual care negates personal contact and can make caregiving more challenging, it requires tailored strategies to help establish relationships and foster meaningful interactions with patients online. By implementing some of the telehealth best practices and communication strategies below, clinicians can help ensure a positive patient experience while strengthening these relationships.

Best Practices

Maintain a Professional Appearance 

Despite the online nature of telehealth interactions, wearing clinical apparel during virtual visits is an important component of conveying professionalism, trust, and quality of care. Per an article published on Patient Engagement HIT, “Dressing the part will go a long way in instilling confidence in a patient receiving care via telehealth, especially for the first time, as will using body language.”

Maintaining a professional appearance relies on more than simply wearing a lab coat during telehealth appointments; physical cues such as looking into the camera, paying close attention, and reducing distractions all play a significant role in the patient’s perception of provider engagement and their satisfaction with the visit.

Give Patients Your Undivided Attention

Clinicians need to remember that 70% of all language is non-verbal and thus, body language and other physical cues can influence a telehealth encounter. Therefore, clinicians should avoid taking notes during appointments, writing or entering data in the electronic medical record, and any other forms of multi-tasking to give patients their undivided attention. Healthcare providers should also remain aware of their facial expressions as these can convey both positive and negative emotions to the patient – such as compassion, disinterest, or carelessness – and look directly into the camera instead of the patient’s on-screen image. 

Be Prepared

As part of ensuring a successful, positive patient experience, clinicians need to be well-prepared for virtual visits with all of the necessary tools at hand. However, proper preparation includes more than access to medical equipment; to guarantee a seamless online interactions clinicians should do the following:

–       Understand how to use equipment and test it beforehand
–       Ensure proper camera, microphone, and speaker placement
–       Clear the physical space of distractions
–       Ensure good lighting
–       Keep interactions private and secure
–       Wear professional clothes, solid and preferably light blue colors
–       Review patient history and electronic medical records before the appointment
 

Establish Rapport

Creating an open, warm environment via remote technology can be difficult yet remains paramount. Part of ensuring a positive overall telehealth experience is communicating empathy despite distance and time constraints so as to establish a meaningful connection with patients.

“Telehealth visits may not be any longer than ten to fifteen minutes. So, establishing a rapport immediately is important,” Jonathan Mack, PhD, RN, NP, director of a telehealth training program at the University of California San Diego told Patient Engagement HIT in an interview. “People tend to look down at the screen during video calls, so that translates to someone on the other side as not maintaining eye contact. The clinician needs to be trained to listen and look into the camera because that’s what’s going to appear on the screen for the patient as though the provider is looking at the patient.”

Establishing rapport and clear, emphatic communication can have a significant impact on the success of telemedicine visits, driving satisfaction while further strengthening patient-provider relationships.

The Many Benefits of Telehealth 

Research has found that an established patient-provider relationship is associated with fewer and shorter hospitalizations, increased reported patient satisfaction, as well as more consistent utilization of preventative strategies. In addition, the number of missed appointments decreases with the use of telemedicine, which can help prevent adverse long-term complications and poor health outcomes.

The convenience and increased engagement of patients with providers associated with telemedical strategies can also replace the urgent care or ER visit, further strengthening the doctor-patient relationship.

From a financial standpoint, telemedicine visits tend to be cheaper than office visits for patients and costs saved from diverting patient use of expensive healthcare facilities (e.g. emergency care) can generate long-term savings.

Looking professional, being prepared, communicating clearly, and establishing rapport are all effective communication strategies that can foster positive patient-provider interactions. Implementing these best practices can help clinicians guarantee a high level of patient satisfaction and quality of care during telemedicine encounters as well as during future in-person services.

From a post-pandemic perspective, continued use of telehealth strategies can be expected for the benefit of the entire healthcare system, both as it recovers from outbreak demands and beyond. With this in mind, providers utilizing telemedicine to care for their patients at this time can better position themselves to form lasting, dependable patient-provider relationships and prepare for a future of remote medical care.