Twitter not a place for intimate moments of death

I love Scott Simon and National Public Radio, but I was shocked at his decision to send Twitter posts recently during his mother's final hours.

Having been with my parents and a dear friend as they died, I couldn't imagine stepping out from that sacred time to send an electronic message to hundreds -- or thousands -- of strangers. One of my closest friends died in June, and all I thought about that day was being with her, totally, to let her know, even on a subconscious level, that she was loved and cared for.

Response to Simon's tweets appeared to be overwhelmingly positive. I felt like I was the only person who was bothered by the idea until I read this essay by Kim Triedman, a poet and novelist, on the website for WBUR, Boston's public radio station.

Triedman writes about "what seems to me a disturbing phenomenon in our society whereby our communication technologies are increasingly commandeering what have historically been intimate human experiences."

She notes that the New York Times said Simon did not begin his deathbed vigil with a "project" in mind. And he did not know when he began tweeting that his mother's hospitalization would end in her passing. But he continued, for more than a week, during which time his mother continued to decline.

Triedman stresses that she's not critical of Simon or even of Twitter. "I know the impulse to reach out, to share the burden."

But she adds: "What I am most concerned with here is the fact that technology has once again afforded us a way to distance ourselves from the very substance of our lives -- to put some other 'thing' between us and our loved ones...

"Twitter, I would maintain, is a zone. A place that is decidedly not where you are. A state of mind in which you're always looking out for the next 140 character windfall, something you can scavenge out of this experience and that, like a photographer so intent on a picture that he neglects to take in the scene.

"Wherever it is, whatever it is, it's not a place I want to be when grief comes to call."

News about blood pressure drugs, monitoring

Joe and Terry Graedon of The People's Pharmacy shined a light recently on two pieces of news regarding blood pressure medicines and monitoring.

Anyone taking anti-hypertensive drugs or monitoring blood pressure at home might be interested in reading these items.

The first is about accumulating research which suggests that popular blood pressure drugs increase the risk for serious cancers.

The second discusses research that demonstrates the benefit of home monitoring of blood pressure.

Charlotte hospital executives on list of CEOs to watch

Becker's Hospital Review has included the two executives of Charlotte hospital systems on its newly published list of "130 nonprofit hospital and health system CEOs to know."

Like others on the list, Carolinas HealthCare System CEO Michael Tarwater and Novant Health CEO Carl Armato were chosen based on their "experience and achievements in the healthcare industry, as well as their professional involvement in the communities they serve," according to Becker's, a bimonthly publication about the healthcare industry.

Tarwater

Armato

Tarwater has been with Carolinas HealthCare since 1981, serving as CEO since 2002. In that time, the system has grown to be one of the largest public nonprofit healthcare systems in the country. It owns, leases or manages about 40 hospitals in the Carolinas, including the largest, Carolinas Medical Center in Charlotte.
It has more than 60,000 full- and part-time employees.

Armato has been with Novant Health since 1988, serving as CEO since 2012. Novant, based in Winston-Salem, is a private nonprofit system with 14 medical centers in the Carolinas, Virginia and Georgia. It has more than 24,000 employees in those states.

Other North Carolina hospital executives on the Becker's list include:

Dr. Victor Dzau, CEO of Duke University Health System, Durham.

John McDonnell, CEO of Wake Forest Baptist Medical Center, Winston-Salem.

Tim Rice, CEO of Greensboro-based Cone Health, which is part of Carolinas HealthCare System.

Dr. William Roper, CEO of UNC Health Care System in Chapel Hill.

David Strong, president of Rex Healthcare in Raleigh.

Does malpractice reform work?

A new study by researchers at the Center for Studying Health System Change has found that Medicare patients receive more diagnostic tests and emergency department referrals when treated by physicians who worry about malpractice liability, regardless of whether states have adopted common malpractice tort reforms.

The study findings, published in the August Health Affairs, indicate physicians’ perception of their risk — rather than their actual risk — of malpractice liability predicts their practice of defensive medicine and suggest that traditional malpractice reforms, such as caps on damages, don’t change how physicians practice.

Funded by the National Institute for Health Care Reform, the study breaks ground by analyzing office-based physicians’ concerns about malpractice liability and the actual tests and ER referrals — based on insurance claims data — they ordered for Medicare patients with chest pain, headache and lower back pain. Patients whose physicians reported higher levels of malpractice concern received more services, the study found.

When researchers compared physicians’ level of malpractice concern with objective state-level indicators of malpractice liability risk, such as whether a state limits economic damages, they found no consistent relationships. In a few cases, referrals and treatments were lower in states with a higher malpractice liability risk.

“Traditional malpractice liability reforms don’t appear to resolve the concerns that drive physicians to practice defensive medicine,” said Dr. Emily Carrier, coauthor of the study.

Past malpractice research has focused on physician self-reporting on hypothetical cases. That generated conflicting results, leading to disagreements about the role of defensive medicine in the overuse of care.

The Health Affairs article, titled “High Physician Concern About Malpractice Risk Predicts More Aggressive Diagnostic Testing in Office-Based Practice,” is is available at www.hschange.org.

Three must-reads in this week's "Sunday Review"

The New York Times "Sunday Review" section carried several must-reads about health issues this week.

On the cover, "Status and Stress," by Moises Velasquez-Manoff, explores the toxic effects on stress for those who feel helpless about their life circumstances. "Even those who become rich are more likely to be ill if they suffered hardship early on."

"The Hype Over Hospital Rankings," by Elisabeth Rosenthal, explores the meaning - or lack of meaning - in all those Best Hospital rankings that marketing departments like to pass along as news.

Frank Bruni's column, "Our Pulchritudious Priesthood," describes the fad among New Yorkers of hiring personal trainers. "What therapists were to the more cerebral New York of yesteryear, trainers are to the more superficial here and now: designated agents of self-actualization, florid expressions of self-indulgence, must-have accessories, must-cite authorities."

Two pioneering health professionals supported each other through cancer

When it comes to getting things done, it’s often the people behind the scenes, as much as the big names in front, who deserve the credit.

That’s true for two pioneering women who shunned the spotlight and whose recent deaths are a great loss for the Charlotte region’s health community.

Donna Arrington, 69, who helped start a regional HIV/AIDS organization in the early years of that epidemic, died May 13 of multiple myeloma.

Donna Arrington

Sharon Dixon, 68, a nurse who helped create Charlotte’s first hospice, died June 27 due to complications from a rare lymphoma – Waldenström’s macroglobulinemia – that she lived with for 20 years.

Arrington and Dixon not only worked together as professionals in fields that often intersected, they became friends. They shared not only their passion for helping people, but their love of animals, and in the end, companionship during treatments for cancer.

In 1990, Arrington became the first executive director of what was then called the Regional HIV/AIDS Consortium. It came “at a time when people were afraid to even touch a person that had AIDS,” recalled Joe Gentry, Arrington’s longtime administrative assistant.

Sharon Dixon

But Arrington, with a supportive board – that for some years included Dixon – helped regional leaders make plans and raise money to help prevent HIV infection and serve people who already had it.

“She had a great ability to put the right people in touch with the right people,” Gentry said. “You wanted the right people at the table.”

One of them was Dr. Bill Porter, a Charlotte oncologist who served a stint as consortium chairman in those early days.

“What I remember is how easy Donna made it for me to sit in that chair and how dependable she was and how confident she was that the work she was doing was terribly important,” he said.

Today, Porter is a physician for Hospice & Palliative Care Charlotte Region, and he also recalls the beginning of that organization in 1978.

“Sharon was present at the creation,” Porter said.

In the early years, Dixon was the only nurse, visiting up to 12 dying patients and their families in their homes.
Later, in administrative roles, she helped hospice grow and thrive. Today it serves 450 patients, has about that many employees and operates two residential centers for dying patients whose symptoms can’t be managed at home.

 “Sharon sort of figured it out – who you needed to talk to, where the money was,” Porter said. “She did all this while she was sick for years with this cancer that finally took her life.”

Dixon’s interest in hospice grew out of childhood experience in Oklahoma. At 17, she took care of her mother who suffered tremendous pain while dying, said Marilyn Morenz, a friend and hospice nurse.
“Sharon never wanted anyone else to experience that kind of suffering.”

In recent months, Arrington and Dixon found comfort in their shared circumstance.

When she felt good enough, Dixon would sit with Arrington through hours of infusion therapy, said Cathy Morelli, Arrington’s partner of 15 years. “Donna in turn would do the same for Sharon....They both did good deeds in their lives and then good deeds for each other as their ends came near.”

When Arrington died first, that was “a really tough loss for Sharon,” Morenz said. “As much as they were able, they were there for each other at the end.”

Outdoor Nation encourages young people to get active

Outdoor Nation has teamed up with Blue Cross and Blue Shield of North Carolina and North Carolina Recreation and Park Association to encourage young people to get outside and get active.

The groups are offering 2013 GO NC! Health Challenge Grants to support initiatives that increase physical activity and promote healthy lifestyles. Grants of up to $7,500 will be awarded for projects from the eastern, central and western parts of North Carolina. They must be based in North Carolina and use outdoor recreation as a way to address health concerns. 

To apply, submit your proposal by Aug. 30. Awards will be announced Sept.18.

Chris Fanning, executive director of the Outdoor Foundation, the organization that started the Outdoor Nation movement, called Outdoor Nation a national initiative that reconnects "millennials" -- also known as Generation Y, born between the early 1980s to the early 2000s.

In the past year, Outdoor Nation has awarded more than $250,000 to youth for projects that reconnect young people with nature. 

“Since 2012, our GO NC! initiative has worked with organizations across the state to increase access to greenways and public bicycles. We’re thrilled to expand this work to support creative and passionate youth who are keyed into new and exciting ways to promote healthy lifestyles in our state,” said Kathy Higgins, BCBSNC vice president of corporate affairs.

The grant program announcement follows the recent Outdoor Nation Signature Summit on the Outdoors. In late June, nearly 200 young people gathered at UNC-Chapel Hill and camped overnight at the 47,000-acre Jordan Lake State Recreation Area to brainstorm and develop projects that get more people outdoors.