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circle-of-6-appSexual assault of women  is a persistent national problem on college campuses and local communities. A smartphone app called Circle of 6 was developed to enable young women to get help if they feel they are in an unsafe situation. But is it effective in reducing sexual assaults among young women–in fact, will women even use it?

On Part 2 of the March 10th HealthCetera radio program, producer Diana Mason discusses this question with Teresa Yang, a registered nurse who works in the Pediatric Intensive Care Unit at the Children’s Hospital of Philadelphia, and has conducted a study of the use of the Circle of 6 app among women college students.

So tune in on Thursday, March 10, 2016 to HealthCetera on WBAI, 99.5 FM in New York City or streaming at www.wbai.org. Or you can listen to the interview anytime by clicking here:

HealthCetera is sponsored by the Center for Health, Media & Policy at Hunter College, City University of New York.

Sexual assault of women  is a persistent

 

Among other historical and philanthropic designations, February has been deemed Go Red for Women month by the American Heart Association. While their motives are good and pure—raising awareness of heart disease in women—encouraging fashionistas to incorporate shades of garnet, ruby, and crimson into their outfits is simply not effective enough. Women need to be our own advocates, educators, and hell-raisers for symptom and risk-factor awareness, and we need to do it all year long.

 

Heart disease kills more women (and men) in the US today than any other cause. More than breast cancer. More than domestic abuse. More than Alzheimer’s disease. Nearly 44 million women today are living with some form of heart disease, yet less than one-third even know the symptoms of a heart attack. We’ve all seen the movies and TV shows where a character clutches his chest in shock, maybe cries out, and then collapses to the floor. While that is one way a heart attack can manifest itself, that series of events rarely happens in women.

 

Rather, the symptoms women experience are typically vaguer and can include a combination of the following: pain or discomfort in one or both arms, chest pressure, shortness of breath, nausea, and back or jaw pain. And because women are, for better or worse, brought up to care less about themselves than others, they often ignore warning signs, brushing them off as “nothing” and not wanting others to fuss.

 

As you can imagine, this kind of behavior does not improve outcomes and many deaths are ultimately preventable.

 

Physicians have also been shown to treat men differently than women, often offering more aggressive screening and prescribing more medications to the former. For many women who do not know any better, their doctor is trustworthy and doing a good job, but the reality is that they are being cheated. Good caretakers take thorough family histories, evaluate risk factors and prescribe accordingly, and follow-up to make sure their patients are living heart-healthy lives. Good patients hold their clinicians accountable, take care of themselves, and seek second opinions when necessary.

 

What also doesn’t help is the fact that heart disease in women remains “understudied, underdiagnosed, and undertreated.” Women make up the minority of patients in randomized clinical trials—the ones that count the most for when organizations like the FDA are evaluating new drugs and devices—and very few studies have been conducted on 100% female populations.

 

So you can wear your red dress, in support of women’s heart health or simply because you like the way it looks on you, but the only way we can invoke change is to take real action. Make the time to talk with your friends, sisters, daughters, mothers, and coworkers to ensure they know the symptoms of a heart attack and that they go for regular check-ups. Normalize the conversation. Learn your family history and know your risk. Write your congressional leaders to allocate more money to research. Exercise, eat right, and for goodness sake, stop smoking.

 

Welcome March and say goodbye to February as you would any other month, but keep the movement growing.

  [caption id="attachment_11171" align="alignright" width="237"] credit: Texas Heart

you're firedMy most recent blog post for JAMA News Forum focused on firing patients.The primary points that the post addresses are that firing patients may increase as we move towards value-based payment models–clearly, an unintended consequence of paying for improvements in processes of care and clinical and financial outcomes; and that our health care system has not yet evolved sufficiently to be able to address the complex health needs of those patients who may be high utilizers of services and, thus, costly.

I’ve had some interesting feedback from colleagues and friends. Some of my nurse colleagues have noted that they have had to terminate their relationship with some patients who had overwhelming social needs that the nurse was unable to address. Whether in private practice or working in a team practice in primary care, few nurse practitioners are situated in practices that have developed the infrastructure and processes for helping patient to address social determinants of health, whether housing, environmental issues, or other concerns.

Other colleagues commented on the challenges of patients with severe, persistent mental illness. Again, few practices have developed the capacity to integrate behavioral health into primary care.

There is little data on firing patients but what exists documents that one of the primary reasons that pediatricians fire families and their children is the refusal of vaccinations. If I can fire you for refusing a vaccination, can I fire you for smoking, or not losing weight, or refusing aggressive treatments?

One colleague asked whether patients shouldn’t consider firing providers. Actually, I think they do all the time–if they have choices.

Should health care providers and systems be able to fire patients?

 

 

My most recent blog post for JAMA