40 Years of Service & a Misspelled Plaque – Thanks!

I attended my hospital’s medical staff quarterly meeting last week. At one time these meetings were mandatory.  If you missed a meeting, you were fined or even suspended.

Voting on major issues required a quorum of three quarters of the active staff.  Hospital employed physicians, or anyone being paid directly by the hospital, were not permitted to vote because they were felt to have a conflict of interest.   Much like the original Federal government which set checks and balances between the Executive Branch, the Legislative Branch and the Judicial Branch we had checks and balances between administration, medical staff and the community mission statement.   All of that is gone today. Meeting attendance is now voluntary.

For the most part, the only medical staff attending are hospital contracted physicians there to push an issue or vote which is beneficial to hospital administration. I have been a harsh critic of the loss of power of the community, and community doctors who support our hospital, but being a small fish in a large pond my thoughts and opinions are rarely considered because the bottom line is the bottom line and that seems to be all that counts in today’s health care environment.

The meeting had some of the vestiges of past meetings including awarding scholarships to worthy young doctors in training, introducing new members of the medical staff and a speech about the future from our new CEO.  The elected Chief of Staff stopped after each introduction and posed for a picture with each scholarship winner and each new staff member.  It was a ritual performed for years at these meetings. The final discussions were about new rules and regulations starting January 1, 2020 regarding ordering of imaging tests and prescriptions. There was no discussion of the communication issues between physician to physician, no discussion of the new policy of nurses not accepting verbal orders from physicians either face to face or over the phone. No discussion of the impact of protocol medicine, one- size-fits-all on individuals with individual problems and needs.

The next morning a representative of the hospital’s marketing department arrived unannounced in our office. She comes monthly to make sure we aren’t having problems ordering outpatient tests at the hospital. On this day, after discussing nothing of earth-shattering importance, she turned to leave and then turned back and reached into her bag and pulled something out. “I almost forgot to leave this here for Dr Reznick.”

The item was incorrectly placed by my staff in my emergency message call box.  I saw it between patient encounters, lifted it up, turned it over and realized it was a plaque for me from Baptist Health System Boca Raton Regional Hospital.  There was a picture of the hospital and inscribed below was a message, “In recognition of 40 years of staff service providing care for the community.”

My name was spelled incorrectly using the spelling of a neurologist who is not on staff and practices 25 miles away.  For years now I have been complaining to no avail that my imaging and lab results are being sent to this physician in error. No one at Boca Raton Regional Hospital has done anything to correct the matter.  So, about twice a month I receive a middle of the night call from Mount Sinai Hospital in Miami Beach looking for their Steven Resnik (with an “R”) but mistakenly calling me (with a “Z”).

I did not ask for any recognition of my 40 plus years on the staff of Boca Raton Community now Regional Hospital.  Although a mention at the quarterly staff meeting, after they introduced the scholarship winners and the new members on staff, would have been nice.  And, receiving a plaque presented as an afterthought, by someone I do not know, with my name misspelled seemed rather disingenuous.

Heart Attack Risk Assessment – Everyone Needs One

MedPage, an online medical news service is reporting that the European Association for Cardiovascular Prevention and Rehabilitation (EuroPrevent), currently meeting in Dublin, Ireland, has called for a once in a lifetime cardiac assessment for all men over age 40 and all women over age 50.

Ian Graham, MD, professor of cardiovascular medicine at Trinity College suggests that we use “age risk terminology,” as it is far easier to understand.  For example, it has been concluded that most 30 year olds are low risk, by virtue of their age, for the presence of cardiovascular disease. “If that 35 year old is a smoker, you can tell him that his risk of having a heart attack is the same as a 65 year old man. That is meaningful.”

The recommendations have been synthesized into a short 63 page document which establishes whether the evidence for each suggestion is strong, moderate or weak.  While many of the guidelines have remained the same, the new documents make it easier for health professionals to access and use the guidelines.  Your primary care physician can easily perform the cardiac assessment.

Lancet Study Emphasizes Long Term Benefit and Safety of Statin Use

Richard Bulbulia, MD, of the Heart Protection Study Group reported in the Lancet that statin medications are safe and effective over long periods of time.  They looked at 20,536 patients at high risk for vascular events. They studied patients who were between 40 and 80 years old. These patients were randomized to one group receiving Simvastatin (Zocor) daily at the 40 mg dose or placebo for 5.3 years. They were then followed for another six years during which both groups received the statin.

Researchers found that during the initial 5.3 years of the study there was a 23% decrease in major vascular events and an 18% reduction in vascular mortality in the Simvastatin treated group.

They also looked at complications of therapy over the eleven year period and concluded, “Reassuringly, there was no evidence that any adverse effect on particular causes of non–vascular mortality or major morbidity, including site-specific cancer, was emerging during this prolonged follow-up period.”  In an editorial in the same edition, Payal Kohli, MD and Christopher Cannon, MD of the Brigham and Women’s Hospital in Boston said the results “provide contemporary and confirmatory evidence that extended use of statins is safe with respect to possible risk of cancer and non-vascular mortality.”

It is noted that the dosages used are higher than what the FDA currently recommends for Simvastatin due to the risk of muscle injury at higher doses. Despite that, the Lancet editorialists concluded that “concerns should be put to rest and doctors should feel reassured about the long-term safety of this life saving treatment for patients at increased cardiovascular risk.”