My professional and personal life keep me on the go. On top of my busy schedule as a doctor of internal medicine in New York City, I also market myself as a medical correspondent for television shows. Currently I work with Fox News, and I appear regularly on the Today Show, where I report on everything from breaking medical news to health-related lifestyle issues. I’ve spoken on air about topics ranging from the removal of Terri Schiavo’s feeding tube to the potential avian flu outbreak. But as a 35-year-old woman, I’m especially attuned to women’s health issues.

“I wanted to break into media work to reach a larger audience than was possible through my private practice. So I took a few strategic steps to position myself as an expert. First I published an article in the Harlem Times in early 2005 on herbal medicines. I was also featured in a lifestyle story in Vogue magazine, which a lot of media people saw. That led to calls from two television producers, and soon more offers came.

“Working with patients keeps me up-to-date so I can be a better medical TV journalist. Most of my patients are female, and my work with them helps me stay informed for what I do on the air.
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“When I was a child growing up in Yellow Springs, Ohio, my father encouraged me to become a doctor from as early as 5 years old. After pursuing an undergraduate degree in English, I made a commitment to medicine and was accepted into Columbia University’s College of Physicians and Surgeons. In 2000 I earned my degree in medicine. And because I’ve always been interested in the art of performance–and I feel comfortable in front of the camera–being a medical correspondent is just what this doctor ordered.”

To this day, the widespread racial disparities that prompted the August 1965 riots in the Watts community of South Los Angeles frame many of the discussions about race in America. The death and destruction wrought during that five-day upheaval, along with the findings of the December 1965 McCone report that the lack of adequate health care facilities was a contributing factor to the civil unrest, prompted city and state officials to put in motion plans to build a medical school and teaching hospital in the Watts community.

The opening of the Charles R. Drew University of Medicine and Science in 1970, followed by the Martin Luther King Jr./Drew Medical Center in 1972, led to critical milestones in the recovery of the community. The thousands of minority doctors produced by Drew helped heal the social wounds that had been ripped open during the riots.

But all has not been well at the teaching hospital. A Pulitzer Prize-winning Los Angeles Times expose in 2004 revealed widespread neglect and mismanagement that the university administrators had swept under the rug for years. Ultimately, Los Angeles County terminated MLK/Drew’s doctor-training program late last year after the hospital failed a make-or-break federal inspection. This prompted the Centers for Medicare and Medicaid Services, or CMS, to pull its vital $200 million in funding for the hospital. Drew University President Susan Kelly, brought in last year to turn around the troubled institution, fears the resulting health care crisis will revive the civil unrest that prompted the riots more than 30 years ago.
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“There were lots of discussions in this community in 1963 and 1964, before the Watts riots, because everyone knew that there were very few beds, very few doctors,” says Kelly. “But it took the Watts riots, 32 deaths and 1,000 people injured and millions of dollars worth of property damage before anyone sat up and said, ‘I think they mean it; I think it’s true? Today, you’ve got a predominately Latino community, and if you understand the Latino community, it is more fragmented politically. I don’t know that you will get riots, but you may get increasing gang warfare.”

Lark Galloway-Gilliam, executive director of the Los Angeles-based Community Health Councils, says the displacement of the 251 residents is going to exacerbate lingering health care disparities, as the number of doctors available to treat South Los Angeles patients has fallen precipitously.

“The number of physicians, the number of beds, the rate of health disparities is so significantly off the scale here than anywhere else,” she says, adding that the Watts community has long relied on MLK/Drew.

Los Angeles County is now trying to contract with private physician groups to fill the void, but persuading private practice doctors to open up shop in the crime- and poverty-plagued neighborhood is an uphill battle.

According to Gilliam, Drew produces 25 percent of California’s minority physicians, so shutting down its doctor-training program will seriously deplete the pool of California physicians equipped to deal with the sometimes harsh realities of urban life.

“We always talk about cultural and linguistic competency, and people tend to think of that strictly in terms of language access,” she says. “But the physicians at Drew were trained to work with this population, to understand some of the unique characteristics, behaviors, nuances … we are losing that knowledge and sensitivity to the needs of this community.”

Michael Wilson, spokesperson for Los Angeles County’s Department of Health Services, concedes that the city is in a health care crisis. But he says terminating MLK/Drew’s resident program was necessary to keep the hospital open. It will now be managed by the UCLA-Harbor Medical Center and be renamed the Martin Luther King Jr.-Harbor Hospital. Wilson says keeping the hospital open was vital, as other local hospitals have closed their emergency rooms, worsening the crisis.

“The department was faced with a set of circumstances when the hospital failed its inspection, and from the very beginning has really remained committed. The emergency room has remained open. We treat the same volume of emergency patients,” he says. “We just had a major ER close here, Memorial in Inglewood, a few months ago. It’s a crisis all over.”

A Sad State of Affairs

The question remains: Why was MLK/Drew allowed to stay in such deplorable shape for years before the government stepped in? A number of patient deaths at the hospital over the years had been attributed to neglect and incompetence by hospital staffers. And by all accounts, county and hospital administrators were given numerous chances by CMS to make necessary changes.

In his letter to MLK/Drew administrator Antoinette Smith Epps, CMS certification official Steven D. Chickering noted that in the 32 months leading up to the termination of the hospital’s Medicare contract, CMS “conducted no fewer than 15 surveys that repeatedly identified events in and practices by the hospital that were found to have severely compromised patient health and safety.” He also says in the letter that CMS “took extraordinary measures and allocated exceptional federal resources” to help correct the substandard care at MLK/Drew, to no avail.

Q: BECAUSE OF AN INJURY, my doctor told me to stop going to the gym. But doesn’t it make more sense to train around the pain?

A: Good question. The answer: It depends. When you have an injury–sports-related or otherwise–you can generally expect that exercise will either help you overcome the injury or make it worse. The trick is in knowing when to follow your doctor’s advice and when to override it, seeking expert advice from someone in the field of your specific injury or simply following your own common sense.

“Keep in mind that a doctor’s first job is to do no harm,” says Tom Seabourne, PhD, author of Pocket Idiot’s Guide to a Great Upper Body (Alpha, 2006). “That means that the advice you get may not always be the best advice for overcoming an injury. A doctor can always safely advise you to take time away from the gym without concern that his advice will worsen your condition.” If you want to keep training and work to overcome your injury, Seabourne makes the following recommendations.

>> Seek an expert’s advice. “Rather than relying on general medical advice, seek out a specialist,” suggests Seabourne. “Sports-med physicians and physical therapists want what you want–to get you back into the gym, pain-free, as soon as possible. Most PTs will show you exercises that increase the strength and flexibility of the muscles surrounding your injury so you’ll prevent future injuries.”

>> Train opposing muscles. “Often, the problem comes not from the injured muscle but from a weakness in the opposing muscle group,” notes Seabourne. “Your body is a kinetic chain of muscles that work together in harmony: quads-hams, biceps-triceps, chest-back. When you’re injured, consider emphasizing the opposing muscle group to develop muscle balance.”

>> Find substitutes. “If a particular exercise is bothering you, eliminate it. Replace bench presses with machine presses; rather than squats, try leg presses,” Seabourne advises. “Use other techniques, too; for example, if heavy weights are a problem, switch to lighter weights and higher reps. Work with very light weights for stabilizing moves such as overhead dumbbell presses, then use slightly more weight for machine presses, which don’t require stabilization.”

Whether you participate in low-or high-impact aerobics, step or KickBoxing classes, you are likely to see or be prone to knee injuries. Organized aerobics classes are now one of the most popular exercise forms–approximately 27 million men and women are currently enrolled in them. With these numbers, it is not surprising that aerobics instructors replaced gymnasts as the athletes with the highest incidence of sports injuries. An estimated 75 percent of aerobics instructors have sustained at least one musculoskeletal injury while teaching aerobics classes. Of the three major lower extremity joints (i.e., hip, knee and ankle), the knee may be the most susceptible to injury during repetitive movement exercises. Since the knee joint only has flexion and extension ranges of motion, it depends on a series of ligaments to maintain alignment and thus is less forgiving to lateral forces and twisting motions. Although skiing is inherently more dangerous to the knee, with the anterior cruciate ligament (ACL) injury commonly found on ski slopes, taking aerobic classes .also poses a risk for injury to this joint.

When the knee suffers injury from blunt trauma, as in a fall, or a twisting injury, in which your foot goes one way and your torso another, it is important to know when to seek medical attention. Despite an obvious major injury (e.g., a compound fracture, severe swelling and/or deformity), applying some well-tested rules will make you more keenly aware of when there Is a problem and help you decide whether the injured person should see his or her doctor.

In 1995, researchers at the Ottawa Health Research Institute created the Ottawa Knee Rules to aid primary care and emergency room physicians in clinical decision-making and reduce unnecessary radiographs (i.e., x-rays). Usually, knee x-rays were ordered solely because of the complaint that the “knee was injured.” This resulted in excessive numbers of “normal” x-rays, thus unnecessarily utilizing a rather expensive diagnostic tool. The Ottowa Knee Rules have reduced the number of normal knee injuries x-rayed by as much as 28 percent. Since no rule is perfect, there will be a few missed abnormals.

I have a family history of melanoma, and to make matters worse, I spent way too many of my teenage summers slathered in baby oil, lying in the sun. My skin-cancer risk is relatively high, so I get regular exams. This time, I was seeing a new dermatologist. She barreled into the room, gave me a quick once-over while she jabbered to the nurse about another patient, then left. She’d barely glanced at my skin, much less given me a chance to ask her anything. I knew that if she had missed a cancerous mole in her hurry to complete the exam, it could mean the difference between life and death–to me.

Fortunately, it didn’t, but her brusque manner had left me tongue-tied, vulnerable and ill at ease, an all too common experience for patients today. “Doctors stand over us while we’re lying on exam tables and call us by our first names while we call them by their titles,” says Jonathan H. Amsbary, Ph.D., an associate professor of health communications at the University of Alabama in Birmingham. “Plus, they’re clothed and we’re not. Of course we feel uncomfortable!”

However, from wrong diagnoses to prescriptions for medications that don’t help, studies show that poor doctor-patient communication is to blame in many cases of bad health care. So it’s vital to know what to say and when to say it during all health-related visits–including those with dentists and dietitians. Here, advice on how to better navigate your next appointment.

Before you go

* Record your medical history. “For an annual exam, take a few minutes to review your ‘health story’ from the past year,” advises Michele Curtis, M.D., M.P.H., a gynecologist in Houston. “Write down anything that’s changed, both major things like surgeries and minor things like new vitamins [or herbs] you’re taking.” Also note any health issues that have come up among your parents, grandparents and siblings, he suggests–your doctor may recommend steps to help prevent the same problems.

* Get your records. If you’ve had gynecologic surgery or a mammogram, request a copy of the procedure records from your surgeon or specialist to bring along (and keep a copy for yourself as well).

PRODUCT DESCRIPTION: FDA-approved for migraine prevention, the NTI device is an inch-wide, custom-fitted night guard that snaps onto the two front teeth to prevent back teeth from clenching during sleep. The product sells to dentists for $20 per blank device; dentists typically purchase 10 blanks at a time, then customize the product for each patient. (Fitting and customization costs about $500 depending on the dentist.)

STARTUP: Boyd spent less than $15,000 developing the product prior to licensing it to dental supplier Heraeus Kulzer in 1998.After the supplier invested more than $100,000 in the initial product roll-out and another $500, 000 in clinical trials, it decided not to continue with the product for financial reasons and offered it back to Boyd in 2000 for $1 million. Heraeus Kulzer financed 70 percent of the sale, and Boyd raised the remaining 30 percent from investors.

THE CHALLENGE: How does an individual, even a medical professional, get a product to market if it requires FDA approval?

Waking up with headaches and dealing with migraines several times per week is a way of life for many people. These headaches often result from the jaw clenching while sleeping. Dr. Jim Boyd, who suffered from migraines himself, found in 1990 that putting a small, custom-fitted device over the front teeth at night sets off a reflex that stops clenching, greatly reducing or even eliminating headaches and migraines. Boyd figured a lot of people could benefit from the NTI, so he set out to get the product to market–a difficult task, considering it would need FDA approval.

But Boyd didn’t back down, especially since he knew the product could help a lot of people: According to NTI-TSS, 23 million people suffer from severe migraine pain, and the NTI device helps more than 75 percent of patients reduce migraines by more than 75 percent.

My professional and personal life keep me on the go. On top of my busy schedule as a doctor of internal medicine in New York City, I also market myself as a medical correspondent for television shows. Currently I work with Fox News, and I appear regularly on the Today Show, where I report on everything from breaking medical news to health-related lifestyle issues. I’ve spoken on air about topics ranging from the removal of Terri Schiavo’s feeding tube to the potential avian flu outbreak. But as a 35-year-old woman, I’m especially attuned to women’s health issues.

“I wanted to break into media work to reach a larger audience than was possible through my private practice. So I took a few strategic steps to position myself as an expert. First I published an article in the Harlem Times in early 2005 on herbal medicines. I was also featured in a lifestyle story in Vogue magazine, which a lot of media people saw. That led to calls from two television producers, and soon more offers came.

“Working with patients keeps me up-to-date so I can be a better medical TV journalist. Most of my patients are female, and my work with them helps me stay informed for what I do on the air.

“When I was a child growing up in Yellow Springs, Ohio, my father encouraged me to become a doctor from as early as 5 years old. After pursuing an undergraduate degree in English, I made a commitment to medicine and was accepted into Columbia University’s College of Physicians and Surgeons. In 2000 I earned my degree in medicine. And because I’ve always been interested in the art of performance–and I feel comfortable in front of the camera–being a medical correspondent is just what this doctor ordered.”

Products used must match the task at hand. Dental assistants are often responsible for preparing treatment rooms before and after each patient, by cleaning and disinfecting surfaces, and for instrument cleaning, disinfection and sterilization. Unless the appropriate product for the task is selected, the results can potentially be damaging to instruments and equipment and dangerous for both health care workers and their patients.

Since the release of the new CDC Guidelines for Infection Control in Dental Health Care Settings, there is a renewed emphasis on infection control products and procedures. It can be difficult to sort through the various products and their claims, make product selections, establish infection control protocols, and train staff to safely implement and maintain the appropriate use of products. Part of the confusion stems from the changes in regulatory approval and registration process (particularly related to the use of disinfectants and sterilants), the broad variability in marketing claims and inconsistency in terminology used to describe the product, its efficacy and intended use. A common misconception is that one chemical will serve all purposes. As a result chemical products may be used that are not intended for the surface or task at hand.

To determine which product to use, you must first assess what you plan to treat–is it a “patient care item” or an “environmental surface”?

Patient care items are categorized as critical, semicritical and noncritical.

a. Critical: These items penetrate or contact soft tissue, bone, bloodstream and normally sterile tissue. Examples include periodontal scalars, forceps, scalpels, and surgical burs.

b. Semicritical: These items typically contact mucous membranes and nonintact skin. Examples include such items as handpieces, mouth mirrors, reusable impression trays, and amalgam condensers.

c. Noncritical: These items come in contact with intact skin such as radiograph head, blood pressure cuff, or facebow.

Environmental Surfaces are divided into two categories: clinical contact and housekeeping.

a. Clinical Contact: These include surfaces in the treatment areas contaminated during patient care by bare hands, gloved hands, saliva, blood or other body fluids. Examples include light handles, switches, x-ray equipment, countertops, chairside computers, reusable containers, drawer handles, pens, telephones, doorknobs and tables.

The U.S. medical and dental instruments and supplies industry is a diverse and technologically dynamic field, consisting of five specific industry sectors. These five sectors are surgical and medical instruments (SIC 3841), surgical appliances and supplies (SIC 3842), dental equipment and supplies (SIC 3843), X-ray apparatus and tubes (SIC 3844), and electromedical equipment (SIC 3845). For the first time, this chapter also includes sections covering ophthalmic goods (SIC 3851), and used and refurbished medical equipment.

The five medical industries manufacture a wide range of health care products used to diagnose and treat patients, ranging from tongue depressors to highly sophisticated, diagnostic devices that can provide clear images of internal organs. Medical items not covered in this chapter include in vitro and in vivo diagnostics, classified under SIC 2835, and surgical gloves, condoms, and similar latex-based products that fall under fabricated rubber products, not elsewhere classified (SIC 3069). For other related topics, see chapters 42 (Health and Medical Services), 43 (Drugs), and 52 (Insurance).

Before reading this chapter, please see “Getting the Most Out of Outlook ‘94″ on page 1. It will answer questions you may have concerning data collection procedures, factors affecting trade data, forecasting methodology, the use of constant dollars, the difference between industry and product data, sources of information, and information about the Standard Industrial Classification (SIC) system.

As the academic year gets under way, the nation’s medical, dental and nursing schools are seeing fewer minorities in the classroom. The numbers are so low that a commission, led by former U.S. Secretary of Health and Human Services Dr. Louis W. Sullivan, is examining how to boost minorities in the medical field.

“We are hearing from deans and other university officials who are saying they have none or only one new Black or Hispanic student in their classrooms for the first time in decades,” Sullivan says.

While African Americans, Hispanics or Latinos, and American Indians represent more than 25 percent of the U.S. population, they represent less than 14 percent of physicians, 9 percent of nurses, and only 5 percent of practicing dentists.

The Sullivan Commission on Diversity in the Healthcare Workforce held its first heating on the matter this summer in Atlanta, collecting testimonies from educators, local legislators, business leaders, students and community advocates. Just last month, the 15-member commission held hearings in Denver and is planning to hold hearings in other major cities before the end of the year.

“Although the problem of underrepresentation of minorities in the health professions is well documented, both state and federal tax dollars continue to support medical schools and residency training programs whose production of physicians falls far short of the goal,” Dr. George Rust told the commission at the Atlanta hearing. “In 1997 the Medical College of Georgia had only one African American student matriculate in its freshman class,” said Rust, professor of family medicine and deputy director, National Center for Primary Care at Morehouse School of Medicine.

“The real questions should no longer focus on ‘does it matter’–but rather how to address the long-standing need for greater depth and diversity in our health care work force. The ‘how’ must consider a wide range of multi-faceted interventions that bring together parents, young people, educators and educational institutions, providers and professional associations, federal, state and local agencies, and society in general,” said Valerie Hepburn, director of the division of health planning for the Georgia department of community health, also testifying before the commission at its Atlanta hearing.