The May 2012 Issue

Would You Like Fries With That?

By Peter Lyle DeHaan, PhD

Author Peter Lyle DeHaan

I needed to order some ink cartridges for my printer, the kind I can only buy from the vendor. I called and told the agent I wanted to order two black ink cartridges. Not surprisingly she suggested I buy a package that included two color cartridges. “No thank you, just black,” I replied.

Upon discovering the age of my printer, she tried to sell me a new printer. “No thank you – I just need ink.”

When I acknowledged that I own several computers from her company, she asked if they were working okay and did I…. “No, I just want to buy ink.”

Then she offered me a special price on anti-virus software for only…. “No, I only want ink!”

Next she inquired if I was interested in a maintenance plan to…. “NO, just ink!”

Perhaps she was supposed to try to upsell me five times, or maybe she was on commission. I don’t know, but I do know the call took much longer than necessary. I became irritated, and I won’t buy another printer from this vendor.

Now let’s imagine a call to refill my prescription. The agent says, “Would you like to meet with the doctor to review your current health status?” I decline.

“When was your last annual checkup? Should I schedule you for one?” I refuse.

“We have a special this month on colonoscopies, and I see you’re at the age….” I spurn that offer.

“Can I have a representative contact you to review all the services that we offer?” I reject her proposal.

“We have a new family plan to save….” “NO!”

What would be the results of this pretend health call? Did we have a positive interaction? Has the agent made a positive impression? The next time I have a healthcare need, will this organization be first on my list to contact – or will they be last?

Peter Lyle DeHaan, PhD, is the publisher and editor-in-chief of Medical Call Center News. He’s a passionate wordsmith whose goal is to change the world one word at a time.


Interpreters in ER Need Training More Than Experience

Professional interpreters who received more than 100 hours of training in medical interpreting had nearly two-thirds fewer errors than those with less than 100 hours of training and significantly fewer errors with medical consequences than ad hoc interpreters, according to a study published online in Annals of Emergency Medicine (“Errors of Medical Interpretation and Their Potential Clinical Consequences: A Comparison of Professional vs. Ad Hoc vs. No Interpreters”).

“One hundred hours of training seemed to be the tipping point for professional medical interpreters,” said lead study author Glenn Flores, MD, FAAP, of the University of Texas Southwestern Medical Center in Dallas, Texas. “Professional interpreters who received that much training on average had twelve errors, while those with less training had thirty-three. Patient encounters that relied on ad hoc interpreters or no interpreters had significantly more errors, including some with potential clinical significance, such as mistaking tablespoons for teaspoons of medicine.”

Researchers studied fifty-seven encounters for pediatric patients for whom Spanish was the primary language spoken at home and English proficiency was limited. In twenty of the encounters, a professional, paid interpreter translated. In twenty-seven of the encounters, an ad hoc interpreter (such as a family member, friend, or hospital employee) provided interpretation. No interpreter was involved in ten of the encounters.

The proportion of errors with potential clinical consequences for professional interpreters with 100 or more hours of training was 2 percent, while the proportion of errors with potential clinical consequences for those interpreters with less than 100 hours of training was 12 percent. Years of experience were not significantly associated with the overall number of errors. The proportion of errors with potential clinical consequences was 22 percent in encounters using ad hoc interpreters and 20 percent of encounters for no interpreters.

“More than 25 million Americans have limited English proficiency, and federal policy requires that hospitals provide adequate language assistance to these patients,” said Dr. Flores. “Our findings add to the growing body of evidence that paid, professional interpreters are essential for delivering high-quality healthcare to our patients.”


Concern Over “Senior Moments”

From Harvard Medical School

Everyone experiences occasional episodes of forgetfulness. When an older loved one has a few episodes of forgetfulness, friends and family members may wonder whether those misplaced keys or trouble finding the right word in a conversation is the result of normal age-related changes or an early sign of something more serious. As the Harvard Medical School Special Health Report “A Guide to Alzheimer’s Disease” reveals, the characteristics of these forgetful moments often offer clues as to whether Alzheimer’s disease or another form of dementia may be the underlying problem. For example:

If the person complains about memory loss and can provide details about the episode of forgetfulness, normal aging is more likely. With dementia, it’s common that the person affected will only complain about memory problems if she’s asked about them and won’t be able to recall specific instances.

When dementia occurs, the person affected is often much less concerned about memory loss than her family members are. The reverse is true for normal age-related memory problems.

If your loved one doesn’t get lost in familiar surroundings but does sometimes pause momentarily to remember the way, normal aging is likely. But if she gets lost in familiar territory while walking or driving and takes hours to return, Alzheimer’s or dementia should be a concern.

Occasional trouble finding the right word probably isn’t worth worrying over, but frequent word-finding pauses and substitutions – for example, calling the telephone “the ringer” or “that thing I use to call you” – are typical of dementia.

While it isn’t uncommon for an older adult to be unwilling to operate new devices or to fumble a bit with their cell phone or DVR, it’s a warning sign if the person has trouble operating common appliances.

While these tips can help distinguish between normal age-related memory changes and dementia, concerns about memory problems should be brought to the attention of a doctor.

“A Guide to Alzheimer’s Disease” is available for $18 from Harvard Health Publications. Order it online or at 877–649–9457.


Nurses Want Drug Data via Their Smartphones

Nurses and future nurses are using smartphones at their patients’ bedside, and they want immediate access to drug reference tools. A recent survey of nearly 4,000 nurses and nursing students found that more and more nurses are turning to mobile technology to help them provide efficient and effective care. Conducted by Lippincott Williams & Wilkins (LWW), publisher of the top-selling Nursing 2013 Drug Handbook, the survey found that 85 percent of nurses and students want a smartphone app version of the drug guide. LWW is part of Wolters Kluwer Health, a global provider of information, business intelligence, and point-of-care solutions for the healthcare industry.

“As the US population ages and the demand for nursing care increases, nurses need easy access to drug information from a variety of sources,” said Judy McCann, chief nursing officer, professional and education, Wolters Kluwer Health. “Nurses have long relied on our pocket-sized guide to support clinical decisions, but today’s nurses want mobile access to the most current information possible.”

LWW’s poll of 3,900 nurses and nursing students found that:

  • 71 percent of nursing professionals use a smartphone for their job
  • 66 percent of students use a smartphone for nursing school
  • 85 percent of respondents want a mobile app version of a drug guide, while 89 percent want access to both an app version and the traditional print version

“Today’s nurses and future nurses need handheld content they can trust, so we are excited to launch a smartphone app of the industry’s best selling and most trusted drug guide,” said McCann.

To learn more about the Nursing Drug Handbook or purchase the book or app.


Survey Reveals Nursing Salaries Increase

UBM Medica’s Physician’s Practice 2012 Staff Salary Survey reveals that with nurses in high demand, America’s medical practices started paying a premium for their services last year, even as pay for most other clinical and administrative support staff stagnated or declined.

Nurses and nurse managers saw average salary increases of 4 percent and 12 percent, according to the survey results, which were released in Physicians Practice and More than 1,260 medical practices around the country provided compensation data during the fourth quarter of 2011 on nine specific clinical and administrative support job titles.

Some interesting trends concerning non-physician providers are seen in the latest salary data:

  • The highest-paid non-physicians on staff are physician assistants, earning an average $84,000, followed by nurse practitioners, at $83,000.
  • Nurse practitioners enjoy more opportunities, with 35 percent of practices employing one compared with only 25 percent of practices who employ a physician assistant.

The Staff Salary Survey provides data nationally and in six individual regions on compensation for nurses, nurse managers, nurse practitioners, physician assistants, medical assistants, front-desk staff, medical billers, billing managers, and medical records clerks. The survey also details salary levels for each position at five discrete levels of experience.


Your Good Health Through a Rainbow of Fruits and Vegetables

Many garden fruits and vegetables are high in vitamins, minerals, and fiber and low in fat and calories. Eating a variety of fruits and vegetables may help you control your weight and blood pressure, ultimately helping reduce the risk for heart disease, the number one killer in the US. The American Heart Association recommends eating eight or more fruit and vegetable servings every day. And, this spring, the Association encourages you to grow your own produce in a backyard garden.

Fresh fruits and vegetables are an important part of an overall healthy eating plan, so including them in your spring gardening plans is a wise thought. Follow these tips to include fruits and vegetables in your garden and your diet:

Keep it colorful. Challenge yourself to plant fruits and vegetables of different colors. See if you can consume a rainbow of fruits and vegetables during the gardening season.

Roast away. Try roasting garden vegetables like cauliflower, broccoli, Brussels sprouts, onions, carrots, or eggplant. Long exposure to high heat will cause these foods to caramelize, which enhances their natural sweetness and reduces bitterness.

Enjoy vegetable dippers. Chop raw vegetables into bite-sized pieces. Try bell peppers, carrots, cucumbers, broccoli, cauliflower, and celery, and dip into low-fat or fat-free dressings.

Sip smoothies and try fruit pops. Puree fruits and place in an ice-cube tray to freeze overnight. You can eat the fruit cubes as mini-popsicles or put them into a blender with low-fat milk for a morning smoothie. Watermelon, strawberries, cherries, cranberries, raspberries, and red apples are great summer treats.

The American Heart Association believes in dramatically changing the way America thinks about food and consumes it. For more information on how fruits and vegetables can support a healthy diet, visit


Hospital Geographic Expansion: The New Medical Arms Race?

Hospitals’ long-standing competitive focus on cutting-edge technology, niche specialty services, and amenities to attract physicians and patients has set the stage for the next chapter in hospital competition: targeted geographic expansion into new markets with well-insured patients, according to a study by the Center for Studying Health System Change (HSC) published in the April edition of Health Affairs.

The study found that many hospital systems are seeking well-insured patients beyond traditional market boundaries, in either prosperous suburbs or in nearby areas with growing, well-insured populations.

Key hospital strategies to expand into new markets include building full-service hospitals, establishing freestanding emergency departments and other outpatient services, acquiring physician practices, and operating medical transport systems. These are all aimed at shoring up referral bases and capturing additional inpatient admissions, the study found.

“Whether these new competitive strategies will raise costs, improve care, or both is hotly debated. Payers and competitors contend that such strategies will lead to higher costs, while hospitals assert that the expansions will increase efficiency, increase access, and improve the quality of patient care,” said HSC senior researcher Emily R. Carrier, MD, MSCI, coauthor of the study with Marissa Dowling, a former HSC research assistant, and HSC senior consulting researcher Robert A. Berenson, MD, also an institute fellow at the Urban Institute.

Funded by the Robert Wood Johnson Foundation and the National Institute for Health Care Reform, the Health Affairs study is based on HSC’s 2010 site visits to twelve nationally representative metropolitan communities: Boston; Cleveland; Greenville, South Carolina; Indianapolis; Lansing, Michigan; Little Rock, Arkansas; Miami; northern New Jersey; Orange County, California; Phoenix; Seattle; and Syracuse, New York. HSC has been tracking change in these markets since 1996.

Other key findings from the study include:

  • In all twelve markets studied, hospitals pursued one or more types of competitive geographic expansions.
  • Among hospitals using these strategies, the drive to pursue well-insured patients beyond traditional hospital market boundaries appeared to be heightened by the recession rather than blunted by it.
  • Some markets, such as Phoenix and Indianapolis, showed evidence of all the geographic expansion strategies, while others, such as Syracuse and Lansing, showed evidence of only one or two.

The report noted that it is too soon to assess the effect these hospitals’ geographic expansions will have on patients’ access and costs.

HSC is based in Washington, DC, and affiliated with Mathematica Policy Research.