Elliott R. Haut, MD - Trauma Surgeon and Critical Care Physician, Johns Hopkins Hospital (Part 2 of 2)
By Admin | May 5, 2008 at 1:05 am
Elliott R. Haut, MD, is a trauma surgeon and critical care physician at Johns Hopkins Hospital. He has recently published Avoiding Common ICU Errors.
Can you describe your current research projects?
My current research interests fall into two main categories. The first is outcomes related to the system of trauma care.
My research group uses information from large databases to determine the best system to treat trauma patients.
We are currently working on a project that hopes to answer the question of, “What saves lives after major trauma? The system or the surgeon.”
My other main interest revolves around deep vein thrombosis (DVT). DVT has been suggested by multiple national agencies as an important quality of care marker as a preventable complication.
However, my research has shown that there may be inherent flaws in using simple hospital DVT rates, and that these rates alone are not valid markers of the quality of care.
As we look more closely for DVT’s, we find more, and we might therefore be labeled as providing poor quality of care, as measured by DVT’s found, when we are actually looking harder for these complications to treat proactively.
I recently wrote an invited commentary on this touchy, yet nationally important, subject entitled “Venous Thromboembolism: Are Regulatory Requirements Reasonable?” for the Society of Critical Care Medicine’s newspaper
(http://www.sccm.org/Publications/Critical_Connections/Archives/April_2008/Pages/VenousThromboembolism.aspx)
What publication are you most proud of?
From a trauma system standpoint, my article titled “Injured Patients Have Lower Mortality When Treated By ‘Full-Time’ Trauma Surgeons Vs. Surgeons Who Cover Trauma ‘Part-Time’” will have the most impact.
This project is helping to establish trauma surgery as its own separate field by showing scientifically that those physicians having an expertise and a specific body of knowledge of trauma surgery improves outcomes for injured patients.
In terms of “cool”, the article in Rolling Stone Magazine (March 6, 2003) is at the top of the list.
I was in the right place at the right time during my trauma fellowship, when Rolling Stone came to Penn to do an article on violent trauma in Philadelphia.
My boss at the time, Bill Schwab, asked me to show the writer around and make us look good. Next thing I know, there I am written about and quoted in Rolling Stone.
Why is there so much penetrating trauma in the neighborhood around Hopkins?
If I could answer that, I would do it and fix the problem. Unfortunately, it is multifactorial, with so many interrelated reasons.
Partially, it is related to a culture of violence- the media, music, movies, and television portraying violence as culturally acceptable and even admirable behavior.
One of my mentors, Eddie Cornwell, has been working tirelessly to fight urban violence and he is currently promoting public service announcements and a video called Hype Versus Reality, showing people what it is really like to be shot, not the glamorized way it is portrayed in movies, TV, or music videos.
If you could be known for solving one clinical problem, what would it be?
I think this would have to be the problem of DVT. Deep vein thrombosis and
pulmonary embolism are the number one preventable cause of death in hospitalized patients.
Up to two million patients per year may be affected by DVT and PE, and more people die of this than breast cancer and AIDS combined each year.
It is a huge public health problem that really has not received the media attention that it deserves.
The American Public Heath Association has called it a “silent epidemic” and the following link can explain how big a problem this is in American healthcare. http://www.apha.org/NR/rdonlyres/A209F84A-7C0E-4761-9ECF-61D22E1E11F7/0/DVT_White_Paper.pdf
What would you say to a bright young medical student who is thinking about going into general surgery?
GREAT! As a general surgeon, especially an acute care / trauma / critical care surgeon, you will be well trained to deal with any clinical problem that comes your way.
I can diagnose and treat nearly any acute surgical or medical emergency. We are perfectly qualified to take care of all types of sick patients whether it is in the emergency department, operating room, or Intensive Care Unit.
The pendulum has swung towards super-specialization within medicine, but we as acute care surgeons are giving some pushback. We can deal with many complex difficult issues in a wide variety of fields.
Do you support the move by The Centers for Medicare and Medicaid (CMS) to not pay hospitals and providers for “preventable mistakes.”
Clearly, physicians should be held accountable for providing appropriate treatment and employing the best practices to avoid preventable medical errors.
However, CMS has to identify “preventable” complications very carefully. Some complications can happen even if we do our best to avoid them.
What gets you out of bed in the morning?
As a trauma surgeon, I start each day not knowing if that will be the day I save a life.
I have many patients out there who have been through multiple huge operations, weeks in the ICU, dozens of units of blood transfusions, and long rehabilitation stays who now are back as functioning members of society.
There is nothing more amazing than shaking someone’s hand a year after his or her injury and saying, “You are all better. Congratulations. You don’t need me anymore. I hope to never see you again.” That’s what gets me out of bed in the morning.
Disclosure: the interviewer is a former staff member at Johns Hopkins Hospital and has co-edited a medical manuscript with Dr. Haut.
Copyright 2008 DailyInterview.com
Topics: Physicians | No Comments »
Elliott R. Haut, MD - Trauma Surgeon and Critical Care Physician, Johns Hopkins Hospital (Part 1 of 2)
By Admin | April 24, 2008 at 3:03 am
Elliott R. Haut, MD, is Assistant Professor of Surgery at the Johns Hopkins Hospital in Baltimore, Maryland. He is a specialist in trauma surgery and critical care medicine. We recently had a chance to speak to Dr. Haut about his medical career and interests.
Where are you from?
I grew up in the suburbs outside of Philadelphia. I also lived in different parts of the city - West Philly, Society Hill, Rittenhouse Square - for another 12 years.
Where did you go to college and what was your academic major?
I went to Brown University in Providence, Rhode Island where I majored in chemistry and economics.
The best thing about my time at Brown was meeting my wife, which happened on the first day of freshman orientation.
Ironically, when I took my first faculty job, the other two people in my division were also Brown University graduates.
What has been your career path from college to your current position?
My career path was one of the most direct routes possible- high school, college, medical school, internship, residency, fellowship, and right into my first academic job.
This traditional pathway is not the only way to get where I am; it just seemed to work out well for me at the time.
What do you like most about practicing at Hopkins?
I would have to say that my favorite thing about working at Johns Hopkins is the joy I get from the people I work with.
I have an incredible group of colleagues on the trauma service and in the Intensive Care Unit.
This includes not only the attending physicians, but the fellows, residents, interns, medical students, nurses, respiratory therapists, pharmacists, social workers, physical, occupational, and speech therapists, as well as countless other people that makes what we do possible.
Nothing gets done in a vacuum. It all gets done with this amazing teamwork.
What do you like least about practicing at Hopkins?
Despite Hopkins’s great reputation, it is still like other hospitals in the country where we struggle to get things done with limited resources.
There are never enough facilities for testing, therapists for rehab, doctors for consults, phlebotomists to draw blood, and critical care transport teams to move patients around the hospital.
If you weren’t a doctor, what would you be doing?
My training and focus has made me an expert in my field of trauma-critical care.
If I couldn’t be a doctor, I’d probably own a toy store, become a park ranger, or be a professional poker player.
What are your current clinical interests?
I am primarily a trauma surgeon, and my main clinical role is the
actual hands on care of injured patients.
East Baltimore is kind of a tough neighborhood and we see many patients with penetrating trauma, meaning stab and gunshot wounds.
I also practice acute care and elective general surgery and spend time dedicated in the Intensive Care Unit (ICU) as a critical care intensivist, dealing with the sickest of the sick patients.
In addition, I perform bedside procedures (percutaneous tracheostomies and endoscopically placed feeding tubes) in the ICU, saving patients from the traditional trip to the operating room.
I love the variety that trauma, acute care surgery, and the ICU brings. I rarely do the same operation twice. I never know what I am going to do until it happens.
Disclosure: The interviewer is a former staff member at the Johns Hopkins Hospital and has coedited a medical manuscript with Dr. Haut.
Copyright 2008 DailyInterview.com
Topics: Physicians | No Comments »
Gillian Woodford - Editor, National Review of Medicine
By Admin | April 6, 2008 at 12:44 am
Gillian Woodford is the Editor of the National Review of Medicine, a print and electronic publication devoted to the Canadian healthcare system. She also publishes the widely read medical blog Canadian Medicine. She gives us her thoughts on publishing and the pros and cons of the Canadian Health System.
Where did you go to college and what was your academic major?
I did English lit. I did my undergrad at the University of New Brunswick - the New Brunswick in Canada, not New Jersey - and my MA at Concordia University here in Montreal.
What was your career path from college to your current position?
I was living in Bristol, England and got a job running the editorial office of the geriatrics journal Age and Ageing. It was a great experience. When I came back to Montreal in 2003, NRM was about to launch and I was hired as features editor.
What properties do you publish?
We started out as a print-only newspaper for Canadian doctors. Gradually all our content was made available on our website (www.nationalreviewofmedicine.com).
About a year ago we launched our blog, Canadian Medicine (www.nationalreviewofmedicine.com/blog) as a way to put up-to-the-minute medical and health politics stories on the web for our readers in between issues.
We’re also conscious that doctors deserve good quality medical reporting - well-written, accurate, speaking to their point of view.
There’s a lot of amazing health writing out there but also a lot of drivel. We try our best to be in the first category with good prose, humour and analysis.
What has been your biggest news scoop?
This one’s a little obscure for US readers, but NRM did a series on a family medicine College certification exam that doctors felt was discriminating against older docs. It came via a tip from a doctor.
The stories we covered - written by a former editor here, Julia Cyboran - stirred up a lot of reaction from older Canadian doctors who felt they were being done dirty by the College and the system in general.
But we also got a few defences from younger docs who aced the exam. We really struck a chord.
Who is your dream interview?
I had the opportunity to interview Dr Henry Morgentaler last fall. For me that was a dream interview.
Dr Morgentaler more or less single-handedly got abortion decriminalized in Canada in 1988. I was in high school at the time and just becoming aware of a lot of inequalities in Canadian society so it was pretty seminal for me.
He’s an amazing man - a Holocaust survivor who went to jail several times because he thought it was wrong that women were being prevented from getting safe, legal abortions.
He’s in his 80s now and he’s still out there suing the provincial governments over abortion access.
How have you built your readership for your publications?
By talking to a lot of doctors we stay on top of what their concerns are and reflect that in the paper.
That’s really crucial - depending on just press releases for story ideas and information -which is what some medical publications do - leads to dull and biased medical journalism and it doesn’t reflect what’s going on in doctors’ practices and lives.
Since we launched in 2004 we’ve evolved the paper a lot, responding to feedback from our readers and adapting to trends like higher web use.
How do you come up with ideas for interviews and stories?
Besides talking to doctors, we read. A lot. And then we read some more. We read medical journals, newspapers, magazines, websites, online forums, medical organization newsletters, hospital notices, blogs — whatever we can get our hands on.
The key to deciding what’s important to cover, whether it’s a new drug that’s been released or a certain aspect of a new government budget, is to get a good grasp on the context of the story.
The question is always really the same one that all journalists ask themselves about every article they write - does this matter to my readers?
Are your publications profit or nonprofit?
We’re hoping to retire on the Google ads on our blog.
Why do you think some Canadians travel to the US for healthcare?
My impression is there aren’t that many doing this, but those who do do so mostly because of long wait times for certain procedures or treatments.
There are a bunch of cases ongoing where patients have gone to the States for a diagnostic test or a treatment and then come back and sue their provincial government to reimburse them.
Or they threaten to do so and the government relents. There was just one case here in Quebec of a woman with a really rare form of cancer, signet-ring-cell carcinoma.
After the government twice refused to pay for her to seek treatment in the US, they finally agreed to pay for the treatment - it’s not available in Canada.
There was also a high-profile case last fall when an Alberta woman had to go to Montana to have her quadruplets because all the closest NICUs were full.
The government is trying to fix the wait time problem by establishing guarantees (and throwing money at the problem), but things have actually gotten worse.
Most doctors think we need to reform the system, including using more private/public partnerships for elective procedures.
Unfortunately, we still have a doctor shortage so we don’t have the people to man more private clinics without bleeding the public system.
What aspects of the Canadian healthcare system most need to be fixed?
As I mentioned above, the doctor shortage, which will have a knock-on effect on wait times. The situation is desperate at the moment here because back in the 90s it was decided we had too many and the provinces cut med school places.
I just wrote an article about doctors who are winding down their practices and the doctors I spoke to are just demoralized.
They are so overworked, they feel undervalued by the system, they worry about providing good care to their patients and maintaining their own health and sanity. It’s pretty grim out there.
What are the best features of the Canadian healthcare system?
The universality of the system is something we’re really proud of here - especially when we hear horror stories from the US about people mortgaging their homes to pay their hospital bills.
Canada’s system is far from perfect, but pretty much everyone - doctors and patients included - think that what you in the States call “socialized medicine” is a good thing. Nobody questions the degree of universality, but we’re starting to question the single-payer model.
Copyright 2008 DailyInterview.com
Topics: Bloggers, Editors | No Comments »
Lori Sundberg, PhD - Germanic Languages Specialist and Rabbit Rescuer
By Admin | March 13, 2008 at 3:35 am
Lori Sundberg, PhD is a specialist in Germanic languages and literature. She spends some of her free time as a foster mother for rescued rabbits. We recently had a chance to get her thoughts on these animals in need.
Where are you from?
I am originally from Oklahoma. I moved to the East Coast to attend graduate school at the University of Pennsylvania in Philadelphia.
Where did you go to college and what was your academic major?
For my doctorate, I attended the University of Pennsylvania in the field of Germanic Languages and Literatures. I also completed one-fourth of my doctoral coursework at Yale University through the doctoral exchange program.
While working on my MA, I attended the Universitaet Heidelberg in Germany. I also spent two semesters at Stockholm’s Universitet in Sweden.
What are you currently doing professionally?
I am currently on the academic job market for assistant professorships in German and Comparative Literature. The last position I held was a visiting assistant professorship at Middlebury College in Vermont.
How did you get the idea to become involved in rabbit rescue?
I was looking for a bunny friend for our pet rabbit Doodles about two years ago. When I started going to area shelters, I became saddened and surprised at the large amount of animals going in and not coming out.
It was at that time I made up my mind that I would do whatever I could to start getting animals out. There was a real need in the community for rabbits to be rescued so I joined Friends of Rabbits.
You might say I dove in headfirst and just started pulling bunnies out of shelters before they were euthanized.
Do you have an official role with Friends of Rabbits?
Yes, I am the fostering director for Friends of Rabbits, a Maryland, DC, and Virginia based 501(c)3 nonprofit organization. Our president is Susan Wong who has been involved with animal rescue for years.
Where do you rescue your rabbits from?
Our rabbits come from area shelters before they are put down. We don’t generally take from the public because of the overwhelming number of bunnies in need at the shelters.
Sometimes we are called by animal control officers to pick up bunnies from cruelty situations. You might say we also help out when bunny expertise is needed.
Many individuals are not knowledgeable about the special needs of rabbits, and we are here to educate the public about their specifics.
What do you tell people who are concerned about the risk of getting tularemia from their rabbits?
Keep your rabbits indoors. Since the disease is spread from arthropods like fleas and ticks, the problem is diminished by keeping the rabbit as a house companion.
With this in mind, it is necessary for a rabbit to receive the same veterinary assistance that would be given to a cat or dog.
Rabbits are now the third most common companion animal in the US. They deserve the same care.
How long do rabbits typically live?
Rabbits can have a lifespan up to 12 years and sometimes even longer.
Generally, when a bunny reaches 8-12 years they are senior citizens in the rabbit world. Keeping your rabbit indoors can easily increase their lifespan.
With indoor housing they are not as susceptible to fly-strike, heat stroke, severe cold, or predators. Domestic bunnies should not be caged outdoors or left in temperatures under 50F or over 85F.
Many people don’t know that just by seeing a predator while caged outside a rabbit can have a heart attack and die. There is also the possibility of a predator digging underneath an outside enclosure.
What screening do you have to go through to adopt a rabbit?
A potential adopter is required to fill out an adoption application and a final contract before the adoption is completed.
We want to be sure of what the home environment is like, so we also require a vet reference and a home visit for first time bunny owners. Our organization is here to help the adopters in ways that shelters and pet stores won’t.
We provide a support network in case there is a question or illness. I can’t think of another group that is as supportive as this one.
If one of the bunnies isn’t feeling well or if I have a question, another group member is over at my home helping with the situation. We offer this kind of support not only to our foster network but also to our adopters.
I would also like to say that we have a very diverse group in this organization, and our different backgrounds help in various situations.
Can you give us an idea of who is in your group?
For example, we have biologists, engineers, IT people, vet techs, a geologist, a law enforcement specialist, accountants, and even a toxicologist with a Ph.D. from MIT.
Believe me, if any of my foster bunnies were to ever eat something they shouldn’t have, the toxicologist would be the first person I’d call. It is this great network of people and expertise that adopters have told me they appreciate having access to.
What type of rabbits do you have available for adoption?
All kinds really. We don’t discriminate about which ones we take in from the shelters. If it’s a rabbit in need and we have room, then we take it in.
Many rescue groups won’t take bunnies that become too large or ones that are harder to get adopted out like the New Zealand rabbits with white fur and pink eyes.
We take all breeds and types, and we even take in those that have been deemed “unadoptables” by shelters, meaning that they have some health problem or anomaly making it difficult for them to find permanent homes.
Basically, our only qualification is that it’s a bunny.
Why do rabbits make good pets?
Rabbits can be litterbox trained just like a cat or a dog which makes them great house companions.
Depending on the temperament of the animal, some of them will enjoy sitting quietly together with you as you read, take a nap, or watch a movie. Others are more active and bounce around in the most playful manner.
How old does a rabbit have to be before you can put it up for adoption?
A rabbit should stay with its mother until it is a least two months old. Since our group advocates spaying and neutering rabbits prior to adoption, we like to wait until the rabbit is old enough to have that surgery done.
It is not uncommon, however, for a shelter to call us with extremely young bunnies that have been dropped off without their mother.
I have a 5 week-old right now at my house because the original owners brought two litters to a local shelter, kept the parents, and then refused to let the shelter spay and neuter the two adult bunnies for free.
It is people like this who create an influx of rabbits at shelters causing them to be unnecessarily put down. In the end, it is the animals that suffer for the overpopulation problem we humans have created.
Do you allow people to adopt more than one rabbit at a time?
Yes, we do. We often adopt out pairs and trios. Rabbits are very social creatures and they enjoy the company of others bunnies.
However, you need to make sure that the rabbits are bonded before you put them together. Otherwise, you will end up with some serious fighting leaving bunnies with some bad injuries.
How do you get the rabbits to get along socially with people and each other?
Most domestic rabbits just generally do this on their own. If the bunny has come from a cruelty situation, has been severely neglected, or abused, then it takes some time to build that trust back.
In these situations, it is often another rabbit that will help them come around. I have a beautiful rex rabbit at my home that has been terrified of people since I picked her up from a county shelter last spring.
While at my house, she has been passed over for adoption many times. The minute someone would even look at her she would run away and hide. I recently bonded her with an older male and she now comes out of hiding to be with him.
Will you place rabbits in homes with cats and dogs?
That depends on the temperament of the cat or dog. Some get along wonderfully, while others could be dangerous.
Rabbits are naturally prey animals so it is important to make sure that the dog or cat is not a threat to the bunny.
Can you give us one generally little known “fun fact” about rabbits?
Rabbits have different personalities just like people do. Some are reserved while others are outgoing. They can get moody and happy just like people do.
How many rabbits have you rescued and placed into a good home to date?
Within the past six months I’ve personally placed around twenty. I’ve helped rescue around a hundred within the past six months.
If I am unable to accommodate a rescued rabbit, then one of our many foster volunteers steps in to keep the bunny until we have found a forever home.
We are a big network of volunteers and we are here to help the bunnies out as much a possible.
Is Easter your biggest adoption season?
In regard to Easter, we try to be very cautious around this time. Often people think that getting a bunny as an Easter gift for a child, spouse, or friend is a good idea without realizing that a rabbit is a long-time commitment.
I know of some rescues and shelters that actually suspend adoptions at this time for that reason. If an adopter is interested in a rabbit at Easter, I make sure they know the full responsibility of what they are taking on.
For rescues and shelters, it is the weeks following Easter that are the busiest and most trying, since those cute little Easter bunnies start getting dumped off at the shelters when people realize they have taken on more than they are willing to handle.
When you adopt a companion animal, you have an obligation to that pet for the rest of its life. Dumping your rabbit at the shelter is, more times than not, a death sentence for the bunny after Easter.
The shelters and rescues can’t handle the large influx all at once and we get overwhelmed. It is a sad time for many of us because we have to turn bunnies away when we’ve run out of room.
People should think long and hard before relinquishing their ownership to any companion animal for this reason.
Disclosure: A family member of the interviewer has recently adopted two rabbits into a terrific loving home with the help of Dr. Sundberg.
Copyright 2008 DailyInterview.com
Topics: Professors, Animal Experts | 1 Comment »
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