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Where are we letting our patients down?

By Rammya Mathew

October 20, 2020

 

    A recent consultation has stayed with me. In many respects it was a run of the mill general practice consultation, but it made me reflect on health inequalities and why the care we provide for people with low levels of health literacy can be woefully lacking.

    He was a patient with type 2 diabetes taking long term insulin, who had developed acute symptoms in the previous 24 hours. He had broken English, but he was able to communicate his history without too much difficulty, so I persevered without an interpreter. In response to some very direct questioning, it became apparent that he hadn’t had anything to eat or drink that morning, he hadn’t checked his blood sugar levels, and he hadn’t thought about adjusting his insulin dose. How was it feasible that a patient taking insulin for so many years had no idea about type 2 diabetes sick day rules? Could it really be that no one had ever taken the time to counsel him about this?

     I looked online for a patient information leaflet that might be of use, but I abandoned the idea quite quickly, as I was unsure whether he’d be able to read it − and even if he could, I was worried that the information might be too complex for him to follow. I decided that giving him the minimum information to avert a crisis was the best course of action. So, I encouraged him to drink more, to check his blood sugar every four hours, and to call a health professional if it was over a certain threshold. I was firefighting, and it didn’t feel good to be in that position.

    His lack of knowledge about type 2 diabetes sick day rules, however, probably reflected his overall understanding of the condition. It made me wonder where we’d let this man down. At diagnosis, was he enrolled onto a structured education programme? Even if he was, could he attend it around his shift work? And if so, was he able to take anything away from it, given his limited English?

    Patients with long term conditions such as type 2 diabetes are meant to have annual reviews with their GP or practice nurse. Was anything meaningful happening at these reviews, or was his medication just being continuously titrated up? A significant part of these reviews is meant to focus on helping patients to set goals and take control of the aspects of their health that matter most to them. But, if you don’t understand your condition and your role in managing it, you can very quickly become a passive spectator in managing your health, and well intentioned tasks such as goal setting just become yet another meaningless, tick box exercise.

    That single consultation and the patient journey behind it capture many of the gaps in our system, and they explain at least partly the stark health inequalities that have become so painfully visible in recent times. There’s a tendency to think that some patients can’t be helped, but the reality is that the system has let them down.

(Adapted from https://www.bmj.com)

Uma tradução adequada para o título desse artigo é

Atenção: Para responder às questão, considere o texto abaixo.

 

For days she couldn’t stop getting sick. At first she doubted the probable cause.

By Sandra G. Boodman
August 22, 2020

 

    The first episode occurred on Halloween night 2016, as Alice Moon and a friend were strolling around her neighborhood admiring the trick-or-treaters. Suddenly Moon began to vomit. “It made no sense,” she said.

   She went home and smoked some marijuana, which she knew could quell nausea and vomiting and is used by some people undergoing chemotherapy. Moon, who promotes cannabis products, had worked in the marijuana industry since 2011, including at a dispensary where she said she “saw all the people it was helping.” (California legalized cannabis for medical use in 1996 and for recreational purposes in 2016).

    For several years Moon had used cannabis at night to combat long-standing insomnia and to moderate anxiety and depression. She described herself as a daily user who was not addicted. “I was never one of those people who was stoned all day,” she said.

    A few days after the Halloween episode, which lasted a few hours, she saw a doctor who diagnosed reflux. He advised her to eliminate spicy or acidic foods, such as tomatoes, and to take a nonprescription acid-blocking drug.

    For a few months, those measures seemed to work. But by early 2017 the vomiting returned. Moon noticed that the episodes, which occurred weekly, appeared to coincide with her consumption of alcohol, even in small amounts, so she stopped drinking.

    The vomiting, however, continued. In late 2017 she read a blog item about an alarming condition affecting some regular users of cannabis: intractable and untreatable vomiting that could last for days.

    “I did let it sit in my brain for a while but it didn’t make sense. I was throwing up the day after using weed.” Moon said.

    As the episodes increased in frequency and severity, Moon discovered that the only thing that seemed to quell hours of vomiting was a hot bath.

    In March 2018 she had one of her worst episodes and decided to see a gastroenterologist who performed a physical exam and questioned her closely after Moon told her she was a regular user of cannabis. Based on Moon’s symptoms and the relief hot baths provided, she suspected cannabinoid hyperemesis syndrome (CHS), the same disorder Moon had read about − and dismissed − a few months .

    The unusual condition was first reported in 2004 by doctors in Australia, who described a small number of frequent cannabis users who developed severe vomiting relieved by hot showers or baths. Like Moon, a few had unsuccessfully tried to quell the vomiting by using marijuana, which has anti-emetic effects in some people. But in some heavy users cannabis, which affects the GI tract, has a paradoxical effect and can trigger severe uncontrolled vomiting. The only way to stop it, Australian researchers reported, was abstinence from marijuana.

    Once thought to be rare, doctors in the United States are increasingly reporting CHS cases in states that have legalized cannabis.

    The gastroenterologist advised Moon to stop using marijuana for three to six months and return if she was still having symptoms. Moon was reluctant. “I was unconvinced this was the cause,” she said. As she was mulling it over, Moon decided to attend a cannabis-themed dinner party in Malibu. A few hours after she got home, Moon began throwing up and didn’t stop for more than two weeks.

    Four days into her ordeal, Moon went to an urgent care center near her home. The doctor on duty had never heard of CHS. He administered intravenous fluids to treat severe dehydration and gave her anti-nausea medication, which is typically ineffective against CHS. When she seemed better, he sent her home.

    Several hours later, Moon began vomiting again. Three days later, still vomiting, a friend drove her to an urgent care center. The doctor hooked her up to an IV and called the gastroenterologist she had consulted. She ordered blood tests as well as CT and MRI scans; all were normal. The gastroenterologist reiterated her suspicion that Moon’s vomiting was caused by cannabis; she couldn’t predict when the vomiting would stop. A few days later, it did.

    For the next five months Moon said she mostly avoided cannabis, while struggling with insomnia and depression. In late September she began intermittently using CBD capsules, hoping they might be less likely to trigger vomiting than edibles or vaped marijuana. That seemed to be the case until Dec. 22 when, on a holiday visit to her family, Moon developed the worst attack she had experienced. The vomiting was so severe Moon cut her trip short and returned to Los Angeles, where she spent four days in a hospital. She said she told her hospital team about her CHS diagnosis; they told her they had never heard of it.

    “People said I looked like I was dying,” remembered Moon, who slowly recovered. It was the last time she used the drug in any form. “I have no desire to touch it,” she said. “It’s just not worth the consequence.”

(Adapted from https://www.washingtonpost.com)

De acordo com o texto,

TEXT

 

Telehealth Is The Future But May Also Be Healthcare Security’s Achilles' Heel

(https://nchc.orr/wp-content/uploads, /2019/01/Gettvimages- 691761024- Converted-01-21546971155813.jpg)

 

Everything changed overnight for telehealth at the onset of Covid-19. We went from a small footprint to telehealth becoming one of the most common ways Americans access care. According to the Department of Health and Human Services, nearly half of Medicare primary care visits were telehealth visits in April 2020, compared to 0.1% in February. Waiting weeks to months for a 15- minute physician exam is no longer acceptable for many when you can just set up a quick telehealth conference. However, with widespread healthcare breaches making news, such as the recent suspected ransomware hack on United Health Services, security executives should be on guard because the rise of telehealth has provided new entry points for hackers to exploit.

[…]

(From: https://www.forbes.com/sites/forbestechcouncil/2020/12/10/telehealthis-the-future-but-may-also-be-healthcare-securitys-achillesheel/?sh=19666a1938b5)

The title implies that the text will discuss

Which of the following best expresses the information presented in the cartoon above?

As questão se referem ao texto a seguir:

 

Stretch my legs, Doc!

 

    Swee Jing paid more money that most Chinese people earn in a year to have both her legs broken and stretched. The pretty college graduate is now lying in a hospital bed, clearly still in pain, after the doctors sawed through the flesh and bone of both legs in eight places. Each leg now has eight steel rods sticking out of it below the knee and these are connected to a steel cage surrounding each leg. Once the broken bones start to heal the doctors will begin to turn the screws on the cage pushing the steel rods apart and so stretching the leg. It is a slow and painful process that will take 18 months to add 8cm to Swee Jing's height.

    Despite the agony, the cost and the inconvenience, the 23-year-old says she does not regret a thing. "It hurts, but it will be worth it to be taller. I'll have more opportunities in life and a better chance of finding a good job and husband."

    Her parents, who financed the operation and are now at her bedside, agree. "It's an investment in our daughter's future. Because she was short, she used to lack confidence, but this should change that."

    Kong Jing-wen is one of a growing number of perfectly healthy Chinese young men and women who are willing to have their legs broken in order to rise up the ladder in height-conscious China.

    In part, the popularity of such surgery can be explained by the surge of interest in fashion and beauty in a country where things like fashion magazines and beauty contests used to be banned. The once closed society is now more open to western influences and the relatively prosperous middle classes have the money to explore cosmetic possibilities. Shops and magazines in the cities show endless images of long-legged western models, inevitably putting pressure on young women.

    There are also domestic pressures. Height is listed among the criteria required on job advertisements. To get a post in the foreign ministry, for instance, male applicants need not bother applying unless they are at least 5ft 7in, while women must be at least 5ft 3in. Chinese diplomats are expected to be tall to match the height of their foreign counterparts.

    For more glamorous positions the conditions are even tougher: air stewardesses have to be over 5ft 5in. But height discrimination is evident even at ground level: in some places, people under 5ft 3in are not even eligible to take a driving test. To get into many law schools, women students need to be over 5ft 1in and men over 5ft 5in. Height requirements are also frequently mentioned in the personal ads of newspapers and magazines.

    Even successful operations can bring pain several months after the initial operation. "During the final weeks of the stretching, I was in so much discomfort that I couldn't sleep at night," says one young woman from Beijing who gave her name as Susan. The 27-year-old is in hospital recovering from an operation to remove the steel rods that have been inside her legs for the past 18 months. Each leg now bears eight circular scars, each half an inch in diameter.

    Now that she is 8cm taller than before, Susan says she would not hesitate to recommend the procedure to her friends. "It hurt at first and had a big impact on my life for a long time because I couldn't walk freely. But it has worked, and I feel very good about that. Before, nobody paid any attention to me because I was short, but now they'll look at me."

Fonte: https://www.fullspate.digitalcounterrevolution.co.uk/english-articlesadvanced/. Acessado no dia 29 de julho de 2021

A palavra inevitably, assinalada em negrito no texto, tem a função de:

As questão se referem ao texto a seguir:

 

Stretch my legs, Doc!

 

    Swee Jing paid more money that most Chinese people earn in a year to have both her legs broken and stretched. The pretty college graduate is now lying in a hospital bed, clearly still in pain, after the doctors sawed through the flesh and bone of both legs in eight places. Each leg now has eight steel rods sticking out of it below the knee and these are connected to a steel cage surrounding each leg. Once the broken bones start to heal the doctors will begin to turn the screws on the cage pushing the steel rods apart and so stretching the leg. It is a slow and painful process that will take 18 months to add 8cm to Swee Jing's height.

    Despite the agony, the cost and the inconvenience, the 23-year-old says she does not regret a thing. "It hurts, but it will be worth it to be taller. I'll have more opportunities in life and a better chance of finding a good job and husband."

    Her parents, who financed the operation and are now at her bedside, agree. "It's an investment in our daughter's future. Because she was short, she used to lack confidence, but this should change that."

    Kong Jing-wen is one of a growing number of perfectly healthy Chinese young men and women who are willing to have their legs broken in order to rise up the ladder in height-conscious China.

    In part, the popularity of such surgery can be explained by the surge of interest in fashion and beauty in a country where things like fashion magazines and beauty contests used to be banned. The once closed society is now more open to western influences and the relatively prosperous middle classes have the money to explore cosmetic possibilities. Shops and magazines in the cities show endless images of long-legged western models, inevitably putting pressure on young women.

    There are also domestic pressures. Height is listed among the criteria required on job advertisements. To get a post in the foreign ministry, for instance, male applicants need not bother applying unless they are at least 5ft 7in, while women must be at least 5ft 3in. Chinese diplomats are expected to be tall to match the height of their foreign counterparts.

    For more glamorous positions the conditions are even tougher: air stewardesses have to be over 5ft 5in. But height discrimination is evident even at ground level: in some places, people under 5ft 3in are not even eligible to take a driving test. To get into many law schools, women students need to be over 5ft 1in and men over 5ft 5in. Height requirements are also frequently mentioned in the personal ads of newspapers and magazines.

    Even successful operations can bring pain several months after the initial operation. "During the final weeks of the stretching, I was in so much discomfort that I couldn't sleep at night," says one young woman from Beijing who gave her name as Susan. The 27-year-old is in hospital recovering from an operation to remove the steel rods that have been inside her legs for the past 18 months. Each leg now bears eight circular scars, each half an inch in diameter.

    Now that she is 8cm taller than before, Susan says she would not hesitate to recommend the procedure to her friends. "It hurt at first and had a big impact on my life for a long time because I couldn't walk freely. But it has worked, and I feel very good about that. Before, nobody paid any attention to me because I was short, but now they'll look at me."

Fonte: https://www.fullspate.digitalcounterrevolution.co.uk/english-articlesadvanced/. Acessado no dia 29 de julho de 2021

O verbo regret, assinalado em negrito no texto, significa: