Heart Month: Disruptive Woman Dr. Bernadette Melnyk Shares Her Story

Bernadette Melnyk, PhD, RN, CPNP/PMHNP, FNAP, FAAN

This post was originally published by the Women’s Heart Alliance on February 10.

When people ask how I became interested in health and wellness, I have to tell them about the tragedy that forever changed my life.

My mom had a stroke right in front of me and died when I was home alone with her at age 15. She had a history of headaches and saw her family physician one week before she died. My mom was diagnosed with high blood pressure and given a prescription for a high blood pressure medication that my dad found in her purse after she died. As you can imagine, this traumatic event had a major impact and left me suffering from post-traumatic stress for a couple of years.

Quote Graphics on Bern Blog Post_ fb_igIt’s hard knowing that my mother’s death might have been prevented. She might have lived if she had known more about how high blood pressure was a major risk factor for stroke and got her prescription filled. I do not want other children to experience the loss of their moms early due to heart disease, which is in large part preventable with healthy lifestyle behaviors.

Heart disease and stroke now takes the life of one woman nearly every 80 seconds. That’s more than 400,000 women each year, who are mothers, daughters, sisters, wives and friends. Even though this silent killer contributes to more female deaths in America each year than all cancers combined, many people still think of heart disease as a “man’s disease.” That thinking can affect how quickly a woman, her family, or even her doctor takes her signs and symptoms seriously or diagnoses them correctly, and time is vital in treating heart attack, stroke, and other complications related to heart disease. Also, women’s symptoms can present differently than men’s, and not all health care providers are up to date with the latest evidence-based practice to know how to recognize symptoms of heart disease in women.

I urge everyone, especially health care providers, to be proactive in learning about how heart disease affects women and men differently, and ways to prevent it.


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Healthcare Reform in President Trump’s America – A Preliminary Look

Jane Sarasohn-Kahn

This post was originally published on 9 November 2016 in http://www.healthpopuli.com/.

Trump-tweet-on-helath-careIt’s the 9th of November, 2016, and Donald Trump has been elected the 45th President of the United States of America. On this morning after #2016Election, Health Populi looks at what we know we know about President Elect-Trump’s health policy priorities.

Repeal-and-replace has been Mantra #1 for Mr. Trump’s health policy. With all three branches of the U.S. government under Republican control in 2018, this policy prescription may have a strong shot. The complication is that the Affordable Care Act (aka ObamaCare in Mr. Trump’s tweet) includes several provisions that the newly-insured and American health citizens really value, including:

  • Extending health insurance to dependent children up to age 26
  • Closing Medicare’s “doughnut hole” (for Medicare Part D which covers prescription drugs for older Americans)
  • Covering people with pre-existing medical conditions
  • Covering preventive services, and
  • Providing subsidies that lower the cost of insurance.

What nobody likes is the direct consumer cost of health care — ACA’s lack of affordability, which was predicated on a competitive insurance marketplace and near-universal sign-ups for health insurance bolstered by a mandate for consumers to purchase insurance. Without these pillars in place, insurance companies have pulled out of local markets where they cannot be financially viable, leaving many consumers with only one choice for health insurance purchasing. Monopoly power in a local market means higher prices. Couple this with millions of consumers opting out of buying health insurance, leaving health plans with a sicker, generally older population to serve. Actuaries in health plans like a more standardized population with young, older, healthy, sick, and demographically diverse to be able to forecast utilization of health care services and, ultimately, the medical loss ratio (that is, patients’ costs incurred in the health plan).

Repeal-and-replace in Donald Trump’s healthcare world could result, in the short-to-medium term, in about 20 million Americans losing health insurance. The Commonwealth Fund estimated that this could increase the Federal budget deficit by between $330 bn to $550 bn over 10 years. (more…)

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Connected Health Symposium 2016 Disruptive Women in Health Care Panel – Boston Strong


Just as trailblazer Kathrine Switzer, the first female Boston Marathon runner, made history in 1967, transforming the “men’s only” Boston Marathon into what it is today, our panelists are changing the world of health care. Meet the Disruptive Women who are transforming health care in and around Boston.


Robin Strongin

Ami Bhatt, MD, FACC

Glenna Crooks, PhD

Naomi Fried, PhD

Lisa Gualtieri, PhD, ScM

Kathy McGroddy Goetz, PhD

Mandira Singh




Thursday, October 20, 2016 – 09:00 to 09:50am

FireShot Capture 37 - Panel_ Disruptive Women in Health Care_ - https___symposium.connectedhealth.


2016 Connected Health Symposium


Morning Events

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Preserving a Diverse Health Workforce

Elena Rios

During these last days of summer, we here at Disruptive Women are reflecting on posts from when we first launched—it’s fascinating to see how far we’ve come and where we still have to go—to push—to Disrupt.  After all, a woman’s work is never done. We originally published this post on September 25, 2008.

As a leader from the Hispanic community with supportive parents and counselors and with a stellar academic background, I was fortunate to have the opportunity to participate in the Federal Health Careers Opportunity Program (PHS Title VII) – not only to be a program coordinator for a local CBO (East LA Health Task Force, 1980), but as a pre-med student from Stanford University who had not completed the pre-med curriculum upon graduation, I was appointed to an HCOP post-bac program (Creighton University, 1981) and was accepted into UCLA Medical School in 1982 where I served as a counselor for minority premed students for the State of California HCOP program. I know several Latino physicians and public health professionals who benefited from this program and wouldn’t be where they are if it hadn’t been for this program. HCOP has been the major recruitment program for disadvantaged students to enter medicine and public health careers – until the Federal government decided to decimate it in 2006. Now with the current physician and public health workforce shortage along with the tremendous growth in the diversity of the U.S. population, this program should be brought back to its 2005 funding level. In addition, I believe there should be a regional approach to workforce planning and implementation, so that programs in regions with large Hispanic populations target their efforts to bring Hispanic students into the region’s medical and public health schools. The next President needs to understand the importance of having a diverse health care workforce – the literature has shown that Hispanic and African American physicians and dentists generally care for more minority, Medicaid and uninsured patients – the most vulnerable patients in our society, and those who, without health care, tend to be the sickest with the greatest health care costs to the nation.

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The Role of Nurse Practitioners in Health Care Reform

This article was originally published by Georgetown University’s family nurse practitioner programs.

The Affordable Care Act created new health care delivery and payment models that emphasize teamwork, care coordination, value, and prevention: models in which nurses can contribute a great deal of knowledge and skill. Indeed, the nursing profession is making a wide-reaching impact by providing quality, patient-centered, accessible, and affordable care.

- Institute of Medicine 1

An estimated 27 million Americans have gained health insurance coverage during the past five years thanks to the Affordable Care Act (ACA).2 But that, coupled with an aging population and an expansion of preventive care benefits, is putting significant strain on the country’s primary care provider workforce. (more…)

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Sexism in Medical Education

heather newThe medical school professor stands affront  a group of first year students in a mid-size auditorium. “I need a go-to guy,” he says, “someone to direct my questions towards.” He scans the room. “I’ve never actually had a go-to girl, before,” he admits. Later in the lecture, he makes a joke at a male student’s expense. “I joke!” he laughs. “Usually I don’t pick on the girls of the class – they can be too emotional – its true! My wife tells me it’s true.”

During an exercise aimed at discussing issues of public health, the facilitator disagrees with a student who says that men and women should be treated equally as patients: “Men and women are inherently different,” he says, and later: “Women are less physically strong than men. If I were in battle, I wouldn’t want a woman fighting next to me. She just wouldn’t be able to carry me out.” (more…)

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Doctors: It’s Not What You Say, But How You Say It

Val Jones, MD

Today’s post originally ran on Better Health on December 28, 2015.

Most physicians will be thrust into the role of patient or caregiver at some point during their careers. Unfortunately, it’s not until this occurs that many become fully aware of the finer points of excellent care and communication. Take for example, the simple act of reporting test results to a patient. We do this every day, but may not realize that how we frame the information is as important as the data themselves.

I came to realize this on a recent hospital visit when I was in the role of healthcare proxy for a loved one with heart disease. Not only did various physicians present information with different degrees of optimism, but individual doctors presented things differently on different days…depending on (I guess) how tired/hurried they were. (more…)

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Leveraging the Expertise of America’s Most Trusted Profession

Pamela Cipriano, PhD, RN, NEA-BC, FAAN

The following post was first published in Huffington Post’s Politics Blog on December 29, 2015.

During a time when Americans’ confidence in many U.S. institutions has declined, the public’s trust in nurses remains unmatched.

For the 14th year in a row, the public rated nursing as the most honest and ethical profession in America, with an 85 percent rating, according to a recently released Gallup survey. Nurses have claimed the top spot since 1999, the first year they were included in the survey, with the exception of 2001, when firefighters were voted No. 1 following the attacks on September 11.

While the U.S. health care system struggles to retain the public’s confidence, with only 37 percent of respondents saying they have a “great deal” or a “quite a lot” of confidence in the system according to findings from a June 2015 Gallup poll, the evidence is clear that nurses have the respect of Americans. (more…)

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What Causes A Toxic Hospital Culture?

Val Jones, MD

Dr. Jones’ post was first published on Better Health on September 30.

Hospital culture is largely influenced by the relationship between administrative and clinical staff leaders. In the “old days” the clinical staff (and physicians in particular) held most of the sway over patient care. Nowadays, the approach to patient care is significantly constricted by administrative rules, largely created by non-clinicians. An excellent description of what can result (i.e. disenfranchisement of medical staff, burn out, and joyless medical care) is presented by Dr. Robert Khoo at KevinMD.

Interestingly, a few hospitals still maintain a power shift in the other direction – where physicians have a strangle hold on operations, and determine the facility’s ability to make changes. This can lead to its own problems, including  unchecked verbal abuse of staff, inability to terminate bad actors, and diverting patients to certain facilities where they receive volume incentive remuneration. Physician greed, as Michael Millenson points out, was a common feature of medical practice pre-1965. And so, when physicians are empowered, they can be as corrupt as the administrations they so commonly despise. (more…)

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When In Doubt, Ask A Family Member

Val Jones, MD

The post below ran on September 9 on Better Health.

I learned a valuable lesson recently about how difficult it can be to make the correct diagnosis when you see a patient for a very short period of time. In the acute rehab setting I admit patients who are recovering from severe, life-altering brain events such as strokes, head injuries, and complex medical illnesses. It is challenging to know what these patients’ usual mental function was prior to their injuries, and so I rely on my knowledge of neuroanatomy, infectious disease, and pharmacology to guide my work up. However, I have learned that asking the patient’s family members about what they were like (in their healthier state) is extremely important as well. Personality quirks, likes and dislikes, and psychiatric history all offer clues to ongoing behavioral challenges and mental status changes.

This fact was never clearer than when I met an elderly gentleman with a new stroke. He was extremely drowsy, non-participatory, and was not oriented to anything but his name. (more…)

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Confronting Scandalous Physician Behavior: The Annals Of Internal Medicine Takes The First Step

Val Jones, MD

This post first appeared on Better Health.

If you have not read the latest essay and editorial about scandalous physician behavior published in the Annals of Internal Medicine (AIM), you must do so now. They describe horrific racist and sexist remarks made about patients by senior male physicians in front of their young peers. The physicians-in-training are scarred by the experience, partially because the behavior itself was so disgusting, but also because they felt powerless to stop it.

It is important for the medical community to come together over the sad reality that there are still some physicians and surgeons out there who are wildly inappropriate in their patient care. In my lifetime I have seen a noticeable decrease in misogyny and behaviors of the sort described in the Annals essay. I have written about racism in the Ob/Gyn arena on my blog previously (note that the perpetrators of those scandalous acts were women – so both genders are guilty). But there is one story that I always believed was too vile to tell. Not on this blog, and probably not anywhere. I will speak out now because the editors at AIM have opened the conversation. (more…)

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Over-Reliance on Tests: Why Physicians Must Learn to Trust Themselves & Their Patients

Val Jones, MD

The post below ran yesterday on Better Health.

I met my newly admitted patient in the quiet of his private room. He was frail, elderly, and coughing up gobs of green phlegm. His nasal cannula had stepped its way across his cheek during his paroxsysms and was pointed at his right eye. Although the room was uncomfortably warm, he was shivering and asking for more blankets. I could hear his chest rattling across the room.

The young hospitalist dutifully ordered a chest X-Ray (which showed nothing of particular interest) and reported to me that the patient was fine as he was afebrile and his radiology studies were unremarkable. He would stop by and check in on him in the morning.

I shook my head in wonderment. One look at this man and you could tell he was teetering on the verge of sepsis, with a dangerous and rather nasty pneumonia on physical exam, complicated by dehydration. I started antibiotics at once, oxygen via face mask, IV fluids and drew labs to follow his white count and renal function. He perked up nicely as we averted catastrophe overnight. By the time the hospitalist arrived the next day, the patient was looking significantly better. The hospitalist left a note in the EMR about a chest cold and zipped off to see his other new consults. (more…)

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Newly Minted Doctors Begin Their First Jobs In July: Should You Be Afraid?

Val Jones, MD

Today’s post first ran on Better Health on July 4.

The short answer, in my opinion, is yes.

The long answer is slightly more nuanced.  As it turns out, studies suggest that one’s relative risk of death is increased in teaching hospitals by about 4-12% in July. That likely represents a small, but significant uptick in avoidable errors. It has been very difficult to quantify and document error rates related to inexperience. Intuitively we all know that professionals get better at what they do with time and practice… but how bad are doctors when they start out? Probably not equally so… and just as time is the best teacher, it is also the best weeder. Young doctors with book smarts but no clinical acumen may drop out of clinical medicine after a short course of doctoring. But before they do, they may take care of you or your loved ones.

It has been argued that young trainees “don’t practice in a vacuum” but are monitored by senior physicians, pharmacists, and nurses and therefore errors are unlikely. While I agree that this oversight is necessary and worthwhile, it is ultimately insufficient. Let me provide an illustrative example. (more…)

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TBT: Turf versus Access to Care

Diana Mason

This week’s TBT post was written during last year;s National Nurses Week. Although the situation has improved there still is a ways to go. The post is a good reminder of what nurses do and how an expanded role for them would improve the health care system.

This is Nurses Week, often a time when health care organizations patronize nurses with free food and tchotchkes. We’d rather have the right to be able to contribute our talents and expertise to improving the health of people by being able to practice to the full extent of our education and training. Last week, the New York Times published a commentary on The Opinion Pages by cardiologist Sandeep Jauhar that continued to prop up the old and inaccurate message by organized medicine that nurse practitioners must be supervised by physicians. It perpetuates turf battles instead of focusing on improving access to safe, quality, affordable care. At a time when the Affordable Care Act has provided millions of people with coverage for care, building our primary care capacity is essential. (more…)

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Mind-Body (in my case Mind-Butt) Connection

Archelle Georgiou, MD

Colonoscopy…no way, no how, don’t want it, don’t need it. I’d rather have colon cancer. I don’t have any risk factors anyway. Can’t I have a root canal instead?

These are the thoughts that swirled through my head starting at age 49 as I anticipated turning 50 and hitting the magic moment for this right of passage.

But, several months ago, the resistance disappeared. I made the appointment in March and didn’t think about it again until I had to start the prep at 4 pm on the day before my procedure. Drinking 64 oz of Crystal Light with Miralax and 10 ounces of magnesium citrate made me feel like a bloatedwhale. I was stuck in a bathroom, chilled from the cold liquid, and could only tolerate wearing grey flannel sweats. (more…)

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