Birthday time again, and this time, for Cosette. The sweetest, most beautiful, most perfect little fluff on Earth.

It’s nice that there is a new TV show out with a nurse in the lead role, but why oh why do they have to pull same old, worn out and tire, dog and pony show? The average medical show (ER, House), has doctors performing deeds that are completely alien to real life. And now, here comes Hawthorne in their footsteps.

Please, a Cheif Nursing Officer (CNO) who steps in and does patient care? A CNO who even leaves her office? A CNO is an administrator, not a clinician. An executive who does not mingle with patients or staff, but instead, attends meetings and does paperwork. Maybe the CNO might put on a pair of scrubs if she worked in a 20 bed rural hospital, but not in a large urban facility. That the CNO is “fighting” for her nurses against the evil establishment is ridiculous, because she is the establishment. Or that she even knows who the nurses are working at the hospital. Even her strutting around in a white coat is ludicrous—CNOs are executives. They wear business suits, no white coats.

Plus, how difficult is it to come up with a script that doesn’t look like it was written by Mickey Mouse. Would a nurse in 2009 really give a med that he/she knew to be detrimental? No, of course not. If the doctor remained firm, the nurse would take it up with the nurse manager of the unit or supervisor, and hold the dose.

And of course, the primary problem that Hawthorne has to contend with is physicians being mean to nurses. Cruelty to nurses, the ongoing war between the money-hungry and callous MD and the saintly self-sacrificing RN. Yawn….

The show is just a jumble of the worn out and worst of Hollywood cliches of the hospital environment, only now we have nurse Hawthorne instead of Marcus Welby. We have the disgruntled male nurse who would rather be a physician, the newbie who cries because a doctor yells at her (and Hawthorne of course is by her side to wipe the tears), the sexy bimbo nurse (didn’t they disappear circa 1950?), the mean incompetent physicians (all of them on the show), nurses who speak in baby talk and giggle over the cute paramedic…need I do on?

Why not do something innovative, like have the main character as an “ordinary” nurse who is fighting for better working conditions, trying to get the nursing staff to unionize, showing how the hospital deals with uninsured, etc. Or even make her the manager of a single unit, where she would realistically be involved with nurses and could have easier contact with patients.

But no, in all their wisdom, Hollywood chose to give us…it’s a bird, it’s a plane, it’s SUPERNURSE! Making her Chief Nursing Officer means that Ms. Hawthorne can now be responsible for saving the entire hospital, as she appears to be the only one who is competent. And who is always right, and never loses her saintly affect.

Hawthorne’s CNO can do everything and anything, from rushing into the NICU to start an IV, because as we know, the regular nurses working there are just too dumb to perform such a “complicated” procedure, to having time for heart to heart talks with patients and even kissing one on the cheek, to making rounds on the hospital units, sitting in on report…and yet, somehow having time to do her job as CNO.

Here’s a hint for the uninitiated. In a large hospital, most if not all nurses have no idea who the CNO is. They wouldn’t know her by sight, name, and probably don’t even know she exists. Ditto for most doctors. The CNO generally got there because she sticks by rules, doesn’t make waves, and is firmly committed to the status quo. She’s not the renegade who’s out there fighting for truth, justice, and revolution.

I hope this silly show dies a quiet death, before making nurses look even more ridiculous. Or before spreading even more myths and legends about life in the hospital.

Very good review from St. Murse, which outlines the glaring idiocy of this new show.

If anyone has any hope of health reform that really reforms the system, then you need to contact your state and national reps and tell them what you want. Also let them know that they can easily be replaced by representatives who are more in tune to what constituents really want.

Here’s a comforting thought from the LATimes:

Sen. Lindsey Graham calls a cost analysis report a ‘death blow’ to ‘a government-run health plan.’ Sen. Dianne Feinstein says there might not be enough votes among fellow Democrats to pass a plan.

They are arguing against a government run public health plan as an alternative, yet not making any demands on the insurance industry. I haven’t seen anyone calling for laws to reform health insurance, like not allowing them to dump people as soon as you send in a claim, or charging exorbitant rates for pre-existing conditions–like if you had strep throat when you were 6 years old and now you’re 60.

Or demanding the insurers offer better coverage, and cut their own internal costs (like zillion dollar bonuses to executives), to avoid raising rates.

So Senators and Congresspeople who oppose the public plan because it will offer “unfair” competition to private insurance–what are you plans to amend the system? Can you offer an alternative other than tearing apart what’s been put on the table?

This article is over a year old, but still quite relevant, as the pot is stirred and the debate over healthcare reform becomes increasingly nasty and bipartisan.

It’s entitled 10 Myths About Canadian Health Care, Busted, written by a person with experience on both sides of the border. While everyone has their own statistics to pull out of a hat, and their own experiences, the writer does knock down a lot of the myths.

But the bottom line is that we should be looking at what works with the Canadian system, rather than making up stories about it, or inflating its shortcomings. The vast majority of Canadians would never change their system for ours, and for good reason.

US News and World Report has once again come out with its ranking of Children’s Hospitals in the U.S. The rankings also appear in the August issue of  scheduled for publication July 21.

While most of the top facilities are well known and have good repuations, I think it is important to read the fine print on this. Selecting the top facilities is not a scientific study. It is not an objective evaluation that is conducted by an independent monitoring group. And most important, all childrens hospitals are not represented.

This is basically, a subjective survey. Yes, survey. It is mailed to hospitals, and they respond, and then the ranking is figured out in-house at the magazine.

Hospitals were ranked by reputation, medical outcomes, and care-related indicators such as patient volume, nursing staff, and availability of specialized programs based on answers to a 65-page survey developed by health care specialists for the magazine.

Of the 160 hospitals contacted, 98 responded.

So essentially, hospitals can fill in whatever they want, and embellish if hey desire, and no one is going to check up on them. No one is checking to see if their nurse to patient ratio is really 1:4. Or how accessible their specifialty programs are. And so on. And according to this, 62 hospitals did not respond. Maybe they were too busy taking care of patients to worry abou filling out a survey?

Granted, this press release does come from industry, but it does make some very good points about a recent proposal about reimbursements for Medicare. Healthcare proposals have to be reasonable and deal with the real world, not the planet bean counters live on. The bottom line is that if physicians are underpaid, they will cease practice in an area and move, which will leave patients without local care. If physicians move and service is cut, that affects the whole healthcare system of an area.

This is an abbreviated press release from the Access to Medical Imaging Coalition:

This data demonstrates that imaging centers in rural areas operate equipment on average 48% of the time their offices are open. This is inconsistent with President Obama’s recent proposal to adopt a 95% imaging equipment use assumption across the board when calculating Medicare reimbursements. Under this proposal, physicians who operate at rates below 95% of the time their offices are open will be underpaid for their services.

The Radiology Business Management Association (RBMA) data, which studied 261 imaging machines in 46 centers, show that imaging equipment in rural regions of the country operates only 48% of the time an office is open, while equipment in non-rural areas operates 56% of the time a center is open for business. Neither rural nor urban non-hospital diagnostic imaging providers operate equipment at rates anywhere near the levels the President or MedPAC recommend the Centers for Medicare and Medicaid Services (CMS) use to base reimbursements.

These cuts would adversely impact patients in rural areas in particular − where fewer providers serve larger geographic areas and more disparate patient populations − causing congestion/delays at the point of care, forcing physicians to scale back services, further reducing care options and making patients travel further to receive care.

President Barack Obama’s imminent approval of the $787 billion economic-stimulus bill will clear the way for the government to compare the cost-effectiveness of drugs, surgery, medical devices and other methods used in treating particular diseases. The legislation, which calls for the creation of an advisory council of up to 15 members, allocates $1.1 billion to fund the systematic analysis of published research as well as head-to-head clinical studies.

However, in the “name of the public interest” 2 Republican senators are furiously working to defeat this aspect of the bill. Sens. Jon Kyl, R-Ariz., and Mitch McConnell, R-Ky., introduced a bill that would block the proposal to conduct comparative-effectiveness research on drugs, medical devices and other treatments. Kyl argued that the research would lead to rationed health care, eventually delaying treatment and weakening the quality of care.

How conducting comparative effectivness research on drugs will weaken the quality of care certainly is a brain twister.  The bottom line is that they are jumping to oppose anything that will interfere with the bottom line of industry, and they immediately throw the fear mongering catch words–ration care! Government interference! Socialized medicine! Apocalypse now!

A few tidbit quotes from Politico:

Senate Minority Leader Mitch McConnell, in a floor speech scheduled for this afternoon warned that what Americans “don’t want is a Washington takeover of health care along the lines of what we’ve already seen with banks, insurance companies

, and the auto industry. Americans don’t want a government-run system that puts bureaucrats between patients and doctors.”

The catchword on this one is that Americans don’t want a system that “puts bureaucrats between patients and doctors.” Uh, perhaps McConnell is living on Cloud 9, but we already have that–its called insurance companies, who continually interfere with patient care.  Our whole system is designed to give bureaucrats the final word. But I suppose that govt bureaucrats will be different from the ones working for a profit-making insurer, whose only interest in their financial health?

Senate GOP Conference Chairman Lamar Alexander (R-Tenn.) predicted that Americans would begin to sour on President Barack Obama’s call for a public option.

“Washington takeover are two words we’ve been hearing a lot from the Obama Administration these days,” said Alexander. “That’s a different direction that Republicans want to go.”

Let’s cut to the chase. The only reason for the opposition to the public plan is that the health insurance industry fears that it will offer competition. But isn’t that what free market is all about? And I guess that Lamar Alexander has been living on Cloud 9 with his pal, and isn’t aware of the millions of Americans who would chance at the chance for a public option, because at long last, they will have insurance. At long last, they may have insurance that they can afford and that actually provides decent coverage.

Talk about fear mongering. It isn’t a Washington takeover, but just offering up another choice for people. So what is wrong with that? But since the Republicans haven’t come up with any alternatives, all they can do is try to stir up fear in the hearts of the uninsured and minimally insured Americans, and those who are overpaying for piddly insurance. It really is sad, I have to say.

But then, these two senators aren’t worried about their own healthcare.  They’ve got coverage for life.

Well, like a flying gumby. But just like a lot of ballet dancers have joint problems later on, I wonder about the consequences of pounding your body against concrete, like he’s doing.

But its nice to see someone fit and healthy, with a strong and flexible body. That seems to be the problem with a lot of older people–their bodies are so stiff with no flexibility, and it isn’t necessarily due to arthritis. Like my mother is in very good health, but she moves like the stereotype old person. Even if you’re not a gymnast or dancer, doing exercises like yoga or pilates do keep your body elastic and flexible, and ward off that “stiff old man” syndrome.

This is Hawthorne, brought to you by TNT.  I guess nurse TV is in vogue now, because this is the second new show to make a debut. But just because these shows are about nurses, doesn’t mean that the medical accuracy is going to be any better than the standard fare. Or that the nurses are going to be likeable and realistic characters.

This is the blurb about the show:

Pinkett Smith plays Christina Hawthorne, a compassionate and headstrong Chief Nursing

Officer heading up a group of dedicated nurses at Richmond Trinity Hospital who spend long days and nights on the hospital’s front lines. Hawthorne is the kind of nurse you want on your side when you or someone you love is in the hospital. She is the kind of nurse who fights for her patients and doesn’t let them slip through the cracks. When necessary, she takes on doctors and administrators who are overworked, distracted or just unable to see the human being behind the hospital chart.

Whether showing humanity to a homeless woman, trying to talk a suicidal cancer patient off a ledge or exposing a doctor’s near-fatal error, Hawthorne will do everything in her power to help her patients. When a patient’s care is at risk, she doesn’t hesitate to violate protocol, defend her staff or stand up to administrators who seem to have forgotten a hospital’s true purpose.

But the long days at the hospital and Hawthorne’s intense focus on helping others take a toll on her personal life. Christina is recently widowed – her husband died one year ago after a battle with cancer, leaving her to raise a smart, rebellious teen-age daughter on her own. Hawthorne is still coming to terms with losing her husband, finding a way to balance her career with her equally important role as a single parent, and finding the time to take care of someone who always seems to fall through the cracks – herself.

Joining Pinkett Smith in HAWTHORNE is Michael Vartan (Alias) as Dr. Tom Wakefield, the oncologist who treated Christina’s husband and serves as Chief of Surgery for the hospital. The cast also includes Suleka Mathew (Men in Trees) as Bobbie Jackson, a fellow nurse and one of Hawthorne’s best friends; David Julian Hirsh (Lovebites) as Ray Stein, a nurse struggling with being accepted in a female-dominated profession; Christina Moore (90210) as Candy Sullivan, a nurse with a unique sense of duty; and Hannah Hodson (TNT’s The Ron Clark Story) as Camille, Hawthorne’s daughter. In addition, special guest star Joanna Cassidy (Six Feet Under) portrays Amanda, Hawthorne’s mother-in-law, who also happens to be a member of the hospital board.

Sounds a little hokey, but then, you never know.

Here’s an interesting tidbit. Well, it’s not really a tidbit but rather a very disturbing announcement from our own Chamber of Commerce–the boys and girls there apparently want to spend hundreds of millions to wage war against Obama’s recovery program. They seem to be orbiting another galaxy and oblivious to all that has occurred because their position is to defend the free market system at all cost.  Government regulation and assistance is for sissies.  Or worse yet, commies.

From Politico:

As the Obama administration encroaches deeper into the private sector and Congress contemplates more regulations, the U.S. Chamber of Commerce is launching a multimillion-dollar campaign to defend the free market system.

Donahue is Chamber President Tom Donohue, and while this particular article doesn’t address it, I’m sure that they will be battling against any form of healthcare reform.  What Mr. Donahue has failed to mention, in his praise to the glory of the free market, is that un-regulated greed got us into our current mess in the first place (and the great Depression as well), and the only thing that will stand between America and another equally bad mess is strong government regulation. It is quite apparent that the free market system cannot be trusted to sselfregulate. As soon as regulations were weakened (remeber the S&L crisis in the 1980s?), as what happened with banking, it was a free for all.  Why does Donahue think that the free market system is suddenly going to magically regulate itself?

Most important, what solutions does he have? How does he propose getting this situation under control without government assistance? And what about healthcare? The free market has failed miserably in that sense.

Then again, people like Donahue and his friends in the Chamber aren’t really affected by all this. They haven’t lost thier jobs, their retirement accounts, their savings, their homes, or their health insurance.  Perhaps he and his pals should go out in the streets and talks to some of the millions who have had a less than enjoyable experience with an unregulated, free market system. Like the guy who can’t get health insurance because of a pre-existing condition, or Mrs. Smith who was set to retire this year but oops–pension and retirement account are gone with the wind.

I haven’t watched the show and don’t intend to (I don’t have Showtime and am not interested enough in the program to try to get it from itunes), but the reviews are slowly coming in. For nurses, what do you think? Do you like it? Find it offensive? See Nurse Jackie as the anti-nurse, the nightmare nurse, doing things you’ve thought about but could never get away with, acting out the frustrations that many nurses feel, or think that she’s just a caricature of the worst possible traits put together?

The AJN has a comment about the show.

Is the American Medical Association hemorrhaging members? Could it be that they are out of step with the majority of physicians practicing in the US? An interesting article discusses how the AMA has opposed any sort of national healthcare program, and that their current president may still have loyalties to managed care.

In August, the AMA launched a $15 million advertising campaign that focused on the problems of the uninsured, hoping to persuade voters to cast their ballots in 2008 with the issue in mind. But this project has frustrated reformers, who contend that the organization’s approach to achieving universal care—providing tax breaks and vouchers for those lacking coverage so they can purchase affordable plans—is too timid.

“At best … the AMA is advocating a completely unproven method of achieving their ends and ignoring things that we know will work,” says Dr. Stephanie Woolhandler, co-founder of Physicians for a National Health Program.

Given these realities, many doctors are turning their backs on the AMA. The medical news service MedPage Today estimated that the AMA represented only 15 percent of practicing U.S. physicians in 2005, down from 70 percent during the 1961 Medicare fight.

Tax breaks and vouchers.  Yep, that’s really going to solve the problem. Their opposition is interesting because if people don’t have insurance, or if they have insurance with enormous copays/coinsurance or huge deductibles, people are not going to see their doctors. They are going to put off surgeries or other treatments. In short, the docs will lose revenue. So how does their opposition help the average physician trying to stay in practice?

The stats are also quite telling. Only 15% of physicians in the US are members of the AMA, a drop from 70% in 47 years. Is the AMA paying attention to this, I wonder?

The end is in sight. I get to leave Florida today and head home. Back to the forest. Of course it figures, that as soon as I leave for Florida, the weather turns warm and sunny. Comfortable warm, as opposed to steamy hot, like in Orlando.

Still a long day ahead of travel to airport, flights, layovers, and finally the shuttle from Seattle back home. That is one definite drawback about living so far from a real airport. What would really be nice if there was a high speed train running up from Seattle to Vancouver, but I know, pipe dream. Although, San Francisco, Atlanta and Chicago do have train service from their airports to downtown. That would be a start for Seattle.

Baked and frozen all at the same time. That’s what it’s like attending a conference in Florida in June. It is hot, sunny and steamy outside. Freezing cold with ice forming on the windows inside of the Convention center. There’s no reason for it and a lot of people are complaining at how cold the session rooms are.

But I’m busy running and writing here at ASCO. Will be back to posting regularly later this week.