The Good Old Days

by Dr. Edwin Leap, MD, FACEP

I’ve been reminiscing about the ‘good old days’ of medicine.  I think about those times because I remember when medicine was focused on the sick and when practice was challenging & exhausting, but at its heart…fun!  So what changed?  Lots of things.  But two things in particular come to mind: EMR and HIPAA.

First, let’s discuss EMR, or Electronic Medical Records.  Where once we used paper charts or simple dictation to record information on patient care, now hospitals and physicians are increasingly forced into purchasing and using expensive and complex computerized record-keeping systems.  This was a growing trend already, but the Affordable Care Act made it all but mandatory, with rewards for implementation and fines for noncompliance.  Many small hospitals and practices, in fact, struggle to pay for the cost of implementation even as EMR companies make vast amounts of money.

I’ll ‘render unto Caesar’ here.  Paper systems are problematic.  The can be illegible.  On paper, written by hand, it is difficult to document complex medical encounters and procedures.  And thus, the next clinician involved may have trouble understanding what happened before.  (As will the attorneys in malpractice suits.)  Finally, hand-written charts lose charges and are often down-coded in billing when insurers can’t find the information they need, or find enough information to generate a proper bill.  Paper charts aren’t perfect. Likewise, dictated charts, while better, have longer turn-around times.  But both are faster and generally make physicians happier than the monstrosities that are modern electronic medical records systems.  

Indeed, to give credit where credit is due, electronic systems capture lots (and lots, and lots) of data.  And they can be helpful in retrieving information from previous visits.  And some use voice recognition dictation programs.  This kind of real-time dictation can be helpful.

And yet…EMR sucks the fun out of medicine.  Because EMR systems leave clinicians slaves to the keyboard.  The sound of modern medicine is the sound of typing.  And the great anxiety for physicians, and nurses, is the terrible tension between doing the thing we love, which is patient care, and doing the thing our employers mandate, which is hour, upon hour, of mind-numbing data-entry, all the while trying to move patients in a way that provides the best satisfaction scores and the lowest wait times.  

EMR are rarely designed with clinicians in mind. So, while the flow of the log-ins, clicks, drop-down menus, signed orders, time stamps, discharges and all the rest make perfect sense to programmers, billing companies and data-collectors, it’s an electronic nightmare for those of us who simply want to get back to our patients.  (The commonly told joke is that physicians are the highest paid data entry clerks in the country!)

In the end we care for the sick and let the charts pile up.  We then end up with ‘in baskets’ or ‘to do lists’ filled with hundreds of clicks and signatures that we have to do on our own time, after shift, to satisfy the appetite for information that administrators and government agencies desire, even when little of it contributes substantively to the care of the sick, injured and dying before us.  And woe-betide those who are delinquent in completing records!  E-mails and threats will abound until they are completed.

Older physicians and nurses, less computer savvy, sometimes simply leave.  They retire, taking their incredible skills and knowledge with them.  Younger physicians and nurses are frustrated, but have no other option except to press on and type away, longing for the bedside and the people they spent years learning to treat and comfort.

What about HIPAA?  The acronym stands for the Health Information Portability and Accountability Act. Passed in 1996, among the goals of this federal legislation is the protection of the confidentiality of patients’ private medical information.  Like so many things the government touches, it had a noble intent.  But now it is less a law and more of a bludgeon.  

Currently, in order to protect privacy, patients are yearly advised of their HIPAA rights and expected to sign forms to that effect.  And physicians are constantly beset by log-ins and passwords.  This may seem like no big deal.  Every computer has a log-in screen!  In fact, plenty of applications exist to store all of our various and sundry passwords for our many programs and devices.  However, the average physician will have a log-in and password for the hospital computer system, then for the electronic medical records (EMR) system and a separate set for the radiology system. And if a physician works in more than one facility, the number of log-ins and passwords just keeps climbing.

Our nurses have a similar burden of logging into EMR computers, but also have to access the medication dispensing cabinets which are password protected.  Taken together, it’s very difficult to move patients quickly, chart effectively or maintain a train of thought because we are constantly accessing computers and trying to remember new passwords.  (Biometrics like fingerprint scans and others might help, but we’re not there yet.)

Furthermore, HIPAA terrifies every clinical staffer because they are warned, over and over, that violating privacy is a federal issue.  Even innocently handing the wrong instructions to the wrong patient can be a huge problem.  To make it worse, clinical employees of a hospital can be fired for simply looking up their own labs.  (Their own labs!  In other words, protected from their own prying eyes!)  Their privacy ensured, their job terminated.  

And where we formerly handed lab and x-ray reports to patients so they could take them directly to their physicians, now they must go through the medical records office the next day or later to obtain what is, in fact, their own information.  (Again, protected from their own snooping.)  Or they must have their physician’s office request them with the appropriate release of information signed.   

And when we, the physicians who cared for a critically ill patient, transfer them to another hospital, it’s pointless to check on their progress.  ‘Hello, this is Dr. Leap and I transferred Mrs. Howard, the multi-trauma yesterday after intubating her and placing a chest tube.  Can you tell me how she’s doing?’  ‘All we can say is that she is in the hospital.’  Great.  That’s good quality control, to be sure.

HIPAA has indeed protected privacy (except of course for instances of computer hacking or carelessly placed and lost computers…all too common).  But it has also created a vast industry of programs and consultants, and left clinical and clerical staff slower, and more anxious, than ever.

No, things aren’t what they used to be.  Many issues conspire to make modern medicine difficult; an aging population, complex diseases, rampant addiction, resistant infections, high costs, high expectations and many more.  In the end, however, HIPAA and EMR reflect a common core issue, which is the disconnect between the administrative and political forces that govern medicine (and stand to profit mightily from supervising it) and those who day in, day out, must practice it in the presence of living, bleeding, hurting, dying, fearful human beings whose bodies have no password, and who care less about privacy than survival.

And until that chasm is bridged, it’s unlikely that medicine will ever again be as fun as it was before.  But I can imagine, can’t I, a shift without a computer and a chart without a log-on screen?  Ah, ‘to sleep, perchance to dream…’

Logging off….

   

Edwin Leap, MD, FACEP

Dr. Edwin Leap is a happily married father of four children in the process of becoming adults. He practices emergency medicine in the southern Blue Ridge Mountains.  In addition to his career in medicine, Dr. Leap writes monthly columns for the Greenville News, Emergency Medicine News and The South Carolina Baptist Courier.  He also blogs at www.edwinleap.com/blog.  From faith to family and from culture to medicine, he covers every topic with humor, insight and compassion.

Occupational Therapy: A New Frontier in Healthcare

by B. Lana Guggenheim

Occupational therapy is often confused for other therapies, such as physical therapy. But while occupational therapy does sometimes make use of medical and physical therapies, its practice encompasses a much wider series of activities and healthcare prerogatives.

Physical therapy is a highly specific medical profession and series of practices focusing on a patient’s abilities to move and perform functions. Occupational therapy can and does encompass this, but its focus is on the daily work and life skills of a patient. As such, it covers not just physical capabilities, but mental and cognitive disorders, and other barriers, both physical and environmental, to a patient’s independence. Occupational therapy is inherently interdisciplinary, drawing from psychology, medical science, and social work.

Both physical and occupational therapies have their roots in ancient medical practices like massage and hydrotherapy advocated by physicians including Hippocrates and Galen. But the earliest evidence of using occupations as a therapy method (occupations meaning activities that occupy a person’s time, rather than paid labor) was by the Greek physician Asclepiades in 100 BCE, who advocated humane treatment of patients with mental illness using baths, massages, exercise and music - practices which had been dropped by medieval times, only to be revived in the past two centuries.

Modern physical therapy was established as a discipline towards the end of the 19th century in response to polio and World War I, which increased global demand for such aid. However, occupational therapy began as part of an 18th century hospital reform by French revolutionaries Philippe Pinel and Johann Christian Reil, using work and leisure activities as part of patient therapies. This was part of something called “Moral Treatment,” an Enlightenment-era philosophy that approached mental illness with humane care, derived both from the emerging science of psychology, as well as moral and religious mores. This led to the rise of asylums, which only declined in use in the 20th century. The Arts and Crafts movement of the late 19th and early 20th century also impacted occupational therapy, as it emerged as a form of human occupation and creativity in the face of loss of autonomy and monotony found in increasingly common factory work, as well as staving off boredom for those confined to long hospital stays, whether that was due to mental illness or physical malady. By the early 1900s, occupational therapy was becoming professionalized, challenging the mainstream views of scientific medicine by being inherently interdisciplinary, incorporating social and economic understandings with medical principles.

Reconstruction aides, an umbrella term for both occupational and physical therapists during World War I, most of whom were women, were very successful. Post-war, in order to keep people interested in the profession, emphasis shifted from war-time altruism to the financial and professional satisfaction of being a therapist, and practice and curriculum were standardized, and the profession obtained medical legitimacy in the 1920s. Today, one requires a minimum of a Master’s degree to practice in the field, but increasingly there are doctorate programs and research avenues opening up as well. Occupational therapy is increasingly focused on a patient’s mental health and in treating mental illness.

Ultimately, the two core principles underlying occupation therapy are the centrality of occupations as a basic human need, bringing meaning to life culturally and personally, and thus is therapeutic, and the concept of holism, indicating that a person and their health can only be properly understood in concept of their larger social environment. Occupational therapy grew out of practical applications of psychology and healthcare practice, but there is an increasing emphasis on research, and occupational science, the study of people as occupational beings, was founded in 1989 as a way to provide evidence-based research to support and advance occupational therapy. Occupational science underlines the ability of people to pursue occupations, specific activities that give their lives structure and meaning. While still young, there are increasing numbers of programs offering doctoral degrees in this emerging social science.

Occupational science understands occupations as an antidote to psychological pain, offering structure and means to find meaning in people’s lives. It influences patients’ health, self-respect, and sense of dignity. It is not so much the specific activities undertaken, so much as that the activities chosen are laden with symbolic meaning, thus making occupation a uniquely human enterprise, a point of human experience mostly ignored by other social sciences, and critically important particularly to the development of occupational therapy. Only once the place and potency of a given occupation, defined as culturally and personally meaningful human activity, in a person’s life is understood can therapies be tailored to their needs.

Occupation therefore encompasses much more than just paid labour, but hobbies, habits, personal rituals, or cultural activities as well. Many occupations are not productive, but primarily pleasurable, as their purpose is to imbue meaning and carry some sort of symbolism rather than material benefit. And research has indicated that mundane, daily activities affect psychological well-being far greater than major life events, meaning that the ramifications of a person orchestrating and organizing their daily lives and engaging in occupations are significant, particularly because unlike animals, human activity requires self-awareness, memory, planning, and engaging in layers of personal and cultural meanings.

Occupational science however addresses both these, as well as neurobiology and physical health. The USC Department of Occupational Therapy developed a Model of Human Subsystems that Influence Occupation to provide a conceptual framework by which all these factors interact and influence a person’s development. The model depicts a human as an occupational being, seen as an open system in interaction with their environment over the course of their life. The use of the systems model, here consisting of six substrates, explain developmental changes in a person over the course of their life is consistent with developmental psychology, of which in this case, a chosen occupation is the output.

These systems allow occupational scientists to examine how a person makes sense of their life via their chosen activities, within the context in which they function and its significance to the individual in question, which in turn requires a synthesis of knowledge from the biological and social sciences. This model allows it to function as a blueprint to organize the research and findings of faculty, students, and practitioners into a unified corpus of knowledge. The applications of this new science, while born from occupational therapy, will apply far beyond it to other disciplines, though both are empowered by the same values, namely the central role that occupation plays in health and life happiness, and viewing a person as an active agent in their own life.

This is important for keeping occupational therapy practices on track, as some worry that it was becoming over-focused on acute care instead of helping patients, especially the disabled or those with chronic disease, improve life opportunities and ability. Instead, therapists are seen as “treatment machines” and patients as “products” to be displayed on a balance sheet. If one’s identity isn’t taken into account except superficially, any therapies are not going to be as effective as they might, especially because many patients are navigating a transition from their old lives to a life with new parameters and limitations. One’s occupations allow a patient to bridge that gap and provide a framework for adaptation and recovery. Occupational science can help occupational therapists aid patients in internalizing this aspect into their clinical reasoning and therapies, helping nurture the human spirit as well as the human body.

Works Cited

Clark, Florence A., Diane Parham, Michael E. Carson, Gelya Frank, Jeanne Jackson, Doris Pierce, Robert J. Wolfe, and Ruth Zemke. "Occupational Science: Academic Innovation in the Service of Occupational Therapy's Future." The American Journal of Occupational Therapy 45.4 (1991): 300-10. Web. 21 Apr. 2016.

Clark, Florence. "Occupation Embedded in a Real Life: Interweaving Occupational Science and Occupational Therapy." American Journal of Occupational Therapy 47 (1993): 1067-078. Web.

"The History Of Occupational Therapy." The History Of Occupational Therapy. N.p., n.d. Web. 21 Apr. 2016.

Jackson, Linda. "The New Research Climate Surrounding Occupational Therapy." The Guardian. Guardian News and Media, 27 Jan. 2015. Web. 21 Apr. 2016.

Sick & Getting Sicker: the Perils of Nursing

By B. Lana Guggenheim, Staff Writer

The recession might be over officially, but many professions are still feeling the squeeze. Healthcare demands are rising as the Boomer generation ages, but even though they are mostly protected from the worst of the volatile job market by virtue of being unionized, nurses are starting to feel the pain of job insecurity.

First in the 90s and again recently, there have been severe budget cuts impacting the health sector as government attempts to minimize budget deficits. Then and now, the results have been mostly negative across the board.  One of the biggest threats to nurses’ jobs are hospital restructurings - which are results of these budget cuts, and are significant changes that nurses often have no voice in. They also have no way to predict or prepare for the nature of those changes either.

Downsizing can make work intolerable: between budget cuts, hiring freezes, overtime restrictions, and wage freezes, nurses reported they had an increasing desire to quit, citing burnout and decreased life satisfaction in addition to job insecurity. In short, hospital restructures often lead to fewer nurses on staff, thus increasing the workload of those who remain, sometimes dangerously so.

Insufficient staffing raises the stress level of the nurses remaining on staff, but it also leads to dangerous levels of insufficient care for patients. Stressed nurses are driven to the breaking point, and many choose to leave their profession as a result. And high nurse turnover and vacancy rates cause avoidable patient deaths. Similar nursing cuts in Canada have led to nurses speaking out about the dangerously sub-optimal care patients now receive as a result.

The increasing instability of nursing jobs might lead one to think that the job market for nurses is over-saturated, but the opposite is true. An aging Baby Boomer population means there is more demand for nurses than ever before. And the aging nurse population means that there are ever increasing numbers of vacancies to be filled as well. The American nursing shortage is projected to grow to 260,000 RNs by 2025 - a shortage not experienced since the mid-1960s, the worst of which is projected to manifest in the South and West. Yet, nursing schools across the country are struggling to expand the capacity to meet this rising demand. Part of the problem is that these schools simply do not have the faculty necessary to expand their programs. According to the AACN’s enrollment data from 2012-2013, American nursing schools turned away nearly 80,000 qualified applicants from bachelor’s and graduate nursing programs due to the insufficient number of faculty, clinical sites, classrooms, and budget.

There is no magic solution to this problem, no easy quick-fix. But there are strategies that can be employed to ameliorate some of the worst effects of this nurse shortage. Hiring retired nurses, or giving incentives to retirement-age nurses to stay on is one way to slow the shortage. This can be done via financial incentives and job enrichment opportunities, such as leadership positions or taking on special assignments. This can also include mentorship programs, which help train newly hired nurses at the start of their careers under a senior nurse with a lot of experience. And it is cheaper than hiring and training a new nurse to take their place. New technology, along with process improvements, can relieve nurses of onerous and redundant administrative tasks, freeing up more time for them to get back to actual nursing. Finally, allowing for flexible scheduling gives nurses a measure of control over their lives. When allowed to dictate their own hours, nurses reported greater job satisfaction, and turnover rates were significantly lowered.

None of the above strategies will resolve the ultimate cause of this nursing shortage in the first place: budget cuts, both at universities and at hospitals and health care centers. However, addressing budget shortfalls is probably out of the reach of most individual nurses, or even most hospitals. These strategies, once implemented, should help stave off some of the worst effects until we ride this crisis out.

Sources:

https://www.psychologytoday.com/blog/diverse-and-competitive/201603/economic-austerity-and-threat-job-security

http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage

https://www.psychologytoday.com/blog/diverse-and-competitive/201602/managing-and-sustaining-aging-nursing-workforce

http://www.tandfonline.com/doi/abs/10.1080/09585192.2014.921634

http://www.thestar.com/news/queenspark/2015/10/22/nursing-cuts-hurting-hospital-care-in-ontario-union-says.html

Animal Doctors, Human Health

By B. Lana Guggenheim, Staff Writer

The history of humans and their animal companions dates back farther than written history has recorded. People have relied on animals for labor and companionship since time immemorial. Dogs are the oldest domesticated animal, co-evolving with humans approximately 27,000 years ago during the Ice Age, functioning primarily as a herding and hunting companion. Cats were domesticated later, approximately 9,500 years ago, about the time of the Neolithic Revolution, in which mankind transitioned from hunting and gathering to farming and settlement building. They served as house companions and pest control, hunting down rodents and insects that threatened grain storage. It is likely that care for these animals alongside their human owners began at this time, primitive though such care might have been.

History

The earliest written record of veterinary medicine comes from Egypt, 1900 BCE, almost 4000 years ago, and from Vedic literature in India (approximately 250 BCE). The latter contains edicts of the Emperor Ashoka of the Mauryan Empire, where he ordered medicinal herbs planted that were of aid to humans and animals alike. Indeed, after his conversion to Buddhism, Ashoka placed so high a value on animal life that he ended the royal hunt, gave multiple edicts concerning the protection and health of animals, outlawed and fined poaching, and was arguably the first ruler in history to advocate conservation measures for wildlife.

Animal care continued to evolve alongside human society. Horses and cattle often received attention due to their economic significance as beasts of agriculture, as farming aids, means of transportation, and as a source of meat. Farriers in the Middle Ages at around the year 475 would be responsible for both horseshoeing as well as horse-doctoring. By 1356, the Lord Mayor of London, concerned at the poor standard of care given to horses in the city at the time, requested at all farriers within a seven mile radius form a fellowship to regulate and improve their standards of care for the animals, ultimately leading to the establishment of of the Worshipful Company of Farriers, in 1674. The first comprehensive treatise on the anatomy of a non-human species was the Anatomy of a Horse by Carlo Ruini in 1598 in Italy.

By 1783, the Odiham Agricultural Society was founded in England to promote agriculture and industry, and played an important role in the foundation of the veterinary profession as it exists today. In fact, one of its founding members, Thomas Burgess, was the one who began to take up the cause of animal welfare for its own sake. The physician James Clark wrote the treatise Prevention of Disease soon after, in which he argued for the professionalization of the veterinary trade, along with attendant veterinary colleges, an idea finally realized in 1790 by the establishment of the Veterinary College in London. The Royal College of Veterinary Surgeons was established via royal charter in 1844, with veterinary science really coming into its own in the 19th Century both in Europe and the United States. Similar schools were established at this time in Boston, New York, and Philadelphia. In 1879, Iowa Agricultural College became the first land grant college to establish a school of veterinary medicine. 

Contribution to Human Medicine

Since then, medicine for both humans and animals has continued to improve with increased medical understanding, evolution of technology, and standards of care. Indeed, there is much overlap in the standards and practice of medicine between humans and animals. The first two-year curricula in both veterinary and human medical schools are very similar in both course names and content, with differences arising in more advanced and clinical courses. While a graduating veterinarian can enter clinical practice immediately after graduation, most medical doctors must complete an average of 3-5 years post-doctoral residency before practicing medicine independently, and often in a narrow or focused specialty. Post-doctoral residency for veterinarians does exist, but it is comparatively rare. However, this means that veterinarians and medical doctors are uniquely positioned to benefit each other's’ fields, and indeed, veterinarians have contributed to many advancements in human medicine and society.

Veterinarians were the first to produce an anticoagulant that has since been used to treat human heart disease, and developed surgical techniques used in surgery for both humans and animals, such as hip-joint replacement, and limb and organ transplants. In 2011, Dr. Ralph Brinster became the only veterinarian to win the National Medal of Science for developing a reliable in-vitro culture system for early mouse embryos, which is the same method used today for human in-vitro fertilizations, mammalian cloning, and embryonic stem cell therapy. The American Academy of Neurology cites more than 12 neurological diseases and disorders that animal research has helped cure, treat, prevent, or furthered understanding. Research veterinarians are also in the forefront of gene therapies, including cures for two forms of blindness, one of which is now in human trials. 

Infectious Diseases and Bioterrorism

With their background in comparative biology,  veterinarians play important roles in public health, particularly in the prevention of zoonoses, or animal-borne diseases that are infectious to humans. Most diseases are easily shared between animals and humans. Approximately 75% of recently emerging infectious diseases are of animal origins, and about 60% of all human pathogens are likewise zoonotic. Some of the world’s most destructive diseases are vector-borne, which means that they are spread by biting insects like mosquitoes, ticks, and fleas. Some examples include the Zika virus, Lyme disease, and the West Nile Virus. It was veterinarians who were in the forefront of the effort to suppress malaria and yellow fever in the United States. Each year, scientists discover an average of two new mosquito-transmitted viruses. Veterinarians are one of the many groups of scientists that are therefore involved in epidemiology, contributing to our understanding and prevention of disease outbreak.

One example of successful disease prevention occurred in Pennsylvania in 2001, when veterinarians developed surveillance technology that provided the ability to stem an avian flu outbreak, which stopped a potentially devastating epidemic at a cost of $400,000; whilst a similar outbreak occurring simultaneously in Virginia cost the state over $100 million. While avian flu is less harmful to humans than other flu strains, because the disease primarily targets domestic fowl such as chicken and turkey, the devastating economic impact on food production speaks for itself. However, with the rapid mutation rate and high adaptability of the virus, public health officials are concerned that strains may adapt to become more easily transmissible between humans, and therefore more dangerous to human health and the cause of a global pandemic - making cooperation between veterinarians and medical doctors all the more crucial.

Veterinarians have aided gains in other parts of medical science as well. Research veterinarians were at the forefront of numerous pharmacological and pathogenic agent discoveries. They were the first to isolate oncoviruses (cancer causing viruses) in chickens and then mice, the first to isolate Salmonella species, Brucella species, the botulism disease-causing agent, and other pathogenic agents. The understanding of cross-species pathogenic transfer, mutation, and disease manifestation also has its uses in preventing and treating agents of bioterrorism in an increasingly politically unstable and hyper-connected world. 

Hunger

Because of their work with animals, veterinarians are also deeply involved in food safety and food production and combating the world’s number one public health threat: hunger. Hunger kills more people worldwide than AIDS, tuberculosis, and malaria combined, according to James T. Morris, Executive Director of the UN World Food Program.  In addition to tackling animal diseases, such as avian and swine flu, veterinarians also develop food safety systems. One such system, which debuted in 2011, enabled eggs to be tested for Salmonella at a swift rate - about 10 times faster than previous methods. This not only saved millions of dollars and ensured public safety, it also increased the distribution of food available to the public. Veterinarians working with dairy farms advise farmers on feed formulations and additives, as well as milking schedules. Not only does this aid the animals, it aids the farmers, as it often results in increased milk production. In the USA, milk production has grown even as the number of dairy cows has decreased.

Beyond enabling and encouraging consumers to eat local foods (a benefit to farmers and the environment at large), this has global implications as both First World and developing countries demand higher quality food and more of it, particularly animal proteins such as meat, milk, and eggs. In the developing world, milk production has not grown despite the increase in number of dairy cows - a trend that veterinary science can help reverse - to the benefit of hungry populations worldwide.

From this brief overview, we can see that veterinary science has huge social effect well beyond care given to companion animals. From aiding advances in medical science, to prevention of infectious diseases, to addressing world hunger, veterinary medicine is responsible for the health and well-being of the entire globe, both for humans and the animals we live with.

Bibliography

http://www.mcall.com/news/breaking/mc-pa-bird-flu-outbreak-20150529-story.html

http://www.upenn.edu/pennnews/current/node/3691

http://www.foodproductiondaily.com/Safety-Regulation/Swifter-salmonella-test-a-milestone-for-egg-industry-researcher

http://www.huffingtonpost.com/joan-c-hendricks-vmd-phd/what-the-world-particular_b_2806181.html

http://www.nap.edu/read/11366/chapter/1

http://www.cdc.gov/mmwr/preview/mmwrhtml/su5502a4.htm

https://www.avma.org/KB/Policies/Pages/Research-Priorities.aspx

http://www.ncbi.nlm.nih.gov/books/NBK22905/


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Veterinarians: The Animal Welfare Experts

Americans truly love their pets, with an estimated 37 - 47% of all households having a dog and 30 - 37% of households having a cat. Taking care of these companion animals and keeping them in good health is a task that takes a significant degree of skill, as dogs and cats are not the only animals Americans keep as pets. Veterinarians are the doctors who focus exclusively on caring for animals of all types, but most in the United States specialize in companion animals, about 75%. Veterinarians are needed in more than just pet healthcare situations, though, as many vets are employed in the food animal safety industry and others are involved in research.

Veterinarians care for the health of animals and work to improve public health. They diagnose, treat, and research medical conditions and diseases of pets, livestock, and other animals. Veterinarians use a wide variety of medical equipment to treat the injuries & illnesses of animals, including surgical tools and x-ray and ultrasound machines. Most veterinarians work in private clinics or hospitals, but some work for government, in labs or classrooms, or on the farm. Vets who treat horses or food animals travel between their offices and farms and ranches. They work outdoors in all types of weather and may have to perform surgery in remote locations.

Becoming a veterinarian is an involved process, and requires a lot of post-secondary education. Veterinarians must complete a Doctor of Veterinary Medicine (D.V.M. or V.M.D.) degree at an accredited college of veterinary medicine, of which there are currently 30 in the United States. A veterinary medicine program usually takes 4 years, most of which are spent in the classroom and laboratory settings. The final year of the program typically involves a clinical rotation in a veterinary clinic or hospital. Admissions to veterinary medicine programs are quite competitive, and less than half of all applicants were accepted in 2014. In order to practice as a veterinarian anywhere in the United States, you must be licensed. The licensure process generally involves completing an accredited veterinary medicine program and passing the North American Veterinary Licensing Exam, but requirements vary by state.

If you are interested in learning more about veterinarians, check out our infographic below. Our Facebook, Twitter, and Instagram pages will be full of veterinary medicine content all week long, so be sure to head there for the latest content!

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Respiratory Therapists: Helping You Breathe Easy

Breathing is something the vast majority of us take for granted, as we do it nearly every second of every day. However, there are many Americans who have difficulty breathing, whether it is caused by injury, age, or diseases like Chronic Obstructive Pulmonary Disease (COPD) or lung cancer. These people often end up in the hospital, doctor's office, or clinic and are treated by breathing care specialists known as Respiratory Therapists. These professionals care specifically for patients that have trouble breathing, from premature infants with undeveloped lungs to elderly patients who have diseased lungs. They also provide emergency care to patients who are suffering from heart attacks, drowning, or shock.

Respiratory therapists, of whom there were 120,700 in the US in 2014, use various tests to evaluate patients. For example, therapists test lung capacity by having patients breathe into an instrument that measures the volume & flow of oxygen when they exhale and inhale. Respiratory therapists may also take blood samples and use a blood gas analyzer to test oxygen and carbon dioxide levels. The field of respiratory therapy is a growing one, and job prospects are expected to continuously improve by 12% from 2014 through 2024. The aging population will lead to an increased demand for respiratory therapy services and treatments, mostly in hospitals. A growing emphasis on reducing re-admissions at hospitals may result in more demand for respiratory therapists in nursing homes and in doctors' offices. Respiratory therapists earn more than the average American, as their mean hourly wage is $28.12 compared to $22.71 for the average occupation. Becoming a respiratory therapist takes a mix of classroom education, clinical training, and licensing exams. The minimum degree required is an associate's degree, but some jobs require a bachelor's. Respiratory therapists require licensing in all states but Alaska.

If you are interested in learning more about the Respiratory Therapy profession, check out our fact-filled infographic below. Our Facebook, Twitter, and Instagram pages will be full of respiratory therapy content all week, so be sure to keep checking in. And don't forget to register for the free beta at Enky.com to help take care of all your continuing education needs!

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Good Health Starts with Clean Teeth

Keeping oneself in good health is no easy task, especially given all of the health risks that come with the trappings of daily modern life; sugary & unhealthy foods, polluted air and water, and high stress levels due to our non-stop lifestyles. With all of these factors, it can be challenging to keep up with regular doctor appointments, let alone making sure we see that one medical provider so many people secretly (or not so secretly) dread: the dentist. However, it is critical to ensure good oral health, as studies have shown that poor oral health can contribute to many severe, even life-threatening non-oral diseases. When most of us go to the dentist's office, we spend the majority of our time dealing not with the dentists themselves, but with their trusted "sidekicks", the dental hygienists.

Dental hygienists clean teeth, examine patients for signs of oral diseases like gingivitis, and provide other preventative dental care. They also help educate patients on ways to improve and maintain good oral health, such as instructing on proper brushing and flossing methods. Hygienists are the first line of defense in the fight against oral diseases, and dentists rely on them to spot abnormalities or issues during regular teeth cleanings so that the dentists can focus on dealing with these more severe cases.

Dental hygiene is a career that needs significant training, requiring an associates' degree that usually takes 3 years to complete. Within these programs, prospective hygienists learn in the classroom, as well as in laboratory & clinical settings. As you may know from visiting any dentist's office, dental hygienists work with a wide variety of tools to do their job, including power & ultrasonic polishing tools used to clean teeth, air-polishing devices that use a combination of air, baking soda, and water to remove stains from teeth, and even occasionally lasers. Hygienists are tasked with explaining the links between diet and oral health to patients, as well as dispensing advice on selecting oral care devices like toothbrushes.

Dental hygienists require licenses in all 50 states, but these requirements vary by state. For most states, a degree in dental hygiene and passing scores on written & clinical exams is enough for licensure, but be sure to check with your state's licensing board for specific requirements. Most states also require hygienists to complete continuing education (CE) credits to maintain good standing. If you are interested in learning more about Dental Hygienists, take a look at our infographic below. Be sure to check out our Facebook, Twitter, and Instagram pages all week long for more great content on this selfless healthcare profession!

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Images courtesy of Shutterstock.

Mental Health First Aid

Guest Post by Kristin DiMiceli, LMSW

What would you do if you are walking down the street and see someone fall & potentially break a bone? If you are a considerate human being, you might run over to help them and/or call someone for help. Now think about a situation where you are walking & see someone in emotional distress: leaning over, breathing heavily, crying, & looking a bit disoriented. There are a variety of ways one might respond, but think about your initial feelings when imagining this scenario. One might turn the other way, try to solve the problem, or start to look panic stricken themselves. It doesn’t feel as clear cut as when you are addressing a medical problem, right?

To help solve this problem, the National Council for Behavioral Health (NCBH) started a movement to train people in Mental Health First Aid. This training was first created in Australia in 2001 by a nurse, Betty Kitchener, & a mental health literacy professor, Tony Jorm. It has been adapted in 23 other countries & was started in the United States in 2008. The NCBH has trained over 500,000 people, & is working towards the goal of reaching 1 million people with the help of Congress putting $15 million towards their cause. Their training sessions are conducted all over the United States to address helping adults & youth who may be experiencing emotional distress.

As a Licensed Social Worker working in the mental health field, I feel that this is a very important movement that will not only help people find ways to help those in need mentally, but to also reduce the stigma that is so heavily ingrained in our society regarding mental health. Whether we mean to or not, we tend to shy away from helping those who are in need due to mental health problems. First Aiders are trained to address individuals who may be suicidal, experiencing a panic attack, or using drugs.

With this training, one can at least try to help those in need by pointing them in the right direction using the Mental Health First Aid acronym, ALGEE. It stands for:

1. Assess
2. Listen non-judgmentally
3. Give reassurance and information
4. Encourage appropriate professional help
5. Encourage self-help and other support strategies.     

There is no quick fix in the moment, but at least the individual is being addressed & recognized, as opposed to being ignored. You never know if you might be the catalyst for a more positive path in their life. This Mental Health First Aid training is excellent for a variety of professionals, from police officers to teachers, as well as lay people. You don’t have to be a medical professional to give the Heimlich Maneuver & you don’t have to be a mental health clinician to give Mental Health First Aid.   

For more information and to sign up for training sessions, check out MentalHealthFirstAid.org.

Also, don’t be afraid to call 911 if you feel someone may need to be further evaluated.  Emergency rooms can evaluate individuals if they appear to need to be admitted.

Images courtesy of Shutterstock.

Athletic Trainers: The First Wave in Injury Treatment

This week we're covering a licensed healthcare profession that is often confused with an unregulated fitness occupation: Athletic Trainers (not to be mistaken for Personal/Fitness Trainers). Athletic trainers specialize in preventing, diagnosing, & treating muscle & bone injuries & illnesses. These professionals, who numbered approximately 25,400 in the US as of 2014, work in a wide variety of environments to help active & at-risk individuals stay healthy. Athletic trainers work in schools, hospitals, fitness & sports centers, rehab centers, senior living centers, & even as specialists for professional sports teams!

Athletic trainers work with people of all ages & skill levels, from young children to soldiers, police, & professional athletes. Athletic trainers are often the first healthcare professionals on the scene when somebody is injured in an active or athletic environment, & must be trained to provide immediate care while EMTs, doctors, or other health personnel arrive. They work under the direction of a licensed physician & with a team of other healthcare providers to treat patients & evaluate their treatment options. Some athletic trainers have administrative responsibilities as well, like reviewing budgets with an athletic director, working with purchasing or making policies

& procedures. Athletic trainers are frequently called upon to create programs that comply with Federal & state regulations, such as laws surrounding young athletes & concussions. Athletic trainers often work outdoors in many different weather situations, so being adaptable is a key skill. Nearly all states require athletic trainers to be licensed, which generally consists of degree requirements along with continuing education & the passing of an exam.

If you want to learn more about Athletic Trainers & how they impact society, check out our infographic below. We will be posting tons of athletic trainer based content all week on our Facebook, Twitter, & Instagram pages, so be sure to visit them as well to find out all you need to know about these dedicated professionals!

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Images courtesy of Shutterstock.

Social Workers: America's Heart & Soul

As the United States celebrates & honors the legacy of Dr. Martin Luther King Jr. today, we here at Enky would like to honor Dr. King's outstanding legacy of civil service & compassion for his fellow man by focusing on some of the hard-working professionals who help to carry out his "dream" today: social workers. These amazing individuals dedicate their careers to helping others solve & cope with problems in their everyday lives. They can help with a wide variety of situations, from adoption of a child to dealing with a terminal illness diagnosis. Some social workers, known as clinical social workers, also diagnose & treat mental, behavioral, emotional, & substance abuse issues. Social workers are not limited in the communities that they help; children, people with disabilities, those with serious illness & addiction, as well as poor & downtrodden communities at large are all served by social workers.

Some social workers choose to work directly in the community to help individuals or families with their specific issues, while others work with groups, community organizations, & policymakers to develop or improve programs, services, policies, & overall conditions. This global focus is known as macro social work. Advocacy is also an important part of social work, as social workers often advocate or raise awareness on behalf of or with their clients & the social work profession on local, state, or national levels. There are many different specializations for social workers, largely depending on the segment of the population you would like to work with or the environment in which you would like to work. For example, some common types of social worker are School Social

Workers, Healthcare Social Workers, & Child/Family Social Workers. Becoming a social worker is a task that requires education in the field, usually either directly in social work or in a related field like sociology or psychology. Some social workers have a bachelor's degree in social work, while others pursue a master's degree or higher. These graduate degrees are necessary for licensing as a clinical social worker in all 50 states.

To learn more about social workers & the good they do for our communities, read through our fact-filled infographic below. Be sure to check back all week on our blog & social media pages, Facebook, Twitter, & Instagram, to find more great social work content!

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Images courtesy of Shutterstock.