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American Medical Association President Dr. Jack Resneck recently recounted how doctors around the country are facing difficulties practicing medicine in states that ban abortion.

Nicole Xu for NPR


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Nicole Xu for NPR


American Medical Association President Dr. Jack Resneck recently recounted how doctors around the country are facing difficulties practicing medicine in states that ban abortion.

Nicole Xu for NPR

Since Roe v. Wade was overturned, 13 states have banned abortion except in the case of a medical emergency or serious health risk for the pregnant patient. But deciding what cases qualify for a medical exception can be a difficult judgement call for doctors.

News reports and court affidavits have documented how health care workers sometimes deny women abortion procedures in emergency situations – including NPR’s story of a woman who was initially not treated for her miscarriage at an Ohio ER, though she’d been bleeding profusely for hours.

In Missouri, hospital doctors told a woman whose water broke at 18 weeks that “current Missouri law supersedes our medical judgment” and so she could not receive an abortion procedure even though she was at risk of infection, according to a report in the Springfield News-Leader.

That hospital is now under investigation for violating a federal law that requires doctors to treat and stabilize patients during a medical emergency.

And a survey by the Texas Policy Evaluation Project found clinicians sometimes avoided standard abortion procedures, opting instead for “hysterotomy, a surgical incision into the uterus, because it might not be construed as an abortion.”

“That’s just nuts,” Dr. Matthew Wynia says. He’s a physician who directs the Center for Bioethics and Humanities at the University of Colorado. “[A hysterotomy is] much more dangerous, much more risky – the woman may never have another pregnancy now because you’re trying to avoid being accused of having conducted an abortion.”

Reports like these prompted Wynia to publish an editorial in the New England Journal of Medicine in September, calling for physicians and leading medical institutions to take a stand against these laws through “professional civil disobedience.” The way he sees it, no doctor should opt to do a procedure that may harm their patient – or delay or deny care – because of the fear of prosecution.

“I have seen some very disturbing quotes from health professionals essentially saying, ‘Look, it’s the law. We have to live within the law,'” he says. “If the law is wrong and causing you to be involved in harming patients, you do not have to live [within] that law.”

These issues have raised a growing debate in medicine about what to do in the face of laws that many doctors feel force them into ethical quandaries.

Medical organizations raise the issue

At the American Medical Association’s November meeting, president Dr. Jack Resneck gave an address to the organization’s legislative body, and recounted how doctors around the country have run into difficulty practicing medicine in states that ban abortion.

“I never imagined colleagues would find

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Heidi Strehl worked as a pharmacy technician at a Rite Aid in the Pittsburgh suburbs for more than 16 years. She loved her customers, enjoyed her job and thought of her co-workers as family. But this fall, Strehl abruptly quit, walking out in the middle of a shift — one of many in a wave of pharmacy technicians who are doing the same.

Most of the people behind pharmacy counters who count pills and fill medication bottles are pharmacy technicians, not pharmacists — low-wage workers in positions that don’t require college degrees. Working in a pharmacy was always fast-paced, Strehl said, but in recent years the workload and stress had increased to unsustainable levels, while staffing and pay failed to keep up. During the coronavirus pandemic, the pace quickened further, especially once pharmacies began giving Covid-19 vaccine shots. Her store regularly ran behind on prescriptions, often with several hundred waiting to be filled each morning.

“It got to the point that it was just such an unsafe working environment, where you are being pulled a thousand different directions at any given time,” she said. “You’re far more likely to make a mistake and far less likely to catch it.” 

The last straws for her came in October. Strehl said she got an “insulting” 25-cent raise, bringing her to $15.08 an hour. A few days later, after yet another customer yelled at her over a delayed prescription, she had a panic attack in a corner of the pharmacy, crying and struggling to breathe while work continued around her. Then she grabbed her things, hugged her co-workers and walked out for the last time. 

Heidi Strehl with her husband and children in 2020.Ashley Costanzo

“I always thought I would retire from that place,” Strehl said. “But all of the parts of my job that I truly enjoyed over the years had slowly just gone away.”

Strehl is one of about 420,000 pharmacy technicians in the U.S. Even though they aren’t highly paid — the median pay is $16.87 per hour — and often have no pre-employment medical training, they are vital to the health care system. They help pharmacists fill and check prescriptions and make sure patients get the right medication in the right amounts at the right time. Some even give vaccinations. 

In recent months, many technicians have quit, saying they’re being asked to do too much for too little pay, increasing the possibility that they will fill prescriptions improperly.

Employers, from major drugstore chains like Rite Aid, CVS and Walgreens to mom-and-pop pharmacies and even hospitals, are struggling to replace them. It’s yet another of the labor shortages that have gripped the country this year. At many drugstores, the pharmacy staff members who remain are stretched thin. The shortage has led to dayslong waits for medication, shortened pharmacy hours and some prescription errors and vaccination mix-ups — like children receiving an adult Covid-19 vaccine shot instead of a flu shot — in a business sector in which delays and

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