Heads up, skiers. John C. Nelson, M.D., a Salt Lake City obstetrician/gynecologist, as often as possible drives the 26 miles from his home to the Alta Ski Area to indulge in one of his favorite pastimes, downhill skiing. To protect himself, he wears a special pair of goggles that won't fog up glasses, and he spreads some sunblock on his nose.
One item he doesn't wear: a helmet. And that didn't change when some doctors and skiers called for laws mandating skiers wear protective helmets following the skiing-related deaths of Michael Kennedy, the son of the late Sen. Robert F. Kennedy; and Sonny Bono, a congressman and former singer.
Nelson isn't like the defiant motorcyclist who puts a "Helmet Laws Suck" sticker on his bike. He just thinks there's not enough evidence as yet to say ski helmets, which can restrict lateral vision, would lead to a net reduction in injuries and fatalities on the slopes.
As an American Medical Association Board of Trustees member, Nelson made the same statement in December after the AMA House of Delegates decided to table action on a Council on Scientific Affairs report calling for the mandatory use of helmets by skiers ages 18 and younger.
"We're concerned, and we feel terrible," Nelson says, about the deaths of Kennedy and Bono. But, he says, "I don't know in either case that a head protective device would have saved their lives" because their injuries were so severe.
Past AMA research has estimated 135,000 skiing accidents per year, including 3,537 potentially serious head injuries. Seventy-seven percent of those injuries were mild concussions; 1% were fatal.
Nelson recommends further research on the matter and helmets for young skiers and professional racers. For now, matching your ability to the terrain of the course will help prevent serious head injuries, he says.
Cut if needed When Nelson hits Alta, he doesn't go beyond the intermediate-ability, otherwise known as the "blue" or "square" runs.
"Skiing is a happy, delightful, wonderful activity," he says. "We need to use some common sense."
Prisoner of habit. The moral of the following story is thus: Even if you threaten to put your patients in solitary confinement, it won't guarantee that they'll give up unhealthy habits.
Consider Dean Rieger, M.D., the medical director of the Indiana Department of Corrections. It's not managed care, but the Indiana Legislature has put Rieger in charge of forcing 10,000 smoking inmates to give up their cigarettes. Indiana is one of 10 states that bans smoking on prison grounds, a ban that affects prisoners, staff and visitors.
Enforcing the ban hasn't been easy. Just before Christmas, two guards were arrested for smuggling cigarettes to prisoners. Another was arrested last October.
Then a prisoner sued because Rieger wouldn't buck Department of Corrections policy and give away nicotine patches. Steven Bland, 44, claimed cruel and unusual punishment from suffering quite a nic fit: severe agitation, irritability, hot and cold chills, abdominal cramps and headaches. Bland lost his lawsuit last month, when a judge ruled that he hadn't alleged a "serious medical need" that would allow him to claim cruel and unusual punishment. Plus, he had plenty of money to buy the patches, which cost $21.80 for a pack of seven.
As of Aug. 1, 1997, when the ban went into effect, Rieger pulled nicotine patches out of the prison commissary. Cessation classes and pamphlets are still available. But Indiana hardly has smoke-free prisons yet. In jail, cigarettes are an underground commodity more valuable than cash.
"The (smuggling) concern before was drugs," Pattison says. "That's been replaced with tobacco."
Animals and aliens need not apply. Open enrollment has taken on a whole new meaning at the Kelsey-Seybold Clinic in Houston, Texas.
Callers to the large multispecialty group practice will be happy to hear that Kelsey-Seybold opens its arms to just about anyone. In fact, according to the recording on Kelsey-Seybold's phone systems, "Whether you're a member of an HMO, PPO, have regular insurance . . . or you're simply a member of the human race, we can care for you."
Dennis Bolin, regional director of marketing, says managed care is an important part of the clinic's business (about 65% of its one million annual patient visits), but the recording is both an effort to reach out to the area's remaining fee-for-service patients and part of a larger strategy to personalize managed care.
"Managed care does an excellent job of creating products and services that meet the needs of people at a price that most employers can afford," he says. "Now I think we're at the next generation of really simplifying the process for people and making it personal."
An earful. Want to clean out a Californian's ear? Get in line.
A new law recently gave California audiologists the right to remove wax from patients' ears. Wax, known medically as cerumen, must be removed to conduct accurate hearing texts and, in the past, audiologists had to refer patients to physicians for its removal. The California Academy of Audiology, which lobbied for the new law, argued audiologists were undermined by the old law.
"We sell over-the-counter kits for people to remove their own ear wax, whereas audiologists, who have to have a minimum of a masters degree and a lot of training, (weren't) allowed to do it," says outgoing academy co-chair Jennifer Fargo Lathrop.
According to Fargo Lathrop, California otolaryngologists supported the law. "The physicians appreciated having it taken off their hands," she says.