Harry W Severance, MD

One, little discussed but prevalent reason that doctors shun rural healthcare.

Physicians, increasingly employees of corporate healthcare systems, are seeing themselves as prgressivly disenfranchised and unable to speak out in defense of their patients and abusee conditions in their workplaces.

One of the chief reasons cited, again, is inability to obtain adequate numbers of doctors, nurses, and other health care workers to keep service lines open, and thus inability to generate adequate revenues to stay afloat.

In part 2 I highlight healthcare Disruptors 9 - 12 and discuss why our leaders seem to find it so difficult to address these issues.

the accelerating, unchecked Healthcare workplace violence is driving more doctors and nurses out of healthcare - thus further destabilizing our already fractured healthcare system. Personal stories of this plight.

Part 1 - The 1st 9 of 18 Critical Disruptors that are threatening our Healthcare System

Increasing moves toward healthcare unionization and an unexpected support from some managers.

A future for A.I. in healthcare.

The healthcare workplace is now the most unsafe of all U.S. workplaces (bar none) with 75% of all workplace violence and assaults occurring in healthcare. this is further aggravating the exit of more physicians and nurses out of healthcare to safer jobs - thus further worsening patient access to healthcare - and ability of hospitals to stay open.

How the design of increasingly corporate-driven hospital management systems and the massive increase in hospital managers (3,200% in the last 25 years) creates an oppositional healthcare workplace and further contributes to healthcare workers dissatisfaction and burnout - leading to increased departures from the healthcare workplace.

In this era of increasing shortages of physicians, nurses and other vital healthcare workers, corporate healthcare is now actively investigating possible pathways of using AI to replace these workers.

How medical employers use family and local geographic ties coupled with non-compete clauses to trap physicians and other healthcare workers into continuing to serve in hostile workplaces.

discussion on how competition for an increasingly scarce resource - Doctors and Nurses, might lead to some improvements in the current healthcare workplace.

I discuss alternative transmission pathways for Monkeypox disease and how these are of concern to service industry workers.

The mistaken notion that healthcare 'burnout' is an individual problem dominates healthcare and decision-maker leadership. It is not. These symptoms are due to the root cause of a demoralizing, destructive toxic healthcare workplace.

Significant medical debt affecting over 1/3rd of all Americans, along with multiple current political, pandemic-related and other disruptions, could with further perturbations significantly disrupt our already fragile healthcare system!

Managing difficulties, unhappiness, burnout from the healthcare workplace with suggestions on how to adjust/improve your workplace conditions - or to know when and how to move on to other options!

Review of what is currently known about Long-COVID, who is at greatest risk, and what interventions are currently available.

Though there is much controversy concerning issues surrounding vaccination 'passports' we look at pathways through which such 'passports' might be appearing.

How mRNA vaccines are new technology differing from previous vaccines, and some myths and hypothetical concerns discussed.

The current pandemic offers a 'wake up call' for pandemic preparedness.

Hyperbaric Oxygen Therapy is emerging as a new strategy for severe COVID-19.

Development of better, more inclusive and downstream-responsive testing platforms needed for emerging infectious diseases!

Adjunctive Pathways to extend your practice, improve job satisfaction, and continue your revenue stream.

Diagnostic testing in the care of patients newly presenting with symptoms suggestive of coronary artery disease may influence risk factor management, independent of test type or test results. However, little is known about changes in medications and lifestyle after anatomical or functional testing.

Although the prognosis of ambulatory heart failure (HF) has improved dramatically there have been few advances in the management of acute HF (AHF). Despite regional differences in patient characteristics, background therapy, and event rates, AHF clinical trial enrollment has transitioned from North America and Western Europe to Eastern Europe, South America, and Asia-Pacific where regulatory burden and cost of conducting research may be less prohibitive. It is unclear if the results of clinical… Show more

Although the prognosis of ambulatory heart failure (HF) has improved dramatically there have been few advances in the management of acute HF (AHF). Despite regional differences in patient characteristics, background therapy, and event rates, AHF clinical trial enrollment has transitioned from North America and Western Europe to Eastern Europe, South America, and Asia-Pacific where regulatory burden and cost of conducting research may be less prohibitive. It is unclear if the results of clinical trials conducted outside of North America are generalizable to US patient populations. This article uses AHF as a paradigm and identifies barriers and practical solutions to successfully conducting site-based research in North America. Show less

Pilot Study

Background: Since 1991, the incidence of injuries associated with pneumatic and explosive powered nail guns has steadily been rising due to increasing use of these devices by the untrained consumer. The vast majority of injuries involve the extremities, but injuries have been reported to occur in virtually every area of the body.

Objective: Discuss the epidemiology, pathophysiology, and management of penetrating cardiac nail gun injuries.

Case report: A 33-year-old man sustained a… Show more

Background: Since 1991, the incidence of injuries associated with pneumatic and explosive powered nail guns has steadily been rising due to increasing use of these devices by the untrained consumer. The vast majority of injuries involve the extremities, but injuries have been reported to occur in virtually every area of the body.

Objective: Discuss the epidemiology, pathophysiology, and management of penetrating cardiac nail gun injuries.

Case report: A 33-year-old man sustained a penetrating cardiac injury from accidental discharge of a nail gun. The patient had successful repair of a laceration to his right ventricle.

Conclusions: Penetrating cardiac injuries from pneumatic nail guns are rare and have mortality similar to stab wounds. Improved safety mechanisms and training are the keys to prevention. Consideration also should be given to implementing legislation restricting the sale of nail guns. Show less

Discussion concerning radiation from airport scanners

Carbon monoxide (CO) poisoning remains a common cause of poisoning in the United States. We describe a case where responding fire department personnel encountered a sick employee with a headache at an automotive brake manufacturing plant. Using both atmospheric CO monitoring and pulse CO-oximetry technology, fire department personnel were able to diagnose the cause of the patient's illness and later identify the source of CO in the plant.

Bombings and other blast-related events place severe demands on pre-hospital and in-hospital systems. The resulting surge of victims can overwhelm the resources of any facility not prepared for such an event. The September 11 terrorist attacks underscore the urgency of our need for preparedness. The challenges become even more daunting when there is possible hazmat exposure as well; this means that adequate and rapid disposition of victims is even more critical in order to avoid contamination… Show more

Bombings and other blast-related events place severe demands on pre-hospital and in-hospital systems. The resulting surge of victims can overwhelm the resources of any facility not prepared for such an event. The September 11 terrorist attacks underscore the urgency of our need for preparedness. The challenges become even more daunting when there is possible hazmat exposure as well; this means that adequate and rapid disposition of victims is even more critical in order to avoid contamination of hospitals systems or whole communities. Federal agencies have been designated and federal mandates have been issued to address mass casualty events, but federal or even regional systems cannot respond in time to address the massive and immediate needs generated by an explosion. Local communities must take the lead in developing incident command systems for initial management of such events. Hospital and pre-hospital providers play a key role in such planning. Ultimate management and disposition of large numbers of casualties, especially if contaminated, cannot follow standard patient management protocols; new protocols are needed. To avoid a total, overwhelming break down of in-hospital resources, hospitals need to assume a lead role in addressing such issues in their local communities. Show less

addressing various myths concerning ballistics and gunshot wound management.

I discuss other transmission routes for Monkeypox, and how those routes may be of concern to service-area workers as and if this disease continues to spread.