October 2014

Antibiotics and Injection Safety

Lexington Insurance recently invited Tom and Evelyn McKnight to speak to Risk Management on injection safety
Lexington Insurance recently invited Tom and Evelyn McKnight to speak to Risk Management on injection safety

Tom and Evelyn McKnight were recently sponsored by Lexington Insurance to speak to hospital risk management on injection safety in Honolulu. While there, they learned about public health threats to the native Hawaiians through disease before antibiotics. Here are some of Tom’s thoughts about the importance of injection safety when delivering antibiotics.
Antibiotics and Injection Safety

Following is a written transcription of the video:

Aloha!
And welcome to the beautiful state of HI.
I’m tom mcknight and i’m a family physician. With my wife Evelyn, I am a co-founder of the organization HONOReform.

We have been invited to the state of Hawaii by AIG to speak to risk managers about injection safety.

As you might remember, the early days of the Hawaii were fraught with many diseases, many of which were brought by western civilization. Chicken pox, measles and even Hansen’s disease had a devastating effect on society. With the advent of antibiotics and injections in 1940’s and 1950’s, their health has become much safer.

But every injection needs to be a safe one. So our organization is promoting safe injection practices, because every injection needs to be handled and distributed properly.

So join with us and all of our co-sponsors in promoting needle injection safety.

Mahalo!

Same Problems, Different Virus

Lauren Lollini is a patient safety advocate who has been integral in changing laws to keep patients safe as well as a member of the Drug Diversion Prevention Committee.
Lauren Lollini is a patient safety advocate who has been integral in changing laws to keep patients safe as well as a member of the Drug Diversion Prevention Committee.

If you are like many Americans out there with access to electricity or cell reception, you have been bombarded by the media attention to this ebola situation. I phrase it as a situation because I do not quite know how else to categorize it, yet. Typically, I am not one to catastrophize. And like my fellow patient safety advocates across the country, we are not surprised by the same things which might mortify the rest of our fellow Americans.

Why not, you ask? Because we have seen this all before, over and over again.
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Tom McKnight reflects on 33 years of family practice

Tom McKnight recently was named the Nebraska Family Physician of the Year at the Nebraska State Capitol
Tom McKnight recently was named the Nebraska Family Physician of the Year at the Nebraska State Capitol

It is a pleasure to announce that Dr. Thomas A. McKnight—Tom—a founding member of HONOReform and our medical director, was honored by Governor Dave Heineman on October 8, 2014. In a special proclamation, Tom was named “2014 Family Physician of the Year” in Nebraska. We are grateful for Tom’s ongoing leadership and guidance.
He is pictured with Representative Jeff Fortenberry and Governor Dave Heineman. The text of his talk is included here.

Thank you Gov Heineman, Representative Heineman, and the NE Academy of Family Physicians. I am humbled and honored by this award. I know that there are many deserving family physicians in our state that provide outstanding, compassionate care on a daily basis to Nebraska families.

I chose to go into family medicine because it provides the opportunity to be involved in peoples’ lives from birth to death. I’ve enjoyed family medicine because of the broad range of challenges emotionally and intellectually that each patient encounter brings. In my daily routine I often celebrate with new parents when they bring their baby to the doctor for the first time and then go to the next exam room to break the news to a married couple that the husband has terminal lung cancer and has only a few months to live. I have to say family medicine is as challenging and exciting now as it was 33 years ago when I started my practice.

After finishing medical school at UNMC i did my residency in Cedar Rapids, IA. I took a temporary position in the ER while we were waiting the birth of Luke. This gave me a chance to see a different side of medicine. It taught me that i wanted to develop long term relationships with patients and that i would only be fulfilled in having my own practice.

We volunteered for 6 months in various Native American Health Centers in NM, MT and AK before we settled in our new home in Fremont. This time period also allowed me to get licensure and staffing in place to open my solo practice in July, 1981. I still remember how happy but anxious i was to see my very first patient with brand new staff. Evelyn and I wonder if it was bravery or foolishness to have a new baby, buy a house, start a brand new practice with no patient base, all with no other income. It worked out. Fremont has been very supportive of us and it has been a marvelous place to practice medicine and raise a family.

The loyalty of my staff is unmatched. In the 33 years of practice 2 employees have been with me from the beginning, 6 have been with me 25 years or more and 9 have been with me for more than 10 years. We have 5 families who have two generations that serve patients with me. With all the stresses and changes in medicine, I think this is remarkable. It shows their dedication to caring for their friends and neighbors in Fremont. Their dedication goes beyond the time they spend at the office. They attend patients’ weddings and funerals, give baby showers for needy patients and organize fundraisers to help with patient’s medical bills. Most importantly they hold patients’ hands when they need a compassionate listener, share in the joy of a new baby and shed tears in the loss of a loved one. Patients know their dedication and i think that often they would rather see their favorite staff member than me. The same devotion the staff shows to our patients they extend to me and my family. They do their best to make my day run as smoothly as possible and that is not easy, given how many emergencies come up in one day. In the years of illness within my own family, they sent supper home with me every day for a year. They took our kids to their activities and hugged me through the time of my mother’s death. We will never forget your kindness and compassion.

The most important part of this journey is my family. They were patient and understanding when i was called from family life to attend to others’ needs. I was privileged to mentor all three sons during their medical education. It was marvelous to see their compassion and care of patients during their family medicine rotations. It gave them an understanding of my career. I’m honored that they have chosen medicine for their own career paths. Its rewarding and sometimes humorous to talk to them about their own patients. I got a phone call from Curtis the psychiatrist recently, asking me how to treat constipation!

The most important person here is Evelyn. She has stood by my side, been the most trusted confidante and understanding partner that i could have. She was the mother, often the father when i wasn’t able to be part of family life. She waited patiently for me many late nights to share the joys and sorrows of my day. I know how difficult it is and she continues to offer her support and love. I am eternally grateful.

Being involved with medical students throughout my career has been extremely rewarding. It is a source of continued stimulation and keeping up with the advancements of medicine. Sharing the joy of their first delivery or the satisfaction of suturing their first laceration gives me a warm feeling. Its interesting to show them private practice medicine and what it is like to be involved in a community. I love following their educational and career advancement and then have them as specialty consultants.

The patient doctor relationship is special. I am privileged to care for 4 generations of families. I am so humbled that they have placed their trust in me, many for 3 decades. We’ve gotten to know each other well and i feel like a part of their lives. They are a part of mine as well; they ask about my family and send me gifts and articles that they know i would like. This is really what family practice is about – caring for families through generations. It is a blessed coincidence that the first baby I delivered in Fremont in 1981 was JoAnne’s baby girl named Christine. I delivered Christine’s baby girl Caitlyn in 2011, the last baby I delivered.

Many things have changed in medicine in the years of my career. Immunizations now prevent many diseases that were devastating to families when i first started practice. I remember many nights interrupted by trips to the ER where i did spinal taps on children, looking for meningitis, which is now very uncommon with meningococus vaccine. We now have genomics to assist with cancer care and cardiovascular disease. We used to have to get hard copy medical journals to research new developments but now i can consult Medscape on my smartphone. Computerized medical records are replacing cumbersome paper charts and will allow patients to have their medical records anywhere in the world. Patients have changed also, for the better. They are more involved and knowledgeable about treatment options. They are full partners in their healthcare, which is better for them and healthcare providers. Patients know their bodies better than anyone and bringing this knowledge to the partnership makes for better health. We need to embrace these changes in technology and patient partnership.

I’ve enjoyed opportunities to serve in ways other than office medicine. Service trips to third world countries, membership on nonprofit boards, medical staff offices and our own patient safety foundation HONOReform has promoted my own personal growth. We have met so many wonderful, committed people in these endeavors. Their dedication inspires me.

Our own experience with medical error and the work of HONOReform has made me a better doctor because i understand both the doctor and the patient side of the relationship. I’m less defensive, more compassionate, and more grateful than i used to be. I’ve learned how to accept responsibility and do the right thing, even when that is a very difficult thing to do. To say “I’m sorry, this is not what i wanted for you” when my care of a patient did not turn out as planned is the right thing to do.

HONOReform is a national organization, and we stay very active here in Nebraska. If I could wish one thing for our state, it would be the adoption of a bill that emphasizes safe injection practices. We have seen many lives here in Nebraska (and throughout the country) altered or ended because of lack of adherence to injection safety. HONOReform is willing to roll up our sleeves and work with Nebraska lawmakers to put an injection safety bill in place. We believe this legislation is overdue.

For all of this, I thank you from the bottom of my heart. Our work is not done, we are eager to see what the next 33 years will bring.

How my 6 year old found the CDC website

Lauren Lollini and her 6 year old daughter Lucy
Lauren and her 6 year old daughter Lucy

When I was infected with Hepatitis C, my daughter had just turned one. The devastation of such a horrendous diagnosis coupled with the new person who was now in my life was almost stranger than fiction. Now more than five years later, after a wild ride and a journey still in process, I have started to open up to my daughter and talk a bit about the drug diversion which caused my disease.

I know, I know, Lucy is only six and the idea of drug diversion seems a pretty intense subject for a first grader. But every so often she asks me to tell the story and I know which one she means. And as it is a very long story with many twists and turns, I always ask, which part?
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