Whether you follow health news or business news, you couldn't help but notice the hub-bub about Steve Jobs, the founder and CEO of Apple Computer, and his liver transplant. While most of us will never need such a drastic and difficult treatment, Jobs' approach to getting the healthcare he needed raises both process and ethical questions.

Some Background:

Steve Jobs, age 54, is an icon of business, the "god" of Apple computer, with a creative and inventive mind. Over the years he has earned billions of dollars for himself, his company and his stockholders.

Steve Jobs is/was also a very sick man. He has battled pancreatic tumors for a number of years, and ultimately knew he could no longer survive without a liver transplant. So, he got one.

What's unique, and is causing controversy, is that Jobs lives in California where the waiting list for a liver would have made it impossible for him to get one. In California he would have died. So instead he kept an eye on areas of the United States where the waiting lists are far shorter. When a liver became available in Tennessee, Jobs hopped his private jet and claimed it.

Some argue that wasn't fair. That someone in Tennessee didn't get a liver (and possibly died) because Jobs jumped the line. In the United States, you can't buy an organ. There is a complicated system that moves people closer to, or farther from, the front of the line depending on the depth of their illness and their geography. Because Jobs had the money and the private plane, he could affect his geography.

There is further controversy because investors in Apple Computers feel as if they should have been told about Jobs' degree of illness. Since it affects their income, they contend they had a right to know, and they are upset because they weren't told about his need and pursuit of a transplant.

The Questions:

Health: Was it fair for Jobs to jump the line by traveling to Tennessee to get his new liver?

Business: Did Jobs owe his stockholders information about his health so they could make business decisions?

My Opinions:

Health: Jobs' ability to jump the line points out the inequities in a system that has mostly been considered to be highly ethical and fair. On any given day in the United States there are 100,000 people awaiting a transplant, and 19 of them die. In a general sense, I understand why some think it's not fair, especially the family of someone who may have died because Jobs got the liver they might have gotten. However -- if you had the need and the means, wouldn't you do whatever you could to get the treatment you needed?

Business: No matter whether Jobs was president of a large corporation or a greeter at Wal-mart, I believe he owes information about his health to no one else. It's HIS health. It's HIS private business. No matter how his investors feel about it, including Warren Buffett who believes Jobs' condition should have been disclosed, I say - no, Jobs owed information to no one. Besides, he's been sick for a long time -- that was nothing new. Granted, we would all like a crystal ball when we buy stock, but he could have been hit by a truck or died in a plane crash and it would not have been predicted.

What do you think?

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Hospitals are dangerous places to be. And there's no more dangerous time of the year in a hospital than during the month of July.

I actually sounded a similar warning to you when I blogged last December about the danger of being in a hospital during the holidays. It's just common sense. During holidays, including Christmas, Thanksgiving, the 4th of July and others, the full time staff takes days off -- as they should! -- but it leaves the part-timers and sometimes temporary staff in charge of your care. And it often means that staffing is not 100%. Fewer good people around to take care of your needs.

But July is even worse in many hospitals across the United States:

1. The 4th of July holiday fits the holiday profile described above.


2. This is the time of year when many of the most experienced medical practitioners take vacations, too... So they aren't absent for just the few holiday-days. They're absent for weeks at a time.


3. NEW doctors. Inexperienced doctors. Interns, first year residents -- those who are now called "doctor" by virtue of the fact that a few weeks ago they completed medical school. They may be finished with their book-learning, and may have spent time with some patients as they accompanied more experienced doctors through hospitals and in offices. But they aren't licensed, and they've spent very little time actually practicing any medicine. If you're in the hospital where they are practicing, they'll be caring for you.

So.... add together a holiday, an absence of experienced doctors, and wet-behind-the-ears doctors and what do you have?

Yes. Danger.

If you must be scheduled to be hospitalized, whether it's for an elective surgical procedure or a specialized form of test, or whatever it might be -- then postpone your hospital stay as long as you can, maybe even into the Fall.

If you must be hospitalized and you can't put it off till later, then know that you or your caregiver will need to be particularly vigilant about keeping track of all aspects of your hospital stay. VERY vigilant.

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Last summer I shared my adventures of cleaning out my medicine cabinet. Most of us don't realize that it's not as simple a task as just throwing things away, rearranging items or wiping off the shelves.

Not even close!

I was reminded twice about that in the past couple of days. First, my morning glance into the medicine cabinet is like a nagging voice in my head. "What a mess! You should be ashamed! How can you find anything in here? You'd better hope Martha Stewart doesn't show up!" It's not unlike opening the refrigerator door. (Don't you always wonder if the mold that forms on leftovers couldn't somehow cure a dread disease?)

My second reminder came from Mark Cichocki, a fellow About.com guide, who provides some very specific ideas about how to dispose of old meds and medical waste. He reminds us that it can be dangerous to pets and children, or even to the entire community, if we don't dispose of old drugs or waste properly. That includes a major problem if we simply flush or dump them.

So here are some of Mark's ideas:

• Be sure to block out your name and other personal information on any pill bottles or other containers. It's a way to protect yourself from medical identity theft.
• Add kitty litter, sawdust or coffee grounds to any liquids to make it less likely someone will (intentionally or unintentionally) try to ingest them.
• There are other options like pharmacies that will take back old drugs or groups that collect them for distribution in third world countries.

Take a moment to review all of Mark's ideas -- he's done a good job. You'll find additional ideas in last summer's review of how to dispose of old drugs, too.

Cleaning out your medicine cabinet is a great summer task. A sense of accomplishment, plus one less thing to worry about if Martha Stewart shows up at your backyard picnic.

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I've seen it coming for several years now.

Apart from my work here at About.com, I call myself Every Patient's Advocate. My writing and speaking is aimed at the general you; outside of helping myself and loved ones navigate healthcare, I've never attempted to hold someone's hand individually to navigate the healthcare system.

But some of you do. And many more of you want to. I hear from you often, and while I can steer you to the articles I've written about becoming a patient advocate, I can't give you first-hand accounts of the actual work itself.

But patient advocacy, or the work of patient navigators, is beginning to hit a tipping point of conversation. I am thrilled!

The proof is in two excellent resources that were published this week:

From NPR: Patient Advocates, Tips from You and Advocates Help Patients Navigate Health Care Maze (which features my colleague and friend, Dr. Jonathan Fine's Bedside Advocates program)

From Encore Careers: Encore Navigators Improve Health, Reduce Costs I expect we'll see many more of these fine articles. If you see one you'd like me to read, will you let me know?

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