Well written article by Deane Waldman in HuffPo on why the lottery mentality should have no place in medical malpractice cases.
 Archive for May, 2009Lottery Mentality in Med MalSunday, May 31st, 2009Vaccinations Cure CancerSaturday, May 30th, 2009According to the American Cancer Society, the cancer rate in the United States has shown a steady decline over the past 15 years, resulting in more than 650,000 lives saved. While the report suggests that “early detection practices” and “improvements in treatment” have attributed to decreases in death, I’ve noted a different trend. According to this position statement from the National Association of School Nurses, the number of recommended vaccines doubled between 1985 and 2000 and could triple in the next 20 years. Obviously the cancers are being caused by subclinical infectious processes that the vaccinations are now preventing. Direct evidence that increasing the number of vaccinations decreases the number of cancer deaths. Take that Jenny McCarthy. As a side note, why in creation would Oprah allow Dr. McCarthy to blog on her web site about analyzing poop to make sure that there are “no yeast, no bacteria, no infections”? The percentage of bacteria in an average stool is 30%. Heck, if we get rid of all the bacteria, we can just have the astronauts recycle all of their excrement. How novel. Cha-chingFriday, May 29th, 2009
You can read my previous post on her case here, but she’s the patient who collapsed in the waiting room of Kings County Hospital in New York and who was ignored by the staff for an hour before being pronounced dead. Later the coroner determined that she died from a blood clot to her lungs – something that would have caused her death regardless of the treatment she received. On Wednesday, New York City agreed to pay Ms. Green’s estranged daughter $2 million to settle a $25 million lawsuit that the daughter filed against the hospital. The plaintiff’s attorney, Sanford Rubenstein stated that the settlement was “fair and reasonable.” Let’s see … he makes 33% of $2 million – or about $666,666.00 – for 8 months’ work in settling a case that couldn’t be proven in court. Sure, I’d call that reasonable. Ms. Green’s daughter, Trecia Harrison, who lives in Jamaica, hadn’t seen her mother for 8 years before the incident. Even though her mother didn’t have a telephone, Ms. Harrison reportedly called her mother “constantly.” Ms. Harrison walks away with $1.3 million. As a result of Ms. Green’s death, the Department of Justice investigated Kings County Hospital and issued a 58 page report about how the conditions in the hospital had become “highly dangerous”. In response, Kings County constructed a new Behavioral Health Center, has added 200 additional staff members, and has reduced the waiting times in the psychiatric emergency department from 27 hours to 8 hours. With NY City tax revenues down $1.38 billion from 2008 and an operating deficit of $3.7 billion in fiscal year 2009 (see page 27), I can’t imagine that the significant increases in expenditures at Kings County will be long-lived. Hospitals struggle to stay afloat while providing increasing amounts of uncompensated care. Wonder why our health care system is going bankrupt? WTF Moment #381Thursday, May 28th, 2009
It was busy and his attitude didn’t help matters, so he walked out after about 15 minutes. The admitting clerk watched him take a leisurely stroll to the vending machines, buy a can of soda, and walk out the door while daintily sipping away. When the tech went to change the linens, her foot slipped when she walked in the room. The patient had left a puddle of urine on the floor as a memento for our time together. Illegitimate child of a neutered muskrat. Doesn’t end there, though. The patient came back that evening holding a paper bag against his chest. He didn’t go to registration, but the clerk recognized him and called security. The patient had gone into the men’s bathroom, locked himself into a stall, and laid out all kinds of porno magazines on the floor. The security guard went into the bathroom and asked him what he was doing. Mr. Jerkey said “I’m going to the bathroom and when I’m finished I’m probably going to sign myself into the emergency room.” Words were had – most of which were unfit to publish here. In the end, the patient ended up changing his mind and leaving – still clutching his paper bag tightly against his chest. I’m just glad that the doors have motion sensors on them so I don’t have to touch any handles on the way out. I Love You Too, HoneyWednesday, May 27th, 2009Through the waiting room monitor we saw a man pushing a woman in a wheelchair up to the registration window. We recognized the woman as someone who frequently comes to the emergency department for treatment of her chronic back pain. She also chooses to sit in a wheelchair and be carted around rather than expending the calories necessary to mobilize her protuberant derriere. Don’t be fooled. She gets out of the chair and onto the bed just fine. This time, though, it was the husband who registered to be evaluated. He has had pain in his upper back for a couple of months and he finally decided to get it checked out. He hasn’t seen a physician in a “coon’s age” and smokes like a chimney. Yes he has had a cough. No he hasn’t had any injury to his back. Other symptoms? Well now that you mention it, he did started getting migraine headaches a few months ago but they seemed to get better with Motrin, so he didn’t pay too much attention to them.
One of the toughest parts of being a doctor is telling someone that they have a serious illness. It’s like you can see the life force just drain out of people sometimes. Not a look that is easy to describe or that you’d ever want to see. Imagine walking into a hospital thinking you’re healthy – maybe you have a back strain – and having a doctor walk into the room and tell you have cancer. Like being hit with a brick. I didn’t have the heart to tell him that he had metastatic disease. How do you walk up to someone you’ve never met before and hand them a death sentence? Both the patient and his wife didn’t believe me at first. “Whaaat?!?!” they both chimed when I said that the chest x-ray looked like it could be cancer. I showed them a printout of the x-ray. The patient sat there with a blank look on his face. I can’t even begin to imagine what was running through his mind. Fear? Family? Kids? Death? I tried to offer a glimmer of hope. “If it is cancer, there are a lot of ways to treat it. For right now, we just have to confirm whether it is or it isn’t and then work on getting you better.” His wife furled her brow and crossed her arms. Then she let loose on him. “I’ve been telling you to get this checked for months! Did you listen to me? NO! Now you’re going to check out and no one is going to be there to take care of ME!” Maybe that was just her way of dealing with bad news. Still a wrong answer. I really felt like grabbing the wheelchair and dumping her onto the ground. Maybe a few good stomps on her back to show her how she just made her husband feel. Tears started to well up in her husband’s eyes. That made me even more angry. I patted him on the shoulder, told him not to worry – we would take good care of him. Then I walked out of the room before I did or said something I would later regret. After the patient was discharged, I watched the patient push his wife out through the lobby and out the front door – just as slowly as they walked in. The edges of crumpled discharge papers wiggled back and forth in his back pocket with each step he took. Then I watched the tech crumple up the linens and toss them into the laundry bin. I’m betting a good portion of the patient’s life force went into the laundry bin along with those sheets. His wife did as much to his spirit with those words as any gang banger could have done with a baseball bat. I’m betting he won’t even make it to Thanksgiving. Why Rationing of Care Won’t Work in the USTuesday, May 26th, 2009I recently read an interesting article by Dick Morris called “Death of U.S. Healthcare” posted on The Hill. Morris was a former adviser to Trent Lott and to Bill Clinton. His opinion is that Obama’s health care reform will cause rationing of medical services and he cites several comparisons between the US and Canadian systems. Another article on The Hill cites President Obama’s promise to provide “basic” health care coverage for everyone. I agree that rationing is going to occur, but there’s at least one thing that will prevent some medical services from being rationed. Let’s use one example. Suppose you want to cut the costs of health care by no longer paying for costly medical care that does not provide a long-term benefit. You assign your employees to perform a “study” on costly medical care. The study done by your employees (kind of like a study on the effectiveness of a medication that is funded by the drug company making the medication) determines that patients older than 90 years of age on dialysis do not show a significant improvement in quality or duration of life. You then create a new medical practice “guideline” that says, based on this medical effectiveness study, dialysis will no longer be an included medical benefit for patients more than 90 years of age. What happens? Some families might pay for the bill for future dialysis out of their own pockets. By excluding preventive care that averts an emergency, the government will create a situation in which the same care becomes more expensive. All grandpa’s family has to do is pick up the phone and hit three little numbers and he’ll get dialysis any time of the day or night. The government will get its wish, though, as it will no longer have to pay for dialyzing nonagenarians. The burden of paying for emergent dialysis will shift from the government to the hospitals. You see, EMTALA requires that hospitals provide stabilizing treatment, but it says nothing about who will pay for the stabilizing treatment. Hospitals will be forced to eat the cost of providing care. As more of the costs are passed on to the hospitals, more and more hospitals will close. Then less medical care, and less emergency medical care will be available for everyone. EMTALA and the numbers 9-1-1 are two reasons why healthcare rationing inherent with socialized medicine will never be a viable alternative in the United States. Rationing will cause cost-shifting which will in turn cause hospitals to close their doors. Should’ve Listened To MomMonday, May 25th, 2009
The patient was a construction worker on an office building and they were using a crane to lift supplies onto the second and third floors. The patient was involved in packing up the pallets of supplies, attaching the large hook from the crane onto the pallets, making sure the pallets balanced, and then unloading the pallets once they were lifted to the upper floors. It was getting toward the end of the day, so the construction worker decided to slide down the crane’s cable to get from the second floor of the building back down to the ground. He forgot what was at the end of the cable until … RRRRRRIIIIPPP! The large hook at the end of the cable tore through his jeans, grabbed him by the gonads, and ripped a huge hole in his scrotum. As in there was a tear from the bottom of his scrotum all the way up to his groin. His testicles were both clearly visible. Happy ending in that there were no injuries to the family jewels themselves and the urologist came in immediately to sew everything back together again. It was funny watching everyone’s faces as they walked out of the room. The urologist had a look of shock on his face. The nurse taking care of him made a face, cringed, crossed her legs, and covered her groin with both hands. The prize for the best response goes to the anesthesiologist, though. After examining the patient, he walked out of the room shaking his head, came up to the desk, began filling out his paperwork and said: “His mom should’ve told him to stay away from hookers.” MesotheliomaSunday, May 24th, 2009The following is a guest post by Richard Moyle. Mesothelioma Often Mistaken for Less Serious Ailments Mesothelioma is a type of cancer that affects the lining of organs, most often the lungs (pleural) but sometimes the stomach (peritoneal) or even the heart (pericardial). The only known cause of malignant mesothelioma is exposure to a toxic mineral known as asbestos. [Editor's note: Asbestos can be contained in such materials as insulators, furnace/pipe coverings, fireproof gloves, brake linings, and asbestos cement products. Additionally, significant occupational exposures to asbestos can occur from building demolition and mining]. Unfortunately, this type of cancer is rarely diagnosed early enough for treatment to be effective. There are two reasons for this. First, mesothelioma has a very long latency period and symptoms do not begin to show until about 25 to 50 years after exposure. Second, early symptoms and warning signs of the disease are very non-specific and often resemble symptoms of other conditions that are less serious. For example, the early symptoms of pleural mesothelioma may be mistaken for influenza or pneumonia, and this can result in misdiagnosis. In most cases this misdiagnosis is by no means the doctor’s fault. If someone comes into an emergency room complaining of shortness of breath or painful breathing, mesothelioma is probably not one of the things that an emergency physician might suspect. Unless the doctor is informed of any previous asbestos exposure, he obviously has no reason to believe someone is suffering from an asbestos-related disease. If you have any of the following symptoms and you are aware that you have been exposed to asbestos in the past, it is very important that you inform your doctor:
Mesothelioma can only be officially diagnosed after a series of imaging, blood and tissue tests have been performed. Statistics show that most mesothelioma patients are diagnosed within 3 to 6 months after their first doctor visit with complaints about breathing problems or chest and abdominal pain. If you are diagnosed with mesothelioma, your doctor will recommend an “oncologist” (a cancer doctor), who is well-versed in treating the disease and will help determine the best options for treatment. More information about mesothelioma is available from the National Cancer Institute and from the Mayo Clinic. Do As I Say …Thursday, May 21st, 2009Pediatricians hate treating kids for diarrhea. The theory is that if you give children medications to slow down the diarrhea, that any infectious organism in the colon will have more time to multiply, will overgrow, and will, in turn, worsen the infection. When children come in with diarrhea, they’re miserable, their parents are miserable, and they just want some help to feel better. Unfortunately, there’s not much on the market for treating diarrhea in children aside from probiotics or antibiotics in certain cases. Imodium elixir has dosing guidelines for kids, but many doctors shy away from recommending it. The goal is to use Oral Rehydration Therapy to get more in the mouth than comes out the other end. Ditto for vomiting. Emetrol may help and is over the counter, but is essentially glorified sugar water. The only other medications to treat vomiting in children are prescription meds. Even the number of available prescription antiemetic medications has been narrowed considerably. Many pediatricians do not like giving children antiemetic medications unless children are dehydrated because there is a risk of “side effects” (although this study suggests otherwise, as does this Cochrane review). By the way, the “side effects” argument was the same one that pediatricians used to get most children’s cold medications taken off the market. Here’s one About.com article on treating vomiting and diarrhea in kids. One pediatrician on staff intermittently raises hell during medical staff meetings because emergency physicians have the gall to give children medications to treat diarrhea and vomiting. He repeatedly suggests that the ED docs “read up on” treatment of vomiting and diarrhea. With a run on gastroenteritis in the community, this same pediatrician apparently thinks that vomiting and diarrhea of less than one day’s duration are impending emergencies. When parents are asked why what prompted them to bring their kids in for evaluation of diarrhea, they repeatedly say that they called the pediatrician and were told to go to the emergency department. Because we aren’t supposed to give medications for vomiting or for diarrhea in children who are not dehydrated, I am now making it a habit to call the pediatrician when patients arrive – to let him know they got there and to ask what he wants me to do in the ED. I also call when the patients are discharged to let him know I have told them to follow up in the office tomorrow to make sure that they still aren’t dehydrated. Kind of feel bad when we keep waking him up in the middle of the night for multiple patients – especially after being called by the parents as well, but through our conscientiousness, I’m hopeful that he will give the ED a better review during the next medical staff meeting. WhiteCoat Challenge #4 – WINNERSWednesday, May 20th, 2009Just got the envelope from the judges for the winners in WhiteCoat Challenge #4. First, thanks to everyone for their submissions. The goal of this challenge was to show people how medicine can be fun and it paid off. These were all great. Winners are: Honorable mentions get a free EP Monthly coffee cup and are Please drop an e-mail to info@epmonthly.com to arrange to get your prizes. Thanks again to everyone for playing along. |
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Remember Esmin Green?
Jerkey Boy comes in pitching a fit because his hemorrhoids are killing him … for two weeks. He starts screaming “God DAMN” as soon as he gets into the room. “Will someone give me a shot of some pain medicine?!?!”
His right lung sounded like crap, so we got an x-ray.
Had a patient come in with a really strange injury not too long ago.
Recently on Twitter:
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Raul Ruiz: Harvard Scholar and emergency physician vies for political office in Southern California http://t.co/5eDo11oC
07:43 AM Jan 19th from Tweet Button -
Greg Henry – A new spin on old physics lessons http://t.co/0QxkDqMR
10:00 AM Jan 11th from TweetMeme
