WhiteCoat

Healthcare Update 12-31-2009

Fudging numbers to please the pencil pushers. The NHS in Great Britain has a goal that no one waits to be treated in “casualty departments” (better than calling them “emergency rooms“, I guess) for more than 4 hours. According to the records, a “vast majority” of patients are seen within 3 hours.
Data collected from other sources shows that patients are often moved out of the departments and into other units prior to evaluation which stops the “four hour clock” from ticking. For example, some patients are put in “emergency assessment units” where the average wait is 17 hours and some patients are put in “medical assessment units” where the average wait is 22 hours.
A representative quote from the article: “Labour’s insistence on forcing doctors to focus on ticking boxes ahead of looking after patients means that more time is spent on devising elaborate schemes to satisfy the bureaucrats rather than making sure unwell patients get better.”
Quick care, quality care, free care. Pick any two.
In other news, as a result of this story, JCAHO is now requiring that hospitals close their emergency departments as a patient safety measure.

Paging Dr. Cheech. Paging Dr. Chong. Emergency physician testifies in Pennsylvania about the medicinal use of marijuana. From an emergency physician’s perspective??? Yeah, I see patients in emergent need of a bong hit just about every shift I do [eye roll].

Woman sues hospitals after waiting too long for care. Roshunda Abney went to a Las Vegas acute care clinic complaining of abdominal pain. She was transferred to a hospital for “higher care.” She waited in the hospital waiting room for six hours before leaving and going to another hospital. There she was “treated rudely” and told that she could face a similar wait in the second emergency department. She left that emergency department and went home where, 20 minutes later, she delivered a 1 pound 6 ounce 26 week old baby girl who later died. Six employees at the first hospital have been suspended pending termination proceedings. Miss Abney is suing the hospital for the death of her daughter, Angel.

Paging Dr. Scumbag. Delaware pediatrician rapes and sexually exploits multiple young children – one as young as 3 months old – and videotapes himself doing so.
In other news, the Delaware town’s department stores suddenly sold out of meat cleavers after this article was published.

Threatening to kill a doctor and his family, the EMTs that bring you to the emergency department, and the police that come to subdue you isn’t the way to get faster care. It is a way to get yourself tazed and thrown in the Greybar Motel, though.
P.S. Grabbing for the police officer’s gun is a dumb idea, too.

Mike Tyson cousin causing trouble in Connecticut emergency department? Probably not, but biting an EMT’s ear during a brawl in the department isn’t going to get you seen any quicker, either.

JCAHO mandates strike again. JCAHO requires that negative strep throat screens be confirmed with a strep culture. The increase in cost is approximately $200  per case. The clinical effects of strep cultures? Aside from added costs, more time reviewing paperwork and more time making patient callbacks … nothing. The disease is self limited. Strep goes away on its own. Yet hospitals that don’t perform strep cultures are being cited with a JCAHO “deficiency.” Rick Bukata addresses some of the issues regarding treatment of strep throat and “follow up cultures.”
See also this previous post about antibiotics for strep throat and this Annals of Internal Medicine article on Appropriate Antibiotic Use for Acute Pharyngitis in Adults.

Sometimes headaches are contagious. Especially when they’re caused by carbon monoxide poisoning.

Primary care physician shortage is coming to Michigan … and probably to the rest of the country. The lack of primary care physicians is what torpedoed the “insurance for all” directive in Massachusetts. Now we’re on the verge of replicating the Massachusetts experiment nationwide, and apparently expecting different results. Didn’t someone once define that behavior as “insanity“?

Guess it’s time to sue the bacteria, then. A study published in the American Journal of Therapeutics showed that the increasing numbers of MRSA infections are in part due to physician’s fears about the potential for being sued if they do not prescribe antibiotics. Researchers noted that “some medical decisions may be made not on the basis of the best medical advice, but instead to avoid legal tangles.”
Oh, and the researchers also found a correlation between the number of MRSA infections and the density of attorneys in a given area. Hmmm. Virulent destructive parasites that maim and kill their hosts. You draw your own inferences from that statistic.
P.S. In case you were wondering, I was talking about the bacteria.

9 Responses to “Healthcare Update 12-31-2009”

  1. hashmd says:

    Re: the last paragraph about antibiotics.

    I was called by my county medical society committee which evaluates medical complaints early in my career when I moonlighted in a local ER. I saw a pt. who had just been given an antibiotic by his PCP the day before for a cough and pleuritic chest pain. He complained of continued posterior chest pain. I heard no rales, no friction rub, no dullness to percussion. As he had just been to his doctor and had less than 24 hours of antibiotic, I did not repeat the CXR nor did I change the antibiotic. This was back in the days Ceclor was still brand name!!!

    He was hospitalized in a nearby town (where he was from by the way) about 3 days later and required a chest tube for presumably empyema.

    The committee suggested I waive my bill and that the ER waive their bill so that the pt. wouldn’t sue.

    So ever since I gave out antibiotics like candy, whether needed or not. Only recently have I finally yielded to the logic of the situation and stopped giving out antibiotics, and I am waiting to be sued for not giving an antibiotic despite a clear chest exam and negative CXR for a fever of 1 hour duration.

  2. Fyrdoc says:

    WC –

    Check this one out for fun. Appellate court in Ohio basically wiped out the statute of limitations on med-mal claims by allowing a “John Doe” suit to be brought and in their ruling state that “the statute of limitations begins to run once the plaintiff acquires additional information of the defendant’s wrongful conduct.” They allow a suit where, during depositions in a suit against one physician, that physician implicates another long after the statute of limitations has run out. So now, in Ohio, the statue begins whenever a plaintiff decides to investigate if a claim should be filed, not when the injury occurs.

    See: http://oh.findacase.com/research/wfrmDocViewer.aspx/xq/fac.%5COH%5C2009%5C20090210_0000755.OH.htm/qx

  3. steve says:

    oops lost the last comment…

    Please don’t use the Daily Mail as a source of UK news, it a joke newspaper.

    Read the story and use your own brain, the *opposition* party says that the government has failed on the NHS, Oh Really!, did you expect them to come out and say what a wonderful job the government has done???

    • WhiteCoat says:

      Don’t know much about the bona fides of the Daily Mail, but are the facts of the story true or not?
      Would you similarly expect the government to come out and say that the NHS has failed?
      We have to at least consider the contrarian point of view.
      Is the Telegraph a good newspaper? It has the same story.
      So does the Democratic Councillor for East Marsh Ward.

      • steve says:

        “Democratic Councillor for East Marsh Ward.” *Choke*, Look at his election results page, he got 825 Votes :) He’s your man if your bin didn’t get emptied, not quite the person I want to turn to about the best health system for 300 Million Americans though.

        Is it true? Yes I imagine it did happen at least one place at one time. It it common, not at all. If it was it would be headline news every single day. Its just a silly anecdotal story.

        The truth. Its been about 20 years since I’ve been in A&E, at the time 3-4 hour waits were common. I went in again recently and my feet barely touched the ground. Reception, triage, doctor, xray, doctor, cast, and out the door. Discussing this with others who are more frequent flyers (they have kids) confirmed my impression that things have improved a lot recently.

        As for the rest of the NHS, well I have private insurance, it comes free with the job. Some years back it was very useful for bypassing long queues to see specialists , these days I don’t even bother to use it, too many forms and phonecalls. I just let the NHS kick in, and its just fine.

        I don’t support the current UK government , but its hard to knock what they have done with the NHS over the last 12 years.

  4. [...] This post was mentioned on Twitter by EPMonthly, Peter Jackson. Peter Jackson said: Healthcare Update 12-31-2009 | WhiteCoat's Call Room http://bit.ly/4n7oMh [...]

  5. paul says:

    wonder what the likelihood of a successful lawsuit is if you walk out before a physician-patient relationship is established. can sue the hospital maybe? for having inadequate staffing?

    happy new year.

  6. You always find great posts for your blog. Well done. I am a bit nervous about the PA doctor testifying about marijuana use. God forbid I start having to supplement their supply because they “ran out early”. We’ll be handing out bongs like MDIs!

    Happy and Blessed New Year to you all.

  7. GrumpyRN says:

    I would back up Steve’s comment, never use the Daily Mail as a reference. It is well known for distorting the truth or only printing parts of the real story. As Steve pointed out, it is the opposition that are saying this – there will be an election in the UK within the next 3-5 months and propoganda is rife and will get worse. The targets that are talked about are that 98% of patients are seen, treated and discharged or admitted within 4 hours. This is seen as perhaps a bit too rigid and that a 95% target would be better. My own hospital achieves 99% and we are a major university teaching hospital. Over the New Year holiday I had to apologise to patients that as it was so busy they would have to wait 2 hours to be seen. I agree though that there can be problems in the NHS, but extrapolating one or two incidents to the whole of the organisation is misleading and wrong.

    2 other points; casualty department is an old fashioned term, we now use ‘Accident and Emergency’ or ‘Emergency Department’, and please stop inferring that the NHS is free, it is not now, nor has it ever been, free. It is paid for by the population as a whole by a National Insurance scheme that everyone pays as part of their deductions from their wages/salary, it is only free in the sense that you do not get presented with a bill when you attend for treatment.

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