Away for the weekend and into Monday (actually posting this from my phone).
Take over the comments section with any medically-related questions or comments you have.
Just remember — no personal attacks.
Will try to answer any questions on Monday.
Have a great weekend!
 Archive for August, 2011Open Mic WeekendSaturday, August 13th, 2011Differences in OpinionThursday, August 11th, 2011There’s a relatively new radiologist on staff at our hospital. He and I just don’t seem to see eye-to-eye. The radiologists like to do real-time readings of xray studies from the emergency department during business hours. Then the radiology tech brings us a report. I tend to look at most of the radiology studies I order regardless of who reads them or when. Many times I have picked up abnormalities that the radiologists have missed … and vice versa. The new guy doesn’t seem to like the ED physicians very much. Once he called me and berated me for ordering a CT scan of the lumbar spine to rule out a fracture on a patient instead of just doing an MRI. I told him “Fine, change the order.” He couldn’t change the order, though, because he had waited until the CT scan was completed and after he read the study before calling to “discuss” the matter with me. His preliminary interpretations – which are made part of the medical record – include written statements such as “sinus CTs are never an emergency procedure.” One report I got this week really got me ticked. A patient comes in with severe dyspnea. She had trouble finishing her sentences without gasping for air. Her blood pressure was good and her heart rate was a little fast. I ordered labs and a portable chest x-ray. I went and looked at the xray and it was fairly normal. Maybe a little CHF, but otherwise good. The report comes back saying “Limited study. Why did you order a portable exam?” I grabbed the report and walked over to his lair. Sooo … I got your report. Just wondering … did you examine the patient? Next time, I’m going in there with a Rey Mysterio mask on.
How Betadine Almost Got Me ArrestedWednesday, August 10th, 2011I often joke around with my co-workers. I just find that it makes the day go quicker and messing around every once in a while sometimes makes it seem, well, not so much like work. Wouldn’t you know it … some people just can’t take a joke. One of the administrators at a clinic where I used to work used to try to razz me quite a bit. She had all kinds of smart-aleck nicknames for me and would make up wacky patient complaints just to try to get my goat. I would give it right back to her. One day, I got to treat her mom during one visit and repeatedly told her mom how much I respected her for having the courage to with her daughter for all these years. By the end of the visit, her mom was rolling her eyes and everyone in the clinic was laughing. Silly stuff like that. One day the administrator was out sick for a couple of days with “stomach problems.” She called the clinic to see how things were going, and, when she found out that I was working, told the nurses to tell me that she would bring me a present in a bedpan when she returned the following day. Oh really? I figured that I would beat her to the punch. As I’m sure that some of you [soon to be all of you] know, Betadine and toilet paper can be mixed together and molded into some pretty realistic looking … um … shapes. I grabbed a bedpan out of the utility closet, put on some gloves, and used the Betadine/toilet paper combination to create some pretty good looking … shapes … if I do say so myself. Well, you judge for yourself. To the right is a picture of the actual bedpan and offending shapes that I created. I went to the super secret location where keys to all the offices are located, grabbed the key to the administrator’s office, and snuck into her office when no one was looking. I left the bedpan on her chair and then pushed the chair under the desk so she wouldn’t see it until she went to sit down. Then I snuck out of the office giggling like a little schoolboy, imagining what the administrator would think when she came to work the next day. I never got to find out. It turns out that the cleaning lady came that night. The cleaning lady had keys to all the offices. And the administrator’s office was a mess. So when the cleaning lady pulled out the chair to vacuum under the desk, she nearly puked. Then the cleaning lady called hospital security. Because no one supposedly had keys to the administrator’s office, the event was treated like a break-in. So I get a call at home from the head of security. Multiple phone calls later, the situation was officially … decontaminated. For the next several weeks, I was razzed by security, by the local police, and, much to my chagrin, by the administrator. Handcuffs on my desk during the next shift. Harr harr. Very funny. I left a box of Imodium with a bow on it for her the next day. Somehow, it just wasn’t the same. If I put some plastic poo inside the Imodium box … now that would have been funny. Commotio Cordis – Literally HeartbreakingTuesday, August 9th, 2011Another story of a probable case of commotio cordis – this one occurring during a softball game. Sad situation, especially since patients often die when the injury occurs. When CPR is started by trained professionals within 3 minutes, only about 25% of patients survive. If resuscitation is delayed more than 3 minutes, more than 97% of patients die. There have only been about 250 cases of commotio cordis reported to the national registry, most occurring during baseball games, but it is likely that the cases are underreported. More than 97% of victims are male and the mean age of victims is 15 years. The cause of commotio cordis is related to the timing of the impact to the chest, not to the force of the impact. Impact during a 15 ms interval at the beginning of cardiac repolarization (about 1% of the total cycle of a complete heartbeat) reliably causes ventricular fibrillation. [Crawford’s Cardiology, 3rd edition]. Projectiles don’t have to be traveling at a high rate of speed in order for commotio cordis to occur. Baseballs and lacrosse balls traveling 40 mph were able to cause ventricular fibrillation in up to 50% of cases – even when chest protectors were used. However, the firmness of the object causing the impact does affect the incidence of cardiac arrhythmias. Commotio cordis tends not to occur with air-filled projectiles such as tennis balls or basketballs, but rather occurs in sports with solid playing objects such as baseball, hockey, and lacrosse. [Netter’s Cardiology, 2nd edition] It has also been reported in football hits, karate strikes, and in one instance where a dad punched his infant child in the chest because he wouldn’t stop crying. The best chance at survival occurs when CPR is started within one minute of the injury and when rapid defibrillation occurs. That’s where AEDs come into play. If you see someone drop after getting hit during a sports event, performing rapid chest compressions without mouth-to-mouth (to the beat of “Staying Alive” by the Bee Gees) and using an Automated External Defibrillator as soon as possible may just save that person’s life. Of course, if you don’t resuscitate someone from what likely to be a fatal condition, there are always lawyers willing to penalize you for doing something “wrong.” Healthcare Update — 08-08-2011Monday, August 8th, 2011You didn’t cure my kid’s vomiting over the phone and I had to take him to the emergency department two days later when the vomiting came back. Speaking about some peoples’ demand for perfect medical care … suppose that after undergoing surgery, your heart stopped beating. Multiple people rush to help you. They attempt to put a breathing tube down your throat to save you, but your airway is difficult and they can’t get the tube in place. Your life is slipping away. An anesthesiologist rushes to the scene and uses a special tool to get the tube in place, literally saving your life. We were thinking of putting a window there, anyway. Man discharged from Massachusetts emergency department, goes to parking lot, puts car in gear and accidentally drives through emergency department wall into radiology suite. I’m thinking a few radiology techs needed to change their uniforms after that event. Government denies cancer treatment for patient … solely because he is a male. Congress reportedly thinks that only women need treatment of breast cancer. The Centers for Medicare and Medicaid Services stated that “In order to change the eligibility requirements, Congress would need to change the law.” Where Are Force Fields When You Need Them?Sunday, August 7th, 2011
Now I see the absolute futility in trying to use logic to defend against lawsuits. Tenet Healthcare has decided to settle the class action lawsuit against it for $25 million. When the nation’s resources couldn’t even rescue many hurricane survivors, the hospital corporation was sued because of “insufficiencies in [its] backup electrical system” and because it did not have sufficient “plans for patient care and evacuation” during one of the worst hurricanes in the country’s history. The failed levees and the government’s lackluster response are not at issue, though. Plaintiff attorneys called those factors “irrelevant” to the responsibility that the hospital had in the face of the hurricane. That leaves me wondering. What is a hospital’s duty to patients in the face of a disaster? I’d ask the lawyers, but I’m sure that no one would answer. And the legal community apparently didn’t set the bar very high for itself during the same disaster. After all, courthouses and law offices in New Orleans were closed after Hurricane Katrina. For heck’s sake, the MAIL wasn’t even being delivered. The problem is that the civil legal system works retrospectively, saying that “if only you took these measures, the injury would not have occurred” or “if only you hadn’t done this, the injury wouldn’t have occurred.” Of course, it is easy to determine what should or should not be done after the fact. Law is the ultimate Monday Morning Quarterback. I have never seen an attorney issue a press release stating that liability should never ensue if a person or corporation takes or avoids certain measures. So what can we do prospectively to prevent similar lawsuits against hospitals in the future? Not defensive medicine … defensive corporate action plans, of course. I’ve come to the conclusion that everyone really needs to pay hospitals a lot more for providing health care. After all, in the event of an invasion from outer space, it’s going to cost a heck of a lot of money to have laser canons mounted on top of every hospital in the United States to defend patients from aliens who are hell bent on sucking out the brains of infirm humans with extra-terrestrial soda straws. The BoxerFriday, August 5th, 2011Paramedics had a difficult time with the patient. Call went out for a patient named Joanne Doroshow that was reportedly “man down” on the city bus. By the time the paramedics arrived, the patient was laying on the sidewalk with a crowd of bystanders around him. He had shallow breathing. His pupils were constricted. Ahhhhh. A sign suggestive of opiate overdose. Paramedics loaded him into the ambulance and tried to get an IV. No luck. One paramedic then mainlined some Narcan. Yup. It was probably a heroin overdose … and the patient wasn’t happy about losing his high. He woke up, then started yelling, cursing, and swinging. He was a little better by the time he arrived in the emergency department, although he still took a swing at one of the paramedics when being transferred onto the bed. He wouldn’t answer any of the questions from the ED staff. He just sat there staring at people. The resident asked if he could try to talk to the patient to calm him down before he was put into restraints. The resident had a calm voice and steady demeanor. OK, why not? I watched the resident introduce himself. The patient gave him a head nod. We didn’t offer the patient milk and cookies, so I’m sure that JCAHO will fine the hospital thousands of dollars for not following approved protocols for restraining patients … if the case happens to be reviewed. So the patient got put in restraints and got a Foley catheter to prevent him from urinating all over the bed. After a significant amount of money was spent ruling out other etiologies for the patient’s symptoms, my initial diagnosis ended up being correct. Instead of being another news story about a patients gone wild, or about someone being arrested for assaulting a health care provider, the patient was discharged with a sammich and a juice. A satisfaction survey will probably be mailed to his last known residence. Hopefully it will be thrown away. Sometimes working in emergency medicine can be pretty damn frustrating. This and all posts about patients may be my experiences or may be submitted by readers for publication here. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me. Google PlusTuesday, August 2nd, 2011The Happy Hospitalist was kind enough to invite me to join Google Plus. I haven’t done much with it yet. but I now have a bunch of invites to give out. If you don’t have one and you want an invite to Google Plus, drop me an e-mail. whitecoat at epmonthly dot com. Healthcare Update — 08-01-2011Monday, August 1st, 2011Study on patients gone wild shows that 40% of emergency department employees in California had been physically assaulted in the previous year. More than 10% had been attacked in the prior week. What do hospitals administrators do? Tell employees things such as “If you are going to work for this hospital, you are not going to press charges.” Staff should press charges against administrators for saying things like that. Welcome to the Minority Report. Hospitals start tracking patients using infrared mapping of veins in their palms. Next it will be little mechanical spiders pulling up your eyelids. Who needs surgeons and anesthesiologists? Southern California man tries removing hernia with a butter knife, then cauterizing himself with a lit cigarette. Good thing he didn’t need a vasectomy. $527,000 verdict after sponge left in patient’s abdomen during Caesarian section. Nurses liable, doctor not liable. |
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Liam Donaldson a Trial Lawyer Shill?
Tuesday, August 2nd, 2011I wrote about this topic in February. In fact, Overlawyered.com just linked to the story today.
The American Association for Justice really cares about “justice” and not about money …
The United States is debt free …
Vice President Biden was a second runner up in the Miss World pageant …
The World Health Organization is responsible for creating drug resistant bacteria and ebola virus in order to effectuate population control …
Let’s think … what other cockamamie stories can we come up with?
Just ask Liam Donaldson, the World Health Organization’s newly appointed “Envoy for Patient Safety.”
According to Donaldson, “If you were admitted to hospital tomorrow in any country… your chances of being subjected to an error in your care would be something like 1 in 10. Your chances of dying due to an error in health care would be 1 in 300.”
WHAAATTT?!?!?!
This guy was formerly England’s Chief Medical Officer for twelve years. England’s own parliament put out a report of England’s Health Committee in 2009 – while Donaldson was the CMO - showing that “around 3,500″ medical errors in the NHS each year involve the death of the patient.
Between 2009 and 2010, there were 14.5 million hospital admissions in England (.pdf file) – at least according to the NHS’s “Hospital Episode Statistics” online. With one in 300 dying from an “error in health care” (according to Dr. Donaldson), then a total of roughly 48,300 patients in England would have died at the hands of us careless, lackadaisical, downright dangerous medical providers.
Same calendar year, but there is a big discrepancy between 3,500 patient deaths cited in the House of Commons report and 48,300 deaths cited by Professor Sir Liam Donaldson.
That discrepancy leaves me with three possible explanations.
First possibility: Those who created the statistics used in the Sixth Report of the Health Committee for the House of Commons were a bunch of incompetents and should all be beheaded. Remember, the report was created during Sir Liam Donaldson’s tenure as England’s Chief Medical Officer, so he is not without blame if this scenario holds true.
Second possibility: There was a MI5 cover up of nearly 45,000 deaths due to medical errors in England in 2009. Someone call Scotland Yard … and Geraldo Rivera.
Third possibility: Sir Liam Donaldson is blowing bubbles out his bum when citing statistics on behalf of the World Health Organization.
I keep wondering whether or not the WHO will pull a John Kyl and come out with a press release stating that “this was not intended to be a factual statement.”
How about it, Dr. Donaldson? Care to cite the source for your statistics? Care to explain why your statistics are so different from those cited by your own country when you were the Chief Medical Officer?
Spreading misinformation about medical errors does no one any good – except those who would profit from alleged unsafe environments, such as trial lawyers who make money based on a jury’s impression of careless medical care and government agencies who are able to deny payments to or impose fines on healthcare providers due to an alleged lack of safety.
Where is an ”Envoy for Fact Checking” when you need one?
Posted in News Commentary | 4 Comments »