WhiteCoat

Government Safety

Remember how the government health care wonks at the CDC thought random HIV testing in the emergency department would be such a great idea?

Things didn’t quite turn out that way in France.

A study in France published in the Archives of Internal Medicine showed that out of 138,000 emergency department visits, 21,000 patients were offered testing and 12,754 actually received testing.
Out of those tested … drum roll … a rocking 18 patients received a new diagnosis of HIV. That’s 0.14%. Or .1400000000% if you want to thumb your nose at JCAHO.
But wait … that’s not all! Of those 18 patients, most were in high-risk groups, had previously been tested for HIV, and were in late stages of the disease. In other words, the patients probably knew that they had HIV before the testing and the docs probably could have told them they had a high probability of having HIV before doing the test.

An HIV test costs $200. Multiply $200 times 12,754 tests and you get $2.5 million spent on testing alone. Then throw in all the wasted nursing and lab time performing the testing instead of providing medical care. That money could provide a whole lot of childhood immunizations.

Oh, and while you’re at it, screen every patient for domestic violence, tuberculosis, substance abuse, heart disease; type everything into a computer so we can measure how quick you’re performing your tasks; see more patients with less resources and higher patient loads; make sure you wash your hands 100 times per day (which would require roughly 1/5 of your entire 8 hour shift to do so); fill out all the other ancillary paperwork involved in creating a safe work environment; and do anything else we think might make people safe but haven’t proven yet. Got all that?

But studies cited by the CDC in the US show that the rate of new diagnosis for patients at hospitals in Los Angeles, Oakland, and New York was between 0.8 and 1.5%. Does that mean that patients in those areas have ten times as much risky behavior as patients in France? Ten times the drug use? Ten times the unprotected sex? Maybe it’s just those French people creating false data trying to make the CDC look bad.

Every patient entering our rural hospital’s obstetrical ward has to either consent to testing for HIV or has to sign a refusal. So far, we’re batting .000 in catching those early asymptomatic cases of HIV.

Cost effective and medically necessary health care. These can be the only result of “safety” directives imposed by government agencies.  Kind of like a directive to perform blood cultures before instituting treatment for pneumonia. Oh, wait, I don’t recall seeing any scientific evidence showing the benefit of that directive, either.

Policymakers wonder why health care costs and delays in care are skyrocketing?

Its own mandates are the rocket fuel.

4 Responses to “Government Safety”

  1. Doc4now says:

    You illustrate exactly why our current healthcare system cannot and will not sustain itself. Politicians are in a popularity contest, and they only care about their next election in the end. They are going to institute exactly what SOUNDS good in the media, logic be damned. Unfortunately, the slow degradation of our society, which started in the 1960’s, is culminating in the near future. I thought we would have more time, but painful changes lie ahead.

  2. Christine says:

    It almost sounded like, for a second there, you were advocating not washing your hands before and after every patient encounter because it takes too long. Surely a squirt of Purell really won’t consume that much time.

  3. re: handwashing x 100 times/shift

    for a different perspective, medics handle one (or two) patient(s) at a time, and if the powers-that-be were serious about reducing disease transmission, they’d have docs and nurses handle fewer patients at at time, thus lowering the chances of transferring germs back and forth. (this is no different than the reason why commercial ground beef is so disgusting versus a local provider grinding one piece of meat at a time, not thousands of pieces at a time, upon request.)

    but then again, that would cost more money. so never mind.

  4. SeaSpray says:

    One thing I wonder about using sanitizers… while better than nothing …do they kill the germs under your nails? If not …isn’t that potential for spreading infection?

    I thought of this when I watched a doc recently use it before touching a body part on me. He massaged quickly and I thought it couldn’t possibly have covered his entire hand and under nails. Just wondering. My skin was in tact. I had just healed from cellulitis in lower leg. maybe had it not been he would’ve worn gloves. ?

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