WhiteCoat

Healthcare Update — 10-17-2011

Also see the Satellite Edition of this week’s Update at ER Stories.net.

How are these two people related? Actually, they are pictures of the same person taken 5 years apart. The woman started itching after having a “bad reaction to seafood.” Afterwards, she aged 50 years “in a matter of days” and she keeps getting worse. Doctors can’t figure out what is causing the problem.

More patients gone wild. Kansas man with “a rash” and who was requesting pain pills for a leg injury becomes agitated and yells at staff. When nurse tries to calm him down, he pulls knife on nurse and holds it “inches from her face.”
Note to future patients: Actions like this aren’t going to get you faster care.
Now the brainiac goes from patient to perp. Get that man a bed in the Greybar Motel.

More good news for patients who are going to get “insurance” from health care reform. “Insurance” doesn’t equal “access” for anyone – especially children with psychiatric problems.
Study shows that pediatric psychiatric ER visits by patients with either no health insurance or Medicaid grew from 46 percent in 1999 to 54 percent in 2007 – equating to “hundreds of thousands” of extra visits per year. Many psychiatrists either don’t accept Medicaid and other public insurances, or are more reluctant to fit these patients into their schedule. Another study cited in the article showed that private psychiatry offices made appointments for 51% of calls in which a child had private insurance and only 17% of calls in which children had public insurance.
But the care is free.

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Emergency medical care in Ireland is becoming dangerous, too.
Irish emergency department nurses strike over unsafe working conditions in the emergency department. The number of patients boarding in the emergency department increased by 54% in two years.
Emergency department conditions “almost unbearable for patients and staff” in University Hospital Galway. Hospitals unwilling or unable to open additional beds. Patients who no longer need acute care cannot be transferred to long term facilities. Almost 35,000 patients are on outpatient care waiting lists. Staff and patients are “demoralized”.
Another report calls conditions at University Hospital Galway “bedlam” as 50 people await inpatient beds and staff has had to move stretchers into the waiting room to accommodate patients in need of care. In response, hospital administrators “ordered that patients be moved to a ward within one hour of a bed being allocated.” Of course, that mandate made matters worse, showing staff that the management has “no understanding of how bed management actually works.”
Now patients are simply told to “stay away from emergency department unless absolutely necessary.”
Yeah. That will work.
But the care is free.

Man gets prescription filled a pharmacy, but doesn’t give them correct contact information. Allegedly takes “Vicodin” four times a day for four days before finding out that it is really amlodipine – a heart medication. Gets dizzy and falls from a ledge, has a mini-stroke, and develops an irregular heart beat from taking the medications. Now he is suing for millions.
Walgreens admits the mistake and said that it tried to contact the patient “within hours” after the prescription was released, but couldn’t reach him because the patient didn’t supply Walgreens with the correct contact information.
Patient withholds correct contact information, patient admits taking medication without reading the bottle, but this is all Walgreens’ fault. Be interesting to see if the amlodipine pills looked different from his usual Vicodin prescription. I’m betting that they did.

Time to ban energy drinks. No. Time to ban caffeine. Ten year old Kentucky girl given a “Monster” energy drink by a friend at a birthday party, drinks it, then “her heart started racing and her blood pressure went up and her anxiety went up and [she] ended up in the emergency room.” According to the article, the American Association of Poison Control Centers said there have already been 331 cases of severe effects from the energy drinks in teens and children this year alone. Pediatricians were up in arms over pediatric cough and cold medications causing adverse events in children a few years ago. Where are the pediatricians now?

Are doctors’ salaries to blame for high health care costs? Do we want to find out?

Study shows that many neurosurgical transfers by helicopter are “inappropriate” based on times until intervention in the receiving hospital. Most transfers by ambulance are “only” 80 miles away or less, so it is OK to have critically ill or injured neurosurgical patients bouncing around in the back of an ambulance through rural Massachusetts for an hour and a half as opposed to being in the air for 15-20 minutes.
If a patient deteriorates en route, the Monday morning quarterbacks at the receiving hospital and the plaintiffs attorneys will harangue the transferring docs for making a “dumb” decision.
And … the study was at least partially funded by the National Institutes for Health. Not like the feds don’t have a vested interest in cutting back on the number of helicopter transports for patients they are insuring.

Three patients end up in California emergency department after eating brownies at a funeral. Seems that someone forgot to mention that the brownies were laced with marijuana. Friends of the deceased person added pot as an ingredient because the dead man used to like his brownies that way.

How extra testing can kill you. One patient got a life-threatening infection after undergoing a prostate biopsy when he had an abnormal PSA test. Another patient died from organ failure after having an abnormal PSA test and undergoing surgery.
Most studies show little benefit from PSA screening and one study showed “surprisingly high rates of hospitalization” after prostate biopsies, yet no one wants to take the chance that they may have cancer – even though that cancer may not have any effect on their health.
In one European study, the rate of cancer overdiagnosis from PSA screening was estimated to be as high as 50 percent. “Based on that study, 1,410 men would have to be screened, and 48 patients would have to be treated, just to save one life from prostate cancer.”
Are the testing and the potential adverse effects from testing worth the potential good?

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11 Responses to “Healthcare Update — 10-17-2011”

  1. ShortWoman says:

    Where are the pediatricians now? They’re busy trying to get pre-schoolers approved for ADD/ADHD drugs!

    The more “recommendations” the AAP makes, the more out of touch with reality they look.

    • Gene says:

      BS. I’ve been bitching about those monster drinks for years. And the psych meds for kids are OUT OF CONTROL! But the number of parents demanding things are out of control. I just spent 10min with a mom in the ED explaining that Hyland’s Teething Gel had been recalled (it contains variable amounts of belladonna)…but it’s NATURAL!!!

  2. doc99 says:

    1/3000 or 2000 annually are estimated to die from colonoscopy. Ultimately, with cancer screening, the choice is often which adverse outcome concerns you more. We can only fight the War on Cancer w the tools we have.

  3. Ross says:

    Studying aeromedical transport is about more than money. Flying, and especially flying helicopters, is inherently risky and a prudent clinician should be able to weigh risks and benefits of an intervention for their patient. Furthermore in an area with limited aeromedical resources one should reserve them for patients that would benefit from expedient transportation, this study suggests that patients with requiring neurosurgery weren’t getting treated any faster. Helicopters seem cool and many times the sending facility is happy to be quickly rid of a challenging patient but we need to engage our brains before prescribing an expensive and risky intervention, especially if we are going to be sending them in a helicopter at night, in poor weather, or from an improvised landing zone.

    • ThorMD says:

      I have never really found helicpoter transport that much faster. It takes much longer for them to arrive, they typically do 30+ minute assessments before even loading the patient. Sure, it’s only a 20 minute flight, but the 75 minutes from the time you call them until they leave is vastly different longer compared to ground transport that can be there almost always right away. In the overwhelming majority of patients, getting to the tertiary care center 10 minutes sooner will not make a difference.

      Yes, for a chopper, the patient is under my supervision for longer, so there’s less left to chance by the ground transport crew. Couple that with the high crash rate of aeromedical transport, I nearly never used them (even when I worked in a rural area where the Level I was 90 minutes away). Usually it was only multisystem trauma who I only wanted out of my control for 20 minutes.

  4. crankypharmacist says:

    All the generic Vicodin I’ve seen looks nothing like amlodipine but it doesn’t surprise me people don’t look at what they are taking. I had someone call complaining we gave them the wrong medication, turns out though they just grabbed the bottle out of the cabinet and was taking their spouse’s meds, never once did they look at the bottle before hand or who’s name was on it.

  5. Anonymous says:

    The rapid-aging asian is an interesting problem. Coincidentally I’m also watching tonight’s episode of House while posting this.

  6. Sarah G says:

    Hmmm…
    “Phuong explained she has long been allergic to seafood and that she had suffered a particularly bad reaction in 2008.

    She said: ‘I was really itchy all over my body. I had to scratch even while sleeping.'”

    I suspect the itching was the lipodystrophy rather than an allergic reaction. But I haven’t consulted Dr. Google yet. :-P

  7. Brenda says:

    the AAP has indeed released a clinical report on the problems of energy drinks. http://pediatrics.aappublications.org/content/early/2011/05/25/peds.2011-0965.full.pdf

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