The Veteran’s Administration intentionally changed and hid data to avoid providing costly yet critical medical care to soldiers from the Gulf War? A head VA epidemiologist alleges that more than two thousand veterans responding to a study felt like they would be “better off dead”. In 95% of those cases, the VA did nothing to assist those veterans with follow up care. In a subsequent study when the same epidemiologist attempted to ensure follow up care for potentially suicidal veterans, he allegedly had disciplinary actions instituted against him. If that’s true, I wonder how everyone else will be treated once they have medical insurance under the UnAffordable Care Act.
American College of Obstetricians and Gynecologists advises against using the da Vinci robots for hysterectomies. Robotic surgery adds about $2000 to the cost of surgery and “there is no good data proving that robotic hysterectomy is even as good as, let alone better than, existing and far less costly minimally invasive alternatives.”
I hope that other specialty societies have the integrity to make similar inquiries.
All those hospitals that spent millions of dollars on these machines to keep up with the Joneses may just be in for a big surprise.
You know all those things your hospital does to stop the spread of clostridium difficile infections? Yeah. They don’t work (.pdf file). 42% of hospitals implementing such policies noted decrease in c. difficile rates while 43% of facilities noted an increase in c.difficile rates.
Can’t wait to see the spin that the Joint Commission puts on this one.
The patient waits 3 hours to be seen. When I enter the room, the patient says “I had a rash on the back of my leg 2 months ago. Can you tell me what it was?”
Out of the 4 or 5 things running through my mind at that point, the least pressing one of them wasn’t about calling up the feds to get satellite video feeds of the patient’s house two months ago so I could zoom in through the window shots and hopefully identify the cause of the mysterious rash.
“The rash isn’t there now?”
“No.”
“Well, sir, I honestly don’t know what caused the rash because I can’t see it any more. As long as it isn’t there any more, I don’t think it’s going to be a problem.”
“Was it scabies?”
“I doubt it because it wouldn’t have just gotten better.”
“Well what does scabies look like?”
At this point, I should have stopped the conversation and discharged the patient. Unfortunately, my foresight gene had gone offline for a few moments.
“Scabies is usually little itchy spots or pus-filled blisters. Most commonly the spots are between the fingers or the toes. Sometimes there will be little red lines where they burrow under your skin.”
“Wait. You mean scabies are bugs?”
“They are mites.”
“Oh my God. That’s what the rash looked like. I’ve got bugs burrowing in my skin.”
“No. You don’t. The rash is gone.”
“What if they’re just sleeping? Couldn’t they still be in my house?”
“I’ll tell you what. If the rash comes back and you think it is scabies, there’s cream called elimite that you can buy over the counter to kill the mites. Until then, I wouldn’t worry too much about it.”
An hour after he was discharged, we start getting the phone calls.
“My son said you told him my house was infested with bugs. What’s THAT all about?”
“How long should he stay home from school for?”
“Can these bugs be sexually transmitted?”
“Should I be going to work? I work in a nursing home.”
[facepalm]
My shift couldn’t end soon enough.
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This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.
A patient calls his family doctor and gives a history of having chest pain on and off for the past few days. Pain worse with activity. Not having any now. Of course, you know that the family doc is going to send the patient to the Emergency Department. You just know it.
So the patient gets to the emergency department and of course the EKG is normal … and the labs are normal … and the chest x-ray is normal.
Because the patient has no history of chest pain workups, of course you know we have to recommend that the patient stay overnight and have a stress test in the morning.
“You’re kidding. I really have to stay? Everything is normal. Can’t I just go home and do it later? ”
“Well … no … not really. We can’t force you to stay in the hospital, but we really think that it would be a good idea.”
Then you start to second guess yourself. This guy’s in good health. He’s not having pain now. Of course the insurance company is going to call this an unnecessary admit.
Fortunately for everyone, you found a reason to justify the admission.
About 15 minutes later, the alarm goes off.
Holy sh**! Torsades! Get the paddles!
It seemed like several minutes, but it ended up being more like 35 seconds until this happened.
“What happened?”
“Um. You nearly died.”
Had the patient not called his doctor, had the doctor not sent the patient to the hospital, had the patient not been brought right back and place on a monitor, or had the patient decided to leave AMA, he probably wouldn’t be here right now.
Triple vessel disease with a CABG.
Every once in a while those useless workups end up saving a life.
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This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.
Not quite a case medical student’s disease, but close. Have to love it.
The thing is that when I was a medical student, there wasn’t an internet and there definitely wasn’t a Dr. Google. So we were a lot more stressed out because we had to rely on the advice of our professors – who weren’t always that well versed in the diseases.
More warnings about superbugs. MRSA is bad enough, but what happens when the organisms living in all of our intestines become resistant to antibiotics?
Patients gone wild returns. Minnesota goof screams profanities and disrupts medical care. Tied down in four point restraints until police arrive. Will likely be charged with disorderly conduct. Wow. If every patient that did this kind of thing was charged with disorderly conduct and whisked off to jail, our ED volumes would drop by a good percentage.
We’re watching you …California wants $10 million in funding to create a prescription-tracking database so that it can find doctors who overprescribe narcotics. Once the system was up and running, doctors and pharmacists would be REQUIRED to check it to look for signs of narcotic abuse. Of course, the definition of “signs of narcotic” abuse is purposely not included. That way the state could just attack at will any physicians who prescribe any narcotics. The database would be paid, in part, by raising physician licensing fees.
Interesting statistic. Top 25% of Medicare beneficiaries account for 85% of total Medicare spending. Prime targets for “death panels,” huh?
Seriously, though the article has several good points about how to improve the medical system, even though it is written by someone with no apparent experience in the medical system.
One point in which I disagree with the author is that “guidelines” should be used both as a shield and as a sword. We all saw what happened when NY Times reporter Jim Dwyermisused guidelines. In general, guidelines are situation specific and failure to follow them to the letter shouldn’t be considered malpractice.
The mother was a high-risk pregnancy (due to VBAC), was post-dates and had gestational diabetes. The fetus wasn’t in a good position to facilitate vaginal delivery, and an ultrasound showed the fetus in possible distress.
The patient was sent to Tampa General hospital for immediate C-section, but refused to have the surgery done that day. She wanted the baby delivered on Friday, not Tuesday. So the obstetrician sent her an e-mail which stated, in part
I am deeply concerned that you are contributing to a very high probability that your fetus will die or your child will incur brain damage if born alive. At this time, you must come in for delivery.
I would hate to move to the most extreme option, which is having law enforcement pick you up at your home and bring you in, but you are leaving the providers of USF/TGH no choice
The doctor was promptly contacted by the National Advocates for Pregnant Women, whose New York attorneys advised him (apparently applying their vast knowledge of Florida law to the case) that he was making “legally and ethically unjustifiable” threats and demanded he cease taking further action against the patient. The NAPW even put up a post about the incident on their web site. Hopefully, the attorneys at NAPW have licenses in Florida, otherwise some might consider them to be practicing law in Florida without a license – which I think might be illegal.
Now the patient is having her baby delivered on Friday as she wanted.
When I initially read this article, I was upset with the doctor.
The more I thought about it, though, the fetus has as many rights as the mother does. If the mother was doing things to endanger the life of the fetus the day after it was born, a call to the police would be expected, not ridiculed. States mandate reporting of suspected child abuse and impose liability on providers if suspected abuse is not reported.
In this case, it is questionable whether a failure to deliver a child that is possibly in distress would be considered “child abuse,” but usually if there is a suspicion, a report is mandated.
I side with the doctor on this one. And I probably would have called the state child welfare agency on the woman just to cover myself.
This case will get ugly real quick if there are complications during the pregnancy or if the child isn’t born healthy.
If the baby is stillborn, should the mother be charged with a crime?
Patients can already sue doctors for prescribing medications if they can prove that writing the prescriptions violated the standard of care and that they have suffered damages as a result. But Tick wants to take the concept a step further. If the patient sues a doctor and wins, the patient should receive payment for rehabilitation, possible punitive damages, and attorney’s fees.
It doesn’t matter that “addiction” can be either physical or psychologic and that there is no reliable way to determine when addiction occurs. Tick’s bill doesn’t define addiction. It also doesn’t matter that people can get addicted to pretty much anything … alcohol, illegal drugs, porn, gambling, even collecting Cabbage Patch Kids. Tick’s bill only cares about those evil doctors. Beware internet service providers, you could be next on the list if your subscribers get addicted to the internet.
But Tick has good reasons for proposing his bill. Since people lived without drugs before, Pharmacologist Tick doesn’t believe that drugs are the only way to treat pain now. That’s true. Patients in cancer pain could always try incantations and faith healing instead of popping pills. Or patients in pain could bust out some whiskey and a bunch of bullets to bite on … after they take anger management classes so they can purchase the bullets. Oops. That’s Florida. Sorry. Wrong state. Double oops. Alcohol could be addictive. Bad example.
Besides, since children are allegedly taught from an early age to do whatever the doctor says, Neuropsychologist Tick says no one has the free choice whether or not to take addictive pain medicines.
It’s not so much that, at least according to his Twitter feed, Tick seems just all … well … tickled … about seeing his proposal published in newspapers. The scary thing is that people like Tick Segerblom are elected to public office and may be able to regulate our lives.
I’m in shock about the case where a nurse refused to give CPR to 87 year old Lorraine Bayless in a California senior living facility – a housing setup akin to an apartment complex.
Ms. Bayless fell unconscious in the dining room of a senior living facility. Facility members called 911. Ms. Bayless wasn’t breathing and the 911 operator recommended that the facility member perform CPR. The person at the facility would not perform CPR.
It took EMTs about 7 minutes to arrive on scene. Ms. Bayless later died from a “massive stroke.”
The 7 minute call can be heard HERE in its entirety.
A couple of other things made known in the case were that the senior living community did not have any trained medical staff. Remember – the facility was similar to an apartment house. In addition, Ms. Bayless had made known her intentions to “die naturally…without any kind of life-prolonging intervention.” According to the family, Ms. Bayless knew that there were no medical staff when she decided to live at the facility.
So why am I in shock?
Look at all the whacked out opinions that are being generated from this case.
Then the “experts” across the news stations pile on.
Virginia Commonwealth professor of geriatrics Dr. Peter Boling stated that without advance directives, patients “wind up sometimes in a very painful and trying situation.” This quote seems to acknowledge that patients may receive unwanted CPR if there is any question about a patient’s wishes.
CBS legal analyst Jack Ford calls the actions “morally reprehensible” but also notes that our society has become much too litigious.
Ah, but what about California’s Good Samaritan statute? It exempts people who provide emergency care from liability for civil damages, but it also contains exceptions. Providers have to act in “good faith”. It doesn’t apply to those who are grossly negligent. And it doesn’t apply if the provider is being compensated. Employees of the senior living facility are, by definition, being compensated. So a plaintiff’s attorney may have the ability to circumvent the protections afforded in the Good Samaritan statute just through the “compensation” angle.
Other people argued that the 911 operator took all liability for the actions of the nurse. How does such a promise, which is essentially a verbal contract, absolve the nurse from liability when the nurse is the one performing the actions? If a lawsuit was filed, the nurse would still be named regardless of the 911 operator’s promises.
Then there’s the question of a DNR order. According to the Bakersfield Fire Department there wasn’t such an order on hand when paramedics arrived. Not that people carry DNR orders around with them in their pockets or anything. After all, this was a dining room in an apartment complex, not an ICU bed. But even if that was the case, does there have to be a readily producible advance directive available to prevent unwanted care?
A sweet old lady entered a senior living facility knowing that there were no trained medical staff and not wanting any life-prolonging treatment.
Now a firestorm has come down on the living facility for abiding by the patient’s wishes and pundits all over the internet are basically demanding that we perform medical procedures on patients who don’t want them. Don’t agree? It’s off to jail with you. You’re a criminal.
Ms. Bayless’ family issued a statement saying in part
We regret that this private and most personal time has been escalated by the media. Caregivers, nurses and other medical professionals have very difficult waters to tread in the legal and medical landscape of our country today.
About the only thing potentially criminal about this case was the unauthorized dissemination of Ms. Bayless’ private health information to the media.
Are state and local authorities investigating that?
Daughter WhiteCoat doesn’t have the stomach for her science class.
They were dissecting a sheep heart in her class not too long ago and she was becoming increasingly queasy. Apparently the sheep had been recently slaughtered because she said that there was still blood in the heart. She was more skeeved because the science teacher was manipulating and dissecting the muscle without using gloves.
She went up to the table where the dissection was taking place, but had to leave the class at one point because she thought she was going to throw up. Mrs. WhiteCoat and I? We can watch surgery while eating a plate of spaghetti and meatballs. Or eggs and sausage.
After the class, several “concerned” classmates came up to my daughter. Instead of consoling her, they said “Eeeeewwww. You have heart juice on your sleeve” or “Gross. There’s heart juice on your notebook.”
Heart juice?
Heart juice?
What the hell is heart juice? It’s called “blood” people. You all fricking fail.
I gave her a bottle of disappearing ink and told her to squirt it on those people’s notebooks, saying that they had crab heart juice on their notebooks (yes, horseshoe crab blood is blue and it contributes to modern medicine), but she wouldn’t do it.
Can’t wait for them to start discussing reproductive system. I’m going to have to send the teacher some smelling salts for use on my daughter.
Another bamblance theft from the emergency department. If you don’t know why it’s called a bamblance, you need to listen to the video below (strong language alert). This latest ambulance theft occurred at University of Michigan. Many of the commenters to the article suggested that the patient was going to a different emergency department due to the wait times.
How much will you be charged for your emergency department visit. This study in PLOS-ONE gives you a good idea of what you should be charged. Keep in mind, though, that the numbers are “median” values, meaning half of patients got charged more than those numbers and half of patients were charged less than those numbers. The range of charges was ridiculous. For a UTI, the lowest charge was $50 while the highest charge was $73,002. That doesn’t mean some poor patients actually paid $73,000 for a Bactrim prescription, only that insurance was billed that much (which is still a crime).
Suing Doctors For Patient Addictions
March 7th, 2013Nevada Senator Tick Segerblom proposes bill that would allow patients addicted to prescription drugs to sue doctors for prescribing the addictive medications and manufacturers for creating the medications.
Patients can already sue doctors for prescribing medications if they can prove that writing the prescriptions violated the standard of care and that they have suffered damages as a result. But Tick wants to take the concept a step further. If the patient sues a doctor and wins, the patient should receive payment for rehabilitation, possible punitive damages, and attorney’s fees.
It doesn’t matter that “addiction” can be either physical or psychologic and that there is no reliable way to determine when addiction occurs. Tick’s bill doesn’t define addiction. It also doesn’t matter that people can get addicted to pretty much anything … alcohol, illegal drugs, porn, gambling, even collecting Cabbage Patch Kids. Tick’s bill only cares about those evil doctors. Beware internet service providers, you could be next on the list if your subscribers get addicted to the internet.
But Tick has good reasons for proposing his bill. Since people lived without drugs before, Pharmacologist Tick doesn’t believe that drugs are the only way to treat pain now. That’s true. Patients in cancer pain could always try incantations and faith healing instead of popping pills. Or patients in pain could bust out some whiskey and a bunch of bullets to bite on … after they take anger management classes so they can purchase the bullets. Oops. That’s Florida. Sorry. Wrong state. Double oops. Alcohol could be addictive. Bad example.
Besides, since children are allegedly taught from an early age to do whatever the doctor says, Neuropsychologist Tick says no one has the free choice whether or not to take addictive pain medicines.
It’s not so much that, at least according to his Twitter feed, Tick seems just all … well … tickled … about seeing his proposal published in newspapers. The scary thing is that people like Tick Segerblom are elected to public office and may be able to regulate our lives.
More comments at Overlawyered.com
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