Hospital-Based Medicine

Steve Jobs received a new liver, and the ethics surrounding his transplant

Orac, a general surgeon who blogs at Respectful Insolence, writes the most comprehensive entry I’ve seen thus far on Apple’s Steve Jobs’ liver transplant.

For those interested in the medicine behind the transplant, go and read his post in its entirety. I’d like to highlight some of the potentially questionable ethics surrounding the case.

For one, there is the question why Mr. …

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Nighthawks, dayhawks, and the demise of the American radiologist

More hospitals are resorting to so-called “dayhawk” radiology services to read their x-rays.

It’s modeled after the “nighthawk” model, where radiologists (via Shadowfax), in some cases as far away as India, remotely read films in the middle of the night.

Now, the phenomenon is happening during business hours as well, which according to radiologist Giles W. L. Boland, means that “some radiologists can no longer assume long-term …

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Did the Canadian health system fail Natasha Richardson?

Would Natasha Richardson be alive today if she had gone skiing in the United States instead?

I don’t think it would have made a difference.

To recap the tragedy, Ms. Richardson died from an epidural bleed, after she fell while skiing. Her presentation was somewhat classic, with the well-described “lucid” period before she deteriorated.

According to Canada’s Globe and Mail, “ambulance workers were not …

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Her hands and feet amputated, a Brazilian model dies from Pseudomonas aeruginosa sepsis. What happened?

Mariana Bridi da Costa, a 20-year old Brazilian model, tragically died early Saturday morning from Pseudomonas aeruginosa urosepsis.

How can this happen?

Miss Bridi da Costa initially presented on December 30th, and was diagnosed with kidney stones. An ultrasound, plain film, or CT scan likely would have been done to confirm the diagnosis. I assume that a urinalysis was also performed, and if …

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Tom Brady and his knee infection

New England Patriots quarterback Tom Brady recently underwent repair of his anterior cruciate ligament at the Kerlan-Jobe Orthopaedic Clinic in Los Angeles. His doctor was Neal S. ElAttrache, who’s a renowned orthopedic surgeon and former team physician of an NFL team.

Unfortunately, his post-op course has been complicated by an infection. On his website, TomBrady.com, he acknowledged this and said that the original procedure was …

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Are MRI results accurate?

Most physicians and patients think that the MRI scan is one of the more sensitive and comprehensive diagnostic tests.

However, there is significant variability in reading and performing the scans, which makes having it done at a reputable institution more imperative:

Magnetic resonance machines, though, vary enormously, and not just in the strength of their magnets. Even more important, radiologists say, is the quality of the imaging …

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Bernie Mac, pneumonia, and sarcoidosis

Comedian Bernie Mac dies at age 50 from pneumonia. Sad news.

He had been recently hospitalized, and as recently as two days ago, it was reported he was stable and responding well to treatment. What happened?

There is very little medical information to go on. It was known that he had …

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Defensive medicine

What is defensive medicine?

Defensive medicine is the deviation from sound medical practice to avoid the threat of malpractice litigation.

According to a 2005 study in JAMA, over 90 percent of physicians surveyed admitted to practicing defensive medicine. This can range from “positive” defensive medicine, like ordering unnecessary tests, referring to consultants, or performing unneeded procedures; to “negative” defensive medicine, like avoiding high-risk patients or procedures.

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Do nurses complain too much?

Scalpel likens nurse complaints to how lawyers consider lawsuits:

Nevertheless, it seems to me that many nurses will complain about each other and about physicians at every opportunity. They will fire off e-mails to their bosses, my bosses, or even the CEO of the hospital about any disagreement or perceived mistreatment, whether or not it affects patient care. Everyone has to walk on eggshells or we will end up …

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A former colleague comments on Dr. Anna Pou

Due to intense interest in the Anna Pou story, the following post will be republished to stay current.

Original post date: 7/19/2006

Waking Up Costs offers his support:

I just learned that a former colleague and friend has been charged with second degree murder in the death of four patients at a New Orleans hospital after Katrina. I worked with Dr. Anna Pou in the operating …

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Tedy Bruschi’s patent foramen ovale (PFO) caused his stroke

It was just reported that Tedy Bruschi is undergoing surgery for a hole in his heart:

New England Patriots linebacker Tedy Bruschi — who once played for the University of Arizona – is back in the hospital tonight, according to sources in Tucson and Boston.

The team isn’t confirming this news yet, but KOLD News 13 has learned Bruschi is undergoing surgery to repair a hole in his heart. …

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Possible causes of Tedy Bruschi’s stroke

As has been reported, Patriots linebacker Tedy Bruschi has been hospitalized with some kind of intracerebral bleed. As one can imagine, this is big news here in New England.

Here’s what we know so far:

Patriots linebacker Tedy Bruschi will remain hospitalized while he undergoes additional tests after suffering a broken blood vessel in his head, a Patriots team source told The Boston Globe on Thursday.

Bruschi, …

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Are testicular biopsies necessary for the diagnosis of testicular cancer?

Man sues over “botched” testicular surgery: Another frivolous lawsuit?
“A man is suing a hospital and one of its surgeons, claiming one of his testicles was wrongly removed during surgery.

Danny Curtis claims the surgeon at Kern Medical Center did not conduct a biopsy before arranging urgent surgery to remove a testicular tumor in July 2004, according to the lawsuit filed in Kern County Superior Court.”

I …

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