Hospital-Based Medicine

Driving to the hospital and heart attacks

Less than half of heart attack victims in a recent study arrived to the hospital via ambulance. When in doubt, call 911:

. . . as many as 5% of patients go into cardiac arrest en route to the hospital “” a very, very good time to be snug inside an ambulance rather than the family SUV. And a growing number of ambulances do electrocardiograms on the way …

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Diagnosing XDR TB

Andrew Speaker’s diagnosis was downgraded. Now Robert Daniels, who was being held under armed guard, also doesn’t have XDR TB. Seems there is tremendous difficulty in pinning down this dangerous diagnosis:

Nevertheless, labs testing for drug resistance often come to different results, said Charles Daley, who oversees TB care at the Denver hospital that re-diagnosed both patients. He discussed Speaker’s case earlier this month. “It happens all …

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Chiropractors and carotid dissection

Paul Levy is wary about this association:

A few years ago, a very good friend of mine suffered a stroke from a dissected carotid artery. Once they had an image of her neck and saw the damaged blood vessel, one of the first questions the attending neurologist asked was, “Has she been to a chiropractor recently?” In fact, every single neurologist who saw her in subsequent weeks asked the …

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Hedge fund managers vs doctors

Who wins the salary competition and why:

. . . society perceived that the pricing mechanism for doctors’ services was broken. That is, if the free market set the price, many citizens would not be able to afford to pay. And society believes implicitly that health care should be widely available to citizens. (That doesn’t mean everybody. 40 million Americans are not covered by health insurance but many of them …

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Pediatrician mistaken for pedophile

Staggering ignorance by a bunch of vandals:

A paediatrician at a south Wales hospital has been forced out of her home by vandals who thought her job title meant the same as “paedophile”.

South African-born Yvette Cloete woke up at her home in Newport to find the term “paedo” spray painted all over her walls.

The specialist registrar at the Royal Gwent Hospital is now in hiding at …

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Missed sepsis in the ER

An ER nurse tells a recent story of how delayed notification of blood culture results led to this outcome:

Now the family has hired an attorney to look into the matter. Could that man have been saved if he had been told to come back to the hospital and was admitted and treated sooner? Hard to say. Maybe.

Lawyers finished destroying medicine, move on to veterinarians

A poignant letter in the WSJ:

I worry about the unintended consequences of the actions to increase the potential compensation to the owners. One only has to look at the increased costs of medical care for humans that are a direct result of malpractice lawsuits to see that a similar situation could occur with vets. My dog has epilepsy and we spend a lot of time and money at the …

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Michael Moore’s Sicko

One stunt is detailed in the NY Post. Get ready for some single-payer love in his upcoming film:

Filmmaker Michael Moore’s production company took ailing Ground Zero responders to Cuba in a stunt aimed at showing that the U.S. health-care system is inferior to Fidel Castro’s socialized medicine, according to several sources with knowledge of the trip . . .

. . . But the sick sojourn, …

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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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TIME.com on the "Pharma Babes"

Despite appearances, some physicians and hospitals are forced to rely on reps:

. . . the most urgent reason we need our reps is that hospitals are low on trained staff these days. With the myriad parts and pieces it takes to do a spine fusion, knee replacement or robotic prostatectomy, operating room staffs need help keeping the trays and trays of little parts organized and ready for action. In …

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Buddhist beliefs and end-of-life care

An ugly dispute involving a brain-dead patient’s religious beliefs and Boston’s BI-Deaconness leads to court:

Last week, doctors declared Cheng, a grandfather of seven who suffered cardiac arrest the day after Thanksgiving, brain-dead and said it was time to remove him from the ventilators and intravenous medicines keeping his organs functioning.

But the family refused to let doctors take Cheng off the life-support system because his heart was …

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How pain patients are treated like criminals

A responsible narcotic-using pain patient writes:

I no longer go to emergency rooms for help with any pain. They might fix my broken bone but then ask, “How many hospitals do you go to to try to get extra drugs?” One ER doctor told me to “go home and play your little drug games.”

Problem is, for every responsible narcotic user, you have another hundred who play the drug …

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Dr. Anna Pou: Here comes the lawsuit fallout

People are going after the hospitals:

The deaths at Uptown’s Memorial Medical Center during the stifling, dark hours after Hurricane Katrina have spawned more than the highly publicized arrests of a doctor and two nurses on murder charges. A predictable thicket of civil lawsuits has also sprouted, records show.

Two suits filed at Orleans Parish Civil District Court concern the deaths of five patients at Memorial, some of them …

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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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The Alaska Board of Medicine admits a mistake and apologizes to a physician. “Shaking with emotion, Murphy said the board established a ‘scary precedent’ by jumping in during an incomplete hospital review of a doctor and suspending that doctor before due process could be completed.

Murphy was referring to the board’s decision to suspend her license based on reports the board received about the Alaska Regional Hospital review.”

Can EMTs be sued for malpractice?

“The wife of a man whose death came under investigation after a San Francisco Fire Department ambulance crew failed to take him to the hospital said Tuesday that rather than helping her husband, the crew had talked him out of getting treatment.

‘He was complaining about his heart,’ Sheila Narcisse Potter said of her husband, Elissa Potter Jr., 59. ‘They kept saying, …

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