Demystifying Medicine One Month at a Time

Category: medical errors (Page 2 of 2)

Let the Buyer Beware

August. And online first.

Some colleagues and I had an editorial published in an academic journal last week.

I’ve written about the topic before. My colleague and I were ticked off that more and more of our patients seem to fall prey to the marketing hype around cash-based, no-doctor-order-required commercial screening tests.

Don’t get me wrong: I’m all for do-it-yourself medicine, provided you have some knowledge, motivation, a good attitude, and know how to get help when you need it. I also applaud the right of people to spend their money the way they want–on entertainment, or medical tests–or hey! medical tests as entertainment.

But what I don’t like is when marketers scam people. Over-sell them, over-promise them, and sell them things they don’t necessarily need to make a buck. And do it under the guise of  this could save your life!!

And tell it to you at church. Or the shopping mall. Where you’re easy prey.

What my colleagues and I want is for these commercial screening entities is to come clean: tell the customers which of these tests are actually indicated–that’s medicalese for appropriate–otherwise, people are just getting a bill of goods. Well-intentioned customers wind up with either false reassurance (the test was never indicated so of course it wouldn’t find something) or worse, unnecessary anxiety (these tests find things that require follow up-even when they shouldn’t have been done and the ‘finding’ is benign).

It’s simple, really: a disclaimer of some sort.

The problem with that is it affects their business model–their profits are predicated on being able to sell these tests to everybody, not just subsets of patients at higher risk. They prey on our naive beliefs that

  • a) more tests are good
  • b) tests are infallible and
  • c) they wouldn’t offer these tests if there was any chance of harm. Right?

When we’ve called companies that do this locally, we’re told that these are ‘recommended’ tests. For anyone.

Come clean, commercial screeners! We’re on to you…

Show & Tell

Came across this video from preventive health expert (and family doctor) Mike Evans of Toronto.

Saw it in some “Best of 2011” health roundups. At that point, it had a couple hundred thousand views. It’s shot up to over 1.5 million (and climbing) at this point. [To watch, click on the play button in the center of the window.]

It’s doubly captivating: the animation is simple, clean, and superb. The information is deep, but the message is startlingly clear–and laid out in the fashion of an argument with irrefutable logic.

Imagine a medicine so potent it could reduce both the absolute risk of death and treat a number of different chronic conditions with tremendous success. You’d probably want some, right?

The video is only nine minutes, and well worth it. Makes you think–and makes doing the right thing sound simpler and thus more possible for all of us:

 

Also, a couple of interesting x-ray photos to share.

You may remember a previous post about how I admired the orthodontic practice where we take our daughter. Turns out in even the most well-run practice things don’t always go right:

Not a candy cane, fish hook, or leprechaun's walking stick.

Two mornings later, the piece had clearly moved down the GI tract.

Two days later. Ready for expulsion?

I just thank heaven that the human body is a) so smart and b) so resilient. Maybe that external headgear wasn’t such a bad thing, after all.

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Programming note: If you’re an NPR fan, try to catch the show Marketplace this week for some interesting commentary. Stay tuned for further details.

Whoops!

I write this blog to try to bring transparency to medical practice. In trying to explain and demystify medicine, I’ve found that I use my ‘patient hat’ to explore topics that you want to know about. Even when I wear my ‘doctor hat,’ there are many things that remain inexplicable to me.

As one example, I’ve often wondered: Who had the shocking boldness to try stimulants on people with attention deficit disorder?

Here’s how I imagine that conversation must have gone:

Mmm Mmm Good!

Psychologist: We keep getting these hyperactive kids referred to us for therapy. I wish there was some pill we could give them to calm down.

Researcher: Have you tried sedatives?

Psych: Yes, but the parents complain that their kids just sleep all the time and aren’t doing better in school.

Researcher: Wait! I know! Let’s give them Ritalin and see what happens!

Psych: [Groans.] Oh sure, great idea! Take some amped up kids and give them uppers. Yeah, that’ll work.

I remember learning about this in medical school. It still doesn’t make any sense to me. But it works. Was it clever neuroscience or just dumb luck?

Similarly, there are often examples of medical errors where the natural reaction is, “How on earth could that happen?”

The most outrageous of these are the stories of wrong site surgery. Imagine going in to have part of your leg amputated (not so easy, I imagine) then waking up to find out the wrong leg had been removed. That would be pretty upsetting. This is the reason that medical authorities have come up with the idea of “never events:” things that should never be tolerated in the world of medicine.

Well, add one more to the list.

Last month a hospital in the U.S. admitted that a kidney was transplanted into the wrong patient. Oops!

As egregious as this seems, it’s not so difficult to imagine. All kidneys look pretty much the same. And even though they are typed (i.e. blood typed) and have identification, it can be easy to confuse things like “the type O kidney goes into the blood type B patient (type O is acceptable to anyone)” or “we need to save that type O kidney for this type O patient.”

Huh? I’m confused already, and we’re only talking about one kidney. Imagine having several operating rooms going at one time (multiple donors and recipients), and you can imagine it’s not that hard to get confused. One transplant surgeon told me that at big centers that do multiple transplants on the same days, the error that happened is not all that far-fetched.

Two good things happened here:

  1. The recipient of the wrong kidney didn’t wind up getting sick or rejecting the kidney, since in fact it was a type O (universally accepted) kidney.
  2. The hospital admitted its error and apologized for the mistake. Oh wait. At least I hope they did. They did in fact temporarily shut down their program to investigate the error and hopefully find ways to prevent something like it from happening again. [As of this post, they are up and running again.]

Which gets me to the bottom line of this week’s post: March 6-12th is national Patient Safety Awareness Week, so declared by the not-for-profit National Patient Safety Foundation. If you’re interested further, there are some worthwhile blog posts and podcasts offered up on the interesting “Engaging the Patient” blog, hosted by the for-profit, but high-purposed, Chicago-based Emmi Solutions. [Imagine: a business created around the idea of improving patient experience…..]

I’d be interested in your thoughts on the quality and content of their blog. Anyone knowing the origin of psychostimulants for ADD is also encouraged to comment.

GlassHospital

 

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