Big hospitals forget who is important - the patient

A while back I read an article about how surgeons at Mass General were double booked for surgery and the hospital policy was okay with this. Double booking is when the surgeon is responsible for two surgeries going on at the same time. A follow up was published yesterday to show the results of this expose and whistle blowing by Dr. Dennis Burke.

"Burke was at the center of the Globe Spotlight Team’s report in October about the propriety and safety of a fairly common practice called concurrent surgery, or double-booking, in which doctors work on more than one patient at a time."
And as long as the doctor is within 1/4 mile of the hospital during both surgeries this is okay. And that's the new policy instituted by MGH as a result of the story. Really? I don't consider this that okay at all. I would not want the patient where the surgeon wasn't even in the room. I assume the surgeon is responsible for the surgery should be in the room at all time.

Burke is uncompromising on the issue. He called it unsafe and unethical, embracing a cautious approach that I think most of us expect from the doctor wielding the scalpel.The hospital's response to this article was appalling. They fired the man who spoke up about this issue. He was a physician at the hospital and ended up moving on to a new hospital, and all his patients followed him.

The hospital disagreed. MGH said it has taken careful steps to assure patient safety. The hospital accused Burke of violating hospital rules and perhaps federal privacy laws by supplying the Globe with copies of some internal records.
Being a whistle blower is a hard thing to do. And by being fired by the hospital, he has become a hero to others. 

"Burke thinks MGH and its advisers blundered by terminating him. “Probably the stupidest thing they did was to fire me,’’ he said. “If they didn’t, this wouldn’t be such a big story.’’

But it is. And that may explain why nearly 300 people turned out at the Fairmont Copley Plaza on Friday afternoon during a risk management seminar sponsored by Harvard Medical School to hear Burke’s version of events and why he believes concurrent surgery is unacceptable.

When he was done, the audience stood as one amid resounding applause." 

Who do you want for your surgeon? One that is up to 1/4 mile away while you are in the OR or the one who said this was wrong? The patient is the most important person here and their safety should be utmost.

The patient hand off

How many times have you been the patient and been handed off from one shift to the next? And  how often does that happen in a slightly overheard conversation between one nurse and the next or one doctor to the next? There never seems to be a formal system of it and it always seems to be rushed. It is a key place where misunderstandings over a patient's care can occur which result in medical errors.

I have learned things about my care from hearing the nurse tell the next nurse that my gall bladder surgery did result in some fairly significant internal bruising during the surgery. The nurse had previously told me that it wasn't that bad and should clear up in a day or two. I also learned that during my knee surgery I had become agitated during the surgery for an unknown reason and should be watched in case I was having a problem with the anesthesia. During a hospitalization I learned that I was doing well but my pain levels were running a little high (I already could tell them that).

Little rushed conversations in the corner or on the side of a busy hallway while updating a patient's file are not in the best interest of the patient. Especially if the nurse tells the next nurse about several patients without time for note taking - can  you say confusion?

Children's Hospital in Boston has come up with a team approach where the full team participates. This has cut medical errors in half. Maybe I should be a kid again and  go there for my next procedure? Or I hope that other hospitals follow suit.

The FDA - a little background

We all love to hate the FDA. I mean they are the people that take food off the market, have all these rules and things that make food cost more, delay the acceptance of new medications, and cause pharmaceutical companies to have all these years of research driving up their 'costs' (which get paid by patients in the end, one way the other).

So why do we have an FDA? How did that happen? I never really knew or thought much about it. I just thought it was another one of those big Washington based alphabet agencies making rules and spending the public's money.

I try to assume that people are going to do the right thing and not rob, steal, or corrupt. People generally do mean to do their best and help others. But this is not always true,  hence the reason for all the government and policing.

Meat packing plants were a wealth of horrors. Its surprising more did not die from food from them.
It is a well known fact that the nineteenth, and probably earlier, centuries were full of patent medicines where you might kill yourself thinking you were healing yourself. Who knew what was in them. These were exposed in an article called "The Great American Quackery" which ran in Colliers Magazine in 1905. This resulted in the Pure Food and Drug Act of 1906.

Finally in 1938, after over 100 people died from taking a patent medicine full of a toxin, the Pure Food and Drug Act was passed which required manufacturers to prove their products were safe. This lead to the creation of the Food and Drug Administration.

So that is your little history lesson for the day. I am heading out for a dentist appointment on this rainy morning....

Life in a paranoid society

I go to the gym - the new high tech, cool gym, where I don't stand around like an idiot looking at the machines trying to figure out how to use them - and everyone there carries around the sanitary wipes to protect from germs. So I don't look like an idiot, I use them too but I really don't think they do much more than move the germs around... My theory is I wash my hands before I work out and after. A little soap and water goes further than the little wipe things.

If you ride a subway, bus, or any other public transportation (taxi anyone?), think about the germs you touch, breath, etc. Or grocery carriages? Or entrance and exit doors to buildings? Or those wheel chairs at hospitals and airports? Or... and the list goes on.

Then its headlines that a hospital notifies people of TB exposure - that's almost as important as a data breach at a bank. Or you hear about cases of measles, HIV, head lice, or other contagious diseases. And what does it do? Make us all paranoid. We are going to get a germ and DIE! We are doomed! No need to wait for the real Rapture, a germ will get us in the meantime. (Did you scratch your head after I said 'head lice'?)

Personally I don't think a little dirt or germs really hurt us. They allow us to build up some natural immunities which protect us from the really nasty stuff. I mean there is no need to hang out with someone with the flu but there is also no need to go overboard with disinfectants. And they are only building disinfectant resistant germs anyway.

But yes it is all in your head, they are not out to get us. If you don't believe me, I'll cough some cancer cooties in your direction.

We are what we eat

I care about what I put in my body. I prefer my own cooking because I know where my food comes from and can limit the amount of salt and oils that go in my food. I prefer to shop locally - from farmers markets, CSA's and farm stands. I do use the local grocery stores but am picky. I do not buy produce and eggs in the grocery store unless it is an emergency. (Its hard to have a vegetable emergency I know but sometimes they do happen.)

I have concerns with the food supply regarding produce, poultry and dairy products. I don't like the idea of factory farms. I don't like the idea of farmed fish. I really don't like the idea of farmed fish or factory farmed meat from outside the US. How clean is the water the farmed seafood was in a Third World country who has water supply problems and is used as a dumping area by factories who face no regulations in regards to toxic waste? I don't know.

I prefer to get my food as close to home as possible. If I really want to I can go visit the live chickens at the local farm stand before purchasing them for dinner. I liked that idea when I was 5. Now I have decided they are too cute to eat so I skip that step and just eat them.

I was concerned that the food safety bill might not pass and was pleased to see that it did pass yesterday. The previous regulations dated from 1938 which was before the import of vast quantities of preserved and fresh foods. The world has changed and the regulations need to change as well. Some can argue that this gives the government too much power but please explain that to the people who died last year from salmonella and e.coli contaminated food.

What I like about the bill is:
- it makes it easier to find out where the contaminated food originated. I didn't understand why it would takes weeks to figure out where the spinach was grown that was contaminated.
- it empowers the FDA to pull food from the shelves without waiting for the manufacturer to voluntarily recall it.
- it ensures that imported food meet US safety guidelines. Why are we eating food from a country where we are told not to drink the water because it is not safe?

There is a lot more in the bill but this is what I like about it. It may mean more control but I think I like these parts.

Thoughts on chaperones

When I hear the word 'chaperone', I think of young ladies in the 19th century who were not allowed in the presence of a male who was not a relation without a chaperone. Or of a parent or teacher who chaperones a school dance. Or of an escort through a business office to make sure the visitors don't stray.

But what about medical chaperones? The kind who is in the room when a male doctor does an exam on a female patient. Do we need those? I don't know. If I am wide awake and able to speak up if I feel the doctor is inappropriate, I usually am comfortable without a chaperone in the room. I don't feel this as much of an issue. Also, usually if there is any kind of internal exam often there is someone else in the room to pass instruments, swabs, and other thingies.

I think I am more concerned when I am sedated and helpless and couldn't speak up. I think I assume that while I am unconscious in surgery, there are multiple people pretty much at all times and while I am in recovery, waking up, there are nurses near by and you are openly visible as they want to monitor you.

If I am lucky enough to be hospitalized, I keep my room door shut at all times. I hate it when people walk by and look into my room. Now does this mean I am taking a risk because someone in passing can't see in to make sure I am safe?

I think this isn't just a matter of patient safety but also of comfort level. I need my privacy to be respected. I prefer to be in private and am usually comfortable that way. But on the other hand, what about safety too? Where do you want to draw the line and what are your expectations? You decide.

How does this work?

The latest medical recall has Johnson & Johnson recalling hip implants. So, if you got one of those and its recalled, how are you supposed to send it back? Do you have surgery to take it out and get a new one?

This is the same thing when they recall medical stents - how do you take it back to the dealer and get a new one? Or do you just walk around with a little time bomb inside you that isn't going to work as expected? I mean if you have a Toyota, you take your car back to the dealer and they fix what was wrong. I don't mean to pick on Toyota but they seem to have recalls weekly - I guess that QA got overlooked there for a bit.

I simplified the salmonella egg problem in our house. I ditched the last of the store bought eggs and bought some from the local farm stand which raises their eggs there. I avoided the tylenol recalls by buying the safe store brands. But if you had a hip replacement, how do you give it back?

I don't know. None of these recalls makes me feel particularly safe and comfy. It goes back to the question should we all be living in a cave somewhere so we can be safe?