When Stories Trump Facts in Health Care
http://online.wsj.com/article/SB125182318206476605.html

By ABRAHAM VERGHESE, M.D.

Every time I see a new patient, I take a history.  And the more years I spend in
medicine, the more I make of the patient's story: It resonates with my
repertoire of patient histories and thereby makes me suspect this disease or
that.

But very often the medical history isn't about diagnosis; it's about
acknowledging the patient's story.  I think what frustrates patients more than
anything else is that no one listens to their story. One study found that the
average physician interrupts the patient in less than twenty seconds.  Patients
think we doctors are too willing to slap on  disease labels, or order tests that
are painful and expensive in order to find the right label; or else we seem to
cut up and piece out their problems to specialists so that no one has the whole
story. For doctors, the money is in poking, prodding, needling, cutting, not in
listening to and understanding patients' stories.
I've been reflecting on this lately as I've watched the vigorous debate over how
to change our wasteful, expensive health care system. Stories have turned out to
be much more compelling than facts.

When the Clintons tried to bring about health care reform in the 1990s, it was
the story of Harry and Louise, in slick ads funded by the health insurance
industry, that took hold. The fact that Harry and Louise were fictional
creations of a PR firm mattered little. This year, Harry and Louise are back,
this time in ads that tell a story intended to drum up support for reform.

Perhaps it is a lesson that  President Obama has taken to heart; he is now
frequently telling the story about his grandmother and her death from cancer.
The story is poignant, and it reminds us that no one is spared such experiences.
  My newspaper recently ran pictures of thousands of Los Angelenos lining up for
free medical and dental care; I was struck by a picture of a kid grinning out
with wonder at  a world he could now clearly see through his new glasses. That
story said to me: We have priced so many Americans out of getting any kind of
health care.

Another story rose and quickly faded from view. A newspaper editorialized that
the famous physicist Stephen Hawking, confined to a wheelchair by Lou Gehrig's
Disease, would be dead if he had been forced to rely on Britain's National
Health Service for his care; turns out he's been getting treated by the NHS for
decades.

And we've heard stories of so-called "Death Panels" that would be created in the
future if health reform legislation is passed. These stories seem to have no
basis in fact. They also obscure the fact that many patients in our current
system suffer needlessly at the end of their life, because physicians often feel
that the patient's story is at standstill unless the doctor orders more
treatments, more tests.

But this is exactly the moment when a physician can be of great value by helping
the family and the patient come to terms with illness and death; it is the
moment we can promise to be with them through thick and thin, to blunt pain, to
reduce suffering and anxiety. There is only one ending to all our stories — and
part of the art of medicine is helping patients and families find their way
through a full healthy life to a peaceful end.

Abraham Verghese is a practicing internist and a professor of medicine at
Stanford. His most recent book is Cutting for Stone.

http://www.prweb.com/releases/2008/12/prweb1762194.htm

The Holiday Season is Hazardous to Hospital Patients

Hospital care is especially hazardous to patient health during the
holiday season, as nurse-to-patient ratios increase, temporary nurse
staffing is brought in who aren't familiar with the hospital or its
routine, and physicians tend to be away. This increases the
probability of medical error. Nearly a quarter of a million deaths in
hospitals nationwide were found to be preventable (The Fifth Annual
HealthGrades Patient Safety in American Hospitals Study, 2008).
Martine Ehrenclou, author of the new book Critical Conditions: The
Essential Hospital Guide to Get Your Loved One Out Alive (Lemon Grove
Press) interviewed over 150 doctors and nurses and discovered that
hospital care in crisis. This crisis is exacerbated during the
holiday season. Here are five steps to increase your chances of
surviving a hospital stay between December 24 and January 7.

(PRWEB) December 17, 2008 -- Hospital care is especially hazardous to
patient health during the holiday season, as nurse-to-patient ratios
increase, temporary nurse staffing is brought in who aren't familiar
with the hospital or its routine, and physicians tend to be away.
This increases the probability of medical error. Nearly a quarter of
a million deaths in hospitals nationwide were found to be preventable
(The Fifth Annual HealthGrades Patient Safety in American Hospitals
Study, 2008).

Martine Ehrenclou, author of the new book Critical Conditions: The
Essential Hospital Guide to Get Your Loved One Out Alive (Lemon Grove
Press) interviewed over 150 doctors and nurses and discovered that
hospital care in crisis. This crisis is exacerbated during the
holiday season.

Here are five steps to increase your chances of surviving a hospital
stay between December 24 and January 7.

1. Ask a loved one to act as your eyes and ears during your hospital
stay. There must always be someone--a family member or good friend--
to act as a sentinel or watchdog to oversee your hospital, medical
care in an effort to prevent medical errors. You as the hospitalized
patient cannot do this for yourself as you are recuperating. Ask your
loved one to get a notebook and write down your hospital room, your
physicians' and primary nurses' names and contact information, your
diagnosis, treatment plan and medications.
2. To prevent medication mistakes. Ask your loved one to write down
your medications and dosages and list what the medication looks like,
the shape and color of any pills, the names on the labels of bottles
or IV bags. Because labels and bottles can look and sound alike, ask
your loved one to make sure that they recognize the medication when
it is administered. If they don't, they must ask questions. Your
allergies to medications must be in your chart. Your loved one must
repeat this information to your primary nurse.
3. To prevent surgery on the wrong body part. Your loved one must
accompany you to the operating room and request to see the surgeon.
They must ask this doctor to mark on your body the correct site to be
operated on and which surgery is to be performed. If the surgeon is
not available, your loved one must ask to see the anesthesiologist
and other staff involved in your care and repeat this checklist with
each one.
4. To prevent the spread of hospital-acquired infectious diseases.
Among the most virulent are MRSA and pneumonia. Your loved one must
ask everyone, including physicians and nurses, to wash their hands
and put disposable gloves before touching you. Antibacterial gel
should be placed next to your bed and everyone must be asked to use
it.
5. To prevent patient name mistakes. With each hospital staff member
who either comes to pick you up for a procedure or who is to
administer a treatment, ask your loved one to match your name with
the correct procedure. They must repeat this checklist with each
hospital staff person.

Above all, your loved one should try to be with you as much as
possible. If you are in pain, you don't want to repeatedly call for a
nurse who doesn't come. Patients with involved family members get
more attention. For a short period of time, your loved ones will help
facilitate this. They could save your life.

Martine Ehrenclou, MA, is the author of Critical Conditions: The
Essential Hospital Guide To Get Your Loved One Out Alive, (Lemon
Grove Press) www.criticalconditions.com
Ehrenclou@...

CMS adds two conditions to Medicare do-not-pay list
CMS says it is adding two conditions to its list of preventable medical
complications for which Medicare will not reimburse hospitals. Costs
associated with treating blood clots in the leg after knee or hip
replacement and complications from poor control of blood sugar are now
not eligible for reimbursement. CMS had been considering seven other
conditions for the list but dropped them after protests from the
medical community. Seattle Post-Intelligencer/Associated Press (7/31)

Author Speaks on Medscape   Please view Julia Hallisy's video at www.medscape.com/viewarticle/572742.   Julia A. Hallisy, D.D.S. www.TheEmpoweredPatient.com 595 Buckingham Way, Suite # 305 San Francisco, CA 94132 (415) 681-1011

Doctor speaks out about medical error and single
payer.........................

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and pass it on please.
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Pathologist: Doctor killed Beethoven
http://news.yahoo.com/s/ap/20070828/ap_en_ot/who_killed_beethoven
By GEORGE JAHN, Associated Press Writer Tue Aug 28, 2:16 PM ET

VIENNA, Austria - Did someone kill Beethoven? A Viennese pathologist claims the composer's physician did — inadvertently overdosing him with lead in a case of a cure that went wrong.
Other researchers are not convinced, but there is no controversy about one fact: The master had been a very sick man years before his death in 1827.
Previous research determined that Beethoven had suffered from lead poisoning, first detecting toxic levels of the metal in his hair and then, two years ago, in bone fragments. Those findings strengthened the belief that lead poisoning may have contributed — and ultimately led — to his death at age 57.
But Viennese forensic expert Christian Reiter claims to know more after months of painstaking work applying CSI-like methods to strands of Beethoven's hair.
He says his analysis, published last week in the Beethoven Journal, shows that in the final months of the composer's life, lead concentrations in his body spiked every time he was treated by his doctor, Andreas Wawruch, for fluid inside the abdomen. Those lethal doses permeated Beethoven's ailing liver, ultimately killing him, Reiter told The Associated Press.
"His death was due to the treatments by Dr. Wawruch," said Reiter, head of the Department of Forensic Medicine at Vienna's Medical University. "Although you cannot blame Dr. Wawruch — how was he to know that Beethoven already had a serious liver ailment?"
Nobody did back then.
Only through an autopsy after the composer's death in the Austrian capital on March 26, 1827, were doctors able to establish that Beethoven suffered from cirrhosis of the liver as well as edemas of the abdomen. Reiter says that in attempts to ease the composer's suffering, Wawruch repeatedly punctured the abdominal cavity — and then sealed the wound with a lead-laced poultice.
Although lead's toxicity was known even then, the doses contained in a treatment balm "were not poisonous enough to kill someone if he would have been healthy," Reiter said. "But what Dr. Wawruch clearly did not know that his treatment was attacking an already sick liver, killing that organ."
Even before the edemas developed, Wawruch noted in his diary that he treated an outbreak of pneumonia months before Beethoven's death with salts containing lead, which aggravated what researchers believe was an existing case of lead poisoning.
But, said Reiter, it was the repeated doses of the lead-containing cream, administered by Wawruch in the last weeks of Beethoven's life, that did in the composer.
Analysis of several hair strands showed "several peaks where the concentration of lead rose pretty massively" on the four occasions between Dec. 5, 1826, and Feb. 27, 1827, when Beethoven himself documented that he had been treated by Wawruch for the edema, said Reiter. "Every time when his abdomen was punctured ... we have an increase of the concentration of lead in the hair."
Such claims intrigue others who have researched the issue.
"His data strongly suggests that Beethoven was subjected to significant lead exposures over the last 111 days of his life and that this lead may have been in the very medicines applied by his doctor," said Bill Walsh, who led the team at the U.S. Department of Energy's Argonne National Laboratory outside Chicago that found large amounts of lead in Beethoven's bone fragments. That research two years ago confirmed the cause of years of debilitating disease that likely led to his death — but did not tie his demise to Wawruch.
"I believe that Beethoven's death may have been caused by this application of lead-containing medicines to an already severely lead-poisoned man," Walsh said.
Still, he added, samples from hair analysis are not normally considered as reliable as from bone, which showed high levels of lead concentration over years, instead of months.
With hair, "you have the issue of contamination from outside material, shampoos, residues, weathering problems. The membranes on the outside of the hair tend to deteriorate," he said, suggesting more research is needed on the exact composition of the medications given Beethoven in his last months of his life.
As for what caused the poisoning even before Wawruch's treatments, some say it was the lead-laced wine Beethoven drank. Others speculate that as a young man he drank water with high concentrations of lead at a spa. "We still don't know the ultimate cause," Reiter said. "But he was a very sick man — for years before his death."

The Beethoven Journal is published by the Ira F. Brilliant Center for Beethoven Studies at San Jose State University in California.

___

On the Net:

http://www.sjsu.edu/depts/beethoven/

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See what you’re getting into…before you go there See it!

 

 

http://www.npr.org/templates/story/story.php?storyId=11781527

 

Nation

Two Doctors in British Bomb Plot Contacted U.S. Group

NPR.org, July 6, 2007 · Two doctors arrested in connection with last week's failed car bombings in Britain took steps to apply for graduate, medical education in the United States, the FBI confirmed on Friday.

FBI spokeswoman Nancy O'Dowd confirmed that neurologist Mohammed Asha and another suspect contacted the Philadelphia-based Educational Commission for Foreign Medical Graduates, as reported by The Philadelphia Inquirer. The organization certifies the qualifications of doctors trained outside the U.S. to work as medical residents in the U.S. hospitals.

O'Dowd said Asha, a Jordanian of Palestinian heritage, contacted the agency within the last year, but apparently did not take the test for foreign medical school graduates.

"He was applying, (but) we don't believe he took the test," she said.

O'Dowd said FBI agents visited the commission's office this week, but she did not identify the second suspect. The second suspect was not named in the Inquirer article.

Asha and his wife were arrested in Britain on Saturday night. In Jordan, security officials said Asha had no criminal record. Friends and family said they found it hard to believe either he or his wife was connected with terrorism.

As police continue to question the eight suspects — six Middle Easterners and two Indian nationals — Britain's intelligence agencies are focusing on the suspects' international links, a British intelligence official and a government official said on condition of anonymity.

The government official said they are investigating links to Iraq and other countries.

MI5, Britain's domestic intelligence agency, said on its Web site that some Britons have joined the Iraqi insurgency and could return to mount attacks in the U.K. "British and foreign nationals linked to, or sympathetic with, al-Qaida are known to be present within the U.K. They are supporting the activities of terrorist groups in a range of ways," MI5 officials said on agency's Web site.

But the metropolitan police, who are leading the investigation into the failed bombing attacks in London and Glasgow, Scotland, refused to confirm or deny the role the MI5 and MI6 are playing in the probe.

The eight suspects arrested in Saturday's airport attack and two failed car bombings a day earlier in London were all foreigners working for Britain's state health system, and investigators are trying to find out what brought them together.

In Australia, police on Friday seized computers from two hospitals as they explored connections between the British plotters and Muhammad Haneef, an Indian doctor arrested there.

"There are a number of people now being interviewed as part of this investigation; it doesn't mean that they're all suspects but it is quite a complex investigation and the links to the U.K. are becoming more concrete," said Australian Federal Police Commissioner Mick Keelty.

Meanwhile, Muslim groups in Britain placed advertisements in British national newspapers in praise of the emergency services and declaring that terrorism is "not in our name."

The ads from the Muslims United coalition also quoted the Quran: "Whoever kills an innocent soul, it is as if he killed the whole of mankind. And whoever saves one, it is as if he saved the whole of mankind."

In Britain, police are still trying to determine if the failed bombings were the work of a small group of people within the country, or part of an international plot. Investigators are still searching the homes and offices of the eight suspects arrested in the case.

One of the suspects was arrested in Australia this week. Investigators there said they raided two hospitals in western Australia and seized computers and files. Australian Federal Police Commissioner Mick Keelty said investigators are trying to gather information about a possible terror network.

"At this stage no one is charged, but it's a very complex and important investigation in support of the investigation in the U.K.," he said.

The Australian investigation is focused on a Perth man who had contact with Muhammed Haneef, an Indian doctor, who was arrested as he tried to board a plane to leave Australia. Police questioned four other men in connection with the case.

British Prime Minister Gordon Brown said police are making significant strides in the investigation.

"From what I know, we are getting to the bottom of this cell that has been responsible for what is happening," Brown said in an interview with British Broadcasting Corp. television.

Brown said Britons should expect intensified security checks in the weeks ahead as the country's terrorism threat level remains at "severe," meaning further attacks are considered likely.

"Crowded places and airports, I think people will have to accept that the security will be more intense," Brown said. "We have got to avoid the possibility - and it is very, very difficult - that people can use these crowded places for explosions."

A number of major, public events are under way now, or about to begin, including the Wimbledon tennis tournament, the Tour de France in London and a Live Earth concert.

There are also several ceremonies on Saturday to mark the second anniversary of London train bombings that killed 52 people and wounded more than 700 on July 7, 2005.

From NPR and The Associated Press reports

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Former physician resentenced to eight years probation

By PATRICK MALONE
THE PUEBLO CHIEFTAIN

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http://www.nytimes.com/2006/11/14/opinion/14mccaughey.html?_r=1&th&emc=th&oref=slogin

 

November 14, 2006

Op-Ed Contributor

To Catch a Deadly Germ

By BETSY McCAUGHEY

WHAT kills more than five times as many Americans as AIDS? Hospital infections, which account for an estimated 100,000 deaths every year.

Yet the Centers for Disease Control and Prevention, which are calling for voluntary blood testing of all patients to stem the spread of AIDS, have chosen not to recommend a test that is essential to stop the spread of another killer sweeping through our nation’s hospitals: M.R.S.A., or methicillin-resistant Staphylococcus aureus. The C.D.C. guidelines to prevent hospital infections, released last month, conspicuously omit universal testing of patients for M.R.S.A.

That’s unfortunate. Research shows that the only way to prevent M.R.S.A. infections is to identify which patients bring the bacteria into the hospital. The M.R.S.A. test costs no more than the H.I.V. test and is less invasive, a simple nasal or skin swab.

Staph bacteria are the most prevalent infection-causing germs in most hospitals, and increasingly these infections cannot be cured with ordinary antibiotics. Sixty percent of staph infections are now drug resistant (that is, M.R.S.A.), up from 2 percent in 1974.

Some people carry M.R.S.A. germs in their noses or on their skin without realizing it. The bacteria do not cause infection unless they get inside the body — usually via a catheter, a ventilator, or an incision or other open wound. Once admitted to a hospital, these patients shed the germs on bedrails, wheelchairs, stethoscopes and other surfaces, where M.R.S.A. can live for many hours.

Doctors and other caregivers who lean over an M.R.S.A.-positive patient often pick up the germ on their hands, gloves or lab coats and carry it along to their next patient.

The blood-pressure cuffs that nurses wrap around patients’ bare arms frequently carry live bacteria, including M.R.S.A. In a recent study at a French teaching hospital, 77 percent of blood-pressure cuffs wheeled from room to room were contaminated. Another study linked contaminated blood-pressure cuffs to several infected infants in the nursery at the University of Iowa hospital.

Among developed nations, the United States has one of the worst records of curbing drug-resistant infections, according to the Sentry Antimicrobial Surveillance Program, an international effort to monitor drug-resistant germs. In this country, M.R.S.A. hospital infections increased 32-fold from 1976 to 2003, according to the C.D.C.

In the 1980s, Denmark, Finland and the Netherlands faced similarly soaring rates of M.R.S.A., but nearly eradicated it. How? By screening patients and requiring health care workers treating patients with M.R.S.A. to wear gowns and gloves and use dedicated equipment to prevent the spread. The Dutch called their strategy “search and destroy.”

A growing number of hospitals in the United States have proved that such precautions work here, too. Recently, a pilot program using screening at Presbyterian University Hospital, in Pittsburgh, reduced M.R.S.A. infections by 90 percent. At a Yale-affiliated hospital in New Haven, screening reduced M.R.S.A. infections in intensive care by two-thirds.

And a recently completed nine-year study at the Brigham and Women’s Hospital, in Boston, found that screening led to a 75 percent drop in M.R.S.A. bloodstream infections among intensive-care patients and a 67 percent decline throughout the hospital. Earlier efforts to stop these infections by installing many more dispensers of hand cleanser and conducting a yearlong educational campaign on hand hygiene had no effect.

Some public health advocates recommend screening only “high-risk” patients — those who recently have been hospitalized, live in nursing homes or have kidney disease. Partial screening is somewhat effective, but universal screening prevents the most infections.

Can hospitals afford to screen for M.R.S.A.? They cannot afford not to. Infections wipe out hospital profits. When a patient develops an infection and has to spend many additional weeks hospitalized, Medicare does not pay for most of that additional care.

Treating hospital infections costs an estimated $30.5 billion a year in the United States. Prevention, on the other hand, is inexpensive and requires no capital outlays. A pilot program at the University of Pittsburgh found that screening tests, gowns and other precautions cost only $35,000 a year, and saved more than $800,000 a year in infection costs. A review of similar cost analyses, published in The Lancet in September, concluded that M.R.S.A. screening increases hospital profits — as it saves lives.

Yet, for a decade, the C.D.C. has rebuffed calls for screening, most recently from a committee of the Society for Healthcare Epidemiologists of America. C.D.C. officials claim that more research is needed to prove the benefits of screening. More research cannot hurt, but we know enough already to move ahead.

Some hospitals are leading the way, including Evanston Northwestern, in Illinois; the Veterans Affairs medical centers; New England Baptist Hospital, in Boston; and Johns Hopkins Hospital, in Baltimore.

The C.D.C.’s lax guidelines give many other hospitals an excuse to do too little. Every year of delay costs thousands of lives and billions of dollars.

Betsy McCaughey, a former lieutenant governor of New York, is the founder of the Committee to Reduce Infection Deaths.