b.cognosco

Just Out: New Book On Solving Health Care Crisis

terrywfrazier@gmail.com — Sun, 01 Jun 2008 23:54:23 GMT

I just read about the new book, Solving America's Health Care Crisis by Dan Perrin and Pat Rooney, in the Downsize DC newsletter. Downsize DC is an organization with principles of downsizing government and personal responsibility that I support. So I went to Amazon to check out the reader reviews. The book is new - released May 2 - so there aren't a lot, but all eight of them are 5-star ratings.

I'll be checking this out. Health care in the US clearly needs an overhaul, and Euro-style social medicine is equally clearly not a useful answer. Government never, ever, runs anything like health care (or education, welfare, or anything else) effectively, instead creating an ever-growing bureaucracy that produces less and less for more and more dollars. Hopefully Perrin and Rooney and provided a roadmap to a system that gets people the health care they need with the proper incentives to keep costs under control.

Why You Need To Be As Smart As Your Doctor

terrywfrazier@gmail.com — Tue, 15 May 2007 19:38:00 GMT

In August of last year a 43-year-old woman undergoing chemotherapy treatment for nasal cancer died after receiving a massive overdose of the chemotherapy drug flourouacil. According to an Incident Report (pdf) issued by the Institute of Safe Medicine Practices Canada the dose was miscalculated by two different nurses and incorrectly programmed into an electronically-controlled pump. The woman was then sent home, where the pump poured four (4) days worth of drug into her in four (4) hours.

When the woman returned to the cancer clinic to report the problem a nursing supervisor contacted the doctor on call and was told nothing could be done - there was no antidote - and the woman should be advised to call the next morning. The woman was warned of vomiting and nausea and instructed to stay hydrated.

For the next couple of days no one at the clinic paid much mind to this incident and no one advised the patient of the potential severity of consequences. On the third day someone contacted the patient and advised her to come in the next day. By the fourth day the patient was sick and returned to the clinic but there were no beds available. She was admitted the next day.

For the next two weeks this woman's body systematically destroyed itself in a rather grotesque and painful sequence of events that led to her death in ICU approximately two weeks after her admission.

This event happened in Canada, but it could happen anywhere. It could happen in every hospital or clinic I've ever been in. The problem is that we rely to much on our doctors, and our nurses, to get things right and they just don't always do so. We simply must know what they are pumping into our bodies. We must know what it is, what it does, and what the potential consequences are.
More importantly we need someone with us, and intelligent advocate, any time we undergo such a procedure because as patients we simply aren't in any shape to think straight and ask the important questions. Someone should have noticed after an hour that the woman's medicine was now 1/4 gone and stopped it. Someone should have known, and told the patient, that she was being poisoned (intentionally) and that an overdose would almost certainly be fatal.

My experience is that when you go into a hospital or clinic you are given a form to sign that says you could die. You get that for everything from having an ingrown toenail removed to open heart surgery. But the realistic outcomes are simply not the same for both cases. And the verbal instructions and warnings given by staff are designed to be comprehended by fifth graders and not raise anyone's anxiety level. The result is everyone signs the form without reading it (I'm not sure it contains anything useful anyway) and, as the report shows, we rarely get the full scoop via verbal instructions or even written discharge orders.

We have made enormous improvements in healthcare over the last 50 years, but we are just nowhere near where we need to be. Until we are we all need to educate ourselves as much as possible on what the doctors are doing to us, what the (realistic) potential consequences are, and what we should be watching for.

Got A Tattoo? You May Get to Have Natural Childbirth

terrywfrazier@gmail.com — Thu, 09 Feb 2006 23:48:00 GMT

All you hip, hot young things getting those spiffy tattoos on the top of your ass cheeks may be in for a surprise. Seems doctors are leery of poking a needle through tattooed skin and pushing it into your spinal column – the procedure used to numb your lower body during childbirth. I’m ambivalent about this and, honestly, find small tattoos in that area kinda sexy. But it is something to think about. Your doctor may not be as reasonable as the one quoted below. [via Waking Up Costs]

Are Lower Back Tattoos A Contraindication To Labor Epidurals?
My Google News section on 'epidurals' came up with an interesting hit: Lower-back tattoos are popular with women, but do they make having epidurals during childbirth more dangerous?. It's a very good question because, at least in my practice, lower back tattoos are extremely common in laboring women. So common, in fact, that Saturday Night Live has a commercial parody for a product called Turlington's Lower Back Tattoo Remover (quicktime | windows media).

I was taught to avoid putting an epidural needle through tattooed skin and have gone to great lengths to do so. For example, one patient had a very large tattoo of what appeared to be the face of the devil on her lower back. On closer inspection, I noticed that the devil's right nares (which was free of tattoo ink) was right over her L3-4 interspace. I wished I'd taken a picture of that epidural catheter snaking out of the devil's nose.

I can't seem to find much science on the subject save for one abstract which makes a very reasonable suggestion to avoid coring out tattooed skin by making a small incision, if necessary. This may sound like a lot of trouble, but all it takes is a 16 gauge (or similarly large) hypodermic needle inserted into the skin first, then the epidural needle through that 'incision'.