January 9th, 2007 by Dr. Val Jones in True Stories
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An attorney from the hospital where I used to work called me out of the blue. He asked me if I remembered a Mr. So and So. “I’m not sure,” I said uneasily. “The name does sound familiar.”
Slowly the case came flooding back to me. I was on call on a weekend covering the neurosurgical step down unit. A nurse paged me to tell me that someone couldn’t move his legs. I asked if it was a new problem. “Yes, he could move them just this morning.”
I ran to the patient’s room and found an anxious appearing, young obese man lying flat in bed with a neck brace on. He had recently had a cervical laminectomy (a neck spine procedure). “I can’t move” he said, a bead of sweat trickling off his brow. “Can you feel anything?” I asked.
“Nothing below my neck.”
I took my metal tuning fork out of my coat pocket and pressed it firmly on his toe nail bed to see if he’d withdraw from pain. Not a flinch. My heart started racing. This is a surgical emergency.
I called the neurosurgery team and told them about the sudden paralysis. They arrived on the floor in under a minute, confirmed the diagnosis, grabbed the chart and took the patient to the O.R. immediately.
Hours later I heard that the man had had a rare complication of neck surgery – a small arterial hemorrhage that rapidly compressed the spinal cord. The surgeons evacuated the blood immediately – though it was anyone’s guess if the man would fully recover.
And apparently he didn’t. Four years later he was suing the hospital for malpractice, and I was named in the lawsuit.
“But I didn’t do anything wrong,” I told the attorney.
“Well, you’d better read the record,” he said ominously.
**See my next post for the end of the story!**
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 7th, 2007 by Dr. Val Jones in Opinion
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I used to believe, quite naively, that hospitals were depressing places simply because no one had noted the connection between environment and recovery. It seemed that white walls, antiseptic scents, and cork boards were somehow required of hospitals – and no one had bothered to imagine anything different.
I thought that the solution was fairly simple – get some creative minds to come in and make recommendations for change. So one day I called the chair of the department of interior design at Parsons School of Design and asked whether she might send her students to my hospital to consider how to improve our situation. She was intrigued with the idea – and we soon had an entire team of bright young designers measuring the floors and windows, considering the limitations of our square footage, and getting to work on some dramatic proposals for exciting change.
Several months later the Parsons students made a presentation to our hospital’s executive team, and this was met with great enthusiasm. We all thought that we were on the verge of an exciting breakthrough for patient wellness. But alas, in the end not a single design suggestion was implemented as our administrators told us that there was no money available for environmental improvements.
I found out much later that our acting CEO was making about ½ million dollars per year in salary at the time. All the while the poor patients had to recover in a grim void of sensory stimulation.
There is ugliness in hospitals – and it runs deeper than the white walls. As with many sectors, money is the deciding factor regarding whether or not something gets done. I think that hospitals should take a hard look at their white walls, and the white linings of their executive pockets and ask themselves whom they were built to serve.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 6th, 2007 by Dr. Val Jones in Expert Interviews
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I recently spoke to Dr. Jorge Mestman about the issue of finding a good doctor. I asked him if consumer ratings of physicians would help patients find their way to better care and he responded with a resounding “no.” I was somewhat taken aback and asked why he felt that way. What he said was surprising (this is not actually a direct quote, I’m summarizing):
“The best doctor is YOUR doctor. Over time a physician develops a relationship with a patient and an understanding of their issues that is very valuable. The problem with seeing a specialist is that they have no baseline to compare you to – they may make recommendations based on their best analysis of the situation at that point in time. But they can be wrong.
Also, physicians – like any human being – have different skills and styles. Some are great listeners and excel in empathy, others have a ‘tough love’ approach, still others are research oriented and like to delve into the ‘nitty gritty.’ How can one person’s rating capture all of that? Most physicians are good people with good clinical skills. The right one is the one that you like. Also, it’s simply not possible for a few highly rated physicians to care for vast numbers of patients. If people limited themselves to only seeing certain physicians (who got high ratings), they’d be turned away due to the over-demand.”
What do you think of Dr. Mestman’s analysis?
Val Jones is a licensed practitioner of Rehabilitation Medicine and Senior Medical Director of Revolution Health’s portal. No information in this blog is intended to diagnose or treat any condition. The opinions expressed here are Val’s and do not necessarily reflect those of Revolution Health.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 4th, 2007 by Dr. Val Jones in News
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So it seems that people who stay in school longer, live longer. But not for the reasons you might expect – it’s not because privileged kids are more likely to stay in school and also happen to get better healthcare. It seems that school teaches kids two things beyond the books: 1) discipline – the ability to delay gratification and 2) social networking skills. These two lessons go a long way to keeping people healthier long term.
Come to think of it, this makes a lot of sense – if a person can learn to avoid fast food for the “higher call” of health, they may live longer. If a person is well integrated in a social network, they’re more likely to seek out medical assistance earlier on – and have caring friends and family spur them on towards regular check ups, taking their meds, etc.
Now, I don’t know what YOU were doing in junior high and high school – but apparently the first hints of your discipline and networking skills were learned there. Although the research described in the NY Times article only made a link between total years in school, and total years of life – I wonder if your high school’s ”expert networkers” – you know them, the ever-annoying popular kids – will fare best of all in the health arena?
Better go to your high school reunion to find out!
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 2nd, 2007 by Dr. Val Jones in News
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Many people use glucosamine and chondroitin sulfate as a natural therapy to treat their arthritis pain. This seems like a reasonable thing to do since glucosamine is a critical building block for cartilage, and chondroitin can help keep joints properly hydrated. And as we know, osteoarthritis is caused by joint wear and tear and decreased cartilage health.
Unfortunately, the research results have been fairly underwhelming.
Here is how one author* summarized the latest research:
“It seems prudent to tell our patients with symptomatic osteoarthritis of the knee that neither glucosamine hydrochloride nor chondroitin sulfate alone has been shown to be more efficacious than placebo for the treatment of knee pain. If patients choose to take dietary supplements to control their symptoms, they should be advised to take glucosamine sulfate rather than glucosamine hydrochloride and, for those with severe pain, that taking chondroitin sulfate with glucosamine sulfate may have an additive effect. Three months of treatment is a sufficient period for the evaluation of efficacy; if there is no clinically significant decrease in symptoms by this time, the supplements should be discontinued. Furthermore, there is no evidence that these agents prevent osteoarthritis in healthy persons or in persons with knee pain but normal radiographs.”
So I guess the bottom line is that these supplements are no magic cure for knee pain – they aren’t known to be harmful (except to the wallet) but they aren’t sure to be helpful either.
*Hochberg, Marc C.
Nutritional Supplements for Knee Osteoarthritis — Still No Resolution
N Engl J Med 2006 354: 858-860
Val Jones is a licensed practitioner of Rehabilitation Medicine and Senior Medical Director of Revolution Health’s portal. No information in this blog is intended to diagnose or treat any condition. The opinions expressed here are Val’s and do not necessarily reflect those of Revolution Health.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
