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Thrombolytics: To Give Or Not To Give

For years now, we’ve all heard the drum-beat.  Bill-boards in cities have proclaimed it.  Various medical associations have touted it’s importance.  Stroke symptoms have to be treated immediately!  Give clot-busting drugs, also known as ‘thrombolytics!’

Until, of course, those in favor of giving the drugs (namely neurologists)  realized that a)  Not everyone with a stroke, aka ‘brain attack’ has insurance and b) people have a very inconsiderate habit of having said strokes at the most inconvenient of hours.  For instance, after 5PM, on the weekend, on holidays.  The nerve!

So across the country, physicians in emergency departments like mine are finding themselves expected by the court of public opinion to give a potentially dangerous drug (albeit a sometimes useful drug) without any neurologist being available to evaluate the patient.  Our emergency department thought we had a tele-medicine link; even that has failed, as nearby physicians in our regional referral center don’t feel keen to take responsibility for our patients.  Our own neurologists, of course, have slipped out the back door on this one.  Too much trouble.  Too much hassle.  But really, really important, so somebody (like physicians in already over-burdened emergency departments) need to be there to ‘do the right thing.’

Medicine is a bullet-train speeding towards a great chasm, and the bridge is out my friends.  Less specialists, less medicine, less research, less primary care and worst of all, most nefarious of all, less moral accountability.  The government and lawyers have been systematically taking up the tracks and laying the charges for decades.

Stroke care, so important that its own proponents don’t want to do it, is merely one more sound of the screeching brakes of our profession, racing toward disaster.  The passengers?  All those poor people who thought it was safe and under control.

*This blog post was originally published at edwinleap.com*


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