August 20th, 2008 by Dr. Val Jones in Medblogger Shout Outs
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Usually I prepare a weekly (or bi-weekly) feature called “Heard Around The Blogosphere” but this time I’d like to devote my list to images – things SEEN around the medblogosphere. Here’s my top 10 list:
1. Paul Levy’s feet (he is the CEO of Beth Israel/Deaconess Hospital in Boston – and he has some pretty impressive bunions)
2. Doggie scuba gear – I doubt the dogs enjoy it
3. Prosthetic limbs inspired by “retro” furniture – from Medgadget.com
4. TV sunglasses for use at the dentist’s office – now that will keep your mind off things!
5. A fake necktie is actually a cooling device – anesthesiologist Joe found this interesting Japanese invention for men.
6. Beer goggles from the Happy Hospitalist
7. Bizarre bread sculptures that resemble human body parts – from Boing Boing
8. Too many fingers – art by Street Anatomy
9. A skeleton necklace – found by Happy Hospitalist
10. Margarine ad with something lost in translation – Fail BlogThis post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 19th, 2008 by Dr. Val Jones in News
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A small research study suggests a link between depression and poorer driving test scores. In fact, there also seemed to be a dose-response relationship with anti-depressants. In other words, the study subjects on the highest doses of anti-depressents got the lowest driving test scores.
Since depression can impair one’s concentration – the link is certainly plausible. I thought it was interesting that anti-depressants seemed to increase the risk for low scores. One would hope that those on anti-depressants were less symptomatic, but it’s also possible that the dosage correlated somewhat with the severity of the disease.
Drivers with conditions that could impact their driving abilities (such as epilepsy or stroke) should report their impairments to the DMV. Will the list of reportable impairments eventually include depression? I doubt it, but it is reportable to the Vehicle Licensing Agency in England.
On the spectrum of risk factors for sloppy driving, I wonder where depression stands?
- Cell phone usage
- Advanced age
- Driving in a foreign country
- Driving while eating/drinking
- Driving while intoxicated
It would be neat to see these risk factors compared to one another on a graph. Has anyone seen such a thing?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 17th, 2008 by Dr. Val Jones in Medblogger Shout Outs
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I’m a big fan of GruntDoc (Texas ER physician Allen Roberts), one of the first medical bloggers on the Internet. To show my appreciation, I’ve decided to plagiarize repost this classic “rant” of his (in case you missed it in 2004):
I work in an Emergency Department, and have noticed that there is one common denominator in the majority of the assaulted patients I treat: they were all assaulted by “Some Dude“. (Also, they were all assaulted for “…no reason…”, but that’s the topic of another rant). This is true no matter where I work, the time of day or day of the week.
“Some Dude” has in the last two weeks shot my patients, sucker-punched, struck with bottles, beaten them with fists and a golf club (or perhaps the entire set), and pushed my patients down stairs.
Additionally, “Some Dude” has ’slipped drugs’ into the drinks of, transmitted sexual diseases to, and stolen the medications of my patients.
I have no idea how “Some Dude” is everywhere at once. I suspect he’s an evil superhero, though in the current times I cannot completely exclude an AlQuaeda conspiracy.
I advocate a vigorous police and public-health effort to locate and confine “Some Dude” due to the clear and present danger he represents to the health and welfare of our republic.
If you encounter “Some Dude,” please turn him in to the appropriate authorities. 
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 16th, 2008 by Dr. Val Jones in Health Policy
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No one wants to become infected during their hospital stay. Unfortunately it’s not possible to guarantee that it won’t happen. Bacteria are everywhere. We carry them on our skin, in our bodies (especially our digestive tract), and they live in food, clothing, and anything we touch. When we undergo surgery, we cut through the skin/blood barrier that keep the bacteria out, making us vulnerable to inadvertent invasion.
There are ways to reduce the risk of infection (sterile surgical technique, appropriate wound care, and personal hygiene) but the risk is not zero. For the risk to be zero, one would have to begin with a “sterile” patient – a patient who carries no bacteria on or in their body. Since that will never happen, I’m afraid that hospital acquired infections are here to stay.
However, with government-sponsored health insurance programs on the brink of bankruptcy, decreasing expenditures is a high priority. Therefore, Medicare is suggesting that there are certain events that should never happen in the hospital and that they will no longer compensate hospitals for care associated with these events. Although I certainly agree that operating on the wrong body part is appropriately classified as a “never event,” the list has become so long that it includes things that cannot possibly be prevented in all cases (things like catching a cold, developing a blood clot, falling, or becoming infected).
What will result from listing infections as a “never event?” Will it encourage hospitals to improve their infection control processes? Maybe. But here’s what I imagine is more likely to happen:
1. More prophylactic antibiotics will be given to patients to reduce the risk of infection, resulting in higher rates of serious drug reactions. Stronger medicine (with broader coverage) will be preferentially selected – further encouraging the development of drug resistant strains of bacteria.
2. Patients who become infected will be transferred to another facility as quickly as possible. The accepting facility will be compensated for the care of the patient since the “never event” didn’t happen at their hospital. Transferring care in the middle of a serious illness increases the risk for other complications, including miscommunications and medication errors.
3. Since Medicare has set the expectation that hospital acquired infections are 100% preventable, anyone who contracts one will be able to sue the hospital. This will deplete the hospitals of their thin operating margins, causing them to cut programs – probably first for the poor and underserved.
4. Additional testing may be done for any surgical admission – nasal swabs (and potentially rectal swabs or urethral swabs) will be used to document the fact that the patient arrived at the hospital colonized by certain bacteria and therefore did not contract a new infection during their hospital stay.
5. Convoluted documentation methods will abound, so that any patient who becomes infected will receive antibiotics for “prophylaxis” and his fevers will be explained as the usual “post-op” central fevers. All staff will be encouraged to carefully document that the patient is being treated prophylactically only, and does not have an infection. In fact, it’s possible that blood cultures will not be drawn so that there will be no documentation of sepsis. Patients who really do have serious infections will receive appropriate care very late (since the first few days will be spent trying to manage the infection without documenting it or identifying the organism). This could paradoxically result in higher death rates.
6. Patients at higher risk for infection (such as those who are immunocompromised – see my research study on risk factors for line infections here) may be passed over for surgical procedures. This risk aversion could negatively impact health outcomes for vulnerable populations (such as cancer patients or HIV+ individuals).
I could go on theorizing, but you get the picture. In my opinion, the “never events” strategy is fatally flawed and will result in excessive litigation, ping-ponging of patient care, over-use of antibiotics, increases in adverse drug events, a rise in multi-drug resistant bacteria, and further reduction of services to the poor. A more reasonable approach would have been to document infection rates at the most hygienic facilities, and offer incentives for others to strive for similar rates.
The “never events” strategy is destined to do more harm than good for patients with hospital acquired infections, though the medical malpractice attorneys may enjoy a new income stream. This is just one more reason why we should never say never.
***
See Buckeye Surgeon’s take on this topic and his coverage of Jerome Groopman’s article for the New Yorker on the rise of drug resistant “super bugs.”
See Dr. Rich’s take on never events here.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 15th, 2008 by Dr. Val Jones in News
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Thanks to KevinMD for highlighting this fascinating blog post by Pallimed. A recent study in the journal Chest showcases the inaccuracies inherent in translating medical conversations. According to the small study, as many as 50% of the statements made by physicians were altered in some way by the designated interpreters. Generally the certified medical interpreters attempted to editorialize or soften the physician’s language. Here is one specific example:
Doctor: I don’t know. Um, this is a very rapidly progressing cancer.
Interpreter (translating): He doesn’t know because it starts gradually.
Although this study had a very small sample size, in my experience it rings true. I speak three languages (English, French and Spanish) however my proficiency in the last two doesn’t quite reach fluency. Although I can comprehend what people are saying, I make some grammatical errors and demonstrate somewhat limited vocabulary in my responses. For this reason, I welcome interpreter services when they’re available, and when they’re not – I proceed with self-translation for convenience and speed.
This puts me in an interesting position – I can understand the difference between what I say in English and how the interpreter translates it. In most interactions I’ve asked the interpreter to rephrase at least one concept to the patient as I note some inaccuracies in editorialization or softening of concepts. The kinds of translational “errors” include things like:
Dr. Val: We need to use IV antibiotics to treat your skin infection because we don’t want it to spread. If we don’t treat it, the infection could enter your bloodstream and cause serious problems, including organ damage, and even death.
Interpreter: The doctor is going to give you some strong medicine through your IV to treat your skin inflammation.
I agree with the conclusions drawn by the study authors – it’s helpful to speak with the interpreters prior to the patient interaction, and stress the importance of translating the exact meaning of your words. Also, physicians should speak in slow, short sentences to increase the chances of accurate translations.
And patients? Don’t hesitate to ask clarifying questions if anything about your condition or treatment plan is unclear to you. Invite a bilingual friend or family member to the meeting if possible, and realize that the quality of interpretation varies. Make sure you understand the risks and benefits of any procedure or medication before you accept or decline it. When you’re in the hospital you certainly don’t want any aspect of your care to be lost in translation.
*See my interview with Access Hollywood reporter, Maria Menounos, about how her dad’s diabetes care was influenced by a language barrier.*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
