July 19th, 2011 by GruntDoc in Opinion
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I watch some TV (and essentially no commercials, thanks to DVRs) and have been enjoying some shows: Necessary Roughness and Covert Affairs. Yes, put a reasonably attractive female in the lead role of a show with some action and I might watch. Demographic shocker.
So, within the last two days I saw one completely egregious professional breach, and one exercise of pretty awful medical judgement (in an ED, which makes it way worse for me), and I will now outline my concerns/gripes.
(Yes, I’m aware they’re TV shows, and are therefore not reality. What I’m unhappy with is the glib way in which these terrible decisions played out, like it’s not a big deal to act against the interests of your patient, even especially, on TV). (I think TV behavior, not the cartoon violence but the everyday mundane stuff, influences how regular people think, which is why I’m writing this: so the zero regular people who watch TV and read this blog have something to consider).
So the Necessary Roughness (episode Anchor Roughness) thing: (Background): the protagonist is a female psychologist hired by a football team to get their star player “TK” (with more than a mild resemblance to “TO“, the former 49ers Eagles Cowboys Bills Browns wide receiver) playing and catching; it’s a TV troubled relationship. (Player is aware she works for the team). In the show TK threatens to leave the team, is convinced not to leave in a bluff by the team to send him to a cold climate, and TK decides to stay with the team. In the denouement, it is revealed that the whole idea for the bluff was the psychologists’ idea, for which she was praised by the team.
Umm, I have an objection. Read more »
*This blog post was originally published at GruntDoc*
May 1st, 2011 by Jessie Gruman, Ph.D. in Health Tips, True Stories
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Nora misjudged the height of the stair outside the restaurant, stepped down too hard, jammed her knee and tore her meniscus. Not that we knew this at the time. All we knew then was that she was howling from the pain.
There we were on a dark, empty, wet street in lower Manhattan, not a cab in sight, with a wailing, immobile woman. What to do? Call 911? Find a cab to take her home and contact her primary care doctor for advice? Take her home, put ice on her knee, feed her Advil and call her doctor in the morning?
Sometimes it is clear that the only response to a health crisis is to call 911 and head for the emergency department (ED). But in this case – and in so many others we encounter with our kids, our parents, our co-workers and on the street – the course of action is less obvious, while the demand for some action is urgent.
The question “which action?” has become more complicated of late because:
- In some communities, there are alternatives to an ambulance or a drive to the nearest ED, such as Urgent Care centers.
- Disincentives exist for going the route of the ED: in many cash-strapped municipalities we are charged for the cost of ambulance ride; we risk not having our ED visit covered by insurance if we make the wrong decision or fail to notify our health plan in a timely manner. Or we don’t have insurance and the ED care is expensive.
- Some of us have a number of clinicians who could guide us about ED versus self care on any urgent health matter, plus our health plan may have a nurse advice line that could do the same. Which among them to call? How long will it take to get an answer in the middle of a busy workday or a late night?
- Many of us have no primary care clinician to call. Read more »
*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*
April 15th, 2011 by Glenn Laffel, M.D., Ph.D. in Research
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The use of Motrin, Aleve and other non-steroidal anti-inflammatory drugs (NSAIDS) is associated with erectile dysfunction, according to a study by scientists affiliated with Kaiser Permanente.
The apparent link surprised the scientists. They had hypothesized that the commonly used pain-killers would actually reduce the risk of erectile dysfunction since NSAIDS protect against heart disease, which has in turn been linked to the troubling condition.
To reach their surprising conclusion, Steven Jacobsen and colleagues used data from Kaiser’s HealthConnect EHR, an associated pharmacy database, and self-reports about NSAID use and erectile dysfunction from an ethnically diverse population of 80,966 men between the ages of 45 and 69.
After controlling for age, ethnicity, race, body mass index, diabetes, smoking status, hypertension, high cholesterol and coronary artery disease, the scientists found that men who used NSAIDS at least 3 times per day for at least 3 months were 2.4 times more likely to experience erectile dysfunction than those who did not consume them on a regular basis. The link persisted across all age categories.
Remarkable in its own right was the finding that overall, 29% of the men in the study reported some level of erectile dysfunction.
The authors emphasized that their findings do not prove that NSAID use causes erectile dysfunction. For example, the study findings could have been confounded by factors not considered by the scientists (such as subclinical disease or the severity of the comorbid conditions that were studied), and the chance that NSAID use was actually an indicator for other conditions that caused erectile dysfunction.
In addition, the scientists recognized that their study had some limitations. These included an inability to temporally link NSAID use and the development of ED, and possible selection bias.
As a result, they cautioned men against discontinuing NSAIDs based solely on the findings of their study. “There are many proven benefits of non steroidals in preventing heart disease and for other conditions. People shouldn’t stop taking them based on this observational study. However, if a man is taking this class of drugs and has ED, it’s worth a discussion with his doctor,” Jacobsen said in an interview.
The write-up appears in the Journal of Urology.
*This blog post was originally published at Pizaazz*
February 26th, 2011 by Steven Roy Daviss, M.D. in Health Policy, Opinion
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I read today that Eastern Ontario has started a bed registry to keep track of where open psychiatric beds are available. This is something I’ve long advocated. The United States now has less than 10 percent of the beds it used to have 50 years ago. Granted, treatment has improved and community resources are enhanced. But there are still areas that often do not have a sufficient number of hospital beds for folks needing acute inpatient psychiatric care.
The Ontario story described in the Ottawa Citizen states that six of the area hospitals have been connected to a computerized “bed board” that provides real-time information on who has an appropriate bed available. This saves time in the ER and gets patients to needed treatment more quickly. Otherwise calls need to be made to each individual hospital, which is very time-consuming.
And it’s not uncommon for all the beds to be full. Last July there was an EMTALA complaint against a hospital in Maryland because a patient sat in the ER all weekend, and this hospital said they had no beds to admit the patient to. The Department of Health and Mental Hygiene (DHMH) investigated the complaint and found that indeed the hospital was full that weekend. The ER’s record indicated that all the hospitals (except the state hospitals) were called that weekend and all indicated their beds were full. So DHMH visited every hospital (about 28, I think) thinking that surely one of them had an empty bed they were hiding. What they discovered was that every single psychiatric bed in the state was full.
Unfortunately, we have no way of determining how often this happens, but we know if happens often enough. A “bed board” like this would be very helpful in quickly finding beds when needed and keeping track of the extent of this problem. Having patients wait in ER for days is unsafe and is even discriminatory. How many people with stroke or uncontrolled diabetes sit in ER for days waiting to find a bed for treatment? I’d like to hear others’ thoughts on how this problem can be addressed.
*This blog post was originally published at Shrink Rap*
February 15th, 2011 by KevinMD in Better Health Network, Opinion
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Abdominal pain is the bane of many emergency physicians. Recently, I wrote how CT scans are on the rise in the ER. Much of those scans look for potential causes of abdominal pain.
In an essay from Time, Dr. Zachary Meisel discusses why abdominal pain, in his words, is the doctor’s “booby prize.” And when you consider that there are 7 million visits annually by people who report abdominal pain, that’s a lot of proverbial prizes.
One reason is the myriad of causes that lead bring a patient to the hospital clutching his abdomen. It can range from something as relatively benign as viral gastroenteritis where a patient be safely discharged home, to any number of “acute” abdominal problems necessitating surgery.
But more importantly, we need to consider how limited doctors actually are in the ER. Consider the ubiquitous CT scan, which is being ordered with increasing regularity:
The pros: CT scans are readily available, able to look at every organ in the abdomen and pelvis, and very good for ruling out many of the immediately life-threatening causes of belly pain. CT scans can also reduce the need for exploratory surgery. The cons: Often, CTs can’t diagnose the actual cause of ER patients’ abdominal pain. Worse, CTs deliver significant doses of radiation to a patient’s abdomen and pelvis (equivalent to between 100 and 250 chest X-rays). Over a lifetime, patients who receive two or three abdominal CT scans are exposed to more radiation than many Hiroshima survivors.
Add that to the fact that patients expect a definitive diagnosis when visiting the hospital — one that doctors can’t always give when it comes to abdominal pain. Read more »
*This blog post was originally published at KevinMD.com*
