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Warning: Hippos Can Really Run Fast … Take Your Medicine

About a year ago I made a house call to an elderly widow which has left a lasting impact on me.

Our “trusting relationship” began twelve years earlier while I attended to her dying husband at home. She couldn’t find another doctor to come in to help.  Now it was her turn to need help, and like her husband insisted that she stay at home.  The woman was being cared for by her middle-aged granddaughter who remained her daily companion.

Both granddaughter and grandmother distrusted the health care industry and had formed many conspiracy theories. They believed in the power of healing through “the Lord” and natural remedies, especially vitamins. I admired their fierce independence while holding my tongue on the magical and, in my opinion, misinformed views of the science of medicine. Both tried, in vain, to convince me that I should use the vitamins and other products they endorsed for my patients.  I smiled obligingly, yet made no move to implement these ideas while pondering the paradox and danger of being invited into the “trusting circle” of such divergent world views. Read more »

What To Do When Your Patient Wants To Leave The Hospital Against Your Better Judgment?

When a patient decides they are leaving against medical advice what responsibility does the physician have to their care?  When I was a resident in training, and even early on in my position as a hospitalist, I would get a call from the nurse that  Mrs Smith was demanding to leave the hospital against medical advice.  I would tell the nurse “Fine. Let her go. I’m not her father.”  I would tell the nurse to discharge Mrs Smith with no medications and leave it up to them to find follow up.

I would suspect this is a prevalent attitude for many hospital and emergency based physicians.   I’ve seen it over and over again.  And I still see it today.  Many doctors and nurses feel obliged to let grown men and women make poor decisions.    However, being a grown man or woman able to make poor decisions is apparently not enough to keep a doctor for being sued and losing that lawsuit because a patient chose to make poor decisions.   Read more »

*This blog post was originally published at A Happy Hospitalist*

Nursing Unions Put Patients At Risk

Only in the United States could a virus like H1N1 bring out the worst in medical politics and greed. We are facing a “pandemic” that requires coordination, communication and the best of medical practice. But what are we getting? Strikes, lawsuits and anything BUT putting patients first!

The strong nursing union, California Nurse Association (CNA), is taking this opportunity to call a strike on three large Catholic hospital chains (including 34 hospitals) throughout California and Nevada. The union bosses say the chief concerns are a lack of protective gear, improper isolation techniques and staffing that requires nurses to work (oh horrors!) 12 hour shifts during the flu crisis.

Although the nurses seem to want to walk out during a pandemic to “protect patients”, the nurses in New York and Washington also filed a lawsuit over the idea that they should be required to get the flu vaccine. You can’t have it both ways, nurses! You either want protection or you don’t. Read more »

*This blog post was originally published at EverythingHealth*

Unexpected Consequences: Wyeth Law Suit Could Limit Patient Access To Medications

Photo of Bert Rein

Bert Rein

On November 3, 2008 the US Supreme Court will hear opening arguments in the Wyeth vs. Levine case. This highly publicized lawsuit has been discussed by the New York Times and the Journal of the American Medical Association and will likely be the most important case during the upcoming Supreme Court term. However, neither source has fully explained the unexpected consequences to the consumer if Wyeth loses.

To get to the bottom of the issue, I interviewed Bert Rein, attorney for Wyeth. Bert has conducted interviews with NPR and the three major TV news networks. Please enjoy this exclusive podcast interview here at Getting Better with Dr. Val, or read my summary of our conversation below.

Dr.Val: Bert, please summarize for our listeners what has happened so far in the Wyeth vs. Levine case.

Rein: Ms. Levine is a guitarist who suffers from migraine headaches and associated nausea. One day she sought pain management therapy at a clinic in northeast Vermont – the same clinic where she regularly received care.  They elected to treat her with a combination of demerol (for pain) and phenergan (for nausea). They delivered the drugs intramuscularly, but several hours later Ms. Levine returned, complaining of an unrelieved migraine headache.

The clinic’s physician realized that the drugs would be more potent if they were injected intra-venously so he asked the PA (physician assistant) to give another dose of the drugs through Ms. Levine’s vein. Unfortunately, the PA inserted a butterfly needle (rather than the usual heplock for an IV) into what she thought was Ms. Levine’s vein, and delivered the phenergan into or near a punctured artery. Phenergan’s label clearly states that the drug can cause tissue necrosis if it comes in contact with arterial blood. Ms. Levine experienced a necrotic reaction to the medication which resulted in the eventual amputation of her arm. She sued the clinic for negligence and was awarded $700,000 dollars in a cash settlement.

Ms. Levine then brought a separate lawsuit against Wyeth, claiming that the phenergan label did not offer sufficient instructions about how to administer it safely, though the risks of necrosis from arterial blood exposure to phenergan are well known and labeled in capital letters as a warning on the drug’s label. Read more »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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