March 10th, 2007 by Dr. Val Jones in True Stories
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Ok, so now that I’ve given you a really good example of the dangers of VIPs bullying doctors, I will present the flip side of the coin: a good kind of patient aggressiveness.
A 10 month old baby was vomiting and febrile, and her new mom brought her in to the hospital for an evaluation. She was told that it was gastroenteritis (my favorite diagnosis of late) and that the baby would get over it soon enough. The young mother insisted that she knew her baby, and that the infant had never been this fussy and that there really did seem to be something more serious at play. Again, she received eye rolls from everyone from technicians to nursing staff to physicians. “New mothers are so histrionic,” everyone thought.
But as the evening wore on, the baby became fussier and fussier, and began scratching herself all over. The nurses came in and tied her chubby arms and legs down so that she wouldn’t tear her skin. The mom wrung her hands all night. The doctor went home, yawning and sure that the baby would be fine in the morning.
Several episodes of violent, projectile vomiting ensued, and the mother pleaded for someone to take another look. No one would listen, as the doctor had written in the chart that the baby had gastroenteritis, so that was what it was.
In the middle of the night, after the physician had gone home, the mom insisted that the nurses page him to come back to the hospital. The nurses initially refused, but the mother told them that she would personally make their night miserable if they didn’t comply. The annoyed physician came back to the hospital against his better judgment, and found the mother and baby looking far worse than when he’d left. In fact, the baby’s vitals were becoming unstable and her abdomen was quite distended.
The physician ordered an abdominal x-ray series. It showed an advanced intussusception and the belly was distended with gangrene. He knew that she was likely to die. He asked the mother if she wanted him to call the general surgeon (who had no experience with operating on babies) or if she’d like to take a chance and get the infant to an academic center in New York City that had a team of pediatric surgeons on call. Time was of the essence, but surgical expertise varied greatly between the two options. The mom could tell that the physician was terrified, and her instincts told her that she should get the most experienced doctor to operate on her baby.
A few hours later, the baby was rushed into the O.R. at Columbia Presbyterian Hospital. The pediatric surgeon on the case told the mother that it was unlikely that the child would live, but that he promised not to give up on the baby. At that point, the baby was septic and seizing.
In a truly miraculous turn of events, the surgeon was able to resect the dead bowel and save the baby’s life. If the baby had arrived even a few minutes later, she probably wouldn’t have made it.
So in this case, I applaud the mother for being persistent and forcing the medical staff to take a closer look at this “gastroenteritis.” In our imperfect medical system, patients and families must sometimes advocate for themselves in order to get the attention they require. This story, in particular, means a lot to me, because I still bear the abdominal scar from the surgery.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 5th, 2007 by Dr. Val Jones in News
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In this latest report from the BBC, we see that our friends across the pond are just as obsessed with appearance as we are in America. Apparently, women in their 70’s and 80’s are getting cosmetic breast surgery and face lifts.
One surgeon is quoted as saying:
“We have a growing population of pensioners – and for those who want to maintain a good appearance, ageing gracefully, the surgical options are there.”
Since when did gracefulness have anything to do with surgery?
I wonder if we’re missing the more important things in life (friendship, love, kindness, charity) by focusing on our exteriors? Beauty is a matter of the heart, I think.
Sophia Lauren once said, “Nothing makes a woman more beautiful than the belief that she is beautiful…” but then again, it looks as if she’s chosen to have extensive cosmetic work done as well.
What do you make of the growing trend in plastic surgery among seniors?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 4th, 2007 by Dr. Val Jones in News
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In a recent poll, 80% of consumers (along with the British Medical Association) preferred a simple “stop light” food label to a long list of percentage figures of recommended daily amounts. The stop light icon simply categorizes food as containing low (green), medium (yellow), or high (red) levels of the following ingredients:
- Fat
- Saturated Fats
- Sugar
- Salt
The guideline daily amounts (GDA – the rough equivalent of America’s RDA system) supporters argue that the stop light is an oversimplification, and does not effectively convey all the important nutritional value of food.
What do you think? Would you like to see this sort of labeling in the US?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 3rd, 2007 by Dr. Val Jones in Medblogger Shout Outs
3 Comments »
Well, twinkies are made of petroleum (among 38 other ingredients), and gasoline is also a type of petroleum product! This gives “food as fuel” a new meaning.
Dr. Charles, a young family physician, reviews the ingredients of twinkies in his recent blog post amusingly called “Reduce Twinkie Consumption and Dependence on Foreign Oil.”
This reminded me of the shock I felt when watching a documentary about America’s oldest citizens recently. I clearly remember them interviewing a man who was about 105 years old, who lived alone and used a golf cart to get around outdoors. The interviewer couldn’t resist asking the man why he thought he had lived so long in such good health.
The man said, “Well, I eat pretty good, get enough sleep, and I don’t worry about much.”
The interviewer then asked a probing question, “What do you eat?”
And I leaned in towards the TV screen, curious as could be.
And the elderly gentleman said, “Well, I eat a bowl of cornflakes for breakfast and then I usually eat a twinkie later on…”
Either the segment didn’t plan enough seconds for further investigation, or that was the sum total of his nutritional advice.
I was dumbfounded. For some people, it seems, good genes and good luck take them a long way.
But I’m still not going to eat petroleum products.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 3rd, 2007 by Dr. Val Jones in Health Policy
5 Comments »
Improving quality in healthcare is an important fundamental goal. New “pay for performance” measures initiated by the Center for Medicare and Medicaid services is a well meaning attempt to provide financial incentives to physicians who demonstrate improved patient outcomes. Unfortunately, this incentive program could backfire.
A recent article in Medical Economics (via Kevin MD) raised the question of “cherry picking and lemon dropping” your way to higher pay. In this frightening scenario, physicians would be tempted to select healthier, more compliant patients for regular treatment in their practices. In this manner, they can demonstrate better outcomes, since the sicker, poorer, or less compliant patients no longer factor into their performance measures. And with the upcoming physician shortage, it really is a seller’s market.
It is critically important for the government programs to allow physicians to accurately risk stratify their patients so that they are not financially penalized for taking care of sicker patients bound to have below average outcomes. The same goes for surgeons, who should not be discouraged from undertaking potentially lifesaving surgeries for patients who are critically ill.
Dr. Kellerman, the president of the American Academy of Family Physicians, reminds us that quality of care is vastly improved by having a central medical home (i.e. one physician who can coordinate care for patients, so they’re not left with a group of disconnected specialists ordering duplicate tests and prescriptions). I personally think that a centralized EMR/PHR controlled by the patient (and located at an Internet based “medical home” complete with disease management tools and the ability to email a physician as needed) would go a long way to improving quality.
What do you think?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
