MD Doesn't Stand for Know It All

Medical doctors are used to people listening to them. Their words are rarely disputed and oftentimes even the most outlandish beliefs seem reasonable when spoken by a doctor. Case in point, Rep. Todd Akin's comments about rape victims and pregnancy: “From what I understand from doctors, that’s really rare. If it’s a legitimate rape, the female body has ways to try to shut that whole thing down."

Try as I might, I can't find any scientific evidence, even on the internet, that rape victims are able to send out ninja assassin eggs to kill rape sperm or deploy mini razors in their uterus to prevent egg implantation.

But, hey, if a doctor said it, it must be...right?

Every day woman are counseled by doctors that taking antibiotics will lessen the effectiveness of their birth control pill. The early data to support this only related to one antibiotic, rifampin. Even though rifampin is now rarely used, and there's been no subsequent link between the use of other antibiotics and unwanted pregnancies, doctors and pharmacists still perpetuate this myth.

Hyper kid? Your doctor might recommend restricting sugar intake. As we've seen on shows like "Toddlers and Tiaras," filling young children with pixie sticks and energy drinks turns exhausted, ill tempered children into enthusiastic dancers and runway walkers. Scientific research debunks the link between sugar and hyperactivity. Instead parents that believe sugar causes excess energy "see" the effect, even when there is none.

Wear glasses? Some doctors believe it's because you spent too much time reading in dim light. Even though reading in dim light may strain eyes, it won't damage your eyes. In fact, strain your eyes all you want on computers, sitting too close to the television, and not wearing your glasses when you need them. None of these will cause permanent damage.

I could go on with doctor misperceptions about using antibiotics, vaccination side effects, and even the use of thong panties, but I won't. Possessing a medical degree and a title doesn't automatically make someone intelligent and well informed. Doctors have as many crackpot, half-baked, and totally wrong ideas as the rest of us.

Too bad our representatives in Washington aren't smart enough to figure that out.

How Not to Solve the Problem

The Exeter Hospital healthcare worker who picked up unattended syringes of potent narcotics, injected himself, and then either refilled the syringes with saline or replaced them with his own previously used needles, causing at least 32 patients to become infected with Hepatitis C, is not an isolated occurrence. This has happened before and will happen again, unless the real problem is addressed.

The incident is being used as a scare tactic to further a bill requiring certain hospital employees, including lab and medical imaging personnel, to meet national standards in order for the facility to receive Medicare reimbursement.

This will not solve the problem. 
 
People who are entrusted by a hospital to draw up and administer medicine should be held accountable when they don't safeguard the medication. Even if they are doctors. Even if they are nurse anesthetists. Even if they are registered nurses. Leaving syringes of narcotics lying about is irresponsible and dangerous. Blaming an addict for picking up these syringes makes no sense.

Instead let's hold accountable the hospitals that don't follow their own policies on medication security. Let's expect to hear how the hospital disciplined the healthcare front line staff that made this tragedy possible through their carelessness.

It has nothing to do with the presence or absence of national licensing standards. It has everything to do with accountability. Until hospitals and their employees are willing to admit their part in this tragedy, nothing will change.

Pain Free Isn't Painless

There’s no question that, at one time or another, everyone will suffer from pain.  The question is how it will be managed.  In the past, before every ache and pain justified an emergency room trip or visit to the doctor’s office, pain was treated with non-narcotic medications, such as ibuprofen and acetaminophen, as well as rest, ice, and heat.  Now, whether it’s a sprained ankle suffered sliding into home plate or a longstanding backache, pain is routinely treated with the narcotics once solely reserved for cancer.

The choice is not without hazards. Tolerance to the medication (requiring ever increasing amounts to achieve the same effect), addiction (both physical and psychological), and respiratory depression leading to death are all known side effects of narcotic treatment.  Unfortunately, the current mindset that every healthcare encounter includes a prescription combined with the unwillingness to man up, has led to an explosion in legally written prescriptions for narcotics and a corresponding increase in the number of drug related deaths.

In four of the last five years New Hampshire has had more drug overdose deaths than deaths due to car accidents. The majority of these overdoses weren’t from heroin or other illicit drugs, they were from prescription narcotics. 

Why? Obtaining prescription narcotics and selling them is easy.  

How easy? The Union Leader newspaper recently reported the arrest of a suspect with more than eleven hundred 30-milligram oxycodone pills, street value approximately $35,000.00.

Where did the pills come from?  Not from thefts at the pharmacy or factory.

Most likely from thefts of medicine cabinets and the voluntary sale of legally acquired pills. Have a little pain? Get a few narcotics. Need extra money? Sell them. Worried about getting caught? Don’t be.

In New Hampshire, over the counter decongestants are more tightly regulated than prescription drugs. Pharmacies won’t dispense OTC decongestants such as Sudafed or Mucinex D without seeing a photo I.D., noting the purchaser’s name, and ensuing the purchaser hasn’t received more than a specified number in thirty days. You’d think it would be a no-brainer to implement a similar process with prescription painkillers. 

No. There’s no widespread method of keeping track of how many pills someone fills per month. There’s no method to determine if they are visiting multiple doctors, various Emergency Rooms, or using aliases to obtain their pills. Walk into any pharmacy and, with enough cash in your pocket, you can walk out with a bottle of pills with excellent resale value and wide appeal. Convince a doctor you have chronic pain, you can repeat this process on a monthly basis. It’s surprising more people aren’t profiting from this easily exploited system.

Our country regulates alcohol. It regulates firearms. It regulates tobacco. It even regulates over the counter decongestants. What’s so hard about regulating prescription painkillers? Maybe no one wants to force the healthcare system to acknowledge the monkey they’ve put on the back of our society.

I’m thinking it’s easier to just write another prescription.

I'll Settle For A Pat Down

Tomorrow I’ll be taking a flight out of my regional airport and will be forced to choose between a full body scan and a pat down.  It’s an easy choice for me, I have no problem with being patted down, but the Transportation Security Administration (TSA) agents never seem happy.  Each time I ask for a pat down in lieu of a full body scan, they try to discourage me. 

Perhaps it’s because they don’t have enough womanpower to accommodate my request. Perhaps the female workers feel uncomfortable and would prefer everyone choose radiation. No matter.  As long as I have a choice, I’d rather have the known hazards of a pat down (essentially none except for the creepy feeling of a stranger’s hands on my body) than risk the unknown hazards of a new technology that’s been implemented without, in my opinion, adequate time and study.  

The TSA, which refers to the full body scanner as advanced imaging technology states it “is safe and meets national health and safety requirements”  and “results confirmed that the radiation doses for the individuals being screened, operators, and bystanders were well below the dose limits specified by the American National Standards Institute (http://www.tsa.gov/approach/tech/ait/safety.shtm).  The Archives of Internal Medicine reports:  “The estimation of cancer risks associated with these scans is difficult, but using the only available models, the risk would be extremely small, even among frequent flyers. We conclude that there is no significant threat of radiation from the scans” (http://archinte.jamanetwork.com/article.aspx?articleid=227603).

Unfortunately I have a hard time trusting these pronouncements.  

History tells us that many times in the rush to develop and market new technology, risks are either underestimated or unknown until something has been used for a period of years and on a multitude of people.  

CT scans became widely available by 1980. After more than thirty years of use, concerns about a possible correlation between CT scans and brain cancer surfaced.  Now the Food and Drug Administration (FDA) has an initiative to reduce unnecessary radiation exposure and notes that CT scans, fluoroscopy and nuclear medicine imaging exams have benefits and risks and “these types of exams expose patients to ionizing radiation, which may elevate a person’s lifetime risk of developing cancer” (http://www.fda.gov/Radiation-EmittingProducts/RadiationSafety/RadiationDoseReduction/default.htm).  

In 2003, DePuy Orthopaedics introduced a new metal-on-metal hip replacement implant. In August 2010 they issued a voluntary recall after discovering a higher than expected number of patients needed revision surgery. 

Vioxx, a medication marketed for arthritis and acute pain, was approved for use by the FDA in 1999. The increased risk of cardiovascular events, including heart attacks and strokes, wasn’t found until a later study in June 2000. An additional warning  was added to the Vioxx label in 2002, but it took another two years before Merck & Co. voluntarily withdrew Vioxx from the market after a third study confirmed the cardiovascular risks. The aftermarket studies for Vioxx were voluntary studies the manufacturer undertook to look at side effects and additional indications. If not for those, Vioxx may have been on the market for many years before its serious, and sometimes fatal, side effects were discovered.  

In all of these cases, decent, hardworking scientists, academics, and government monitors gave their seal of approval for something that turned out to have unintended, dangerous side effects. In all of these cases the product was in wide use before the danger was known.  

In ten years, maybe I’ll have a different opinion on the full body scanner.

For tomorrow, pat me down.

Why Hospitals Make Great Killing Fields

Someone asked me about the connection between healthcare and serial killers. Well, if bank robbers rob banks because that's where the money is, healthcare serial killers kill patients because that's where the victims are. There are no locks on hospital doors. Anyone can enter at any time. Once inside the room, there's an excellent chance a  patient won't ask too many questions. particularly if the person who enters is confident and dressed in scrubs or a white coat. (Watch TV, people. Scenario after scenario shows the bad guy/gal throws on a lab jacket and does whatever they want).

A patient who is sedated by medications can't question what is done to them. A patient constrained by intravenous lines, bed alarms, chest tubes, etc, can't get away even if they suspect something is wrong. Hospitalized patients and their families quickly become used to a constant stream of people cycling through the room, playing with equipment, taking blood, giving medications. Be as suspicious at a hospital as you are at a hotel when an unknown person comes to your door. Ask questions, verify the answers.

Perhaps the one thing that most elevates inpatients to victim status is the innate desire to be a good patient. Good patients are docile, take direction, and don't ask too many questions. For many people, there is the fear that questioning the doctors or nurses will result in substandard care. I can't cite statistics, but I'll say in many cases I've personally witnessed of people getting the wrong interventions,  (medication, procedure, vaccination) when the patient questioned whether it was appropriate, they were told the doctor ordered it. At those magic words, the questions and hesitation stop. Be a bad patient. Trust your healthcare providers, but verify what they tell you. Ronald Reagan had Alzheimer's, yet he still knew the value of verification.

Still, most people would rather be subjected to an invasive procedure than upset the doctor. The healthcare system has helped to create a population of victims, and they know it. Make sure you aren't one.

 An article in the Journal of Forsensic Science (2006 Nov;51(6):1362-71) provides some relevant facts on the particulars of healthcare serial killers.

Their method:  "Injection was the main method used by healthcare killers followed by suffocation, poisoning, and tampering with equipment."

You're in the hospital, someone approaches you with a needle. If you're hooked up to an intravenous line or have a capped intravenous access, it's not shocking to have someone come to your bedside and inject medication into the line or the intravenous bag. If a patient asks what's going on or what's going in, standard  healthcare response is it's something the doctor ordered. Key point -  No one wants to argue with the doctor. Same if someone walks into your room with a syringe and tells you they're there to administer a medication. Most patients won't argue if the request to insert a needle is prefaced by saying it's something the doctor ordered. I've been in healthcare long enough to know this is a dangerous practice even for a nurse who isn't a serial killer. Patients should be identified, educated about the medication, and verify it's something that's been discussed with them by the ordering provider. I've heard and seen too many patients who have accepted medications meant for others because those magic words, "the doctor ordered it", seems to override the common sense that would kick in under most situations. Doctors write down their orders.  Why shouldn't the nurse let you see it?

Healthcare serial killers breakdown by role: "Nursing personnel comprised 86% of the healthcare providers prosecuted; physicians 12%, and 2% were allied health professionals."

Of course nursing personnel are the majority of healthcare serial killers. They're the ones spending the majority of time with the patients. They're the ones who go in and out of rooms without anyone asking questions. They're the ones who have access to the drugs and equipment to kill people. Why is the percentage of doctor healthcare serial killers so small compared to nurses? Doctors have less alone time with hospitalized patients and spend less hours with them. If your doctor showed up at your hospital bed at 3 a.m. with a syringe, you'd ask questions, wouldn't you? Most of the time,  if a doctor shows up on a hospital floor, the nurses are right beside him trying to get orders clarified and their concerns addressed. Doctors aren't rock stars, but they get plenty of attention. That doesn't make them right.

"The number of patient deaths that resulted in a murder conviction is 317 and the number of suspicious patient deaths attributed to the 54 convicted caregivers is 2113."

Wow, 2113 suspicious deaths, but only 317 murder convictions. Why? Because people die in the hospital. They die for lots of reasons. It takes a lot for an institution to become suspicious that someone's having too many deaths, and if the heat is on, the healthcare provider can easily go to another facility and start over. That's the sad truth. Want a quick and easy way of finding out the caliber of your healthcare provider? Check out how many different facilities they've worked in. The more facilities a provider has worked at should mean the more the little hairs on the back of your neck should stand up. Trust me, hospitals don't deal with problems, they move them along.

How do you protect yourself? Ask questions. Pay attention. Question what's going on. Most patients are probably more suspicious of their local auto mechanic than they are of their healthcare provider. Guess what? Your auto mechanic might sell you something you don't need, but your healthcare provider can kill you.

Still not convinced? Check out truTV's series on healthcare serial killers, conveniently broken down into the doctors, the male nurses and the female nurses. The Angels of Death are out there. Protect yourself.
http://www.trutv.com/library/crime/notorious_murders/angels/index.html