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Radiation Therapy Mistakes Cost Lives
jmtpi recommends a long NY Times investigative report about how powerful medical linear accelerators have contributed to at least two deaths in the New York area. Although the mistakes were largely due to human error, buggy software also played a role. "...the records described 621 mistakes from 2001 to 2008... most were minor... The Times found that on 133 occasions, devices used to shape or modulate radiation beams... were left out, wrongly positioned, or otherwise misused. On 284 occasions, radiation missed all or part of its intended target or treated the wrong body part entirely. ... Another patient with stomach cancer was treated for prostate cancer. Fifty patients received radiation intended for someone else, including one brain cancer patient who received radiation intended for breast cancer."
year ago i worked in a pathology lab, and i can atest to the fact the medical field is populated with a lot of highly trained morons. many times the application of these treatments aren't done by someone with enough brain power to understand whats actually happened.
If you mod me down, I will become more powerful than you can imagine....
Surprise, surprise. A little link-jumping through the manufacturer's products and job openings reveal .NET on Win32.
Or could somebody prove that the machines themselves run Linux or some kind of other embedded OS?
People make mistakes with technology which results in unintended consequences. Giving someone treatment for the wrong disease may have adverse side effects.
Basically this only proves that people are stupid in general. I don't see anything wrong with this technology.
Sewage Treatment Facilities - "Our duty is clear."
Bad software combined with poor training is not a new problem. In fact, one of the most famous serious failures of medical radiation technology. The most famous example is the Therac-25 debacle in the 1980s http://en.wikipedia.org/wiki/Therac-25 which caused multiple deaths. In that case, a combination of bad software design (leading to race conditions), bad hardware interfaces and training issues combined to create a perfect storm of bad conditions. This appears in textbooks. Problems like this shouldn't still be happening.
This is scary indeed when you are under the assumption that you are going into a hospital or clinic for a treatment like this, and assuming he/she is well trained and know what they are doing to your body... to read something like this makes one wonder just what, if any training they get to operate these machines?
How did one guy above me put it... Highly trained morons? I have to agree!!!
You must master your joystick like a fisherman masters bait! - Gimpy
http://en.wikipedia.org/wiki/Therac-25
Famously killed 2 people as a result of radiation poisoning. It's also a case study in software design - the software was reused on a model without hardware interlocks; this allowed the machine to get into an inconsistent state where it would deliver something like a hundred times the intended dose.
You'd think people would've learned.
I have developed a truly marvelous proof of this comment, which this signature is too narrow to contain.
Therac-25 is only the most prominent medical radiation incident from the past 20 years or so. The IEEE linked at the bottom explores problems with replacing hardware interlocks (mostly literal interlocks) with software interlocks, which fell prey to memory errors, bugs and human intervention. Tools like this require constant diligence and skepticism, which is nearly impossible to maintain when faced with incentives to update, promote and distribute new technology. I suspect this will devolve into some meta-discussion about regulation, but look closely at the allegations regarding cover-ups in the Therac-25 case and this article--market response presupposes that customers and investors are informed about errors in products. Where companies downplay or obfuscate errors of this magnitude, public choice fails. Regulatory bodies won't work perfectly, but I suspect that their intervention in the market would reduce these errors at some high but acceptable cost (in either monetary terms or terms of new technologies forgone due to the cost of compliance).
...such as the Therac-25 malfunction that is the textbook case of how poorly-designed UIs can have catastrophic repercussions. The Nancy Leveson article cited is a fascinating read. It is required reading for my advanced computer science students.
The whole point is to kill part of the body but a lot of the time this involves almost killing the rest of the body. My wife's father died because he had a rare sensitivity to a chemotherapy drug. They kept going back to the hospital and saying "it feels like this is killing him" and the hospital people would say "yes, that's normal, everybody thinks that". And by the time they realised it really was killing him he had no bone marrow left at all, which is fatal. In that case the problem could have been identified if more people were on the ball, but in practice they are just doing their jobs, going through the motions.
Its a bit different in technology. Normally when you (say) shut down a server you can check which server you are shutting down first and triple check it. Sure, if data has been left in a machine and you didn't check then thats a problem. But more commonly in medicine its a case of "lets try this, it might work" with no opportunity to check along the way.
http://michaelsmith.id.au
These numbers don't mean anything unless we know how many procedures are conducted in total. It could be that the probability of a fatal complication, defined as (# of fatal complications) / (# of procedures) is quite low.
I took a course on clinical decision analysis last semester. Every intervention, even diagnostic ones, carry a risk. The risk needs to be weighed versus its benefit to determine its overall efficacy. If the patient is very ill and has a short life expectancy or very low quality of life, then even dangerous procedures become acceptable.
One can conduct analyses based on expected life expectancy, QALYs (Quality-Adjusted Life Years), QOL (Quality of Life), or from a purely economic point of view. How much is a patient's life worth? Is a 5-year-old's life worth more than an 85-year-old's life? What about a 45-year-old? This can get quite philosophical. One could even conduct an analysis against a combination of outcomes, though how we choose to weigh the different outcomes is arbitrary.
Bayesian probabilities figure heavily into these analyses, and they can give quite counter-intuitive results. For example, if a test for AIDS is 99% "accurate" (in terms of sensitivity and specificity), it can still have a very high false positive rate (if AIDS is rare in the general population). In this sense, the AIDS test carries a toll of emotional devastation for the false positives. It can be a challenge to convince the general public, even your average physician, of the validity of a model. A good model will have conducted sensitivity analyses to allow for the possibility that a given procedure may have a higher (or lower) risk than expected.
You may be tempted to share someone else's radiation to catch a buzz or light one up or ride the blue dragon as you kids say. But if you read the bottle, you will see: "Federal law prohibits the transfer of this radiation to any person other than the patient for whom it was prescribed." Let this article be a warning to those looking for a cheap high or quickie chemo: Radiation Kills!
Linear accelerators have contributed to saving far more lives than these errors have taken. Fortunately, these kind of errors are comparatively rare and not the menace to health that the summary leads one to believe.
Sigs are too short to say anything truly profound so read the above post instead.
Great job on the therac25 tag!
IMHO: one should never forget about the Therac 25 incident, as a reminder of the impact on society of technology.
Not to put too fine a point on it, but buggy software is also human error.
What do you mean they cut the power? How can they cut the power, man? They're animals!
"Dr. David Banner: physician; scientist. Searching for a way to tap into the hidden strengths that all humans have. Then an accidental overdose of gamma radiation alters his body chemistry. And now when David Banner grows angry or outraged, a startling metamorphosis occurs..." Apparently they misspelled "rigor morphosis." Bah.
Never assume about your medical professionals, at least not when it comes to surgery or cancer. Get referrals from people in the field who know what they're talking about. If you can understand it, read the relevant literature yourself and ask intelligent questions about your cancer. Well-respected surgeons can be terrible in the OR and highly-published doctors can fail to read the patient's chart. Most doctors try to do a good job--and they deserve respect for that. But if the doctor's attention isn't squarely on your case when you're in front of him, if he's not thinking about you, your options and the medical facts, if he's not up on the relevant literature... keep your eyes out for warning signs. Trust him up to a point, but get a second opinion if anything seems out of whack--and maybe otherwise. The fact is, medicine is a demanding thing to do well, and despite how hard it is to get into medical school, somehow, there's still a lot of bad medicine out there.
Above all, be respectful. Not only is it usually deserved on one level or another, but it can make a difference in the quality of care you receive and the frankness of the answers you receive. Because medicine is a highly political field.
Note: This is my personal opinion, and I am not a doctor, so do what you'd like; but if it were me, I'd do something like this.
-- IANAL, this isn't legal advice, and definitely isn't legal advice for you. Also, Squee!
Dangerous treatments are more dangerous than normal treatments, all around. For example, if someone presents with an uncomplicated infection, you prescribe them antibiotics. Let's say a five day pack of zithromax, also known as a Z-Pak. There are several ways this can be dangerous. For example, if you didn't ask them if they were allergic, they could turn out to be. Or if they didn't know they were, so they said no. Or if the pills in the pack are actually something else. Or if there's a misdiagnosis.
A few ways to be dangerous.
Each treatment with radiation therapy involves HUNDREDS of variables. You aren't just applying radiation to a perfectly spherical mass in the abdomen. You could be applying it to a starfish shaped glioblastoma multiforme tumor in the brain, knowing that if you miss some of it, it will just grow back and they'll die from it anyway. You could be applying it to a bone marrow tumor, but you want to save the remaining bone marrow. Each of these situations involves a radically different configuration of the machine. The difference between a treatment dose and a face melting dose is only a few notches on a knob.
A knob that might be overlooked by a radiologist who has worked for 16 hours straight because the other one is off having a baby.
Job? I don't have time to get a job! Who will sit around and bitch about being broke and unemployed then?
This appears in textbooks. Problems like this shouldn't still be happening.
They happen because the entire medical system is flawed; look at where many of the errors occurred. They had nothing to do with software. If the radiation shield/guide isn't installed, that's not the software's fault. Don't blame human problems on technical things, and don't solve human problems with technical solutions. If a nurse forgets to put a radiation shield in place, FIRE THEIR ASS.
How flawed is the medical system in the US?
These are people who are some of the most highly paid people in society, who have taken an oath (which the are happy to get uppity about whenever it serves them.) When they fuck up, their malpractice insurance covers the lawsuit. And then the doctors turn around and bitch at us about how expensive it is to be a doctor, mostly because of their insane malpractice insurance.
Did I mention that everyone goes into obscure specialties, meaning that if you want a Toe Oncologist, you can see one in a few days, but you've got to wait weeks in most major cities for a general practitioner...who just so happens to be the only person who can approve your care if you're on an HMO?
Please help metamoderate.
Is there some reason they aren't required to put a radiation probe of some kind on the patient for each treatment, to double check they are getting the prescribed dose?
Wouldn't that prevent all these accidental overdoses, so the only people who suffer are people with doctors who accidentally prescribe 1000x the normal dose because they're idiots?
Surely the savings in catching these things early and the malpractice cases that come out of it would be cheaper then when you burn giant holes in peoples chests from overdoses and don't even have the brains to realize what happened.
Comment forecast: Bits of genius surrounded by a sea of mediocrity.
I don't know what Varian uses, but the Therac incident involved an embedded PDP-11, probably running RT-11 or RSX-11.
Purely for trivia fans: RSX-11 was Dave Cutler's first OS, followed by VMS and NT.
Ok, I'm responding to a troll, I know. But here goes. The post has a core of truth, but like all Slashdot-postings the "It's so simple I could just figure it out and do better" high-school naivety predominates.
>Doctors and surgeons routinely **** up on the most basic things, like which side of the body they're operating on, often in some VERY serious, permanent operations, like amputations.
- I have done thousands of operations and never a wrong-side operation. It is something that is taken *extremely* seriously, and we have at least three checks that guard against this. With over a billion procedures done per year, yes, there will be many that make the news, not unlike planes taking off on the wrong runway, etc., etc.
>Doctors and nurses, time and time again, have been shown to not practice the most simple procedures for infection control, like washing their hands before/after every patient.
- True again to a small degree, but everybody at my hospital does this. It probably could make a bit of difference if done nationwide, but again, this is taken extremely seriously.
>A couple of doctors in the Boston area have a)left patients on the operating table (opened up!) to run an errand at the bank b)shown up drunk or high for operations c)been beyond unprofessional to staff 'below' them (screaming, throwing things etc.)
- a) I was a resident at the very same major hospital when this happened. I know the inside story, and it was nowhere near as simple as it sounds.
- b) ?? The MD would be promptly fired. I don't understand what kind of life you imagine we lead.
- c) Yes, I agree this is a problem. This is a very big problem that the medical "culture" has some deficiency with. Equally bad is an antagonistic attitude by people "below" the MD who try to passive-aggressively sabotage things or "protect the patient" by alienating the rest of the staff. We need to work as a team, and at my hospital I strive to make sure that is always done.
> When the *** up, the malpractice covers the lawsuit.
Again, you have some sort of "fantasy" about M.D.s that is not remotely grounded. I'm guessing you wanted to go to med school and never had the wherewithal to go through with it? Or maybe had some unfortunate experiences as a patient?
- Nobody, NOBODY wants to get sued. The idea that we just sit in a lounge and make patients wait, etc., is pure nonsense. I work my a$$ off every day, and my friends with similar education and ethic get paid twice what I do. I am far from "among the most highly paid in society."
If you want a realistic sense of what may go on during a suit, read this piece:
http://www.nytimes.com/2009/12/29/health/views/29case.html?_r=1
Slashdotter, ID #101. UIDs are in binary, right?
orly?
So you take a wave motion gun, and give it to some techs who make $15 an hour, and are union, and you expect them to care where it's pointing?
I want to delete my account but Slashdot doesn't allow it.
While, as nerds, everyone here leaps to 'computer error'(And everyone mentions that Therac-25 disaster we all learned about in comp sci 101.), computers aren't really responsible for a brain cancer patient getting treatment for breast cancer.
A computer might say where to aim the machine, but someone who was even slightly familiar with the case would say 'Um...the breasts? No, that can't be right.'.
What is responsible is the constant reduction in the amount of staff at medical facilities, and consequently, the inability for any actual checking or familiarity with patients.
Read the horrific description of what happened to Jerome-Parks, please notice that it was people trying program crashing machines, machines that were obviously screwed up, and no one bothering to actually look at the result. And then doing it twice more because no one bothered to look into the obvious mistake.
Essentially, the problem here isn't the Therac-25 one, where a shitty user interface resulted in the screen saying one thing and doing another. Note that in every described situation, the machine clearly described what it was doing. It wasn't 'doing something else besides what it said', it was doing what it had, incorrectly, been told to do. It said it was doing it, it did it. The machine worked perfectly.
It is equivalent of being a newspaper reporter, and Word crashes while I save my article...but I submit it anyway, and the front page of the newspaper is filled with gibberish. You know whose fault that is? Sure as hell not Word. It's my fault, it's the editor's fault, it's the guy doing the final check before the print run. If I were to claim the solution to this constantly happening was 'crash-proof software', I'd get laughed out of society.
Oh, but newspapers actually, you know, pay people to check that before spending thousands of dollars doing a print run. If only someone's life was worth more than that.
Yes, we can argue the machine should have fail safes to stop them from working in obvious stupid situations, but this just stops obviously stupid situations, and only overdoses. What is that is a perfectly reasonable dose...aimed at entirely the wrong spot, for someone with an entire different type of cancer?What if it's 100x what you should be getting, but still within the bounds of reasonable for certain extreme types of cancer? What if that is, in fact, practically no dose at all, so you die of a fucking treatable cancer because you got not treatment?
More to the point, why are we worried about this, when drug errors kill ten thousand times as many people? (Because machines often do have failsafes, unlike prescriptions.)
If only we had a system where all the money wasn't sucked out of the system by insurance companies, one where we actually paid to have competent medical staff who could actually watch what was going on, instead of spending ten damn seconds a patient.
If corporations are people, aren't stockholders guilty of slavery?
These "Highly Trained Morons" are working on killing my wife. She went in for a Hysterectomy and ended up with her ureter sutured or cauterized shut resulting in her kidney backing up and shutting down. Now she has a tube out her back to keep her kidney alive and in a few weeks they'll go in an cut her ureter above the blockage and reattach it to her bladder. All for the low, low, price of $$$$$$$$$$$$. Meanwhile, the nursing staff and E/R staff have done everything in their power to see how much additional damage they can do. No one has any common sense or care that I can see. I'm fit to be tied!
Over-the-top Response Guy! Giving "Over-the-Top Responses" since 1970.
Two fatalities? In 8 years? And we are talking about rather intensive procedures for which informed consent is obtained either directly or by proxy?
If we're going to stick to a medical scene, how many fatalities due to surgical 'mistakes' occurred? Drug related accidents too. Either makes the 'two' look like Disney material.
During the same period NTSB general aviation (ie not commercial airlines) reports show 181 incidents, 147 accidents, 109 fatalities in the US.
For commercial accidents and fatalities, go world wide and enjoy http://en.wikipedia.org/wiki/List_of_accidents_and_incidents_involving_commercial_aircraft Feel free to discount the Sept 11 2001 entry as a statistical outlier. Take a calculator.
What I'd like to see is some in depth journalism investigation (a subset of investigative journalism) to determine how many accident fatalities due to inaccurate reporting of weather/road/building/etc conditions, suicides due to news reports detrimental to the victim, suicides among employees, and covert/extended suicide by employees via such as alcoholism occurred due to the NYT. And when the count is in, maybe a comparison about how hard it is to run a newspaper vs. running a linear accelerator based medical radiation system. And before you go counting how many people each takes, consider how much of the operation of the latter is automated and how many people it would take to do it without the automation.
"I may be synthetic, but I'm not stupid." -- Bishop 341-B
I have a friend who recently was laid off from a smallish Fresno, CA-based company (I think it was Fresno...) that makes computers and software for radiation dosing and administration. Apparently, the owner of the company bought it from the previous owner, who in turn had purchased it from the original owner. The original owner sold it some 20 years ago, and in the shuffle of ownership, all of the people who actually wrote the original code (which was buggy to begin with) were lost. So, for the last 20 years or so, the company has been trying to "band-aide" software that they don't really understand themselves. Essentially they were one of the first companies to come up with software for the treatment of radiation, but due to bad ownership and terrible business decisions (such as firing all the employees that know what they're doing, because it costs them too much in payroll), they've basically been relegated to servicing poor hospitals and nations who can't afford anything better. Personally, if I were to get radiation treatments, knowing what I've heard from an inside source, I'd very much want to research the companies that make the software and hardware that I'll be at the mercy of. That, and not go to a poor hospital that can't afford the good stuff. $0.02 Cheers!
My wife is a therapeutic radiographer - not that this means I'm qualified to understand it, but it does mean I hear of some of the incidents.
Radiation therapy is potentially dangerous. So is all cancer treatment - the reason we use it is because it's a sight less dangerous than letting nature take its course. The main solution is a combination of two things:
However, neither of these are foolproof. The machinery has to be calibrated - it doesn't magically give out the correct dose when told to when it leaves the factory. Calibration errors have caused people to receive much higher doses than intended - and usually the first you hear about it is when a patient complains of significantly worse side effects than you were expecting significantly earlier. Other times patient errors have very nearly resulted in the wrong treatment altogether.
Patient errors? Yep, it can happen. Two patients with a similar name in the waiting room, the next patient is called for and the wrong person gets up. You're supposed to check the patients' date of birth every time but a lot of people seem to lapse into just nodding and agreeing with everything the person in uniform says, so if the patient is asked "Is your date of birth 1st March 1960?" (rather than "Can you confirm your date of birth for me please?"), they just mindlessly agree. My wife's suggestion to help reduce this risk was that photographs of patients be taken on their first treatment and kept with their records - frankly, the only amazing thing about this is it was 2009 when it was made and it wasn't standard practise.
Paradoxically, one of the ways errors are dealt with is to instigate a firm "no blame" policy. The reason for this is so people aren't tempted to try and cover up errors.
People survive just fine with one arm? People survive just fine that are blind? People survive just fine who can't hear? People survive just fine with a permanent colostomy bag? People survive just fine with their tongue cut out? People survive just fine with one leg? People survive just fine with their face melted off with acid or burned off in fire? People survive just fine with their testicles mistakenly removed? People survive just fine with their dick cut off? People survive just fine without a bladder of any sorts?
You're welcome to accept any of these conditions any time you want jack-ass!
Over-the-top Response Guy! Giving "Over-the-Top Responses" since 1970.
I'm not the GP, but... It is great that you (claim to) have high moral standards. It really is. But that most certainly isn't the case for all the doctors and based on my experience, I would claim that it might not even be the case with most doctors.
I personally have breathing problems. I can't give you the diagnose as I have never been diagnosed with anything. All I know is that I occasionally have great difficulties breathing and get exhausted easily. It's not about me being in bad shape either (I'm not athletic, but I'm 20 years old male with no extra weight. I shouldn't get exhausted from simply speaking). Breathing problems are a terrible thing to have: They affect your life, your mood, keep you up at nights, etc... Especially when you don't know why you have those.
I have seen doctors because of this. Many doctors. About a dozen, before I just gave up. None of them implied that these might be just in my head or anything like that (though perhaps two of them asked if I had stress, etc.) but most simply don't care enough to examine their patients that well. If it is some simple disease or infection that can be quickly diagnosed and treated, great. If it is something chronic? You are out of luck. Most doctors seem to care only about the current visit: If you go there, complain about breathing problems and they find nothing, they say "Okay, it's probably nothing to worry about." without caring about the fact that it's the 10th time you've felt like you really need to see the doctor about the problem.
Eventually I found a doctor that was willing to send me to tests about asthma and x-ray my lungs. The day I was x-rayed I had breathing problems again and the doctor also thought that it seemed as if I had some liquid in my lungs. She sent me to ultrasound to be sure but they found nothing (that day I also had no breathing problems) so that was it then, no diagnose again. At that point I just gave up even trying and decided to live with it.
I have a very similar problem. Chronic issues with breathing and nasal irritaion and pain. Stomach irritation and pain. Nothing seems to help. I had severe Asthma as a kid, so was diagnosed. Used to be highly allergic to just about everything. Supposedly, I outgrew those allergies, but, really all I did was outgrow such a strong reaction to them that I'd need to be hospitalized and put on oxygen or die. Now, everything is just pain and struggle to breather, but, hey, I'm alive. I should be thankful, right? Doctors don't know anything to help me. I gave up. It's not really their fault, they just don't really know that much about these kinds of conditions period. It sucks. But, it's noones fault.
Wish I had some answers for you. Maybe, since you are so young, that soon they'll figure some of these issues out and you won't have to live for 40 years with this problem. Here's hoping.
Over-the-top Response Guy! Giving "Over-the-Top Responses" since 1970.
or at least at a safe distance
I had the radiation oncologist review the status of every single treatment with me face to face 41 times.
Again, ridiculously simplistic analysis.
>you should be excited every time you hear a doctor is being sued for malpractice.
You have got to be kidding; that statement is simply ludicrous. I don't engage in some sort of weird schadenfreude when somebody gets sued, even if it were somewhat legitimate. Medical school is relatively difficult to enter, selects for the most driven people, and is a long process where several dozen people work with you and gauge your progress and abilities. *OF COURSE* bad doctors need to be stopped, just like "bad pilots" or "bad computer programmers." Indeed, a lawsuit is one of many ways, in fact a poorly targeted way, of doing this. There are many other options including board registration, hospital credentialing, and outcomes monitoring. Life is not black and white.
The second paragraph of your post makes little sense. Can't have it both ways? Are you advocating ruining the career of good physicians in the hope of catching bad ones with a broad net? I am not advocating increased lawsuits, as the *vast majority* of them are groundless. That is not an opinion.
And yes, I am a doctor. You can check my long posting history for a bit of confirmation or at least support.
Slashdotter, ID #101. UIDs are in binary, right?
Had radiation go wide during a 6 day cycle, radiation burns and good times. It was picked up the following cycle and "adjusted" for.
... and stuff like this makes me anxious. I had 30+ zaps to my leg. Initially there was a rather involved simulation to precisely aim the beam. They made a mold to hold my leg in place for the treatments and tattooed targeting dots on my leg.
They screwed up. It was completely bungled and part of the beam was aimed to go right down the side of my leg, frying the top layer of skin. Within a couple of treatments they adjusted it and just used sharpies to make new targeting dots.
One day I was lying on the table with my balls in the lead sphere to protect them when over the PA I heard the old Windows error sound. Scared the crap out of me until they told me they only used Windows for their scheduling software.
I remember reading in some programming instructional material a story of the Therac-25. A lovely device, killed 2 patients due to software errors. Always know your logic-trees!
CHECKLISTS! Pilots have an easy job and they need them. huge benefits resulted from giving them checklists.
Doctors and medical workers must be forced to use checklists. period.
Democracy Now! - uncensored, anti-establishment news
Hollywood upstairs medical college is like that and the dockets where wow dates by getting them any (drug) that they want.
...to thank all those who expressed concern. Wasn't intended as a sympathy shopping expedition, but, thank you anyway.
Over-the-top Response Guy! Giving "Over-the-Top Responses" since 1970.
Yeah, the nurse should have installed it, and she fucked up. However, it is a basic fact of humans that all of them fuck up from time to time, some more than others, and more under some conditions than others. Unless that particular nurse has an atypically bad record for forgetting, it is unlikely that firing her will improve the quality of the system as a whole very much. Instead, such safety critical systems should be designed to take human error into account. Routine use of checklists, for instance, has been demonstrated to reduce human error.
When the failure could or WILL result in the patient dying, that nurse is aware of the consequences and should take whatever steps THEY feel is necessary to make sure THEY get it done.
It's not society's place to shepherd those who hold the lives of others in their hands. If you can't recognize the importance of something and make sure you follow proper procedure, you're undeserving of the job.
Please help metamoderate.
...they don't have to worry about being invaded and having their resources taken away because other countries do all the heavy lifting in keeping the peace throughout the world and then take nothing but crap about it from everyone else.
Over-the-top Response Guy! Giving "Over-the-Top Responses" since 1970.
ack... I know I shouldn't be doing this but : “Prayer is stronger than radiation” ... why ... would ... anyone ... say ... this ?
Nothing wrong with prayer, I suppose, but I get the sense that sometimes it detaches people form the physical reality of problems and discourages actual attempts at change. If I were dying, I'd probably want people to be working harder to finding general cures for the ailments of our species. Do you think praying is a psychologically necessary part of grieving that is going to happen anyway? I suppose if that were the case then it would be beneficial. I suppose I just don't understand why doing nothing is preferable to seeking physical solutions.
without this technology the cancer would just kill you slowly anyway, so... maybe the odd horribly painful deadly screw-up is worth it.
I don't want to die of cancer. I want to die of a self inflicted overdose of very fun drugs at a very old age, or die sacrificing myself in some useful way.
You speak up. They dismiss you explaining that that is not the way it is done. Who are you to argue. They're the doctor. Oh, but, don't hold them responsible if something goes wrong. After all, what they do is so completely, absolutely complicated that mistakes will happen. So suck it up and die schmuck!
Over-the-top Response Guy! Giving "Over-the-Top Responses" since 1970.
- I have done thousands of operations and never a wrong-side operation. It is something that is taken *extremely* seriously, and we have at least three checks that guard against this. With over a billion procedures done per year, yes, there will be many that make the news, not unlike planes taking off on the wrong runway, etc., etc.
And yet, despite all those checks, surgeons still fuck it up. And of course, why were all those checks necessary in the first place? Answer: incompetent, arrogant surgeons/doctors. You make it out like it's a rarity. http://www.google.com/webhp?hl=en#hl=en&q=surgery+"wrong+side+of+the"
*Golf clap*. You just justified something completely moronic (operating on the wrong part of the patient) by saying that because it's done so many times, we should excuse the "few" idiots.
I don't care how many fucking operations you do. The surgeon should be aware of the patient's history to the extent that something as unbelievably simple as "which side am I operating on" should not be possible. How can they possibly treat/operate effectively if they can't even get something that simple done?
The post has a core of truth, but like all Slashdot-postings the "It's so simple I could just figure it out and do better" high-school naivety predominates.
It IS SO SIMPLE. Fire and criminally prosecute doctors, nurses, and surgeons who injure or kill patients through their incompetence. Watch as the medical profession suddenly becomes more interested in competence, safety, etc- and not just exploiting med students. If patient safety is so important, why are med students run through a meat grinder? What a bunch of macho bullshit to claim it's to "test" them. When I'm seen by a med student who is operating on 3 hours of sleep over the last 48 hours, I'm not going to get anything remotely approaching a level of decent care.
By the way, take that ad hominem and cram it up your ass; I never applied for med school. Zero interest.
Please help metamoderate.
Just where the fuck did this idea come from? Who the fuck is selling this? Who the fuck is buying it?
Everyone wants to say this until they are the victim of someone else's mistake. If I drive too fast for conditions and I slide on the ice and wreck my car into your livingroom and kill your children, then I shouldn't be blamed. It was just a mistake. We should just work on better protocols to help keep me from doing this in the future. Maybe we can make the cars have ice sensors (temperature/humidity etc) that automagically govern the speed to a much lower value than otherwise. No need to blame me. After all, I was just driving in what seemed like a safe manner.
Over-the-top Response Guy! Giving "Over-the-Top Responses" since 1970.
Probably a lot of books written on it -- Atul Gawande did a pretty big "study" with safety checklist prior to OR activation. We have several checklists (independent of anesthesia) before starting any invasive procedure, so this is kind of behind the times. It is more targeted at foreign hospitals or places that have a lot of mid-level providers that are not used to things. If you are interested, the full study can be found here:
http://content.nejm.org/cgi/content/full/NEJMsa0810119
gbutler69 writes:
>Says who? Citation Please?
[snip a bunch of rhetorical questions]
From your questions I infer you are completely out of touch with this field in any sort of form. If you want a citation, do a tad of research on your own and you will discover things; I won't spoon-feed.
Poke around here to start (but some of this might be biased the *other* way.) Do a good deal of academic reading and you will get a good feel of what is going on:
http://www.sickoflawsuits.org/
Slashdotter, ID #101. UIDs are in binary, right?
Instead, "snip, a bunch of rhetorical questions". What the fuck is that supposed to mean? Fuck You! You're not a good doctor, you're a piece of shit! You don't want to take responsibility for anything and you want everyone to kiss your ass because you know better and they are dumbasses. After all, you went to MEDICAL SCHOOL!
Noone can question you (with their silly Rhetoric)? No, you are beyond reproach and above criticism. Fuck You!
Over-the-top Response Guy! Giving "Over-the-Top Responses" since 1970.
Did you even read my post. I know it's incredibly pretentious quoting myself but seeing as you cant read.
Responsibility != blame. Blame is cast, responsibility is taken. The point of my post (that you so conveniently missed with your inaccurate rant) is that a mistake needs to be fixed and the biggest roadblock to fixing mistakes is the blame game.
This implies two things, 1. you knew that your chose speed was not sufficient for the conditions and 2. you still chose to drive at that speed.
Your example is not an accident, it is negligence. Negligence is when one knowingly and deliberately ("on purpose") causes harm to themselves or others, accidents are when harm is done via actions with were not done deliberately. There is a big difference between negligence and accident.
An accident happens when you are driving under the speed limit and taking all legal and prudent precautions and slide into someone's living room. Considerably less inflammatory then your inaccurate analogy. Look at it this way, which of our two scenario's would the insurance company weasel out of paying? You deliberately put yourself at risk it is not an accident. Kindly get a clue.
Calling someone a "hater" only means you can not rationally rebut their argument.
Negligence has nothing to do with deliberate.
Negligent Neg"li*gent, a. [F. n['e]gligent, L. negligens,p.
pr. of negligere. See Neglect.]
Apt to neglect; customarily neglectful; characterized by
negligence; careless; heedless; culpably careless; showing
lack of attention; as, disposed in negligent order. "Be thou
negligent of fame." --Swift.
[1913 Webster]
Over-the-top Response Guy! Giving "Over-the-Top Responses" since 1970.
Where is "Deliberate" or "On Purpose" in any of that? Now I see why health practioners object to lawsuits. They don't think they are negligent because they don't even know what the goddamn word means! Syn: Careles; heedless; neglectful; regardless; thoughtless;
indifferent; inattentive; remiss.
[1913 Webster]
Over-the-top Response Guy! Giving "Over-the-Top Responses" since 1970.
I think you lack reading comprehension. Failing to take reasonable care is not the same thing as deliberate. You just proved my point. You so want to believe that a medical mistake is not negligence, that you will twist words to mean what you think they should mean rather than what they in fact mean. I feel like I'm arguing with Bill Clinton over what the meaning of the word "is" is.
Over-the-top Response Guy! Giving "Over-the-Top Responses" since 1970.
You are completely ignorant. How does someone "Choose to drive at a speed that they knew was unsafe for conditions if the believed they were traveling at a safe speed?"
Then you say, "This is why we have laws that regulate speed, ..." Yeah, and we also have laws that regulate medical safety. So what the fuck is your goddamn point?
"Did I pass my driving test," you say. Did you pass your medical exam? What's the difference?
With your terrible example you are expected to know how to perform a medical procedure safely. Do you remeber that test you had to take before getting your license to practice medicine? You cannont "accidently" suture or cauterize an unrelated organ or system when operating on another.
You are making even less sense than before.
Over-the-top Response Guy! Giving "Over-the-Top Responses" since 1970.
There is painstaking care involved in radiation therapy (at any decent hospital or medical center). Linear accelerators have many safety interlocks. They go through a specific QA protocol daily, weekly, monthly and yearly at the hands of a qualified medical physicist. Gross failures that injure patients are extremely rare, but they inevitably become famous making people suspicious of the field as a whole. Regarding smaller errors and setup uncertainty, the total dose is fractionated - spread out over many days- to prevent any one small error from having a dominant effect. Thousands of people receive radiotherapy with a positive outcome or, at least, without any problems associated with the delivery of therapy.
Yep..
My husband is on Medicare and the care he receives is outstanding. This last year he had several operations and hospitalizations. Much of his care has been at the University of Washington Medical Center, rated among the top 10 hospitals in the US, and he has had great care with extremely qualified doctors, professors with decades of experience. There are never any questions about his care not being covered. You hear horror stories of private insurance companies denying care or delaying decisions until the patient is too ill to recover. We've never had any problems with Medicare.
In other breaking news: the sun is hot, granite is hard and water is wet.
Sometimes a dumb mistake can be dumb luck. For instance, if the best diagnostician in the country misdiagnoses a patient and orders radiation which would then wipe out his immune system and leave him doomed to the infection that is really his underlying problem, dosing the wrong patient might work out in the end. It could happen.
IIRC RFID tags are indeed used to track patients against procedures in at least one Japanese hospital system working now. I met the developer, who worked for years on it. He tried to open source it once a decade or more ago, and someone tried to push him off a train platform he was convinced in retaliation for threatening their income. He may try it again now that things are a bit different.
I also visited a radiation facility and remember something about them using RFID checks on the patient.
It sounds like totally irresponsible procedure design by a fucked up health system run by insurance companies, why my Dad (a cancer surgeon) was glad to get out of it. The kind of things discussed in this thread just should not be happening at all. There is no reason in this age for a single patient to be wrongly irradiated even counting human error. What must have happened is the insurance actuarialists computed statistics of a bad dose compared to the cost of overengineering the entire medical procedure from patient checkin to irradiation. The patients lost. Or can someone give a better reason?
Although the mistakes were largely due to human error, buggy software also played a role.
What the...?
And where do you think, that software came from?
Please hand in your geek card.
Just like everyone who thinks that Kasparov lost against a machine, and not against a couple of engineers with a loong time to prepare.
Any sufficiently advanced intelligence is indistinguishable from stupidity.
It was a "Routine" hysterectomy (their words, not mine) that presented with no complications. It was gonna be in and out with no problems. The only reason they were doing it was because my wife was having a lot of pain (for a number of years) during her cycles. She went to the surgeon originally because her doctor recommended Endometrial Ablation. The surgeon said that wasn't going to help. She had had a Tubal Ligation several years earlier after her last child. They said they needed to do the Hysterectomy because she had cysts (non-cancerous/non-life-threatening) on her Ovary. It was, they said, only going to continue to cause ever increasing pain and that this was the only alternative. It was routine though. No complications that would cause them to expect anything other than a routine, easy hysterectomy.
Now, it is obvious to me based on the responses from those who claim to be doctors and/or medical practioners, that they all believe that they should never be held culpable for anything. Their attitude can be summarized as "Shit Happens". This experience, coupled with the kind of responses to what I said, as well as what others are saying on this topic, has drastically changed my perception of the Medical Profession. It is obvious to me that most (I'm sure there are exceptions) practioners see themselves as some kind of infallible gods. They don't make mistakes! No, there are complications! Us mere mortals could never possibly understand the complexity of what they deal with. We should thank our lucky stars that they even lower themselves to the indiginity of actually attempting to address our health problems. We should bow down, kiss their feet, and worship their skillZ!
Again, thanks to all those who expressed concern. And for those other smart-asses, I only hope that you don't have to face this sort of thing and learn the hard way (as I have done) how unprofessional, and uncaring this system really is.
I, for one, will never again question the legitimacy of "All the Frivolous Lawsuits" that get filed!
Oh, and for those doctors that don't think their Malpractice Insurance should have to pay for someone's ongoing care when they make this kind of mistake, I say to you, since their is no other recourse, I recommend that anyone who has their family member or loved one killed or serioulsy injured, hunt you down and injure or kill you. After all, it's only fair!
Over-the-top Response Guy! Giving "Over-the-Top Responses" since 1970.
You are a complete idiot. You so want words to mean what you think they should mean rather than what they mean, that you fail to respond in any meaningful way to my arguments. You entire argument boils down to, "We're Doctors. We know best. You can't possibly understand. Shit Happens!"
Since you don't think doctors should be held financially responsible for their actions and their should be no recourse in tort law for injured parties, then I think that people who are injured should be able to exact restitution from you in any way they themselves deem appropriate.
I would love to get a list of your patients and forward your diatribes here to them. I think it would be a wonderful eye-opener for them.
Over-the-top Response Guy! Giving "Over-the-Top Responses" since 1970.
Take your medicine, you stupid fuck, and get the hell off the internet.
You make us all look bad to the few reasonable dudes who post stuff.
And zero ability. I never went to med school either but I'm not jealous of those with power like you are.
Dude, you are retarded. Nobody will ever take you seriously in life, you loser.
Sure, software records are a problem. But the problems will be noticed and accounted with more detail than the paper systems currently in use.
When something wrong in paper it is noticed eventually but we don't track the thing as well and have less data to help contribute to avoiding a repeat. There is less error checking possible as well- its not digital.
Software bugs tend to stick out and get feedback because its unhuman and people don't have to deal with blame games (blame the computer.)
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