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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."
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
Indeed, most of these errors don't sound like Therac-25 type errors, more like PEBKAC errors.
These can only be solved by double checking(more labor costs? not likely) or by patients who care enough about themselves to take a black marker and write "radiation goes here, dumbass".
I've done similar things ever since I went in for an operation where they started the incision on the wrong side then decided they'd just go with it and tunnel across my abdomen instead of starting over in the right spot.
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.
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.
We have public health care in Norway and I see far fewer problems than in the US...
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!
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.
- 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.
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?
Yep, my dad got radiation treatment, he got "gamma knife" treatment for brain cancer. You get a special plastic mesh helmet that is specifically molded to your head (for brain cancer paitents, it's molded to other parts for pancreas or breast cancer, etc paitents), and then there are marker dots on the mesh helmet that align with set lasers in the walls. so your body is properly aligned. Then the actual "gamma knife" is placed in the correct position so it creates a red + sign on the targeted area, which matches up with the plastic mesh helmet. Your name is also written on the helmet, and you fetch your own helmet from the same cubbie each time and put it on your own head. A tech makes sure it's secured and double checks that it's your helmet. Not only are you picking out your helmet, but they cross reference your name, and unless you have a very small head, only your helmet is going to properly fit you. The red + sign isn't going to lay "flat" and the laser dots won't line up. It's at least a triple redundancy mode of failure and it seemed to work pretty well. Added bonus: the table looks like that room in the bond movie where bond goes "you expect me to talk?" and the villan responds "no mr bond, i expect you to die! (maniacal laughter). It's kind of neat to do medicine in a room that looks like a bond villian's secret layer.
moox. for a new generation.
Medicaid is top-notch from what I've seen having 2 friends on it. The problem with Medicaid is that it's too good. You can get a $400 prescription for antidepressants and not be able to pay your rent. What's more important, really? Antidepressants or rent money.
Well, they did the right (i.e. least risky) thing. Every hole cut into the bodys line of defense against the hostile exterior is a possible site for an infection, hence you want to keep the number and size of the holes as low as possible.
Well, a doctor is only a apothecary with a tiny further training. Who after being finished, assumes that he knows everything and will continue to do so forever. If he does not know it, it does not exist. If he knows no cure, there is no cure.
Also they are trained to “fix” the symptoms. (Which is practice means, to hide them under painkillers, so you can continue to ignore what you’re doing wrong.) Finding the causes is only happening in colorful Hollywood productions. In reality, it’s actually a taboo. Every time I ask a doctor to find the cause, I get a blank stare, and a “can’t parse” error. Or him telling me that a part of my body is the cause! (WTF? A part of the body an by definition not be the cause.)
Finding causes... it seems... is what scientists are for.
Any sufficiently advanced intelligence is indistinguishable from stupidity.
I daresay often it's not the unskilled hands that's killing people in hospitals.
It's more likely poor processes. No checklists of important stuff. Not enough training, practice and preparation in critical areas. (and of course dirty hands ;) ).
See:
http://www.telegraph.co.uk/news/1527497/Ferrari-pit-stop-saves-Alexanders-life.html
and:
http://shimworld.wordpress.com/2008/11/19/operation-pit-stop-lessons-from-the-fast-lane/
The doctors took cues from two Formula 1 teams: McLaren and Ferrari. The Chief Medical Officer for McLaren racing team watched a video of a hospital handover, studied the footage then asked, "Why is there so much noise and people colliding with each other, doing things that don't need doing? Why not space them out and make an organised list of instructions?" When the doctors met with then Ferrari's technical manager, Nigel Stephney, who watched the video of the handover and he made the following observations:
"I don't understand," Stephney said. "Who's in charge?" ... Stephney shook his head in disbelief. Then he asked more questions: did they brief and debrief? Were there check lists? Did they rehearse without a patient? Each time the doctors said no. Stephey explained: "It's not about having the best people and just putting them together--it's about a group of people who can work as a team." Staff were forgetting basic things -- even omitting to switch vital equipment to mains power on reaching the ICU, leaving it on the portable battery system. An hour later the batteries would run out and alarms would sound. Moreover, the medical teams had no briefing for what do do if things did go wrong, being left to use their initiative. Pit-stop crews, by contrast, knew exactly what to do if, for example, a wheel nut rolled away. (Take out the spare in their right hand pocket).