Let me clue you in. I spent several years following medical malpractice for doctors, and also product liability.
Insurance companies like to raise their premiums. Policy-holders don't like to pay more money. So insurance companies come up with all kinds of bullshit excuses to raise their premiums, like, "We have to raise our premiums because of these crazy malpractice awards." And then they come up with some bullshit story about one of those awards.
(One of the bullshit stories that the insurance companies came up with was the "lawnmower case." The story, which they published in national newspaper and magazine ads calling for product liability "reform", was that two guys decided to each hold up one side of a power lawnmower, and use it to trim a hedge. One guy lost his arm, sued the lawnmower company, and won. Therefore we need product liability reform. Business Insurance magazine tracked the story down and it turned out to be a lie. There were Congressional hearings about it. Insurance companies lie. And right-wing politicians lie even more brazenly.)
I'm not talking about Central Africa. If you compare the U.S. to similarly developed countries with good health care systems and good legal systems, their malpractice laws are similar to ours, and sometimes our laws are comparatively favorable to doctors.
Sure there is a reason. If a patient were to die. (likely event), they don't want to be sued by a lawyer. It would look like they are not following 'standard best practices'. How bad does it look when you just throw someone in the station wagon, when you could wait 15 minutes and transport him in approved medical / lawyer free manner.
Well, if you're talking about throwing someone in the station wagon when he's having a medical emergency, that doesn't sound like such a good idea any more. You do have to transport them in a medically-approved manner, in case they go into defibrillation or something.
I thought the hospital was close enough that they could transport them on a gurney, while giving the patient supportive services. Some medical institutions have covered or underground passageways to protect them from the elements.
If the geriatric hospital doesn't have a good way to transport the patient to the hospital, then they should be calling an ambulance. They should also be able to arrange with an ambulance service to do it cheaply.
Or they could get their own ambulance and attendants, but rather than having the attendants on call all day, it might be cheaper to call an ambulance as needed.
Also 911 HAS to be called. If 911 isn't called it looks like 'standard best practices' aren't being followed.
I don't know why they have to call 911, unless that's the fastest way to get an ambulance in your area. Who says calling 911 is the "standard best practice"?
I like to be careful with my facts so I can't draw any firm conclusions without finding out first hand, but when lawyers tell you to do something, they either have a good reason for it, or you should get a new lawyer.
It's also a part of the culture of medicine (which is changing).
The BMJ had a comic routine about the worst-ranked hospital in the UK. The head of the surgery department would solve all problems by working longer hours.
They can't dump the responsibility on the patient, especially by shoving an informed consent form under his hand in the 15 minutes before surgery.
Oh yes they can (legally speaking)
I've gone to legal conferences where lawyers explained to doctors and hospital administrators what constitutes a valid informed consent form.
If they put a paragraph in the informed consent form saying, "I realize that my surgeon is operating on me after not getting any sleep the night before, and he is more likely to make a mistake," I don't think that would protect the doctor if he *did* make a mistake.
If he leaves a screwdriver inside you because he was sleepy, that's malpractice in any case, and he's still legally liable for malpractice, whether you signed that consent form or not. You can't consent to have the doctor practice incompetently on you.
The doctors in the NEJM article were just saying that as a way of making hospitals uncomfortable about a practice that many of them accept even though they know it's wrong.
Medical malpractice costs aren't really a serious problem,
You must live outside the USA.
I live in the USA, but malpractice laws in other countries, such as Canada, are even stricter. In Canada, and in the UK, when doctors make a mistake that harms a patient, they're required to tell that patient. And Canada allows damages for things that wouldn't get damages here, such as the anxiety you have between the time they tell you that you may have been infected by improperly sterilized equipment and the time that you find out you're not infected.
The total cost of medical malpractice is about 2% of the health care dollar, and the bulk of that 2% reimburses patients who actually were injured.
Since that wasn't too impresive, the tort reform people came up with a new argument: It's not just 2%. Doctors are forced to do expensive, unnecessary procedures out of fear of lawsuits.
There is a grain of truth to that, but for the most part, if a doctor follows the standard best practice, he won't be guilty of malpractice.
(Juries are a lottery, and often come up with crazy results, but that's the price of the jury system. These are the same jurors who decide death penalty cases. And they're also the voters who choose our elected officials.)
In the example you give, if the geriatric home shares the same parking lot as the hospital, and they can easily move a patient to the hospital on a gurney, I don't understand why they have to call an ambulance, but they may have a reason. Maybe the EMTs can perform emergency cardiac care better than the people at the geriatric center.
Lots of times when people do stupid things, they blame the lawyers. When I've checked them out, it often turns out that the lawyers didn't tell them to do it at all.
Maybe one of the geriatric home owners has a brother-in-law with an ambulance business. Happens all the time.
Lawyers don't sue for altruistic concerns. They sue to make obscene amounts of money. Try to get a lawyer to represent you, against a doctor when large amounts of money aren't on the line.
Not true. Lawyers often do sue for altruistic concerns.
I used to work for lawyers who had a big pro bono practice.
One of the cases was suing New York City to provide housing for homeless men, which was required by the New York State constitution. (One of the lawyers in the firm used to come in to work through Pennsylvania Station, and he wondered why there were so many homeless men sleeping there.) He was successful and there are relatively few homeless people living on the street today.
Another one of the cases was to give teenage girls the right to get an abortion without approval by a judge, and without having to explain why she wants it. They one that one too.
It's true they made a lot of money doing commercial work for corporate clients. But there's a long tradition of lawyers taking cases because they're outraged at the abuse of justice.
And there are a some lawyers who don't make a lot of money from corporate clients, and still take on their cases for altruistic reasons. Some lawyers inherited a lot of money, and can do whatever they want. The rich are not like you and me.
Asking me to sign a waiver should a surgeon about to cut me open be tired seems only like a CYA policy. I can't make an informed decision, and I am most likely in distress and need of the surgery and saying no would delay it.
Exactly. I don't think the authors were seriously concerned about the patient consent problem. They wanted to change the scheduling policy.
I think they just wanted to drop a hot potato into the laps of doctors and hospitals that do perform elective surgery after a night on call: "If you insist on doing this, then you have to inform the patient."
What doctor or hospital is going to give a patient an informed consent form that says, "My abilities may be impaired because I didn't sleep last night"?
I work a night shift in a hospital. If you've never worked one before, know that some nights you will be absolutely exhausted. I'm sure most night-shifters have fallen asleep at work before, if not on a regular basis. Doctors are not above this. Our hospitalists have on-call rooms to sleep in every night. If you code in a hospital overnight, chances aren't bad that one of the doctors that shows up was woken up by your code seconds before he showed up in your room.
My point is, hospitals are open 24/7. There is a night shift. Those people are usually tired. Also, emergencies happen 24/7. Sometimes patients can't consent to anything.
Imagine this: A patient shows up at 2am with an injury that would kill the patient before the morning shift came in. All the surgeons are asleep. You'd have to wake up an entire surgical team. All of them will be tired when they come in.
All that is true. Doctors often have to perform emergency surgery after inadequate sleep. But the point of the NEJM article http://www.nejm.org/doi/full/10.1056/NEJMp1007901 was that doctors shouldn't schedule elective surgery the day after they're on call. Some hospitals already have that policy. They argue that if they don't adopt that policy, they should at least inform the patient. I think it was more of a way to embarrass doctors and hospitals into adopting the policy rather than a serious solution to an ethical problem of informed consent.
There's a culture in medicine of working heroic hours. The fundamental solution is to change that culture. Surgeons have a culture of working long hours and making lots of money. The sleep research suggests that their outcomes would be better if they worked fewer hours (and made less money). I don't know how you can change that culture. Have woman surgeons?
I agree. If the surgeon's abilities are impaired for lack of sleep, he shouldn't operate, and it's the responsibility of the surgeon and the hospital to enforce that rule.
They can't dump the responsibility on the patient, especially by shoving an informed consent form under his hand in the 15 minutes before surgery. The patient isn't qualified to evaluate that risk.
This wasn't a BusinessWeek article, btw. It was a HealthDay rewrite of a New England Journal of Medicine article http://www.nejm.org/doi/full/10.1056/NEJMp1007901 [free]. The NEJM article more clearly made the important point that hospitals shouldn't get into these situations in the first place by letting surgeons schedule elective surgery after a night of being on call. Here's the hypothetical case from the original article:
A surgeon on overnight call responds to an 11 p.m. call from the hospital, where a patient has presented with an acute abdomen. After working up the patient for several hours, the surgeon decides to call in an anesthesiologist and perform a bowel resection. By the time the procedure is completed and the operative note has been dictated, it is time for morning rounds. The surgeon has not slept all night and is scheduled to perform an elective colostomy at 9 a.m. Does the surgeon have an obligation to disclose to the patient the lack of sleep during the past 24 hours and obtain new informed consent? Should the surgeon give the patient the option of postponing the operation or requesting a different surgeon? Should the hospital have allowed the surgeon to schedule an elective procedure following a night he was scheduled to be on call? Should it allow a surgeon to perform elective surgery after having been awake for more than 24 hours? What potential unintended consequences of disclosing a clinician's sleep deprivation should be considered?
Things that can be done to correct the disaster that is U.S. heath care:
3)Eliminate Malpractice lawyers / insurance.
These three things would restore market forces to the medical industry.
So you think that the problems with the U.S. health care system would be corrected if we eliminated the right of patients to sue when they were needlessly crippled by an incompetent doctor.
Scroll down to the bottom of TFA and note the lack of scientific credentials on the part of the author. Read TFA and note the lack of scientific facts or discussion.
Then you'll understand why.
You mean scroll down to these credentials?
About the Author
Seth Blumsack, an economist in the College of Engineering at Pennsylvania State University, says of his colleagues, "Engineers have this idea that economics is about money." But he warns them "not to depend on him for stock tips." He does have lots to say, though, on electricity economics (as a part of the Penn State Electricity Markets Initiative), which he shares in "How the Free Market Rocked the Grid"
Blumsack is an economist who works at an engineering school. The school seems to think he has something important to tell engineers. He's written a lot for peer-reviewed engineering journals, including IEEE journals, on the economics of electric generation. He can get all the scientific information he needs -- all he has to do is walk down the hall. Just because he didn't show off with a lot of scientific information, that doesn't mean he doesn't understand it. More likely he decided, and the Spectrum editors decided, that such information wasn't necessary in this story.
Their readers already understand the technical details. What they need is someone who can put it together and tell them what it means.
When engineers design systems like the electrical grid, they need to understand the science, but they also need to understand the economics. Otherwise, they'll design systems that will fail. This is particularly important for Spectrum's audience, which includes engineers in management. People like Peter Agre http://en.wikipedia.org/wiki/Peter_Agre have argued that scientists and engineers must become more active in civic affairs, because they have the expertise necessary to make decisions about public affairs. If they don't get active, those decisions will be made by people who don't have the expertise. This article is trying to give engineers the information they need to understand how the electrical grids they design perform in the real world, so that they can influence policy makers. Blumsack has exactly the background he needs to do that.
Besides, Blumsack isn't just posting on a blog. This article was commissioned, reviewed and edited by the editors of Spectrum, who have access to all the experts in the IEEE. They decided that this was the information their readers needed.
I know some of the people who write for Spectrum, and I wrote a story about Spectrum. http://www.nasw.org/users/nbauman/redesign.htm Susan Hassler, Spectrum's editor in chief, isn't an engineer. She was the editor of Nature Biotechnology. IEEE hired her because Spectrum was publishing long, technical articles that nobody read. The more scientific details they put in, the less IEEE members read them. They needed someone who knew how to publish articles that IEEE members would actually read.
When engineers write something, they often make a common mistake. They think the more technical details they put in, the better. They wind up with articles that are unreadable, even by engineers.
I remember the blackout of 2003. When I read this Spectrum article, I understood it a lot better. This is after reading about it in Science, the New York Times, and the Wall Street Journal. I read platitudes about deregulation and the free market in the Wall Street Journal editorial page all the time. Now I understand a lot better what the results of deregulation actually are. To the conservatives, the free market, with deregulation, is the panacea. This Spectrum article shows us that, when you look at the facts with the understanding of an engineer, the free market isn't a panacea. It has pros and cons. That's important for engineers to know. Maybe they can convince our politicians.
The IEEE publishing a political editorial like this really discredits them as a professional organization.
Why?
I think they have a right and a responsibility to take stands on public issues, because they understand the science better than the general public, and better than most politicians. Public policy is an important part of science.
Most of the publications of professional societies publish editorials. When they think government policy is wrong, they say so, and explain why.
I see that in Science, Nature, New England Journal of Medicine, JAMA, and BMJ.
For example, Science had lots of editorials about the Bush Administration's abuse of science policy -- the Republican war on science.
When the President of the United States wants to teach creationism and Darwinian evolution as equally valid positions in the public schools, I think scientists have to warn the world.
More recently, Science and Nature have had editorials about global warming. When scientists think the world is headed for catastrophic warming, and politicians deny it, scientists have an obligation to say that the politicians are wrong.
Scientists should speak out, because they understand the facts better than, for example, the economists and conservative hacks on the Wall Street Journal editorial page and the Heritage Foundation.
The readers of professional publications should be smart enough to read the editorials and make up their own minds. I do think they have an obligation to print both sides of the story, particularly letters in dissent, and they do.
Minneapolis Star Tribune http://www.startribune.com/ had several stories, which you can find by searching for "Ardolf". Good stories, although not too technical.
The victim, Matt Kostolnik, worked in a law firm, and Ardolf sent messages to the firm. The law firm hired an investigator to figure out what was going on. The investigator tracked Kostolnik's wireless traffic, and fingered Ardolf. Then they sent the cops with a search warrant to Ardolf's house, which produced even more incriminating evidence.
Ardolf turned down a plea bargain on the identity theft charges alone, so they added the child porn charges and went to trial. When he saw the evidence against him, he gave up and pled guilty.
I can remember a handful of cases like this where the victim got out of it because they managed to catch the real criminal. (Wasn't there one recently in England?) I wonder how many cases there were where the innocent victim got convicted.
I said the worst of the Communists left the Party and became the conservative movement of today.
Under George W. Bush, the White House ordered interrogators at Guantanamo Bay to use the *exact* same torture techniques that were used by the Soviet and Chinese Communists against American prisoners and their own political prisoners in Siberia, according to U.S. training manuals disclosed at a Senate Armed Services Committee hearing. http://www.nytimes.com/2008/07/02/us/02detain.html
(Of course, as a conservative, you will say that you don't believe disclosures by the Senate Armed Services Committee.)
Most Communists left the Party when they realized its brutality and anti-democracy.
Most Republican conservatives just hunkered down and defended their leaders when their party did the same thing.
I'm here to start the call to arms, I just don't know what to do after that.
I'll probably be blacklisted for saying this, but what the hell --
During most of the last century, we had an active, well-organized left in the U.S. Their simple method was to organize people to work together for their own interests against wealthier, more powerful organizations. They accomplished a lot -- getting negroes the right to vote in the south, building a union movement that guaranteed working people a better standard of living than they have today, Social Security, Medicare, a social safety net, and most of the progressive reforms we had then and are losing now. The left worked best by being militant, threatening liberal Democrats, Republicans and unions, and pushing them further to the left -- just as conservative extremists push them to the right today.
I once read a memo from one of Franklin D. Roosevelt's aides to his boss, about how, on the street corners of Harlem, Communist orators were attracting crowds, and if the government didn't respond to their needs, the Communists would become more influential. During the depression, in negro neighborhoods, when people were disposessed from their homes and their posessions put out on the sidewalks, the Communists would mobilize a crowd, march to the home, and move the families and their posessions back in. It seems clear that FDR was pushed to the left by the socialist and Communist movement.
The Communist Party had horrible problems, the worst of which was requiring its members to follow the Party line, even during Stalin's worst brutalities. (See George Orwell's Homage to Catalona.) But the Communists knew how to organize workers, including socialists and other allies (whom they often double-crossed), and they had a network that let them organize around the country (and the world).
If the FBI is to be believed, Communists organized the Highlander Folk School, which taught Martin Luther King how to organize, starting with the Montgomery bus boycott. http://en.wikipedia.org/wiki/Highlander_Research_and_Education_Center (This raises the question, "What was the FBI doing to guarantee negroes the right to vote during all those years?") If you want to know how to organize for change, a study of the civil rights movement is instructive.
Almost every Communist reached a point where he got disgusted and left the party. They often went on to use their organizing techniques to organize other political organizations, like the civil rights movement, the peace movement in the Vietnam war days, and the gay rights movement. Hold a meeting, collect names and phone numbers, call them all to remind them to show up at the next demonstration, and use your numbers to get attention. Demand fundamental change, not compromises. Large demonstrations were a good way to show your strength. The Communist Party was to politics what General Electric was to corporate management -- people worked there, learned, left, and spread their techniques everywhere.
The best thing the left did in this country was to push compromising politicians further to the left. Too bad we didn't have a Communist Party to push Obama to keep his promises and create a public option health plan. The most important message of the left is that we have to change the system, and we have to change it ourselves. We can't depend on leaders to do it for us. (People on the left saw through Obama a mile away.)
Eugene Debs said: "I am not a Labor Leader; I do not want you to follow me or anyone else; if you are looking for a Moses to lead you out of this capitalist wilderness, you will stay right where you are. I would not lead you into the promised land if I could, because if I led you in, some one else would lead you out. You must use your heads as well as your hands, and get yourself out of your present condition."
He doesn't sound quite as dumb as the blog post made him out to be.
If I deposit a check, and the bank tells me on the phone or in writing that it cleared, as an ordinary non-financial person I would assume that the money is secure in my account.
A bank has a greater knowledge of these matters than its consumer customers, and therefore a greater obligation.
My bank should be serving me and making a reasonable effort to look after my interest and avoid fraud.
The bank should know that these scams are going on. They should know that some of their customers are likely to fall for them, thinking that they've deposited valid funds.
The banks could stop this fraud by making it clear to their customers that even though the check has cleared and the money has been entered into their account, the entry is just provisional.
I think a bank has an obligation to do so.
So the victim had a reasonable case against the bank. He might have won if the courts decided that way. They didn't.
Is Tony Kushner one of your detractors? I thought Angels in America gave a pretty sympathetic view of Mormons, and even some Mormons agree. http://www.unc.edu/~jcduffy/angels.pdf
I just looked at that IOL page, because a friend was getting cataract surgery and asked me about it. I knew a lot about IOLs 10 years ago, but I wanted an update.
I agree, it looked like they pasted together the patient information brochures of a collection of IOL manufacturers, and ophthalmologists' web sites.
Interestingly, the cataract surgery page was much better. It wasn't until they got into specific brands that they got into trouble.
I don't think the manufacturers were touting their own lenses themselves, because they're highly regulated, there's a good chance they would get caught, and there are potential regulatory problems. But it does look like there are some WP editors who are very enthusiastic about certain brands.
I do know that investors in some of those companies create pages touting their latest buy.
In general, the medical pages are pretty good. There are lots of doctors, medical students, graduate students and PhDs on WP. If I get a good page half the time, I'm satisfied.
Blacks in the US could surely have chosen violent revolution, and lost hundreds of thousands of lives on the small chance that they might defeat the white population; instead they chose cooperation and measured defiance, resulting in a progression which eventually lead to complete freedom for their descendants.
So you think blacks in the US will eventually have complete freedom some day?
It's not my opinion, it's the opinion of Herbert Stein, Nixon's economic adviser, in the Wall Street Journal editorial page, and of the Encyclopedia of Economics which I looked up in the library.
I'm not sure I follow you, but you seem to be saying that a $1,000 a year raise is greater from $20,000 to $21,000 than it is from $60,000 to $61,000, because you take home more of it at the $20,000 level. That's the way it should be. We have progressive taxation in this country (and every major industrial country, as far as I know).
There is exhaustive documentation, from the Journal of the American Medical Association, the National Institutes of Health, the Wall Street Journal, and many other consistent sources, that about 20% of the population can't afford health care, and about 50,000 people die every year of preventable deaths as a result.
I believe that we (or any society) should provide those people with the health care they need, at a higher priority than the manufacture and sale of X-Boxes. It's a greater benefit to society to prevent some 50-year-old man from having a stroke paralyzing half his body, and spending the rest of his life in a wheelchair unable to feed himself, than it is to give some nerd an X-Box. I think preventing strokes is more interesting than playing an X-Box anyway.
Once we've taken care of the necessities -- like health care for the needy -- you can spend all you want on X-Boxes. But first things first.
The conservatives claim that we can provide health care through the free market. The overwhelming evidence is that the free market doesn't do that. You can let them die or pay for their health care out of taxes. I think we should pay for it out of taxes.
I never supported Obama. I voted for Kucinich, and support a single payer health plan (like a majority of Americans, according to multiple polls). Obama's health plan (actually Rahm Emanuel's health plan) was a compromise with the his campaign contributors, the insurance companies, and the Republicans. If the Supreme Court doesn't overturn this court decision, the cost of Obama's plan will be twice as much as a Canadian-style plan (what we would call a Cadillac plan with no copayments).
Since I don't really follow your argument, I can't discuss it with you. I'm not an ideologue. I believe in doing what works. Free market health care doesn't work. Canadian health care does.
In economics 101, a flat tax is called a regressive tax.
If I make $100 a week, and you make $1,000 a week, 20% of my income is a much greater burden for me than it is for you.
If Steve Forbes makes $1 billion a year, and he has to pay 20%, it wouldn't affect his lifestyle significantly (if at all). After $1 million a year, most consumption is luxuries.
Adam Smith opposed luxuries. He thought they were a wasteful and didn't contribute anything to the economy. He thought tax policy should discourage luxury.
By *greater* proportion, Adam Smith meant that if I made $100 a week, I might not pay anything. If you made $1,000 a week, you might pay 20%. If someone made $10,000 a week, he should pay 30%. If Steve Forbes made $1 billion a year, he might pay 50%. Steve Forbes could still live a pretty good life on $500 million a year. I couldn't live a very good life on $80 a week.
Pascal said that the benefit of money was in proportion to the logarithm of the amount. So if I make $100 a week, my benefit is 2x. If you make $1,000 a week, your benefit is 3x. Our combined benefit is 5x.
Suppose we transfer $450 a week from you to me. We both make $550. Our benefit is 2.7x each. Our combined benefit is 5.4x. So by equalizing income, we've increased the total benefit by 0.4x.
Right. According to dozens of reliable surveys, a plurality or majority of Americans would prefer a Medicare-for-all or Canadian-style health care system.
David Himmelstein, the co-founder of Physicians for a National Health Program, said that if a majority of the people want something, and their politicians tell them that the political system won't let them do it -- you don't have a democracy.
(BTW, the economist Adam Smith said in Wealth of Nations that those who benefit more from society should pay proportionately more in taxes for the costs of running society -- in other worlds Adam Smith believed in progressive taxation. Unfortunately conservatives today don't know the difference between Adam Smith and Karl Marx.)
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Let me clue you in. I spent several years following medical malpractice for doctors, and also product liability.
Insurance companies like to raise their premiums. Policy-holders don't like to pay more money. So insurance companies come up with all kinds of bullshit excuses to raise their premiums, like, "We have to raise our premiums because of these crazy malpractice awards." And then they come up with some bullshit story about one of those awards.
(One of the bullshit stories that the insurance companies came up with was the "lawnmower case." The story, which they published in national newspaper and magazine ads calling for product liability "reform", was that two guys decided to each hold up one side of a power lawnmower, and use it to trim a hedge. One guy lost his arm, sued the lawnmower company, and won. Therefore we need product liability reform. Business Insurance magazine tracked the story down and it turned out to be a lie. There were Congressional hearings about it. Insurance companies lie. And right-wing politicians lie even more brazenly.)
There are crazy jury awards on all sides, but for the most part, juries award malpractice damages when doctors actually cause harm as a result. http://en.wikipedia.org/wiki/Medical_malpractice#Studies_of_malpractice
I'm not talking about Central Africa. If you compare the U.S. to similarly developed countries with good health care systems and good legal systems, their malpractice laws are similar to ours, and sometimes our laws are comparatively favorable to doctors.
Sure there is a reason. If a patient were to die. (likely event), they don't want to be sued by a lawyer. It would look like they are not following 'standard best practices'. How bad does it look when you just throw someone in the station wagon, when you could wait 15 minutes and transport him in approved medical / lawyer free manner.
Well, if you're talking about throwing someone in the station wagon when he's having a medical emergency, that doesn't sound like such a good idea any more. You do have to transport them in a medically-approved manner, in case they go into defibrillation or something.
I thought the hospital was close enough that they could transport them on a gurney, while giving the patient supportive services. Some medical institutions have covered or underground passageways to protect them from the elements.
If the geriatric hospital doesn't have a good way to transport the patient to the hospital, then they should be calling an ambulance. They should also be able to arrange with an ambulance service to do it cheaply.
Or they could get their own ambulance and attendants, but rather than having the attendants on call all day, it might be cheaper to call an ambulance as needed.
Also 911 HAS to be called. If 911 isn't called it looks like 'standard best practices' aren't being followed.
I don't know why they have to call 911, unless that's the fastest way to get an ambulance in your area. Who says calling 911 is the "standard best practice"?
I like to be careful with my facts so I can't draw any firm conclusions without finding out first hand, but when lawyers tell you to do something, they either have a good reason for it, or you should get a new lawyer.
It's also a part of the culture of medicine (which is changing).
The BMJ had a comic routine about the worst-ranked hospital in the UK. The head of the surgery department would solve all problems by working longer hours.
They can't dump the responsibility on the patient, especially by shoving an informed consent form under his hand in the 15 minutes before surgery.
Oh yes they can (legally speaking)
I've gone to legal conferences where lawyers explained to doctors and hospital administrators what constitutes a valid informed consent form.
If they put a paragraph in the informed consent form saying, "I realize that my surgeon is operating on me after not getting any sleep the night before, and he is more likely to make a mistake," I don't think that would protect the doctor if he *did* make a mistake.
If he leaves a screwdriver inside you because he was sleepy, that's malpractice in any case, and he's still legally liable for malpractice, whether you signed that consent form or not. You can't consent to have the doctor practice incompetently on you.
The doctors in the NEJM article were just saying that as a way of making hospitals uncomfortable about a practice that many of them accept even though they know it's wrong.
I do agree with you on the profit motive, though.
Medical malpractice costs aren't really a serious problem,
You must live outside the USA.
I live in the USA, but malpractice laws in other countries, such as Canada, are even stricter. In Canada, and in the UK, when doctors make a mistake that harms a patient, they're required to tell that patient. And Canada allows damages for things that wouldn't get damages here, such as the anxiety you have between the time they tell you that you may have been infected by improperly sterilized equipment and the time that you find out you're not infected.
The total cost of medical malpractice is about 2% of the health care dollar, and the bulk of that 2% reimburses patients who actually were injured.
Since that wasn't too impresive, the tort reform people came up with a new argument: It's not just 2%. Doctors are forced to do expensive, unnecessary procedures out of fear of lawsuits.
There is a grain of truth to that, but for the most part, if a doctor follows the standard best practice, he won't be guilty of malpractice.
(Juries are a lottery, and often come up with crazy results, but that's the price of the jury system. These are the same jurors who decide death penalty cases. And they're also the voters who choose our elected officials.)
In the example you give, if the geriatric home shares the same parking lot as the hospital, and they can easily move a patient to the hospital on a gurney, I don't understand why they have to call an ambulance, but they may have a reason. Maybe the EMTs can perform emergency cardiac care better than the people at the geriatric center.
Lots of times when people do stupid things, they blame the lawyers. When I've checked them out, it often turns out that the lawyers didn't tell them to do it at all.
Maybe one of the geriatric home owners has a brother-in-law with an ambulance business. Happens all the time.
Lawyers don't sue for altruistic concerns. They sue to make obscene amounts of money. Try to get a lawyer to represent you, against a doctor when large amounts of money aren't on the line.
Not true. Lawyers often do sue for altruistic concerns.
I used to work for lawyers who had a big pro bono practice.
One of the cases was suing New York City to provide housing for homeless men, which was required by the New York State constitution. (One of the lawyers in the firm used to come in to work through Pennsylvania Station, and he wondered why there were so many homeless men sleeping there.) He was successful and there are relatively few homeless people living on the street today.
Another one of the cases was to give teenage girls the right to get an abortion without approval by a judge, and without having to explain why she wants it. They one that one too.
It's true they made a lot of money doing commercial work for corporate clients. But there's a long tradition of lawyers taking cases because they're outraged at the abuse of justice.
And there are a some lawyers who don't make a lot of money from corporate clients, and still take on their cases for altruistic reasons. Some lawyers inherited a lot of money, and can do whatever they want. The rich are not like you and me.
Medical malpractice costs aren't really a serious problem, they're just a hot-button issue for (mostly) conservatives.
Malpractice premiums are about 2% of health care costs. Insurance company administrative costs and profits are 15-20%.
Asking me to sign a waiver should a surgeon about to cut me open be tired seems only like a CYA policy. I can't make an informed decision, and I am most likely in distress and need of the surgery and saying no would delay it.
Exactly. I don't think the authors were seriously concerned about the patient consent problem. They wanted to change the scheduling policy.
I think they just wanted to drop a hot potato into the laps of doctors and hospitals that do perform elective surgery after a night on call: "If you insist on doing this, then you have to inform the patient."
What doctor or hospital is going to give a patient an informed consent form that says, "My abilities may be impaired because I didn't sleep last night"?
I work a night shift in a hospital. If you've never worked one before, know that some nights you will be absolutely exhausted. I'm sure most night-shifters have fallen asleep at work before, if not on a regular basis. Doctors are not above this. Our hospitalists have on-call rooms to sleep in every night. If you code in a hospital overnight, chances aren't bad that one of the doctors that shows up was woken up by your code seconds before he showed up in your room.
My point is, hospitals are open 24/7. There is a night shift. Those people are usually tired. Also, emergencies happen 24/7. Sometimes patients can't consent to anything.
Imagine this: A patient shows up at 2am with an injury that would kill the patient before the morning shift came in. All the surgeons are asleep. You'd have to wake up an entire surgical team. All of them will be tired when they come in.
All that is true. Doctors often have to perform emergency surgery after inadequate sleep. But the point of the NEJM article http://www.nejm.org/doi/full/10.1056/NEJMp1007901 was that doctors shouldn't schedule elective surgery the day after they're on call. Some hospitals already have that policy. They argue that if they don't adopt that policy, they should at least inform the patient. I think it was more of a way to embarrass doctors and hospitals into adopting the policy rather than a serious solution to an ethical problem of informed consent.
There's a culture in medicine of working heroic hours. The fundamental solution is to change that culture. Surgeons have a culture of working long hours and making lots of money. The sleep research suggests that their outcomes would be better if they worked fewer hours (and made less money). I don't know how you can change that culture. Have woman surgeons?
I agree. If the surgeon's abilities are impaired for lack of sleep, he shouldn't operate, and it's the responsibility of the surgeon and the hospital to enforce that rule.
They can't dump the responsibility on the patient, especially by shoving an informed consent form under his hand in the 15 minutes before surgery. The patient isn't qualified to evaluate that risk.
This wasn't a BusinessWeek article, btw. It was a HealthDay rewrite of a New England Journal of Medicine article http://www.nejm.org/doi/full/10.1056/NEJMp1007901 [free]. The NEJM article more clearly made the important point that hospitals shouldn't get into these situations in the first place by letting surgeons schedule elective surgery after a night of being on call. Here's the hypothetical case from the original article:
A surgeon on overnight call responds to an 11 p.m. call from the hospital, where a patient has presented with an acute abdomen. After working up the patient for several hours, the surgeon decides to call in an anesthesiologist and perform a bowel resection. By the time the procedure is completed and the operative note has been dictated, it is time for morning rounds. The surgeon has not slept all night and is scheduled to perform an elective colostomy at 9 a.m. Does the surgeon have an obligation to disclose to the patient the lack of sleep during the past 24 hours and obtain new informed consent? Should the surgeon give the patient the option of postponing the operation or requesting a different surgeon? Should the hospital have allowed the surgeon to schedule an elective procedure following a night he was scheduled to be on call? Should it allow a surgeon to perform elective surgery after having been awake for more than 24 hours? What potential unintended consequences of disclosing a clinician's sleep deprivation should be considered?
Things that can be done to correct the disaster that is U.S. heath care:
3)Eliminate Malpractice lawyers / insurance.
These three things would restore market forces to the medical industry.
So you think that the problems with the U.S. health care system would be corrected if we eliminated the right of patients to sue when they were needlessly crippled by an incompetent doctor.
Scroll down to the bottom of TFA and note the lack of scientific credentials on the part of the author. Read TFA and note the lack of scientific facts or discussion.
Then you'll understand why.
You mean scroll down to these credentials?
Blumsack is an economist who works at an engineering school. The school seems to think he has something important to tell engineers. He's written a lot for peer-reviewed engineering journals, including IEEE journals, on the economics of electric generation. He can get all the scientific information he needs -- all he has to do is walk down the hall. Just because he didn't show off with a lot of scientific information, that doesn't mean he doesn't understand it. More likely he decided, and the Spectrum editors decided, that such information wasn't necessary in this story.
Their readers already understand the technical details. What they need is someone who can put it together and tell them what it means.
When engineers design systems like the electrical grid, they need to understand the science, but they also need to understand the economics. Otherwise, they'll design systems that will fail. This is particularly important for Spectrum's audience, which includes engineers in management. People like Peter Agre http://en.wikipedia.org/wiki/Peter_Agre have argued that scientists and engineers must become more active in civic affairs, because they have the expertise necessary to make decisions about public affairs. If they don't get active, those decisions will be made by people who don't have the expertise. This article is trying to give engineers the information they need to understand how the electrical grids they design perform in the real world, so that they can influence policy makers. Blumsack has exactly the background he needs to do that.
Besides, Blumsack isn't just posting on a blog. This article was commissioned, reviewed and edited by the editors of Spectrum, who have access to all the experts in the IEEE. They decided that this was the information their readers needed.
I know some of the people who write for Spectrum, and I wrote a story about Spectrum. http://www.nasw.org/users/nbauman/redesign.htm Susan Hassler, Spectrum's editor in chief, isn't an engineer. She was the editor of Nature Biotechnology. IEEE hired her because Spectrum was publishing long, technical articles that nobody read. The more scientific details they put in, the less IEEE members read them. They needed someone who knew how to publish articles that IEEE members would actually read.
When engineers write something, they often make a common mistake. They think the more technical details they put in, the better. They wind up with articles that are unreadable, even by engineers.
I remember the blackout of 2003. When I read this Spectrum article, I understood it a lot better. This is after reading about it in Science, the New York Times, and the Wall Street Journal. I read platitudes about deregulation and the free market in the Wall Street Journal editorial page all the time. Now I understand a lot better what the results of deregulation actually are. To the conservatives, the free market, with deregulation, is the panacea. This Spectrum article shows us that, when you look at the facts with the understanding of an engineer, the free market isn't a panacea. It has pros and cons. That's important for engineers to know. Maybe they can convince our politicians.
The IEEE publishing a political editorial like this really discredits them as a professional organization.
Why?
I think they have a right and a responsibility to take stands on public issues, because they understand the science better than the general public, and better than most politicians. Public policy is an important part of science.
Most of the publications of professional societies publish editorials. When they think government policy is wrong, they say so, and explain why.
I see that in Science, Nature, New England Journal of Medicine, JAMA, and BMJ.
For example, Science had lots of editorials about the Bush Administration's abuse of science policy -- the Republican war on science.
When the President of the United States wants to teach creationism and Darwinian evolution as equally valid positions in the public schools, I think scientists have to warn the world.
More recently, Science and Nature have had editorials about global warming. When scientists think the world is headed for catastrophic warming, and politicians deny it, scientists have an obligation to say that the politicians are wrong.
Scientists should speak out, because they understand the facts better than, for example, the economists and conservative hacks on the Wall Street Journal editorial page and the Heritage Foundation.
The readers of professional publications should be smart enough to read the editorials and make up their own minds. I do think they have an obligation to print both sides of the story, particularly letters in dissent, and they do.
That's how science works.
Minneapolis Star Tribune http://www.startribune.com/ had several stories, which you can find by searching for "Ardolf". Good stories, although not too technical.
The victim, Matt Kostolnik, worked in a law firm, and Ardolf sent messages to the firm. The law firm hired an investigator to figure out what was going on. The investigator tracked Kostolnik's wireless traffic, and fingered Ardolf. Then they sent the cops with a search warrant to Ardolf's house, which produced even more incriminating evidence.
Ardolf turned down a plea bargain on the identity theft charges alone, so they added the child porn charges and went to trial. When he saw the evidence against him, he gave up and pled guilty.
I can remember a handful of cases like this where the victim got out of it because they managed to catch the real criminal. (Wasn't there one recently in England?) I wonder how many cases there were where the innocent victim got convicted.
kmac06, you have a reading comprehension problem.
I said the worst of the Communists left the Party and became the conservative movement of today.
Under George W. Bush, the White House ordered interrogators at Guantanamo Bay to use the *exact* same torture techniques that were used by the Soviet and Chinese Communists against American prisoners and their own political prisoners in Siberia, according to U.S. training manuals disclosed at a Senate Armed Services Committee hearing. http://www.nytimes.com/2008/07/02/us/02detain.html
(Of course, as a conservative, you will say that you don't believe disclosures by the Senate Armed Services Committee.)
Most Communists left the Party when they realized its brutality and anti-democracy.
Most Republican conservatives just hunkered down and defended their leaders when their party did the same thing.
I'm here to start the call to arms, I just don't know what to do after that.
I'll probably be blacklisted for saying this, but what the hell --
During most of the last century, we had an active, well-organized left in the U.S. Their simple method was to organize people to work together for their own interests against wealthier, more powerful organizations. They accomplished a lot -- getting negroes the right to vote in the south, building a union movement that guaranteed working people a better standard of living than they have today, Social Security, Medicare, a social safety net, and most of the progressive reforms we had then and are losing now. The left worked best by being militant, threatening liberal Democrats, Republicans and unions, and pushing them further to the left -- just as conservative extremists push them to the right today.
I once read a memo from one of Franklin D. Roosevelt's aides to his boss, about how, on the street corners of Harlem, Communist orators were attracting crowds, and if the government didn't respond to their needs, the Communists would become more influential. During the depression, in negro neighborhoods, when people were disposessed from their homes and their posessions put out on the sidewalks, the Communists would mobilize a crowd, march to the home, and move the families and their posessions back in. It seems clear that FDR was pushed to the left by the socialist and Communist movement.
The Communist Party had horrible problems, the worst of which was requiring its members to follow the Party line, even during Stalin's worst brutalities. (See George Orwell's Homage to Catalona.) But the Communists knew how to organize workers, including socialists and other allies (whom they often double-crossed), and they had a network that let them organize around the country (and the world).
If the FBI is to be believed, Communists organized the Highlander Folk School, which taught Martin Luther King how to organize, starting with the Montgomery bus boycott. http://en.wikipedia.org/wiki/Highlander_Research_and_Education_Center (This raises the question, "What was the FBI doing to guarantee negroes the right to vote during all those years?") If you want to know how to organize for change, a study of the civil rights movement is instructive.
Almost every Communist reached a point where he got disgusted and left the party. They often went on to use their organizing techniques to organize other political organizations, like the civil rights movement, the peace movement in the Vietnam war days, and the gay rights movement. Hold a meeting, collect names and phone numbers, call them all to remind them to show up at the next demonstration, and use your numbers to get attention. Demand fundamental change, not compromises. Large demonstrations were a good way to show your strength. The Communist Party was to politics what General Electric was to corporate management -- people worked there, learned, left, and spread their techniques everywhere.
The best thing the left did in this country was to push compromising politicians further to the left. Too bad we didn't have a Communist Party to push Obama to keep his promises and create a public option health plan. The most important message of the left is that we have to change the system, and we have to change it ourselves. We can't depend on leaders to do it for us. (People on the left saw through Obama a mile away.)
Eugene Debs said: "I am not a Labor Leader; I do not want you to follow me or anyone else; if you are looking for a Moses to lead you out of this capitalist wilderness, you will stay right where you are. I would not lead you into the promised land if I could, because if I led you in, some one else would lead you out. You must use your heads as well as your hands, and get yourself out of your present condition."
Look where Obama lead us.
Unfortunately, a lot of ex-Communists
He doesn't sound quite as dumb as the blog post made him out to be.
If I deposit a check, and the bank tells me on the phone or in writing that it cleared, as an ordinary non-financial person I would assume that the money is secure in my account.
A bank has a greater knowledge of these matters than its consumer customers, and therefore a greater obligation.
My bank should be serving me and making a reasonable effort to look after my interest and avoid fraud.
The bank should know that these scams are going on. They should know that some of their customers are likely to fall for them, thinking that they've deposited valid funds.
The banks could stop this fraud by making it clear to their customers that even though the check has cleared and the money has been entered into their account, the entry is just provisional.
I think a bank has an obligation to do so.
So the victim had a reasonable case against the bank. He might have won if the courts decided that way. They didn't.
So now this fraud will go on.
Is Tony Kushner one of your detractors? I thought Angels in America gave a pretty sympathetic view of Mormons, and even some Mormons agree. http://www.unc.edu/~jcduffy/angels.pdf
They have an Otterbox off-the-shelf rugged case, too.
Well, in his defense, Maylasia isn't in Africa. http://en.wikipedia.org/wiki/Maylasia
When a bank tells you a check has cleared, that's only provisional subject to final clearance. Who knew?
Maybe they downgraded it.
I just looked at that IOL page, because a friend was getting cataract surgery and asked me about it. I knew a lot about IOLs 10 years ago, but I wanted an update.
I agree, it looked like they pasted together the patient information brochures of a collection of IOL manufacturers, and ophthalmologists' web sites.
Interestingly, the cataract surgery page was much better. It wasn't until they got into specific brands that they got into trouble.
I don't think the manufacturers were touting their own lenses themselves, because they're highly regulated, there's a good chance they would get caught, and there are potential regulatory problems. But it does look like there are some WP editors who are very enthusiastic about certain brands.
I do know that investors in some of those companies create pages touting their latest buy.
In general, the medical pages are pretty good. There are lots of doctors, medical students, graduate students and PhDs on WP. If I get a good page half the time, I'm satisfied.
Blacks in the US could surely have chosen violent revolution, and lost hundreds of thousands of lives on the small chance that they might defeat the white population; instead they chose cooperation and measured defiance, resulting in a progression which eventually lead to complete freedom for their descendants.
So you think blacks in the US will eventually have complete freedom some day?
It's not my opinion, it's the opinion of Herbert Stein, Nixon's economic adviser, in the Wall Street Journal editorial page, and of the Encyclopedia of Economics which I looked up in the library.
I'm not sure I follow you, but you seem to be saying that a $1,000 a year raise is greater from $20,000 to $21,000 than it is from $60,000 to $61,000, because you take home more of it at the $20,000 level. That's the way it should be. We have progressive taxation in this country (and every major industrial country, as far as I know).
There is exhaustive documentation, from the Journal of the American Medical Association, the National Institutes of Health, the Wall Street Journal, and many other consistent sources, that about 20% of the population can't afford health care, and about 50,000 people die every year of preventable deaths as a result.
I believe that we (or any society) should provide those people with the health care they need, at a higher priority than the manufacture and sale of X-Boxes. It's a greater benefit to society to prevent some 50-year-old man from having a stroke paralyzing half his body, and spending the rest of his life in a wheelchair unable to feed himself, than it is to give some nerd an X-Box. I think preventing strokes is more interesting than playing an X-Box anyway.
Once we've taken care of the necessities -- like health care for the needy -- you can spend all you want on X-Boxes. But first things first.
The conservatives claim that we can provide health care through the free market. The overwhelming evidence is that the free market doesn't do that. You can let them die or pay for their health care out of taxes. I think we should pay for it out of taxes.
I never supported Obama. I voted for Kucinich, and support a single payer health plan (like a majority of Americans, according to multiple polls). Obama's health plan (actually Rahm Emanuel's health plan) was a compromise with the his campaign contributors, the insurance companies, and the Republicans. If the Supreme Court doesn't overturn this court decision, the cost of Obama's plan will be twice as much as a Canadian-style plan (what we would call a Cadillac plan with no copayments).
Since I don't really follow your argument, I can't discuss it with you. I'm not an ideologue. I believe in doing what works. Free market health care doesn't work. Canadian health care does.
That's not what Adam Smith meant.
In economics 101, a flat tax is called a regressive tax.
If I make $100 a week, and you make $1,000 a week, 20% of my income is a much greater burden for me than it is for you.
If Steve Forbes makes $1 billion a year, and he has to pay 20%, it wouldn't affect his lifestyle significantly (if at all). After $1 million a year, most consumption is luxuries.
Adam Smith opposed luxuries. He thought they were a wasteful and didn't contribute anything to the economy. He thought tax policy should discourage luxury.
By *greater* proportion, Adam Smith meant that if I made $100 a week, I might not pay anything. If you made $1,000 a week, you might pay 20%. If someone made $10,000 a week, he should pay 30%. If Steve Forbes made $1 billion a year, he might pay 50%. Steve Forbes could still live a pretty good life on $500 million a year. I couldn't live a very good life on $80 a week.
Pascal said that the benefit of money was in proportion to the logarithm of the amount. So if I make $100 a week, my benefit is 2x. If you make $1,000 a week, your benefit is 3x. Our combined benefit is 5x.
Suppose we transfer $450 a week from you to me. We both make $550. Our benefit is 2.7x each. Our combined benefit is 5.4x. So by equalizing income, we've increased the total benefit by 0.4x.
Right. According to dozens of reliable surveys, a plurality or majority of Americans would prefer a Medicare-for-all or Canadian-style health care system.
David Himmelstein, the co-founder of Physicians for a National Health Program, said that if a majority of the people want something, and their politicians tell them that the political system won't let them do it -- you don't have a democracy.
(BTW, the economist Adam Smith said in Wealth of Nations that those who benefit more from society should pay proportionately more in taxes for the costs of running society -- in other worlds Adam Smith believed in progressive taxation. Unfortunately conservatives today don't know the difference between Adam Smith and Karl Marx.)