Thursday, August 11, 2011

Popular Medicine

When I was in the US last week the front page of the newspaper reported that the hospitals which were 'popular' in 'consumer surveys' had the unfortunate concommitant disadvantage of having the highest 'morbidity and mortality'.  People in those hospitals were most likely to stay sick and die.  So how could 'consumer surveys' be wrong?
A famous medical study 20 plus years ago looked at two surgical wards.  Each ward accepted patients from the same surgery where the same doctors operated and the same kinds of patient were treated. The problem was that when the patients went for post surgical care to one ward, ward A,  they tended to die and have multiple complications whereas when they went to the other ward, ward B, they lived and went home healthy.  "Consumer surveys' consistently rated 'Ward A", the deadly ward as 'most popular'.  The nurses on that ward further were always getting roses and chocolates compared to the nurses on the other ward where 'tips' were less likely.
An investigative team of Community Medicine specialists was assigned to 'sort out' the problem.  Community Medicine includes the 'epidemiologists', 'statiticians', "public health' folk and those researchers trained specifically in 'validity' of 'research tools.  These 'scientists' came back with an interesting analysis.
1) The people who died on Ward A didn't get to fill out a 'consumer survey' so their 'opinion' went un recorded.
2)  The most important factor in post surgical care on this ward was the early mobilization of the patient so that they did not have clots and complications. No one post surgery wants to walk and dance.  "Tough love" post surgical nursing care involves 'cajoling' patients to get out of bed and walk up and down the hall.  If ever I have abdominal or heart or lung surgery and somebody like me gets me out of bed I will gladly report that person as a 'sadist'.  When I did surgery, patients post surgery commonly told me 'let me just lie and die....I can't get out of bed."  Well, the nurses on Ward A did just that. They responded to the 'wishes' of their patients and left them to 'die'.  It wasn't intentional. They were being 'nice' even though 'nice' can kill you cold.
3) The patients who 'survived' Ward A having seen the body bags leaving had an inordinate appreciation for their own 'survival' and wrongly accreditted this to their 'nursing care' which as 'survivors' had almost killed them.
4) The patients on Ward B not seeing any body bags passing didn't appreciate that their 'survival' had been 'life and death' but thanks to good nursing care they'd made it. Indeed they really didn't appreciate how good the nurses were and how much they had done for them.
In another famous case in Canada, a fake doctor got by for several months in a northern community.  When the 'authorities' finally caught up with this 'con man' it turned out that his patients had been 'protecting' him.  Traditionally if you offer person short term gain they are less worried about long term consequences.  Doctors are supposed to be parental in this matter though the radical feminist popularity with girls was to call anything 'parental' patriarchal despite the fact that 50% of medical doctors and surgeons were female.  Girls and boys equally dislike 'parentalism' whether patriarchal or matriarchal. In this town the doctor was a 'winning friend'. He was a consumate 'salesman' and very 'popular'.  He smoozed everyone just like CEO's and politicians are taught in their Business Administration school. He was superb at 'marketting. He gave the people what they wanted.  As a consequence overnight the addiction to opiates and benzodiazepines in the community soared. He ladled out tylenol #3, percocets, and valium.  He wrote everyone glowing reports to get out of work and on the dole. He wrote insurance companies and probation officers notes with glowing reports about his patients. Mostly since this was a northern community he referred everyone who wanted to the southern city. Every alcoholic and party girl in town overnight got a 'free' ride to the biggest party town in the province.
Not surprisingly this doctor's behaviour didn't go unnoticed for long and indeed it was found out that he'd only been an orderly at most before stealing credentials and setting up a racket where he billed 10 times what another other doctor would bill for services in the short space of time he was there. When the authorities discovered the fraud he was arrested. Many charges were laid and the fellow to the best of my knowledge went to jail despite a very short stint 'playing doctor'.  What was most revealing though were the excessive numbers of letters written on his behalf by townspeople.  Indeed there was a petition asking that he be 'allowed" to "practice' medicine because he'd been so 'good'.  Mind you this northern community had had difficulty getting any doctor and as a particularly drunken drug addicted violent community had had problems attracting or keeping 'good' doctors. Still the analysis of why the town had found their 'fake' doctor so "popular" was most telling.
I was delighted recently to learn that a brilliant colleague who practice 'forensic' psychiatry was 'suing' rate your doctor.  This gentleman is accountable to the community for identifying psychotic serial sadistic rapists and pedophiles. Naturally psychotic serial sadistic rapists and pedophiles don't like to be 'identified'. They think it's absolutely marvellous that 'Rate Your Doctor' is there for them to 'anonymously' express their opinion.  A few years back my dog was poisoned when I refused to ignore a number of government workers in 'safety sensitive jobs' had  urines positive for cannibis, a definite breach of contract. The other doctor who reported this had his dog poisoned where as the third person who chose to ignore it suffered no negative consequences. In fact he was 'popular' with the drug users and 'protected'.
"My own Rate Your Doctor" took a decided 'dip' when I reported staff for theft and deceit and advised a number of patients that their 'wives' were not the problem but their drinking 26 ounces a day of vodga might just be a concern.  I am truly thankful this colleague is addressing this by personally doing what I believe our administration has failed to do .
Please God save me from "popular medicine" and mostly God, save me from "politically correct" medicine.

1 comment:

Anonymous said...