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I swear there ain't no heaven but I pray there ain't no hell.
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I'm not a doctor, but know enough that all of those things add up to a rather nasty head injury which may be causing other damage.
Instead, they gave stomach medicine, and was told to eat easier food.
Not paying attention until a real check of the head was done almost killed him.
This isn't about the further risks of what is going on, this is just not paying attention to all of the symptoms and/or being smart enough to consider putting them together.
Unless there is a paragraph in the system that suggests that when someone falls and hits their head, gets sick for it, that you should address the symptoms instead of what caused the symptoms, as it's cheaper to wait...
Again, not directly addressing your case but speaking generally, in most adults (if not all) who fall with hitting their head will get a head CT, maybe neck CT. If you added nausea and AMS (altered mental status), I would argue it would be malpractice not to. CT of head rules out hemorrhage, fracture (99% sensitivity or so). It also is a very good assessment of ventricular megaly, obstructive hydrocephalous, etc (things you should be worried about with nausea and AMS). If all of that is OK, it might be reasonable to send a patient home. You should also address their symptoms.
It is also not just cheaper to wait, but sometimes safer. Take the above example in a child or young adult. If they are improving, seems just like a concussion, you may wait on a head CT. There is a lot of radiation and you are non-trivially increasing someone who is young's chance for brain cancer. If they have reliable parents, or good support, you may send them home without the scan with instructions to return if it is not better or see your PCP in the morning.
The point is procedure trees, decision trees, etc have a somewhat limited use and need to be implemented carefully. They can lead to cookbook medicine, which is unthinking, and often can lead to harm. Checklists are important, and have been proven to improve outcomes. But implementing strict algorithms across the board lead to overtesting, undertesting, and doctors who shut their brain off.
The Ring of Fire waking up??
@FoxNews: Japan hit by 6.2 earthquake off coast of Honshu, day after Alaska quake https://www.foxnews.com/world/2018/01...ska-quake.html
There was one in the Indonesia area a few days before the Alaska quake.
But you need to recognize that not all doctors are good. They don't pay attention to all the symptoms. There are many who lord over their patients as if they barely matter.
That's the real issue- just because you spent the time getting a Dr put in front of your name, that does not always mean you are really that smart or that ethical. And that's why people don't trust doctors. You being a doctor can help clean that crap up, but instead, you just make excuses for them- because your example of leading to "cook book medicine" is more valid than others experiences. You should pay attention to what people are actually saying about doctors instead of assuming whatever it is that you are assuming.
I am active on our institutions quality improvement board. I teach medical ethics and evidence based medicine to a large residency program. I train people to be better, more compassionate doctors.
Just an FYI. if I admit a patient that does not meet "inpatient criteria" as deemed by insurance or medicare, insurance does not cover it and the patient is left with the entire bill of the hospitalization. You can financially destroy someone very easily as a physician and you can do so even if you are only being "sure" nothing is wrong. It is not a responsibility I take lightly.
If they were really that much of a minority, then the distrust of doctors would not be so high. Just want to point that out.
Most of the distrust of people have a source. And in this case, it's the doctors not being THAT trustworthy.
Healthy skepticism had been replaced by outright disbelief.
The cumulative stupidity of the species continues to decrease and will as long as access to a good diet and information improves and military personnel are the majority of major war fatalties. What's changed is public discourse used to be a gated community that you gained access to with education (or, to be fair, money). There was a public discourse of the stupid in the bloids or the bars or High Weirdness by Mail, but it was very easy to ignore.
Now, public discourse is close to a democratic mob where in Asimov's words "my ignorance is just as good as your knowledge." At some point the smart people will need to secede into our own gated community again.
Last edited by Kepler; 01-24-2018 at 09:18 PM.
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I am basically on your side. I think there should be no tolerance for what you are describing. But there is also a lot of nuance to individual situations and without medical training and a complete set of facts, it can be extremely challenging to determine if there is blame to be had.
My original thought was that there should be a more broadbased approach to healthcare than what sometimes occurs - heart surgery and other serious internal medicine conditions/procedures should always recommend a broadbased, detailed, personalized lifestyle consultation (diet, water, exercise, stress evaluation based on bloods, etc). It doesn't matter what the strategic framework is or how its executed that gets the system there.
Can everyone afford that? No. But that doesn't mean that you just leave a patient with out the means to actually solve the underlying causes long term.
But for the most part that is not realistic. Evidence is very poor in most nutrition fields (not their fault entirely, just very difficult to study in a clinically meaningful sense). I know you like Mayo and a year or two ago they had a good series of articles describing the state of crisis the field was in. If there is no evidence, insurance sure as hell not going to cover it. And for the most part, people are not going to want/be able to pay out of pocket for these things so in the end...they are on their own. The system needs to be fixed but it will have to start at a much higher lever. I am not optimistic as politicians do not get it or don't give a ****.
Not blaming you...but the fact that its considered not 'realistic' is part of the problem. Too often people just assume 'we can't fix it' perfectly and so do absolutely nothing to improve it. Also the fact that patients are sometimes not willing to pay out of pocket...does not mean that the physicians shouldn't have a full custom lifestyle as a recommendation and option available. Afterall, lifestyle changes are in fact recommended practice in these health outcomes...there's just no follow through to help keep the patient from coming back into the hospital a year later.
What matters here is not the doctor...rather its the patient outcome. The patients health we're talking about...and ultimately they are the customer and they foot the bill. Patients are often wrong - but the resulting outcome is anywhere between patient feedback that improves the diagnosis...to at minimum doctors that are continually challenged to stay on top of their game. Not ultimately wonderful for doctors...but better overall for quality of healthcare.
Doctors are challenged all of the time by other doctors. These are probably the most useful interactions in improving quality. Academic centers are challenging in a very good way. You want to order a test? The first question will be how does it change management. The docs I worry most about are those on their own or in small groups where they can slowly drift away from best practice. But then again, that is why we have robust continuing education requirements, reboarding etc.
Here are a few things:
Happy (satisfied) patients, for the most part, have worst outcomes
VIPs, for the most part, have worst outcomes
There is a customer element to healthcare but the trends in the literature have been showing that when the customer is right, outcomes are worse.
And again, while I can believe everything you say above as correct...it doesn't mean an educated patient is not a good thing for the overall quality of healthcare.
A knowledgeable consumer pushes a product/service provider to produce better offerings and do it with better service/support. This is the case whether you're ordering food at a restaurant, buying a dishwasher, booking a hotel or receiving healthcare. If you're the provider getting pushed, it makes your life more difficult...but the resulting improved offering makes for a better marketplace overall and improves quality of life for all.
The system is broken. Doctors and patients have poor advocacy for themselves. Politicians do not give a **** or listen to the profit makers in medicine over patients and health care professionals.
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