Maybe spending stupid amounts of money on power cords isn't entirely harmless

[Jud]

<< Quoting myself, as I am incredibly busy at the moment >>

 

Interesting chart - one wonders, for instance, how suicides using guns are accounted for: as suicides, gun deaths, or both.

[Jud]

[ATTACH]26239[/ATTACH]

 

Jud

 

Ironically, the regulation of the pointy heads often comes from right wing bureaucrats.

 

Although the situation I related was factual, my "conclusion" was very much tongue in cheek.

[Jud]

I find it very hard to believe that, for example, instituting checklist would dramatically reduce the incidence Of *deaths* caused by wrong site surgery.

 

Then you would be surprised. There's a fair amount of popular (Atul Gawande?) and academic literature showing very significant efficacy of simple checklist protocols.

[Priaptor]

This junior-high debate tactic of yours detracts from your argument and undermines it. The question at issue is not a political one, and even if it happens to be informed by a conservative or liberal or "left wing" perspective, so what? You use terms like "liberal" and "left wing" as terms of dismissal. You falsely label people like me, and then, once dehumanized, go into your attack mode, sometimes to an extent that appears psychotic.

 

Do yourself (and us) a favor and apply your considerable analysis skills in a more objective and dispassionate manner. You may find you are more likely to persuade people to your viewpoint (and as an added benefit, might find you get banned from fewer internet sites).

 

When I see you deploy labels in an attempt to dismiss a viewpoint you oppose, I stop reading. From what I can tell, "left wing" to you means anyone you happen to disagree with.

 

Why do you believe, especially you who is so critical of manipulating truth as it applies to data, so against calling out manipulations, which in the case of what I am referring to is almost strictly related to the left to make a point, in order to institute more regulations and therefore control. I have no problem calling out the other side, when it occurs and there is plenty to go around.

 

OK, just to start off the the retort on my part, here is how the Washington Post, a very "neutral" newspaper, reports on retained instruments post-surgery.

 

I love to use this article to illustrate a point. If it gets you to read, I will leave out any bias, left right or otherwise and just use the article to show manipulations occur.

https://www.washingtonpost.com/news/to-your-health/wp/2014/09/04/when-your-surgeon-accidentally-leaves-something-inside-you/

 

The two main issues to focus on from the article, as the rest is just blathering after making their manipulative point are:

1. They claim "studies estimate that this happens once in every 5,500 to 7,000 surgeries"

2. There were 51.4 million in patient procedures performed in 2010, according to the National Center for Health Statistics.

 

Those two claims are the basis for their whole argument as to scope. So if you do a simple division of (5,500-7000/51.5 million) the incidence, according to this unbiased article, is astounding!!! Unfortunately if you go to the site they claim, (FastStats - Inpatient Surgery) and if you know anything about medicine, you quickly see that ONLY 3.5% of the "procedures" they are referencing in the denominator have ANY chance for leaving sponges or surgical instruments behind.

 

And that my friend is how biased and crappy news reporting becomes imbedded in the general public. AND that is just one example. I have tons.

[PopPop]

Although the situation I related was factual, my "conclusion" was very much tongue in cheek.

 

Understood.

[Jud]

Why do you believe, especially you who is so critical of manipulating truth as it applies to data, so against calling out manipulations, which in the case of what I am referring to is almost strictly related to the left to make a point, in order to institute more regulations and therefore control. I have no problem calling out the other side, when it occurs and there is plenty to go around.

 

OK, just to start off the the retort on my part, here is how the Washington Post, a very "neutral" newspaper, reports on retained instruments post-surgery.

 

I love to use this article to illustrate a point. If it gets you to read, I will leave out any bias, left right or otherwise and just use the article to show manipulations occur.

https://www.washingtonpost.com/news/to-your-health/wp/2014/09/04/when-your-surgeon-accidentally-leaves-something-inside-you/

 

The two main issues to focus on from the article, as the rest is just blathering after making their manipulative point are:

1. They claim "studies estimate that this happens once in every 5,500 to 7,000 surgeries"

2. There were 51.4 million in patient procedures performed in 2010, according to the National Center for Health Statistics.

 

Those two claims are the basis for their whole argument as to scope. So if you do a simple division of (5,500-7000/51.5 million) the incidence, according to this unbiased article, is astounding!!! Unfortunately if you go to the site they claim, (FastStats - Inpatient Surgery) and if you know anything about medicine, you quickly see that ONLY 3.5% of the "procedures" they are referencing in the denominator have ANY chance for leaving sponges or surgical instruments behind.

 

And that my friend is how biased and crappy news reporting becomes imbedded in the general public. AND that is just one example. I have tons.

 

Journalists failing to adequately understand technical, medical, or scientific subject matter and thus coming to stupid, utterly illogical conclusions is an unfortunate feature of our contemporary world. Never has there been so much factual subject matter available to so few inexperienced, poorly trained journalists. One reads of the theory of evolution being exploded or overturned or revolutionized on a monthly basis. (Hint: this is not really happening.)

 

This (the sloppy rather than purposeful variety at least) has nothing to do with political leanings.

[Priaptor]

People forget that half the doctors finished in the bottom half of their classes at medical school. The same is true of lawyers, of course, but you want to discuss medical errors. How many deaths are the result of them may be debatable. That many of those deaths could and should have been avoided is not. Of course, that is equally true of non-fatal errors. When one considers some of the measures implemented after an avoidable error, it sometimes boggles the mind that those measures were not part of standard procedure in the first place, e.g. marking the area to be operated upon, counting the number of instruments, etc. before and after surgery. Similarly, when one reads about how many hours that medical residents are required to put in at many hospitals, with the corresponding lack of sleep, one has to believe that is one obvious area to be addressed in reducing the number of medical errors. Thankfully, a number of hospitals have recently done so.

 

Well Allan, you are assuming that those that finish in the bottom half of their class aren't capable. Do you even know how medical students are graded or ranked or just making some unsubstantiated claims of capabilities. I have seen some of the dumbest doctors graduating in the top of their class from some of the best medical schools and I have also seen some amazing doctors from the same. Having spent close to 40 years in the field, I can tell you the quality of doctor being produced, IMHO is on the decline (to be expected with the huge number of medical schools opening, loss of independence, employee status, with increasing regs and decreasing pay). However, even during the toughest years to get in, namely during the 60s and 70s one could easily question the methods used to train doctors. The one place that ranking in the class clearly make a difference, is in the perceived quality of residencies available to the applicant. Having said that, one can debate if I received better training at my super duper Ivy League training program than the guy in Coney Island Hospital. Too many variables in medical school and residencies to boil it all down to where you finished in your class; although I will grant you it is a legitimate variable.

[wgscott]

Why do you believe, especially you who is so critical of manipulating truth as it applies to data, so against calling out manipulations, which in the case of what I am referring to is almost strictly related to the left to make a point, in order to institute more regulations and therefore control. I have no problem calling out the other side, when it occurs and there is plenty to go around.

 

I have not read the WSJ report yet (link?), so I have no idea whether I will wind up agreeing with you or not. Lawyers have the expression "When the law is not on your side, stick to the facts. When the facts are not on your side, stick to the law. When neither the facts nor the law are on your side, you resort to denouncing your opponent."

[Priaptor]

Journalists failing to adequately understand technical, medical, or scientific subject matter and thus coming to stupid, utterly illogical conclusions is an unfortunate feature of our contemporary world. Never has there been so much factual subject matter available to so few inexperienced, poorly trained journalists. One reads of the theory of evolution being exploded or overturned or revolutionized on a monthly basis. (Hint: this is not really happening.)

 

This (the sloppy rather than purposeful variety at least) has nothing to do with political leanings.

 

Jud,

 

I admit you are a better person than me and give people the benefit of the doubt. However, IMHO, this was a hack job. Plus it is not just journalists. Mr. Lieber I quoted from the WSJ morphed stats using as did the Johns Hopkins physicians in releasing this data to show that medical errors account for 1/3 of all deaths in America. I used the Washington Post article as but one illustration, but clearly not the only and many others are by "experts" and those in the field itself.

 

In prior posts I brought up the definitive "study" that showed "blacks receive suboptimal care in level I trauma centers". Why? Because they used mortality rates as their only variables and didn't normalize for the types of trauma. When normalized, blacks actually did better. But does anyone ever look at the latter? Of course not because the former is more sensational and proves an agenda many want to foist on the American public ( I will refrain using left and right in my example so not to get wg's balls in an uproar).

 

If you look at the article from Hopkins it is all inferred crap and Mr. Lieber and others run with it and of course because it is from John's Hopkins it must be true and now becomes the 11th commandment written in stone. I mean of course infections in the hospital must be a medical error and lets extrapolate how many are going to die as a result, of course an untoward event leading to a death in the hospital MUST be a medical error with required reporting to AHCA. Yes if a radiologist "misses" a finding it must be a medical error, etc, etc. The variables used and the assumptions made are preposterous.

 

I am not claiming there are no medical errors. There are plenty. One of my qualms is how we classify an "error". Is a subtle mediastinal contour abnormality on a chest x-ray in a 70 year old that is called probably overlapping bony and vascular structures seen in over 90% of patients that age which later turns out to be a mediastinal mass a medical error? Lieber and Hopkins thinks so. Most rational people would disagree. Unfortunately in this country the malpractice business and courtroom where the doctor is not tried by his peers is the final arbiter.

 

The funny thing is that as an insider the real medical errors no one knows about, the main one being shitty medicine being practiced much as a result of the fear of being sued or the requirement to use EMR which in the states at least is a hindrance to good quality care rather than improving quality of care. So the doctor has become an automaton checking boxes, where it is estimated that anywhere from 55-90% of the stuff he/she is spending their time doing has nothing to do with the care of the patient during the encounter with the patient.

 

Equally silly is the simple "fixes" that the Liebers recommend. More, not less EMR. Well get rid of HIPAA and maybe you can accomplish his simple goal. Referring physicians should consult with radiologists before ordering the next exam??? Great recommendation. What makes him think they aren't or that they will listen as most of the useless crap being ordered is CYA and just checking a box regardless of what the radiologist recommends. Plus the radiologist IS recommending follow up studies when appropriate and there is nowhere to show they aren't. Without going into all of his or others hyperbole I will just leave it here as illustrations as to the manipulation and sophomoric recommendations as a result.

[Priaptor]

I have not read the WSJ report yet (link?), so I have no idea whether I will wind up agreeing with you or not. Lawyers have the expression "When the law is not on your side, stick to the facts. When the facts are not on your side, stick to the law. When neither the facts nor the law are on your side, you resort to denouncing your opponent."

 

WG,

 

Mr. Lieber's simple approach is just parroting the Johns Hopkins nonsense and his "fixes" are nothing but simple jargon from a knee jerk response to a study that lacks substantially on facts. It is very easy to give a knee jerk response to this stuff. Such as reducing time a resident works (well that hasn't helped as residents work almost 1/3 less than they did in the 60-80s), better sign offs (well in the era of medical records, particularly in training programs there is better sign off than ever and these so called errors are increasing not decreasing), referring doctors listening to radiologists (implying they don't without any substance to prove the claim), more use of EMR (at least here in the states, with limited exceptions most doctors believe and can prove it is interfering with the care of their patient distracting from patient care) and on and on and on it goes.

 

What I find funny is that we are required to take a course in Medical Errors every two years. I actually find it a pretty good course and have tried to follow the recommendations laid out in these courses. However, it is impossible in the modern health care world. In fact the Government not only fosters activities these courses recommend you avoid but requires it for payment. So instead of me spending 90% of my time on the patient's problem I now spend 90% of my time on regulatory crap and am now being bothered with absurd secretarial tasks of "doctor to doctor" dialogue, a virtual impossibility in today's climate, trying to find the patient's problem in the morass of useless EMR that is substituted for a simple referral, dictating idiotic indicators that has nothing to do with the patient care but everything to do with requirements by CMS in order to get paid, having to document idiotic things that likewise have nothing to do with patient care, being bothered non-stop by physicians who can't find results in the "computer" and don't want to or have had enough in their dealings with moronic secretaries or paraprofessionals (hired of course to improve things) in their search for information, and on and on and on it goes.

 

So the point being, the Medical Error requirement course for relicensure teaches you to avoid all those idiotic activities that the "fix" for medical errors by those like Mr. Lieber want to impose more of.

[bluesman]

Never has there been so much factual subject matter available to so few inexperienced, poorly trained journalists

...and to patients, families, lawyers, judges, underwriters, healthcare executives, pundits, investors, bus drivers, artists, tile workers, winemakers, CA regulars......

 

With apologies for the poor grammar (I couldn't find an image starting with "Him...") I'm staying out of this one for fear of sounding like

 

[esldude]

Does that mean that most elderly drivers are stoned?

Most are on multiple medications.

[tranz]

"Randomness"

 

Surely you joke, at least I hope.

 

Give me a map and I can point to you with a much higher probability, probably greater than 90% which is much higher than you could ever discern the differences between DACS, where the gun violence is going to take place here in the states...

 

Now there is an app in the making. And have it be seamlessly integrated with my TomTom navigation app so that it can adjust the route and/or warn me about areas with high probability stray (or purposeful) bullet activity.

 

Perhaps in Montana this is not needed; still need to visit.

[Priaptor]

Now there is an app in the making. And have it be seamlessly integrated with my TomTom navigation app so that it can adjust the route and/or warn me about areas with high probability stray (or purposeful) bullet activity.

 

Perhaps in Montana this is not needed; still need to visit.

 

Your post reminds me of the first "Vacation" where they make that wrong turn, in St. Louis I believe. Funny but I am not sure the PC police would be endearing to the app.

 

I think the biggest risks in Montana are driving on "black ice", driving drunk (tons of that), hitting deer and bear with your cars, getting hurt hiking and mountain biking. I think drunk driving in MT is probably the biggest risk.

 

You should definitely visit. It is a "magical" place, assuming you visit the right places. I love Glacier and the Canadian Rockies. Pretty amazing places. More than anything taking a long hike in Glacier NP surrounded by majestic mountains, etc is awesome! The Canadian Rockies equally if not more awesome.

[Priaptor]

As an aside, for those of you vilifying Trump for his desire to place tariffs, I post the following to show you that Obama beat him to it:

 

US slaps China steel imports with fivefold tax increase - BBC News

[bluesman]

I think the biggest risks in Montana are driving on "black ice", driving drunk (tons of that), hitting deer and bear with your cars, getting hurt hiking and mountain biking. I think drunk driving in MT is probably the biggest risk. You should definitely visit. It is a "magical" place, assuming you visit the right places.

Although it makes perfect sense in view of the harsh winters, we were unprepared for the high number of Montana roads that are unpaved. The gravel surface is a big hazard if you drive a nice vehicle, which is why our friends in Big Timber drove the same Suburban they bought used sometime around '95 for 20 years.

[jacquesr]

That's not enough! We should also build a wall between the US and China. Oh, crap, they already did!

...

 

 

As an aside, for those of you vilifying Trump for his desire to place tariffs, I post the following to show you that Obama beat him to it:

 

US slaps China steel imports with fivefold tax increase - BBC News

[jabbr]

Then you would be surprised. There's a fair amount of popular (Atul Gawande?) and academic literature showing very significant efficacy of simple checklist protocols.

 

Well I understand the analysis and proponents. But first:

 

1) what is the actual incidence or wrong site surgery?

2) how many of these lead to deaths?

 

Perusing info on the medical error death book -- looks to me like a number of these deaths are due to infections-- staph etc. Not sure I'd classify these as "errors"

[lucretius]

As an aside, for those of you vilifying Trump for his desire to place tariffs, I post the following to show you that Obama beat him to it:

 

US slaps China steel imports with fivefold tax increase - BBC News

 

There are two types of politicians:

1. Those that are economic know-nothings.

2. Those that make appeals to economic know-nothings.

[Priaptor]

Well I understand the analysis and proponents. But first:

 

1) what is the actual incidence or wrong site surgery?

2) how many of these lead to deaths?

 

Perusing info on the medical error death book -- looks to me like a number of these deaths are due to infections-- staph etc. Not sure I'd classify these as "errors"

 

Ahh, there lies the rub. All of the data is extrapolations based on flawed data.

 

Wrong site surgery is extremely rare but highly sensational. There was a case in northwestern FL years ago of a man having the wrong leg amputated. Obviously extremely sensation, highly unlikely event. The policies and procedures instituted as a result were never tested for cost benefit and whether or not the new policies and procedures had better outcomes BUT in typical fashion a knee jerk response so people could feel they "did something" and doing something is better than doing nothing; both of which I take issue with.

 

Now the "wrong site" that usually occurs when it indeed does occur is not necessarily "wrong" but a patient comes in in moribund and the trauma doc doesn't hear breath sounds and places a chest tube in and after the x-ray comes back the pneumothorax is on the other side and the reason the doctor placed the chest tube was because the breath sounds were decreased because the patient was barely breathing. Hey bad stuff happens when people get sick.

 

I am all in favor of trying to improve my and my peers practice patterns but because of propaganda, not without well thought out plans, not without cost-benefit analysis or outcome analysis. Sometimes the cure is worse than the disease.

[Jud]

Well I understand the analysis and proponents. But first:

 

1) what is the actual incidence or wrong site surgery?

2) how many of these lead to deaths?

 

Perusing info on the medical error death book -- looks to me like a number of these deaths are due to infections-- staph etc. Not sure I'd classify these as "errors"

 

Oh, I would (or at least lean that way while allowing additional facts to change my mind). The chain of events that led to my dad's death was started by an infection that resulted from an operation to implant a new pacemaker - one of a series of infections from pacemaker implantation operations at that clinic, until they determined what they were doing wrong. (Another doctor then gave my father an antibiotic that interacted with other drugs he was on to cause intestinal bleeding and reduced kidney function, starting a several-month downward spiral that ended with his death from congestive heart failure. But he was 91 at the time, after having his first heart attack at 62 and being overweight most of his life. On balance, the medical system did him a powerful amount of good.)

 

Hospital- or clinic-acquired infections are very much a known problem, and if you look at the data (which is publicly available for hospitals), they are non-random. Particular hospitals consistently do better.

[Priaptor]

Although it makes perfect sense in view of the harsh winters, we were unprepared for the high number of Montana roads that are unpaved. The gravel surface is a big hazard if you drive a nice vehicle, which is why our friends in Big Timber drove the same Suburban they bought used sometime around '95 for 20 years.

 

Bluesman,

 

Montana, if you really want to enjoy it is not a place for "nice cars". As those who have hit it big in Alberta and BC move into my area as well as the Californians and Texans, I a seeing more Porsches, Lamborghinis, Ferraris, etc than ever before. When I first got my place in 2002, if a truck was washed it was considered "exotic". That definition is changing. It's pretty funny actually to watch.

[lucretius]

The Ayn Rand Institute. Now that's where we are going to get a truly objective analysis ...

 

Excellent pun!

[Priaptor]

Oh, I would (or at least lean that way while allowing additional facts to change my mind). The chain of events that led to my dad's death was started by an infection that resulted from an operation to implant a new pacemaker - one of a series of infections from pacemaker implantation operations at that clinic, until they determined what they were doing wrong. (Another doctor then gave my father an antibiotic that interacted with other drugs he was on to cause intestinal bleeding and reduced kidney function, starting a several-month downward spiral that ended with his death from congestive heart failure. But he was 91 at the time, after having his first heart attack at 62 and being overweight most of his life. On balance, the medical system did him a powerful amount of good.)

 

Hospital- or clinic-acquired infections are very much a known problem, and if you look at the data (which is publicly available for hospitals), they are non-random. Particular hospitals consistently do better.

 

Jud,

 

Some hospitals do better than others for a variety of reasons, including those that just suck. However, there are many hospitals, particularly those with large numbers of ventilators, dialysis patients and elderly that are going to have higher infection rates as the hospital is basically one big petri dish.

 

The above notwithstanding, with rare exceptions, I don't think a hospital acquired infection can or should be used solely as a metric of "medical error" and I am not saying you are.

 

My mother too, had huge complications towards the end of her life. While by all modern metrics her terminal event/events would probably be listed as "medical errors" they cannot and should not be viewed as such. Don't need to go into all the details but her terminal events were unfortunate but more due to her end stage heart disease from her mitral stenosis on Coumadin and debilitated state from having a stroke 35 years earlier. No doubt my mother lived as long as she did as a result of the health care system and find it an insult that her demise would be counted as a medical error.

[esldude]

Ahh, there lies the rub. All of the data is extrapolations based on flawed data.

 

Wrong site surgery is extremely rare but highly sensational. There was a case in northwestern FL years ago of a man having the wrong leg amputated. Obviously extremely sensation, highly unlikely event. The policies and procedures instituted as a result were never tested for cost benefit and whether or not the new policies and procedures had better outcomes BUT in typical fashion a knee jerk response so people could feel they "did something" and doing something is better than doing nothing; both of which I take issue with.

 

Now the "wrong site" that usually occurs when it indeed does occur is not necessarily "wrong" but a patient comes in in moribund and the trauma doc doesn't hear breath sounds and places a chest tube in and after the x-ray comes back the pneumothorax is on the other side and the reason the doctor placed the chest tube was because the breath sounds were decreased because the patient was barely breathing. Hey bad stuff happens when people get sick.

 

I am all in favor of trying to improve my and my peers practice patterns but because of propaganda, not without well thought out plans, not without cost-benefit analysis or outcome analysis. Sometimes the cure is worse than the disease.

I think your objective metrics, cost/benefit ideas etc miss out on the truly important results. It is only with long term living one can evaluate medical outcomes. While short term living might seem to be a guide that always leads one to erroneous conclusions. Quite often the quality of the power supplies in medical gear make the difference. Only after months of living when significant cell replication and replacement has occurred will the results of noisy PS show up in faulty DNA replication.