Not one but two mistakes on the same prescription! The pharmacy erroneously cut the prescribed dose in half. The pills in the bottle did not match the label and reduced the dose to one-forth of that prescribed. Furthermore, I had to sign three times for this one prescription (authorization to pick up, waiver of further information, and credit card). What is the purpose of all the checks and balances in the prescription system? Caveat emptor -- consumer beware!
(This is a shorter version of a posting in 2003.)
Wednesday, December 17, 2008
An Imperfect Medical System
Every medical system depends on imperfect people, which means medical care is not perfect. Here are some examples of quirky personal experience.
1. I found myself in a power struggle between a primary care physician and a colorectal surgeon because each wanted to do the colonoscopy. After reading a medical research study on the subject and realizing that I had low risk factors, I decided to disappoint both. Medical errors in the procedure remain a significant risk to the patient that must be weighed against benefit. To illustrate the point, a colonoscopy probe got stuck in a friend of mine for over an hour until they figured out how to remove it.
2. My medical records have disappeared on two occasions when a physician ended practice. In the second such instance, when I called asking for the records, I was referred to the physician's lawyer. He had a bit of a legal problem. In some localities at least, it appears that patient records need to be retained for only six years.
3. One time, I found that an unusual medical lab test result had not been reported to me. It took multiple requests for the test results to be given to me. The physician had not told me about an out of range result. I searched the Internet and found out a possible cause and treatment, which was ultimately successful in giving an in-range test result.
References:
Patient's Rights - New York State Department of Health (021014)
http://www.health.state.ny.us/nysdoh/hospital/english1.htm
Slocum-Dickson Medical Group
http://slocum.trainor.com/admin_services/medical.shtml
Title 22 - §1711. Patient access to hospital medical records
http://janus.state.me.us/legis/statutes/22/title22sec1711.html
FindLaw
http://caselaw.lp.findlaw.com/nycodes/c30/a124.html
(This is a shorter version of a post from 2003.)
1. I found myself in a power struggle between a primary care physician and a colorectal surgeon because each wanted to do the colonoscopy. After reading a medical research study on the subject and realizing that I had low risk factors, I decided to disappoint both. Medical errors in the procedure remain a significant risk to the patient that must be weighed against benefit. To illustrate the point, a colonoscopy probe got stuck in a friend of mine for over an hour until they figured out how to remove it.
2. My medical records have disappeared on two occasions when a physician ended practice. In the second such instance, when I called asking for the records, I was referred to the physician's lawyer. He had a bit of a legal problem. In some localities at least, it appears that patient records need to be retained for only six years.
3. One time, I found that an unusual medical lab test result had not been reported to me. It took multiple requests for the test results to be given to me. The physician had not told me about an out of range result. I searched the Internet and found out a possible cause and treatment, which was ultimately successful in giving an in-range test result.
References:
Patient's Rights - New York State Department of Health (021014)
http://www.health.state.ny.us/nysdoh/hospital/english1.htm
Slocum-Dickson Medical Group
http://slocum.trainor.com/admin_services/medical.shtml
Title 22 - §1711. Patient access to hospital medical records
http://janus.state.me.us/legis/statutes/22/title22sec1711.html
FindLaw
http://caselaw.lp.findlaw.com/nycodes/c30/a124.html
(This is a shorter version of a post from 2003.)
Helping Men Live Longer
The average man is doomed to a shorter life simply by being male. Recommendations to improve men's health such as more vitamins, more exercise, and better behavior have not changed this. Do women know something that men don't that allows women to live longer? It should be noted that married men live longer than single men, so whatever women do for themselves must rub off on their mates.
If one looks at mortality tables, men have a higher death rate from most causes. Men have an extremely higher death rate in the cardiovascular area. This suggests that it is time to redouble efforts at cutting out the dietary fats, cake and cookies! Time for more cardiovascular exercise: open the jar of mayonaise for your wife, take out the trash, go to the store! Another area of higher risk for men is their dramatically higher suicide rate as compared with women. Women might help by cheering up their men and keeping them happier. Given that women on average live five years longer, they might spend a bit of their time improving quality of life for their shorter-lived men. On the other hand, I suppose if a man is making life into hell for a women, then her goal will be to have a breather in the last five years after the man dies.
Information Sources:
Wired News: A Few Ways to Win Mortality War http://www.wired.com/news/medtech/0,1286,56476,00.html
Morbidity and Mortality Weekly Report http://www.cdc.gov/mmwr/
Table 2.15-- CAUSE OF DEATH, BY SEX: 2000 http://www.state.hi.us/dbedt/db01/02/021501.pdf
NCHS - FASTATS - Life Expectancy http://www.cdc.gov/nchs/fastats/lifexpec.htm
(This is a shorter version of an original post from 2003)
If one looks at mortality tables, men have a higher death rate from most causes. Men have an extremely higher death rate in the cardiovascular area. This suggests that it is time to redouble efforts at cutting out the dietary fats, cake and cookies! Time for more cardiovascular exercise: open the jar of mayonaise for your wife, take out the trash, go to the store! Another area of higher risk for men is their dramatically higher suicide rate as compared with women. Women might help by cheering up their men and keeping them happier. Given that women on average live five years longer, they might spend a bit of their time improving quality of life for their shorter-lived men. On the other hand, I suppose if a man is making life into hell for a women, then her goal will be to have a breather in the last five years after the man dies.
Information Sources:
Wired News: A Few Ways to Win Mortality War http://www.wired.com/news/medtech/0,1286,56476,00.html
Morbidity and Mortality Weekly Report http://www.cdc.gov/mmwr/
Table 2.15-- CAUSE OF DEATH, BY SEX: 2000 http://www.state.hi.us/dbedt/db01/02/021501.pdf
NCHS - FASTATS - Life Expectancy http://www.cdc.gov/nchs/fastats/lifexpec.htm
(This is a shorter version of an original post from 2003)
When Anonymity Interferes with Community
I received a holiday wish list for a child whose care is managed through a social services program. My assignment was to obtain gifts that matched items on a list. Apart from the list, I received a first name for the child (Kevin W.), the name of a 'case worker', and a brief description of the child: age 8, shirt and pants size 8; shoes size 12. In this preceding description, I even altered the first name to further shield the vaguely described child -- an example of anonymity engendered by caution.
As I gathered gifts for this boy, I reflected on the meaning of the transaction. The parties in this relationship are nameless and faceless to each other. They are shadows with details left to the imagination. Anonymity of this type, and privacy which is another face of anonymity, have become central to our society. Many reasons pop to mind as justification including the avoidance of unpleasant interference, unwarranted intrusion, loss of dignity, undesired social entanglements, and embarassment. These seem all to be different manifestations of fear having to do with potential harm, real or imagined.
But what about the down side? How does anonymity affect the concept of a community as a collection of individuals who support each other and including the children? It seems to me that in the present situation, anonymity means that all interactions with the child become focused on the case worker. This gives the case worker more control, which can be a blessing in managing the case. More control is also a curse because it means more demands on the case worker who has to maintain some personal distance (translate this as coldness) in order to avoid being overwhelmed by the 'case load'. In an alternative community model, the role of supporting the child is distributed so that no one person has a large load. Anonymity has other disadvantages. The anonymity may embolden an independence of the case handlers leading to behaviors different from community norms. It may sew seeds of distrust. It can reduce accountability due to lack of transparency in actions taken. It weakens the opportunity for transition away from the case worker into other support models such as direct community support.
Truely, many if not most case handlers, use their authority wisely. Also, anonymity has essential roles in our society. The U.S. Supreme Court has repeatedly reinforced the right to anonymous free speech as protected by the First Amendment. The right to privacy in voting is commonly accepted and arguably necessary given the differences in power that individuals may have over each other influenced by their vote.
One could argue that the transparency (i.e, freedom from anonymity) should be considered a right just as anonymity and privacy are rights under other circumstances. The U.S. Freedom of Information Act supports transparency in a wide range of circumstances related to government actions. However, individual privacy or anonymity is generally considered to trump freedom of information. It wouldn't hurt to similarly recognize individual transparency as a right under limited and well thought out circumstances when privacy claims may be abused. An analogy exists with patient rights that are now posted prominently in most medical facilities. Transparency rights could well deserve to be posted prominently where the potential exists for abuses in claims of individual privacy.
As I gathered gifts for this boy, I reflected on the meaning of the transaction. The parties in this relationship are nameless and faceless to each other. They are shadows with details left to the imagination. Anonymity of this type, and privacy which is another face of anonymity, have become central to our society. Many reasons pop to mind as justification including the avoidance of unpleasant interference, unwarranted intrusion, loss of dignity, undesired social entanglements, and embarassment. These seem all to be different manifestations of fear having to do with potential harm, real or imagined.
But what about the down side? How does anonymity affect the concept of a community as a collection of individuals who support each other and including the children? It seems to me that in the present situation, anonymity means that all interactions with the child become focused on the case worker. This gives the case worker more control, which can be a blessing in managing the case. More control is also a curse because it means more demands on the case worker who has to maintain some personal distance (translate this as coldness) in order to avoid being overwhelmed by the 'case load'. In an alternative community model, the role of supporting the child is distributed so that no one person has a large load. Anonymity has other disadvantages. The anonymity may embolden an independence of the case handlers leading to behaviors different from community norms. It may sew seeds of distrust. It can reduce accountability due to lack of transparency in actions taken. It weakens the opportunity for transition away from the case worker into other support models such as direct community support.
Truely, many if not most case handlers, use their authority wisely. Also, anonymity has essential roles in our society. The U.S. Supreme Court has repeatedly reinforced the right to anonymous free speech as protected by the First Amendment. The right to privacy in voting is commonly accepted and arguably necessary given the differences in power that individuals may have over each other influenced by their vote.
One could argue that the transparency (i.e, freedom from anonymity) should be considered a right just as anonymity and privacy are rights under other circumstances. The U.S. Freedom of Information Act supports transparency in a wide range of circumstances related to government actions. However, individual privacy or anonymity is generally considered to trump freedom of information. It wouldn't hurt to similarly recognize individual transparency as a right under limited and well thought out circumstances when privacy claims may be abused. An analogy exists with patient rights that are now posted prominently in most medical facilities. Transparency rights could well deserve to be posted prominently where the potential exists for abuses in claims of individual privacy.
Wednesday, November 26, 2008
News Update: Our earth is really a giant fishbowl
In the long gone past, everyone who bothered to think about the shape of the earth would tell you it was flat. They would say that it you went far enough, you could fall off the edge. Anyone who spoke otherwise at the time was kooky, or worse, was a heretic. Then some people, who thought they were smart, made the claim that the earth was a round globe. They argued their point until most people believed it, and they pointed to the images of the earth seen from space. The flat earth types thought the images were fake but were then labeled the kooky ones.
Now we are being told that the global earth view is wrong. Some people, who think they are smart, tell us that the earth is really a giant round fishbowl. In their view, the fish are being crowded out and humans are being crowded in so much as to threaten all life in the fishbowl. Who would have believed it!
Tuesday, November 18, 2008
OSTP and A Sustainable World
The following message was entered at www.change.gov.
Office of Science & Technology Policy: Population increase is testimony to human success but I also would point to the very serious risks of rapid growth in world population. The current growth rate is a harbinger of future failure in responding to global and U.S. ills such as environmental deterioration, poverty, and hunger. My wish for change would be that the OSTP or associated groups encourage leadership and provide focus for the fundamental issue of a sustainable world population. For lack of attention, we increase the likelihood of a sudden global livability meltdown, that would rival or exceed the consequences of the current global financial meltdown.
Office of Science & Technology Policy: Population increase is testimony to human success but I also would point to the very serious risks of rapid growth in world population. The current growth rate is a harbinger of future failure in responding to global and U.S. ills such as environmental deterioration, poverty, and hunger. My wish for change would be that the OSTP or associated groups encourage leadership and provide focus for the fundamental issue of a sustainable world population. For lack of attention, we increase the likelihood of a sudden global livability meltdown, that would rival or exceed the consequences of the current global financial meltdown.
Saturday, November 15, 2008
Who is the decider? The deck of cards analogy
Prof. Philip Heymann of Harvard Law gave a talk that fleshed out for me the uneasy story concerning the U.S. treatment of those labeled enemy combatants. He described in a dispassionate way the tension among different government agencies as each proceeded to implement, or not, new policies that were being promulgated in the aftermath of 9/11. Different decisions won out for different agencies. The policies originated particularly from the top of the federal administration.
After further thought, an analogy with card games occurred to me in which the winning outcome is a decision. I had a sense of the different 'trump' cards that came into play and dominated in the outcome. These cards included the Constitution and Bill of Rights, public (and individual) sense of morality, federal law, international law, appeal to authority, paranoia, fear of liability, and covert subterfuge. I suppose that public complacency could have been a card, but did not seem to be played. The subterfuge card, was the wild card in the pack that some thought could beat out the rest in a winning decision. Others argued, as would I, that subterfuge should not have been in the deck.
The rules of the game continue to develop. A useful rule would include that the trump cards not all be in the hands of one person or one group or one branch of government. Some felt that too many cards moved into the wrong hands.
After further thought, an analogy with card games occurred to me in which the winning outcome is a decision. I had a sense of the different 'trump' cards that came into play and dominated in the outcome. These cards included the Constitution and Bill of Rights, public (and individual) sense of morality, federal law, international law, appeal to authority, paranoia, fear of liability, and covert subterfuge. I suppose that public complacency could have been a card, but did not seem to be played. The subterfuge card, was the wild card in the pack that some thought could beat out the rest in a winning decision. Others argued, as would I, that subterfuge should not have been in the deck.
The rules of the game continue to develop. A useful rule would include that the trump cards not all be in the hands of one person or one group or one branch of government. Some felt that too many cards moved into the wrong hands.
Wednesday, November 05, 2008
Why are people celebrating after the election?
The barber giving me a haircut today had heard Obama's speech last night right after the win and asked me, "Why were all those people celebrating? Barack Obama hasn't done anything yet?" I know he had been rooting for the other side. I told him that people who had been feeling hopeless before were now excited because they had some hope for change. He said, "Okay I understand." That made me feel good to think I had an influence in resolving his perplexity. His next question was, Why is it that Hamas and Hezbollah wanted Obama to win? I said that the reasons are complicated, This answer seemed not to satisfy him. But I added, Al Quaida apparently wanted McCain to win. I said this is another complex situation and maybe Al Quaida wanted McCain as a person who could be more easily identified as an enemy to their supporters. I think the barber may have understood my point, but am not sure. I told him I thought both the McCain and Obama speeches last night were excellent. He had not heard McCain's concession speech, which I think would have been helpful to him. He said that the outcome of the presidential election didn't affect him either way, because people still need haircuts. I didn't say any more. I wasn't about to get into too passionate a discussion with him while he was working with scissors in hand, but anyway I was happy to share a different point of view with him.
Tuesday, November 04, 2008
An Unexpected Peril in House Hunting
Recently, we saw a house for sale and wanted to check it out. The realty company that listed the place was called, and a friendly agent gave us a tour. The agent took pains to point out defects in the place, an approach that seemed a little unusual for someone trying to promote the sale of a property -- but maybe it was just a matter of being friendly and honest. At the end of the tour, we were told about new state regulations requiring paperwork to be signed, so as to protect the interests of a potential buyer. I wanted to be done with this paperwork intrusion, and I could have perfunctorily signed. Instead I quickly scanned the form handed to me, and as I read, alarm bells went off in my mind. The paperwork was a blanket agreement for this friendly agent to become our buyer's agent for any property we might purchase. The seller's agent had morphed into a buyer's agent before our eyes. I said we weren't comfortable with the paperwork, and that was the end of it. Thank goodness I took the time to read. The experience is another reminder to avoid automatically signing a piece of paper before reading it.
Friday, October 31, 2008
High Efficiency Home Heating: It's Cool
A new high efficiency hot water heating system was installed at our home recently to replace an old rusting gas-guzzling bucket of a heating system. The 'boiler' of the new system hangs on the basement wall and a small pipe sticks through to the outside for the exhaust and also for air intake. We went from one to three temperature-controlled heating zones, each with its own circulator displayed on a mounting board next to the boiler. The setup looks awesome.
The quoted cost for the different high efficiency systems were all about the same -- expensive. Hopefully ours will pay for itself through reduced use of fuel and low maintenance. We chose Viessmann after getting estimates. Interestingly enough, we were steered away from Viessmann in a couple of cases. Our best guess is that they were afraid of installing the high-end tech.
Among the features in the new system are a 'modulated' boiler temperature that adjusts to outside temperature. The furnace room controller for the unit seems complicated but still can be fiddled with to adjust the system according to time of day and other conditions. We are finding that the three zones is a wonderful improvement in terms of both living comfort and keeping down the use of heat. We are looking forward to find out where we end up on fuel costs this winter -- hopefully a lot less.
The quoted cost for the different high efficiency systems were all about the same -- expensive. Hopefully ours will pay for itself through reduced use of fuel and low maintenance. We chose Viessmann after getting estimates. Interestingly enough, we were steered away from Viessmann in a couple of cases. Our best guess is that they were afraid of installing the high-end tech.
Among the features in the new system are a 'modulated' boiler temperature that adjusts to outside temperature. The furnace room controller for the unit seems complicated but still can be fiddled with to adjust the system according to time of day and other conditions. We are finding that the three zones is a wonderful improvement in terms of both living comfort and keeping down the use of heat. We are looking forward to find out where we end up on fuel costs this winter -- hopefully a lot less.
Thursday, October 30, 2008
Corn: Too Much of a Good Thing?
I can think of a few times in my life when I have had a sudden and permanent attitude-altering experience. In this case, the source of the alteration was very simple, I watched the documentary film King Corn, a story about the role of corn in the U.S. One image in the film especially caught my eye. It was the corn fed cattle. I am talking about the bulked up, hefty, cattle that go into hamburgers. As I listened to the film, my mind wandered fleetingly to see all the bulked up people in the U.S. -- you can see them everywhere. I would not embarass them or me by telling them so directly, but some of these people look bulked up just like the cows. As pointed out in the film, all of us depend heavily on corn for calories, both directly eating corn products and also eating corn-fed livestock and their products. Getting too bulked up has become an obesity problem accounting for an epidemic of deteriorating health for those of all ages. I realized that I too could be bulking up, because of my own intake of corn -- especially when I looked in the mirror, and no, I am not anorexic.
The reliance on corn in U.S. diets was a brilliant initiative that began in the 1970s with Earl Butz, the Secretary of Agriculture under President Nixon. The emphasis on corn was in many respects a very good thing, because it led to an abundance of calories at low cost. The problem today is that corn has become a ubiquitous part of the food chain for the food on our tables, and is not infrequently present in quantities that reduce the nutritional quality of our diet.
Take a look at how many grocery store items contain high fructose corn syrup. When I go to the grocery store these days, I try to find products without high fructose corn syrup. There are not many on the shelves without these sweeteners. For good measure, I cast aside also the products that contain sugar, or cane syrup or other processed sugars. I also exclude milk products which may come from corn-fed animals. I have worked hard to find a nutritional, enjoyable and satisfying combination of foods without the corn and other sweeteners. Leaving aside the sweeteners was difficult for a person that grew up enjoying sweets with gusto. But artificial sweeteners have become my friends, and keep me happy. My dietary approach is probably more drastic than necessary, but on reflection I am especially happy with the nutritional content that has resulted. And now after a couple of months, in my mind's eye at least, I look a little less like those corn-fed cattle.
For futher information about the film:
Wednesday, October 29, 2008
Supercilious
He first chomped down on his cigar and then opening his mouth sneered "You aren't smart enough to know what you are talking about."
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