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.)
In the blogging environment, short is a virtue, but sometimes longer is necessary.
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.
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