If you’re not reading Running a Hospital by the CEO of Beth Israel Deaconess Medical Center, one of Boston’s big famous hospitals, you should be. It’s a really fascinating look at another side of medicine–often thinking through and discussing administrative decisions that end up affecting the whole community–patients, doctors, nurses, techs–everyone.
Shadowed/eavesdropped on calls today at the California Poison Control Center, which was pretty cool. The center here in SF shares the duties with 3 other centers in the state, operating the 24 hour, toll-free number to answer pretty much any question and either make sure people get the right treatment or some needed reassurance. Each state has its own poison control center and the people are incredibly helpful, knowledgeable and friendly–definitely call if you have any questions.
My one experience with it involved my mother making some sort of pasta or tuna salad, while also getting out some hydrocortisone cream for a rash or something, with a tiny bit of the steroid cream ending up in the bowl. Don’t ask me how this happened. I just remember my brother and I freaking out and SCREAMING for her to throw out the entire bowl of food, not wanting our mother to die. She called poison control and they said it would be fine (she’s a nurse so she knew this anyway) but I think we put up such a fit she tossed it anyway. (Or at least she told us she did.) So everyone does silly things, and children eat everything. No matter how silly, it’s no reason not to call. The call centers have heard everything.
Most calls dealt with toddlers eating pills. One “licked the coating off a bunch of Advil and Tylenol.” One important point: Tylenol is actually incredibly dangerous in overdoses–which is hard to do unintentionally in adults–but isn’t so difficult for small children, since overdoses are generally based on weight. Tylenol in overdose has been bad enough to cause patients to go into liver failure and require a liver transplant. Keep pills out of the reach of kids!
Oh, interesting fact: Those little freshness packets in shoe boxes that say “don’t ingest?” They’re just silica, and non-toxic. It’s like eating sand, apparently. (This is not medical advice!)
Med Innovations goes on the attack about the NYTimes’ reporting of medical stories and wishes they were more in line with his beliefs about the true America:
It all comes down to altitude and attitude. From their lofty perch, The New York Time’s editorial staff has yet to tumble to the reality America is basically a conservative nation, distrusts centralized government, wants choices of care and providers, demands access to the wonders of high tech medicine, and believes a market-based system, with all its faults, such as profits for entrepreneurial and innovative health care companies and doctors, are worth the price and value received.
He is talking about the United States of America, right? I was wondering why this poll didn’t get more coverage on the medical blogosphere showing that two thirds of Americans believe the government should provide national health insurance even at the cost of higher taxes. I don’t think our country is at all as “basically conservative” and distrustful of centralized government as Med Innovations thinks. I don’t think the country believes in a market-based system either.
I think the country knows that the health care system sucks, but many are scared of change or reform because they would have to risk their coverage to provide it for everyone. They know someone in the middle class or have read about someone with cancer–or even a kid with asthma–losing their wonderful “market-based” coverage after having paid into the system for years, and they’re worried they could be next. And they know if you’re uninsured and really sick it can devastate you not just physically and emotionally, but financially too, and that’s not something people should have to risk, especially kids. They worry about waiting times because everything everyone talks about is waiting for elective hip replacements in Canada.
I think they want their health care to work like I want my electricity does–when I flick the switch, the light should go on. That is, if Medicare or a single-payer or whoever can keep the level of quality and choice the same but provide coverage to everybody, then we should all get it–they’ve been screwed over by HMOs and for-profit HMO billing fraud and drug company lobbying enough. They know the “efficiency” of the “market place” is crap in health care, because they’ve spend 30 minutes on the phone with a claims reviewer getting something covered that should’ve been covered in the first place. And they know that “pre-existing conditions” are an America-only concept created only to maximize profits and resist providing medical coverage for actual medical problems.
Do you think the government should provide a national health insurance program for all Americans, even if this would require higher taxes?
Yes 64%
No 35%
No opinion 2%Do you think the government should provide a national health insurance program for all children under the age of 18, even if this would require higher taxes?
Yes 73%
No 25%
No opinion 2%
Panda commits an error probably all too common for ER physicians: patients are how they are because they are who they are, and their situation and environment has but a small impact. Fundamental attribution error well at work.
Mr. P. Bear believes that doctors are helpless to help their patients and improve their health outside of the hospital or office–and even argues that advocacy work somehow “dilute[s] the only real authority they [doctors] have, the authority to make medical decisions on behalf of the small subset of the population who are their actual patients.” (I swear, Panda and I are opposite ends of a magnet.) To say that physicians are powerless to improve people’s lives is laughable, ridiculous, and more an effort to ignore our responsibility to do so than anything. Distributive justice is one of the four pillars of medical ethics, and I don’t know how Panda can so quickly write it off. I don’t care how hard we work, we are our patients’ advocates, and we should be demanding that they receive not only the best care possible but that they should have healthy environments outside of the realm of doctor’s office or hospital.
Panda Bear says “We have no special powers of persuasion denied to the general population… we are not magicians.” I beg to differ. The Cochrane Database reports that even “brief advice” from a physician increases the likelihood that a smoker will quit smoking, leading to a absolute reduction of smokers by 2.5%. If you consider all the cost and suffering continued smoking will cause, that’s not bad for “brief advice.” We are seen as knowers of the body and authorities of health. When doctors talk, patients do listen. It’s like when my dental hygenist puts the fear of god into me for not flossing enough and threatening me with a deep cleaning: she knows about oral health. I listen and try to change my behavior. (Flossing daily now, thank you very much.)
Doctors’ beliefs and advocacy does not fall on deaf ears. When doctors speak, people are happy and eager to listen. Often it is the opposite–they know that doctors’ time is valuable and rare, so any issue that physicians choose to spend their time on is even that more important. One of the great memories that has driven me through med school is a meeting with pediatricians, Chicago aldermen, and researchers at Children’s Memorial Hospital in Chicago. The pediatricians were upset that lead levels in many communities were on the rise, and wanted to bring the issue to the attention of the aldermen. They knew that no, they couldn’t go into their patients’ houses and make sure that they were eating healthy, balanced meals, but they also realized that their patients were being affected by an environmental hazard that lowered their IQs and made them chronically ill. So they decided to do something about it.
Who are people going to listen to on health matters? A physician, or an individual parent or patient? If you say anything but the former, you’re kidding yourself. We have so much power and influence when compared to most of our patients that to not speak for them is an injustice and an abdication of our responsibility as physicians.
Can we fix everything about our patients’ lives? Of course not. But are there areas where we as physicians can truly make a difference? Absolutely. Just because we can’t do everything doesn’t mean we shouldn’t do something.
Homage to the guilty pleasure Overheard in New York: