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Archive for February, 2008

Friday, February 29th 2008

Transplant Surgeon Charged In Hastening A Patient's Death

A transplant surgeon is charged with hastening a patient’s death, after coming to a hospital he did not have priviliges at to retrieve organs from a patient, and making some overzealous medication orders at the end of life. This entire case could defintely have some negative consequences.

[A] transplant team including Dr. Roozrokh arrived at the hospital. .

According to a police interview with Jennifer Endsley, a nurse, Dr. Roozrokh stayed in the room during the removal of the respirator and gave orders for medication, something that would violate donation protocol. Ms. Endsley, who stayed to watch because she had never seen the procedure, also told the police that Dr. Roozrokh also asked an emergency room nurse to find and administer more “candy” — meaning drugs — after Mr. Navarro did not die after the removal of his respirator.

Dr. Roozrokh shouldn’t have even been in the room with the patient and he certainly shouldn’t have been making orders for the patient’s care at a hospital with which he was unaffiliated. In his Kaiser Permanente online biography, Dr. Roozrokh says,

I THRIVE by endeavoring to practice good karma.

That will certainly be tested here.

I will say there is at least something fishy about the civil complaints (if not the criminal charges) he is facing. Obviously it is difficult to put yourself in the place of a parent who has lost a child, but the civil suit by the mother seems borderline…at best. Indeed, it doesn’t even appear she was around when they took her son off life support. And her excuse for such, if accurately reported by the media (always a possibility that it wasn’t), borders on ludicrous.

Ms. Navarro, a disabled machinist from Oxnard, Calif., said she did not have enough money to stay another night near her son.

Now, despite the fact that the coroner has already ruled the patient’s death was of natural causes, the mother has filed suit against everyone involved (and already settled with the hospital). We don’t know the whole story or the whole of the mother’s position and obviously I cannot ever truly empathize, truly understand her pain but you can’t help but question some elements of her lawsuit.

In the end, despite Dr. Roozrokh’s actions the organs ended up being unusable. Just an unfortunate story all the way around. Hopefully this will not scare desperately needed organ donors away.

Friday, February 29th 2008

Talk About Backtracking

Remember all the hoopla about doctor’s in direct to consumer pharmaceutical ads that has arisen lately? Well, Pfizer is getting the hell out of the way of the controversy by killing the Dr. Jarvik-Lipitor ads

Pfizer has spent more than $258 million advertising Lipitor since January 2006, most of it on the Jarvik campaign, as the company sought to protect Lipitor, the world’s best-selling drug, from competition by cheaper generics.

But the campaign had come under scrutiny from a Congressional committee that is examining consumer drug advertising and has asked whether the ads misrepresented Dr. Jarvik and his credentials. Although he has a medical degree, Dr. Jarvik is not a cardiologist and is not licensed to practice medicine.

The [House Committee on Energy and Commerce] investigation has rekindled a debate over the so-called direct-to-consumer advertising of pharmaceuticals, a $4.8 billion business. Mr. Dingell and Bart Stupak, another Michigan Democrat who heads an investigations subcommittee, applauded Pfizer’s decision to pull the Lipitor ads.

“I commend Pfizer for doing the right thing and pulling the Lipitor ads featuring Dr. Jarvik,” Mr. Stupak said in a statement. “When consumers see and hear a doctor endorsing medication, they expect the doctor is a credible individual with requisite knowledge of the drug.”

While endorsing Pfizer’s decision, the committee showed no sign of shutting down its investigation. Mr. Stupak said the committee planned to meet with Dr. Jarvik and collect all of the documents it had requested.

Yeah, Congressional investigations and bad press will do that to ad campaigns.

Sunday, February 24th 2008

Awkward Moments With Patients

Having just performed a DRE on a patient in the ER, the patient reached for my now ungloved hand. I pulled away.

Patient: “I just want to hold you hand. You’re cute.”

A very brief awkward pause followed, which the patient decided to break by saying something even more biazzare.

Patient: “Actually what I want to do is sexually assault you.”

Can we say borderline or something? Perhaps blessedly I haven’t had my psych rotation yet.

Sunday, February 24th 2008

Walk Off The Job And You're Prosecuted

I have definite mixed feelings about this. 10 nurses conspired hurt their employer by walking off the job without notice. Now they’re facing criminal charges for endangering the lives of their patients with their sudden resignations.

Prosecutors say the nurses’ resignations — without notice — on April 7, 2006, jeopardized the lives of children at Avalon Gardens in Smithtown, where some of the patients are on ventilators and required constant monitoring.

None of the patients suffered ill effects, but an indictment alleges the nurses knew their sudden resignations would make it difficult to find replacements. Their trial is scheduled to begin Jan. 28.

Defense attorneys say they are perplexed why the case is proceeding to trial because two separate state-agency investigations cleared the 10 nurses. [Prosecutor] Spota said the legal standards for a prosecution differ from those of the state agencies.

While, not knowing the specifics of the incident, in general I would say something like this should be far from a criminal matter…in a just society.

Thursday, February 21st 2008

Spine Patients Pay A Lot And Get A Little

I’m shocked, shocked I say! I’ve made this point before but treatments for back pain simply are a crap shoot. Too many patients simply never get better.

Back Pain, Quick Call A Surgeon!

Surgeons who specialize as orthopedic spine surgeons average more per hour than any other physician. But even as spending to treat back pain increases a new study says Americans get little in return.

[S]pending on spine treatments in the United States totaled nearly $86 billion in 2005, a rise of 65 percent from 1997, after adjusting for inflation. Even so, the proportion of people with impaired function because of spine problems increased during the period, even after controlling for an aging population.

The report is the latest to suggest that the nation is losing its battle against back pain, and that many popular treatments may be ineffective or overused.

“I think the truth is we have perhaps oversold what we have to offer,” said Dr. Richard A. Deyo, a physician at the Oregon Health and Science University in Portland and a co-author of the report. “All the imaging we do, all the drug treatments, all the injections, all the operations have some benefit for some patients. But I think in each of those situations we’ve begun using those tests or treatments more widely than science would really support.”

I worked in a huge ortho spine practice all through high school and I can vouch for the above quote. I say this even though I’m on neurosurgery right now — what spine surgeons are offering is half fluff. I would personally be real sure what I was doing before getting decompressed fused…no matter how terrible my back pain was.

The study is published in JAMA.

Monday, February 18th 2008

NY Times Magazine Article: Miracle Workers?

This is a pretty spot on examination of patient expectations of physicians and why the paternalistic physician-patient relationship will always linger in the background, no matter how much we promote patient autonomy. Go read the entire thing.

When my mother found out she had myelodysplastic syndrome, the terrible blood cancer that eventually took her life, she oscillated between numb despair and acute panic. When she was panicked, nothing those who loved her did or said could calm her down, let alone console her. And yet we soon learned that if we could reach Stephen Nimer, her principal physician at the Memorial Sloan-Kettering Cancer Center, by telephone, or if, better still, Dr. Nimer could make time to see my mother, however briefly, her awful distress would abate — at least for a while.

[W]hen all was said and done, I think that my mother’s relationship with her principal doctors can only be fully understood — and was only fully effective — because it was in some ways as shamanistic as the relations our ancestors knew before the advent of modern scientific medicine.

Monday, February 18th 2008

General Surgery Be Done

It was fun, especially on trauma call. But beyond trauma call it was a pretty repetitive service. My home surgical residency program, admittedly merely through faculty report, has the single highest average number of lap choles performed per graduate. I’m not sure that’s really a selling point (although the laparoscopic cholecystectomy is one of the most popular operations in this country), but I do believe it.

On the slowest general surgery service (one to two ORs depending on the day, one fifth year, one second year, two interns) in the hospital (average probably 8-12 cases a week) and with three other students to split up the cases I probably was scrubbed into 12-15 lap choles in six weeks or about two a week. I think a disproportionate number fell to me. While lap choles probably did literally make up the majority of our service, it wasn’t like they represented 90% of the operative load. Even so that seems like there were a lot of choles.

Indeed, I’m pretty sure with my attending on the other side of the table I could perform a lap chole right now with the complication risk about the same as when my junior resident on the service did it.

I will mention one health policy issue which I’ve come to appreciate and it concerns the way we handle trauma. I’m really naive about the issue, but I think as long as we’re throwing around proposals for further government funding of health care that we might also consider the way we fund trauma in this country. It goes beyond EMTALA. We need to seriously consider some kind’ve national trauma insurance pool (I’m sure there are proposals out there) and even consider further mandates to hospitals for Medicare participation (I’m being serious, despite the complications of doing such).

Read More »

Saturday, February 16th 2008

Americans Don't Know The First Amendment

Okay, this post is yet more political commentary and deals with medicine in no way.

We have yet another reminder that Americans are woefully underinformed…and worse, likely uninterested about history and political machinations. Looking at it through this lens you wonder why it’s even an honor to be elected President. Yes, these people voted for you.

The study by the new McCormick Tribune Freedom Museum found that 22 percent of Americans could name all five Simpson family members, compared with just one in 1,000 people who could name all five First Amendment freedoms.

.1%? Are you kidding me? I’m sure the percentage is something better amongst those who actually cast a ballot, but still this is appalling. Two points:

  • It absolutely, positively is important and relevant to actually be interested and informed of something like the Bill of Rights when going to cast your ballot
  • Our lack of attention to American history and political current affairs is a currently worsening problem…this isn’t something that has always been the case

There is absolutely no cerebral involvement in how we decide to vote nowadays. We fill out the ballot based simply on who we feel will do the best by us or by who tugs at our hope or (more commonly) fear.

This is why we elect people like George Bush.

In honesty I’d probably need a moment to remember the right to petition the government for grievances, but given a moment to think I could certainly rattle the first amendment off. Congress shall not abridge the rights to/of: speech, assembly, press, religion, petition government.

Saturday, February 16th 2008

Scrubs and Fleece

Is this not essentially the world’s best outfit? It’s certainly popular this time of the year in the hospital.

From October until the end of February/beginning of March, I could pretty much go into the hospital everyday wearing scrubs, my North Face fleece and never pull out my short white coat once and you would not hear me complain.

Saturday, February 16th 2008

I Need It, So I Should Get It

Edwin Leap looks at how much physicians should be paid (h/t Kevin MD) in light of some grumpiness over physician earnings. Here’s the comment I’m interested in and which I couldn’t agree more with,

On to medicine. Doctors just make too much money, right? I don’t know. Maybe, because medicine is something people need, rather than want, we think physicians get paid too much. Maybe we do, maybe we don’t. But I think there’s an inherent danger in the very question.

The idea of America has always been, not equal success, but equal opportunity to try and succeed.


I hope that we remember that. I hope that we don’t decide that someone, read ‘government’ is going to start deciding who makes how much.

The growing public opinion of entitlement to health care is certainly helping to create some ire concerning the piece of growing spending on medical care that physicians take for themselves. That ire is misplaced.

Despite contributing to the rising health care costs, health care providers are far from overpaid.

Let’s take a hypothetical situation involving essentially the highest earning physicians (if not by hourly earnings).

Hey, I Probably Make At Least $300,000 A Year As A Neurosurgeon

If We:

  • Removed all negotiated schedules with the cabal of payers
  • Removed all restrictions on who can practice neurosurgery
  • Removed all debt protections (i.e. the surgeon can balance bill; the surgeon take the house, the car, the first born to collect his fee)
  • Essentially made it into a situation where neurosurgeons could charge whatever the market would bear (and were able to take any assets to collect their fee)

Do you think there’s any chance neurosurgeons would earn less than the average salaries spelled out here? What is having that spinal fusion or having that tumor out worth? Everything. Even when anyone can do it, how many surgeons would actually arise? Few.

Health care is something you need. And even if we remove the admitted restrictions the fraternity of medicine have in place for admittance, health care will continue to be of relatively limited supply based on the great stakes and the true limit of those actually skilled/qualified in the art of medicine.

Who Do You Want Treating Your Heart Disease?

Why in the world would the public expectation be that because it is something you need it costs less? “Well I need it, therefor I’m entitled to it,” just doesn’t fly. And yet that is what I truly believe is arising as the culture in this country.

Okay, that’s enough of a rant I suppose. Not that I’ve posted anything new here as I’ve made similiar arguments before on this blog.