Safer Health Care

Your doctor has two or more letters behind his/her name. Did you ever stop to think what those mean?

Let’s start with the common ones relating to medical school:
M.D.- this is the usual American Doctor of Medicine (from the latin Medicinae Doctor). Each of these physicians has graduated from an accredited (or equivalent) medical school. Virtually every jurisdiction in the US requires that licensee complete a bachelors degree (or substantial undergraduate education). This is the degree conferred by essentially every American medical school. In contrast, the M.D. is actually a higher degree in some foreign contries indicating substantial post-medical school education.

D.O.- Doctor of Osteopathic Medicine. Osteopathic medical schools are largely indistinguishable from allopathic (MD) medical schools with one exception. Osteopathic medical schools continue to teach manipulation similar to that used by chiropractors. Most “osteopaths” do not use manipulation routinely after graduation. Many osteopaths have post-graduate training in allopathic residencies. No states in the US distinguish between MD and DO degrees. Both are referred to as doctor.

Now the titles get more colorful:
M.B. B.S.- Bachelor of Medicine and Bachelor of Surgery. This is the combination of two degrees conferred primarily by English and (formerly)commonwealth countries. It is an undergraduate degree in that students generally go straight from high school to a professional school. The school encompasses five or more years of study. Graduates are generally recognized as “doctor.”

There are many forms of MBBS. The most interesting comes from McGill University in Canada. M.D. C.M.- Medicinae Doctorem et Chirurgiae Magistrum (Doctor of Medicine, Master of Surgery). A fancy name meaning “doctor.” Other Variations also include: MB ChB, BM BCh, BMed, MB BChir, BM BS. Again, all are referred to as doctor.

My favorite medical degree however comes from Ireland. M.B. B.S. B.A.O. The BAO stands for
Baccalaureus in Arte Obstetricia (Bachelor of the Obstetric Art or Bachelor in the Art of Obstetrics). Now thats a cool name.

Many states allow doctors to use “MD” regardless of what their actual degree says. Osteopaths will always distinguish themselves and generally will refuse to use MD.

Be informed. It’s your health.

The re-use of single-use medical devices has again attracted the attention of the popular media, this time the Wall Street Journal.

The article quotes a study of devices manufactured by Medtronic. The study found that new devices were of excellent quality but “a majority of reprocessed devices had corroded parts and traces of human hair and protein, bringing into question the effectiveness of the reprocessing efforts.”

This stands in stark contrast to the comments from Kenneth Kizer, MD, MPH who stated “single-use labeling is a real scam for a lot of devices, and by not using reprocessed devices where possible it is wasteful and not environmentally responsive, since these items have to be disposed of as biomedical waste.” Dr. Kizer continues: “The reuse of medical devices that are labeled for single-use only is a well-established and safe practice regulated by the FDA and utilized by most of the top-ranked hospitals in the country.”

This is only partly true. The FDA strictly regulates the original device. The FDA has some oversight for reprocessing but it was only 2002 that the FDA required these devices to be marked as reprocessed. Safety has yet to be definitively determined. Top hospitals re-use to save money, not to improve care. After all what patient would say his/her care is improved by implanting “corroded parts and traces of human hair and protein” into him/her? Some hospitals may be concerned about waste material but only because they pay to haul it away.

For now the safest thing for patients is to insist on disclosure of the use of reprocessed devices. If reprocessed devices are to be used ask about cost differences to you the patient. Do not hesitate to insist on new devices- especially if there’s no cost difference and now demonstrable equality of quality.

It’s your health. Take it seriously and take care.

In many ways I yearn for the old days when my doctor checked my pulse and blood pressure himself. The smell of Old Spice and cigarettes combined with the comfort of his huge furry hands holding my wrist and looking at his watch gave an immediate sense of comfort.

In many cases automated equipment does as well or better than the old fashions manual methods. A Canadian group has recently validated another automated blood pressure monitor. Physicians must use caution when interpreting these results. All of these patients were ambulatory. The monitor has no track record for surgical or very ill patients.

It’s OK for patients to ask about the use of technology in thier health care. It’s your health take part and take charge.

What traits would you like to see in your doctor? This deceptively easy question haunts medical educators every day. Medical school admissions ideally must screen for but academic ability and ethical behavior. A recent editorial from England suggests that cognitive ability is a better predictor.

As we have noted previously, medical schools in the United States have very small attrition rates, particularly compared to law schools. Having done both I am hard pressed to see any reason to account for this discrepancy except the obvious conclusion- medical schools do not effectively “eliminate” inappropriately chosen students. Instead they are promoted and graduated.

I applaud the English proposal. Anything to improve the quality of medical school entrants should improve the quality of the product.

Ask your doctor where he/she went to school. Ask how long it took him/her to graduate. It’s your health- take care of it.

It is hard to question your doctor or other health care provider. This becomes harder if your physician is sufficiently impatient, arrogant, and narrow-minded to believe that he or she should be making your decisions for you in some archaic paternalistic fashion. Despite Dr. Haig’s rant patients generally have a small number of diseases. Physicians, in contrast, must care for a much larger number of diseases in more patients. Therefore many patients will, in fact, know much more that the physician about their own disease.

Yet you must ask questions. If your questions are not answered in a timely, accurate, and satisfactory manner then you need a new doctor. A recent survery indicates that some of the most important questions are also the hardest to ask. If these questions make your doctor uncomfortable then it’s his/her problem. It really is OK to “bother” the doctor- after all that’s what he/she gets paid for.

It’s your health. Take charge.

Here at Safer Health Care we link to a large number of articles. The only rules are that the material must be accurate and useful to patients and potential patients in makiung health care decisions. The writers over at RNCentral have recently posted very usable information. Thier tips for protecting your self are HERE.

As we’ve noted before modern medicine is a very dangerous place. Modern physicians are frequently more concerned about bank statements and boat payments than patient care. You and your family may be the only things preventing your physician from becoming you executioner.

It’s your health- Take it seriously and take charge.

Peeking into someone’s medical records just out of curiosity is wrong. It’s actually against the law. Unfortunately the federal law does not provide a private cause of action under such circumstances. You’d have to find another reason to sue. Fortunately most states recognize privacy torts for just these kinds of circumstances.

But it’s still wrong. It does not matter if you’re a physician or lay person. IT’S WRONG. It doesn’t matter that UCLA medical centers choose not to protect the rights of patients and conform to federal law by only slapping the wrists of snooping physicians.

Even Governor Schwarzenegger believes that his medical records have been violated. Physicians could be disciplined by the California Medical Board even if the physician or hospital is not sanctioned by the federal government. The irony in this situation is that the medical board is an executive agency that answers to the governor.

Californians, indeed all citizens, deserve better. They have the right to expect that state medical boards and federal agencies will protect their rights when physicians fail to properly discipline themselves.

I urge Governor Schwarzenegger to press the state medical board for swift and aggressive penalties for the scofflaw physicians involved. I urge the federal government to impose similarly harsh penalties on UCLA hospitals. You should take an active role and join me in this call to action.

It’s your health. Take it seriously.

Our previous post regarding awareness under anesthesia received enormous numbers of comments. Some were vacuous and vitriolic and so lacking in educational value that they were simply deleted.

We also heard simple heartfelt stories from those who had suffered. To each of you we offer our sincerest apology. As you will see from my final comment to the previous post no one should be awake unnecessarily. I say “unnecessarily” since there are time when the patient’s survival requires that low doses of anesthesia be used to avoid death or severe physical injury.

As a follow-up we sincerely hope that there may be a way to eliminate the possibility of awareness associated with accidental unesthetic underdoses. Currently however there continues to be growing evidence that the consciousness monitors are ineffective- in fact they may increase the risk of awareness under anesthesia. An abstract of the most recent study can be found HERE. As I have asserted previously the current monitors fail the first criterion for cost-effectiveness- they are not effective. (See comments associated with THIS post.)

We appreciate the willingness of individuals to bear the cost of monitoring but who would pay extra for additional risk? Would everyone like value for the cost? Doesn’t each patient deserve better care for more cost? As I have noted previously I would not let someone use the current monitors on me.

Until there is reliable monitoring you must rely on your anesthesiologist. Check him out- thoroughly. Don’t hesitate to fire him/her. He/she has your life and future in his/her hands.

It’s your health, take charge and take it seriously.

Many readers know I’m merciless, brutal even, regarding issues of competence and the relationship between diligent care and outcomes. Mistakes can happen. Good physicians remember the names of every patient who suffered an adverse event while in their care. It’s a sign of conscience.

One such example is Dr. Gary Brandeland. His patient’s death wasn’t his fault. Yet it sent him into a tailspin from which many of us might not have recovered. You can read his story HERE. It’s a moving testament to the kind of caring to which every physician should aspire. Dr. Brandeland is an inspiration.

It’s OK to ask you physician about patient deaths. It’s OK to ask if they cry or the effect it had on him/her. It’s your health. Your physician should care as much as you do.

There’s a lot of danger in sex. That danger isn’t decreased just because we don’t talk about it. It also isn’t decreased by not teaching about it. A recent study indicates that about 25% of teenage girls have common sexually transmitted diseases. On top of that is the possibility that the 25% is just the “tip of the iceberg” since we don’t test for all of the diseases.

Teens are pretty creative though. They understand the idea of virginity and (possibly due to Bill Clinton) don’t think oral sex is real sex. However oral cancers have been linked to the same virus that causes cervical cancer.

They’re your kids. You are the only one who has any chance of assuring they have the right information to make reasonable decisions and enter adulthood prepared and uninfected. Make sure they have the information they need. Ignoring their sexuality won’t make it go away.

It’s their health help them preserve it.