WHAT YOU KNOW WILL KILL YOU
By Dr. David Eifrig Jr.
excerpt:
In 2000, there was a JAMA article (this is the American Medical Association's main journal), which estimated that 225,000 deaths occur every year in hospitals from unnecessary causes. Read that again... almost a quarter of a million people dying at the hands of error. This is more than the number of people dying from lung cancer every year... more than the number of people dying from stroke every year.
When it comes to health care... What do I do?
1. I encourage everyone to question his or her medical care. If you feel like it's not right... I guarantee it's NOT! Speak up.
2. I look up questions online and in the published literature searches, such as Pub Med. Many of the abstracts make sense and can easily be applied to your case.
3. I demand that everyone on the health care team use common sense and stick to the facts. If they don't know, they should say so and find out.
The whole article (very long):
WHAT YOU KNOW WILL KILL YOU
By Dr. David Eifrig Jr.
It ain't what you don't know that gets you into trouble.
It's what you know for sure that just ain't so
‚Mark Twain
As we know, there are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns ‚ the ones we don't know we don't know.
‚Donald Rumsfeld
They say things come in threes, and this holiday season was no exception.
The first: A week before Christmas, my sister in Minneapolis was taking her annual two-week reprieve from her daycare. For more than 25 years, she has somehow taken care of other people's children... and is now starting to care for a second generation of kids. I truly don't know how or why she does it. Don't get me wrong; I love kids, just not 10 at a time. But I'm always amazed to watch her work: Her home is crowded with all these kids so well-behaved and so attentive to their world... I almost wish she had raised me.
But this Christmas break was tough.
She was especially nervous about this break because she was having knee surgery. If anything went wrong, her kids would suffer. They would be without their daily culture and without their pseudo-mom. I assured her that the surgery is simple, and she'd be dodging linebackers in a few weeks.
Thirty-six hours after surgery, I got a panicked call from my mother. Cathy was in the ER and was having trouble breathing. It turned out that she had a blood clot or two lodged in her lungs. Worse, I suspected it would happen‚¦
The second: Around this same time, another dear friend who lives in New York City called to tell me she was having emergency surgery for possible ovarian cancer. I was floored. I had recently eaten lunch with her and she never mentioned disease, pain, or anything medical. And trust me, since the day I started medical school, most of my friends ask me about any and all medical ailments.
Her story didn't make any sense. Her family history includes no breast, ovarian, or cervical cancer. She didn't have many symptoms of anything, other than an occasional bout of tiredness and a rare, vague abdominal pain. I quizzed her incessantly about all this and finally discovered that her doctor had ordered a test used to monitor cancer after it has been treated, a so-called CA-125 test. This made no sense to use the test before a diagnosis, but she assured me her doctor was trustworthy and knew what he was doing.
I even told her the old saying... "If you go to a barber, you're gonna get a haircut"... You may already know that surgeons were barbers and vice versa ‚ hence the red and white poles from the bloodied bandages hung out to dry. I think the historical innuendo was lost on her, but at least I tried to discourage her surgery.
Needless to say the planned small-incision laparoscopy turned into a full-blown abdominal surgery, but with no cancer found. Sadly, her mobility is extremely limited as she heals, and she may not be able to work for several months. What makes this story bad is that I suspected it would happen...
The third: Last week, a good friend's ex-husband suffered a heart attack. I have been in his room during much of the crisis. I have not identified myself as a doctor to the hospital staff and have tried to stay out of the way. But I am able to listen and ask pointed questions.
Last night, he was leaving for a minor procedure and knew the room where they were heading was cold. When he asked for extra blankets, a nurse told him that he couldn't have one because he had a "low-grade temperature."
"You know, they used to think that letting the fevers go would kill the bugs," the nurse said‚¦
("Uh, yes it still does, you idiot," I thought.)
"... but now we know that he could overheat and die."
I said, "Oh, we wouldn't want a simple blanket or two to do that now would we?"
"No, sir," she responded.
Later that night, I asked if he was getting any food? Multivitamins? Vitamin C? Enzyme CoQ10? The nurse informed me that they have to be careful what food he eats. And so he remains hungry and has been for three days. Living on an occasional salt-less broth. She claimed that all of this is done to protect his heart and help him recover. What was most frustrating is that his ex-wife told me to just stop "talking about things that could be done" and just let them trust their doctor.
All three cases remind me how dangerous and deadly health care can be.
The night of my sister's surgery, doctors strapped her leg in some contraption that moved the leg mechanically and "exercised it so it would heal faster." When I first heard this, it just didn't make sense. I even told my sister to not follow the instructions. You see, after cutting and bleeding the body needs rest, ice, compression, and elevation. In fact, there is even a mnemonic for this: R-I-C-E. Clots and tissue trying to heal hours after the trauma of surgery do not need movement and "exercise" of any sort. Think about how a clot on your skin forms, turns to a scab, and then falls off days later. Imagine if you started picking at it and moving it around hours after your injury. It would take a long time to heal and would probably not heal correctly.
My sister was ripe for a blood clot and luckily she didn't die from it ‚ as happens with many blood clots going to the lungs from the legs. Frighteningly, when I asked her to ask her doctors to explain the original plan and the connection with improper forming of clots and healing tissues, they responded with "hmmm, that makes sense... we'll have to look into that and ask some other colleagues." Damn, she could have died.
My friend with the "suspected cancer" implicitly trusted and believed whatever her doctor said. Yet a quick literature search and half a brain in logic would have put her odds of cancer in the 1 in 1,000s. And the absurdity of using a test meant for following cancer AFTER cancer is treated is beyond my comprehension. For some reason, our minds tend to ascribe significance to numerical values regardless of logic. For example, a test might give readings of 25 and 30, and people assume that 30 is more significant than 25. But in fact, the test's sensitivity might be five points, so no true difference exists between the numbers.
In my friend's case, the test is meant to look for large increases or decreases of the protein CA-125 after a cancer is removed. It cannot screen for cancers because healthy individuals don't share a specific, "normal" level of CA-125.
Beyond the irrational choice to operate based on lab values, my friend had a history of abdominal surgery that the surgeon used as an excuse to explain the larger incision than originally planned. He apparently said "that old surgery made this surgery much more difficult." When I heard this I became very upset. Was he unaware of the prior surgery? Did he not ultrasound her belly prior? I wondered why the surgeon didn't just make a small incision, look around for the alleged cancer, remove ONE of the worst-looking ovaries, test it for cancer, and then plan accordingly. My friend would be out running in Central Park and still have most of her body parts remaining. The risks the surgeon took with her abdomen in the name of "cleaning things up" are beyond my comprehension.
And she too could have died.
Finally, the guy with the myocardial infarction (or "heart attack") is in desperate need of antioxidants. (And he probably needs a warm blanket or two to keep him comfortable so he can rest.) Research has shown that things like vitamin C and CoQ10 help patients heal faster and improve the functions of the heart. In Europe and Russia, doctors often give these to anyone with heart failure. Also studies show CoQ10 helps prevent damage after heart attacks. In addition, with all the stress, he is likely low on many of the vitamins found in a multivitamin, especially the Bs, Zinc, and E. The side effects are minimal, and the upside potential huge. I guess what bothers me the most is that the nurses and the doctors aren't thinking about these issues. Perhaps worse, they're making things up ‚ like the warm blanket and broth responses. I also heard that one of the nurses told a family member that he has sepsis (which is deadly) because he has a temperature (which is common after trauma to the heart). And so the doctor has to run blood tests, which means more painful sticks of a needle to confirm or refute the sepsis notion. Guess what? Each time he is stuck, his risk of infection increases. I hope he doesn't die from the thoughtless care.
As I wrote in a piece almost three years ago:
In 2000, there was a JAMA article (this is the American Medical Association's main journal), which estimated that 225,000 deaths occur every year in hospitals from unnecessary causes. Read that again... almost a quarter of a million people dying at the hands of error. This is more than the number of people dying from lung cancer every year... more than the number of people dying from stroke every year.
When it comes to health care... What do I do?
1. I encourage everyone to question his or her medical care. If you feel like it's not right... I guarantee it's NOT! Speak up.
2. I look up questions online and in the published literature searches, such as Pub Med. Many of the abstracts make sense and can easily be applied to your case.
3. I demand that everyone on the health care team use common sense and stick to the facts. If they don't know, they should say so and find out.
Here's to our health,
David Eifrig Jr., M.D., M.B.A