Medical Errors Leading to Death

Off Topic Politics & World Issues
41

[quote]Gambit_Lost wrote:
DrSkeptix wrote:
Bill Roberts wrote:
DrSkeptix wrote:

The origin for these inflated “estimates” of unnecessary deaths is a notoriously inacccurate NEJM article of the early 1990’s, in which epidemiologic estimate for a population risk was applied to the population as a whole. In short, these deaths did not happen. (Compare all this to a similar poor estimate on Iraqi deaths in the Lancet.)

Further, the estimates include “errors”–whether grave or not–in patients who die of their disease or irremediable problems. (Dana Carvey had a grave error, but did not die. Many patients have minor mistakes which do not contribute to a lethal diagnosis.)

I do not condone errors, but perfection does not exist anywhere. The IOM seems to have compounded its own error through exaggeration.

Good point. I have heard and read similar numbers before – perhaps ultimately coming from the same source, I don’t know – and the claims always seemed bizarre to me.

Not that I know it can’t be right, but it doesn’t seem plausibly right.

If you are interested, here is a critique of methodologic errors in the IOM report, and in the influential Harvard claptrap 0f 1991 (see ref. 6)

Of course, this is off topic, and does not detract in the least from snipeout’s point.
Perhaps I, too, would prefer my chances with the police rather than with doctors. I have often said that with a shortage of prisons, we should sentence criminals to medical care…but that would probably constitute cruel and unusual punishment.

I’m interested in learning more about this. I ran a quick google scholar search and it seems most of the articles I found referenced the 1999 IOM report you’re speaking of. However, most of them agreed with the numbers and some even suggested they may be low. Your article makes a good critique of the stats, however.

Do you happen to know of any other, similar studies that you can quickly reference here?

Cheers
[/quote]

OK. Here is a link to the IOM whitepaper, but let’s start with Methodology:

You will notice that it is a grandiose accumulation of nonsense, a survey vetted by 19 “experts.” In other words, this isn’t good social science; it even isn’t–you should excuse the expression–good epidemiology.
Those citing this article, I propose, do so for political reasons.

I cannot download the 1991 Harvard paper (HPM). It has been roundly criticized, but thoughtful criticism may not show up in Google searches (not popular enough).

If I were to devise a model for estimating unnecessary deaths due to medical errors I would look to one high-risk specialty: anesthesia. The estimate of deaths due to anesthesia in Classes 1-4 (patients not expected to die) is in the neighborhood of 1/10,000. This includes deaths not due to errors.

The HPM paper estimated a 3.7% risk of errors leading to a disabling condition–not death. In many studies, the chance that any error leads to or contributes to death is estimated at 7%. So…are we to believe that, with this range of deaths, the HPM study would have reported (as a lower boundary) 3 to 5 deaths in their sample of 30,000? But none were reported (in the abstract).

Not only are the estimates of 90,000 unnecessary deaths implausible–the cemeteries would be overflowing, and the courts would be packed with suits–but the HPM researches could not even agree on the pre-study definitions of “error.” (To my memory, there was no concordance study to verify internal agreement.)

As in computers, so in social or medical policy: garbage in, garbage out.

42

[quote]DrSkeptix wrote:
Gambit_Lost wrote:
DrSkeptix wrote:
Bill Roberts wrote:
DrSkeptix wrote:

The origin for these inflated “estimates” of unnecessary deaths is a notoriously inacccurate NEJM article of the early 1990’s, in which epidemiologic estimate for a population risk was applied to the population as a whole. In short, these deaths did not happen. (Compare all this to a similar poor estimate on Iraqi deaths in the Lancet.)

Further, the estimates include “errors”–whether grave or not–in patients who die of their disease or irremediable problems. (Dana Carvey had a grave error, but did not die. Many patients have minor mistakes which do not contribute to a lethal diagnosis.)

I do not condone errors, but perfection does not exist anywhere. The IOM seems to have compounded its own error through exaggeration.

Good point. I have heard and read similar numbers before – perhaps ultimately coming from the same source, I don’t know – and the claims always seemed bizarre to me.

Not that I know it can’t be right, but it doesn’t seem plausibly right.

If you are interested, here is a critique of methodologic errors in the IOM report, and in the influential Harvard claptrap 0f 1991 (see ref. 6)

Of course, this is off topic, and does not detract in the least from snipeout’s point.
Perhaps I, too, would prefer my chances with the police rather than with doctors. I have often said that with a shortage of prisons, we should sentence criminals to medical care…but that would probably constitute cruel and unusual punishment.

I’m interested in learning more about this. I ran a quick google scholar search and it seems most of the articles I found referenced the 1999 IOM report you’re speaking of. However, most of them agreed with the numbers and some even suggested they may be low. Your article makes a good critique of the stats, however.

Do you happen to know of any other, similar studies that you can quickly reference here?

Cheers

OK. Here is a link to the IOM whitepaper, but let’s start with Methodology:

You will notice that it is a grandiose accumulation of nonsense, a survey vetted by 19 “experts.” In other words, this isn’t good social science; it even isn’t–you should excuse the expression–good epidemiology.
Those citing this article, I propose, do so for political reasons.

I cannot download the 1991 Harvard paper (HPM). It has been roundly criticized, but thoughtful criticism may not show up in Google searches (not popular enough).

If I were to devise a model for estimating unnecessary deaths due to medical errors I would look to one high-risk specialty: anesthesia. The estimate of deaths due to anesthesia in Classes 1-4 (patients not expected to die) is in the neighborhood of 1/10,000. This includes deaths not due to errors.

The HPM paper estimated a 3.7% risk of errors leading to a disabling condition–not death. In many studies, the chance that any error leads to or contributes to death is estimated at 7%. So…are we to believe that, with this range of deaths, the HPM study would have reported (as a lower boundary) 3 to 5 deaths in their sample of 30,000? But none were reported (in the abstract).

Not only are the estimates of 90,000 unnecessary deaths implausible–the cemeteries would be overflowing, and the courts would be packed with suits–but the HPM researches could not even agree on the pre-study definitions of “error.” (To my memory, there was no concordance study to verify internal agreement.)

As in computers, so in social or medical policy: garbage in, garbage out.[/quote]

Thanks for the info. I wish I had more time to get into it now, but I’m leaving the country on Sat and can’t really research now.

Some quick questions though: why is it that the criticisms aren’t popular enough? Given the popularity of this article, couldn’t a career be made of crushing it? Why hasn’t there been another study done that counters it?

I e-mailed an old friend who is an MD in PA, he seemed, overall, not to much care about the article but also not to really question its findings too much. He suggested PubMed as a better source to find articles. Would you concur? Is there a better place to search?

If this thread is still alive when I get back, or if I remember to bump it, I’ll try to look into this stuff, very interesting.
Thanks again for the information.

43

[quote]Gambit_Lost wrote:
DrSkeptix wrote:
Gambit_Lost wrote:
DrSkeptix wrote:
Bill Roberts wrote:
DrSkeptix wrote:

The origin for these inflated “estimates” of unnecessary deaths is a notoriously inacccurate NEJM article of the early 1990’s, in which epidemiologic estimate for a population risk was applied to the population as a whole. In short, these deaths did not happen. (Compare all this to a similar poor estimate on Iraqi deaths in the Lancet.)

Further, the estimates include “errors”–whether grave or not–in patients who die of their disease or irremediable problems. (Dana Carvey had a grave error, but did not die. Many patients have minor mistakes which do not contribute to a lethal diagnosis.)

I do not condone errors, but perfection does not exist anywhere. The IOM seems to have compounded its own error through exaggeration.

Good point. I have heard and read similar numbers before – perhaps ultimately coming from the same source, I don’t know – and the claims always seemed bizarre to me.

Not that I know it can’t be right, but it doesn’t seem plausibly right.

If you are interested, here is a critique of methodologic errors in the IOM report, and in the influential Harvard claptrap 0f 1991 (see ref. 6)

Of course, this is off topic, and does not detract in the least from snipeout’s point.
Perhaps I, too, would prefer my chances with the police rather than with doctors. I have often said that with a shortage of prisons, we should sentence criminals to medical care…but that would probably constitute cruel and unusual punishment.

I’m interested in learning more about this. I ran a quick google scholar search and it seems most of the articles I found referenced the 1999 IOM report you’re speaking of. However, most of them agreed with the numbers and some even suggested they may be low. Your article makes a good critique of the stats, however.

Do you happen to know of any other, similar studies that you can quickly reference here?

Cheers

OK. Here is a link to the IOM whitepaper, but let’s start with Methodology:

You will notice that it is a grandiose accumulation of nonsense, a survey vetted by 19 “experts.” In other words, this isn’t good social science; it even isn’t–you should excuse the expression–good epidemiology.
Those citing this article, I propose, do so for political reasons.

I cannot download the 1991 Harvard paper (HPM). It has been roundly criticized, but thoughtful criticism may not show up in Google searches (not popular enough).

If I were to devise a model for estimating unnecessary deaths due to medical errors I would look to one high-risk specialty: anesthesia. The estimate of deaths due to anesthesia in Classes 1-4 (patients not expected to die) is in the neighborhood of 1/10,000. This includes deaths not due to errors.

The HPM paper estimated a 3.7% risk of errors leading to a disabling condition–not death. In many studies, the chance that any error leads to or contributes to death is estimated at 7%. So…are we to believe that, with this range of deaths, the HPM study would have reported (as a lower boundary) 3 to 5 deaths in their sample of 30,000? But none were reported (in the abstract).

Not only are the estimates of 90,000 unnecessary deaths implausible–the cemeteries would be overflowing, and the courts would be packed with suits–but the HPM researches could not even agree on the pre-study definitions of “error.” (To my memory, there was no concordance study to verify internal agreement.)

As in computers, so in social or medical policy: garbage in, garbage out.

Thanks for the info. I wish I had more time to get into it now, but I’m leaving the country on Sat and can’t really research now.

Some quick questions though: why is it that the criticisms aren’t popular enough? Given the popularity of this article, couldn’t a career be made of crushing it? Why hasn’t there been another study done that counters it?

I e-mailed an old friend who is an MD in PA, he seemed, overall, not to much care about the article but also not to really question its findings too much. He suggested PubMed as a better source to find articles. Would you concur? Is there a better place to search?

If this thread is still alive when I get back, or if I remember to bump it, I’ll try to look into this stuff, very interesting.
Thanks again for the information.
[/quote]

I never use Google for medical or health information. Its search engine does not serve any useful purpose, other than a popularity poll.

Pubmed cites 2000 articles about medical errors, but of these perhaps 1000 are worthy of scanning. SO yes, there are literally hundreds of studies which contribute, modify or detract from the IOM or HPM articles. A problem I encounter frequently is the unquestioning acceptance of the results–often only take from the abstract–without understanding the inherent errors of the publication itself! Such is the case with the IOM whitepaper.

There is no career to be made in criticizing bad “social medicine” articles such as the IOM and HPM studies.
Writers cannot even agree on definitions and methodologies for this work.

But there does seeem to be a confluence of fidings: of all serious errors, something between 5% and 7% of such errors contribute to avoidable deaths.

44

[quote]DrSkeptix wrote:

I never use Google for medical or health information. Its search engine does not serve any useful purpose, other than a popularity poll. [/quote]

We’re both talking about “google scholar” right?

[quote]

Pubmed cites 2000 articles about medical errors, but of these perhaps 1000 are worthy of scanning. SO yes, there are literally hundreds of studies which contribute, modify or detract from the IOM or HPM articles. A problem I encounter frequently is the unquestioning acceptance of the results–often only take from the abstract–without understanding the inherent errors of the publication itself! Such is the case with the IOM whitepaper. [/quote]
Thanks again.

[quote]

There is no career to be made in criticizing bad “social medicine” articles such as the IOM and HPM studies.
Writers cannot even agree on definitions and methodologies for this work. [/quote] Really? I’m not too familiar with the field, but I assumed a rigorous medical scholarship similar to other fields. huh.

For example, Easterly really came out of the woodwork with his critique of David Dollar’s piece regarding Foreign Aid.

[quote]
But there does seeem to be a confluence of fidings: of all serious errors, something between 5% and 7% of such errors contribute to avoidable deaths.[/quote]

Thanks again.

45

[quote]Gambit_Lost wrote:
DrSkeptix wrote:

I never use Google for medical or health information. Its search engine does not serve any useful purpose, other than a popularity poll.

We’re both talking about “google scholar” right?

Pubmed cites 2000 articles about medical errors, but of these perhaps 1000 are worthy of scanning. SO yes, there are literally hundreds of studies which contribute, modify or detract from the IOM or HPM articles. A problem I encounter frequently is the unquestioning acceptance of the results–often only take from the abstract–without understanding the inherent errors of the publication itself! Such is the case with the IOM whitepaper.
Thanks again.
[/quote]
Yep. Google scholar included. But I did use it just this once, and found this criticism of the IOM report, from a Hahvahd MDJDMPH:
NEJM Volume 342:1123-1125 April 13, 2000

[quote]

There is no career to be made in criticizing bad “social medicine” articles such as the IOM and HPM studies.
Writers cannot even agree on definitions and methodologies for this work. Really? I’m not too familiar with the field, but I assumed a rigorous medical scholarship similar to other fields. huh.

For example, Easterly really came out of the woodwork with his critique of David Dollar’s piece regarding Foreign Aid.

But there does seeem to be a confluence of fidings: of all serious errors, something between 5% and 7% of such errors contribute to avoidable deaths.

Thanks again. [/quote]

The article cited above is worth reading, even if written by an esteemed Hahvahd colleague with crimson underwear. He struggles with the lack of agreement in the very definitions of error. But note:

“All these points might be considered hairsplitting over definitions if it were not for four important aspects of the IOM report. First, the report and the accounts of it in the media give the impression that doctors and hospitals are doing very little about the problem of injuries caused by medical care. Yet the data that the report cites give a different impression. In the three studies cited, the rate of injury due to medical care was 4.6 percent in California in 1976, 3.7 percent in New York in 1984, and 2.9 percent in Colorado and Utah in 1992.4,5,6 Moreover, if one extrapolates from our studies in New York and in Colorado and Utah in order to calculate the number of deaths nationwide due to substandard care, the total decreases from 92,000 deaths in 1984 (on the basis of the data in New York) to 25,000 in 1992 (on the basis of the data in Colorado and Utah). Although no statistician would be convinced by data extrapolated from three different settings, and although my colleagues and I have cautioned against drawing conclusions about the numbers of deaths in these studies,7 the evidence suggests that safety has improved, not deteriorated. More serious efforts to prevent injuries from medical care are needed, as the IOM report suggests, but we should not assume that hospitals and physicians have become more complacent.”

The editorial goes on to indicate the dangers of over-legislating and over-regulating, since these have a tendency to make honest discussion of error more protected and hidden.

The Leape papers (HPM) and the IOM report cannot be used for accuracy. The “92000 deaths” are fiction, repeated and cited often enough to achieve a patina of “fact.” The reports themselves are terrible scholarship, even if they serve to promote patient safety concerns.

46


To keep it light

47

Medical deaths? shit happens - get over it.

You are all going to die.

If lucky it will be peacefully in your sleep like grandpa, not screaming in terror like his passengers.

Medical deaths don’t get the attention you think they should because THERE IS NOTHING THAT CAN BE DONE. Mistakes are made, sometimes slight, people are sick, people die. the best you can do is find yourself the best doctors - that costs money. Not everyone can have the best doctors. Even throwing 10x the money at training and support you still won’t get a perfect system. It is a money game, a numbers game. And sometimes no amount of money will fix the problem.

Look after your health and don’t be an idiot. Especially the fu#@$king moron who drinks and drives. When you die in a crash I hope you are alone, and not surrounded by kids. Or the father working late to support his family. Or any other human who isn’t a shitbag loser.

48

I for one, as snipeout, am more afraid of a “medical state” than a “police state”.

49

[quote]DrSkeptix wrote:
Bill Roberts wrote:
Strange quote from the FDA article:

"In its report, To Err Is Human: Building a Safer Health System, the IOM estimates that 44,000 to 98,000 Americans die each year not from the medical conditions they checked in with, but from preventable medical errors.

"A medical error, under the report’s definition, could mean a health-care provider chose an inappropriate method of care, such as giving a patient a certain asthma drug without knowing that he or she was allergic to it.

Or it could mean the health provider chose the right course of care but carried it out incorrectly, such as intending to infuse a patient with diluted potassium chloride --a potassium supplement-- but inadvertently giving the patient a concentrated, lethal overdose…

"Despite the recent focus on the IOM statistics, experts assure that the health system in the United States is safe. But its safety record is a far cry from the enviable record of the similarly complex aviation industry, which is being held up as an example for the medical world.

A person would have to fly nonstop for 438 years before expecting to be involved in a deadly airplane crash, based on recent airline accident statistics. That, IOM says, places health-care at least a decade behind aviation in safeguarding consumers’ lives and health."

Um, in 1999 the airlines were killing 44,000-plus Americans per year?

In fact, back in the days of the DC-3 the aviation industry had a far better safety record than this.

10 years behind?

It is a strange quote because the data upon which it is based does not exist.

The origin for these inflated “estimates” of unnecessary deaths is a notoriously inacccurate NEJM article of the early 1990’s, in which epidemiologic estimate for a population risk was applied to the population as a whole. In short, these deaths did not happen. (Compare all this to a similar poor estimate on Iraqi deaths in the Lancet.)

Further, the estimates include “errors”–whether grave or not–in patients who die of their disease or irremediable problems. (Dana Carvey had a grave error, but did not die. Many patients have minor mistakes which do not contribute to a lethal diagnosis.)

I do not condone errors, but perfection does not exist anywhere. The IOM seems to have compounded its own error through exaggeration.

[/quote]

I agree with some of what you have stated, but you are not telling the entire story.

There is, and has been for some time, a large scale effort to make things safer in healthcare. And yet, Doctors are the last ones to get on board. Because of their AMA lobbied autonomy they are free to do the right thing or not. For example, evidenced based medicine has clearly shown better outcomes than fly by the seat of your pants medicine, and yet Doctors are reluctant to follow these proven guidelines. Why?

One of the biggest errors seen in medicine today is wrong site surgery. So how friggin hard is it to know what leg to cut, joint to fix, etc. These are just dumb ass mistakes that had physicians got on board with appropriate safety practices they could have avoided. But because their autonomy is more important than patient safety we will continue to have people die needlessly.

50

i hate local cops(they think they’re gods)at least state police are professional,you treat them good,they’ll return it.but these local cops, they all think they’re on some damn swat team.christ i live in a small town 8000,they’re nothing but assholes.

51

[quote]Lorisco wrote:
DrSkeptix wrote:
Bill Roberts wrote:
Strange quote from the FDA article:
…

It is a strange quote because the data upon which it is based does not exist.

The origin for these inflated “estimates” of unnecessary deaths is a notoriously inacccurate NEJM article of the early 1990’s, in which epidemiologic estimate for a population risk was applied to the population as a whole. In short, these deaths did not happen. (Compare all this to a similar poor estimate on Iraqi deaths in the Lancet.)

Further, the estimates include “errors”–whether grave or not–in patients who die of their disease or irremediable problems. (Dana Carvey had a grave error, but did not die. Many patients have minor mistakes which do not contribute to a lethal diagnosis.)

I do not condone errors, but perfection does not exist anywhere. The IOM seems to have compounded its own error through exaggeration.

I agree with some of what you have stated, but you are not telling the entire story.
[/quote]
Well, yes, it is not my place to tell the whole story. But as much as it pains me to say so, Lorisco, since much of what you write is sensible, I disagree with almost every declarative sentence which follows, since they are not true, or they are simply facile expressions of some political prejudice.

Not in the least true. Please read the article I cited in my last post, from the Harvard MDJDMPH. If you have firm data to the contrary, share it. My experience is that is first nurses and then doctors who show the most concern for patient safety on a day-to-day basis. Insurers and government are late to the party.

I am sorry, but who do you think it is that develops this “evidence-based medicine?” Trout fisherman? Fur trappers?
Doctors all use evidence and studies; there are formal criteria by which studies and reports are rated for quality. Liability concerns motivate doctors, if not a genuine concern for their patients. What confuses the public is when Insurance companies use the same term to deny payment. This is self-interest only; when the evidence is ambivalent, is a doctor “flying by the seat of his pants?” No, but the Insurers would like you to think so.

I am offered a chance here to join in the education of a respected writer, Lorisco.
No, wrong site surgery is not “one of the biggest errors in medicine.” The JCAH document you site is a report (over 13 years) of sentinel events, not of errors leading to death. Clearly this report of 5000+ cases over 13 years does not account for 92,000 (or 25,000) fictitious deaths per year.
First, sentinel events are self-reported by hospitals’ they precipitate an investigation–this is failure analysis at its best, not at its worst. (I may add that wrong side/site surgery is of course lamentable–who can defend that?–but this data also includes occurrences such as “wrong” side operations in patients who need planned bilateral procedures : cataracts, knees, etc. Wrong, true, but it triggers a thorough investigation.)

Last, you need to understand a little about the fearsome JCAH. Disproving your assertion that doctors protect only their autonomy, the JCAH is a joint commission of, well, the professional organizations (your hated and AMA, the ACP, ACOS), the Hospital Commissions, and the public. It is not an arm of the government, and they are a mean and picky lot.

And now, a little true story to amuse you, and reassure you about “appropriate safety practices.”
At my hospital, at a nursing station, there was a goldfish bowl. One goldfish. The JCAH inspectors came one year, and went, and with them went the goldfish bowl. Gone. I asked what happened, and the clerk said, “JCAH.”
“Of course, that explains every radical change around here,” I said, “but how could one goldfish in a bowl, way out here, harm a patient?”
“Oh, it wasn’t the goldfish that the JCAH objected to,” replied the clerk.“We just could not produce for them a Policy and Procedures Manual for the Cleaning of The Goldfish Bowl.”

I am not making this up.
If you wonder why regulations strangle both imagination and safety, read no further.

52

[quote]snipeout wrote:
I am just curious why every time a medical error leads directly to death or disfigurement it is not newsworthy.

We put our trust in these people same as we do police officers and do not expect to die in their hands. You would figure 10+ years of school and residency would error proof a person.[/quote]

I think the term is (intent)

53

I think the biggest difference is that the medical community is always trying to help and the police are trying to help sometimes, but the majority of police work is to justify their existence .That is my opinion why law enforcement does not want to cease and desist with the war on drugs.

54

[quote]DrSkeptix wrote:

I am sorry, but who do you think it is that develops this “evidence-based medicine?” Trout fisherman? Fur trappers?
Doctors all use evidence and studies; there are formal criteria by which studies and reports are rated for quality. Liability concerns motivate doctors, if not a genuine concern for their patients. What confuses the public is when Insurance companies use the same term to deny payment. This is self-interest only; when the evidence is ambivalent, is a doctor “flying by the seat of his pants?” No, but the Insurers would like you to think so.
[/quote]

True doctors are involved in the development of evidenced based protocols. But the 3 doctors who worked on prophylactic antibiotic timing guidelines by no means represent the majority. The majority of doctors are very slow to come around to new science. Many continue doing what they learned in school dispute new evidence to the contrary.

Personal attacks only demonstrate the weakness of your argument.

No one said anything about deaths. The issue is mistakes.

Not sure how you think a self-reported wrong site event reported after a thorough investigation (Root cause analysis) is not valid? It’s that the same process that the FDA uses for doctors to report medication events (self reported).

You are naive. The JCAHO (not JCAH as you keep indicating) is actually now the Joint Commission. They changed their name a few years ago. They have what is called ‘Deemed Status’ with CMS (Centers for Medicare/Medicaid Services), which is, yes my friend, the Federal Government. Deemed Status means that they can review a hospital for CMS regulations and impose sanctions based on their findings. So contrary to your assertions, you could indeed call them an ‘arm of the Government’.

I agree the Joint Commission is not too rational at times, but I also see many physicians doing what they want totally ignoring recent proven evidenced based protocols.

And regardless of how you try and twist it, there is no excuse for wrong-site surgery when there are protocols that could be followed that would greatly reduce its occurrence. Your excuse appears to be that no one died and or the outcome was not always bad, but what happens when it is? How many on this forum are cool with having some perfectly good body part cut off because some cowboy surgeon was too gung-ho to follow the correct verification procedure? Not many.

55

[quote]Lorisco wrote:
DrSkeptix wrote:

I am sorry, but who do you think it is that develops this “evidence-based medicine?” Trout fisherman? Fur trappers?
Doctors all use evidence and studies; there are formal criteria by which studies and reports are rated for quality. Liability concerns motivate doctors, if not a genuine concern for their patients. What confuses the public is when Insurance companies use the same term to deny payment. This is self-interest only; when the evidence is ambivalent, is a doctor “flying by the seat of his pants?” No, but the Insurers would like you to think so.

True doctors are involved in the development of evidenced based protocols. But the 3 doctors who worked on prophylactic antibiotic timing guidelines by no means represent the majority. The majority of doctors are very slow to come around to new science. Many continue doing what they learned in school dispute new evidence to the contrary.

I am offered a chance here to join in the education of a respected writer, Lorisco.

Personal attacks only demonstrate the weakness of your argument.

[/quote]
But I am offering a compliment to you, Lorisco! In no way is this construed as a personal attack.

See? I am joining you in an education!

But you will read again what I wrote about wrong-site surgery: “who can defend that?” Certainly not I. I twist nothing.

I was calling attention to “misproportion.” The JCAH (I used the older acronym, and everyone pronounces it Jay-Co) sentinel events report is data, each point of which is worthy of analysis.
In reporting accidents, judge the source, the method of discovery, and the consequences, since what follows may be misguided regulation.

Now then, show me a specific example of how “physicians doing what they want totally ignor(e) recent proven evidenced based protocols,” and we can study it together.

56

[quote]DrSkeptix wrote:
I am offered a chance here to join in the education of a respected writer, Lorisco.

Personal attacks only demonstrate the weakness of your argument.

But I am offering a compliment to you, Lorisco! In no way is this construed as a personal attack.
[/quote]

Sorry, I took this as sarcasm.

I don’t think many are interested in this stuff, and I’m sure posting stuff like this will kill this thread, but because you asked I will post a little.

There have been national guidelines out for prophylactic antibiotic use in surgical patients for several years: http://www.facs.org/cqi/scip.html

http://www.aaos.org/about/papers/advistmt/1027.asp

http://www.facs.org/education/gs2006/gs49barie.pdf

http://www.cdc.gov/ncidod/eid/vol7no2/nichols.htm

So the bottom line is that antibiotic resistant organisms have been created through inappropriate use of antibiotics. These evidenced based guidelines have been created to reduce unnecessary use of antibiotics related to prophylaxis. For example, the guidelines indicate that antibiotics should not be given more the 24hrs after surgery. Yet, many physicians continue to use antibiotics prophylacticaly beyond this time with no literature supported rationale. Why? Because that is what they learned 20 years ago.

Now I must say that this is getting less and less as more physician come on board, but I’m always surprised at how long it takes some physicians to come around to new technology or science.

Anyway, not trying to bash physicians, but because you asked I just wanted to point out that my comments where not totally unfounded.

57

[quote]Lorisco wrote:
DrSkeptix wrote:
I am offered a chance here to join in the education of a respected writer, Lorisco.

Personal attacks only demonstrate the weakness of your argument.

But I am offering a compliment to you, Lorisco! In no way is this construed as a personal attack.

Sorry, I took this as sarcasm.

But you will read again what I wrote about wrong-site surgery: “who can defend that?” Certainly not I. I twist nothing.

I was calling attention to “misproportion.” The JCAH (I used the older acronym, and everyone pronounces it Jay-Co) sentinel events report is data, each point of which is worthy of analysis.
In reporting accidents, judge the source, the method of discovery, and the consequences, since what follows may be misguided regulation.

Now then, show me a specific example of how “physicians doing what they want totally ignor(e) recent proven evidenced based protocols,” and we can study it together.

I don’t think many are interested in this stuff, and I’m sure posting stuff like this will kill this thread, but because you asked I will post a little.

There have been national guidelines out for prophylactic antibiotic use in surgical patients for several years: http://www.facs.org/cqi/scip.html

http://www.aaos.org/about/papers/advistmt/1027.asp

http://www.facs.org/education/gs2006/gs49barie.pdf

http://www.cdc.gov/ncidod/eid/vol7no2/nichols.htm

So the bottom line is that antibiotic resistant organisms have been created through inappropriate use of antibiotics. These evidenced based guidelines have been created to reduce unnecessary use of antibiotics related to prophylaxis. For example, the guidelines indicate that antibiotics should not be given more the 24hrs after surgery. Yet, many physicians continue to use antibiotics prophylacticaly beyond this time with no literature supported rationale. Why? Because that is what they learned 20 years ago.

Now I must say that this is getting less and less as more physician come on board, but I’m always surprised at how long it takes some physicians to come around to new technology or science.

Anyway, not trying to bash physicians, but because you asked I just wanted to point out that my comments where not totally unfounded.

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All good points. You are clearly knowledgeable and dedicated to this subject.

I reflect that, 30 years ago, the value of prophylactic antibiotics in clean heart surgeries was severely disputed–for fear of causing resistant organisms! the data you present show a lot of progress–at least in documentation–since the late '90’s.

In my humble experience, surgeons have adopted evidence-based practice–as you have shown it–because of nurses and anesthesiologists, with back up from infectious disease nurses (and a few ID doctors).

How much more thorough these citations are than the HPM and IOM reports, at the top of the threat, that so irk me.
Thanks for engaging!

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Well, to be honest, doctors are private citizens working for private business. The police are operatives of the state, and as such, should be held to a higher standard than an average civilian. Not a lower standard as is the case.

It would take me years of medical school to become a doctor. Forest fucking Gump is more than smart enough to be a cop. And yes, if I wanted to I could go to cop school and be a fucking cop. ITs not fucking rocket science.

For the most part, doctors are trying to help/make money. Cops are just assholes that like to exert their power over individual citizens because it makes their dick hard. There is obviously exceptions to this, but this is a pretty good general rule.

I know being a cop isnt an easy job, but that doesnt take away from the fact that they should not get away with doing fucked up shit to people. Deliberately doing fucked up shit to people is wrong. Even accidentelly is wrong, but not as much so. Getting people thrown in jail based on planted evidence and a fictional informant is wrong, and attempting to do so should net the offending officer hard time.

Beating the shit out of someone for no fucking reason then throwing them in jail for 10 years for defending themselves is fucking wrong. ITs not just the cops fault that this happens, the system is largely to blame, stupid politicians, and dipshit citizens. That doesnt mean officer asshole has the right to go nuts on some fucker with his beatstick.