Home / Tag Archives: News Commentary (page 4)

Tag Archives: News Commentary

Amanda Trujillo

I finally took the time to read some other blogs today. One of the issues that I found disturbing was the case of Amanda Trujillo. There are a lot of bits and pieces out there about what actually happened in this case. This blog post was reportedly an e-mail from Amanda describing the events. A summary of the post follows. Amanda was a registered nurse of six years , specializing in cardiology, geriatrics, and end of life/palliative care. In April 2011, she was caring for a dying patient at Banner Del E. Webb Medical Center who had agreed to a major invasive surgery recommended by a staff surgeon. Amanda used materials from her hospital to educate the patient about the details of the surgery and the aftercare. The patient became upset, stating that the surgeon never explained details of the surgery or what had to be done after the surgery (complex lifetime daily self care). Amanda also discovered that the patient “had no idea” that surgery could be refused or that the patient could enroll in hospice care. She educated the patient on those options as well. Afterwards, the patient requested a case management consult to visit with hospice. Amanda documented her discussions with the patient and informed the nurse at shift change that the surgeon needed to clear up a “gross misunderstanding” the patient had about the surgery. “The surgeon became enraged, threw a well witnessed tantrum in the nursing station, refused to let the patient visit with hospice, and insisted I be fired and my license taken.” She was fired and she is not able to find employment due to the actions taken against her license. As a result of this incident, Amanda’s career has been destroyed. She is a single mom with three nursing degrees and now, unemployed and unemployable, she has no other option than public aid to feed her family. Back in 1913, Supreme Court Justice Louis Brandeis once wrote: “Publicity is justly commended as a remedy for social and industrial diseases. Sunlight is said to be the best of disinfectants; electric light the most efficient policeman.” I’ve tweeted to Amanda to contact me so that I can get more information from her. If the above events can be substantiated, what happened to Amanda was deplorable. And if the events can be substantiated, I’m going to shine some sunlight on the actions of other parties involved. I’ll request the patient’s permission for release of the patient’s medical records from the hospital. With the patient’s permission, I’ll publish them here, including the surgeon’s notes and Amanda’s notes. I’ll get the names of the nursing supervisor and everyone involved in Amanda’s firing, including the hospital CEO. We’ll take a look at their careers on this blog. I’ll get the names of the people from the Arizona State Board of Nursing who reviewed this case and who recommended that Amanda lose her license and undergo psychiatric testing. I’ll publish any correspondence that they sent Amanda. We’ll take a look at just how they arrived at their conclusions. And I’ll get the name of the surgeon who allegedly does not take the legal doctrine of informed consent too seriously and who allegedly uses temper tantrums as a means to bully people into submission. Maybe we can look into his background a little. If he did have a “tantrum” in a patient care area, has the hospital investigated him for his conduct? Everything will be published here. And if ends up that Amanda was wrong for what she did I’ll publish that as well. That reminds me … When two ...

Read More »

Demanding Perfection?

Want more evidence about how many people expect perfect outcomes in medical practice? Look no further than the Wall Street Journal: “What if the Doctor is Wrong?” by Laura Landro. As a substantive basis for the conclusion that initial treating physicians are “wrong” when they haven’t yet reached a diagnosis, Ms. Landro interviewed two patients who, in the midst of a workup, left the doctor who was trying to diagnose and treat their problems. Said patients then went to a “mecca” to have their workup completed where … amazingly … the problem is “discovered” and “properly” treated. Even though the initial provider in all likelihood would have done the same testing that the “mecca” performed after reviewing the results of the initial testing – had the patient stuck around long enough to have the testing performed. Even though the “standard of care” may have been to do things exactly the way that the initial provider was doing them. Nope, they’re wrong because they didn’t get to the answer sooner. When reading about all these “errors” I couldn’t help wondering: Did Ms. Landro have a neutral physician review the patients’ medical records to see whether the care provided to the patients was appropriate? Did Ms. Landro interview the initial treating physicians to determine what the next step in their treatment plans would have been? If so, she kind of left those points out of her article. I understand the idea that second opinions can be useful and I agree that misdiagnoses are sometimes made. Until we find a single test that is 100% sensitive and 100% specific for diseases such as cancer or complaints such as abdominal pain, there will always be misdiagnoses made. Even once a diagnosis has been made, there are disagreements about how to proceed with treatment. Some prefer one medication for treating certain types of cancer, some prefer another medication. Does that make one side “wrong” and the other side “right”? Hardly. The title of this article and the slant of this reporting make it appear as if doctors are “wrong” just because they don’t make a diagnosis after the first round of testing. Did Ms. Landro even explore how often the “meccas” get their diagnosis “wrong” on the first visit? Are the “meccas” that much better? If patients want to mortgage their house to get the tens or hundreds of thousands of dollars necessary for a “down payment” at MD Anderson (original link to WSJ article here) or some other “mecca” when they likely would have gotten similar testing done had they stuck with their initial providers, that’s free market medicine at work. When journalists imply that excluding diseases on a list of differential diagnoses in the midst of a workup or coming up with “inconclusive” results during testing is “wrong”, shouldn’t we start looking into journalistic malpractice? What if the Journalist is Wrong?

Read More »

Most Dangerous Items in the House

There was a good article posted on My Health News Daily about the five most dangerous things around the house. They interviewed several experts (I must have been out of reach during my vacation, so I wasn’t quoted – although one of my friends was quoted) and came up with a pretty useful list of dangerous things around the home and how to make them less dangerous. What are my top 5? 1. Pain medications and other narcotics. They kill more people via overdoses than anything else. If we want to just use the general category “medications,” I’d throw in blood thinners and diabetes medications as well. 2. Alcohol. ‘Nuff said about that. 3. Weapons. I personally like the idea of being able to protect our home. We own several guns and will probably purchase a couple more in the near future. They are safely stored. However, mix guns with alcohol or guns with anger and there is a huge danger. Teach children about proper gun use. Knives are also a problem – most of the time people are using knives to cut food and instead cut fingers. 4. Floors. I see a lot of elderly patients who either slip on bathroom floors or who slip on the edges of carpets and severely hurt themselves. That goes for stairs, too. Having non-slip tiles in the bathroom and bath tub will help. Also, making sure that throw rugs are securely taped will prevent slips and falls. Stairs and alcohol don’t mix. If elderly relatives need a walker, they shouldn’t be walking up and down stairs, either. 5. Television. First, I see about one kid every month or two who has a TV on a shelf fall on him or her. But televisions encourage a sedentary lifestyle, encourage people to snack while watching, and even provoke some fights where I end up sewing up someone who was talking jack about a video game. Any other dangers? BTW, the first one of you to say “get-gos” gets your IP address blocked.

Read More »

Addressing Transgender Patients

I read this story about how transgender patients are upset because they are addressed incorrectly when they seek medical care. Because of this, some people are demanding sensitivity training for medical personnel and are alleging that “transphobia” must be occurring. “Transphobia”? Sorry, but I think that the whole transgender rights thing is going a little far when transgender people are offended because medical staff need to appropriately identify them before they receive medical care. The article states that “We tell them, hey, if a trans person comes in with a stomach ailment or a broken ankle there’s no need to go on a tangent about what different types of surgeries they may have had.” Yeah. Good advice. Knowing that a man has ovaries would  have no impact on my differential diagnosis of abdominal pain. None at all. If a woman was taken for prostate surgery because medical staff didn’t want “offend” her by asking her whether or not the “MALE” designation on her ID bracelet was incorrect, you know these same people alleging “transphobia” would be demanding that all the providers’ licenses get revoked. Don’t want to be embarrassed? Go to the hospital desk ahead of time and explain the situation or call the hospital ahead of time and discuss it with the administrator. Don’t get upset because someone is trying to properly identify you, then scream discrimination when none exists. Make it easy on us and we’ll usually try to make it easy on you. If you act unreasonably, you’re probably going to end up offended, but it won’t be because of your current or desired gender.

Read More »

Man Cuts Arm Off with Guillotine

“I tried to think of a witty comment to this story … but I was stumped.” So begins the comments section to the story about a Washington man who was rushed to the emergency department after cutting off his arm with a homemade guillotine. While the story is sad, many of the comments are amusing … in a morbid kind of way. A picture of the actual guillotine is here. Then there’s this article about whether the patient may have Body Integrity Identity Disorder. A related story describes a man who wanted to cut his arm off with a table saw but who lost his … nerve. Aaaaugh. Make it stop.

Read More »

Worst States For Medical Malpractice Risk

I just read an article in American Medical News about medical malpractice insurance costs. Included in the article was a small graphic about how much internists pay for medical malpractice insurance. Internists in Dade County, Florida paid medical malpractice insurance premiums that were 1400% higher than internists in the state of Minnesota. Illinois internists in Chicago paid more than 12 times as much in malpractice insurance premiums as their Minnesota counterparts. In other words, internists in select Florida and Illinois counties pay more for malpractice insurance in one month than internists in the state of Minnesota pay for an entire year. There are similar premium disparities for general surgeons and obstetricians, with Long Island, NY and Las Vegas NV also consistently being on the list for high malpractice premiums Does that mean that the Florida and Illinois physicians were 1200% to 1400% more negligent than doctors in Minnesota? Doubtful. It just means that Miami, FL; Chicago, IL; Las Vegas, NV; and Long Island, NY are places where insurance companies have determined that it is much more risky to practice medicine. When doctors search for the best states in which to practice medicine, they should consider the medical malpractice environment when making that decision. Given these statistics, doctors should not practice in Miami, Chicago, Las Vegas, or Long Island if they want to reduce their medical malpractice risk. Yet Florida lawmakers reach out to news stations and claim that the state “desperately needs more doctors.” Suing your way to better health care doesn’t work very well, does it, Senator Nelson?

Read More »