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How About A Little See-Through Medicine?
And no, I'm not talking about that clear plastic skeleton I had as a kid. Hospitals fuck up and it's covered up, and Schwarzenegger talked transparency, and then nixed provisions for it.

(Bet there are some scary stories at some California hospitals. Too bad you're not allowed to know what they are.)

Other states, on the other hand -- New Jersey, Kentucky, Missouri, and Maryland -- are beginning to release annual death and infection rates. Pennsylvania is supposedly the best at reporting the stats. Jordan Rau writes for the LAT:

Healthcare experts say that one of the most inexpensive and effective ways to encourage hospitals to improve patient care is to make their failures public. Schwarzenegger has endorsed this approach, saying as recently as March that greater transparency would "drive healthcare providers to perform at peak levels," "boost the power of consumer choices," "save a lot of money" and "save a lot of lives."

But the governor on Friday vetoed a bill passed by the Legislature that contained provisions that would have made it easier for the public to review hospital performance.

The governor's own healthcare bill, released last week, adopted many sections of the legislative plan.

But he omitted or weakened patient-oriented provisions that are objectionable to the California Hospital Assn., one of Sacramento's biggest lobbyists and donors.

...Few patients are aware of the dangers. Actress Alicia Cole contracted a deadly flesh-eating bacterium that began devouring her abdomen shortly after she underwent surgery at Providence Saint Joseph Medical Center in Burbank in 2006.

"One of the nurses pulled my parents inside a room, closed the door and said, 'something is wrong here,' " Cole said. The 45-year-old from Sherman Oaks is still recovering from the illness.

The hospital declined to discuss her case, but said no other patients contracted necrotizing fasciitis, the infection that attacked Cole. Spokesman Dan Boyle said the hospital's infection rates are below the national average. The hospital would not provide actual figures and is not required to make them public.

California's hospital lobby has not supported aggressive public reporting of infection rates. The association is a dominant presence in the Capitol, spending $2.9 million on lobbying during the 2005-06 legislative session and giving $680,713 to candidates for office.

C. Duane Dauner, president of the state's hospital association, said he supports transparency if rates are accurate and their public reporting does not "open the institutions up for nonmeritorious and frivolous lawsuits" or discourage employees from reporting infection dangers.

"We in no way intend to be obstructionist," Dauner said. "We just want to have fair reporting for the hospitals and not unduly scare patients in their communities."

You know what? Scare me. I'd rather know.

Posted by aalkon at October 27, 2007 10:26 AM

Comments

"he supports transparency if rates are accurate and their public reporting does not 'open the institutions up for nonmeritorious and frivolous lawsuits'"

While he has 2 good points, I believe that statement about as much as I believe that the NEA has students' best interests at heart.

"Scare me."

Ok. Halloween is just around the corner, so I will. This is a story told to me by my ex-girlfriend a few years ago. She's a medical translator and this happened at one of the hospitals or clinics where she worked. If that weren't the case, I would treat it as urban legend.

A woman went in for a mastectomy because she had a cancerous lump in her breast. They removed the wrong one. So, she had a mastectomy on the other breast. At this point I'm thinking that some medical lawsuits with high settlements are justified. It's an easy mistake to make, but it's also an easy mistake not to make. And the incentives to not make it should be in place. Here's the kicker: in the ensuing review it was discovered that her lab results were mixed up and the lump was not cancerous in the first place.

Posted by: Shawn at October 27, 2007 12:47 PM

I saw something similar on CNN. I'm for more information and more skepticism. Sometimes, as in the case of full-body MRIs, you can, perhaps, have too much information, and that can be a negative, leading to highly invasive and unnecessary testing. But, it's really hard to say where to draw the line, and I'd rather have the information than not.

Posted by: Amy Alkon at October 27, 2007 1:23 PM

This reminds me of the old joke:

Q: "What do you call a doctor who graduated at the bottom of his class?"

A: "Doctor."

-----

Overhauling the methods by which doctors, hospitals, clinics and labs are paid will put an end to a great deal of anonymity. I hope it happens soon, although it's only half of what's necessary. The other part is that the patient must learn about their body before authorizing any sort of surgery. What's cut remains cut.

Posted by: Radwaste at October 27, 2007 1:49 PM

It's not just surgery, either. Medications have side-effects, and it's essential to research not your condition, but to consider whether the diagnosis is correct, and whether the course of action or prescription is wise and doesn't seem like it could cause worse problems than it solves.


Posted by: Amy Alkon at October 27, 2007 2:34 PM

There may be reason for hope on the transparency front - here in Chicago, the local hospitals have been forced to get out in front of the recent spate of MRSA virus cases that are spreading across the country. Although they're still criminally lax in their screening procedures, they're now calling this an official epidemic:

http://www.usatoday.com/news/health/2007-10-24-staph-infections_N.htm

Somehow, I think the threat of class - action lawsuits for victims of this virus may trump the "patient privacy" concerns so often mentioned as reasons why proper notification is generally not heeded.

Posted by: Dmac at October 27, 2007 2:40 PM

Whoo-hoo, I am all for knocking down some hospitals a notch or two. Even the one we're dealing with for prenatal care, one the best I have ever dealt with, pisses me off on occasion. With a slightly elevated risk pregnancy, my partner is going through a lot of tests, most of which have us waiting with bated breath. The bloody damned nurses are just really good at making everything sound far worse and risky than it actually is.

On top of that, they just went through a spate of the anti-biotic resistant viruses in the ER. Mind, they didn't talk about it, or the risks of going in there, it took three different patients, who were infected within a four day window, discovering this and contacting one of the local papers, for us to find out. Apparently nearly thirty people were infected, within a six day time period, while the hospital quietly did a major deep-cleansing of the affected areas, hoping no one would put it together. Six weeks later, the hospital still hasn't commented on it or admitted how many folks got sick. The people reported in the news, saw the initial reporting and contacted them about it, or we wouldn't know a thing.

On the upside, they are generally really good folks to deal with. I had to take the (then) four year old into the ER there, at midnight, with a 104.2 fever. He was obviously miserable, but they actually had him somewhat cheerful by the end of it all. And I am glad that my next is being birthed there. We're shooting for a vaginal, after a C-section and they're the absolute best for it and problem pregnancies.

But I definitely would like to see more reporting. Patient confidentiality can be maintained, even if they actually let us know what's happening. They don't need to pump out names, just stats.

Posted by: DuWayne at October 27, 2007 4:30 PM

Cathy's nurses at Cedars were extraordinary. (Cathy Seipp, my friend who died of lung cancer this spring.) I can't speak to how sterile things were there, but caring for somebody seriously or terminally ill is a terribly hard job, and I don't know how they manage dealing with the level of suffering they do day in and day out. Perhaps it's the fact that they're alleviating some of it. If anyone reading this is a nurse, please weigh in.

Posted by: Amy Alkon at October 27, 2007 4:57 PM

It's very important that you know your own body, and your family medical history. Question everything and don't let anyone pressure you into taking any medication or doing any tests that you don't want. There's a lot of scare-mongering going on, partially because the medical staff actually believe they are trying to help, and partially I think to make money.

Take some time to think about anything they want to do to you, talk to your friends, read up on medical websites, and then decide.

It's your health and your body and you have to live with any decisions, right or wrong, not the doctors.

Posted by: Chrissy at October 27, 2007 5:49 PM

The problem is -- in the suggestion to "read up on medical websites" -- that most people don't have the ability to know what's quackery and what's good, evidence-based medicine. (Even doctors don't always recognize the difference.)

Posted by: Amy Alkon at October 27, 2007 6:49 PM

While we're mentioning, "know what's going on with your treatment", I have to point out two errors above. Staph is a bacterial infection, not a virus; antibiotics have no effect whatsoever on a virus. Antibiotics are over-prescribed for colds and flu, and are commonly so for the placebo effect as well as for any opportunistic bacteria which may be about. This practice is greatly feared by epidemiologists who think that it is paving the way for things like, gee, this new staph epidemic. Please make a note of it.

Posted by: Radwaste at October 27, 2007 7:44 PM

According to the Centers for Disease Control and Prevention, "Staphylococcus aureus, often referred to simply as "staph," are bacteria commonly carried on the skin or in the nose of healthy people."

http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_public.html

Posted by: Kristen at October 27, 2007 8:53 PM

Sorry Radwaste. I am obviously reading this blog too late in my day. Time for bed.

Posted by: Kristen at October 27, 2007 8:54 PM

I am a nurse, and I work damn hard at making sure my patients get treated as human beings. Unfortunately, this often means running interference with technicians,orderlies, doctors, and other nurses.

I can't speak for other nurses, but what holds me up through all the suffering is the faith that what I am doing is important whether it is appreciated or not, and that I am first and foremost the patient's advocate.

I may not be able to cure the problem, but I can sure make things easier and better for the patient. The problems would still be there if I weren't around to do my job, I just wouldn't have to deal with them. But then, I would be doing nothing to alleviate things, either.

Posted by: C. Siegel at October 27, 2007 10:21 PM

Whether or not it's appreciated (maybe somebody suffering can't really think about what you're doing), it definitely is important, and definitely makes a difference.

Posted by: Amy Alkon at October 28, 2007 1:23 AM

"The problem is -- in the suggestion to "read up on medical websites" -- that most people don't have the ability to know what's quackery and what's good, evidence-based medicine. (Even doctors don't always recognize the difference.)"

This is where your critical thinking skills come into play. If you read enough information from a variety of sources, it should help you get closer to the truth. If you are thinking about taking a drug, for example, you should try to find the actual double-blind studies that should have been carried out by the drug company before it went to market. Alternatively, you could look for any lawsuits for damages from the drug.

I read the book 'Limits to Medicine: Medical Nemesis, the Expropriation of Health' by Ivan Illich, and I found it very interesting. It is an older book, but the concepts are still relevant.

Posted by: Chrissy at October 29, 2007 9:43 AM

Here in Fresno, CA we have unauthorized altering of water and sewer lines taking place - discharging infectious, disease-carrying raw sewage, which the City then LIES about. Linked to the so-called "infrastructure upgrade." No wonder the Gov wants to keep this under wraps.

Posted by: Marla at January 25, 2008 4:50 PM

My pal André-Tascha Lammé is all over water issues in Sacramento. Here's his site:

http://www.sacwaterrates.com/

Perhaps you can get some similar activism going in Fresno.

Posted by: Amy Alkon Author Profile Page at January 25, 2008 5:36 PM

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