Wednesday, November 28, 2012

Differences in Ethics of UK vs. US Physicians

 A new report has come out from Medscape comparing marked ethical differences between United Kingdom physicians and US physicians.  The study surveyed over 25,000 US and UK  doctors on their beliefs about futile care, patient confidentiality, full disclosure to patients, and even informing patients about bad doctors.  It was surprising to me that doctors who are trained so similarly, have such divergent views when it comes to ethical issues.

On many of the questions the responses across the Atlantic were similar.  Only 10% (US) and 14% (UK) of physicians would hide information from a patient to bolster their spirit.  About a quarter of doctors on both continents might ration care to a younger, sicker patient rather than an older one.

An analysis of the findings points to differences in how doctors are paid as possibly driving the different values.  US doctors face more malpractice costs and face more litigation.  More US doctors work independently in a "fee for service" environment.  UK physicians are mainly funded by the country's socialized National Health Service (NHS) and decisions are less driven by financial concerns.

Here are the results of the survey:

Table. Differences in Attitudes Between US and UK Physicians, Medscape 2012 Ethics Report
Question US Physicians UK Physicians
Would you ever go against a family's wishes to end treatment and continue treating a patient whom you felt had a chance to recover? Yes: 23% Yes: 57%
Is it ever acceptable to perform "unnecessary" procedures due to malpractice concerns? Yes: 23% Yes: 9%
Is it right to provide intensive care to a newborn who either will die soon or survive with an objectively terrible quality of life? Yes: 34% Yes: 22%
Would you ever hide information from a patient about a terminal or pre-terminal diagnosis if you believed it would help bolster the patient's spirit? Yes: 10% Yes: 14%
Would you give life-sustaining therapy if you believed it to be futile? Yes: 35% Yes: 22%
Should physician-assisted suicides be allowed in some situations? Yes: 47% Yes: 37%
Would you inform a patient if he or she were scheduled to have a procedure done by a physician whose skill you knew to be substandard? Yes: 47% Yes: 32%
Is it acceptable to breach patient confidentiality if a patient's health status could harm others? Yes: 63% Yes: 74%
Would you ever decide to devote scarce or costly resources to a younger patient rather than to one who was older but not facing imminent death? Yes: 27% Yes: 24%

Thursday, November 15, 2012

Hearing Impaired Tattoo

I love the creativity here.  This young lady has bilateral hearing impairment.  Great tattoo!!

Monday, November 12, 2012

Subdural Hematoma-One Patient's Experience

This email came from one of my patients  this morning.

I read your blog about technology helping you and wanted to share this story with you. 
 My husband has had ongoing migraines for weeks that never really stopped. Meds at home were not working to control the pain. He was suffering and his docs recommended a trip to the ER for stronger meds to stop the headache.

Friday night we drove to the Hospital where they got him into a bed right away and soon did a CT scan. The scan showed a large subdural hematoma on the left of his brain. All his symptoms were attributable to the pressure being applied to his brain.

He underwent an emergency left temporal craniotomy on Saturday. The operation was successful, although the origin of the bleed  is not known. There had been no head trauma.

Today he said my name and tonight he was more lucid and wanted to watch 60 Minutes. He could see the wall clock at 6:55 and knew the show was about to begin. I hadn't even been aware of the TV on the wall. Amazing that he had brain surgery yesterday and was so alert tonight.

His neurosurgeon said he does 2-3 of these same procedures each week. This is much more common that I would have imagined.

Go to the ER for a headache, and end up getting emergency brain surgery! I am grateful beyond measure for CT scan imaging technology, radiation or no.

Oh, I used my iPhone  camera to capture an image of his hematoma from the computer screen as The doctor showed me the whole picture. Then we took that image to the bedside so that his doc could show him what I had seen. Really useful technology once again.

Much to be grateful for. And thank you for all that you write in support of patient care and wellness. 

For more information on Subdural Hematomas, see my prior blog post.

Technology and Medicine

I love technology that lets me be a connected doctor and saves my patients time and money.  I got an email from Justin last weekend because his foot was painful and swollen and it included the following photo:

Wow. this was obviously a serious infection that was spreading beyond the big toe to the entire foot.  He needed immediate attention and was sent to the ER.  He was given pain medication, two antibiotics and the toe was drained.  The next photo looked was this:

Clearly better now that it was opened up but the swelling remained and he was not out of the woods.  Rather than  have him come into the office, when he really needed to keep it elevated, I had him check in with me with daily updates:

Clearly improved.  Notice the redness on the other toes is disappearing as is the streak that was going up the foot.  The wound looks really clean.  I advised hot soaks and continued antibiotics and elevation and it continued improving:
All was going well until today.  His pain was gone and Justin thought he was ready to go back to work but one week later the toe looked like this:

Oops, that fresh pus shouldn't be there.  Overall the healing is great but now I suspect a foreign body that might be keeping a nidus of infection.  Unfortunately he will need further debridement to see what is causing that continued oozing.

Tomorrow I'll get him hooked up with a surgeon who can take a look at it. 

Tuesday, November 6, 2012

Americans are Trying to Lose Weight

More than half of Americans (55%) say they are trying to lose weight according to a study by The International Food Information Council Foundation.  From 1960 to 1980 the obesity rate remained stable at about 15%.  Since that time it has risen to 36% in 2010 and is still on the rise.  Despite the fact that we are getting healthier in many other ways, the obesity epidemic stands to wipe out all of the other health gains.

Body weight is the result of genes, metabolism, behavior, environment, culture and socioeconomic status.  But genes and metabolism have not contributed to the rapid obesity rise in the U.S.  The other factors are at play here.

If you think it is from the proliferation of fast, easy available food, cheap junk food calories and the fact that fewer people cook at home anymore, you would be correct.  Just look around at how easy it is to find food.  Every mini-mart, drug store, public place has vending machines and available junk food.  And serving sizes have grown along with our waistlines.

 Physical Ed has been eliminated from schools and our society doesn't let kids go out and play alone anymore.  When they do play organized sport the moms bring treats and snacks for the whole team on a rotating basis. 
Just about everything in our culture is poised AGAINST healthy eating and maintaining a healthy weight.  Jaimie Oliver was on TV for awhile with his food revolution, promoting healthy diets for school kids.  But we are fickle with our TV habits and he is off the radar now.  We need to bring that information back and keep promoting healthy eating for our kids. We need to create environments that promote health and education is a place to start.

Back to the survey that reported 55% of us are trying to lose weight.  Unfortunately our fast-food culture isn't helping much,  but change has to start at the beginning and eliminating soft drinks, processed carbohydrates and sugar would go a long way to restoring health and reversing this worrisome trend. 

When to Use Urgent Care

We all know that Emergency Departments are over-crowded with long waits and exorbitant fees.  Free standing Urgent Care is a great solu...