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Better Health » What Does The Surgeon General Do?

Dr. Val has a nice Q&A with Dr. Carmona (current Surgeon General) about what the office actually does.

Way to go Dr. Val!

From a reader, and a folowing question:

Hi GruntDoc,

At the gym last night I came upon a relatively recent issue of Self
Magazine (the womens’ fitness mag) in which you and KevinMD were cited as
blogs for health-conscious women to read. I had to chuckle a little because
I doubt this mag would be your targeted reader. I wish I had stolen it to
tell you what issue and page but the brawny trainer had the stink eye on me.
I think it was Dec or Jan. check it out!!

So, anyone have a copy of the article in Self Magazine about medical bloggers? It’s not one of my regular reads…

AMNews: Jan. 5, 2009. Supreme Court asked to examine Texas peer review case … American Medical News
The U.S. Supreme Court could be the next stop for a lawsuit that peer reviewers have followed closely. A Dallas cardiologist is asking the high court, which only takes up a small number of cases it is requested to consider each year, to review his lawsuit claiming unlawful peer review.

The case has led physicians serving on peer review panels and hospital officials to worry that peer review immunity could be eroded. And it has given physicians who believe they were improperly peer reviewed hope for retribution.

Interesting.  I only know of peer-review inside my own division, and don’t know anything about this case other than what’s in the news.  I can understand a need for checks and balances in any system, but wonder if tearing peer review apart is the right answer.

Updated: I should clarify the basic problem with peer review, and what’s at stake.

Peer review is meant to be just that, a review of a doctors’ work viewed through the eyes of their peers, i.e., docs who do the same work.  Ideally, they’re the perfect people to throw the flag when there’s a foul, and as far as I know (and, lawyers, that’s all I know) it works like it’s supposed to.

Nearly without exception those subjected to discipline will complain of personality conflict, or business conflict, and there’s the rub: determining whose complaint about their discipline is meritorius and those who are covering their troubles with obfuscation.  It doesn’t help that peers who do the review in the non-hospital based disciplines are nominally colleagues but are also competitors with egos and agendas.  It is a given that those ase motives are left at the closed door of peer review, but there’s always going to be friction over an adverse decision.

I’d like to point out here that just because peer review is unhappy with someone doesn’t automatically result in adverse action, there’s usually the hospital Medical Board or Credentials Committee that has to actually impose a discipine, so there is some outside oversight (which relies on the peer review for the nuance of whether care was appropriate for their discipline).  If this sounds incestuous it’s not supposed to, nor is it supposed to be in practice.

Again, all I know of this case is what I’ve read in the papers, and so far (knock wood) I haven’t fallen afoul of a peer review action, but I (and everyone else in my position) has recourse in the event of an adverse review.

So, again I hope peer review is left intact as a tool for self-policing.

Michael Yon - Online Magazine: Border Bullies

Empowered bureaucratic bullies. We can, and certainly should, do better.

Shame.

Oh.

richard[WINTERS]md: Seductive Detail

Wow.  A new year brings a new post.  Could this be a trend?

Revived from the Dead.  For now.

…to my wife, who no doubt deserves better.

Thanks, honey!

From the CDC:

During week 51 (December 14-20, 2008), a low level of influenza activity was reported in the United States.

• One hundred three (3.4%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories and reported to CDC/Influenza Division were positive for influenza.
• The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.
• The proportion of outpatient visits for influenza-like illness (ILI) was below national and region-specific baseline levels.
• Two states reported regional activity; six states reported local influenza activity; Puerto Rico and 36 states reported sporadic influenza activity; five states reported no influenza activity; and the District of Columbia and one state did not report.

In case you wondered what that looks like, in graph form:

160 cases, Nationwide, week 50.  Lucky so far.

Postscript: Three Cheers For Middlesex Hospital’s New E.R.

By JOSH KOVNER

December 29, 2008

MIDDLETOWN — - Middlesex Hospital’s new $31 million emergency department, which opened in March, has settled into a groove.
The waiting room is usually empty and people are seeing doctors in a third of the time, even though the patient caseload has risen 4 percent since March — in what has been one of the busiest emergency centers in the state.
Memories of a crowded waiting room and patients on gurneys in the hallway are fading.
The largest renovation project in the history of the hospital increased the number of emergency beds from 26 to 44 and added new technology that has streamlined patient care.

Up 4% already.  If you build it, they will come.  I give it 6 months until the waiting room is full again.

Yes, I’m jealous.  Rumor had it our ED was next for an expansion.  Until the economy acted up, which has everything on hold.

Congrats, Middletown, wherever you are.

…when your patient realy has pseudotumor cerebri:

Doctor says: we need to do a lumbar puncture.

Patient says: Oh, thank god, and isn’t at all sarcastic.

Wow.

California Medicine Man: ER Docs Feel the Police Use Excessive Force
ER Docs Feel the Police Use Excessive Force
To me, this story should be filed under the category of “There’s less to this than meets the eye”.

Amen, Brother.

This was sent by one of our nurses (and a frequent commenter) with her title “Growing our own Nurses”.

When she originally showed it to me, she said this is how to treat doctors: the pacifier does the trick.

I’m not saying she’s wrong…

That’s one of my favorite medical aphorisms, taught to me by Dr. Peacock in El Paso.  He was one of the trauma surgeons there, and it nicely summed up an approach to medical care in the acutely traumatized.

I thought that when I read this:

Army halts use of battlefield first aid item after test found it might cause blood clots

By PAULINE JELINEK | Associated Press Writer

10:25 PM CST, December 23, 2008

WASHINGTON (AP) — Until more testing can be done, Army medics are being told to stop using a new product just sent to the war front to help control bleeding among wounded troops.

Officials were in the process of distributing some 17,000 packets of WoundStat, granules that are poured into wounds when special bandages, tourniquets or other efforts won’t work. But a recent study showed that, if used directly on injured blood vessels, the granules may lead to harmful blood clots, officials said Tuesday.

To recap: a medication to be used as essentially a last resort when a trauma patient is bleeding to death cannot be used because …it might cause blood clots.  Bleeding that cannot be controlled with direct pressure, tourniquets or the newer ‘combat gauze’ with pro-coagulants built in. 

I have to say that, were it me in that situation, I’d risk some clots elsewhere to get clots to keep me from literally bleeding out.  But that’s just me.

It’s commendable the Army takes the medical care of its troops seriously, but there’s a disconnect in this case.

Movin’ Meat: I’m Impressed

So am I!

Thanks to fellow medblogger Symtym I’ve read the decision in the execrable event blogged about yesterday.

Here’s the actual text of California’s Good Samaritan Law:

California Health And Safety Code Section 1799.102

No person who in good faith, and not for compensation,
renders emergency care at the scene of an emergency shall be liable
for any civil damages resulting from any act or omission.  The scene
of an emergency shall not include emergency departments and other
places where medical care is usually offered.

I have to tell you, that seems pretty straightforward to me. You help (not for profit), you’re covered.

Now, for the problem: the decision is here (.pdf file), and it exemplifies why normal people don’t trust lawyers.

Here’s the crux of their reasoning (page 2 of the ruling):

We hold that the Legislature intended for section 1799.102 to immunize from liability for civil damages any person who renders emergency medical care. Torti does not contend that she rendered emergency medical care and she may not, therefore, claim the immunity in section 1799.102. Accordingly, we affirm the judgment of the Court of Appeal.

Why do they believe that to be the correct reasoning?

One can infer from the location of section 1799.102 in the Emergency Medical Services division, as well as from the title of the act of which it is a part, that the Legislature intended for section 1799.102 to immunize the provision of emergency medical care at the scene of a medical emergency.

This is remarkably obtuse; where does health and safety legislation go, except into H&S legislation.  Thank goodness it wasn’t in a farm bill, else it’d only apply on farms.

To say I disagree with this interpretation (as a non-lawyer) is a bit of an understatement.  Read the whole decision to see the tortured logic involved.

I find myself in agreement with the dissent by Baxter J (at the bottom of the decision).  He’s supposedly a liberal activist judge, but no matter, he’s right on here.

Health and Safety Code section 1799.1021 states that “[n]o person who in good faith, and not for compensation, renders emergency care at the scene of an emergency shall be liable for any civil damages resulting from any act or omission.” (Italics added.) Nothing in this clear statement limits or qualifies the kind of emergency aid — medical or nonmedical — that an uncompensated lay volunteer may provide without fear of legal reprisal from the person he or she tried to help.

He goes on to point out the absurdity of the majority decision:

Thus, in the majority’s view, a passerby who, at the risk of his or her own life, saves someone about to perish in a burning building can be sued for incidental injury caused in the rescue, but would be immune for harming the victim during the administration of cardiopulmonary resuscitation out on the sidewalk. A hiker can be sued if, far from other help, he or she causes a broken bone while lifting a fallen comrade up the face of a cliff to safety, but would be immune if, after waiting for another member of the party to effect the rescue, he or she set the broken bone incorrectly. One who dives into swirling waters to retrieve a drowning swimmer can be sued for incidental injury he or she causes while bringing the victim to shore, but is immune for harm he or she produces while thereafter trying to revive the victim.

The legislature wrote what it meant, in plain language.  The California Supreme Court says the plain language isn’t correct, that their intent was clearly different than that written.

Nothing good will come of this.  I can only hope the California Legislature doesn’t go broke before they can clarify their very plain language so even lawyers can understand it.

(The defendant is going to go to trial over whether her actions were negligent, which is pretty much unavoidable.  I’m told that she’ll probably win, as juries are made of more reasonable people than lawyers.  That doesn’t change the problem this decision will make for all society.)