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Russian woman “embalmed alive”?

Russian woman “embalmed alive”?

  No, she wasn’t, but it was just as bad. Early this month, 28-year-old Ekaterina Fedyaeva died three weeks after what was supposed to have been a routine laparoscopic operation to treat ovarian cysts suspected of causing infertility. I want to discuss two issues about the incident. 1. Sloppy reporting. Initial reports in several media outlets stated her death had been due to the intravenous administration of formalin instead of saline. WSVN 7 News: “Russian woman dies after doctors put formaldehyde instead of saline into IV drip.” Newsweek: “Woman killed with formaldehyde drip in-hospital blunder.” CBS News: “Woman died after hospital put formaldehyde instead of saline in IV, reports say.” Syracuse.com: “Woman dies after accidentally getting formaldehyde drip in surgery in Russia.” The Washington Post: “Her surgery was supposed to be routine. Instead, this Russian woman was ‘embalmed alive.’” The Scottish Sun: “Russian woman, 27, dies in agony after she was ‘embalmed alive’ instead of being put on saline.” 2. Here’s what really happened. Many physicians on Twitter questioned the supposed IV administration of formalin because we know it is supplied in nonsterile jugs or bottles not compatible with IV tubing and therefore nearly impossible to confuse with IV sterile saline. It has a distinctive odor often described as irritating. Saline has no odor at all. Formalin contains formaldehyde and is used to embalm dead bodies and to preserve surgical specimens for histologic examination. Specimen jars filled with the liquid are located in each operating room. OSHA and EPA regulations call for formalin storage bottles to be clearly marked as formalin and labeled as a chemical hazard. If any...
Beyond malpractice: Doctors in real trouble

Beyond malpractice: Doctors in real trouble

What could be worse than being sued for malpractice? Prison. Kang Se-hoon, a surgeon in South Korea, operated on a popular rock singer and song writer in October 2014. According to reports, Shin Hae-chul had abdominal pain, and the surgeon performed laparoscopic lysis of adhesions. Without having obtained consent, he decided to also do a weight reduction procedure. The patient was discharged a few days after surgery but returned a day later with fever and severe abdominal pain. Kang did not investigate the cause of the pain and instead prescribed pain medication. Shin Hae-chul was eventually transferred to another hospital where he underwent an attempt at life-saving surgery. Ten days after the original surgery, he died of peritonitis, pericarditis, and sepsis. An autopsy revealed a perforation of the small intestine which had been leaking bowel contents and a hole in his pericardium which was inflamed. Evidence of a procedure to shrink the size of the stomach was also found. A lawsuit was filed by the family. Kang was found negligent and also guilty of manslaughter. He was ordered to pay the equivalent of $1.41 million in damages to the family and sentenced to 10 months in prison plus two years’ probation. Kang appealed the case, and in January 2018, the Seoul High Court not only upheld the verdict, it increased his prison term to 12 months. So much for the appeal. Exactly how many US doctors have faced prison time for malpractice is unknown, but it is still considered rare. Here’s a recent example. In September of 2017, a 71-year-old physician underwent a plastic surgery procedure at an outpatient...
Charges dropped against surgeon accused of assaulting nurse

Charges dropped against surgeon accused of assaulting nurse

Last month in this space, I wrote about “Things doctors should not do—like attacking their nurses” and included this story among others: “A surgeon at a Long Island, New York hospital, angry because a nurse gave one of his patients a dose of medicine at the wrong time, allegedly took a drawstring from his sweatshirt and wrapped it around her neck. As reported by Outpatient Surgery, the complaint says the surgeon, while choking her, told her he should kill her for what she did. He was arrested and charged with strangulation and assault.” I did not reveal the surgeon’s name in my post, but interested readers could have clicked on the link to the Outpatient Surgery article about him. After an investigation, the surgeon was cleared of all charges because surveillance video and witnesses did not substantiate the nurse’s accusation. When I learned of this, I inserted an update into the post, but the positive ending to the situation needs to have the same amount of exposure as the original negative story. As you might guess, the arrest received widespread coverage by various media outlets. Reporting it was legitimate news, but so was the dropping of charges. A few responsible websites, such as CBSlocal.com, newsday.com, and abc7ny.com, described the happy outcome in detail. Outpatient Surgery posted a brief notice that the charges had been dropped but in a less prominent area of its website than the first story. Three well-known websites had published lengthy articles about the alleged assault but made no mention of the surgeon’s later exoneration. That a reputable newspaper like the Chicago Tribune failed to do...
“Officials find NYC hospitals riddled with shocking violations.”

“Officials find NYC hospitals riddled with shocking violations.”

I know it’s only the New York Post, but that headline could not be more misleading: The article says that state health inspectors found “19 instances of safety or security lapses that put New York City hospital patients in ‘immediate jeopardy.’” The inspections took place from January 2015 through January 2018. Pop quiz. How many hospitals are in New York City? A. 28 B. 51 C. 73 D. 96 The five boroughs of New York City are home to 96 hospitals. I don’t know about you, but I would say 19 violations among 96 hospitals over a three-year period does not meet the definition of “riddled with.” To be sure, some of the violations were egregious and should never have happened. The Post article listed a few. Two patients died of cardiac arrest during minor surgery at two different facilities run by one hospital. The story implied that delays in the recognition of problems occurred and the surgeons were responsible. The role of anesthesia was not mentioned. Another hospital failed “to properly investigate the claims of two women who said they were sexually abused” by an emergency physician. The “immediate jeopardy declaration” was lifted after the hospital proved that its staff had been educated—exactly which staff and what the education was is unknown. We do know a fine of $2000 was imposed upon the hospital, which does not seem like much to me. A Bronx hospital was cited for discharging a patient after a two-day stay and telling him to go to a walk-in clinic. He had made two previous suicide attempts. Unfortunately, he took his own life. A...
Things doctors should not do—like attacking their nurses

Things doctors should not do—like attacking their nurses

Do not [allegedly] assault the nurses. A former nurse at a surgery center affiliated with Cedars-Sinai Medical Center in Los Angeles is suing an ophthalmologist who, she alleges, pushed her out of an operating room. Surveillance video shows what happened. An article in Modern Healthcare says the doctor then grabbed the nurse’s arm and told her he could do it because he knew she liked abuse. The nurse’s lawyer said his client was punished with a transfer and a decrease in her work hours leading to her eventual resignation. Cedars-Sinai declined to say whether the doctor had been disciplined. A surgeon at a Long Island, New York hospital, angry because a nurse gave one of his patients a dose of medicine at the wrong time, allegedly took a drawstring from his sweatshirt and wrapped it around her neck. As reported by Outpatient Surgery, the complaint says the surgeon, while choking her, told her he should kill her for what she did. He was arrested and charged with strangulation and assault. Whether he was sanctioned for wearing a hoodie in the OR is unknown. Updated on 2/28/18: After two witnesses said the alleged assault did not occur, the charges against the Long Island surgeon were dropped at the request of the assistant district attorney handling the case. For more details see this Medscape story. Do not carve your initials in the organs of patients you are operating on. Simon Bramhall, a surgeon in Birmingham, England was £10,000 for using an argon beam coagulator to carve his initials on the organs of two different patients while they were undergoing surgery. He...
Things medical personnel should not do

Things medical personnel should not do

Here are some tips from an experienced former provider—me. Nude Pictures… Do not take nude pictures of fellow employees. A woman unit secretary in the operating room of a hospital in Greene County, Pennsylvania said while she was anesthetized for an incisional hernia repair, an operating room nurse took photographs of her naked body and later showed them to several coworkers. The patient, known only as Jane Doe, has filed suit against the hospital, several of its employees, and the surgeon who operated on her because he did not report the nurse who took the pictures to hospital administration. According to the local newspaper, the OR nurse was fired after Ms. Doe reported the incident, but things did not go well for Ms. Doe either. After she returned to work, she was blamed for what happened and treated poorly by the staff. Someone wrote her a note that said, “What were you thinking?” and added an obscenity. She returned to work and suffered “migraines, anxiety, and insomnia.” After she took an unpaid leave recommended by her physician, the hospital terminated her. As is typical of lawsuits such as this [see my post of December 28, 2017], hyperbole must be used in order to fill up the 39 pages of the complaint. Despite no claim of a postoperative complication, Ms. Doe’s lawyer said she was at increased risk of infection because a cell phone, not necessarily one with more bacteria than a toilet seat, was taken into a sterile operating room. Murder… Do not [allegedly] murder a patient. An anesthesiologist was arrested and charged with murder in December because his...
The Burnout Paradox: Why Are We Still Surprised?

The Burnout Paradox: Why Are We Still Surprised?

If you go to medical school, you will be stressed—bigly. It should not come as a surprise. Two posts on the Kevin MD website highlight the problems facing many medical students today. The first was by an anonymous rising fourth year student who has come to the conclusion that going to medical school was “a terrible, terrible decision.” It ended with a comment that medical school “is not fun. It’s jarring, scary, disappointing and absolutely depressing.” The second was by another anonymous student who described how miserable he (or she) has been since he started medical school. He said “’burnout’ is the word I would use to best describe my medical school experience.” On the day he wrote his post, he was about to text the surgery residents to tell them he would not be there for the last day of his rotation because he was too anxious. He mentioned a strong family history of anxiety disorders and being diagnosed with depression and anxiety as he was applying to medical school. He did not disclose this during the application process. Burnout is not limited to a few students. A literature review in 2013 found “at least half of all medical students may be affected by burnout during their medical education.” Nor is the problem confined to medical students. A national survey published in Academic Medicine in 2014 found that 58.2% of medical students, 50.8% of residents/fellows, and 40% of early career physicians screened positive for depression. Last week, Medscape’s 2017 Lifestyle Report, a survey of practicing physicians, found that 51% were burned out—an increase from 40% in 2013. The...
Going off the deep end about water

Going off the deep end about water

The latest water craze has generated a lot of discussion. The New York Times reported that some people in California [where else?] have started drinking “raw water” which is “unfiltered, undertreated, unsterilized spring water.” Why are they doing this? They claim that tap water should be avoided because of fluoride. Google “evils of fluoride,” and you’ll find treatises such as “Top 10 dangers of fluoride.” What, only 10? Bottled water is not the answer because it is also treated to remove some minerals and beneficial bacteria. Before you go out and buy some raw water—also known by the brand name “Live Water” [eliminating the pejorative word “raw”], be aware that since the Times piece, a gallon costs $60.99. and as of this writing, it is back ordered. And here is a list of organisms that can be found in untreated water—giardia, legionella, norovirus, campylobacter, cryptosporidium, salmonella, and E. coli. Some illnesses resulting from drinking contaminated water can be fatal. Maybe the name “Live Water” is meant to alert you to the fact that it contains living things. The founder of the company that sells Live Water says drinking tap water is like “drinking toilet water with birth-control drugs in them [sic].” But he also points out that Live Water should be used “within one lunar cycle of delivery” because waiting longer may result in the water turning green. Sounds enticing, doesn’t it? Medical Twitter was not enthusiastic. Many commented that treated tap water has prevented diseases for the last 100 years or so. However, no epidemics will occur because an investigation by menshealth.com found Live Water comes from a...

Can Incident Reports Backfire?

Incident reports are frequently submitted by hospital personnel. Did you ever wonder what happens to them? I have. Over the years, I estimate that I’ve heard of hundreds of such reports being filed, but rarely have I heard of a problem being solved or for that matter, any action being taken at all. In fact, I don’t even know where they went or who dealt with them. When I was a department chairman, I sat on quality assurance and risk management committees. Yet we never discussed individual incident reports. According to a post by patient safety expert Dr. Bob Wachter, the original intent of incident reports was to identify patient harms and increase patient safety. Hospital incident reports are a spinoff from the Aviation Safety Reporting System, which  successfully uses them for identifying potential safety issues such as near misses. At Dr. Wachter’s hospital, San Francisco General, about 20,000 incident reports were filed every year. That is about half of what the Aviation Safety Reporting System receives per year, and San Francisco General is only one of about 6,000 hospitals in the United States. Do hospitals train people what to write and not write in incident reports? I don’t think so.   Dr. Wachter feels that analyzing incident reports is not worth it. He estimates that each incident report creates about 80 minutes of work, which multiplied by 20,000 reports equals about 26,600 hours of wasted time. He also says that about 25% of U.S. hospitals do nothing with incident reports. That saves time but renders the reports completely useless. He says an even bigger problem is that incident reports...
Ordering unnecessary laboratory tests continues to be a problem

Ordering unnecessary laboratory tests continues to be a problem

Unnecessary testing wastes money and can lead to further testing. Why does it occur? Almost 60% of medical personnel surveyed at a large academic medical center believed that hospitalized patients should have daily laboratory testing. Of 1580 attending physicians, fellows, residents, physician assistants, nurse practitioners, and nurses sent surveys, 837 (53%) responded; 393 (47%) were RNs, and 80% of those nurses felt that daily laboratory testing should be done on all patients. Nurses strongly felt that patient safety and protection against malpractice litigation were enhanced by daily laboratory testing. Of note is that more than half of those who returned completed surveys said they thought attendings would be uncomfortable with less testing, and 37% said they ordered unnecessary tests to satisfy attendings. However, the category of respondents who least felt daily tests were needed was attending physicians at 28%, and 84% of attending physicians said they would be comfortable if their patients had fewer laboratory tests. Unnecessary lab testing on their units was observed by 60% of respondents, but only 37% said they had requested unnecessary testing themselves. Perhaps the unnecessary tests had been ordered by people who did not respond to the survey or the tests were ordering themselves. The authors of the JAMA Internal Medicine study, done at Memorial Sloan Kettering Cancer Center in New York, concluded that although nurses did not order laboratory testing themselves, they might have some effect on the frequency of lab tests being done. Another recent survey published in Hospital Medicine asked internal medicine and general surgery residents at the Hospital of the University of Pennsylvania why they ordered unnecessary tests as...
Surgeon sued for talking on cell phone during an operation

Surgeon sued for talking on cell phone during an operation

A surgeon took a Spanish language proficiency test while performing varicose vein surgery on a 70-year-old woman. The doctor said he had to take the test during the procedure because no other time was available. Since the case was being done under local anesthesia, she could hear what he was saying. She said she speaks Spanish, heard him talking about diabetes and blurred vision, and was fearful for her safety because she thought the doctor was talking about his own medical problems. Nothing is more distracting than a cell phone in the operating room. In a perfect world, we would leave our cell phones in our lockers and sign out to another surgeon to cover us while we are operating. Unfortunately, the world is not perfect. Many times when I was on call, I was the only general surgeon covering two hospitals. I had to have my cell phone in the operating room to field any calls that came in. However, I cannot condone the actions of the surgeon in this case. Taking a language proficiency test while operating is inappropriate. According to a report, he admitted this as did his group’s medical director and risk management administrator. A malpractice suit has been filed alleging the patient suffered emotional distress which is still ongoing. The outcome of the procedure is not an issue. I have several thoughts. If the test was offered at only one time, he should have scheduled the operation for another time. If the patient was fluent in Spanish, she must have realized the surgeon was not talking about his own medical problems. A successful malpractice...
Patient satisfaction surveys are worthless

Patient satisfaction surveys are worthless

For several years, Medicare has tied hospital reimbursement to its definition of quality of care. Poorly performing hospitals can be penalized as much as 2% of their Medicare payments. As part of Medicare’s assessment of quality, surveys are used to measure patient experience and satisfaction. One of the components of the Medicare survey is pain management, which Medicare describes as follows: I’m not sure who, if anyone, does Medicare’s copy editing, but that’s the way it looks in a screen grab from the website. The emphasis on “always” controlling pain, which many patients equate with “no pain,” is one reason we have an opioid epidemic. How valid is patient satisfaction as a measure of quality? Some conflicting research has been done, but a recent paper from JAMA Internal Medicine implies the answer is “probably not valid.” Researchers from the Department of Family and Community Medicine at the University of California, Davis surveyed 1141 patients immediately after they made 1319 visits to 56 different family doctors; 897 visits involved one or more patient requests with 1441 (85%) fulfilled. The authors did not comment on that percentage, but acquiescing to 85% of patient requests seems quite high. From 10% to 18% of patient requests for pain medication, referrals, laboratory tests, and new medications other than antibiotics or pain medication were refused and resulted in statistically significant decreases in patient satisfaction of 9 to 20 percentiles after the results were adjusted for numerous patient characteristics known to affect patient satisfaction such as age, sex, race/ethnicity, education, marital status, body mass index, overall self-rated health, mental health status, personality factors, life satisfaction, worry...
Elective surgery ban for smokers and obese patients

Elective surgery ban for smokers and obese patients

The committee that plans and oversees medical care for the county of Hertfordshire, England announced recently that unless obese patients lose a specified amount of weight and smokers quit smoking for at least 8 weeks, they will not be allowed to undergo elective surgery. Patients with a body mass index (BMI) greater than 40 must lose 15% of their weight within 9 months, and patients with a BMI over 30 must lose at least 10%. Free counseling for weight loss and smoking cessation is available to all. Variations of these rules have been in effect in about one-third of England for quite a while. In some areas, similar rules have been waived if patients fail to meet their targets after a certain period of time. The Hertfordshire rules are unprecedented because they are in place indefinitely. The idea is that losing weight might decrease hospital lengths of stay and the incidence of complications after surgery and lead to better outcomes while saving money for the National Health Service (NHS). Opponents question the ethics of the decision, doubt that withholding surgery will work, believe the delay will cause more suffering, and even may be more expensive because patients might need more care while they await their operations. According to a CNN story, the Hertfordshire committee countered that the policy would “encourage patients to take more responsibility for their own health and well-being.” More than 60% of adults in Hertfordshire, a county of over 1.1 million, are overweight or obese, and almost 16% are smokers. Surveys have shown that the public supports the committee’s proposal with 85% agreeing that people should...
Can a handheld ultrasound replace your doctor?

Can a handheld ultrasound replace your doctor?

    Dr. Mercola, described by Wikipedia as “an alternative medicine proponent, osteopathic physician, and web entrepreneur, who markets a variety of controversial dietary supplements and medical devices through his website,” is jumping the gun. Yes, it’s true that a handheld ultrasound connected to a smart phone enabled a man to diagnose his own cancer. However, it was not just any man. It was vascular surgeon John Martin, MD. As an advisor for the company that developed the ultrasound device, he happened to be testing it. Noticing a sense of fullness in his throat, he put the probe on his neck and found what turned out to be a 3 cm squamous cell carcinoma. He did not know it was a cancer at the time but was suspicious. As reported in the MIT Technology Review, he eventually had a biopsy, lengthy operation, and radiation therapy. The ultrasound device, developed by a company called Butterfly Network, is much smaller than a conventional ultrasound machine because it generates the sound waves using thousands of vibrating drums the width of a human hair instead of larger vibrating piezoelectric crystals. Because it is so advanced, the multiple probes used in previous generations of ultrasound machines are unnecessary. Here’s a photograph of the probe containing the entire works connected to an iPhone. The Butterfly ultrasound is much less costly than most conventional ultrasounds, which can run as high as the mid-five figures. The price will make it attractive to hospitals, doctors, and first responders, but $1999 would be a lot for an individual to pay for something not readily usable by the average patient....
A surgical resident’s legal battle with her program

A surgical resident’s legal battle with her program

  A surgical resident is suing St. Louis University, its surgical residency program director, and its trauma service chief for what she claims is an unjustified decision requiring her to repeat her fourth year of training. The St. Louis Post-Dispatch article about this has a link to a 42-page PDF describing the details of the suit. Because I suspect you won’t read that PDF and maybe not even the article, I will give you some highlights. Remember, these are allegations that have not been adjudicated. Because of poor scores on the American Board of Surgery In-Service Training Examination (ABSITE), she had been placed on academic probation at the end of her third year of training even though other residents with poor scores were not subjected to the same disciplinary action. At that time, she was not provided a faculty advisor as mandated by university policy. During her fourth year of residency, written evaluations by faculty were generally very good, but some oral feedback she received was negative. However, she received no specific recommendations for improving her performance. In fact, she contends that attendings on some services filed no written evaluations at all which is contrary to the regulations of the Accreditation Council for Graduate Medical Education—the national organization that oversees all residency training in the United States. She says some backdated written evaluations appeared in her file. The surgery department’s Clinical Competency Committee met and disregarded all of the written evaluations previously submitted for this resident. Instead they relied on hearsay and a “consensus letter” supposedly endorsed by all of the trauma service attending staff but later repudiated by...
Nearly 42% of users are satisfied with their EHR systems, survey finds

Nearly 42% of users are satisfied with their EHR systems, survey finds

Okay, what was your first reaction when you read the above headline? Mine was a tweet: “How’s this for positive spin? LOL.” Some responses to me. @cwrightmd tweeted, “I’m nearly 42% satisfied with mine.” @catjacarol01 said, “Less than half is supposed to be good? Try to imagine saying nearly 42% of patients survive this surgery.” @manders8589 wondered how many of the 42% were physicians who used the electronic health record clinically? Good question. The brief SmartBrief article linked to one on the website of Healthcare IT News which produced the survey. Details about it were sketchy. The number of respondents in various healthcare roles was not provided. All we know is, “The readers who contributed to our research run the gamut of hospital jobs: chief information officer, IT director, clinical engineer, application analyst, facility risk manager, telehealth coordinator, nursing informaticist and more.” Did that gamut included any nurses or doctors in the trenches? The article did not provide that information, nor did it say how the survey was conducted, how many people were surveyed, and how many responded. Healthcare IT News never missed an opportunity to portray the EHR in a positive light. Here is the Healthcare IT News headline. Another example is this glowing endorsement. When asked, “What was your overall satisfaction with the EHR system?” nearly 42 percent of respondents gave their system either an eight or nine on a scale of 1-10. More than 5 percent gave it the top “Most Satisfied” score.” Wow 5 percent! I am impressed. But my favorite part of the piece was this gem: Nearly half [well, almost 42%] of those...
Why public reporting of individual surgeon outcomes should not be done

Why public reporting of individual surgeon outcomes should not be done

  Last week Dr. Ashish K. Jha, a Harvard internist and health policy researcher, published an opinion piece in JAMA, advocating public reporting of individual surgeon outcomes [full text here]. I have followed Dr. Jha for many years on Twitter and have enjoyed his blog posts and papers. However, I must respectfully disagree with much of what he wrote this time. He tries but fails to refute the arguments that critics of individual surgeon reporting have put forward. For example, Jha says that the way to solve the problem of small sample sizes is to aggregate cases over several years. For most operations, aggregating over 3-4 years would still not yield enough volume for proper analysis. He feels that combining the outcomes for similar operations could make it easier to assess a given operation. To illustrate this point, he wrote “a surgeon’s performance on esophagectomy improves with the number of other similar surgeries she performs.” I can’t think of a single operation that is like an esophagectomy because the esophagus anatomically differs from any other organ. Jha says that publicly reported data would be enhanced by including confidence intervals “to highlight the level of imprecision so that those reading the report are aware of the statistical limitations.” I chuckled at that one because many physicians don’t understand confidence intervals. To expect the public to do so is wishful thinking. The notion that surgeons would avoid difficult cases so as not to tarnish their records is dismissed by Jha who says while citing no references, “the evidence on the extent to which this occurs is weak and anecdotal.” I will...
Who is to Blame for Resident’s Legal Battle with Her Program?

Who is to Blame for Resident’s Legal Battle with Her Program?

Our blogger, Skeptical Scalpel, recently wrote about a surgical resident’s legal battle with her program, which highlights a surgical resident who is suing St. Louis University, its surgical residency program director, and its trauma service chief for what she claims is an unjustified decision requiring her to repeat her fourth year of training. The article has generated a lot of different opinions and comments online, coming from a wide range of professionals in the medical field. To add some background on this topic, the resident had been placed on academic probation at the end of her third year because of poor test scores on the American Board of Surgery In-Service Training Examination (ABSITE). Other residents with poor scores were not subjected to the same disciplinary action. During her fourth year of residency, written evaluations by faculty were generally very good, but some oral feedback she received was negative. However, she received no specific recommendations for improving her performance. In fact, she contends that attendings on some services filed no written evaluations at all which is contrary to the regulations of the Accreditation Council for Graduate Medical Education—the national organization that oversees all residency training in the United States. She says some backdated written evaluations appeared in her file. The resident, a nurse before attending medical school, was told she acted too much like a nurse by the residency program director, who is a woman, and the male trauma chief said she was “too nice” to be a surgeon. Too nice to be a surgeon? That’s a serious accusation. We can’t have that. The resident appealed the program’s decision to...
Do good online ratings mean you’re a good doctor?

Do good online ratings mean you’re a good doctor?

  If you are a patient looking for help when trying to find the right doctor, you probably think checking out online reviews would be a good thing to do. Two studies should give you pause. The first paper looked at risk-adjusted mortality rates for cardiac surgeons in 5 states (California, New York, New Jersey, Pennsylvania, and Massachusetts) that have published this data. Of the 614 surgeons whose information was public, 96% were rated on one or more of the well-known rating websites. The average risk-adjusted mortality rate for all the surgeons was 1.68% with a range of 0% to over 16%. The median rating for all surgeons was 4.4 on a scale of 1 to 5, and the median number of reviews per surgeon was 4. That’s right, 4. From the paper, the figure below shows the risk-adjusted mortality rate on the Y axis plotted against the average online ratings on the X axis. As you can see, ratings did not correlate with mortality rates, p = 0.13. Some surgeons with the highest risk-adjusted mortality rates had ratings of 5. The authors understated conclusion was “Patients using online rating websites to guide their choice of physician should recognize that these ratings may not reflect actual quality of care as defined by accepted metrics.” The second paper compared ratings data from three popular sites for 410 physicians who had been placed on probation by the Medical Board of California to controls matched by zip code and specialty. Again the average number of ratings was low at 5.2 for the probation group and 4 for the controls. Doctors with some...
Bladder catheter + oxygen supply tubing = death

Bladder catheter + oxygen supply tubing = death

  According to the coroner of South Australia, a 72-year-old former member of the Australian national men’s soccer team died a “horrific” and “macabre” death after his urinary bladder catheter was connected to his oxygen supply. His bladder then filled with oxygen until it burst. As the oxygen continued to flow at 2 L per minute, the resulting tension pneumoperitoneum caused his diaphragm to rise and eventually collapse his lungs so he could not breathe. The photo of an x-ray below illustrates what occurred. It is not an x-ray of the Australian patient, but the findings are similar to what would have been seen if an x-ray had been taken. The green arrows show the extent of the intra-abdominal free air leading to elevation of the diaphragm (blue arrows). The red arrows represent the decreasing lung volumes on both sides as the diaphragm rises. Not long after this tragedy came to light in late 2016, I blogged about the early progress of the coroner’s inquest. Speculation on how this could have occurred centered around two possibilities—the patient somehow cross-connected the tubing himself or a caregiver did so. As I explained in my original post, it was hard to imagine a confused old man figuring out how to connect two very different types of tubing. The coroner came to the same conclusion. A nurse said she had seen a white connector between the green oxygen tubing and the brown catheter but did not know what it was or understand its significance. Reports said the evidence was “destroyed” before it could be examined. Ironically, he should not have been receiving oxygen...
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