How twitter helped a technology consultant escape from an evil hospital(inmantechnologyit.blogspot.com)
inmantechnologyit.blogspot.com
How twitter helped a technology consultant escape from an evil hospital
http://inmantechnologyit.blogspot.com/2009/09/social-media-and-my-escape-from-spinal.html
15 comments
Having worked as a trauma nurse for years, I really can't believe that the entire hospital staff was conspiring to keep him there because he had good insurance. More often than not, we are kept entirely in the dark about people's insurance.
They may well have had a poor bedside manner, and they may well have tried to pressure him into having a surgery they thought necessary, but doctors disagree with treatment methods all the time. That doesn't mean that they were necessarily evil in disagreeing with the doctor in Boston.
It's also fairly standard practice for insurance companies to decline to pay a patient's hospital bill if that patient signs out against medical advice. So, if they said that he would have to pay out of pocket, they may well have been telling the truth. If he was signing out against medical advice, he may well have been responsible for the entire transfer bill, which would likely have been in the tens of thousands of dollars.
Also, if the hospital was the closest qualified trauma center, and if it was deemed by the Attending Neurosurgeon that he have surgery soon or risk permanent paralysis, it's understandable that they would have been reluctant to transfer the patient. And, if he was refusing emergency back surgery and if he was demanding transfer, he may well have been risking permantent paralysis as well as being financially liable for the hospitalization.
They may well have had a poor bedside manner, and they may well have tried to pressure him into having a surgery they thought necessary, but doctors disagree with treatment methods all the time. That doesn't mean that they were necessarily evil in disagreeing with the doctor in Boston.
It's also fairly standard practice for insurance companies to decline to pay a patient's hospital bill if that patient signs out against medical advice. So, if they said that he would have to pay out of pocket, they may well have been telling the truth. If he was signing out against medical advice, he may well have been responsible for the entire transfer bill, which would likely have been in the tens of thousands of dollars.
Also, if the hospital was the closest qualified trauma center, and if it was deemed by the Attending Neurosurgeon that he have surgery soon or risk permanent paralysis, it's understandable that they would have been reluctant to transfer the patient. And, if he was refusing emergency back surgery and if he was demanding transfer, he may well have been risking permantent paralysis as well as being financially liable for the hospitalization.
I want to agree with you, but what I am interested in knowing is why the boston doctor was insisting on a mobility test prior to surgery and why the small town folks were insisting on surgery first.
The same thing happens in small town India as well where doctors are more interested in keeping you admitted above and beyond the needed duration and doctors in large cities are just better because they have a greater patient load to be well versed with complex surgeries if needed.
The same thing happens in small town India as well where doctors are more interested in keeping you admitted above and beyond the needed duration and doctors in large cities are just better because they have a greater patient load to be well versed with complex surgeries if needed.
Watching her in the hospital and knowing that she swam to shore and stood up would have made a mobility test irrelevant. Being 40+ with a shattered T12, she made the riskier decision by opting out of the surgery. If you remove the hyperbolic language from her story, it reads like the hospital was being relatively conservative and trying to take the approach with the least risk of paralysis or other spinal cord injury. That said, It's awesome that she's able to recover without surgery. Even "successful" back surgeries usually have many complications. Surgery or not, back injuries suck and require tons of PT, exercise and lifestyle changes to get back to normal.
She made the riskier decision? What qualifications do you have to claim that?
According to the Harvard neurosurgeon she made the less risky decision. Given the choice between believing a random poster to hacker news and someone with those qualifications, I'm going with the known expert every time. It is just icing on the cake that the expert's opinion fits with what I've been told about the risks of back surgery by multiple doctors, physical therapists, and even a panel appointed by the US government. (Admittedly the last is somewhat out of date.)
According to the Harvard neurosurgeon she made the less risky decision. Given the choice between believing a random poster to hacker news and someone with those qualifications, I'm going with the known expert every time. It is just icing on the cake that the expert's opinion fits with what I've been told about the risks of back surgery by multiple doctors, physical therapists, and even a panel appointed by the US government. (Admittedly the last is somewhat out of date.)
I read it in the article I linked to in my previous post. But you're obviously more up to date on the facts, so you win.
The article suggests the small town folks were following outdated procedures, while the boston team was following modern procedures.
That's not really true. There are a lot of insurances that cover an airlift upto a million dollars. Some kitebording insurances I know do so.
An airlift from the scene of an accident is different than an air transport from one qualified trauma center to another per patient's request.
It never occurred to me that carrying high-level heath insurance would mark me as a candidate for unnecessary surgery.
Perhaps this is exactly why health care costs have gone up so dramatically. We have insurance, so the doctors take advantage of it -- needlessly. We very well could be spending a lot less money for the same amount of health care.
I think the solution to the health care problem is for someone to start saying NO, like in that other article on the front page now. No to more test, no to unnecessary treatments and surgeries and non-generic drugs.
Say no!
Perhaps this is exactly why health care costs have gone up so dramatically. We have insurance, so the doctors take advantage of it -- needlessly. We very well could be spending a lot less money for the same amount of health care.
I think the solution to the health care problem is for someone to start saying NO, like in that other article on the front page now. No to more test, no to unnecessary treatments and surgeries and non-generic drugs.
Say no!
As much as I think "tort reform" is a right-wing dog-whistle term, medical malpractice law has a lot to do with cases like this. Put simply, if you're insured and there's an incredibly remote chance that a test could show something, most doctors will issue it - it doesn't cost them anything, it doesn't cost you anything, and it protects them if something happens to you in the long run, at which point they can say "well, we tested for it and it was negative, so it's not our fault". From the doctor's point of view, ordering the additional test (or surgical procedure, etc.) has very little downsides and either marginal or significant upsides, depending on what ends up happening.
If you're interested in this, read up on the PSA (Prostate-Specific Antigen) test: it's the main test used to check for prostate cancer in males. You'd think that doctors would issue it to all males of a certain age annually, and up until recently most doctors did that. But there's been an interesting change of thinking in the past few years: someone noticed (and importantly, some insurance companies agreed) that the combination of an increase in the power of drugs/surgical techniques available to treat the disease and a stabilization of the relatively-high false-positive rate in the PSA test (and the dangers of what happens with a false-positive) means that unless someone has a predisposition to prostate cancer, it's often better not to test for it. The net result when the options are getting prostate cancer and taking the treatment vs. getting screened early and undergoing the invasive diagnostics needed to confirm a PSA test at that stage, it's usually a better choice just to get prostate cancer.
Note that this math goes out the window, however, if you have a family predisposition to prostate cancer. In that case, the risk of option #1 goes up (since it's predicated on the relatively low incidence rate of prostate cancer), and the dowsides of option #2 go down (since the probability of a false-positive is much lower).
If you're interested in this, read up on the PSA (Prostate-Specific Antigen) test: it's the main test used to check for prostate cancer in males. You'd think that doctors would issue it to all males of a certain age annually, and up until recently most doctors did that. But there's been an interesting change of thinking in the past few years: someone noticed (and importantly, some insurance companies agreed) that the combination of an increase in the power of drugs/surgical techniques available to treat the disease and a stabilization of the relatively-high false-positive rate in the PSA test (and the dangers of what happens with a false-positive) means that unless someone has a predisposition to prostate cancer, it's often better not to test for it. The net result when the options are getting prostate cancer and taking the treatment vs. getting screened early and undergoing the invasive diagnostics needed to confirm a PSA test at that stage, it's usually a better choice just to get prostate cancer.
Note that this math goes out the window, however, if you have a family predisposition to prostate cancer. In that case, the risk of option #1 goes up (since it's predicated on the relatively low incidence rate of prostate cancer), and the dowsides of option #2 go down (since the probability of a false-positive is much lower).
This is essentially the thesis of Arnold Kling's "Crisis of Abundance":
http://www.amazon.com/Crisis-Abundance-Rethinking-Health-Car...
Except for a few blockbuster interventions (antibiotics for bacterial infection, orthopedics, reading glasses), the expected return of many health care interventions is negative; they cost so much, and have the potential to do so much harm, for such uncertain good, that we're better off avoiding them. The only reason individual consumers subject themselves to so many negative-expected-value treatments is that they do not bear their full costs, sharing the financial part of them with their insurers.
http://www.amazon.com/Crisis-Abundance-Rethinking-Health-Car...
Except for a few blockbuster interventions (antibiotics for bacterial infection, orthopedics, reading glasses), the expected return of many health care interventions is negative; they cost so much, and have the potential to do so much harm, for such uncertain good, that we're better off avoiding them. The only reason individual consumers subject themselves to so many negative-expected-value treatments is that they do not bear their full costs, sharing the financial part of them with their insurers.
The problem with that philosophy is there are thousands of "blockbuster" treatments, everything from a simple filling, to a Tylenol would be miraculous if you steeped back a few hundred years.
Finding the right balance between cost and heath is hard, but blaming everything but the blockbusters is the wrong place to start. Two years ago my father went from fine to dead in one week in part because the doctor failed to ask for a single test. He had health inshurance, went to a doctor who liked to avoid extra tests and died. A hundred years ago, dieing at 62, could have been seen as living a long life, but today a simple test and a quick surgery and he could have lived another 20 years in good heath.
PS: If you really want to look for waste in heath care figure out where the money goes. Starting with the payments to your heath insurgence company and how little get's back to actual treatments.
Finding the right balance between cost and heath is hard, but blaming everything but the blockbusters is the wrong place to start. Two years ago my father went from fine to dead in one week in part because the doctor failed to ask for a single test. He had health inshurance, went to a doctor who liked to avoid extra tests and died. A hundred years ago, dieing at 62, could have been seen as living a long life, but today a simple test and a quick surgery and he could have lived another 20 years in good heath.
PS: If you really want to look for waste in heath care figure out where the money goes. Starting with the payments to your heath insurgence company and how little get's back to actual treatments.
Whether or not you like that philosophy in general, and despite your father's tragedy, it is extremely appropriate for spinal surgery. Spinal surgery costs a lot of money, frequently goes very badly, and even "successes" tend to be temporary and are followed in a few years by being worse off.
This is why in the mid-90s the Agency for Health Care Policy Research (AHCPR) looked at the subject and concluded that back surgery was inadvisable if any other options were available. Unfortunately for the AHCPR back surgeons are a fairly well off group, got the AMA on their side, and the result was that Congress nearly destroyed the AHCPR. The remnants have learned not to issue politically controversial opinions, no matter how well-founded in fact they may be. Thus a well-meaning attempt to actually evaluate expensive medical treatments for effectiveness ended.
Incidentally experts claim that the vast majority of the gains in life expectancy over the last 150 years have been due to improvements in public health, not medicine. Each of vaccination, sanitation and clean water supplies has done more to contribute to longevity than any medical advance you care to name, including antibiotics. Yet people are unaware of the contribution of public health. I find this odd.
This is why in the mid-90s the Agency for Health Care Policy Research (AHCPR) looked at the subject and concluded that back surgery was inadvisable if any other options were available. Unfortunately for the AHCPR back surgeons are a fairly well off group, got the AMA on their side, and the result was that Congress nearly destroyed the AHCPR. The remnants have learned not to issue politically controversial opinions, no matter how well-founded in fact they may be. Thus a well-meaning attempt to actually evaluate expensive medical treatments for effectiveness ended.
Incidentally experts claim that the vast majority of the gains in life expectancy over the last 150 years have been due to improvements in public health, not medicine. Each of vaccination, sanitation and clean water supplies has done more to contribute to longevity than any medical advance you care to name, including antibiotics. Yet people are unaware of the contribution of public health. I find this odd.
You just swapped your argument from the majority of modern medicine to a specific case. Spinal surgery is also a moving target, the risk / reward line keeps shifting as better treatments shows up. Still in a wide range of cases it's a bad idea, for now.
I just swapped whose argument? Look at the names of the posters in this thread...
In any case the original article was about a woman who went through a nightmare to get a hospital to not perform unwanted, unneeded and dangerous spinal surgery. So to my eyes I was bringing the discussion back to the example under discussion. And pointing out that it has been well known for over a decade that spinal surgery is a generally bad idea to me underscores the horror of what happened to her.
In any case the original article was about a woman who went through a nightmare to get a hospital to not perform unwanted, unneeded and dangerous spinal surgery. So to my eyes I was bringing the discussion back to the example under discussion. And pointing out that it has been well known for over a decade that spinal surgery is a generally bad idea to me underscores the horror of what happened to her.
Ops, sorry.
Hmm,
You don't specify what missed test killed your father.
There are, however, many symptoms where, given the uncertainty of all technology today, giving an operation or a drug prescription to might save X lives whereas NOT taking action would save Y lives, where X and Y are very uncertain.
The harder thing, though, the lives that are lost through giving the operation or the drug tend to be even harder to measure - people die through being prescribed 4,5,6...X drugs up to the point that interaction fry them without any one drug being "to blame". People die from complications of many surgeries, yet if the surgery is possibly necessary, people don't think to blame the decision to operate (the New Yorker figure that surgical accidents kill more than auto accidents is remarkable - auto accidents were once the 4th leading cause of death in the US). And there is a hidden if you test everyone for everything. False positives can kill people - false positives do kill many people today.
And as the New Yorker article mentions, physician incentives to make tests (or in other circumstances, to avoid them) can make a big difference.
You don't specify what missed test killed your father.
There are, however, many symptoms where, given the uncertainty of all technology today, giving an operation or a drug prescription to might save X lives whereas NOT taking action would save Y lives, where X and Y are very uncertain.
The harder thing, though, the lives that are lost through giving the operation or the drug tend to be even harder to measure - people die through being prescribed 4,5,6...X drugs up to the point that interaction fry them without any one drug being "to blame". People die from complications of many surgeries, yet if the surgery is possibly necessary, people don't think to blame the decision to operate (the New Yorker figure that surgical accidents kill more than auto accidents is remarkable - auto accidents were once the 4th leading cause of death in the US). And there is a hidden if you test everyone for everything. False positives can kill people - false positives do kill many people today.
And as the New Yorker article mentions, physician incentives to make tests (or in other circumstances, to avoid them) can make a big difference.
http://en.wikipedia.org/wiki/Pulmonary_embolism it's an accute problem and highly treatable. He had a collapsed lung and went to the doctor 4 days before he died. It's a common killer because it masks as other things, but you can do a fairly cheep pretest. Mortality from untreated PE is said to be 26%.
[edit] Anticoagulation is the more common treatment because it has better long term odds. But, that assumes fairly early detection.
[edit] Anticoagulation is the more common treatment because it has better long term odds. But, that assumes fairly early detection.
This article in the New Yorker is excellent:
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_...
Atul Gawande argues that the problem with healthcare in the US is overutilization.
The surgeon gave me an example. General surgeons are often asked to see patients with pain from gallstones. If there aren’t any complications—and there usually aren’t—the pain goes away on its own or with pain medication. With instruction on eating a lower-fat diet, most patients experience no further difficulties. But some have recurrent episodes, and need surgery to remove their gallbladder.
Seeing a patient who has had uncomplicated, first-time gallstone pain requires some judgment. A surgeon has to provide reassurance (people are often scared and want to go straight to surgery), some education about gallstone disease and diet, perhaps a prescription for pain; in a few weeks, the surgeon might follow up. But increasingly, I was told, McAllen surgeons simply operate. The patient wasn’t going to moderate her diet, they tell themselves. The pain was just going to come back. And by operating they happen to make an extra seven hundred dollars.
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_...
Atul Gawande argues that the problem with healthcare in the US is overutilization.
The surgeon gave me an example. General surgeons are often asked to see patients with pain from gallstones. If there aren’t any complications—and there usually aren’t—the pain goes away on its own or with pain medication. With instruction on eating a lower-fat diet, most patients experience no further difficulties. But some have recurrent episodes, and need surgery to remove their gallbladder.
Seeing a patient who has had uncomplicated, first-time gallstone pain requires some judgment. A surgeon has to provide reassurance (people are often scared and want to go straight to surgery), some education about gallstone disease and diet, perhaps a prescription for pain; in a few weeks, the surgeon might follow up. But increasingly, I was told, McAllen surgeons simply operate. The patient wasn’t going to moderate her diet, they tell themselves. The pain was just going to come back. And by operating they happen to make an extra seven hundred dollars.
My wife had the exact same problem: first time gallstone pain, and the hospital wanted to operate immediately.
Instead, we got second opinions from various sources and decided to wait.
I am sure the pain will come back some day and then we will have to make another decision, but meanwhile we have avoided an invasive surgery.
I am sure the pain will come back some day and then we will have to make another decision, but meanwhile we have avoided an invasive surgery.
Another good article which I don't think is getting as much press as the New Yorker article:
http://www.theatlantic.com/doc/200909/health-care
http://www.theatlantic.com/doc/200909/health-care
Fantastic article, but it was on the front page about a month ago:
http://news.ycombinator.com/item?id=760477
http://news.ycombinator.com/item?id=760477
This is a fascinating read. It's long but worth it.
A friend of mine who works for Qualcomm in san diego says this happened to him as well. He went to the dentist to have all 4 wisdom teeth removed. They asked him to schedule it over 4 separate days rather than doing it all at once, just so that they could charge the maximum allowable amount per day to the insurance company -- they actually explained that to him!
We very well could be spending a lot less money for the same amount of health care.
... not to mention greater actual health.
When health care was the leading issue in Canada a few years ago and every politician was going around promising to expand it, I remember wondering if I was the only one thinking we need less of it, not more.
It might be helpful if we used a more accurate label than "health care" (perhaps "disease industry").
... not to mention greater actual health.
When health care was the leading issue in Canada a few years ago and every politician was going around promising to expand it, I remember wondering if I was the only one thinking we need less of it, not more.
It might be helpful if we used a more accurate label than "health care" (perhaps "disease industry").
Hey, as a Canadian, if you feel you don't want as much health care, just use it less. The system is designed so that people take as much as they need, but not more.
One of the problems in Canada (at least Ontario -- because healthcare is run by the province not the federal government) is people using the emergency room as a doctor's office. This is because regular practice doctor's are regulated on the number of patients they can see (this is an attempt to prevent doctors from seriously overbooking themselves with patients in an attempt act like a 'health factory' where patients are just pushed down an assembly-line) so people have a hard time getting an actual physician.
There are a couple of solutions to this, but no one really talks about them. (1) There are plenty of people that are qualified to be doctors, but because they did their medical school in India or China before immigrating to Canada, they aren't allowed to be certified as doctors. (2) Lots of doctors 'jump ship' to more profitable countries like the USA because they can just charge insurance and they aren't regulated from creating a 'factory practice' where no patient ever gets more than 5 minutes of the doctor's time.
There are a couple of solutions to this, but no one really talks about them. (1) There are plenty of people that are qualified to be doctors, but because they did their medical school in India or China before immigrating to Canada, they aren't allowed to be certified as doctors. (2) Lots of doctors 'jump ship' to more profitable countries like the USA because they can just charge insurance and they aren't regulated from creating a 'factory practice' where no patient ever gets more than 5 minutes of the doctor's time.
Uh,
In the US, a large number of people use the emergency room as a doctor's office because they have no other choice.
So, Canada: problematic. US: fail
But if Canada keeps using US logic, it might wind-up in our boat. Good luck to you...
In the US, a large number of people use the emergency room as a doctor's office because they have no other choice.
So, Canada: problematic. US: fail
But if Canada keeps using US logic, it might wind-up in our boat. Good luck to you...
> In the US, a large number of people use the emergency room as a doctor's office because they have no other choice.
How do you mean though? I'm saying that people with flu/colds/UTI/etc just go to the emergency room instead of a doctor's office (or even walk-in clinics at times) in Canada. I've been without healthcare, but I spent most of my life on a good healthcare plan through my parents. I don't have much experience with people that are off of the healthcare system (the only time I've had friends that were 'poor'[1] was in Canada where they were still covered for healthcare and social assistance).
[1] By poor I mean, barely making any money and living off of welfare and/or living in subsidized housing. I don't mean starving/homeless, though I was a couple of 'degrees' away from people that were homeless.
> But if Canada keeps using US logic, it might wind-up in our boat.
How do you mean?
> Good luck to you...
I'm currently living in the US, but I was living in Ontario for a time. It just irks me when people start talking about the 'problems with the Canadian system' when it's not a unified system as I understand it. The same when people start talking about 'socialized medicine,' since every country that has such a system has a different take on it.
How do you mean though? I'm saying that people with flu/colds/UTI/etc just go to the emergency room instead of a doctor's office (or even walk-in clinics at times) in Canada. I've been without healthcare, but I spent most of my life on a good healthcare plan through my parents. I don't have much experience with people that are off of the healthcare system (the only time I've had friends that were 'poor'[1] was in Canada where they were still covered for healthcare and social assistance).
[1] By poor I mean, barely making any money and living off of welfare and/or living in subsidized housing. I don't mean starving/homeless, though I was a couple of 'degrees' away from people that were homeless.
> But if Canada keeps using US logic, it might wind-up in our boat.
How do you mean?
> Good luck to you...
I'm currently living in the US, but I was living in Ontario for a time. It just irks me when people start talking about the 'problems with the Canadian system' when it's not a unified system as I understand it. The same when people start talking about 'socialized medicine,' since every country that has such a system has a different take on it.
Rational appraisal of risks, especially about your own healthcare and as a non-expert, is difficult.
The remedy isn't about saying no, the remedy is sunlight and transparency. There should be consequences to overbilling, unnecessary treatments. There are after all a great deal of medical treatments and tests that are necessary and should be done but because of third party payers, it creates perverse incentives and discourages competition and accountability which is what we really need.
I agree, and I said, No! Less was way more, for me.
According to the author, the story is being used as fodder by both sides of the healthcare debate. All I can see is the perverse economic incentives on display.
AFAIK Canada gets around this problem by capping the number of billable patients a doctor can see per day (adjusted by specialty of course). Any patients in excess of the cap is only paid by the government at a steeply discounted rate.
This discourages doctors from overworking themselves and offering shoddy care (instead choosing to move patients through like a cattle farm), and also discourages the sort of unnecessary treatment this article talks about.
This discourages doctors from overworking themselves and offering shoddy care (instead choosing to move patients through like a cattle farm), and also discourages the sort of unnecessary treatment this article talks about.
I suspect that the doctors at this hospital would be well under the quota you speak of. Remember, the author suggested the hospital might lose it's accredition for this type of surgery since they didn't do enough of them.
I wonder if the treatment was really all about the "really great health insurance" and not just the doctors at the hospital deciding that they knew better than another doctor many hours away that had not seen the patient or the pictures of her spine.
Upon reading the description of how the accident took place, my first thought was, "Really, is her insurance going to pay for that!?" And according to the last comment on her blog post, apparently the answer is, "No."
I would imagine either hospital would have to have enough familiarity with that type of accident to question whether her insurance would cover it as well.
Upon reading the description of how the accident took place, my first thought was, "Really, is her insurance going to pay for that!?" And according to the last comment on her blog post, apparently the answer is, "No."
I would imagine either hospital would have to have enough familiarity with that type of accident to question whether her insurance would cover it as well.
Ah,is that really a question? My comment on my blog that my health insurance decided it was best to leave me on the ledge to die of exposure was-need I say-tongue in cheek.You must be under the impression the insurance companies are in possession of that awesome perfect blame calculator - parsing an infinite number of scenarios to detemine blame for accidents and disease, then confirm or deny coverage based on their magic box. That is your insurance company, not mine. Please reply quickly, unless you are tied up arguing with them about whether they should cover your AIDS since everyone knows sharing needles is unsafe.
I got too say, I would be surprised if an insurance would not cover something like this. This is equivalent to a sports injury. Frankly no one can tell me that jumping off a cliff mountain biking is less dangerous than a bridge jump. I've bridge jumped before (not fifty feet I believe but high) and I wasn't the only one around, I didn't think it was that dangerous at the time but I understand how a bad landing could cause such an injury. Hell Olympic divers have really bad landings doing 33 feet dive and don't die.
The reason I questioned whether they would cover this is because in the past I've seen exclusion clauses that stated an insurance company would not cover extreme sports related injuries with a standard health insurance policy. The examples I remember for extreme sports were things like base jumping and bungee jumping and parachuting.
I don't pretend to know much about this stuff. I did state that it was just a question I had. If insurance companies routinely cover people who have accidents while doing things significantly more dangerous than your typical day to day activities then that is great... I guess.
The first part of my comment still stands regardless. I wonder how much of the battle was over getting insurance money and how much of it might have been over the doctor's ego.
I don't pretend to know much about this stuff. I did state that it was just a question I had. If insurance companies routinely cover people who have accidents while doing things significantly more dangerous than your typical day to day activities then that is great... I guess.
The first part of my comment still stands regardless. I wonder how much of the battle was over getting insurance money and how much of it might have been over the doctor's ego.
And the ultimate lesson of all of this: If your friend jumps off a bridge, are you going to jump off of a bridge too?
Although your comment looks like a vacuous redditesque one-liner, I'll respond: I've jumped from similar heights under similar circumstances, i.e. a spot favored by locals, surrounded by people happily jumping and swimming. It's only in hindsight that what she did was an obviously bad move, and even then it sounds like a slightly different angle would have made it harmless.
This aspect is hardly "the ultimate lesson of all this": if the post were merely about someone who jumped into a pond when they shouldn't have, no one would be discussing it.
This aspect is hardly "the ultimate lesson of all this": if the post were merely about someone who jumped into a pond when they shouldn't have, no one would be discussing it.
Three other people were injured that day from jumping, and the ambulance that was called wasn't even called for the heroine of our story. I don't know what the denominator is, but it doesn't sound good.
I do agree though, that jumping or not wasn't the main issue here.
I do agree though, that jumping or not wasn't the main issue here.
Seems like it was a 'hot spot' because people used it often. Sure she says that other people were injured, but how badly? It's possible that her injury was the worse injury anyone has ever sustained from jumping there. If that's the case, and parents still encourage/let their children jump from that bridge, I would say it's a problem. (Not that I would ever let my kids jump from a 50' bridge, at least not until they're old enough to make decisions on their own -- I'm not advocating 'babying' your children after they've left the nest.)
Parents often do silly things for their kids :/ It's sort of beside the point as you say.
I wasn't really trying to be funny; it's advice my Mother gave me, repeatedly. I think it's sound, regardless of the issue with the hospital.
Here, let me repackage it for you so it's less topical: if people are doing something that you think is dangerous, don't do it just because they did it.
Here, let me repackage it for you so it's less topical: if people are doing something that you think is dangerous, don't do it just because they did it.
It's like that Paul B article: what's the worst that could happen, and what's the best possible outcome. IMO, the best possible outcome from jumping off a bridge is not really worth the worst possible outcome.
If my friends (who are sane and not dumb) decide it is best to jump off the bridge, I think I will jump also. I get the feeling that there is something on the bridge that will have a higher chance of killing me then the fall from the bridge. Also, it is always the idiot who stays and says "what's going on" that get killed in the horror movies.
"According to Ithaca Fire Department statistics, Lowe was the fifteenth person to die in Ithaca's gorges since 2000—and the fourth to drown in that particular pool since 1986. When most people think of gorge deaths, they think of the jumpers who have given Cornell an unwanted (and unwarranted) reputation as a suicide hot spot. But Ithaca Police Officer Doug Hoyt estimates that about half of those fifteen deaths were accidents caused by turbulent water, slippery rocks, fallen trees, and a host of other natural features. The local community has mourned each death. But Lowe's passing—coming in the wake of the drowning the previous year of Jeevan Mykoo, a thirty-year-old tourist from Ottawa, and the 2006 death of Navin Parthasarathy, a visiting graduate student from the University of California, Santa Barbara—has spurred a widespread debate about how to deal with the dangers and appeals of one of Cornell's great natural attractions."
http://cornellalumnimagazine.com/index.php?option=com_conten...
http://cornellalumnimagazine.com/index.php?option=com_conten...
That is a harrowing story. If it's half true, the hospital really is evil.
Doubt the doctors are the evil ones. If they're using an outdated procedure it means they haven't been kept up to date on the latest treatment protocols. The hospital beaurocrats trying to keep their accredation and earn big bucks, those are the evail ones.
They are evil because they were thinking of themselves before the patient and using lies to intimidate her into agreeing with them -- when they were wrong.
That's evil. Unfortunately, it's a story repeated across the nation every day.
That's evil. Unfortunately, it's a story repeated across the nation every day.
No accreditation means no funding, means no hospital, means no job. So by your definition, the only way doctors can remain doctors at said hospital is by being evil. Hence, I would blame the short-sighedness of whoever created and approved for the rules of accreditation for hospitals, not the people at the whims of those rules.
If you're right, all it means is that no ethical doctor would remain at said hospital. Ethics only count when they go against one's own interests, otherwise they'd be pointless.
I can't believe you're making excuses for doctors who (if the story is true) tried to bully a woman against her will into having major spinal surgery that she clearly didn't need.
I can't believe you're making excuses for doctors who (if the story is true) tried to bully a woman against her will into having major spinal surgery that she clearly didn't need.
Not quite making excuses, just pointing out that the system that necessitates 'evil' behavior is also to blame...
Wrong, there are many people who may go to that hospital by choice. It only is the act of lying and not obeying the patients wishes that are evil.
If they can't keep their accreditation then perhaps they could offer discounts to entice people to their hospital.
If they can't keep their accreditation then perhaps they could offer discounts to entice people to their hospital.
One's choices are never completely at the whim of someone else's rules.
Don't downmod this, it has a valid point. It's by far better if the rules of the game don't give incentives to being evil. If they do it's as good as guaranteed that sometime somewhere you will get this kind of incident. Whether you choose to also blame the individuals involved is up to you, but it's the rule-makers who created this.
Every rule system ever designed has the potential to be misinterpreted, misused, and create incentives that were never intended.
Rule systems and rule makers can't be held responsible for idiotic/selfish/malicious behavior by individuals. Yes rules and systems can be refined to improve them but ultimately it will always be up to the individual to exercise judgement and moral character. So I'm afraid I have to disagree with you. If you blame the system for being misused you miss the point.
Rule systems and rule makers can't be held responsible for idiotic/selfish/malicious behavior by individuals. Yes rules and systems can be refined to improve them but ultimately it will always be up to the individual to exercise judgement and moral character. So I'm afraid I have to disagree with you. If you blame the system for being misused you miss the point.
It's interesting that you try to absolve the doctors by rendering them passive ("they haven't been kept up to date" - whose responsibility is that? and how did they react when presented with correct information?). Most evil happens by default. The same is no doubt the case with the hospital administrators.
The interesting characters in the story (again, assuming this is all true) are the sympathetic subordinates - nurses and so on - who supplied information about what was really going on.
The interesting characters in the story (again, assuming this is all true) are the sympathetic subordinates - nurses and so on - who supplied information about what was really going on.
Oi, that sure was lengthy. Summary: Some hospital in Pennsylvania tries to make money by doing unnecessary procedures on patients with good health insurance and went to great lengths to keep this lady from seeking a second opinion regarding her injury.
IMO, this is the incentive of nearly all doctors in America - the dentists I've had span the entire spectrum of opinions about my wisdom teeth. From "if we don't take them out, you can die from a gum infection" to "do they hurt? no? do you eat meat? then you should keep them, they'll makes it easier to chew".
IMO, this is the incentive of nearly all doctors in America - the dentists I've had span the entire spectrum of opinions about my wisdom teeth. From "if we don't take them out, you can die from a gum infection" to "do they hurt? no? do you eat meat? then you should keep them, they'll makes it easier to chew".
About 15 years ago, the dentist I went to said dire things about the immense pain my wisdom teeth were going to cause in my immediate future. I told him I'd make an appointment right away when that happened, even though his advice was to intervene as soon as possible to 'avoid any future problems'. I still have all of them and aside from the occasional twinge, they are just fine.
It's not necessarily about money though. To my knowledge, most people have problems with their wisdom teeth coming in wrong and screwing up their other teeth. If this is the majority case, then going on the offensive and taking care of them early can make sense rather than waiting to have issues.
Sometimes these cases end up sounding to me like the people who try to decry the state laws requiring you to wear a seatbelt by pointing out the relatively few cases where not wearing a seatbelt did save (or could have saved) someone's life. They completely ignore the overwhelming number of cases where seatbelts do save people's lives. It's just a case of people trying to make the facts fit a conclusion that they've already come to and don't want to change.
Sometimes these cases end up sounding to me like the people who try to decry the state laws requiring you to wear a seatbelt by pointing out the relatively few cases where not wearing a seatbelt did save (or could have saved) someone's life. They completely ignore the overwhelming number of cases where seatbelts do save people's lives. It's just a case of people trying to make the facts fit a conclusion that they've already come to and don't want to change.
You'd have to go to statistics to make any sort of real determination, of course (anecdotes, data, etc...), but it's definitely not something where I'm trying to make the facts fit a conclusion - it happened that way and it made me suspicious of at least one dentist.
That comparison is like saying that when someone gets diagnosed with diabetes, they should preemptively amputate their feet so as to avoid trouble with them later.
So you are saying that removal of wisdom teeth gives you a disability similar to removal of feet?
Point taken. How about giving everyone an appendicectomy, just in case?
So far as I know appendix removal is move invasive of a surgery with more risk than removal of wisdom teeth is.
Other than that, I would want to see the numbers on '% of people that need appendix removal' vs '% of people that need wisdom teeth removal.' My suspicion is that the latter is much higher than the former, but I could be wrong.
Other than that, I would want to see the numbers on '% of people that need appendix removal' vs '% of people that need wisdom teeth removal.' My suspicion is that the latter is much higher than the former, but I could be wrong.
This seems like a situation where knowing a certain phrase might help. I don't know what that phrase might, but a lawyer or someone else familiar with the medical industry might.
Something like "I will not authorize you to perform this procedure and have notified my physician and lawyer of this, if you perform anything that I have not authorized will result in an expensive lawsuit" or something.
Anyone know what the right terms to use are? It seems in other situations there are magic words that can be used to produce immediate results.
Something like "I will not authorize you to perform this procedure and have notified my physician and lawyer of this, if you perform anything that I have not authorized will result in an expensive lawsuit" or something.
Anyone know what the right terms to use are? It seems in other situations there are magic words that can be used to produce immediate results.
You can always -- provided you are sane, sober, and alert -- decline treatment or even just check yourself out of the hospital "against medical advice." Generally this involves signing some forms releasing the hospital from all responsibility for you. And then you can just walk out.
Hospital personnel will try to strongly discourage you from doing this -- not because they're evil, but because in most situations it's a really, really bad idea. But if you just keep saying "no, I don't want treatment, I want to leave, give me the forms to sign out AMA," and you're not clearly nuts or high on morphine or otherwise impaired, you can pretty much just leave.
However, unless you have a very specific reason for believing that the treatment protocol at work isn't correct or best for you, it's generally a bad idea.
Hospital personnel will try to strongly discourage you from doing this -- not because they're evil, but because in most situations it's a really, really bad idea. But if you just keep saying "no, I don't want treatment, I want to leave, give me the forms to sign out AMA," and you're not clearly nuts or high on morphine or otherwise impaired, you can pretty much just leave.
However, unless you have a very specific reason for believing that the treatment protocol at work isn't correct or best for you, it's generally a bad idea.
Since that time, people on both sides of the health care debate have listened to my story and pointed out it supports their views, both pro and con.
Unsurprising. I think this is more about patients' rights than healthcare funding, though.
Unsurprising. I think this is more about patients' rights than healthcare funding, though.
Yea. I can see people on both sides saying crap about this.
Pro: This wouldn't happen with government healthcare because there would be standards in place (i.e. the 'mobility test' would be standard everywhere not just in 'cutting edge' facilities)
Con: In government-run healthcare, she would have been forced to stay in that hospital so as to minimize the costs of treating her (i.e. no expensive transport from PA to Boston). The government would be taking away her individual rights to take ownership of her situation.
The healthcare debate is a lot more nuanced than the 'Arg! Socialism!' or 'Arg! Health insurance is evil!' crowds make it out to be.
Pro: This wouldn't happen with government healthcare because there would be standards in place (i.e. the 'mobility test' would be standard everywhere not just in 'cutting edge' facilities)
Con: In government-run healthcare, she would have been forced to stay in that hospital so as to minimize the costs of treating her (i.e. no expensive transport from PA to Boston). The government would be taking away her individual rights to take ownership of her situation.
The healthcare debate is a lot more nuanced than the 'Arg! Socialism!' or 'Arg! Health insurance is evil!' crowds make it out to be.
Well, it's more like the pro is that there is no profit motive to keep her there. The staff would be delighted to get rid of her to a bigger facility elsewhere. I live a kilometre north of a large hospital in Sydney, Australia and we get helicopters coming in all hours of the day and night, presumably doing just that.
The "con" would probably be that there would be no facility for spinal surgery in a rural area in the first place. She would not be able to choose to be treated there and she's getting on one of those helicopters.
The "con" would probably be that there would be no facility for spinal surgery in a rural area in the first place. She would not be able to choose to be treated there and she's getting on one of those helicopters.
Well, it all depends on the 'type' of government healthcare that happens.
If hospitals are still privately owned, but the government basically starts it's own 'insurance company' that covers everyone that isn't part of the private insurance company plan (similar to Germany) then it's possible that a rural area could still have spinal surgery experts. Even if the hospitals are all government-owned and run (similar to the UK method of healthcare), it's still possible to have spinal surgery experts in a rural area. It just would depend on what was cheaper. Is it cheaper to have a spinal surgery-trained staff at the rural hospital or to fly everyone 300 miles to another hospital? (Or the 3rd option of having staff at a different hospital, but making sure that it is less than 300 miles away -- i.e. spread out facilities that can handle such injuries so that there aren't hugely expensive transit costs for treatment)
If hospitals are still privately owned, but the government basically starts it's own 'insurance company' that covers everyone that isn't part of the private insurance company plan (similar to Germany) then it's possible that a rural area could still have spinal surgery experts. Even if the hospitals are all government-owned and run (similar to the UK method of healthcare), it's still possible to have spinal surgery experts in a rural area. It just would depend on what was cheaper. Is it cheaper to have a spinal surgery-trained staff at the rural hospital or to fly everyone 300 miles to another hospital? (Or the 3rd option of having staff at a different hospital, but making sure that it is less than 300 miles away -- i.e. spread out facilities that can handle such injuries so that there aren't hugely expensive transit costs for treatment)
With a government healthcare system, it won't simply be a cost/benefit analysis. There is also the all important question to be answered: "does this create jobs in my congressional district?"
Interesting. Yeah, it does sound like if either group has their way, it very likely could have a side effect of preventing this particular scenario from happening again.
True, but clearly that some have too little and others, relatively, too much- i think that was a major issue in my situation.
The story really doesn't involve Twitter much at all.
But that's not true. It describes her as using Twitter throughout the ordeal. Most importantly, it was through Twitter that she met the ethical neurosurgeon who saved her.
Incidentally, her title references "social media" rather than Twitter, which I think is right; it's not hard to imagine, say, Facebook playing the same role. What's relevant is that she got word of her plight out to a network of people in a way that would be harder to do otherwise, and that feedback from this network led to a fundamentally different outcome than that experienced (I imagine) by most people with broken spines who are having unnecessary surgery and narcotics forced on them against their will.
Incidentally, her title references "social media" rather than Twitter, which I think is right; it's not hard to imagine, say, Facebook playing the same role. What's relevant is that she got word of her plight out to a network of people in a way that would be harder to do otherwise, and that feedback from this network led to a fundamentally different outcome than that experienced (I imagine) by most people with broken spines who are having unnecessary surgery and narcotics forced on them against their will.
Are people that responsive on Facebook?
Absolutely. I see people basically chatting in comments on status updates. I think the problem would be more about spreading the story quickly. Twitter doesn't have the "friend" requirement, ultimately making it the better tool(?) here.
I do to from time too, but I asked because personally, I rarely see people get questions answered on Facebook the way they regularly do on Twitter. But then again, the people that Twitter and get questions answered quickly are probably your blogger, big personality types too.
And then yet back on the other hand, as you say, there is no friend requirement so those big personality types could really only amplify their voice in that way over Twitter.
And then yet back on the other hand, as you say, there is no friend requirement so those big personality types could really only amplify their voice in that way over Twitter.
Perhaps the network doesn't matter as much as who you are connected with and how much they want to help. Those girls that updated their Facebook status instead of calling local emergency services after being stuck in a storm drain eventually got out because a friend called for them (see http://www.switched.com/2009/09/08/endangered-pre-teens-upda...). I'm sure there's plenty of similar stories out there.
This really just amounts to part of the Twitter Hype machine.
That is an amazing story!
Its also why we need to fix healthcare.
Raze that place to the ground, and throw those "medical" staff in jail for life.
A rural surgeon is going to be professionally offended if their patient calls up an egghead at Harvard from their pre-op hospital bed and then tells him she doesn't trust his judgement and instead wants to be medivac airlifted back to Boston. It's like when you watch a detective show when the FBI takes over and the local cops are all bent out of shape. The hospital staff may have been thinking about health insurance and losing their accreditation but I doubt it was a sinister plot to meet their spinal surgery quotas. It was probably more along these lines: "a crazy lady from Boston just broke her back jumping off a bridge with some 13 year olds. Now she's telling us to schedule a chopper to Boston because she's Facebook buddies with some prick neurology prof at Harvard. Quick, give her some morphine and get her under the knife before her spinal column collapses and she's paralyzed and we get slapped with a half billion dollar malpractice suit... "
Note that I'm not defending that sort of attitude. That's just what I think they would be thinking, rather than some nefarious conspiracy to maximize insurance profits, which is what the article and most commenters on this post seem to be suggesting.
The other thing is that I don't think the doctors were necessarily wrong in their diagnosis. The higher you go up in the spine, there's a lot more danger of paralysis or other severe spinal cord problem. If you're over 30 and shatter your T12, there's a 50% chance you're going to end up with a serious neurological problem. The odds for recovery are far better the sooner you have surgery, if the surgery is necessary.
Timing of surgery is also an important issue in the treatment of thoracic spine fractures. ... Some studies suggest that patients with thoracic spine fractures treated within 72 hours, irrespective of concomitant injuries, do much better physiologically postoperatively than those in whom stabilization is delayed.
http://emedicine.medscape.com/article/1267029-treatment
Lastly, I don't think a patient requested 370 mile helicopter flight for a treatment which could be performed locally could possibly be covered under any insurance plan, no matter how good the coverage is.