Thursday, August 13, 2009

Slap on the wrist for negligent Australian cancer doctor

So you cannot trust even a specialist and the regulators who are supposed to protect you do nothing to stop it. Could he not at least have been fined a substantial sum or barred from anything but general practice work? His interest in patient care was obviously nil. Regulators so often let negligent and incompetent people run riot that you wonder what they are for. Even when complaints are received, it always seems to take them years to act. DO NOT rely on them to protect you from incompetents. Make your own enquiries when and where you can. And Google your own illnesses so you get an idea of what SHOULD be happening

A UROLOGIST repeatedly failed to order a biopsy for a patient who presented with symptoms of prostate cancer over four years, by which time the tumour had become aggressive and spread, an inquiry has found. William Lynch, a consultant at the Sydney Prostate Cancer Centre and Urology Sydney, has been reprimanded by the NSW Medical Board for displaying ''a serious lack of care in the management of [the] patient''.

The treatment of all Dr Lynch's patients will now be subject to an audit that will look at his history taking, recall system for follow-up of patient test results, diagnostic process and decision-making.

Last month the Professional Standards Committee found that Dr Lynch failed to monitor the patient's escalating prostate specific antigen (PSA) levels, which can indicate the presence of prostate cancer. He also failed to arrange a biopsy, which would have diagnosed the cancer and indicated how likely it was to metastasise, despite suspicious results of rectal examinations and the patient's symptoms and strong family history of the disease. When the cancer was finally diagnosed 3½ years later it was graded nine out of 10.

Dr Lynch is a director of the Australasian Urological Foundation and has published extensively on the use of minimally invasive treatments for prostate cancer such as cryotherapy, in which intense cold is used to kill cancerous cells. He consults at Sutherland and St George Hospitals as well as St George Private, President Private and the Mater Private hospitals.

A number of expert reports to the Health Care Complaints Commission said his conduct was significantly below the standard expected of a specialist of his seniority.

Dr Lynch told the committee that some of the patient's clinical notes had gone missing when Dr Lynch moved offices, but from memory, the patient had been reluctant to undergo a biopsy - an argument the patient's wife strongly rejected and the committee did not accept. He did not know why alarm bells did not ring when the patient's PSA reached a high level of 15.8 and could not explain why he failed to write detailed letters back to the patient's GP.

The committee also found that Dr Lynch had not provided any evidence of the changes he claimed to have made since the case, such as an electronic medical record system and ''triple checks'' to ensure abnormal results were followed up.


Australian Leftist health reform ideas as crazy as Obama's

More limits on what care you can get will be coming

Barack Obama wants $US1000 billion over a decade to fund health reform. It is an unfathomable amount of money and if the drug companies and other vested interests in US medicine's vast corporate edifice fail to sink his proposal, then the seeming impossibility of financing may sink it anyway. If Kevin Rudd accepts the proposals of his own health reform gurus, he may have to ask us for what amounts to almost the same sum, per capita.

Last month the National Health and Hospitals Reform Commission estimated its proposals - with a dental health scheme, better community care for long-term conditions including mental illness, and new performance standards for emergency care and surgery - would cost at least $2.8 billion to $5.7 billion a year. Over a decade, that makes $32 billion to $64 billion. Multiply the upper end by 15 (roughly the factor by which the US population is larger), convert the currency and you reach $US800 billion.

It's no coincidence. Despite different financing regimes, both countries need to spend now to realign towards more rational health care, which keeps people well instead of just saving them when they are sick. We have identical pressures: an ageing population and the rising real cost of treating more people better for longer. Each year the use of intensive care beds (which cost $1.5 million a year to run) by those over 70 increases 14 per cent, the Australian and New Zealand Intensive Care Society says. Changing technology means more now survive previously unthinkable treatment.

While specialists want debate about limiting medical heroics for the very old and very sick, they do not want to start it. As the head of intensive care at a large Sydney hospital recently commented privately, it is ''tiger territory''. It's not hard to see why. Take Erbitux, a drug for advanced bowel cancer. It costs $US80,000 for an average extra 1.2 months of life, say doctors from the US National Institutes of Health. Calculations published last week in the Journal of the National Cancer Institute put the annual cost of extending the life of every American cancer patient by one year at the same price pro rata at $US440 billion. If you use the same formula for Australia, it's about $35 billion.

Australia does health care comparatively efficiently and well. We spend half, per capita and as a proportion of gross domestic product, what the US does - where outrageous private doctors' fees are rife and the quality of care is uneven and often woeful. We spend about 10 per cent more than Britain, but for that we get a life expectancy two years longer. It's a good start, although insufficient to hold back the twin tides of demographics and technology. Minor tweaks are not going to help in a world where a single costly breakthrough drug can bring the system to its knees.

But in the reform commission's nearly 300-page report lurks a grenade. Under the anodyne name Medicare Select is the seed of a plan that could end the generally unlimited access to medicine Australians enjoy. The Government would determine a ''mandatory set of health services made explicit in a universal service obligation'', or minimum treatment standards all Australians could expect from their health insurance, of which the Commonwealth would become just one, no-frills, provider. All services, including doctors, public hospitals and ambulances, would be covered. Private opt-in funds could supplement that legislated minimum with extras such as fancier hospitals and orthodontics, as they do now.

The key word is ''explicit''. How explicit? Australians have grown used to implicit access to medicine, a warm and fuzzy sense that in our darkest hour the system will rescue us. State public hospitals have few explicit caps on what care is offered to whom and for how long, and managers have leeway to fund unusual therapies in special circumstances. Medicare and the Pharmaceutical Benefits Scheme have more precise rules. But doctors work around them, stretching the truth to, for instance, justify dementia medication if they believe standard tests miss the subtleties of the person's condition.

Another clue to the commission's agenda is in its description of how Medicare Select might be funded: ''To aid the community's understanding of the cost of the universal entitlement to health care, it could be financed through a publicly identified share of consolidated revenue or from a dedicated levy.''

Australia spent $94 billion on health care in 2007 - a rise of 4.8 per cent (double the inflation rate) on the previous year - but fragmented among state and federal accounts and out-of-pocket payments. A single government budget item - goes the thinking - running to $70 billion and spiralling upwards, would focus the community mind. The current round of health reform talk is just the beginning. Next, we need to discuss how much medicine we are prepared to pay for, and when we stop.


Botched NHS surgery in Scotland

It is a macabre and not particularly amusing joke shared by doctors that the absolutely worst time to have a baby, undergo surgery or be involved in a road traffic accident is around now. Early August and February are traditionally when new medical rotations for junior doctors begin and hospital corridors are filled with panicky people in white coats and surgical scrubs who look as if they should be advertising Clearasil, not assisting with aortic valve replacements.

I know of two consultants who on their very first day as junior doctors in different Accident & Emergency wards were faced with multiple victims of serious road accidents, people whose lives depended on the first doctor they met being confident, knowledgeable and very fast. Instead of ER they got “er . . .”.

The only thing worse than being a new junior doctor expected to perform potentially life-saving interventions beyond your capabilities and experience is being the patient. Yet, that sense of being out of your depth is an accepted rite of passage for young medics, something to be joked about over a pint in the pub.

The news that 5,500 operations were botched or bungled in Scottish hospitals over the past five years will come as no surprise, then, to the medical profession. In 3,000 cases, organs were accidentally punctured or damaged but there were also incidents of the wrong operation being performed, surgical instruments being left inside patients’ bodies and sterilisation of instruments not being carried out beforehand.

The response of the government and the medical authorities to the news is revealing. Dr Charles Swainson, medical director at NHS Lothian, the health authority with the highest number of “incidents” said that because of the way the data are recorded, the statistics are unreliable. A spokeswoman for the Scottish government described the figures as regrettable but insisted they must be seen in the context of the vast majority of procedures being carried out safely.

Both responses are axiomatic of what is wrong with the NHS today. It is unlikely to be of much comfort to the former Scotland football captain Colin Hendry that in the vast majority of cases of liposuction there are no complications. All that matters to him is that his wife Denise died last month at the age of 42 following 20 operations to try and rectify plastic surgery that went horrifically wrong.

You don’t tend to hear car manufacturers or airlines stating that a faulty car or a crashed plane should be seen in the context of all the thousands of planes which take off and land safely or all the cars which don’t develop potentially lethal faults. If there is an incident with a plane — however minor — air accident investigators are all over it, usually producing an initial report within 48 hours. If a new car develops an unexplained fault, every car in that range is recalled and checked. Passengers and drivers will simply take their business elsewhere if an airline or a manufacturer behaves irresponsibly or doesn’t make safety its priority. The NHS can afford a scandalous degree of complacency because, despite successive government mantras of “patient’s choice” most patients have about as much choice as Hobson.

There is a consensus among the medical profession that because all medical procedures carry a degree of risk, a certain level of risk is acceptable. But is an average of three botched operations a day in Scotland really tolerable? Were our airlines to maim three passengers a day, there would be outrage. Last year the National Audit Office said that there may be up to 34,000 deaths annually in Britain as a result of what it coyly calls “patient safety incidents”. The NHS’s attitude to safety is frankly appalling and would not be accepted in any other industry. Forgetting to sterilise equipment or leaving foreign matter inside a patient after an operation is never an acceptable risk. It is carelessness bordering on malpractice.

Then there is Swainson’s argument that the statistics are irrelevant because of the way they are collated. The 5,500 botched operations cover everything from removing the wrong kidney to a tiny nick with a scalpel. It is certainly true that, for the statistics to be meaningful, we need to know how many of the botched operations were fatal, life-threatening or serious enough to affect quality of life. They also need to be broken down on a surgeon-by-surgeon basis to see if patterns emerge.

As a result of devolution, Scotland, England, Ireland and Wales have been following significantly different health policies. We are involved in a huge medical experiment in which we are all guinea pigs by default. The one upside would be the ability to analyse which of the four models has proved the most successful. However, the idiosyncratic way in which the different countries collate statistics has meant that in many key areas, comparisons are simply impossible. It is outrageous that there isn’t a universal system for collating health statistics that would allow direct comparisons not only throughout the UK but across Europe.

While the NHS insists on treating patients as statistics and statistics as propaganda tools, the safety and efficiency of the health service will never improve.


On Canadian Health Care

My wife is Canadian. So are my kids. The kids are American, too -- they have US Birth Abroad papers, and yes, they have birth certificates. They have passports from both countries. I met my wife while shooting in Vancouver. She didn't want to leave just because we were getting married, so I lived there for 3 years. Those three years changed my views about a lot of things. Health care is one.

I went into it with an open mind. After all, I'm not Canadian, so I wasn't paying for it. I paid if I needed to go to the doctor. The prices were really low, because they were government-subsidized. One pretty big emergency room visit for a kidney stone cost me CDN $500. Not bad, in comparison. Of course, Canadians picked up the rest of my tab. Boy, did they ever.

One of the reasons I never became a Landed Immigrant (Canadian equivalent of a Green Card) was because I didn't want Revenue Canada near my paycheck. My business was in the US, and the IRS is plenty, thank you. Back then, which was almost 10 years ago, I think it was CDN $35,000 or so that was the beginning of the 50% bracket. (I do not know if that number is accurate. It could be higher. But it's really, REALLY low, compared to our highest threshold.) Now, add Provincial (state) income tax to that. Note that you cannot deduct any mortgage interest, or much of anything, from either. Then add a national GST (Goods and Services Tax) to everything you buy. On top of that, add PST (Provincial Sales Tax) to everything you buy. AND add special provincial and local taxes to purchases of special things, which aren't, typically, all that special, and actually cover a lot of the things you buy. One special thing, for instance, is gasoline. I just got off the phone with my brother-in-law, who can't remember, exactly, but he thinks gas is about $1.09 right now in Vancouver. That's for a liter of gasoline. A LITER. Which would make it over $4.00 a gallon. And that's not too bad, these days, he says. If you smoke (I don't), the tobacco taxes will kill you before cancer will.

So, what do all those taxes buy you, in the form of health care? Well, let's talk about that kidney stone I had. If you've ever had one, you know immediately why I went to the emergency room. As it turns out, growing up in Florida, and as a member of my particular family, means I'm predisposed to more. Looking forward to that. Anyway, this one was my first one, and it hurt worse than anything had ever hurt. I didn't see a doctor at the ER, but the nurse (or PA - I don't know for sure) was able to give me some Darvocet, and a prescription for more. I also got an appointment with a urologist for the following week, which was a fast-track exception, because I was a foreigner. A week later, still a bit dazed from a growing Darvocet habit, I got to see the guy, who was really nice, and was hoping to move to the US to practice, so he could make a decent living. He told me I'd probably pass the stone, and would simply need to take the Darvocet until I did. If, however, I didn't pass it in about a week, they'd have to think about breaking it up with ultrasound. I'd heard about this from my dad. Apparently, it's pretty quick, and totally painless -- the machine breaks up the stone into small bits with sound waves, and you pass the bits easily. Most US hospitals, and a lot of clinics, have a machine to do this. The only hitch? In all of BC, there's one machine. This is a place about 125% bigger than Texas. Vancouver is the third largest city in Canada. And there's one machine. It travels the province like a roving minstrel. It wasn't due back in Vancouver for 6 more weeks. I passed the stone two days later. Thank God.

The brother-in-law I spoke to tonight is an interesting story. Seems his tonsils reached the point, about 3 years ago, when they simply could not do their job anymore. In fact, they began to cause serious infections. So serious that, more than once, he had to be rushed to the hospital, and kept for several days. He required IV for fluids, and for drug delivery, while in the hospital -- and was listed as critical on both occasions. The doctor informed him he required a tonsillectomy as soon as possible. Until he got his tonsillectomy, there would be, he was assured, more hospital visits. The first available date for him -- a guy in his 20s -- was two years away. For 9 months, in order to stave off infection, he did an outpatient plan where he went to the hospital 3 times a day, every day, to receive treatment via IV. (Once every 8 hours.) A week on the plan, a week off. Doesn't seem like a cheap, or pleasant, experience to me, but what do I know? Luckily, his tonsillectomy got fast-tracked, and he was able to get it after only 9 months of this regimen. Nine freakin' months. Makes the expense of ice cream and cowboy pajamas, and the week of quiet, back when I was five and had my tonsils out, seem -- I dunno -- quaint.

I have a lot of stories like this. More than I can write here, and way more than you'll read. And I only lived there three years. Stories about my wife, her mom, more brother-in-law stories, some pretty scary ones about my kids, and a particularly sad one about my wife's grandmother. Most aren't life and death -- the grandmother one is -- but all of them illustrate a health care system that's inefficient, and reduces choice -- because it's run as a government bureaucracy. I tell the funnier ones because there are plenty of truly scary ones already out there. I didn't want to be accused by the YouTube lady at the White House of spreading disinformation. Hey, this is comedy. Of sorts. I do want to tell one more story, though. Because it illustrates how socialized health care -- socialism in general -- reaches beyond the doctor's office:

One night when my son was six months old, he had a raging fever that went beyond normal baby fever. My boy is, well, feverish, so it wasn't a completely unusual thing -- but this one was unusually high, and climbing. Unfortunately, we were out of Infant Tylenol, which had shown past success in bringing his fever down. So I went to the store to get some. Now, we lived in a suburb, about an hour from downtown Vancouver. It was about 9:30 p.m., so the only nearby store that was open where I could buy Infant Tylenol was the big Safeway, which had a good pharmacy. When I got to the cold medicines isle, I found that the Tylenol, including Infant Tylenol, was locked up behind a plexiglass door on the shelf. I was no stranger to locked OTC medicines -- I've lived in New York and Miami, and I know that people steal stuff. Especially drugs. So I asked the clerk if she could unlock it so I could buy some Infant Tylenol. She looked at me like I was from Mars.

"Oh, no, Hon -- the pharmacist has gone home. She leaves at 9:00. She has to be here for us to sell it."

Well, that's a stupid rule, I thought. And I said so. But, it's not a rule, she assured me. It's the law in BC. That's right -- the law. Never mind that even if the pharmacist had been in the store, she wouldn't have a clue what I was buying -- or even that I exist -- because when she's there, it's unlocked, and it's four aisles away from where she works. You can buy it at a regular register. That is, as long as the pharmacist is in the building. Why? Because somebody might have a question. This is Infant Tylenol, for cryin' out loud! What is there to ask?

We ended up calling an ambulance when my son's fever reached 103F (still can't do Celsius) and continued to climb. We had an emergency room visit, where, you got it -- Infant Tylenol -- brought the fever down, and he was ok in an hour. Well, thank goodness we took the economically efficient way out of that one. The Tylenol at the Safeway might have cost us $25 or $30 (remember all those taxes...). But the ambulence and the ER were FREE. Well, ok, the Canadians paid for it somehow.....

Incensed, I went back to Safeway the next day to see what, exactly, I can't buy when there's no pharmacist on site. Cold medicines, of course, can be dangerous, so what else is too dangerous for people without proper guidance? Turns out most anything with any kind of medicine in it. Tegrin Medicated Shampoo, is, apparently, dangerous. So is Oxy-10 facial scrub. And the list goes on, and on, and on. It's funny, in a very sad kind of way. Socialized medicine leads to socialized over-the-counter medicine, which leads to socialized zit medicine. It, itself -- socialism, I mean -- is a disease.

I know this post is long. But the stories are worth repeating. Because the issue is big, and it's complex, and it has unintended, and intended consequences. Our elected representatives don't want to read the bill, because they don't want to know, or hear about those consequences. Or because they do know, and they believe those consequences are perfectly acceptable, in the name of increased control of our choices, and our lives. I won't pretend that the US health care system is perfect. It's not. But it's a hell of a lot better than what exists in Canada. And anyone who tells you different is either lying, or just plain wrong.


Rasmussen: 32% Favor Single-Payer Health Care, 57% Oppose

Thirty-two percent (32%) of voters nationwide favor a single-payer health care system where the federal government provides coverage for everyone. A Rasmussen Reports national telephone survey finds that 57% are opposed to a single-payer plan.

Fifty-two percent (52%) believe such a system would lead to a lower quality of care while 13% believe care would improve. Twenty-seven percent (27%) think that the quality of care would remain about the same.

Forty-five percent (45%) also say a single-payer system would lead to higher health care costs while 24% think lower costs would result. Nineteen percent (19%) think prices would remain about the same.

There's wide political disagreement over the single-payer issue. Sixty-two percent (62%) of Democrats favor a single-payer system, but 87% of Republicans are opposed to one. As for those not affiliated with either major party, 22% favor a single-payer approach while 63% are opposed.

Investors oppose a single-payer system by a three-to-one margin. However, a narrow plurality of non-investors favor such a plan.

Data released earlier today shows that 51% of voters fear the federal government more than private insurance companies when it comes to health care decisions. Forty-one percent (41%) have the opposite fear.

More here

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