NOTE- The name of this article was NOT designed just to shock the reader…in point of fact, it was meant to stress the true state of things in today’s hospitals.
When my Mother was admitted into the ER of the hospital, the FIRST thing they did was to discontinue ALL medications she was taking, and stop her breathing treatments. THIS was done to an 89 year old woman with pneumonia and Alzheimers, and she had been on those meds for some time. My Mother died September 24th after being subjected to treatment that, can only be classified as being intended to kill her. I’ve spoken to lawyers and doctors, and after they hear the facts, they agree with me.
So, I thought Mom’s case was singular in the treatment she received at the ER, but after speaking with doctors, nurses, and others, I have discovered the same thing being done to other elderly patients at other hospitals, at least, here in Texas. I have not spoken to health care professionals in other states yet, but I would not be surprised if this has not become some sort of unwritten policy in the treatment of elderly patients.
Now, I never did believe the “death panels” thing, but this is something different, and since it seems to be covert, is much more insidious and evil than any Government mandated directives.
As you may know, “Medical Errors” is rated as the number THREE cause of deaths in the USA…but, since it is known that doctors cover for each other in much the same way cops do for each other, instead of a “thin blue line”, there appears to be a thin “white” line. That said, I believe if the truth were known, the additional cases of deaths due to inappropriate iatrogenic actions / inactions, might raise the number of deaths from “Medical Errors” up to number two status.
But, let me say this…I do believe that many of the deaths are due to “Medical Errors”, but, and I hate to say this, there are some, perhaps more than a few, which are not errors in the sense of being accidental.
This may sound bizarre at first, but not after you find out that the two most prolific serial killers in modern times were both MDs, H.H. Holmes, MD https://en.wikipedia.org/wiki/H._H._Holmes (who literally built a house as a killing machine to take advantage of people coming to the fair in Chicago) and Harold Shipman, MD https://en.wikipedia.org/wiki/Harold_Shipman. Estimates on how many people each of them murdered varies, but each one is believed to have murdered hundreds of people by themselves.
So, I was asking one health care professional friend of mine “WHY would they take an elderly patient off all their meds?” What one told me was chilling…but, as usual, the “follow the money” rule enters in. When a patient is admitted, any and all drugs they are on must be paid for by someone, and if the patient is being treated “in hospital”, as I understand, the hospital has to pay for the medications. For those wanting to delve into the mechanics of this whole mess, the key to understand more about it is found in three little letters… DRG. Here’s a Medicare link that goes into it more in depth. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html?redirect=/acuteinpatientpps/ Here’s another link https://en.wikipedia.org/wiki/Diagnosis-related_group
So, if this is correct, and elderly patients as a group, tend to be on more meds, and perhaps more “EXPENSIVE” meds that young folks, taking them off all meds certain cuts down on how much money the hospital has to spend on an elderly patient. Now, if this is so, that alone is so Nazi like that, given the mindset of hospital administrators, it may be understood from a purely dollars and cents perspective, even though, it is clear that cold turkeying an elderly person from the meds they have been on for quite a while, regardless of the condition the medications are treating, is patently dangerous.
But, I believe there is a truth that is far more hideous, far more monstrous than merely a penny pinching administrator who sends out a memo to all ER doctors to
“DC” (discontinue) all meds that new admits are taking.
This next idea gets into perhaps some controversial ideas, and I know that many will not agree, however, facts are stubborn things and if we let the facts take us where they are tending to go, there are some things that are not only “suggested” by the facts, but are downright inescapable.
I’m not a racist, bigot, not xenophobe. I never have been. I’ve always been proud of being able to fit in with most groups I find myself whether they are Latter Day Saints (Mormons) , Iranians, Sikhs, Buddhists, whatever.
That said, one thing has struck me in the past ten years, a trend that has grown until many are noticing it. More and more, doctors and nurses in hospitals (and to some extent in the general population of doctors) are trained in foreign medical schools. I recently met a doc with a very American name, who looked American, but a little digging on his background revealed he was born in Iran and went to Medical school in Hannover Germany. I have encountered some doctors from the Middle East who seem very prejudiced against Westerners. Oh, they may act civil to your face, and put on this air of professionalism, but behind closed doors, or in emails or other communications with their friends who are also doctors trained in the Middle East, you find out the truth.
Atop all this, there is what appears to be a widespread prejudice of “ageism“, meaning, if someone is 75,85,90, that they’ve lived a long time, so it’s time for them to go, so why spend a lot of time or money on them. As I write that, I can hear the PR people of the Government and Hospitals decrying such a statement, saying that they do the utmost to help patients regardless of their age or situation. But, those of us who have had elderly family in hospital here in the USA, especially here in the South or Southwest, KNOW how things are going in hospitals. Ageism is real, whether you are talking about bias in a hospital setting or in the job market ( http://www.forbes.com/sites/lizryan/2014/01/31/the-ugly-truth-about-age-discrimination/)
If you don’t believe this, take an elderly parent of yours into an ER here in Texas and indicate they are “full code” and see what happens. I’ve gone through it, so I can speak as a direct fact witness on this matter. One thing you hear is “we might break their ribs”…well, if I am a patient, and the choice is perhaps fracturing a couple of my ribs on the one side, and letting me die on the other…crack a couple of those sons of bitches…if I live, those ribs may heal just fine.
Since arguably, most of these elderly patients are PROBABLY Medicare patients, I think it begs for an investigation by the Department of Health and Human Services.
Of course, it is not just the elderly patients at risk in modern USA hospitals. MRSA and C Diff are rampant. There is a strain of vancomycin resistant MRSA, so-called VRSA ( https://en.wikipedia.org/wiki/Vancomycin-resistant_Staphylococcus_aureus and, when nosocomially acquired, can be quite dangerous. Clostridium difficile, also a common nosocomially acquired infection, can cause serious diarrhea and colitis. https://en.wikipedia.org/wiki/Clostridium_difficile_colitis
Where do you think most people die in the USA ? On the highway, in a war zone, at home, at work ? NO… 63 percent, the vast majority of Americans, die in hospitals.
Add to this ANOTHER 17 percent, die in institutional settings especially like long term care, skilled nursing facilities. SO, if you had the percent of Americans who die in hospitals with the number who die in nursing home type facilities, that amounts to EIGHTY (80)PERCENT dying in “health care institutions”.
So, that leaves only 20 percent of Americans to die everywhere else...in the woods, in a war zone, on the road, in their home, at work, etc.
And, if we want to look at the dollars and cents, dying in a hospital costs more than surviving an inpatient stay.
Back to the preponderance of doctors training in foreign medical schools. In South Texas, my Mother, when she was in better shape, had about 10 doctors who had seen her at one point or another…many were either in private practice or a multi-doctor practice. Out of that number, only ONE had gone to medical school in the USA. Most went to medical schools in Latin Countries such as Guatemala, Columbia, etc..
This is in direction contradiction to the picture they want to paint in this article => http://www.theatlantic.com/health/archive/2014/11/doctors-with-borders-how-the-us-shuts-out-foreign-physicians/382723/ from November 18, 2014.
You know, in the world, there are articles you read and rely on because you have no first hand experience in the topic…but then, there are articles you read which conflict directly with your real world experience. My real world experiences in more than one city in Texas, in 2015, reveal that Atlantic article to paint a false picture because daily, more and more, it is almost impossible to find a doctor who went to school in the USA in hospitals…and although it is not that bad with nurses, I predict the same trend will be found with nurses before long.
This is one interesting article, hosted on the prestigious NIH site…
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140753/ Unconscious (Implicit) Bias and Health Disparities: Where Do We Go from Here?
Irene V Blair, PhD, John F Steiner, MD, MPH, and Edward P Havranek, MD
(Note- the following is used via the FAIR USE provision of Title 17 of the US Code)
“Definitions and Measures
In the present context, bias is the negative evaluation of one group and its members relative to another. Such bias can be expressed directly (eg, “I like whites more than Latinos.”) or more indirectly (eg, sitting further away from a Latino than a white individual). In addition to their different expressions, direct or explicit bias differs from implicit bias in terms of underlying process. Explicit bias requires that a person is aware of his/her evaluation of a group, believes that evaluation to be correct in some manner, and has the time and motivation to act on it in the current situation.4–6 Congruent with everyday experience, research suggests that explicit bias toward ethnic/racial groups has declined significantly over the past 50 years7 and is now considered unacceptable in general society. In contrast, implicit bias appears to be common and persistent.8,9
Implicit bias operates in an unintentional, even unconscious manner. This type of bias does not require the perceiver to endorse it or devote attention to its expression.4–6 Instead implicit bias can be activated quickly and unknowingly by situational cues (eg, a person’s skin color or accent), silently exerting its influence on perception, memory, and behavior.4–6,8–10 Because implicit bias can operate without a person’s intent or awareness, controlling it is not a straightforward matter.
Implicit bias cannot be measured with standard (self-report) survey questions. Instead, sophisticated instruments have been developed for this purpose, the most commonly used being the Implicit Association Test (IAT).11,12 The IAT is a computer-based measure that relies on differences in response latency to reveal implicit bias. The IAT has been used in hundreds of studies across a wide array of disciplines, including psychology, health, political science, and market research.8,9,12 The IAT operates on the principle that it is easier to make the same response (eg, a key press) to concepts that are more strongly associated, compared to concepts less strongly associated. Respondents are thus asked to sort words or pictures into one of four superordinate groups, representing two concept dimensions (eg, race: black vs white; and evaluation: good vs bad). The strength of association between concepts is determined by the respondents’ speed in sorting the items under two different conditions, with faster responses in one condition indicating a stronger association. Most white respondents, for example, are significantly faster when the “black” and “bad” items require the same response and the “white” and “good” items require another response, compared to when “black” and “good” responses are the same and “white” and “bad” responses are the same.8,9,12 The larger the performance difference, the stronger the implicit association or bias for a particular person. Demonstrations of this test can be found at https://implicit.harvard.edu.
Background: What We Know So Far
The theoretical framework for the role of implicit bias in health care is based on well-established empirical findings in social psychology and research on health care processes. We refer interested readers to existing reviews of that work,13,14 confining ourselves to broad strokes for the present purposes. Figure 1 provides an illustration of the pathways through which implicit bias may affect the patient-clinician relationship and related processes. Consider a white male clinician whose implicit bias has been activated by a clinic visit with an elderly African-American patient who is receiving antihypertensive medications but whose blood pressure is uncontrolled. Without realizing that he is being unduly influenced, the clinician perceives the patient as uncooperative and unlikely to adhere to a more intensive drug regimen. The clinician may even erroneously “remember” that this patient can’t afford the pharmacy copay. Consequently, although the patient’s hypertension is not under control, the clinician decides not to intensify the treatment regimen. This clinician believes that he made the best decision given the situation, unaware that his perceptions were distorted by implicit bias.
Conceptual model of the influence of implicit bias on hypertension control.
Also shown in the figure is the possibility that in addition to affecting clinical decisions directly, implicit bias may also affect treatment through its effects on interpersonal communication. A number of studies have shown that people with more implicit ethnic/racial bias have poorer interpersonal interactions with minority individuals, often in very subtle ways.6,9,10 Such interactions, in turn, may contribute to a lack of trust and commitment on the part of the patient, leading to poor adherence. The figure also notes that patients bring their own implicit biases to the clinical encounter (eg, against a white physician), further complicating communication, treatment, and achievement of mutual clinical goals.
Research to Date on Implicit Bias in Health Care
Presence of implicit bias in health care. A handful of studies have measured implicit bias among clinicians15–21 (Table 1), all using the IAT. Five of these studies examined racial/ethnic bias, specifically against African Americans as compared to whites. Four of the five studies found evidence for implicit race bias among clinicians (Table 1), with the average level of bias ranging across the studies from “small” (Cohen’s d = 0.41) to “large” (d = 0.90). The one study that did not find bias against African Americans17 is notable in its reliance on a small and primarily minority clinician sample.
Published studies measuring implicit biases of clinicians
Although the magnitude of the reported bias varies, the presence of implicit bias is generally consistent across the studies and suggests that clinicians have similar implicit biases to others in society. The presence of implicit bias among clinicians further suggests that it could play a role in health care disparities just as it plays a role in differential outcomes elsewhere in society.
At the same time, the limitations of the existing work cannot be ignored. First, there are questions about the degree to which the results can be applied to clinicians more generally. Four of the studies listed in Table 1 are of relatively young and inexperienced clinicians (residents and students), and six of the studies include either a low number of respondents from the pool of eligible clinicians (26% to 38%) or the response rate is unknown. For example, the study by Sabin et al18 is impressive with its large sample size. However, the individuals in this study decided of their own accord to visit the Web site, and there is no known denominator of eligible clinicians who could have participated. It will be incumbent on future research to include more experienced clinicians and obtain response rates that are more representative of the entire study population.
The second major limitation of existing research is the almost exclusive focus on African Americans as targets of implicit bias. The vast health disparities shown for African Americans certainly raise the priority of assessing implicit bias against this group. However, disparities have also been shown for other racial and ethnic groups22,23 that may be more prevalent in certain geographic regions. Disparities have also been found in many other social domains including gender, age, sexual orientation, and socioeconomic status (SES).22–25 Implicit bias against individuals with specific clinical conditions such as disability, obesity, or mental illnesses may also be present as suggested by the two studies in Table 1 on implicit bias toward injecting drug users.
The presence of implicit bias among clinicians further suggests that it could play a role in health care disparities just as it plays a role in differential outcomes elsewhere in society.
Consequences of implicit bias in health care. Of even greater need is research on the correlates and consequences of implicit bias in health care. Even if one were to accept the findings shown in Table 1 as sufficient evidence of implicit bias against African Americans among clinicians, one must still ask to what degree this bias affects health care and outcomes. There is even less evidence to answer these questions. Of the five published studies already discussed, two also investigated the degree to which the clinicians’ implicit bias related to their clinical judgments in hypothetical scenarios, with one study16 showing that implicit race bias was related to treatment recommendations for an African-American patient and the other study19 showing that implicit race bias was not related to clinical judgment. One additional study17 examined implicit race bias in relation to interpersonal behavior, showing that more biased clinicians were rated by their African-American patients as lower in warmth and friendliness. No published study yet has examined the relation between implicit bias and actual medical treatment or outcomes.
A Roadmap for Future Research on Implicit Bias in Health Care
The next generation of research on implicit bias in health care must accomplish three goals: 1) determine the degree of different implicit biases for different groups; 2) assess the associations among implicit bias and processes and outcomes of care; 3) test interventions to reduce implicit bias in health care and outcomes, if bias is found to be important in health care. In this section we expand on these three goals and highlight potential approaches to accomplish them.
Goal 1: Determine the degree of implicit bias with regard to the full range of social groups for which disparities exist
Health disparities have been shown along multiple social dimensions22–25 (eg, race/ethnicity, gender, age and SES) and local circumstances may bring additional dimensions to the forefront (eg, military or religious groups). Research is needed to determine whether implicit bias exists toward each of these groups. In some cases, the approach used in existing research can be easily adapted. For example, an IAT has already been developed to assess bias against elderly vs young individuals.26 In other cases, additional research is needed to determine what types of bias might be operating. This is likely to be particularly important with regard to gender. Research shows that people are more often implicitly biased in favor of women over men,27,28 so why does it appear that in some situations women are less likely to receive high-quality care? An even greater challenge will be the consideration of overlapping group biases. Patients are not simply members of a racial/ethnic group, a gender group, or an age group; they are simultaneously members of all these groups. The interaction among biases for or against these groups is relatively unexplored. In our earlier example, the care provided to an elderly African American by a clinician with biases against both social groups may be of lower quality, whereas implicit bias in favor of the elderly may offset some of the effects of implicit bias against African Americans. As millions of newly insured individuals prepare to enter the health care system under health care reform legislation during the next few years, the interaction of socioeconomic bias and other forms of bias (eg, SES by race) will require particular attention.
The extent to which implicit bias exists among different groups of health care professionals (eg, physicians, nurses, front-office staff), with regard to patients from different social groups must also be more fully understood. As shown in Table 1, the few studies of implicit bias in health care have focused primarily on physicians. In an environment in which care is increasingly provided by multidisciplinary teams, it is important to assess the biases of the entire range of health care professionals. A bad health care experience may come from poor service in the pharmacy or on a phone call with front-desk staff. Furthermore, little research has addressed the implicit biases that patients themselves bring to clinical encounters (eg, bias against a clinician of different race/ethnicity or with a foreign accent). Given evidence that racial, ethnic, or gender concordance between clinician and patient can affect communication and treatment,29–31 the implicit biases of patients, particularly in combination with those of their clinicians, need further study. Finally, research on implicit bias ought to be broadened to include health care beyond the US and in different cultures.
Goal 2: Understanding the relations between implicit bias and clinical outcomes
The second step is to test and refine the conceptual model presented earlier that describes how implicit bias might be related to the processes and outcomes of clinical care. As shown in Figure 1, the relevant processes of care necessary to achieve clinical goals also require assessment if we are to understand the mechanisms through which implicit bias affects those goals. Decisions or behaviors by either clinician or patient may suggest that implicit biases are at work. In our earlier example, both clinician-determined processes, such as the decision to prescribe an additional antihypertensive medication, and patient processes, such as the decision to adhere to that new drug, need to be assessed. The quality of communication between clinician and patient is also important to assess. If implicit bias is found to be expressed through simple aspects of communication such as speed of speech or body positioning, specific training for clinicians may be suggested. Insight may also be gained by stratifying analyses of current measures of patient satisfaction with clinicians by patient characteristics such as race and ethnicity.32 There are also sophisticated analytic systems for coding audio-taped or videotaped encounters, that consider both the content and style of communication.33,34
Assessing the relation between implicit bias and outcomes is critical. In statistical terms, one needs to go beyond the demonstration of a main effect such as a health disparity between Latinos and whites, and determine whether differences in the levels of disparity found from one clinician to another co-vary with differences in levels of the clinicians’ bias.
To refine the simplistic causal model shown in Figure 1, both laboratory and clinical studies are needed. In laboratory studies, implicit bias is most likely to have an effect in situations with substantial ambiguity, room for “judgment calls,” and constraints on time and attention.14,35 Translated to the clinical setting, implicit bias may be more influential when treatment algorithms are less developed than in situations that have clearly defined algorithms for treatment. Likewise, implicit bias may have more of an effect on decisions made during a one-time visit than on decisions made in the context of an ongoing clinical relationship in which one presumes more accurate patient data has accumulated. On the other hand, laboratory research has not examined implicit bias in long-term relationships, and the possibility exists that such bias may have a cumulative effect with early instances of miscommunication building into larger problems later on.
Goal 3: Interventions to reduce effects of implicit bias on processes of care and clinical outcomes
If implicit biases are found to be important in health care, the third step is to adapt and test theory-based interventions36–38 at all levels, including the individual practitioner, the care team, and the delivery system. Such interventions could attempt to reduce implicit bias directly, could bolster patients’ defenses against bias, or could alter care delivery systems to mitigate the effects of bias.
The most obvious point of intervention is with the individual. If health care professionals’ implicit biases are contributing to disparities, reducing those biases seems an obvious solution. Basic research on implicit bias supports the plausibility of this approach by showing that implicit bias is potentially malleable, changing in response to situational cues and norms.36 Despite its intuitive appeal, a direct approach of confronting an individual with evidence of bias may actually have little effect on that bias. Although people can be rationally convinced that they ought to feel or think differently and they are motivated to do so, the operation of implicit bias is not open to easy identification and effortful control. Indeed, research shows that intentionally trying to suppress bias may actually make it “rebound” at a later time.39 Instead a less direct approach can be more effective.
If one thinks of implicit bias in psychological terms as an automatic cue-response association, then one might see that changing the cue is likely to be more effective than trying to will the response to change36—at least in the short term. The challenge then, becomes identifying cues or situational variables that matter. Laboratory research suggests that implicit bias can be diminished by cues that bring to mind associations that run counter to the bias.4,40–42 To illustrate, one study found that white individuals who had been exposed to many admired African Americans, subsequently showed reduced implicit bias.42 Such methods need to be adapted and tested in clinical settings, but they nonetheless suggest the real possibility of change.
In addition to direct intervention on health care professionals’ implicit bias, the conceptual model shown in Figure 1 makes it clear that there are many pathways between implicit bias and health outcomes, with the possibility of intervention at each one. Patients play a role in the quality of the clinical interaction and successful treatment is often reliant on their own efforts. Patients may respond to bias in a variety of ways, some of which can worsen the situation and some of which can help to deflect a negative outcome.
Recent research on stereotype threat and, importantly, the positive effects of a self-affirmation intervention hold great promise. Stereotype threat43 is a stressful psychological state that occurs when a person fears being judged by others on the basis of negative stereotypes. In health care settings, stereotype threat may impair patient-clinician communication, reduce self-efficacy, and increase mistrust.44 Because stereotype threat can impair communication between patient and physician, interventions that reduce patients’ perception of threat might lead to more functional behavior for both patients and physicians. Self-affirmation, a process in which people affirm their self-integrity (eg, important values) in the face of a threat, has been shown in educational settings to reduce racial differences in performance over time periods of up to two years.45–47 Self-affirmation thus represents a possible component of a theory-driven intervention to reduce the impact of implicit bias in health care. Studies to assess this are in progress.
If one thinks of implicit bias in psychological terms as an automatic cue-response association, then one might see that changing the cue is likely to be more effective than trying to will the response to change36 …
Of course, interventions at the team, clinic, or delivery system level can also reduce health care disparities. Such interventions are primarily organizational in nature, and, despite their great potential, are beyond the scope of this discussion.”
===End of quote===
My assertion is that the biases which are affecting clinical outcomes, are NOT unconscious, they are NOT biases or prejudices which the clinician is unaware of, but are biases the clinicians are fully aware of, biases based on culture, perhaps religious biases, and of course, ageism as we have spoken about, that the clinician is aware of, but due to the potentially negative outcomes if they admit to the bias, they do their best to hide.
I believe that if a multi-factorial analysis is done of the outcomes of patients, combined with the ethnicity, the medical school at which the doctor or clinician was trained, that such a meta-analysis would reinforce my assertions. Given the amounts of monies our government wastes on many blind alleys in research and development of exotic weapons systems, and wastes in many other areas such as perks for congress people, such a study, such a meta-analysis of these factors is warranted and I am almost 100 percent sure that we would find that not only does bias have an impact on patient outcomes, but that it is causing deaths of patients who otherwise, might be saved.
We would, of course, have big problems if a surgeon who is schedule to operate on a black, elderly male, wore a KKK white hood into the OR, or an Aryan white power tietack, or have “The Fourteen Words” tattooed on his inner wrist…and yet, we let doctors from the Middle East who culturally and religiously might have severe bias against Caucasian Westerners.
We get very upset and demand justice when a white cop murders a young black man with a Glock on the street…but truth be told, more people die in hospitals, under the “care” of doctors, than die at the hands of cops…remember, “Medical Errors” are the third most common reason for deaths in the USA. A slip of a scalpel, the wrong meds, any of a number of small, easily missed clinical actions, can result in death…accidentally, OR intentionally.
Remember that the REAL mastermind of Al Qaeda was NOT Bin Laden, but was instead a Medical Doctor, an ObGyn named Ayman Mohammed Rabie al-Zawahiri, MDhttps://en.wikipedia.org/wiki/Ayman_al-Zawahiri who stepped in and took over leadership of Al Qaeda after Bin Laden’s death. Zawahiri’s dad was also an MD
“. Mohammed Rabie became a surgeon and a medical professor at Cairo University”
“Ayman al-Zawahiri worked in the medical field as a surgeon. In 1985, al-Zawahiri went to Saudi Arabia on Hajj and stayed to practice medicine in Jeddah for a year. As a reportedly qualified surgeon, when his organization merged with bin Laden’s al-Qaeda, he became bin Laden’s personal advisor and physician. He had first met bin Laden in Jeddah in 1986.”
Now, make NO mistake. Hospitals are corporations, they are big businesses, and, as with other corporations, they have PR people to try to keep a positive image of their hospital, to keep the rubes, the naive folks, coming in to wonder at the man behind the curtain who they think has the answer to all their illnesses. So, there is definitely an effort to control the image of hospitals and the providers therein, in the eyes of the public, and they spend a lot of money on media advertising to control that image.
Consider this article. by Kirstine Crane (FAIR USE is claimed pursuant to Title 17 of the US Code) http://health.usnews.com/health-news/patient-advice/articles/2014/06/25/could-your-hospital-make-you-sick “Victoria Nahum thought 2006 had just been a really bad year. After years of suffering symptoms including fatigue, sore muscles and rashes, Nahum’s doctors identified the source of her malaise: Her left breast implant was coated in slime that was the result of a staph infection on the implant from when it had been placed six years earlier in Macon, Georgia.
Six months later, Nahum’s son Josh fractured his skull in a sky diving accident in Longmont, Colorado, landing in an Intensive Care Unit there. He was recovering well – until he contracted a bacterial infection in his cerebrospinal fluid that pushed his brain onto his spinal cord, turning him into a quadriplegic before killing him.
That same year, Nahum’s father-in-law contracted pneumonia during his hospitalization for a heart attack in Rochester, New York.
After the initial shock of her son’s death wore off, Nahum says that she started to put the puzzle pieces together. “I went to the [Centers for Disease Control and Prevention] and said, ‘What is this?’ It can’t just be a coincidence that three of us were harmed in a year,” she says.
With CDC support, Nahum, 58, who lives in Atlanta, started the Safe Care Campaign, which works with hospitals throughout the nation to prevent hospital-acquired infections.
The Risk of HAIs
The CDC released data in March showing that 1 in 25 hospital patients in the U.S. is at risk of developing an HAI, and an estimated 721,800 occur annually. Scott Fridkin, the deputy surveillance branch chief in the Division of Healthcare Quality Promotion at the CDC, calls this “a fairly huge problem,” adding that there’s some evidence that HAI occurrence has decreased. The most common infections, Fridkin says, are pneumonia, diarrhea and urinary tract infections.
The real issue is that hospitals are full of germs, and patients invariably pass infections on to each other – if not directly, then through the doctors and nurses with whom they come into contact. Patients can also contract infections from bacteria that live on devices like catheters.
Nahum’s son Joshua most likely developed his infection from bacteria living on the tube leading to his brain during his ventriculostomy, a surgical procedure that relieves swelling in the brain. Nahum’s own infection occurred during her breast implant surgery.
While controlling the spread of bacterial infections during surgery is usually not feasible for patients, there are certain measures they can take during their hospital stays to minimize their risk of infection.
4 Things Patients Can Do to Prevent HAIs
“Hand hygiene is the basic foundation of all safe care,” Nahum says. “That’s how you pass germs around, so wash your hands frequently – and that means the doctor, nurse and friends because that’s how you are going to get infected. Patients have to know that it’s OK to say ‘Please wash your hands before you touch me.’” Soap and water will do the trick, and that combo trumps hand sanitizer, which does not kill clostridium difficile, commonly known as C. diff, a bacterial infection that causes severe diarrhea. Gloved hands also need to be washed.
Communicate with your health care team, Fridkin says. “Patients should ask every day if they still need the invasive devices that they may be using,” including central lines and urinary catheters. Also ask if prescribed antibiotics are really necessary, since antibiotic resistance is one of the causes of circulating bacterial infections – and that occurs because of over-usage of certain antibiotics, Fridkin explains. If your antibiotic is truly necessary, he adds, take it as prescribed and report any adverse effects.
Choose your visitors well. Bring an advocate with you to the hospital – be it a friend or loved one – “someone who can kind of be the eyes and ears that you don’t have at the moment,” Nahum says. At the same time, leave anyone who is frail or sick at home, and same goes for children. “I would say to anybody walking into the hospital, ‘Be prepared because germs are there.’ I wouldn’t take my sick grandfather or little kids.” Visitors also need to be vigilant about washing hands because infections can travel outside of the hospital, putting others at risk. C.diff and methicillin-resistant Staphylococcus aureus, commonly known as MRSA, are both on the rise in people who have never been hospitalized.
Do your homework on hospitals and choose wisely. Nahum says that hospitals have become more accountable about reporting their rates of HAIs, and the Centers for Medicare & Medicaid Services, through its Hospital Inpatient Quality Reporting Program, provides incentives for compliant hospitals. Medicare’s “Hospital Compare” website contains this comparative information. State health departments are also a good source of information on hospitals’ infection rates.”
And, hospitals and Medical Associations such as the AMA, do not want you to know about how many times a doctor has been sued for malpractice, how many times the patient won, how many times a hospital has been sued for wrongful death and lost.
As a health consumer, it would be fitting (I would say essential) that, to make a proper, informed decision about what health care facility or provider treats you, that you should know their history. If they’ve been sued for malpractice a hundred times, and another provider at the same facility who has worked in the same field, for same number of years, has never been sued, don’t you think this is something you deserve to know, and don’t you think this MIGHT influence your choice of doctors ?
As it is, here in Texas, a doctor could be sued for medical malpractice a thousand times in a year, and you would never know it from looking at his or her profile on the Medical Board website.
The truth is, things have changed a lot in the last 50 years in American hospitals and in multi-doctor clinics, and not necessarily for the better. Fifty years ago, if you demanded you only be seen/ treated by doctors who graduated from Medical Schools here in the continental USA, it would not be such a problem. If you did the same these days, the hospital administration would probably ask you to leave their hospital.
Medicine and health care, are NOT like retail sales of clothes, not like auto mechanics…if a mistake is made in a clothing shop, they can refund your money or exchange the clothes…if a mistake is made at a mechanic’s shop, they can get another part and work on it a bit more til they get it right. If a mistake is made at a hospital, a life could be lost, and a family forever damaged by that mistake…kids can lose parents, parents can lose children, husbands can lose wives.
Mistakes in bookkeeping get erased or fixed..mistakes in medicine get buried or cremated.
But , if anything comes from this article, if you are to get any message from this article, it is NOT that “mistakes”, ie simple negligence or accident, is the thing that can end your life in an institution. My message, and one that demands investigation, is how many deaths which are chalked up to “mistakes”, were not mistakes at all, but were in fact, criminal acts in which a professional intentionally did the wrong thing, but covered it up, and his or her fellow doctors, participated either passively or actively in the covering up of the real reason this patient died.
Thanks for reading this.