Who was that doctor?

So who was that doctor that treated my daughter in the ER and the hospital this past weekend??  Who was the radiologist that discovered that object?  Who was the nurse that made the ER visit so bearable?

Easy, right?  Not so much.

My daughter got sick over the Thanksgiving weekend.  She had two ER visits and one overnight hospital stay.  Fortunately, we averted what could have been a critical situation and she is now fully recovered.

This was due partially to serendipity.  We were simply lucky that I took her to the ER in time.  Had I waiting another 12 hours, her condition would have worsened and it's quite possible that the unthinkable might have happened.  But it was more than just luck which prevented that catastrophe.  I credit the many doctors, nurses and technicians who treated my daughter with saving her life.

I want to send a note commending the CT technician who decided to extend the field of view beyond my daughter's abdomen (which caught the potentially dangerous condition).  I want applaud the nurses and phlebotomists who worked so hard to get a good venipuncture.  I want to credit the X-ray technician who decided, on a hunch, to take an x-ray of her colon when all that was ordered was an esophagram.  I also want to find out more about the GI doctor who consulted on the case.

Unfortunately, I don't have this information.  Since my daughter was admitted to the hospital directly from the first ER visit, we never got ER discharge papers and I can't remember the name of the ER doctors or nurses (not an unusual event).  But even if we got discharge papers (such as we did from the second ER visit), it would not have included the nurse's name.  The hospital discharge papers did include the attending physician. But it did not include any consulting physicians.

The only way to give credit where credit is due is get my daughter's medical records and read thru the volumes of pages.  This requires a physical visit to the hospital with my daughter.  I am not even certain that the technicians and nurses' names would be included.

Maybe it's not that important to know the names of all of the team members.  Perhaps, I should simply be content with the positive outcome.  On the other hand, the entire healthcare system is moving quickly towards measured outcomes and accountable care.  This requires access to data on individuals as well as institutions.

Now, I am a big believer in providing constructive feedback not only when something goes wrong but also when something goes right.  I feel that I don't have the right to complain if I don't also acknowledge success.  This belief probably stems from a small poster my father (a CPA) had in his office which said:  "When I'm right no one remembers.  But when I'm wrong no one forgets."

Perhaps institutions want to protect the identities of these people from overzealous patients.  That would certainly be reasonable if an error was made.  Yet, I feel that is the patient's right to know who treated them and who performed the procedures and tests. It should be a lot easier to find out this information.

So who was that doctor?  I don't know.  (Third base.)

P.S.:  Surveying the successes and failures of hospitals is the main mission of Hospital Consumer Assessment of Hospitals Provider and Systems (HCAHPS).  (The data here is great and I wish that more people would access it.)

PSA Tests vs. a Poke in the...

Very publicly, Ben Stiller wrote last week about how a PSA test probably saved his life.  On the surface it seems like a no-brainer to get a PSA test every year much like it would be for a woman to get a mammogram every year after a certain age.

However, recommended test frequencies have changed for both tests and in the wrong direction, in my opinion.  The logic appears to be similar to both tests in that very early detection can lead to surgical solutions when less drastic (and less costly) solutions might suffice.  These procedures can have possible adverse side effects which, arguably, could have been avoided.  I can completely understand why there is an increase in cancer surgeries.   The "C" word still generates a knee-jerk fear that often leads people to say, as some of my friends have said, "Just cut the damn thing out."

The reality, at least with prostate cancer, is that it usually has a very slow growth rate and early detection does not show a significant positive impact on the survival rate.  According to the American Cancer Society, the 5 year survival rates (the typical bench mark for all types of cancer) are:

• The 5-year relative survival rate is almost 100%
• The 10-year relative survival rate is 98%
• The 15-year relative survival rate is 95%

I don't know the statistics for all types of cancer.  But this seems about as good as it gets.   And these statistics were based on the traditional, annual PSA and other prostate examinations.  

But the other statistics from ACS about prostate cancer are sobering:

• Prostate cancer is the 2nd most common cancer for American men (behind skin cancer)

• 1 in 7 men in the U.S. will be diagnosed with prostate cancer during their lives

• Prostate cancer is the 2nd leading cause of cancer deaths in men (behind lung cancer)

So, as a layperson, I simply can not see the logic of preventing the earliest possible diagnosis of cancer. If the recommendations to lower the frequency PSA and prostate cancer are designed to reduce the costs and the potential complications of unnecessary procedures, then, perhaps, I think it's up to physician's to help patients developed a reasoned response to a diagnosis of prostate cancer.  

If You Need Expensive Prescriptions, Go To Norway.

• In 2015, the total amount spent on prescription drugs in the U.S. was $425 billion (12.2% higher than 2014).
• In 2015, the total amount spent on OTC (over-the-counter) drugs in the U.S. was $32.1 billion ( a modest 4.6% increase).

It's common knowledge that prescription drugs are more expensive in the U.S. than in other countries.  A great article in the Wall Street Journal summarizes the problem:  Why The US Pays More Than Other Countries  (check out the comparison to Norway).

But did you know that OTC (over-the-counter) medicines such as Tylenol, Zantac, and many others are also more expensive in the U.S.?  Probably not.  When drugs like Zantac, Allegra, Claritin got approved for OTC, it wound up costing consumers more to use the same drugs than if they were getting the generic prescription version.

Even commonplace medications such as Tylenol cost more in the U.S.  Why?  Mostly, the answer is just "because".  In other words, Americans are asked to spend more just because the drug companies decided that they should.   This is one reason why medical tourism is so high.  Sometimes, it's the only way to afford expensive, life-saving, medication.  (And don't get me started on the whole Epi-Pen situation.)