[jogiba]

You Tube

You Tube

[GeneV]

Those who say that malpractice suits are significant causes of our healthcare costs are half right--but it is not so much the suit. This last trip to the hospital, I was amazed by how many warnings I received about hospital infections, etc. They admit you, but then tell you you really don't want to be here very long because it is a risky place.

[rparmar]

Such has always been the way. Just ask Florence Nightingale.

[seacapt]

Jogiba that is in my opinion absolutely the best vid you've ever posted!

[Ash]

These are typical first world statistics, but both sensationalised and misrepresented somewhat.
The data speaks of 'unnecessary' hospitalisations, procedures and antibiotic prescription but this can be misleading.

Patients can seek hospitalisation themselves, particularly if privately insured - as crazy as that may sound, it is true for those 'borderline' conditions that could safely be managed at home but also have good justification for being treated under supervision in hospital. For elderly patients, this threshold for hospital treatment is greatly reduced.

Adverse reactions to drugs alone is a poor indicator of the utility of modern medicine. Of course there will be side effects to medications - they are considered foreign chemicals to the human body, and each have toxic effects in some individuals even in the 'safe' therapeutic level. This is not a cause for despising drugs. Without them there would be a hugely inflated mortality rate around the world. It is important to keep the value of medicines in perspective.

Surgery is no different. No medical intervention comes without considerable risk. The risks should always be assessed in light of the benefits of the procedure to decide its implementation. When a death or adverse result occurs from a medical procedure, it is not automatically a malpractice issue - but no doubt, a law suit is always on the cards...

As for antibiotics, this has been going on for as long as penicillin was discovered. Family doctors have to work a lot on intuition and educated projection to decide on the prescription of antibiotics for early presentations of bacterial infections (usually respiratory tract infections). It is not unusual for a doctor to prescribe antibiotics for what appears to be a viral infection when the patient will be away from medical care for some time, or is prone to repeated bacterial infections. The history can determine the treatment a lot of the time - so what seems like 'unnecessary' prescription on paper is more like patient reassurance and prevention from impending illness. There's a lot more to it than that (hence the many years of tertiary education required for the profession) but I think I've said enough...

[Rondec]

The stats quoted in this video are not even close to the reality and Dr Mercola is quite suspect (see: Joseph Mercola - Wikipedia, the free encyclopedia). There is also a nice excerpt on him on quackwatch, as well.

Clearly with every medical intervention, there is the possibility of a bad side effect, with every hospitalization, there is the possibility of a hospital acquired infection. However, much care in the developed world is taken to try to see that this does not happen.

To listen to proponents of alternative medicine talk, you would think that lifespans and quality of life was declining rather than increasing. Looking at the twentieth century, it is clear that there are three major reasons for improvement in longevity: improved sanitation, vaccines, and antibiotics.

[Ash]

The stats quoted in this video are not even close to the reality and Dr Mercola is quite suspect

I didn't want to call Dr Mercola's character into question, but data of this nature can be collated and analysed in a plethora of ways to make an intended message (his one is clearly that of hospitals being 'unsafe' or 'unclean' places, which is misleading and sensational).

Hospitals are where sick people go to (shock, horror), and so why wouldn't there be MRSA, VRE, and the like all over the place within the hospital wards? Infection control standards are very strict in most first world hospitals, and relatively rare cases of cross-contamination are taken very seriously.

[Rondec]

In the United States, the risk of nosocomial or hospital acquired infection is quoted at around 5 percent or 1 in 20 risk. That is less than half of the 1 in 9 risk he quotes in his video. It is still far too much and I know that hospitals are working hard to bring down that risk. The problem is that hospitals are full of sick people, with significant infections and weakened immune systems.

People are actually much less likely to be admitted to the hospital in 2011 and tend to stay for much shorter periods of time. Even as recently as 10 years ago, most people who had a gallbladder removal would stay in the hospital for 2 days, now it is often done as an outpatient. Many other infections that would have been treated with many days in a hospital setting in the past are now treated as outpatients. So, I am not certain where this high number of unnecessary hospitalizations is coming from, either.

[Ash]

Hospital stays have shortened as a direct result from medical and surgical technology. 'Keyhole' surgery itself has certainly been revolutionary in reducing hospital costs (and therefore government expenditure on post-surgical care), but also improving patient outcomes.

I am not certain where this high number of unnecessary hospitalizations is coming from

What I've observed is a move from the general public seeing the hospital as a place to go only when very ill to insured individuals using their privilege to have relatively simple conditions managed by hospital staff out of convenience and little extra cost (justifying their health insurance premiums).

But don't mind me, cynicism in the medical arena comes easy.

[seacapt]

Although the statistics in the video and Mercola's motivation may be suspect , it does reflect some real problems in the medical business in the USA.
The attitude of write a perscription and keep the patient happy is overwhelming and not nessescarily in the patients best interest. It has become common practice and is profitable for the doctor's office and pharmacuetical companies.
It is the main reason perscription drug addiction is so prevalent in America today.
Anti depressants , mood levelers , pain killers ,diet drugs and tranquilizers are perscribed far too frequently for too long of a duration. It's the "Dr. FeelGood " syndrome.

[GeneV]

In the United States, the risk of nosocomial or hospital acquired infection is quoted at around 5 percent or 1 in 20 risk. That is less than half of the 1 in 9 risk he quotes in his video. It is still far too much and I know that hospitals are working hard to bring down that risk. The problem is that hospitals are full of sick people, with significant infections and weakened immune systems.

People are actually much less likely to be admitted to the hospital in 2011 and tend to stay for much shorter periods of time. Even as recently as 10 years ago, most people who had a gallbladder removal would stay in the hospital for 2 days, now it is often done as an outpatient. Many other infections that would have been treated with many days in a hospital setting in the past are now treated as outpatients. So, I am not certain where this high number of unnecessary hospitalizations is coming from, either.

If I read this Wiki correctly (and if it is accurate), the CDC estimate is around 8.5%. Nosocomial infection - Wikipedia, the free encyclopedia . I suspect that this is somewhat understated because many of the infections aren't reported. I can also imagine that there is a good deal of wiggle room in the definitions used by various persons who may be publishing a statistic.

Being full of sick people is not the only problem with Hospitals. Hospitals have always been full of sick people, but the MRSA infections are a fairly recent phenomenon, and the problem is not yet under complete control. I don't see a clear consensus between 5% and 10% in the literature online, but whether it is 1 in 20 or 1 in 9, the risk is too high. It is a disturbing proposition to be hospitalized in a room next to a MRSA patient (as I was in October).

IMHO, there is a high number of unnecessary hospitalizations being generated by an unnecessary number of people coming to a hospital for care. Urgent Care closes at 6-7 p.m. and house calls are a thing of the past, so even insured patients tend to end up in hospitals for things that come on at times other than 9-6 M-F, but don't really need hospital care. Call your doctor about a problem after hours, and the odds are he will send you to the ER. Then, there is the large uninsured population that only sees a doctor in the ER. Once there, you are probably more likely to stay.

On the other hand, I don't see hospitalization as the film clip does--as an attempt to generate billings. On the contrary, my experience (which this year has been way too extensive) has been that I felt rushed out after very serious injury or surgery.

[GeneV]

What I've observed is a move from the general public seeing the hospital as a place to go only when very ill to insured individuals using their privilege to have relatively simple conditions managed by hospital staff out of convenience and little extra cost (justifying their health insurance premiums).

But don't mind me, cynicism in the medical arena comes easy.

Well, as I discussed above, I think a lot of it here comes from the hospital being the only place to be treated if you are acutely sick or injured--even if that sickness turns out not to be serious enough to require a hospital. Most people would rather not go the ER and wait 3-8 hours for care, and do not see that experience as a convenience they have purchased with their insurance.

I remember some time back I sliced my hand with my razor sharp Japanese chef's knife. I was so glad that I did that before 7, so that I could go to Urgent Care for the stitches, and not make an evening of it.

[Ash]

The attitude of write a perscription and keep the patient happy is overwhelming and not nessescarily in the patients best interest.

It's more involved than just a matter of keeping a patient happy. Granted, it takes some guts for a doc to be firm about not prescribing an unnecessary medication when a patient had expected to get one (and had paid for the consultation so that this expectation could be met), but there is also the doctor-patient relationship or what I prefer to call the therapeutic alliance between the doctor and the patient that needs to be considered in the equation. Building trust is one of the most difficult obstacles a doctor faces when establishing rapport with patients; its main goal is to foster a working relationship that allows a patient to feel comfortable to approach the doctor for any sociomedical problem. Without this trust, the therapeutic alliance is threatened, and this is *definitely* not in the patient's best interest. In order to achieve this, the doctor has to be truthful while at the same time supportive to the patient and advocating on his/her behalf.

When it comes to medication prescription, particularly with antibiotics, it is common practice to prescribe a course for an illness based on the prediction that it *may* transform into a condition that indicates that medication (in the case of antibiotics, a bacterial infection). Clinical acumen decides this on the basis of probability for an event that hasn't even occurred, but this is far from being 100% accurate. Indeed, as I mentioned before, social circumstances can determine the 'need' for a patient to be prescribed a medicine even if the indication is not present at the time of the consultation. All of such prescriptions would be considered as 'unnecessary' by the stats presented.

As for anti-depressants, the overprescription is definitely evident. Cognitive behavioural therapy and interpersonal counselling are effective non-pharmaceutical interventions that are more difficult (and even more costly) to undertake, but the evidence shows that clinical depression is most effectively treated by the *combination* of anti-depressants and psychotherapy. The issue is that despite best intentions, doctors get the feedback from a lot of patients that the psychotherapy didn't work, so they'll just keep taking the anti-depressants, thanks. This is very common and a common road to the apparent reliance on anti-depressants - patients have been on their drug for a few years but they 'can't' come off it because their partners have left them or their children are giving them too much grief at home or their still a wreck at work, or any combination of the above. Which brave doctor is going to deny such patients (and there are many of these) further prescriptions of 'unnecessary' anti-depressants when they could be most effectively treated with psychotherapeutic methods, and still manage to maintain a working 'doctor-patient relationship' to foster ongoing trust and alliance? It's much easier for the doctor who's not the patient's regular doctor to say no (and I have done this countless times for new patients seeking valium or opiate supplies), but that leaves the regular doctor in a bind. Why? Because a sick patient coming repeatedly to their usual doctor has a better outcome than if left without one for being principled about prescribing an unnecessary anti-depressant or tranquilliser.

It is a disturbing proposition to be hospitalized in a room next to a MRSA patient

Unfortunately, this is reality in a hospital with limited isolation rooms. Nevertheless, this would (or perhaps should) not happen in the case of an airborne infectious disease of concern such as TB, but MRSA is only transmissible by direct contact with an infected individual. There of course is the assumption that patients are not in shared rooms to socialise by means of direct contact with each other, or sharing items or bedding...



Certainly any number of nosocomial infections is too many, but real world medicine is laden with resistant infectious diseases, and it is impossible to avoid all cases of MRSA, VRE, influenza spreading around the confines of any building.

[Rondec]

If I read this Wiki correctly (and if it is accurate), the CDC estimate is around 8.5%. Nosocomial infection - Wikipedia, the free encyclopedia . I suspect that this is somewhat understated because many of the infections aren't reported. I can also imagine that there is a good deal of wiggle room in the definitions used by various persons who may be publishing a statistic.

Being full of sick people is not the only problem with Hospitals. Hospitals have always been full of sick people, but the MRSA infections are a fairly recent phenomenon, and the problem is not yet under complete control. I don't see a clear consensus between 5% and 10% in the literature online, but whether it is 1 in 20 or 1 in 9, the risk is too high. It is a disturbing proposition to be hospitalized in a room next to a MRSA patient (as I was in October).

IMHO, there is a high number of unnecessary hospitalizations being generated by an unnecessary number of people coming to a hospital for care. Urgent Care closes at 6-7 p.m. and house calls are a thing of the past, so even insured patients tend to end up in hospitals for things that come on at times other than 9-6 M-F, but don't really need hospital care. Call your doctor about a problem after hours, and the odds are he will send you to the ER. Then, there is the large uninsured population that only sees a doctor in the ER. Once there, you are probably more likely to stay.

On the other hand, I don't see hospitalization as the film clip does--as an attempt to generate billings. On the contrary, my experience (which this year has been way too extensive) has been that I felt rushed out after very serious injury or surgery.

Statistics vary depending on where you look. The CDC assumes a rate of 5 percent (although where they get that number from, I don't know).

MRSA is a problem in a variety of places where people are housed close together. It is a problem in boot camps, prisons and jails, and even on sporting teams. It is surprising how prevalent it really is in the community at large and all it takes is one individual in close proximity to others to spread it.

Emergency departments want to move people on, they really don't care if that is to admit patients or to send them home. At the same time, hospitalists are paid salaries that do not increase if their daily census increases. They would rather keep volumes low rather than high.

[Rondec]

I guess I should say that I am all for limiting hospital acquired infections and limiting admissions as they are not needed.

However, I do believe (a) that very sick people need to be in the hospital, but also are at some of the highest risk for getting these infections (b) that Dr Mercola is selling something that he hopes to sell more of if he scares people (c) that Medicare is putting pressure on hospitals by refusing to pay for hospital acquired infections. This is a good thing and has inspired a lot of changes in the last couple of years.

Things can get an awful lot better and I hope they do, but it isn't all doom and gloom either.