Category Archives: Health care
Donald Trump and the Republicans have vowed to repeal and replace the Affordable Care Act and it is very likely they will follow through. If they repeal the ACA and do not replace it with something comparable or better, as many as 25 million people could be without insurance by 2020. Additionally, many if not most people may have less comprehensive coverage and higher co-pays, but that all depends on what kind of replacement plan the congress approves if any. And that — is only the tip of this ugly iceberg.
This blog only deals with repeal while the House has approved a replacement bill, the U.S. Senate has not. We will cover that as thoroughly as possible when it happens.
Few remember this, but just before ACA passed in 2010 the health insurance companies hiked their rates significantly. Since then they have raised rates several more times. Let’s be clear here, ACA is NOT raising your rates, there is no provision in the act that allows for that. Many have complained that ACA is responsible for increased rates, but that’s really an empty claim because we don’t know what insurance rates would have done if there was no ACA. One thing for sure, rate hikes always come from the Insurance companies. If ACA is repealed you will get far less coverage, but you can be sure the insurance companies don’t reduce their rates by a single dime.
If ACA is repealed everyone will feel it, even the very wealthy. The difference is they can afford to self-insure– maybe. Today the cost of some procedures and care is so high that it might even hurt the mega rich to have to pay out-of-pocket. 10 years ago I had a heart transplant. According to the National Transplant Foundation, the average cost today for the same procedure would be $1.2 million. That price includes first-year medications and care. You can review other costs here. (http://www.transplants.org/faq/how-much-does-transplant-cost). A heart/lung transplant would cost $2.3 million. That would make even a wealthy person sit up and take notice. (If you would like to examine the effect of ACA on health care costs Gary Cameron of the Reuters news service.wrote this for Time.http://time.com/money/4503325/obama-health-care-costs-obamacare/ )
The Trump administration is also talking about cuts to both Medicare and Medicaid. It remains to be seen what that means but this congress is in a cutting mood, so it is unlikely that their actions will result in anything beneficial to many with chronic illnesses. You can also expect that if there was ever any hope of extending coverage for anti-rejection drugs past 36 months for Kidney transplant patients it ended with Trump’s Inauguration.
Very few people are aware that Medicare is also affected by repeal of Obamacare. There are several areas that will be negatively impacted but the part that helps seniors with Prescription costs will take the biggest hit.
The Senate bill slashes tax revenues by $701 billion over a decade, while reducing Medicaid spending by $772 billion versus current law. Overall, the Senate bill reduces federal health care spending by $1 trillion.
The Center for Budget and Policy Priorities estimates the bill’s tax benefits for the 400 highest earning households in America alone are equal to the cost of keeping Obamacare’s Medicaid expansion in four states that cover 726,000 people.
- The ACA helps seniors in the donut hole until it is closed. Copayments required for brand-name and generic drugs are being phased down to the standard 25 percent by 2020. Brand-name drugs discounts from manufacturers increase each year in the coverage gap. Copayments for generic drugs are reduced by seven percentage points each year until the coverage gap is eliminated.
- In 2016, seniors receive a 55 percent discount on brand-name prescription drugs and a 42 percent discount on generic drugs, which is applied at the pharmacy. Below are the amounts that beneficiaries will pay for their medications until the donut hole is closed in 2020.
- 2016: 45 percent for brand-names and 58 percent for generics
- 2017: 40 percent for brand-names and 51 percent for generics
- 2018: 35 percent for brand-names and 44 percent for generics
- 2019: 30 percent for brand-names and 37 percent for generics
- 2020: 25 percent for brand-names and 25 percent for generics
Ever since the Affordable Care Act (ACA) passed in 2010, Republicans have vowed to repeal it. They have made many claims about what a “Disaster” it is, but offer little in the way of evidence other than point to increased premiums. Premiums, though, were out of control long before there was an ACA and many experts say that if anything the sweeping health care bill slowed their increase. If Republicans are successful in repealing the act you will be affected in many ways, now and in the future. I’d like to keep this blog relatively short so I will only address four issues here, but they are big ones.
- Pre-existing conditions
- Children on your policy until age 26
- Medicaid changes
- Medicare adjustments
Effect Number One. Pre-existing Conditions
People have short memories so let me remind you what the health insurance environment was like prior to 2010. Example. A woman I know was having problems sleeping,, that’s all. She was in otherwise excellent health. To help her sleep, her doctor prescribed Remeron which is also an anti-depressant. Due to family circumstances, she had to move to a different state, a state in which her current health insurance had no coverage. She thought nothing of it because she was healthy, so she shopped around for new insurance, found one she liked and applied. Almost immediately she was denied coverage due to a pre-existing condition of depression even though she was not suffering from depression. The drug, Remeron, was prescribed to help her sleep but the new insurance company ignored that detail. Her only option was to keep her old insurance from another state even though she was out of network. Under those circumstances, this healthy woman had become uninsurable because of one medication that was not even prescribed for the purpose identified in the rejection notice. That is what we likely will be returning to. But there’s more.
If the ACA is repealed without a replacement plan and maybe even with one here’s what you can expect.
Let’s say a young couple finds they are about to have a child. The husband just got a new job in another state so they will have to move and get new insurance as well. Here’s what they are likely to run into if ACA is repealed.
- Pregnancy could easily be considered a pre-existing condition, at least the insurance companies would have that option. That means when this family looks for new coverage insurers could deny it or charge exorbitant rates.
- Even if they got insurance, the plan would likely not include maternity coverage, as was the case for over 60 percent of enrollees in individual market plans in 2011.
- They’d get no financial assistance to help ensure they can find a good plan within their budget and there would be no help in paying their out-of-pocket costs.
- Healthy pregnancy, births, and newborns programs would no longer exist, putting the family at greater risk for other health problems.
- And the family would likely have to pay out of pocket for each new baby visit and any ensuing treatments, injections or other procedures.
Some estimates indicate that nearly a half of all Americans have a pre-existing medical condition that could make it difficult to find insurance, and about 3 million of them are now insured under the ACA. If and when it is repealed those who have insurance could lose it and those without insurance, or who leave their old plans for any reason such as job change, divorce, or relocation, may find it impossible to get a new plan. The Kaiser Family Foundation projects that if the pre-existing conditions provision is repealed, 52 million Americans could be at risk of being denied health care coverage.
Effect Number Two. Children Covered by Parent’s Insurance to Age 26
If ACA is repealed and not replaced with something equivalent or better, that means that once you turn 19 or are no longer a full-time student, you are on your own for insurance coverage, increasing the financial burden on young adults who are unemployed, underemployed, contractors, working for small companies, or those starting their own businesses. Young people are less likely to get seriously ill and often don’t use insurance when they have it. Insurance companies would love to have these men and women paying premiums again, though, because they use so little of the coverage and help to defray the cost of covering others.
This is a popular benefit among some Republican office holders because their children are affected so it might be added to whatever replacement the GOP drafts, although the age limit could potentially get lowered by a year or two.
Effect Number Three. Medicaid
One of the most appealing aspects of health-care reform for many was the ability to get subsidized insurance policies, reducing out-of-pocket costs. According to Kaiser Health News, all but 19 states expanded the income limits for people to get Medicaid insurance and in some cases limits were pushed to 300 percent of the federal poverty level. Also, tax credits beyond that helped even middle-class workers and families afford their monthly premiums. The Affordable Care Act was affordable largely because of the Government subsidies. While all Republicans in congress opposed the expansion of Medicaid, many Republican State Governors accepted the plan for their states. Medicaid is funded by the Feds but run by the states. If ACA is repealed and Medicaid expansion goes out the window the states will be left with the choice of funding it or telling their citizens that they are cutting the program. That could have disastrous effects for Republicans in coming elections.
Based on the resistance that red states had to the idea of expanding Medicaid coverage in the first place — even with the federal government covering almost all of the expense — it will not be surprising to see a GOP plan that either decreases or completely remove the tax credits or other subsidies. Almost all Republicans agree it must go. There seems to be little agreement on if or how to replace it.
Effect Number Four. Medicare Cuts
Here comes trouble. Like Social Security this is the healthcare third rail, it can mean political suicide for anyone that makes any negative changes in the national health care system for people age 65 and over. The great majority of them are not working, have no income other than Social Security and some savings and they are uninsurable outside of Medicare (supplemental programs excepted). Some see Medicare as totally separate from the ACA and in some ways it is, but they are also intertwined. Too many seniors think they are immune from change, they are not.
According to the Kaiser Foundation, a full repeal of ACA would restore higher payments for services performed under the managed-care portion of Medicare known as Medicare Advantage. That, then, could lead to increased Medicare Advantage premiums. It could also mean an end to free preventive services and could result in greater premiums and increased out-of-pocket costs, or both.
Perhaps the most notable change would be to reverse efforts to close the “doughnut hole” for prescription drugs. One provision of the Affordable Care Act dramatically cut the amount that seniors on Medicare have to pay for their medicines under Medicare Part D. prior to the ACA’s passage, beneficiaries got some coverage up to a certain dollar amount, and then none until high-dollar, catastrophic coverage provisions kicked in. Once in that “donut hole” seniors paid the full price. Under ACA that coverage gap was supposed to end in 2020.
Now here’s what they are NOT telling you. It is now projected that ACA spending between now and 2020 is $1 trillion LOWER than the original Congressional Budget Office estimate. That means the trust fund for Medicare is now projected to remain solvent 11 years longer than before the Affordable Care Act was enacted. Strangely none of the repeal advocates has mentioned that fact.
For these reasons, it is important to be clear. The repeal of Obamacare will mean that Medicare beneficiaries will have to pay millions more for prescription drugs and won’t have access to free preventive care, while the program itself will be put in financial jeopardy.
As long as this blog is, it doesn’t begin to cover the full impact of ACA repeal and it says nothing about replacement because we have been unable to find a single plan for doing that that has been released. There are several people who say they have plans, but none have provided documents yet. We’ll keep our eye on it and do what we can to keep you informed. We’ll report more as we can.
Bob Aronson is the founder of Facebook’s 4300 member Organ Transplant Initiative and also of this site, Bob’s Newheart. Look through the index and you’ll find nearly 300 blogs of interest to Transplant patients, their families, friends, caregivers, donors and donor families.
By Bob Aronson
Antibiotics and drugs called antimicrobial agents have been used for the last 70 years to treat patients with infectious diseases who might genotherwise have died. Unfortunately these “Miracle” drugs were used for such a long time and so indiscriminately that the organisms they were designed to kill have mutated and become more resistant to them. In some cases the drugs don’t work at all anymore.
Each year in the United States, at least 2 million people become infected with antibiotic resistant bacteria and at least 23,000 of them die as a result. While 23,000 is a significant number it does not even come close to being in the catastrophic category so there’s not much media attention given to the problem – until now and this headline.
Is Antibiotic resistance: the greatest public health threat of our time?
The WHO says we are in a “post-antibiotic era”, in which even the most minor bacterial infections could mean death, a statement made true because of antibiotic misuse, overprescribing and poor diagnoses.
A world without antimicrobials would be a world without modern medicine, so why is there not more urgency in addressing the global rise of drug resistance? The New Statesman brought leading health experts together to discuss the problem. http://www.newstatesman.com/sci-tech/2014/07/antibiotic-resistance-greatest-public-health-threat-our-time
Antibiotic-resistant infections can happen anywhere. The CDC says that most of them happen in the general community; however, most deaths related to antibiotic resistance happen in healthcare settings such as hospitals and nursing homes. http://www.cdc.gov/drugresistance/threat-report-2013/index.html
The Threat to You
Diseases that either are or are becoming antibiotic resistant http://www.cdc.gov/drugresistance/DiseasesConnectedAR.html
A growing number of disease-causing organisms or pathogens, are resistant to one or more antimicrobial drugs—including the bacteria that cause tuberculosis, the viruses that cause influenza, the parasites that cause malaria, and the fungi that cause yeast infections. All are becoming resistant to the antimicrobial agents used for treatment. Curious about other diseases that may not respond to your antibiotics? Here’s a partial list from the CDC. The full list can be seen by clicking on the above link.
Acinetobacter is a type of gram-negative bacteria that is a cause of pneumonia or bloodstream infections among critically ill patients. Many of these bacteria have become very resistant to antibiotics.
Anthrax is a serious disease caused by Bacillus anthracis, a bacterium that forms spores. Anthrax most commonly occurs in wild and domestic mammalian species, but it can also occur in humans when they are exposed to infected animals or to tissue from infected animals or when anthrax spores are used as a bioterrorist weapon. Some strains of B. anthracis may be naturally resistant to certain antibiotics and not others. In addition, there may be biologically mutant strains that are engineered to be resistant to various antibiotics.
Untreatable and hard-to-treat infections from carbapenem-resistant Enterobacteriaceae (CRE) bacteria are on the rise among patients in medical facilities. CRE have become resistant to all or nearly all the antibiotics we have today. Almost half of hospital patients who get bloodstream infections from CRE bacteria die from the infection.
Group B Streptococcus (GBS) is a type of bacteria that can cause severe illnesses in people of all ages, ranging from bloodstream infections (sepsis) and pneumonia to meningitis and skin infections.
Methicillin-resistant Staphylococcus aureus (MRSA) causes a range of illnesses, from skin and wound infections to pneumonia and bloodstream infections that can cause sepsis and death. Staph bacteria, including MRSA, are one of the most common causes of healthcare-associated infections.
Non-typhoidal Salmonella (serotypes other than Typhi, Paratyphi A, Paratyphi B, and Paratyphi C) usually causes diarrhea (sometimes bloody), fever, and abdominal cramps. Some infections spread to the blood and can have life-threatening complications.
Shigella usually causes diarrhea (sometimes bloody), fever, and abdominal pain. Sometimes it causes serious complications such as reactive arthritis. High-risk groups include young children, people with inadequate hand washing and hygiene habits, and men who have sex with men.
Streptococcus pneumoniae (S. pneumoniae, or pneumococcus) is the leading cause of bacterial pneumonia and meningitis in the United States. It also is a major cause of bloodstream infections and ear and sinus infections.
Tuberculosis (TB) is among the most common infectious diseases and a frequent cause of death worldwide. TB is caused by the bacteriaMycobacterium tuberculosis (M. tuberculosis) and is spread most commonly through the air. M. tuberculosis can affect any part of the body, but disease is found most often in the lungs. In most cases, TB is treatable and curable with the available first-line TB drugs; however, in some cases, M. tuberculosis can be resistant to one or more of the drugs used to treat it. Drug-resistant TB is more challenging to treat — it can be complex and requires more time and more expensive drugs that often have more side effects. Extensively Drug-Resistant TB (XDR TB) is resistant to most TB drugs; therefore, patients are left with treatment options that are much less effective. The major factors driving TB drug resistance are incomplete or wrong treatment, short drug supply, and lack of new drugs. In the United States most drug-resistant TB is found among persons born outside of the country.
Salmonella serotype Typhi causes typhoid fever, a potentially life-threatening disease. People with typhoid fever usually have a high fever, abdominal pain, and headache. Typhoid fever can lead to bowel perforation, shock, and death.
Staphylococcus aureus is a common type of bacteria that is found on the skin. During medical procedures when patients require catheters or ventilators or undergo surgical procedures, Staphylococcus aureus can enter the body and cause infections. When Staphylococcus aureus becomes resistant to vancomycin, there are few treatment options available because vancomycin-resistant S. aureus bacteria identified to date were also resistant to methicillin and other classes of antibiotics.
Malaria is a mosquito-borne disease caused by a parasite. People with malaria often experience fever, chills, and flu-like symptoms. The development of resistance to drugs poses one of the greatest threats to malaria control and has been linked to recent increases in malaria morbidity and mortality. Antimicrobial resistance has been confirmed in only two of the four human malaria parasite species, Plasmodium falciparum and P. vivax.
WHO: Antibiotic Resistance Now a ‘Major Threat to Public Health’
Antibiotics are powerful tools for fighting illness and disease, but their overuse has helped create bacteria that are outliving the drugs used to treat them.
Antibiotic resistance is a quickly growing, extremely dangerous problem. World health leaders have described antibiotic-resistant bacteria as “nightmare bacteria” that “pose a catastrophic threat” to people in every country in the world. Many more people die from other conditions that were complicated by an antibiotic-resistant infection.
In addition, almost 250,000 people who are hospitalized or require hospitalization get Clostridium difficile each year, an infection usually related to antibiotic use. C. difficile causes deadly diarrhea and kills at least 14,000 people each year. Many C. difficile infections and drug-resistant infections can be prevented.
How Bacteria Become Resistant
When bacteria are exposed to antibiotics, they start learning how to outsmart the drugs. This process occurs in bacteria found in humans, animals, and the environment. Resistant bacteria can multiply and spread easily and quickly, causing severe infections. They can also share genetic information with other bacteria, making the other bacteria resistant as well. Each time bacteria learn to outsmart an antibiotic, treatment options are more limited, and these infections pose a greater risk to human health.
Infections Can Happen to Anyone, Anywhere
Anyone can become infected with antibiotic-resistant bacteria anywhere and anytime. Most infections occur in the community, like skin infections with MRSA and sexually transmitted diseases. However, most deaths related to antibiotic resistance occur from drug-resistant infections picked up in healthcare settings, such as hospitals and nursing homes.
What you can do to protect yourself against drug-resistant infections
Bob’s Newheart is providing two answers to this question. The first from the CDC and the second from a panel of physician experts who were interviewed for the PBS TV show, Frontline.
There are many ways you can help prevent the creation and spread of resistance. First, when you are sick, do not demand antibiotics from your doctor or take antibiotics that were not prescribed to you directly for your specific illness. When taking antibiotics, do not skip doses, and make sure to follow the directions about dose and duration from your doctor.
Second, like all diseases, common safety and hygiene methods can prevent disease and spread. Make sure to:
- Get updated and regular vaccinations against drug-resistant bacteria
- Wash your hands before eating and after using the restroom to avoid putting drug-resistant bacteria into your body
- Wash your hands after handling uncooked food to prevent ingesting drug-resistant bacteria that can live on food
- Cook meat and poultry thoroughly to kill bacteria, including potential drug-resistant bacteria
What healthcare providers can do to protect patients from drug-resistant infections (CDC)
- Follow all necessary infection control recommendations, including hand hygiene, standard precautions, and contact precautions.
- Diagnose and treat resistant infections quickly and efficiently. Treatment options change often because resistance is complex. Make sure to follow the latest recommendations to ensure you are prescribing appropriately.
- Only prescribe antibiotics when likely to benefit the patient, and be sure to prescribe the right dose and duration.
- Be sure to clearly label dose, duration, and indication for treatment, and include appropriate laboratory diagnostic tests when placing antibiotic orders. This will help other clinicians caring for the patient to change or stop therapy when appropriate.
- Take an antibiotic time out, reassessing therapy after 48-72 hours. Once additional information is available, including microbiology, radiographic, and clinical information, a decision can be made on whether to continue the same therapy.
- When transferring patients, ensure the other facilities are notified of any infection or known colonization.
- Keep tabs on resistance patterns in your facility and in the area around your facility.
- Finally, encourage prevention methods with your patients. Make sure they understand how to protect themselves with vaccines, treatment, and infection control practices such as hand washing and safe food handling.
From PBS “Frontline”
Eight Ways to Protect Yourself from Superbugs
October 22, 2013, 9:32 pm ET by Sarah Childress
Everyone is at risk of becoming infected by drug-resistant bacteria, especially as some have begun to appear outside of hospitals in the general community. So how worried should you be?
The PBS investigative show, “FRONTLINE” asked three infectious disease doctors these questions: what the risks are, how to protect yourself, and what questions to ask when a loved one is in the hospital.
|Dr. Sean Elliott is the medical director of infection prevention at the University of Arizona Health Network||Dr. Brad Spellberg is an infectious diseases specialist at Harbor-UCLA Medical Center||Dr. Wendy Stead is an infectious diseases specialist at Beth Israel Deaconess Medical Center in Boston|
Frontline condensed their advice into eight handy tips to help keep bugs at bay.
Of course, none of this substitutes for actual medical advice. For serious concerns, always consult your doctor.
1. Don’t Panic
Everyone may be at risk, but the chances of catching a drug-resistant bug outside of the hospital are small for most. “For the average healthy person walking down the street? Those organisms are not much of a threat,” Stead says.
“The first principle is to try to live a healthy lifestyle to reduce the need to be in the hospital” where you are more likely to encounter these bugs, Spellberg says. Keep your home and work space clean. Be aware of the food you eat: Wash fruits and vegetables carefully and cook other food properly to reduce your chance of coming into contact with harmful bacteria.
2. Know What to Look For
How do you know if you have a superbug?
“You don’t. And your doctor won’t either, at least at first,” Spellberg said. “The infections caused by antibiotic-resistant bacteria do not cause different symptoms than infections caused by antibiotic-susceptible infections.”
While it’s impossible to give broad advice about so many different kinds of bacteria — and if you’re concerned, you should call your doctor first — there are some signs that an illness might be more serious. “In general, fevers, if they’re accompanied by shaking chills, if they’re getting worse instead of better, that would suggest there’s a bacterial process,” Elliott said.
With community-acquired MRSA, many people first notice a skin infection or boil that becomes larger and more painful, Stead says.
But if you do suspect such an infection, don’t rush to the emergency room, where you might be exposed to other bugs or infect others. Call your primary-care doctor first for advice.
3. Wash Your Hands with Soap and Water. Really wash them. Doctors say they cannot recommend this enough.
“Wash your hands regularly and religiously in the normal times that you would think you should wash them,” Stead says. “Give it a good amount of time” — about 15 seconds — “scrubbing hands thoroughly, not just in and out of the water.”
Turn off the faucet using a paper towel.
Alcohol-based hand-sanitizers are handy too, but remember that one bug, C.Diff, is resistant to that as well. But it does respond to soap and water. So Wash. Your. Hands.
4. Be Careful with the Antibacterial Soap
The FDA hasn’t determined whether these soaps are more effective than regular soap, and some doctors don’t recommend using them. “You do not need to take ‘antibacterial’ soaps for routine use,” Spellberg says. “There may be specific medical circumstances that warrant special antibacterial cleansers, but these should be prescribed by your physician.”
“A lot of the antibacterial soaps are more drying to the skin than would be a simple soap,” Elliott says. “So the more that we break down our skin barriers the higher the risk of getting superimposed bacterial. The real key is the soap and water and the physical action — and keeping hands moisturized. “
5. Ask Your Doctors to Wash Their Hands
“It is every patient’s right to have every health-care provider entering the room to have clean hands,” Elliott says. “We’re supposed to do it, we mandate 100 percent hand- hygiene compliance, but the reality is that doesn’t happen,” he says.
Some hospitals even make health-care providers wear buttons encouraging patients to ask them if they’ve washed their hands. Even if they’re buttonless, you should feel free to ask your providers about it.
“Really — we are not offended by that,” Stead says.
6. Get A Flu Shot
“When people get influenza, they actually become at higher risk as they recover for complicating bacterial infections,” Stead says, because people with weakened immune systems are more vulnerable to other bugs.
“Community-acquired MRSA is a big risk in patients who have recently had influenza,” she notes. “They get influenza and they start to get better, and then the staph comes in. … That’s life threatening. They wouldn’t have been at risk for that if they hadn’t had influenza in the first place.”
7. Ask Whether You Need that Antibiotic
Doctors sometimes feel pressured by patients or their families to prescribe an antibiotic, even if it’s not necessary. Don’t assume you need one — antibiotics don’t work on viral infections like colds or the flu. If your doctor does recommend one, ask whether you really need it.
“Using antibiotics does kill off non-resistant bacteria in your body and makes you likely to acquire antibiotic-resistant bacteria in their place,” Spellberg says. “If your doctor says that they think your infection is probably caused by bacteria and that you do need an antibiotic, ask, ‘Do I need a broadly active antibiotic, or can I take a narrower antibiotic?’ The broader the antibiotic, the more damage to your normal bacteria can be caused. We want physicians to try to prescribe antibiotics that are as narrow as possible for a given infection.”
8. Advocate for Loved Ones in the Hospital
One of the ways drug-resistant bacteria spreads in hospital is through tubes inserted in the body, such as catheters. If someone you care about is on such a device, don’t be afraid to ask doctors whether they still need it, and when the tubes can come out.
“Hospitals are much more aggressive about removing things if they’re not needed anymore,” Stead says. “But having patients be aware and try to get things out too is good.”
“Every day that decision needs to be made: Do these things need to stay in or do they need to come out?” Elliott says. The key, he says, is “empowering patients or their advocates to stand up for their health-care needs.”
While physicians and health care workers have a responsibility to provide the best health care, patients also have some responsibility for their own well-being and it boils down to being informed and not being afraid to ask tough questions.
Most of us don’t like challenging physicians, we just assume that will all those many years of education and the raft of framed diplomas on the wall that they must know what they are doing, but the practice of medicine is as much art as it is science. That means even highly educated medical experts can come to the wrong conclusions, so it is extremely important for patients to expand their knowledge of the conditions to which they are exposed or have contracted, ask tough, knowledgeable questions and then, demand clear unequivocal answers. Doing so could mean the difference between life and death.
Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s over 4,000 member Organ Transplant Initiative (OTI) and the author of most of these donation/transplantation blogs. You may comment in the space provided or email your thoughts to me at firstname.lastname@example.org.
Bob’s Newheart was established to support and help everyone, but particularly those who need or have had organ transplants. Some of our blogs are specifically related to donation/transplantation issues while others are more general, but they are all related. Because anti-rejection drugs compromise immune systems, transplant recipients are more susceptible to a variety of diseases. We provide general health and medical information to help them protect themselves while at the same time, helping others live healthier lives and avoid organ failure.
Bob’s Newheart mission is three-fold; 1) to provide news and information that promotes healthier living so people won’t need transplants; 2) To help recipients protect their new organs and; 3) to do what we can to ensure that anyone who needs an organ can get one. About 7,000 Americans die every year while waiting for a life-saving organ. I am sure you will agree that should not happen.
In the U.S. the great majority of people support organ donation, but only about 40% of us officially become organ donors. Many have good intentions but just don’t get around to it. It is hard to accept, but no one knows how long they will live. My transplanted heart came from a 30 year old man. I’m sure he had no intention of being a donor at that age. If you are not yet a donor, please register at www.donatelife.net it only takes a few seconds. Then, tell your family so there is no confusion when the time comes to donate. One organ donor can save or positively affect the lives of up to 60 people. There is no nobler thing you can do than becoming an organ donor.
Founder of Bob’s Newheart
Established November 3, 2007
Introduction by Bob Aronson
Dr. Priscilla Diffie-Couch, regularly sends out health, fitness and medical tips and ideas to family members and some friends. She is highly regarded as a resource, and an amazing researcher with a knack for cutting through the medical terminology and making it understandable. In our family it is not uncommon to hear, “Priscilla says…..” and that makes it gospel.
Today I received this email from her:
“INAPPROPRIATE TEST ORDERS INUNDATE HEALTH SYSTEM”
From Priscilla Diffie-Couch
That was the headline in one of my health sources today. They cited three health tests that are misused frequently:
- Test for healthy vitamin D levels. The correct test is called 25-dehydroxyvitamin D test. The incorrect test ordered more often than not is called 1,25-hidroxyvitamin D test. Note the 1 and the comma in front of the wrong test (designed to detect renal failure) plus the “I” instead of an “E” in the word dehydroxyvitamin. Of course, you who read my health notes have known the correct test to request for several years now.
- Test for anemia by determining levels of B12. The older you are, the more questions you need to ask about the lab standards that apply to your B12 test results.
- Ionized calcium tests are overused and do not tell you if you have a shortage of calcium.
Upon reading Priscilla’s email I wondered what other tests might be unnecessary so I did some quick internet research and found plenty. Here’s my quick intro followed by a report from AARP.
Physicians are among the most trusted people on earth. When a Doctor orders a CT scan or an X Ray or even a blood test few of us think to question her. We know she has completed several years of medical school and for many of us it is unthinkable to question that kind of expertise.
But – question we must because physicians regularly order unnecessary tests and those tests can negatively affect the patient in two ways; 1) it could well be money out of your pocket either in higher medical bills (An MRI, or magnetic resonance imaging scan, can cost $1,000 or more), increased co-pays or more costly insurance and; 2) the tests could be dangerous. Ordinary X-rays are rarely a concern, but super-sharp X-rays called CT scans involve relatively large radiation doses and can raise the risk of cancer. And So, you might ask, “Why would they order tests they know are unnecessary? Is it because they are afraid of lawsuits?” Good question, and lawsuits are part of the answer. Professional pride is another. Like us, doctors don’t like being wrong either.
As suggested, the most commonly cited reason is “defensive medicine”: the fear of being sued by patients for not ordering a test. An American Academy of Orthopedic Surgeons study that involved 72 orthopedic surgeons who saw over 2,000 patients reported ordering 20% of their expensive imaging tests “for defensive reasons.” Included was 57% of bone scans, 53% for ultrasounds, 38% for MRIs, 33% for CT scans and 11% for x-rays.
Those unnecessary and overused tests account cost the American patient upwards of $60 billion a year. That’s a whole lot of hard earned money, but fear of lawsuits alone is not the prime motivator. The leader is something most people have never heard of. It’s called the M & M conference (Morbidity and Mortality). That’s where you stand up in front of your peers and “fess up” to your mistakes. Needless to say, that can be quite embarrassing. The M & M conference, though, is a double edged sword because while it is unlikely the physician will ever make that mistake again, it is very likely they will order more unnecessary tests because they are good insurance against another M & M visit.
With that background here is a summary of 7 tests that may be unnecessary. Tests you should ask about when you are scheduled for any of them. AARP did a fine job of assembling this information along with the dangers the tests present and the exceptions that can be made for having them.
7 Medical Tests and Treatments You May Not Really Need
Think twice before getting these procedures
by: Elizabeth Agnvall, AARP
The American Board of Internal Medicine Foundation (ABIM) asked nine medical societies — from family doctors to allergists and cardiologists — to each identify five commonly used medical tests and treatments that are often unnecessary. A list of 45 overused procedures was presented Wednesday, April 4, 2012, at a news conference at the National Press Club in Washington, D.C.
“We’re changing the culture in medicine,” says Christine K. Cassel, M.D., president of the ABIM, about this new Choosing Wisely campaign, which represents some 375,000 doctors. Consumer Reports also has joined the doctors’ campaign.
- What tests and screenings do you need if you are over 50? Read
- Understanding lab test results. Read
- Clean out your medicine cabinet. Read
“Too much testing is being done that isn’t needed, that doesn’t work,” says John Santa, M.D., who directs health ratings for Consumer Reports.
Here are seven of the most popular, most overused tests and treatments for people over age 50 that the AARP Bulletin has selected from the Choosing Wisely campaign. For the complete list go to www.choosingwisely.org.
American Academy of Family Physicians
These can be lifesaving for those experiencing chest pain or other symptoms of heart disease. But a 2010 Consumer Reports survey found that 44 percent of people with no signs or symptoms of heart diseasehad an EKG, an exercise stress test or an ultrasound. For several years, cardiology guidelines have discouraged heart screening tests for people who have no symptoms and are not at high risk, and yet their use “is more common than it needs to be,” says James Fasules, M.D., an official with the American College of Cardiology. For those at low risk for heart disease, an EKG or cardiac stress test is far more likely to show a false positive result than find a real problem.
Dangers: False positive tests often lead to more tests and even invasive heart procedures.
Exceptions: If you have diabetes or other conditions that raise your risk, talk to your doctor. Use this calculator to find out your 10-year risk of having a heart attack.
American Academy of Family Physicians
Bone density decreases and the risk of fractures increases with age, but medical experts say that most women don’t need a bone density test until age 65. Still, many doctors recommend the scan starting at age 50.
Dangers: Bone density (DXA) scans can lead to unneeded medications that can have serious side effects.
Exceptions: Talk to your doctor about a scan before age 65 (70 if you’re a man) if you were or are a smoker; you’ve used steroid medications regularly; have low body weight; or have already had a fracture. ThisFRAX tool can help you calculate your risk.
American Academy of Family Physicians, American Academy of Allergy, Asthma & Immunology
Despite physician awareness campaigns about the overuse of antibiotics for sinus infections, the drugs are prescribed in more than 80 percent of cases, according to the American Academy of Family Physicians. More than 90 percent of sinus infections are caused by viruses — and the drugs only work against bacterial infections.
Dangers: The widespread overuse of antibiotics is behind the spread of increasingly virulent strains of drug-resistant bacteria.
Exceptions: If symptoms last more than seven days or worsen after initially improving. Some people develop a secondary bacterial infection and then antibiotics may be needed.
American Society of Nephrology
Many people use Advil, Motrin (ibuprofen) or prescriptions such as Celebrex and Voltaren for everything from arthritis to headaches. But these common painkillers can be dangerous, especially for people with high blood pressure or kidney disease. (These medications can raise blood pressure, cause fluid retention and interfere with kidney function.) Tylenol (acetaminophen), tramadol, or short-term use of narcotic painkillers may be safer than NSAIDs, according to the nephrologists.
Dangers: These drugs are linked to stomach bleeding and increased risk of heart and kidney problems.
5. X-ray, CT scan or MRI for low back pain.
American College of Physicians, American Academy of Family Physicians
About 80 percent of Americans will suffer from back pain. Low back pain is the fifth most common cause for all doctor’s visits. “The vast majority of people with nonspecific low back pain simply get better … within four to six weeks, with or without a physician’s intervention,” says Patrick Alguire, M.D., an official with the American College of Physicians. If older people get an image, experts say the results will almost always show an innocent abnormality that has nothing to do with the back pain.
Dangers: Some tests expose people to unnecessary radiation and can lead to expensive back surgery.
Exceptions: When the doctor suspects serious underlying conditions or if the pain isn’t better in six weeks.
American Academy of Allergy, Asthma & Immunology
Some 35 million Americans suffer from seasonal allergies. And millions of Americans increasingly blame a food allergy or sensitivity — fromgluten to milk — for their health woes. Some doctors or health providers now perform a blood test, called an immunoglobulin (IgG), for food allergies. But Linda Cox, M.D., president elect of the allergy group, says the test simply doesn’t work. For seasonal allergies, many doctors run abattery of blood and skin tests dubbed IgE, when just a few specific tests would do. By asking patients when and where they have symptoms, doctors can pinpoint what tests they should run.
American College of Radiology
Severe headaches can be excruciating and frightening, but unless they are accompanied by other key symptoms it rarely makes sense to get a CT scan or MRI of the brain. Yet “it happens all the time,” says David Seidenwurm, M.D., a neuroradiologist in Sacramento, Calif. Patients get frightened, doctors worry about lawsuits and people “want all the information right away,” he says. “It’s easier to do the scan than to have the conversation.”
Dangers: Radiation exposure raises cancer risks in the population and false-positives lead to more testing and patient anxiety.
Exceptions: Worrisome symptoms — trouble speaking, blurred vision, weakness on one side — or other signs that the headache is caused from something more dangerous, such as a brain tumor.
Remember readers, despite all the diplomas on the wall, the high tech office and the “Dr.” title, the physician works for you, just like your plumber, electrician or carpenter. If you don’t understand, if you are confused or if you disagree, speak up. It is your health we are dealing with here so be polite and courteous but be firm. Physicians have been known to make mistakes. Make sure they don’t happen to you. Probe a little more and demand understandable answers . By being a little more assertive you just might get better care.
Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s over 4,000 member Organ Transplant Initiative (OTI) and the author of most of these donation/transplantation blogs. You may comment in the space provided or email your thoughts to me at email@example.com. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.
By Bob Aronson
Almost everyone is familiar with the commercials and ads that offer relief for men suffering from “Low T.” Most interpret that to mean “diminished sex drive” and there is no end to the number of claims of treatments and/or cures. Bottom line? They are selling sex. The manufacturers of “Low T” products, physicians, clinics and therapists are pandering to the male fear of erectile dysfunction and there’s absolutely no guarantee that any of the products will work. Worse yet, they could kill you.
The ads produced by those who are promoting Testosterone therapy amount to fear mongering at its
worst. Nothing will destroy a man’s ego faster than an inability to perform in bed and many will go to any extreme to make sure that doesn’t happen. If you could drill deeply into the male ego you likely would find that the ability to get and hold an erection is extremely important and when that ability is lost even once, many men will feel as though they have lost their manhood and that their life is over. The ads posted here are real.
The “Low T” condition should not be taken lightly, if in fact that is an accurate diagnosis. Unfortunately the number of physicians and others who offer that diagnosis is far greater than the number who are qualified to do so or who even perform a thorough examination
In 2013, 2.3 million men received a prescription for testosterone, up from 1.3 million in 2010, according to the U.S. Food and Drug Administration (FDA). About 70 percent of men prescribed testosterone drugs were between the ages of 40 and 64.
According to an FDA analysis, 21 percent of patients prescribed testosterone drugs did not appear to have had their testosterone concentrations tested before or during treatment, something the agency described as “concerning.”
On Tuesday, September 17, 2014 an FDA advisory panel said that Testosterone replacement therapies should be “Reserved for men with specific medical conditions that impair function of the testicles.” While the FDA is not obligated to follow advisory panel advice, it typically does. The panel also recommended that companies be required to conduct additional studies to assess the cardiovascular risk of their products for patients with age-related low testosterone.
Symptoms of low testosterone include loss of libido, decreased muscle mass, fatigue and depression.
The panel voted 20-1 in favor of restricting the drugs’ authorization to people with medically related low testosterone, such as a tumor or genetic disorder.
If the FDA acts on the recommendation companies could not market or promote their products for age-related low testosterone, but physicians would still have the right to prescribe products “off label” in any way they choose. An important lesson for consumers is that just because a physician prescribes it, doesn’t mean it’s right for you.
What is Testosterone?
The Mayo Clinic says this: Testosterone is a hormone produced primarily in the testicles. Testosterone helps maintain men’s:
- Bone density
- Fat distribution
- Muscle strength and mass
- Red blood cell production
- Sex drive
- Sperm production
Hypogonadism is a disease in which the body is unable to produce normal amounts of testosterone due to a problem with the testicles or with the pituitary gland that controls the testicles. Testosterone replacement therapy can improve the signs and symptoms of low testosterone in these men. Doctors may prescribe testosterone as injections, pellets, patches or gels.
What are the Risks of Testosterone Therapy?
Also according to the Mayo Clinic http://www.mayoclinic.org/healthy-living/sexual-health/in-depth/testosterone-therapy/art-20045728?pg=2
Testosterone therapy has various risks. For example, testosterone therapy may:
- Contribute to sleep apnea — a potentially serious sleep disorder in which breathing repeatedly stops and starts
- Increase your risk of a heart attack
- Cause acne or other skin reactions
- Stimulate noncancerous growth of the prostate (benign prostatic hyperplasia) and growth of existing prostate cancer
- Enlarge breasts
- Limit sperm production or cause testicle shrinkage
- Increase the risk of a blood clot forming in a deep vein (deep vein thrombosis), which could break loose, travel through your bloodstream and lodge in your lungs, blocking blood flow (pulmonary embolism)
The American Recall Center http://www.recallcenter.com is a consumer oriented group with the following vision. “At the American Recall Center, we aim to give pertinent information on FDA warnings for prescription drugs and medical devices. Through our extensive library of recalls and medical information, and our experienced editorial team, it is our mission to empower those who have been adversely affected.” In other words, they monitor the health care environment and provide accurate and timely information about drugs, procedures, devices and practices that affect individual Americans.
Recently I was contacted by The American Recall Center http://www.recallcenter.com and alerted to their concerns about Testosterone Therapy and the various actions being taken with regard to the practice. I looked carefully at what they had to say and also conducted my own brief investigation that resulted in verification of their claims. What follows is a direct copy from their website. It is alarming and should be taken very seriously by anyone either undergoing such therapy or considering it.
The treatment of low testosterone (also known as hypogonadism or Low-T) in men has increased significantly since the year 2000. However, with the growth of such testosterone replacement therapy, there has also been an increase in the number of studies that have shown a link to various medical problems, such as the increased risk of heart attacks, strokes and other potentially deadly outcomes. As a result, the FDA has issued several statements on the use of testosterone therapy, and a number of lawsuits have been filed claiming that treatments to combat low testosterone have resulted in harm to the patient or even fatalities.
FDA Investigation and Testosterone Replacement Therapy
Although the FDA has not issued any recalls of testosterone due to the possibly dangerous nature of various treatments, early in 2014 the agency published an alert stating that it was going to begin investigating the potentially adverse outcomes of testosterone supplements. Specifically, the FDA denied any conclusions related to increased probability of heart attacks, strokes or death in men undergoing testosterone replacement therapy. However, the agency said that would analyze data from multiple studies and monitor side effects of testosterone treatments as reported through its MedWatch program. The FDA also advised patients and physicians to understand both the risks and the benefits of drugs and supplements before beginning any treatment.1
In June 2014, the FDA announced that it manufacturers of testosterone would be required to add a warning label to their products indicating the possible formation of blood clots in patients’ veins. The agency stressed that this requirement was unrelated to the separate investigation into the other health problems that may be associated with testosterone use.2
Testosterone Lawsuits and Multidistrict Litigation
As a result of the potentially dangerous consequences of taking various low-testosterone treatments — which are available as topical gels, transdermal patches, buccal systems, subcutaneous pellets and injections — a significant number of lawsuits have been filed against manufacturers of testosterone products.
Because of the large number of cases related to testosterone products, and the even larger number of potential future case that could expand into the thousands, the United States Judicial Panel on Multidistrict Litigation has created MDL No. 2545 to handle actions related to testosterone products. In the original order, the panel noted its hesitancy to encompass an entire industry with a broad range of products under a single MDL. However, the panel members acknowledged that even among different products and across competing companies, many of the claims associated with the testosterone cases have common discovery, and thus are suitable for MDL status.
At the time of the original order on June 6, 2014, forty-five cases across four districts were pending. Since then, additional cases have been added.4
Testosterone Manufacturers Facing Lawsuits
The following table lists companies that have faced lawsuits related to their testosterone treatments, along with the names of some commonly known testosterone products they have developed. Other companies also may have faced litigation for their testosterone products.
|AbbVie Inc./Abbott Laboratories Inc.||AndroGel|
|Eli Lilly and Co./Lilly USA LLC||Axiron|
|Endo Pharmaceuticals||Aveed, Delatestryl, Fortesta|
|Actavis, Inc.||ANDA, LibiGel, Testosterone Enanthate Injection USP, Testosterone Cypionate Injection USP, AndroDerm|
|Auxilium Pharmaceuticals, Inc.||Testim, Testosterone Gel CIII, Testopel, Striant|
|Pfizer, Inc./Pharmacia & Upjohn Co.||Depo-Testosteroneh, Depo-Testadiol|
According to Healthline (http://www.healthline.com/health/low-testosterone/natural-boosters#1), there are some alternatives to Testosterone Therapy and while there’s no guarantee they will work, there is no guarantee the therapy will work either and these alternatives, unlike the therapy, won’t hurt you.
Additionally, following these suggestions can help your general health as well as low testosterone production. Try them, you have nothing to lose and a better life to gain.
- Get a Good Night’s Sleep
It doesn’t get more natural than a good night’s sleep. A University of Chicago study showed that lack of sleep can greatly reduce a healthy young man’s testosterone levels. That effect is clear after only one week of shortened sleep. Testosterone levels were particularly low between 2:00 and 10:00 p.m. on sleep-restricted days. Study participants also reported a decreased sense of well-being as their blood testosterone levels dropped.
How much sleep your body needs depends on many factors, but theNational Sleep Foundation suggests that adult males generally need between seven and nine hours per night.
- Lose That Excess Weight
It is not uncommon for overweight, middle-aged men with prediabetes to also have low testosterone levels. A 2012 study revealed that weight loss among men with prediabetes improved their testosterone levels by almost 50 percent.
These findings don’t mean you have to go on a crash diet. The healthiest way to achieve and maintain a healthy weight is through a sensible diet and regular exercise.
- Get Enough Zinc
Men with hypogonadism generally have zinc deficiencies. Studiessuggest that zinc plays an important part in regulating serum testosterone levels in healthy men.
According to the Office of Dietary Supplements, adult males should get 11 mg of zinc and females should get 8 mg of zinc each day. Oysters have a lot of zinc. It is also found in red meat and poultry. Other food sources include beans, nuts, crab, lobster, whole grains, and many fortified foods.
- Go Easy on the Sugar
Zinc isn’t enough to ensure you’re getting the all the nutrition you need. The human body is a complex system that requires a wide variety of vitamins and minerals for smooth operation.
Research published by The Endocrine Society shows that glucose (sugar) decreases testosterone levels in the blood by as much as 25 percent. This was true of study participants whether they had prediabetes, diabetes, or a normal tolerance for glucose.
- Get Some Good Old-Fashioned Exercise
Studies show an increase in total testosterone levels after exercising, especially after resistance training. Low testosterone levels can affect your sex drive and your mood, but the good news is that exercise improves mood and stimulates brain chemicals that help you feel happier and more confident. Exercise also boosts energy and endurance and helps you sleep better. All that can help with your sex drive and sexual performance, too. Fitness experts recommend 30 minutes of exercise every day.
Avoid Alcohol. And…a final tip and this one is mine. If you are concerned about your ability to perform sexually you should know that consuming alcohol will not help. Alcohol often will present two contradictory effects. The first effect is that it will diminish your inhibitions and therefore boost your desire for sex. Unfortunately, the increased desire is usually met with a decreased ability to get an erection. You get all dressed up with nowhere to go.
Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s over 4,000 member Organ Transplant Initiative (OTI) and the author of most of these donation/transplantation blogs. You may comment in the space provided or email your thoughts to me at firstname.lastname@example.org. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.
By Bob Aronson
When your life has been saved in hospitals several times as mine has, it is difficult to write a blog that is critical of those institutions but, it is just as difficult to ignore the facts. As a writer who has made a commitment to provide accurate and timely information to his readers it would be irresponsible to do so.
This blog is about and for pre and post-transplant patients, their families, donors, donor families, caregivers and friends. Those of us who are awaiting transplants or who have had them spend an inordinate amount of time in hospitals and clinics. Our compromised immune systems make us far more susceptible to a myriad of diseases and problems than the average patient and that means we have to be more alert and aware of our surroundings. It is for that reason that I am posting this information.
I did not make up the numbers you are about to read. They are available for everyone to see and to analyze through the links I have provided. Your comments are not only welcome, they are encouraged.
Never Events, Hospital Acquired Conditions and Sentinel Events
Heart disease and cancer are the number one and two causes of death in the United States. Number three is medical errors. The very people who are supposed to be experts in saving lives are also responsible for thousands of deaths.
Medical errors in hospitals are killing us faster than chronic lower respiratory diseases, stroke (cerebrovascular diseases), accidents of all kinds, Alzheimer’s disease and diabetes combined. The very people we trust our lives to – are not only contributing to our deaths they don’t seem to be learning from their mistakes because the problem appears to be getting worse. While many hospitals claim they are making progress the national numbers don’t show it. The evidence to the contrary is overwhelming. And — one cannot help but believe that the problem is even worse than is stated in this posting because there is no system in the U.S. for reporting and tracking medical errors and their results. Voluntary reporting is spotty and incomplete so we are left with educated guestimates and they are frightening.
In 1999, the Institute of Medicine published the “To Err Is Human” report. It generated huge front page headlines everywhere by estimating that nearly 100,000 people die every year as a result of hospital errors. At first there was widespread denial in the medical community but no longer. The medical profession accepts that number. The problem is that the number is wrong.
In 2010 another number was announced. The Office of the U.S. Inspector General for Health and Human Services said that poor hospital care contributed to the deaths of 180,000 patients in Medicare alone in any given year… Note — they said Medicare alone! But — that number is wrong, too. The story is about to get much worse.
A study published in September of 2013 in the Journal of Patient Safety says the numbers may be much higher. They say that between 210,000 and 440,000 patients die in hospitals each year as the result of preventable errors. Please note that the numbers quoted in the preceding reports only refer to deaths. None of the numbers I have seen say anything about the number of injuries caused by medical errors.
The new estimates were the result of work by John T. James, who works as a toxicologist at NASA’s Houston, Texas space center. James also runs a group called Patient Safety America. http://patientsafetyamerica.com/ James dedicated the site to his 19-year old son, John Alexander James, who he says, “Died as a result of uninformed, careless, and unethical care by cardiologists at a hospital in central Texas in the late summer of 2002.”
ProPublica an investigative journalism group asked three prominent patient safety researchers to review James’ study and all said his methods and findings were credible. http://www.propublica.org/ The American Hospital Association, though, rejects the number preferring to believe the number of 98,000 deaths from the 1999 report.
What’s the right number? Nobody knows for sure but we do know it is not getting smaller. As stated earlier there is no standardized national reporting system on medical errors, who is affected and who makes them.
So we’re left with approximations, which are imperfect in part because of inaccuracies in medical records and the fact that a good many of the errors that take place are never reported. Hospitals and physicians have traditionally fought establishing a formal reporting system for fear of prosecution. Instead they advocate a voluntary reporting system which begs the question, “Who is going to voluntarily admit to committing an error that resulted in a patient’s injury or death.” I have to believe the number would be quite small. Admissions of that nature could have extremely negative effects on careers and may even open the door to civil suits or criminal prosecution. Perhaps I can be persuaded to think otherwise but I’ve seen nothing so far to indicate any voluntary system can work.
While the lay public calls them medical mistakes or errors the medical community has chosen to use different terminology. They refer to their errors as “Never Events” or Hospital Acquired Conditions (HACs) Never events are never supposed to happen – but they do and the onus is clearly on hospitals to do something about them. The Government found that one way to force hospitals to deal with these problems is to refuse payment so for several years now Medicaid and Medicare do not pay for any Hospital Acquired Condition.
When I was a communications consultant I specialized in health care so I spent a great deal of time working in and around hospitals and clinics. The great majority of them take the issue of patient safety very seriously and have implemented a multitude of actions to address the problem. They all have preventive programs and systems on what to do when there is an error. Most hospitals conduct a “Root Cause Analysis” every time there is a significant error so they can be sure the same error doesn’t happen again. They are working on the problem but patients owe it to themselves to always be alert and to question everything. Hospitals need to know that we are watching very carefully and that we will report what we see and experience.
Here is a list of HACs or Never Events as prepared by the National Quality Forum (NQF).
|Table. Never Events or Hospital Acquired Conditions
|Surgery or other invasive procedure performed on the wrong body part|
|Surgery or other invasive procedure performed on the wrong patient|
|Wrong surgical or other invasive procedure performed on a patient|
|Unintended retention of a foreign object in a patient after surgery or other procedure|
|Intraoperative or immediately postoperative/post procedure death in an American Society of Anesthesiologists Class I patient|
|Product or device events|
|Patient death or serious injury associated with the use of contaminated drugs, devices, or biologics provided by the health care setting|
|Patient death or serious injury associated with the use or function of a device in patient care, in which the device is used for functions other than as intended|
|Patient death or serious injury associated with intravascular air embolism that occurs while being cared for in a health care setting|
|Patient protection events|
|Discharge or release of a patient/resident of any age, who is unable to make decisions, to other than an authorized person|
|Patient death or serious disability associated with patient elopement (disappearance)|
|Patient suicide, attempted suicide, or self-harm resulting in serious disability, while being cared for in a health care facility|
|Care management events|
|Patient death or serious injury associated with a medication error (e.g., errors involving the wrong drug, wrong dose, wrong patient, wrong time, wrong rate, wrong preparation, or wrong route of administration)|
|Patient death or serious injury associated with unsafe administration of blood products|
|Maternal death or serious injury associated with labor or delivery in a low-risk pregnancy while being cared for in a health care setting|
|Death or serious injury of a neonate associated with labor or delivery in a low-risk pregnancy|
|Artificial insemination with the wrong donor sperm or wrong egg|
|Patient death or serious injury associated with a fall while being cared for in a health care setting|
|Any stage 3, stage 4, or unstageable pressure ulcers acquired after admission/presentation to a health care facility|
|Patient death or serious disability resulting from the irretrievable loss of an irreplaceable biological specimen|
|Patient death or serious injury resulting from failure to follow up or communicate laboratory, pathology, or radiology test results|
|Patient or staff death or serious disability associated with an electric shock in the course of a patient care process in a health care setting|
|Any incident in which a line designated for oxygen or other gas to be delivered to a patient contains no gas, the wrong gas, or is contaminated by toxic substances|
|Patient or staff death or serious injury associated with a burn incurred from any source in the course of a patient care process in a health care setting|
|Patient death or serious injury associated with the use of restraints or bedrails while being cared for in a health care setting|
|Death or serious injury of a patient or staff associated with introduction of a metallic object into the MRI area|
|Any instance of care ordered by or provided by someone impersonating a physician, nurse, pharmacist, or other licensed health care provider|
|Abduction of a patient/resident of any age|
|Sexual abuse/assault on a patient within or on the grounds of a health care setting|
|Death or significant injury of a patient or staff member resulting from a physical assault (i.e., battery) that occurs within or on the grounds of a health care setting|
Real Life Examples of Medical Mistakes
- Wrong Heart and Lung Transplant. One of the most tragic medical blunders ever took place at Duke University medical center in 2003, when surgeons transplanted a heart lung combination with the wrong blood type into 17-year-old Jesica Santillan. Her body began to shut down almost immediately. The hospital somehow secured a second and proper matched heart lung combination for Jessica but it was too late and she died. Dr. James Jaggers accepted responsibility for the tragic mistake, and Duke along with most other hospitals now have systems that require double checking the blood and tissue matches for transplants.
- Souvenir of surgery. In the year 2000 49 year old Donald Church had an abdominal tumor removed at the U of Washington Medical center in Seattle. While he left the hospital without the tumor, he had something that he didn’t have on admission — a 13-inch-long retractor had been left in Church’s abdomen by mistake. To make matters worse it was a repeat performance for the hospital, four other such occurrences had been documented there between 1997 and 2000. Fortunately, surgeons were able to remove the instrument but also agreed to pay Church nearly $100,000.
- Healthy kidney removed. Park Nicollet Methodist Hospital in Minnesota’s twin cities was the site of the next never event. A man was admitted to have one of his kidneys removed due to a cancerous tumor. Surgeons did just that but upon a post-surgical examination of the removed kidney they found no malignancy. That’s when they discovered they had removed the wrong one. We can’t report further because the family involved requested anonymity but Park Nicollet publicly admitted the error.
What Patients Can Do
The cable network developed this list of what they call “10 Shocking Medical Mistakes and Ways to Not Become a Victim.
1. Mistake: Treating the wrong patient
• Cause: Hospital staff fails to verify a patient’s identity.
• Consequences: Patients with similar names are confused.
• Prevention: Before every procedure in the hospital, make sure the staff checks your entire name, date of birth and barcode on your wrist band.
2. Mistake: Surgical souvenirs
• Cause: Surgical staff miscounts (or fails to count) equipment used inside a patient during an operation.
• Consequences: Tools get left inside the body.
• Prevention: If you have unexpected pain, fever or swelling after surgery, ask if you might have a surgical instrument inside you.
3. Mistake: Lost patients
• Cause: Patients with dementia are sometimes prone to wandering.
• Consequences: Patients may become trapped while wandering and die from hypothermia or dehydration.
• Prevention: If your loved one sometimes wanders, consider a GPS tracking bracelet.
4. Mistake: Fake doctors
• Cause: Con artists pretend to be doctors.
• Consequences: Medical treatments backfire. Instead of getting better, patients get sicker.
• Prevention: Confirm online that your physician is licensed.
5. Mistake: The ER waiting game
• Cause: Emergency rooms get backed up when overcrowded hospitals don’t have enough beds.
• Consequences: Patients get sicker while waiting for care.
• Prevention: Doctors listen to other doctors, so on your way to the hospital call your physician and ask them to call the emergency room.
6. Mistake: Air bubbles in blood
• Cause: The hole in a patient’s chest isn’t sealed airtight after a chest tube is removed.
• Consequences: Air bubbles get sucked into the wound and cut off blood supply to the patient’s lungs, heart, kidneys and brain. Left uncorrected the patient dies.
• Prevention: If you have a central line tube in you, ask how you should be positioned when the line comes out.
7. Mistake: Operating on the wrong body part
• Cause: A patient’s chart is incorrect, or a surgeon misreads it, or surgical draping obscures marks that denote the correct side of the operation.
• Consequences: The surgeon cuts into the wrong side of a patient’s body.
• Prevention: Just before surgery, make sure you reaffirm with the nurse and the surgeon the correct body part and side of your operation.
8. Mistake: Infection infestation
• Cause: Doctors and nurses don’t wash their hands.
• Consequences: Patients can die from infections spread by hospital workers.
• Prevention: It may be uncomfortable to ask, but make sure doctors and nurses wash their hands before they touch you, even if they’re wearing gloves.
9. Mistake: Lookalike tubes
• Cause: A chest tube and a feeding tube can look a lot alike.
• Consequences: Medicine meant for the stomach goes into the chest.
• Prevention: When you have tubes in you, ask the staff to trace every tube back to the point of origin so the right medicine goes to the right place.
10. Mistake: Waking up during surgery
• Cause: An under-dose of anesthesia.
• Consequences: The brain stays awake while the muscles stay frozen. Most patients aren’t in any pain but some feel every poke, prod and cut.
• Prevention: When you schedule surgery, ask your surgeon if you need to be put asleep or if a local anesthetic might work just as well.
There are other steps you can take to protect yourself besides those offered by CNN. For example:
Demand a hand-wash. While hospitals try to be germ free it is hard when almost everyone who enters the building is sick. It is a well-known fact that the best thing people can do to protect themselves from disease is frequent hand washing. The potential for contamination is everywhere so you are well within your rights to ask personnel to wash their hands before touching you. And…by the way, wash your hands frequently too.
Make sure your room is clean. Usually hospital rooms are thoroughly washed between patients but not as thoroughly if you are going to be there for a while. If you are concerned with the state of your room ask for certain areas or all of it to be disinfected. Transplant recipients in particular must be sure they are in as germ free an environment as possible. Certainly if hospitalized they should always wear a face mask to protect themselves. And, do your best to stay out of crowded areas like elevators. If you must enter a crowded room, wear a face mask. All hospitals have them you just have to ask for one…
To be even more specific though, Patient Safety America suggestions these you do the following to stay safe http://patientsafetyamerica.com/truth-about-healthcare/
1. The single most important way you can help to prevent errors is to be an active member of your health care team.
That means taking part in every decision about your health care. Research shows that patients who are more involved with their care tend to get better results. Here are some specific tips, based on the latest scientific evidence about what works best.
2. Make sure that all of your doctors know about everything you are taking. This includes prescription and over-the-counter medicines, and dietary supplements such as vitamins and herbs.
At least once a year, bring all of your medicines and supplements with you to your doctor. “Brown bagging” your medicines can help you and your doctor talk about them and find out if there are any problems. It can also help your doctor keep your records up to date, which can help you get better quality care.
3. Make sure your doctor knows about any allergies and adverse reactions you have had to medicines.
This can help you avoid getting a medicine that can harm you.
4. When your doctor writes you a prescription, make sure you can read it.
If you can’t read your doctor’s handwriting, your pharmacist might not be able to either.
5. Ask for information about your medicines in terms you can understand—both when your medicines are prescribed and when you receive them.
- What is the medicine for?
- How am I supposed to take it, and for how long?
- What side effects are likely? What do I do if they occur?
- Is this medicine safe to take with other medicines or dietary supplements I am taking?
- What food, drink, or activities should I avoid while taking this medicine?
6. When you pick up your medicine from the pharmacy, ask: Is this the medicine that my doctor prescribed?
A study by the Massachusetts College of Pharmacy and Allied Health Sciences found that 88 percent of medicine errors involved the wrong drug or the wrong dose.
7. If you have any questions about the directions on your medicine labels, ask.
Medicine labels can be hard to understand. For example, ask if “four doses daily” means taking a dose every 6 hours around the clock or just during regular waking hours.
8. Ask your pharmacist for the best device to measure your liquid medicine. Also, ask questions if you’re not sure how to use it.
Research shows that many people do not understand the right way to measure liquid medicines. For example, many use household teaspoons, which often do not hold a true teaspoon of liquid. Special devices, like marked syringes, help people to measure the right dose. Being told how to use the devices helps even more.
9. Ask for written information about the side effects your medicine could cause.
If you know what might happen, you will be better prepared if it does—or, if something unexpected happens instead. That way, you can report the problem right away and get help before it gets worse. A study found that written information about medicines can help patients recognize problem side effects and then give that information to their doctor or pharmacist.
10. If you have a choice, choose a hospital at which many patients have the procedure or surgery you need.
Research shows that patients tend to have better results when they are treated in hospitals that have a great deal of experience with their condition.
11. If you are in a hospital, consider asking all health care workers who have direct contact with you whether they have washed their hands.
Hand washing is an important way to prevent the spread of infections in hospitals. Yet, it is not done regularly or thoroughly enough. A recent study found that when patients checked whether health care workers washed their hands, the workers washed their hands more often and used more soap.
12. When you are being discharged from the hospital, ask your doctor to explain the treatment plan you will use at home.
This includes learning about your medicines and finding out when you can get back to your regular activities. Research shows that at discharge time, doctors think their patients understand more than they really do about what they should or should not do when they return home.
13. If you are having surgery, make sure that you, your doctor, and your surgeon all agree and are clear on exactly what will be done.
Doing surgery at the wrong site (for example, operating on the left knee instead of the right) is rare. But even once is too often. The good news is that wrong-site surgery is 100 percent preventable. The American Academy of Orthopedic Surgeons urges its members to sign their initials directly on the site to be operated on before the surgery.
Other Steps You Can Take
14. Speak up if you have questions or concerns.
You have a right to question anyone who is involved with your care.
15. Make sure that someone, such as your personal doctor, is in charge of your care.
This is especially important if you have many health problems or are in a hospital.
16. Make sure that all health professionals involved in your care have important health information about you.
Do not assume that everyone knows everything they need to.
17. Ask a family member or friend to be there with you and to be your advocate (someone who can help get things done and speak up for you if you can’t).
Even if you think you don’t need help now, you might need it later.
18. Know that “more” is not always better.
It is a good idea to find out why a test or treatment is needed and how it can help you. You could be better off without it.
19. If you have a test, don’t assume that no news is good news.
Ask about the results.
20. Learn about your condition and treatments by asking your doctor and nurse and by using other reliable sources.
You may ask yourself upon reading all of this what the U.S. Food and Drug Administration (FDA) is doing to make hospitals safer. Well, they can’t be in every hospital all the time to watch everything and…that’s not their role. The FDA is probably not doing enough to protect us, there’s no way you can satisfy everyone but they are doing a few things that could make a huge difference. One of which is to eliminate drug name confusion.
To minimize confusion between drug names that look or sound alike, the FDA reviews about 300 drug names a year before they are marketed. “About one-third of the names that drug companies propose are rejected,” says Phillips. The agency tests drug names with the help of about 120 FDA health professionals who volunteer to simulate real-life drug order situations. “FDA also created a computerized program that assists in detecting similar names and that will help take a more scientific approach to comparing names,” Phillips says.
After drugs are approved, the FDA tracks reports of errors due to drug name confusion and spreads the word to health professionals, along with recommendations for avoiding future problems. For example, the FDA has reported errors involving the inadvertent administration of methadone, a drug used to treat opiate dependence, rather than the intended Metadate ER (methylphenidate) for the treatment of attention-deficit/hyperactivity disorder (ADHD). One report involved the death of an 8-year-old boy after a possible medication error at the dispensing pharmacy. The child, who was being treated for ADHD, was found dead at home. Methadone substitution was the suspected cause of death. Some FDA recommendations regarding drug name confusion have encouraged pharmacists to separate similar drug products on pharmacy shelves and have encouraged physicians to indicate both brand and generic drug names on prescription orders, as well as what the drug is intended to treat.
The last time the FDA changed a drug name after it was approved was in 2004 when the cholesterol-lowering medicine Altocor was being confused with the cholesterol-lowering medicine Advicor. Now Altocor is called Altoprev, and the agency hasn’t received reports of errors since the name change. Other examples of drug name confusion reported to the FDA include:
- Serzone (nefazodone) for depression and Seroquel (quetiapine) for schizophrenia
- Lamictal (lamotrigine) for epilepsy, Lamisil (terbinafine) for nail infections, Ludiomil (maprotiline) for depression, and Lomotil (diphenoxylate) for diarrhea
- Taxotere (docetaxel) and Taxol (paclitaxel), both for chemotherapy
- Zantac (ranitidine) for heartburn, Zyrtec (cetirizine) for allergies, and Zyprexa (olanzapine) for mental conditions
- Celebrex (celecoxib) for arthritis and Celexa (citalopram) for depression.
For more information on the FDA and what they are doing click on this link http://www.fda.gov/
The bottom line on medical errors is activist patients. Don’t sit by quietly when you perceive something to be wrong with your care or the care of someone near and dear to you. Speak up, tell someone about your concerns. Every city and state has some sort of health department so if you see something wrong speak up and tell the appropriate authority starting with the hospital.
Most importantly, though, be aggressive and knowledgeable about your own health care. Don’t be afraid to ask for second opinions, to question physicians, nurses and other practitioners. Force your health care provider to speak to you in plain English and if you don’t understand ask for clarification. Hospital personnel work for you so they have a responsibility to respond to your concerns in as thorough and clear a manner as possible. The only way hospitals will really change for the better is for citizens, patients like you and me to speak up and let them know we know.
Now retired and living in Jacksonville, Florida with his wife Robin he spends his time advocating for patients with end stage diseases and for organ recipients. He is also active in helping his wife with her art business at art festivals and on her Rockin Robin Prints site on Etsy.
Bob is a former journalist, Governor’s Communication Director and international communications consultant.