Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Happy Friday the 13th

 
This is a day for superstitious people to pretend that there is some sense to their superstition.

The number 13 will somehow cause bad things to happen.

This is from the elevator of the local Best Hospital in the World. While it is an administrative decision, what about administrative decisions that affect patient care.
 


 

When we make decisions based on superstition, how much harm do we do to our patients?

We will probably never know, because we use superstition to justify ignoring evidence or to justify preventing research to obtain evidence.

A black cat crossing your path will somehow cause bad things to happen.

A backboard and collar forced on a patient will somehow protect the spine from forceful worsening of an injury.[1]

A broken mirror will somehow cause bad things to happen.

Giving fentanyl to someone in pain will prevent them from giving consent to treatment.[2]

Speak of the devil and he will appear.

Response times matter for patients who are not dead.

This is based on superstition, because the only response times that have been shown to matter are for cardiac arrest.[3]

How much less superstitious are people in medicine than anyone else?

Probably even more superstitious.
 


Identifying information obscured to protect the superstitious.
 

People will wave their hands around to manipulate your imaginary energy fields.

People fall for this at many hospitals that claim to be the Best Hospital in the World.[4]

They are just demonstrating their lack of understanding of the placebo effect, random variation, reversion to the mean, and other things that lead us to believe that nothing is something.

Nothing Superstition is harm.

Footnotes:

[1] The cause of neurologic deterioration after acute cervical spinal cord injury.
Harrop JS, Sharan AD, Vaccaro AR, Przybylski GJ.
Spine (Phila Pa 1976). 2001 Feb 15;26(4):340-6.
PMID: 11224879 [PubMed – indexed for MEDLINE]
 

All but two patients had complete injuries at admission. One patient with incomplete injury and another that was neurologically intact had early complete cervical cord injuries after cervical immobilization.

 

Four of the five patients in the early group (mean age 56 years) developed neurologic worsening during application of cervical immobilization less than 24 hours after injury.

[2] Refusal of base station physicians to authorize narcotic analgesia.
Gabbay DS, Dickinson ET.
Prehosp Emerg Care. 2001 Jul-Sep;5(3):293-5. No abstract available.
PMID: 11446548 [PubMed – indexed for MEDLINE]
 

Nevertheless, the notion that a patient’s decision-making capacity may be compromised by “excessive” analgesia seemingly permeates medical practice, but is not evidently supported by the medical literature.11

 

Even a more disturbing possible coercion is the possibility that when pain medication is withheld prior to consent, the patient is either directly or indirectly made to understand that once he or she provides consent, that pain medication will be given as a “reward” for agreeing to the procedure.

[3] Emergency medical services intervals and survival in trauma: assessment of the “golden hour” in a North American prospective cohort.
Newgard CD, Schmicker RH, Hedges JR, Trickett JP, Davis DP, Bulger EM, Aufderheide TP, Minei JP, Hata JS, Gubler KD, Brown TB, Yelle JD, Bardarson B, Nichol G; Resuscitation Outcomes Consortium Investigators.
Ann Emerg Med. 2010 Mar;55(3):235-246.e4. Epub 2009 Sep 23.
PMID: 19783323 [PubMed – indexed for MEDLINE]

Free Full Text with link to Free Full Text PDF Download from PubMed Central
 

To date, patients with out-of-hospital cardiac arrest remain the only field-based patient population with a consistent association between time (response interval) and survival.18,19 Despite the paucity of outcome evidence supporting rapid out-of-hospital times for the broader population of patients activating the 911 system, EMS agencies in North America are generally held to strict standards about intervals, particularly the response interval.

[4] Shock Trauma Infested With Evil Spirits
Wed, 10 Jun 2009
Rogue Medic
Article

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Comments

  1. And yet you failed to properly lampoon all the EMS organizations out there that similarly refuse to include 13 in their workplaces for fear of it’s power….