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

- Rogue Medic

Have a Slow, Quiet Friday the Thirteenth

Also to be posted on ResearchBlogging.org when they relaunch the site.


Superstitious appears to be common among medical people, so this may be seen as offensive. If you doubt me, comment that it is slow or quiet and see how many respond negatively, while they do not receive any criticism for their superstition-based complaints. Rather, people will make excuses for coddling the superstitions of those who are entrusted with the lives of patients.

The evidence does not support their superstitions.

One study did appear to show that women die in motor vehicle collisions more often on Friday the 13th, but that appears to be due to a lack of understanding of statistics by many who cite the article.

An additional factor is anxiolytic medication, used by significantly more women than men in Finland (7), which has been reported to reduce attention span and worsen driving performance (8). . . . Why this phenomenon exists in women but not in men remains unknown, but perhaps the twice-as-high prevalence of neurotic disorders and anxiety symptoms in women (7) makes them more susceptible to superstition and worsening of driving performance.[1]


The author suspects that those people with conditions that could be diagnosed as neuroses or anxiety disorders may be disproportionately affected by superstition.

In other words, superstition is not an external force affecting you. You are doing it to yourself.

The sample size was national, but still small, and was not able to adjust for many possible confounding variables, so the study would need to be replicated using a much larger data base to be useful.

In other superstition news – the next apocalypse, in a long line of predicted apocalypses, is going to be this Sunday – the 15 of October, 2017, according to David Meade. Meade twice previously predicted that a magical planet would hit the Earth and kill us all. This time he claims that his calculations are accurate, because that was the problem with his previous calculations – inaccuracy, not that they were a superstition deserving of derision.

If you are superstitious, and feel that your neuroses/anxieties will cause you to harm others, or yourself, you may want to stay home today and Sunday – perhaps even until you are capable of grasping reality.

Of course, we would never base treatment on superstition in medicine.

Amiodarone is the go to antiarrhythmic drug for cardiac arrest and ventricular tachycardia, but there are much safer much more effective drugs available. We have our own prophets misrepresenting research results to make it seem that using amiodarone for these is a good idea. The research says these preachers are wrong. The next guidelines will probably promote the superstition and reject the science.[2],[3]

Ventilation during cardiac arrest has been shown to be a good idea only for patients who arrested for respiratory reasons. We do a great job of identifying these patients. We have our own prophets misrepresenting research results to make it seem that providing ventilations for these is a good idea. The research says these preachers are wrong. The next guidelines will probably promote the superstition and reject the science.[4]

Medicine is full of superstition and superstitious people.


Too many of us believe the lie that, I’ve seen it work.

I have also written about the superstition of Friday the 13th here –

Acute coronary syndrome on Friday the 13th: a case for re-organising services? – Fri, 13 Jan 2017

The Magical Nonsense of Friday the 13th – Fri, 13 May 2016

Happy Friday the 13th – New and Improved with Space Debris – Fri, 13 Nov 2015

Friday the 13th and full-moon – the ‘worst case scenario’ or only superstition? – Fri, 13 Jun 2014

Blue Moon 2012 – Except parts of Oceanea – Fri, 31 Aug 2012

2009’s Top Threat To Science In Medicine – Fri, 01 Jan 2010

T G I Friday the 13th – Fri, 13 Nov 2009

Happy Equinox! – Thu, 20 Mar 2008


[1] Traffic deaths and superstition on Friday the 13th.
Näyhä S.
Am J Psychiatry. 2002 Dec;159(12):2110-1.
PMID: 12450968

Free Full Text from Am J Psychiatry.

[2] The PROCAMIO Trial – IV Procainamide vs IV Amiodarone for the Acute Treatment of Stable Wide Complex Tachycardia
Wed, 17 Aug 2016
Rogue Medic

There are a dozen links to the research in the footnotes to that article. There are also links to other articles on the failure of amiodarone to live up to its hype.

[3] Dr. Kudenchuk is Misrepresenting ALPS as ‘Significant’
Tue, 12 Apr 2016
Rogue Medic

[4] Cardiac Arrest Management is an EMT-Basic Skill – The Hands Only Evidence
Fri, 09 Dec 2011
Rogue Medic


Baby with cancer improving using chemotherapy does not get worse after meeting Pope Francis


Doesn’t get worse with real medicine? Continues to get better with real medicine?

It’s a miracle!

Who would expect a baby with a benign tumor, that is improving with chemotherapy, to continue to get better after benign picked up by Pope Francis? Apparently, many in the news media expected the baby to deteriorate and die after meeting the pope, because they are claiming that this is a miracle.

Fairy Godmother image credit.

Cancer treatment saves lives and we need to improve the treatment of the many types of cancer that exist, especially the ones that do not respond well to medicine, yet. It is a mockery of medicine and science to avoid giving credit where it is due – to the doctors, nurses, and others involved in the care of this baby.

When the baby was born, she failed a hearing test — the reason her tumor was diagnosed — and doctors were concerned she might not be able to see, speak or swallow. But In December, doctors at The Children’s Hospital of Philadelphia determined that the rare tumor on her brain stem was benign but still pressing on vital nerves.[1]


She has been receiving treatment since long before meeting Pope Francis.

This summer, little Gianna pulled out her feeding tube, is starting to eat solid food and doctors know she can see. Chemotherapy treatments that she must undergo every couple of weeks have reduced the size of the tumor, though it is still causing paralysis on one side of her face.[1]


If the article is correct, she was getting better long before meeting Pope Francis.

Maybe they wanted to give credit to Pope Francis because of his recent record with cancer that is not benign.

A Phoenix-area teen with a rare form of cancer, and who was blessed by Pope Francis in June as part of a dream granted by the Make-A-Wish Foundation, died early Friday morning, her mother announced. Jazmin Negrete was 15.[2]


If you want to donate to someone helping children with cancer, there are plenty of cancer organizations genuinely improving the care of patients with cancer.

A miracle is something that is not yet explained by science.

Unless we expect people with cancer to suddenly get worse when meeting Pope Francis, there is nothing unexplained about a cancer patient improving with chemotherapy. It is also not a surprise that a child dying of stomach cancer continued to die after meeting Pope Francis.

What is the excuse for the death of Jazmin Negrete? Are the miracle advocates going to claim that she didn’t believe enough? That is what the alternative medicine pushers claim when their miracles don’t work and that is what a lot of religious people claim when prayers don’t work, but is anyone a jerk enough to use that excuse here?

The reality is that there is no reason to believe that Pope Francis had any effect on either of these cancer patients. He didn’t save the child who was getting better before he picked her up and he didn’t kill the child who was dying before he blessed her. That is not miraculous.

It is sad that people are this desperate to reject reality.

I expect that Gianna Masciantonio will continue to improve with appropriate medical care.

My condolences to the family of Jazmin Negrete.


[1] Pope makes dream come true for parents of sick baby
Posted: Sunday, September 27, 2015 10:15 pm
By Peg Quann, Staff writer
Bucks County Courier Times

[2] Tolleson teen, blessed by pope, succumbs to cancer
Justin Sayers
The Republic | azcentral.com
5:35 p.m. MST November 20, 2015


The LUCAS, Research, and Wishful Thinking


Does the LUCAS improve outcomes?

No. The authors state that clearly.[1]

Do people think that we should use the LUCAS anyway?

Yes. The excuses are presented by many people.

What are the possible benefits?

1. The LUCAS allows us to free up a pair of hands to do other things that do not benefit the patient, so this adds nothing useful.

2. The LUCAS allows us to transport the patient safely. This is a rehash of #1, since routine transport does not improve outcomes.

3. Treatment will be consistent, regardless of the quality of the EMS. Rather than improve quality, we will have a machine take over something we think is done poorly, so that EMS can harm the patient by doing other things poorly.

4. The LUCAS can take over one of the two treatments that can improve outcomes. An AED can take over the other. We no longer need to have EMS respond to cardiac arrest calls until after ROSC (Return Of Spontaneous Circulation).

If the dramatic success of Seattle is due mostly to the frequency of bystander CPR, that would suggest that the best use of the LUCAS is in the hands of bystanders, not EMS.


If that is too much adult material, we can do the version for kids.


Or we can do the version for toddlers.


If EMS cannot manage that, should we be giving them equipment to free them up to mess up intubation or drugs or other things that do not improve outcomes.

Why are we so eager to add treatments that do not help patients?

Ethical patient care means limiting ourselves to treatments that improve outcomes.

Dr. Brooks Walsh also explains the failure of the LUCAS in this study in “We had a LUCAS save!” – No, you didn’t.

Also see –

The Failure of LUCAS to Improve Outcomes in the LINC Trial


[1] Mechanical chest compressions and simultaneous defibrillation vs conventional cardiopulmonary resuscitation in out-of-hospital cardiac arrest: the LINC randomized trial.
Rubertsson S, Lindgren E, Smekal D, Östlund O, Silfverstolpe J, Lichtveld RA, Boomars R, Ahlstedt B, Skoog G, Kastberg R, Halliwell D, Box M, Herlitz J, Karlsten R.
JAMA. 2014 Jan 1;311(1):53-61. doi: 10.1001/jama.2013.282538.
PMID: 24240611 [PubMed – indexed for MEDLINE]

The current sample size has a 95% confidence interval for the 4-hour survival ranging from −3.3% to +3.2%. Translated another way, while the point estimate for treatment effect was near 0.0, our study could not rule out the possibility of a 3.2% benefit or a similarly sized harm from mechanical CPR relative to standard CPR.


Not just not helpful, but this could be harmful.


The Failure of LUCAS to Improve Outcomes in the LINC Trial


We love gadgets in EMS.

Dr. Bryan Bledsoe tells us that if we paint it orange and put a star of life on it, we can sell any product for a lot more money.

How much would you pay to not improve outcomes?






Why ask how much money we would pay for no improvement?

There is no price that justifies no improvement.

Image credit.

Experimental studies with the mechanical chest compression device used in this study have shown improved organ perfusion pressures, enhanced cerebral blood flow, and higher end-tidal CO2 compared with manual CPR, with the latter also supported by clinical data.9- 11 [1]


These are surrogate endpoints. What are surrogate endpoints? They are not outcomes that matter. Who cares if you got the pulse oximetry to 100% if the patient died? Survival matters.

There is good evidence that blood-letting improves surrogate endpoints.[2] We know that blood-letting kills.

Should we start bleeding patients based on improved surrogate endpoints?

Of course not. Treating patients based on surrogate endpoints kills patients.

There is good evidence that the LUCAS improves surrogate endpoints.

Should we start treating patients with the LUCAS based on surrogate endpoints?

Of course not. Treating patients based on surrogate endpoints kills patients.

The current sample size has a 95% confidence interval for the 4-hour survival ranging from −3.3% to +3.2%. Translated another way, while the point estimate for treatment effect was near 0.0, our study could not rule out the possibility of a 3.2% benefit or a similarly sized harm from mechanical CPR relative to standard CPR.[1]


What do you mean by this could be harmful?

The apparent benefit could be misleading and the device really could be more harmful than beneficial.

Anyone telling you otherwise is not being honest.

The authors are honest.

Thus, in clinical practice, CPR with this mechanical device using the presented algorithm can be delivered without major complications but did not result in improved outcomes compared with manual chest compressions.[1]


If you want to use the LUCAS because you believe in miracles, you are not discussing medicine. The LUCAS is a medical device that has failed to improve outcomes.

Dr. Brooks Walsh also explains the failure of the LUCAS in this study in “We had a LUCAS save!” – No, you didn’t.

Also see-

The LUCAS, Research, and Wishful Thinking.

In Defense of No Improvement by Medic Madness – Part I.


[1] Mechanical chest compressions and simultaneous defibrillation vs conventional cardiopulmonary resuscitation in out-of-hospital cardiac arrest: the LINC randomized trial.
Rubertsson S, Lindgren E, Smekal D, Östlund O, Silfverstolpe J, Lichtveld RA, Boomars R, Ahlstedt B, Skoog G, Kastberg R, Halliwell D, Box M, Herlitz J, Karlsten R.
JAMA. 2014 Jan 1;311(1):53-61. doi: 10.1001/jama.2013.282538.
PMID: 24240611 [PubMed – indexed for MEDLINE]

[2] Blood-Letting
Br Med J.
1871 March 18; 1(533): 283–291.
PMCID: PMC2260507

Rubertsson S, Lindgren E, Smekal D, Östlund O, Silfverstolpe J, Lichtveld RA, Boomars R, Ahlstedt B, Skoog G, Kastberg R, Halliwell D, Box M, Herlitz J, & Karlsten R (2014). Mechanical chest compressions and simultaneous defibrillation vs conventional cardiopulmonary resuscitation in out-of-hospital cardiac arrest: the LINC randomized trial. JAMA : the journal of the American Medical Association, 311 (1), 53-61 PMID: 24240611


Dissecting the ACLS Guidelines on Cardiac Arrest from Toxic Ingestions

In ACLS (Advanced Cardiac Life Support) one thing is consistent. Poisons are treated the same way before the patient codes, during the code, and after the code. Why?

Dr. James R. Roberts writes that there is no good reason for this –

Don’t confuse post- or pre–arrest toxicologic interventions with the actual cardiac arrest event.[1]

Toxicology is much more complicated than the ACLS guidelines.

American Association of Poison Control Centers

But everybody knows that any potential poisoning/overdose gets naloxone and the megacode is over with a successful resuscitation.

Any medical professional who suggests that naloxone (Narcan) is a resuscitation drug needs remediation or termination.

This is completely wrong and very dangerous thinking. This is magical thinking, which has no place in medicine. This is the kind of thinking that results in everyone being strapped to a backboard based on Mechanism Of Injury.

Don’t think, just do something dangerous.

Image credits – 123

Repeat the mindless sequence as often as necessary, until the desire to understand patient care has been destroyed.

With a dog, the bell ringing only leads to drooling, but medics are generally more dangerous than drooling doggies. Rabies is one way of producing drooling doggies that can compete with medics for ability to cause harm.

What do we expect to get, when we reward ignorance?

Routine naloxone use is a demonstration of incompetence.[2]

naloxone will not reverse cardiac arrest from an opioid.[1]

Only CPR and defibrillation seem to be life-saving. Not unexpectedly, this theme continues with the proclamation that there is no drug, antidote, or intervention that alters the outcome of cardiac arrest from a toxin.[1]

But what about Bicarb?

The use of sodium bicarbonate is not as common as the use of naloxone, but it is no better understood and sodium bicarbonate is a more dangerous drug. As with naloxone, ventilation is more important than medication. That is assuming that acidosis is the problem, which is usually not the case when sodium bicarbonate is given.

Hyperkalemia? Calcium is the treatment, not sodium bicarbonate. We avoid calcium, because we are told that calcium is dangerous and sodium bicarbonate is safe. This is nonsense.[3]

Although a few antidotes have the potential to rapidly neutralize or reverse the toxic effects of drugs in the still living, the majority of one’s arsenal to treat cardiorespiratory collapse secondary to a drug overdose is primarily basic support.[1]

Supportive care is the best treatment for opioid and benzodiazapine overdose when the patient is alive. That is even more true when the patient is dead. Too often we ignore supportive care in favor of magic.

Ignoring respiratory depression/arrest in order to give naloxone or flumazenil (Romazicon) is incompetence.

even flumazenil has “no role in the management of cardiac arrest” from benzodiazepines.[1]

Death from an overdose is quite unusual, probably less than two percent. Those patients who do succumb to their ingestion usually die in the prehospital phase or likely have their fatal course well ensconced before seeing the paramedic or clinician.[1]

If they are still alive when they meet us, we probably will not kill them – unless we do something thoughtlessly routine stupid.

The AHA recognizes that gastrointestinal decontamination, once a generic mainstay in managing any toxin, has a minimal role in changing the outcome of a toxic ingestion.[1]

We can make it difficult/impossible to manage the airway by routinely giving charcoal or ipecac. As I wrote yesterday, ipecac is a really bad idea.[4]

Resuscitation from poisonings with beta blockers, calcium channel blockers, digoxin, tricyclic antidepressants, cocaine, local anesthetics, carbon monoxide, cyanide and more are discussed in the article.

Go read the whole thing and learn a lot about the toxicologic management of resuscitation.


[1] Dissecting the ACLS Guidelines on Cardiac Arrest from Toxic Ingestions
Emergency Medicine News:
October 2011 – Volume 33 – Issue 10 – pp 16-18
doi: 10.1097/01.EEM.0000406945.05619.ca
Roberts, James R. MD

[2] Naloxone
Rogue Medic
The problems with naloxone in four parts –

Narcan Solves Riddle – Part I
Narcan Solves Riddle – Part II
Narcan Solves Riddle – Part III
Narcan Solves Riddle – Part IV

[3] EMS 12 Lead Bradycardia Post – Part II
Rogue Medic

[4] Ipecac for Tricyclic Antidepressant Overdose
Rogue Medic


President Obama’s Speech on Health Care

The part of the President’s speech that relates to health care are copied from White Coat’s Call Room.

For that same reason, we must also address the crushing cost of health care.

This is a cost that now causes a bankruptcy in America every thirty seconds.

Isn’t this supposed to be the President, who makes us forget about all of the verbal blunders of the past 8 years? When nobody understands statistics, will any intelligent decisions be made?

On average the statement may be true, but that is not what he said. You would have to believe that there is some official timer making sure that each bankruptcy happens at just the right time. Those 3 AM bankruptcies are probably the most difficult. You’ll just have to wait your turn. The people in front of you still have 17 seconds before they become bankrupt.

The same thing is done in misrepresenting rapes, deaths of babies, becoming a millionaire, . . . . If this is all so controllable, I think I would choose to become a millionaire, rather than to become a dead baby, or to get raped. I’m odd that way.

This is not some minor point. The people in charge do not understand statistics. The people in charge are using statistics to make decisions. Slasher movies are less scary than this.

Look at what has been done with the economy. The bankers have misrepresented the risks they were taking. This is probably because they did not understand those risks. These same bankers are still considered to be an essential part of the solution. The only problem the administration seems to be worried about is capping salaries and bonuses. The real problem is the bankers and the regulators. The people who continually encouraged the reckless risk taking that they claimed was not risky.

The solution seems to be to keep the guilty in positions where they can continue to cause harm and pass the buck. They are passing out bucks like crazy. that is the right word for it. Crazy. Bernanke, Paulson, the heads of the banks, . . . . Why get rid of the problem, when you can throw money at it – and end up with more control over the banks?

By the end of the year, it could cause 1.5 million Americans to lose their homes. In the last eight years, premiums have grown four times faster than wages.

Health care costs are rising for many reasons. One is the attempt to do everything for everybody. When people feels entitled to concierge level care, then who will turn down having everything done, just in case? Not many do. Then, if everything is not perfect, some of these pampered idiots will sue. There are many things that might help, but hardly a consensus on what will work.

Perhaps the best start would be to eliminate JCAHO/TJC and Press Ganey. JCAHO/TJC is the Joint Commission for Accrediting Healthcare Organizations – now trying to give the appearance of impressive new management with a new name – The Joint Commission. Their motto is, There is no such thing as a health care Mafia. That is just a myth to discredit our valiant efforts to prove that the clipboard is mightier than the physician.

Press Ganey is the empowerment organization for malingerers with inconveniences or addictions. Scum who demand to be treated ahead of those with life threatening conditions – true emergencies. The Press Ganey motto is, We will help you make those know-it-all doctors jump through hoops, just to please you. Remember, you’re worth it!

And in each of these years, one million more Americans have lost their health insurance. It is one of the major reasons why small businesses close their doors and corporations ship jobs overseas. And it’s one of the largest and fastest-growing parts of our budget.

Pay no attention to the slight problem of printing money faster than we can throw it at people, people who have demonstrated gross incompetence in money management.

Given these facts, we can no longer afford to put health care reform on hold.

Given the facts of printing money like a counterfeiter on methamphetamines, keeping the dangerous people in charge, and completely misunderstanding the problems, why put anything on hold? Do it all now. Wave a magic wand of change and it will all get better. Really.

Already, we have done more to advance the cause of health care reform in the last thirty days than we have in the last decade.

But is it good reform?

Is the cause health care reform for the sake of health care reform, or health care reform for the sake of patients?

When it was days old, this Congress passed a law to provide and protect health insurance for eleven million American children whose parents work full-time.

Parents will no longer have to pay for health insurance directly. The government will pay for it. Which just means that parents pay for it indirectly. Not seeing the cost of health care choices is part of the problem. The solution to the problem is more of the same.

Our recovery plan will invest in electronic health records and new technology that will reduce errors, bring down costs, ensure privacy, and save lives.

It is a good thing that President Obama learned from the mistakes of President Bush. Don’t declare victory too soon.

When none of these things happen, will President Obama apologize to America.

Ensure privacy? Since that is impossible, we are obviously dealing with someone, who does not understand the problems.

It will launch a new effort to conquer a disease that has touched the life of nearly every American by seeking a cure for cancer in our time.

JFK did a slightly better job of getting people interested in going to the moon. This cancer comment fell flat. Did Bobby Voodoo Jindal write this for him?

And it makes the largest investment ever in preventive care, because that is one of the best ways to keep our people healthy and our costs under control.

Since preventive care means to keep our people healthy, he might as well be saying that cancer treatments are the best way to treat cancer.

President Obama seems to think that the best way to reform financial problems is by giving money to those who caused the banking problem. What could possibly go wrong with this approach?

This budget builds on these reforms. It includes an historic commitment to comprehensive health care reform – a down-payment on the principle that we must have quality, affordable health care for every American. It’s a commitment that’s paid for in part by efficiencies in our system that are long overdue. And it’s a step we must take if we hope to bring down our deficit in the years to come.

At White Coat’s Call Room, this is debunked very nicely.

Now, there will be many different opinions and ideas about how to achieve reform, and that is why I’m bringing together businesses and workers, doctors and health care providers, Democrats and Republicans to begin work on this issue next week.

Gosh, there is not yet a plan, but there are already results.

I suffer no illusions that this will be an easy process. It will be hard. But I also know that nearly a century after Teddy Roosevelt first called for reform, the cost of our health care has weighed down our economy and the conscience of our nation long enough. So let there be no doubt: health care reform cannot wait, it must not wait, and it will not wait another year.

Non sequiturs rule!

Note to Bobby Jindal. American astronauts did land on the moon. This is science, and nobody would expect you to be aware of science. You managed to major in biology, yet still think Intelligent Design should be taught as science. So what if they did not return with cheese?


The Controversy Over Vaccines

OK, a bit of bait and switch. There is no genuine controversy.

Vaccines work.

Vaccines are safe.

That is the wrong controversy.

Why do so many people distrust vaccines?

Why are so many people listening to explanations of science from a movie star, who might make more sense wearing a shirt with a slogan written across her two most prominent attributes – If only these were brains?

Are the other movie stars any more scientifically literate than Jenny McCarthy?


Movie stars are not known for writing their own lines. Do they make sense when they start to ad lib?

Still, no.

At least the movie stars are basing their complaints on good science.

Not a chance.

Now that I have clearly established the authority of movie stars to speak on this topic, I will fight fire with fire. A movie star (Amanda Peet) defending vaccines. Take that you evil anti-science movie stars.

On NPR there is a less than 5 minute long clip at the link below.

Defending Vaccines: Actress Dispels Link To Autism

The doctor on the show is Dr. Paul Offit. He may be more familiar to Anti-vaccinationists from this kind of image. Dr. Offit is the one in the middle.

They are not finding fault with the science, but with the scientist.

Anti-vaccinationists also demonstrate their generosity by sending him death threats.

Wouldn’t that make the Anti-vaccinationists the terrorists?

I suppose that is too complicated a question for the people who buy into their Anti-logic.

On the other hand – Death Threats?

Where do I sign up?


Needless Scan Reflex

This week the Normal Sinus Rhythm blog is doing our un-themed theme. I again apologize for being late in posting my contribution.

Dr. Shadowfax at Movin’ Meat writes an excellent post about defensive medicine practitioners. It is called Running Scared. Needless to say, with such a topic this received a lot of comments on both sides.

There has been quite a bit of writing about defensive medicine lately, but this made some points that seemed different from the other posts. If there are any posts that address this from a legal standpoint, not “What if you get sued?” but posts by someone with a legal background. Something that provides a discussion of the actual risks a competent doctor faces in testing and treating according to accepted medical practices (what a concept), rather than spending as much of everyone else’s money to protect themselves from tort OCD, please let me know.

What is reasonable to protect the patient and the doctor?

How much risk should a doctor be allowed to inflict on a patient, especially without informed consent?

Are these doctors explaining that there is no medical benefit to the patient other than the one in a whateverillion chance, and that the doctor is not doing this to protect the patient?

Are these doctors explaining that the extra cost to you, if you have health insurance, is to protect the doctor’s income? That the extra cost, if you pay taxes, is to protect the doctor’s income? That the extra cost to the people who pay for your medical care, if no money comes out of your pocket, is to protect the doctor’s income, not to get one over on The Man?

In one of the comments, igloodoc states:

In the great “learned helplessness” environment of the ER, the theory goes that you develop behaviors to help you cope with a situation which you cannot control.

Your coworker is just exhibiting the major side effect of learned helplessness… he is running the algorithms. He is attempting to exert control in the one area he can…

I guess this makes these doctors the biggest welfare queens around. Is the behavior of the person who chronically goes to the ED to insist on constant attention and the million dollar workup any different? They are all attempting to control life, but failing miserably. They are worshiping whatever superstition appeals to them at the moment.

Since everyone seems to be afraid of lawyers, the lawyer is the big threat that is used by the powerless to grab at power. Likewise, the doctor, who is uncomfortable using clinical judgment becomes an overpaid automaton, ordering tests based on remote possibility, rather than clinical judgment. If we are to be saddled with algorithm reciting drones, we should at least avoid having to put up with the superior attitude.

How often does a good workup, but short of the million dollar workup, result in an adverse legal outcome?

Is there any statistical basis for this?

Why are the defense lawyers not able to convince juries of the wisdom of the clinical judgement of the doctor?

Isn’t there anyone left in this country who understands statistics and the harm of “You can’t be too safe?”

In a later comment igloodoc writes:

Everyone will agree not to do the CT until the visit where the CT needs to be done. Figuring that out is why we get the “big” bucks. You will never be rewarded for the money and radiation saved, but will be penalized for the one CT you didn’t do. You may call this running scared, but as I suggested above (rather poorly perhaps) that the behaviors are a product of what your coworker has learned. Not necessarily fear.

Maybe igloodoc has an important point – the medical reform we need is that we need to punish the doctors for this bad patient care.

So much for the often quoted Hippocratic Oath. When it suits the purposes of the doctor to cite it no problem. “We don’t do that. It would be unethical. Behold the almighty Hippocratic Oath.” When it comes to not increasing the costs to the patient – out of no legitimate concern for the patient’s health, but for the doctor’s pocketbook – then where is this oath? When it comes to not increasing the risks to the patient – out of no legitimate concern for the patient’s health, but for the doctor’s pocketbook – then where is this oath?

“Oh, that is just a medical anachronism.”

“It isn’t a binding oath.”

“You misunderstand the purpose of the oath.”

“Pay no attention to that man behind the curtain.”

What can be done to get doctors to practice medicine as an art that is for the benefit of the patient?

“What if . . . ?” does not have an ICD-9 code, does it?

How can doctors really complain about snake oil salesmen, homeopaths, and other anti-science groups in one breath and order a useless, expensive, test with the potential of harm to the patient in the next breath?

Well, I’m not a doctor, so I don’t have any place giving anyone any suggestions about how to be a doctor. This is what I often hear from those who appear to limit their medical decisions to admitting everyone who cannot be tested to death, or to calling someone for a second opinion.

Then, on the other hand, I am getting free legal advice from someone who isn’t a lawyer; someone who would be apoplectic at the suggestion that a lawyer might give medical advice – regardless of cost; so this legal advice is worth what?

The best suggestion in my non-doctor, non-lawyer opinion is the one proposed by Common Good. Medical courts that are handled by medical professionals (I would hope limited to the small fraction of doctors who do understand statistical relevance), not the impressionable innumerate wealth redistributing members of the medical illiterati. Of course those awarding these huge amounts of money, even when the doctor did not do anything wrong, are only exhibiting signs of “learned helplessness.” They are keeping alive the dream of the lawsuit lottery.

And in EMS these same doctors, who are terrified of not testing for Zebra Syndrome ignore dangerous medics, allowing them to do whatever they do to unsuspecting patients. Not that EMS is special, how many doctors will do anything to prevent a dangerous doctor from harming patients. Why do something to protect patients, when there are theoretical lawsuits to to be obsessed over.

Maybe I exaggerate too much. Maybe I just don’t have a clue, but the lawyers I do know have told me that the best way to avoid a lawsuit is to act in the patient’s best interests. I suppose it would be silly to rely on the advice of real lawyers, when there are doctors just thrilled to provide me with legal advice, as if that were to justify their DSM-IV behaviors. Some do not seem to order lunch without an expensive, to somebody else, test. My apologies to the rest – this is not about you. We need to improve critical judgment in all areas of medicine, not abandon it to computerized algorithms.