Use Measured Firmness When Dealing With Pediatrician About Swine Flu Concerns

If you're like me and live in a large metropolitan area (Chicago) and have small children (18 months) in school or daycare (the latter), you may be a little concerned about the swine flu. There is no vaccine or cure, it is spreading quickly in crowded environments and it has proven deadly in the very young. I imagine that many pediatric and family practice offices are being inundated with calls from worried parents wondering if little Johnny's or Jane's sniffles could be related to this growing epidemic. I have to admit that I have visited the website of a well-known pediatric office here in Chicago to check on recommendations for dealing with this situation. Should I be stocking up on Tamiflu just in case? The answer, of course, is no for now. Frequent hand washing and avoiding obviously sick people is all one can reasonably do for the moment.

But what if your child starts to experience flu-like symptoms?

Take him or her to the doctor and request a test for the swine flu, aka the H1N1 virus. A quick test can be done at the doctor's office to determine if your child has influenza (flu). If that test is positive additional testing can be done to determine if it's the H1N1 virus vs. the garden variety flu. Do not allow your doctor to brush you off with comments like, "It's probably just a cold," or "I'm sure she's fine." I appreciate that physicians will likely grow weary of patient concerns about the swine flu, but there is simply no reason for such speculation, especially with regard to young children. Do not allow your concerns to be brushed aside. If your child has flu symptoms, ask for the test. Time is of the essence because Tamiflu, which can reduce the severity of H1N1 virus once contracted, must be given within 48 hours of the onset of symptoms.

Not All Hospitals Are Created Equal

Last week I wrote that when it comes to picking a family doctor you don't need the best. What you need is someone who is competent and caring and whom you like and feel comfortable communicating with. To treat a serious ailment, injury or disease the family practice doctor will refer you to a specialist anyway. However, when it comes to picking a hospital, it's a different story. Not all hospitals are the same. The importance of choosing a good hospital is highlighted here.

Choosing a good hospital can be tricky, but the bottom line is that it usually comes down to resources, money. Some hospitals have it, and use it to create fantastic centers for diagnosis, treatment and learning, and others do not. There are some hospitals here in Chicago that constantly seem to be spending money to improve patient services. Northwestern Memorial Hospital just opened its brand new Prentice Women's Hospital and Loyola University Hospital is expanding its Center for Heart & Vascular Medicine. With regard to hospitals like Roseland Community Hospital and St. Bernard I have to wonder how they manage to even keep the lights on. A hospital's wealth is certainly no guarantee that it will provide safe, error free care to all of its patients, but odds are that you'll be better off.

The other thing you'll need to consider in choosing a hospital is they type of care you need. Some hospitals are simply better at treating certain kinds of patients than are others. For example, if you are having a baby I doubt you could do better in Chicago than the aforementioned Prentice Women's Hospital. If you have heart issues, St. Francis in Blue Island (now Metro South) has a good reputation. Once again, no hospital is perfect. I am aware of serious errors committed at each of the hospitals I have mentioned here. But remember, you are playing the odds. Do your homework before you require a significant hospital stay and you will decrease your chances of becoming a victim.

Here is a link to what US News & World Report thinks are the best hospitals in the United States.

VA patients test positive for HIV after treated with contaminated equipment

Here's a follow up to the story about Veteran's Administration patients who received treatment with contaminated endoscopic equipment. Some have tested positive for HIV.

Less Romance, More Communication

Several years ago I was sitting in the back of the courtroom during closing arguments in a medical malpractice case tried by two senior and very talented trial attorneys. The case arose from the death of a man who died of meningitis after physicians completely ignored obvious signs and symptoms. The man left a grieving widow and a son. During his closing argument the defense lawyer asked the jury rhetorically, "What is a doctor?" He then preceded to wax on eloquently about the challenges physicians face during their careers. I remember the defendant doctor sitting there emotionless in his expensive looking suit as his lawyer went on, painting him as a tragic hero. I also remember seeing the wife of the deceased sitting at the adjacent table looking forlorn and detached. I was sure that she wanted to be anywhere else. The doctor's lawyer, coming near the end of his closing, again asked the question, "What is a doctor?" clearly feeling that by that point, everyone had received his message that a doctor, his client, was nothing less than a hero. As the lawyer took his seat a tense silence enveloped the courtroom. The judge looked over at the widow's attorney, "Counsel?" The old attorney looked grim as he stood, a bit of anger on his face as he strode slowly to the center of the courtroom to face the jury. "What is a doctor?" he growled; "What is a husband?" His voice trailed as he looked at the jury. It looked as if he might say something else, but he didn't. He turned quietly and returned to his seat next to the widow.

Earlier this week I saw a story in USA Today announcing a new book called The Soul of Medicine by Sherwin Nuland, a former physician. The headline of the story proclaimed the apparent premise and primary subject matter of the book, that A doctor's 'Soul' is tormented by medical errors. Reading that reminded me of the closing arguments in that trial from several years ago. It bothers me too. I have no doubt that some physicians feel haunted by their mistakes. However, I have spent too many years going after arrogantly unrepentant doctors to feel anything but cynical with regard to the medical profession. I remember going to visit a neurosurgeon at his office to discuss a client of mine. I remember being shocked to see clear evidence of his god complex hanging right on his wall:



We all feel haunted by our mistakes. When any of us make a mistake that causes harm to another person the pain we feel is worse. I become deeply troubled, however, by the romanticizing of the medical professional. I feel this way because I frequently witness the impact it has. It makes physicians seem like exalted "others"; like gods among us mere mortals. This falsehood creates an atmosphere of tension, apprehension between doctor and patient. The patient all too often feels intimidated by his caregiver. This is undoubtedly a counterproductive state of affairs.

One of the reasons that we trust our doctors is that there is a perceived difference in social status between them and us. But this is not healthy. It discourages frank and open communication, which leads to poor treatment and an increase in medical errors. The more you communicate with your doctor the more you will see each other as individuals entitled to equal amounts of respect. This will encourage even more communication and openness which will lead to better care and fewer mistakes.

Pick A Doctor You Like, Then Hold On Tight

Continuity of care. That concept is vital when it comes to fostering good health care where a minimum of errors are made. What it means is that you should stick with the same doctor for as long as possible. Doing so is often difficult in our current system where patients usually rely on private health insurance to cover costs. Often a insurer will unexpectedly decide to drop a physician or physician group from its plan. Many times a physician's office will decide to no longer except a patient's health insurance. Those significant realities aside, the importance of doing whatever possible to keep seeing the same doctor cannot be overstated. This is especially true when it comes to your primary care or family physician.

A good friend of mine who is a board certified family practice doctor recently forwarded to me a video from ABC News discussing the importance of continuity of care and the family practice doctor. The video can be seen by clicking here. Continuous care with the same family doctor means regular medical follow ups. It means preventative and consistent care for chronic health issues like diabetes and allergies. There are few if any formulas for patient care. Different physicians have different approaches to patient care and treatment. There is nothing necessarily wrong with this. However, when a patient constantly switches from doctor to doctor with their different approaches to treatment and prescribing medication, confusion is all too often the end product. This leads to more medical errors and patient injury or death as a result.

Let's be frank, you do not need the very best doctor to be your family care physician (as if there were a way to measure what it means to be the best.) You need a competent, caring physician who knows you, your body and your medical history. In my view there is nothing more important to safeguard patient safety and to reduce preventable medical errors.

What's Up In Wisconsin

For quite a few years Wisconsin Medical Society has maintained a victim's compensation fund to provide for the harms done to patients due to medical errors. Here is an interesting story about how the State has stolen money from that fund.

Illinois Hospitals Working to Overcome Language Barriers

The importance of communicating clearly and effectively with your doctor cannot be overstated. This can be a huge problem where you and your physician do not share a common first language. The Chicago Tribute recently reported on an innovation that is meant to help patients and doctors overcome a language barrier. Click here to view full story.