Category: Medicine Hat News

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Physician Errors

What is the difference between god and a doctor? God does not think he is a doctor!

You have heard this joke before. But it is not funny when you are a patient and your doctor thinks he is god, he knows it all and he can do no wrong. Well, do doctors make mistakes?

Errors in medicine is a touchy subject. It is a hot potato. Not many people want to touch it or swallow it. But recently, medical journals in Canada, USA and Britain have started to discuss the subject in the open.

In health care, doctors are not the only ones who make mistakes. All humans who work in the system make mistakes: nurses, pharmacists, physiotherapists etc. Even machines make mistakes.

And as we rely more on the machines to make diagnoses for us, the mistakes are increasing. False negative and false positive results from the multitude of tests we order are putting patients at risk every day. That is the price we pay for modern technology.

A report released in US last year says that medical errors kill about 100,000 Americans each year. The chairman of the 19-member panel that issued the report says, “These stunningly high rates of medical errors resulting in deaths, permanent disability, and unnecessary suffering are simply unacceptable in a medical system that promises first to ‘do no harm’.”

An editorial in the British Medical Journal says that studies in Australia, Israel, the United Kingdom and elsewhere, suggest levels of error and hazard in patient care that are no lower than in America. Canada is not immune to the problem. Death of infant Trevor Landry from a narcotic overdose in a Toronto-area hospital is one example of medical errors in Canada. Currently, in Canada, no mechanism exists to track medication or other errors to develop strategies to prevent their occurrence.

Are health care professionals superhuman?

No. But they are highly trained individuals. Each one comes with certain weaknesses and strengths. They are not all born or trained to do everything.

John Hubbard, in a book called “Measuring Medical Education”, says that two types of physicians make mistakes – a shotgunner, who prescribes and does procedures without adequate information and indications; and a timid soul, who makes diagnoses without adequate information.

But there are other reasons for errors as well which people fail to appreciate. Over worked and underpaid workers, inadequate resources, manpower shortages, political interference and personal and family stress does not provide a healthy environment for error free practice.

Is there a mechanism to prevent errors in medicine?

Yes. But the American report condemns the current fragmented system of handling medical mistakes, which relies on a combination of peer review, federal and sates regulation, malpractice lawsuits, and evaluations by professional bodies. The panel suggests mandatory reporting and public disclosure of serious medical errors.

In my view, there are only 5 ways to prevent errors in life: 1. Give your hundred percent to the task at hand, that is, be thorough 2. Do not do anything you are not comfortable with 3. Do everything neatly and clearly 4. Know your strengths and weaknesses and 5. Learn to say ‘I don’t know’.

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Teenage Smoking

Why do teenagers smoke?

Is it because it is “cool” to smoke? Is it because the idols of many teenagers – movie actors and actresses – smoke on screen? These are the questions asked in an editorial in the Annals of the Royal College of Surgeons of Canada.

But we do not know the answer. What we know is that if you are not addicted to tobacco by the age of 20, then it is less likely that addiction will start later. Hence, teens and pre-teens should be key groups for whom anti-smoking programs should be designed.

Do you think movies and television may have a significant role to play in this public-health problem? Well, next time you go to a movie or sit down to watch TV, think about it!

Do you think smoking protects against dementia?

Well, that is what some people think. But the British Medical Journal writes that Richard Doll, who has been studying the smoking habits of doctors since 1951, says that contrary to previous suggestions, persistent smoking does not substantially reduce the rate of Alzheimer’s disease or of dementia in general. If anything, it might increase rather than decrease the rate, but any net effect on severe dementia cannot be large in either direction.

Which Canadian province spends the most money on health care?

It’s not Alberta. Alberta has the 5th lowest expenditure at $2832 per person. Quebec has the lowest expenditure per capita among the provinces – $2453 per person in 1999. According to the Canadian Institute for Health Information, Albertans continued to spend a lower proportion of their provincial gross domestic product on health in 1999 (7.6 percent) than citizens of any other jurisdiction on Canada.

Among the provinces, spending per person was highest in Ontario and British Columbia in 1997, at $2,746 and $2,728, respectively. The three Prairie provinces occupied third to fifth positions. The Atlantic provinces and Quebec occupied the lower half of the distribution.

Now that Bill 11 has gone through the Alberta legislature, does the government think that for-profit health delivery is cheaper than publicly funded health care?

An article in New England Journal of Medicine says that US healthcare spending in 1995 in for-profit markets resulted in $5.9billion in excess costs when compared with spending in not-for-profit markets. So private health is not cheap!

In the last column we discussed six important risk factors for cardio-vascular disease. Somebody was kind enough to remind me that I missed the seventh risk factor – diabetes.

Diabetes causes hardening of the blood vessels. When diabetes develops, the blood sugar level goes up because insulin (the substance which keeps blood sugar level under control) is in short supply.

Insulin is produced by pancreas. In diabetics, pancreas either does not produce enough insulin or our body does not respond to insulin as it should.

Warning signs of diabetes are many – drowsiness, excessive weight, easy fatigue, constant urination, family history of diabetes etc. Discuss these symptoms with your family doctor.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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Heart Disease

Recent newspaper headline says that heart and blood vessel disease kills more women than breast cancer. Are you surprised? Well, you shouldn’t be!

We know that heart and blood vessel (cardio-vascular) disease is a number one killer of all adults, irrespective of gender. Over the years, and from time to time, our doctors and our media, remind us about the known risk factors associated with cardio-vascular disease. But how many of us have the ability to remember and recall these risk factors?

Now, if you are one of those Canadians who can remember and recite these risk factors before each meal then you run the risk of being left alone to eat your own breakfast, lunch and dinner. You will be a social outcast!

And if you are a physician, sitting with non-physicians who enjoy extra salt, a blood soaked 20-oz steak cooked in butter, and double size cheesecake with extra whipping cream then you better keep your mouth shut! And you better keep your mouth shut, if you are a non-physician sitting with physicians who smoke and eat just like “normal” human beings!

In any case, how can we change our eating habits if we are to stay healthy? Is it by keeping our mouth shut or by being a social outcast? Before you start your meal, would rather say “grace” or recite the innumerable commandments of healthy eating?

While you are struggling to make up your mind, lets look at recent articles in Canadian Medical Association Journal that say that in order for a person to change his behaviour, he has to rely on his knowledge or have access to information to make sound judgement on what is good for his health. They also believe that monitoring the population’s knowledge of risk factors can help guide public health programs.

Here is a test for you! In the next 60 seconds, name the six risk factors for cardiovascular disease. Now compare yourself with how 23,000 Canadians aged 17 to 74 did in a survey conducted by Canadian Heart Health Research Group between 1986 and 1992.

Overall, the percentage of Canadians who identified the six important risk factors for cardio-vascular disease is: fat in food (60 percent), smoking (52 percent), lack of exercise (41 percent), excess weight (32 percent), elevated cholesterol (27 percent), and high blood pressure (22 percent). So, how did you do? Never mind, must be that mental block!

The researchers found that the behaviour related risk factors – fat consumption, smoking and exercise – were mentioned more often than physiologic ones – high blood pressure and raised cholesterol level. They also found that all segments of the Canadian population are missing some information about the different cardio-vascular risk factors.

Their findings suggest that health promotion campaigns should consider individual differences and include distinct messages for subgroups of the population, at least those defined by age and education level. And not to forget the disadvantaged segments of our population.

Now, can you recall the six important risk factors for cardio-vascular disease?

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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Pilonidal Cyst

Dear Dr. B: My son is 18. About a year ago he had surgery for pilonidal disease in the tailbone area. The wound got infected and has not healed. The wound continues to drain bloody discharge. My son finds it very frustrating as it soils his clothes. Can you please tell me about pilonidal disease? Yours, Mrs. Z.

Dear Mrs. Z: The pilonidal disease most commonly occurs between the buttocks, close to the tailbone. This condition has been described since 1847. The term pilonidal means “hair-nest”. It can also occur in other areas such as beard, the armpit, the belly button and the web spaces of the hands (in barbers) and feet.

Pilonidal disease is a spectrum of three conditions: acute pilonidal abscess, chronic pilonidal abscess or sinus, and the unhealed pilonidal surgical wound.

For many years, experts believed that this was a congenital condition. In 1946, Patty and Scarff challenged this theory and drew attention to the role of hair in the origin of this problem. Current evidence strongly indicates an acquired origin for pilonidal disease, with most infections being related to penetration of the skin by hair through small midline pits.

Where do these pits come from? Some people believe they are congenital while others believe them to be enlargement of hair follicles. These pits have sinus openings through which the hairs penetrate. Hirsutism in the buttock and perineal area appears to be associated with the development of pilonidal disease.

Management of the condition depends on the type of presentation. Acute pilonidal abscess needs to be drained immediately once the diagnosis is made. The area should be kept shaved. Daily bath or shower will keep the area clean. Once healed, it may become necessary to excise the midline pits under local anaesthesia to prevent recurrence.

Treatment of chronic pilonidal abscess or sinus remains controversial as no one treatment has proved superior. The choices are: non-operative treatment with repeated phenol injections; conservative excision of the sinus openings and midline pits; laying open the sinus tract and stitch the skin margins to fibrous tissue (marsupialization); or wide excision with or without different types of closures of the skin.

The unhealed pilonidal surgical wound and recurrence of pilonidal disease after initial treatment is very common. Management of this problem can be very difficult. To start with, the unhealed wound should be curettaged to control the excessive granulation tissue (healing tissue which fills the wound), and the surrounding skin should be shaved weekly. The wound should be kept clean and dry with gauze. Strapping the buttocks apart may help prevent the continuous shearing movement during walking.

The wound may take six to eight weeks to heal. Quite often healing does not occur. Then a skin graft or some form of plastic flap may help the healing process. Overall, treating pilonidal disease should not be taken lightly as the results are quite often disappointing. If it ain’t broken then don’t fix it!

Finally, on a personal note, I would like to thank all those who phoned, e-mailed or sent messages through my family about last week’s column on my mother. The reaction from the readers was overwhelming. Many people reminded me that it is Mother’s Day this Sunday!

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!