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Jewish World Review Nov, 20, 2003 / 25 Mar-Cheshvan, 5764

Julia Gorin

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Consumer Reports

The Doctor Shrugged | I find the show "ER" fascinating. On it, the people in white coats actually rush around as if something is at stake. Their faces show expression, often of concern, as if they're worried whether a patient lives or dies. It isn't like any emergency room or doctor's office I've ever seen.

In real life, one goes to a hospital if he or she is curious to have a near death experience. Show up with heart attack symptoms and you'll be treated for indigestion and sent home. Come in for a colonoscopy, and end up in the intensive care unit, as a 115-pound former co-worker of mine did when she was injected with enough local anesthetic for a 220-pound man.

My former college professor, who has a heart condition, caught on early: Whenever hospital staff enter his room, he asks, "What is my name? And what am I here for?" If all hospital patients don't do as much, healthy organs will get removed and the wrong appendages amputated.

Until he got a second opinion, one disgruntled patient had spent the past year thinking he had Parkinson's, because that's how his doctor diagnosed his shaking hand — despite being aware that the patient had undergone major surgery to that arm after a bad car accident.

When I was paying out-of-pocket for an HMO that didn't cover medication, I was given a prescription for medicine to treat a condition opposite of what I had. After the mistake was discovered — and after I had paid for and ingested the pills — I asked the substitute doctor if I could get reimbursed for the expensive but incorrect prescription his partner prescribed, if only to help pay for the right one. Indignation gave way to condescension as the doctor defended his colleague, saying, "Doctors are only human. We make mistakes. Haven't you ever made a mistake?" Stunned that I dared to answer "yes, but I've always paid for my mistakes," he and the nurse walked out snickering and shaking their heads. Needless to say, I got a new ob-gyn — with whom I was very happy until one day, after performing a cesarean on a patient, he decided to carve his initials into the woman's abdomen.

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As a kid I used to think that the "MD" imprint on many license plates stood for Mercedes Driver, since I'd always see it on Mercedes Benzes (though now it's usually on a Lexus or BMW). But eventually I found out that what it really stands for is "licensed to kill."

Just look at what happened in Israel in early 2000, when medical doctors went on strike: the funeral industry tanked. The burial association complained to the government to increase doctors' salaries. The only city that did not see a decline in its death rate was Netanya, where doctors had a no-strike clause in their contracts.

Doc, when your parents sent you to medical school so you could make a killing, they didn't mean literally.

Medical treatment is the third leading cause of death in the United States, after heart disease and cancer, according to a 2000 Journal of the American Medical Association article by Dr. Barbara Starfield, of the Johns Hopkins School of Hygiene and Public Health. Starfield places medically-related deaths at 225,000 a year, while a more conservative estimate by a 1999 Institute of Medicine report places the number of deaths by medical error at 100,000 (but does not include the 106,000 deaths caused by correctly prescribed medications that Starfield's article includes — something that seriously injures an additional 2.1 million annually).

ABC's "Primetime Thursday" last month attributed that figure to deaths from hospital infections alone — at least 50,000 of them preventable through the practice of basic hygiene by hospitals. The broadcast mentioned that ABC sportscaster Dick Schaap died two years ago from a hospital infection he got after routine hip replacement surgery because the medical staff at New York's prestigious Lenox Hill Hospital couldn't be bothered to wash their hands between patients. Meanwhile, unlike all these reports — which looked only at hospital deaths — in a study to be published this January in Life Extension Magazine Dr. Carolyn Dean MD ND considers out-patient-procedure-related deaths as well as hospitalized seniors whose deaths were expedited by bedsores. The annual figure she came up with was over 700,000 iatrogenic (treatment-inflicted) deaths. Doctor handwriting alone kills a few thousand a year, according to USA Today — part of the more than 7,000 annual deaths by prescription error. And 35 percent of doctors themselves complain about the doctor care they or their families get, the IoM reported.

The frightening statistics, not to mention the negative doctor-patient experiences behind them, might explain why there is something called alternative medicine. It gives people an alternative to dying.

Yet mention to a physician that you see a holistic practitioner and he may well call such party a "quack." One friend actually refused to seek a neuro-skeletal specialist's care to address a pinched nerve when standard medical tests were coming up empty (as they tend to do) — for fear that doing so would ruin her and her husband's relationship with their primary doctor.

When medical experts are cited on the issue of homeopathy the favorite word they employ to warn the public away from exploring such treatments is "unproven." But is treatment that is "unproven" to those who haven't sought it really worse than treatment that is proven to kill?

One primary care physician actually did call alternative practitioners "quacks" after discovering that I'd been seeing a holistic chiropractor for chronic back trouble. Sounding a bit like a spurned lover, he whined, "You didn't have me look at your back."

But why see an MD for a misaligned back? So he can say, "It's not fractured. Do you want a painkiller?" (as one said to my sister when she came in barely able to move).

Indeed, to be a doctor in America all you need to know is the word "painkiller." One young physician admitted at a party, "We're basically pill pushers," and added that, much like a diner waitress hoping you'll stick to the menu, they're looking for the path of least resistance. The term "conveyor belt" also came up.

Conventional medicine operates on a principle known as allopathy, defined by the American Heritage Dictionary as "a method of treating disease with remedies that produce effects different from those caused by the disease itself." Which is a bit reminiscent of the days when complaining of a headache got you a kick in the shin, making the head hurt less.

Observing an MD trying to diagnose, much less treat, a chronic neuro-musculo-skeletal condition is better than slapstick. Test after test after test, it's like watching a game of Pin the Tail on the Donkey. From the physicals to the check-ups to the trial-and-error means of diagnosing, coming into a general practitioner's office for any reason other than securing antibiotics is an exercise in futility. It's a running joke that a primary care physician's competence is best measured by how expeditiously his staff fills out referrals. These archaic places best serve as a geriatric hangout — who really do push doctors to push pills.

Don't think I didn't chuckle when my homeopath told me the pain in my neck was being caused by a troubled gallbladder. But sure enough, after she treated the gallbladder I could move my neck. That's because holistics and osteopaths know how one body part can "refer" pain to a seemingly unrelated body part. Conventional doctors don't know that one body part has anything to do with another, or else why would they operate on the wrist for carpal tunnel syndrome when the pain and tingling usually stem from a pinched nerve in the neck or back?

Unless you demonstrate classic symptoms of one of the six or so conditions that fall into a medical doctor's limited repertoire of common, recognizable, rigidly drawn, diagnosable conditions that he knows how to handle, he won't really know what's wrong with you until the autopsy. You get more answers from a veterinarian, for crying out loud. (Which would explain the expression "healthy as a horse.")

God bless Western medicine for all the breakthroughs — the vaccinations, the transplants, the emergency life-saving procedures, cutting-edge modern miracles and yes, anesthetics. But these days its practitioners perform best for those on the brink of death, and that's where you'd better be when you come to these people, or they'll bring you there.

Certainly everyone makes mistakes — as one common defense of doctors goes — but there is a pervasive attitude problem among MDs. Which is why when I hear that other hackneyed defense, "They're only human," I point out that so is Charles Manson.

In the 1800s, when hospitals had up to an 80 percent death rate, blood on a doctor's frock was considered a status symbol. While it took a crusade by a nurse, Florence Nightingale, to get hospitals to operate under sanitary conditions, Joseph Lister — now called the father of modern surgery — was ridiculed by his colleagues when he suggested that maybe if doctors washed their hands between patients, sterilized their instruments before operating, and changed their clothes if they had blood from the previous patient, hospitals could reduce their mortality rates. Many continued to laugh even as others followed suit. Because science didn't tell them that it needed to be so. Hand-washing, clothes-changing and sterilizing were unproven methods, so doctors just accepted that 80 percent of their patients would die.

I'm not saying doctors have to be flawless. I'm just asking them to appreciate the difference between a patient and a piece of furniture. Because there are errors, and there is apathetic negligence. There is also an arrogance that is buttressed by a rigid hierarchy and an atmosphere of intimidation at hospitals, wherein ranking doctors can't be questioned or corrected by nurses or lower doctors (something even more unthinkable than a patient challenging a doctor). It's not uncommon for nurses to sneak around doctors' orders to keep from killing the patients, as a nurse friend of mine observed a fellow nurse do when the doctor was overdosing a patient on intravenous medication. Indeed, the latest IoM report cited a study that found that 86 percent of medication errors at two hospitals were intercepted by nurses before reaching patients.

Writes one trauma coordinator and emergency department supervisor (original emphasis preserved): "When nurses get together without others, the subject often turns to how we prevented another needless MD-related death by circumventing orders or interpreting them in a light favorable to the patient. To nurses, it is a horrible truth that physicians CANNOT be questioned or overseen. They answer to no one but the third party payer, and resent the hell out of anyone even thinking about questioning their practice. Nurses who 'disparage' the medical establishment or licensing boards can lose their license to practice nursing and could possibly face criminal charges. Physicians can and sometimes do pursue vigorous legal action against those they feel threaten their practice. Medicine is, for all intents and purposes, a 'closed shop.'"

He attributes the growing annual nurse flight (Health and Human Services projected a 20- percent nurse shortage by 2015) partly to such practices, adding that "all of my colleagues love patient care, but counsel others to not enter the profession."

He continues, "Even the very best physicians get into a 'routine,' sometimes discounting patients' and nurses' knowledge and suggestions. It is extremely rare to find a physician who is really 'bad', but it has been my experience that physicians DO NOT do a very good job of monitoring each other. It seems professional courtesy to 'look the other way.'"

Indeed, for all the talk about the "blue wall of silence" that police departments are criticized for, we've heard very little about the white wall of silence. When a doctor does blow the whistle on dangerous patient care at a hospital, he is labeled "disruptive" and blacklisted nationally, according to a recent medical series by the Pittsburgh Post-Gazette. The vicious cycle between hospitals and doctors teaches medical professionals to fall in line or else.

Yet doctors and hospitals want skyrocketing malpractice insurance costs contained and punitive damages from lawsuits capped. Malpractice is a two-way street, and more doctors need to do their part to earn these reforms. They also need to stop discouraging patients from seeking alternative care — whose purpose is not to compete with, but to supplement, traditional care — or they will look increasingly like relics. Thankfully, there are the "radicals" of the profession, bridging the Western model and the Eastern model. Some physicians actually practice both, while others have started to refer patients to alternative and osteopathic care (which insurance companies are increasingly covering), and seek it themselves. There is a place for conventional medicine, but there is also a place for alternative medicine. And MDs should know their place.

If any of the symptoms mentioned here hit too close to home for some doctors, they should read this twice and call each other in the morning. And if the truth still hurts, take a painkiller and ignore the problem.

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© 2003, Julia Gorin