Re: Applications in Medicine

[Judith Rosen <***>]

Tom Staiger wrote:
> >  <x-tad-smaller>I would agree that an optimal system would benefit from a redesign around a new paradigm.  FYI, similar concerns to yours have been expressed by Don Berwick, head of the Institute for Healthcare Improvement, an organization that has been quite influential in trying to promote quality improvement in healthcare.  Dr. Berwick was one of the contributing authors to "Crossing the Quality Chasm"  an Institute of Medicine publication that followed "To Err is Human" a publication which received lots of attention in the public and healthcare press with regard to its estimates of deaths due to medical errors. </x-tad-smaller>
> >

Wow!  A whole bunch of questions arose over this post of yours... One is; "How did he arrive at his estimates for the # of deaths due to medical errors???" I have a hunch that those numbers are just the tip of the iceberg. To tell you the truth, I think my father's death was one of those-- but it certainly isn't recorded as one. Cause of death is listed as "natural causes; end-stage diabetes". 

It's quite true that he was an "end-stage diabetic" whose kidneys had already failed. However,  there were two huge causative factors that in my view were directly involved in causing his death and both were generated by medical "care". The first was that his internist (who was new and she didn't know him that well yet) put him on Prozac for depression but she didn't follow up. He started developing what I called "Parkinson's Syndrome"-- it looked like Parkinson's Disease but it came on suddenly with a tremor in one hand a few weeks after beginning the Prozac, slowly worsening over the next few weeks until he was physically incapacitated-- couldn't walk even with a walker and that put him in the position of requiring medical assistance with his insulin/blood-sugar regulation... which, I believe, was what ultimately killed him. I had begun frantically researching Prozac when his muscles suddenly wouldn't support him at all and I learned that Prozac is known to cause this side effect in some people-- a fact his doctor apparentlydidn't  know-- because she said the symptoms were "probably the beginning of Parkinson's disease" (a diagnosis, incidentally, that really depressed the hell out of my father, on top of everything else he was dealing with-- dialysis and all that). I also found out that two other members of the extended Rosen family had the exact same experience with Prozac in years previous-- the first had very dramatic symptoms that included being wheelchair bound until someone thought to do some research and get them off the Prozac. The symptoms reversed in a matter of weeks, disappearing completely once the drug cleared the system. So, I had just arranged for a doctor's order to get Dad off the Prozac and told him to "hang in there, Dad..." to see if he had the same response to going off the drug...

But his insulin situation was an everyday requirement and his physiology was never what can be called "typical".  Every time he was ever in the hospital and the medical personnel were in charge of his blood sugar management, they always, without exception, put him in a coma. It never failed. It was always caught early enough to be reversed and then they would listen to him/me when we tried to describe why they had to deviate from textbook protocols when managing his diabetes. Well, in this case, it was only a couple of days that he was not able to do his own insulin shots and he didn't make it through the second night. They found him in the morning. He had an emergency button thing on a cord as a necklace, but if he woke up in the midst of an insulin reaction, he decided not to call for help. I can see that as a distinct possibility; He was very, very unhappy with his health situation, and the spectre of being wheelchair-bound (which would necessitate a move to a nursing home on top of everything) was probably enough to make him embrace the prospect of a lethal coma. That's if he woke up at all. It's more probable he died in his sleep. I didn't realize he wasn't doing his own insulin until a few days after he died, and I had arranged the cremation already-- it was too late by then. To be honest, I didn't really have the heart to launch an investigation or prosecute even if I'd known. And it would have been very hard to prove malpractice if it was possible at all. I was also 5 months pregnant with my third (and we already knew there was something significant going/gone wrong in the pregnancy) so I was scattered, I was grieving, and I was trying to hold myself and my family together.  Those were some very hard times.

In any case, I am sure that situations like this are rampant and the numbers of known or suspected accidental, medically-caused deaths are vastly underreported. 

Tom S. wrote:
> > <x-tad-smaller>One of the recommendations in "Crossing..." is that "purchasers, health care organizations, clinicians, and patients should work together to redesign healthcare processes in accordance with the following rules:</x-tad-smaller>
> >
>  
> <x-tad-smaller>1. Care based on continuous healing relationships</x-tad-smaller>
> <x-tad-smaller>2. Customization based on patient needs and values</x-tad-smaller>
> <x-tad-smaller>3. Patient as the source of control</x-tad-smaller>
> <x-tad-smaller>4. Shared knowledge and free flow of information</x-tad-smaller>
> <x-tad-smaller>5. Evidenced-based decisions</x-tad-smaller>
> <x-tad-smaller>6. Safety as a system property</x-tad-smaller>
> <x-tad-smaller>7. The need for tranparency</x-tad-smaller>
> <x-tad-smaller>8. Anticipation of needs</x-tad-smaller>
>

These are really fabulous. I was very pleasantly  surprised by such a comprehensive list, especially the fact that it was generated by a Physician who is very well-versed in modern medical care, etc. What a nice, hopeful sign! You made my day!

Judith


Web address: http://www.rosen-enterprises.com
BioTheory: An electronic journal of general science based on the Relational (Rosennean) Complexity Paradigm
On Oct 20, 2005, at 1:42 PM, Tom Staiger wrote:
> > >