Tuesday, March 4, 2008

On Greed and Medicine

"Clark County prosecutors said they were investigating a medical clinic accused of shoddy injection practices that exposed patients to potentially deadly infections."

What's going on in the world of medicine of late? I realize that every time the media catches wind of a story about (actual) medical malpractice it immediately becomes headline news--if not nationally, at least regionally. Also, I think that as professions go, doctors are the most ethically minded. But why does this ever happen? How can someone make such sacrifices to get through medical school and residency (supposedly to help their fellow man) and then become an utterly different person after they become full doctors? How does a doctor snap, or have "angel of death" doctors already snapped before medical school, and are simply good actors?

For those that don't want to spend a lot of time reading about the long and short of it, I'll summarize for you.

Within the past few days a story has broken in Las Vegas that a small practice in the city (Endoscopy Center of Southern Nevada) has been reusing syringes in order to save a buck or two. Workers at the clinic reportedly were told by the doctor in charge of the center to reuse supplies and medications in order to save money.

Here's an example: say I come in to have some procedure done that requires intravenous anesthesia. The nurse (or whomever) walks in and begins an IV by sticking a needle into one of my veins. Little do I know, but a few minutes/days/weeks ago, that very same needle was stuck into a patient who came in for HIV. Many years later, I now have been infected with HIV as a result of almost unbelievable choices by people that I have been indoctrinated to trust.

"This should never happen in contemporary health care organizations."

The one thing I will never understand is how someone can go through a minimum of four years of medical training and still take part in practices like this. Let's say for the sake of argument that the nurses and other staffers were told to reuse medical supplies to save money, and let's say that there were not any incentives given by the doctor relating to number of items reused (which are both accurate assumptions, given the data). How on earth can you, in good conscience, keep silent. Do not get me wrong, the doctor who was in charge deserves the lion share of the blame, I hope this disgusting act of greed puts him in jail for a long, long time. But why didn't anyone say something. It seems a sad commentary on the modern view of responsibility in this country when a handful of people can all go along with something they know for a fact is wrong and endangering patients.

Doctors are consistently ranked as the most respected and trusted of professions. And 99.999% of doctors spend every day earning that trust, but a seemingly increasing number of health professionals are being found out as betrayers of that trust. How will this change medical practice in America. Will patients be less apt to agree to necessary surgical procedures? Will nurses have to remove packaging of medical supplies in from of patients (this wouldn't surprise me if it was required in the near future)?

"Southern Nevada Health District officials said last week they traced six cases of hepatitis C to the clinic, including five people who were infected on the same day."

If this is accurate, then this is unbelievable. I don't know what the chances are of getting Hep C from a needle stick, but I've heard that the chances of getting HIV from a contaminated needle (from a needle stick, which I would assume is less dangerous than the practices described above) are something on the order of 1 in 300, at least among medical professionals who are accidentally stuck. Basically (although I am by no means an expert) this would seem to point to the fact that the needles were used tens, maybe even hundreds of times.


"We need to let them come up with what exactly is the problem. In the meantime, that place is closed."

I'll tell you what the problem is. Greed mixed with zero care for patients well being. There seems to be a spectrum in medicine, a spectrum that goes deeper than statistics like "patients per hour." On one hand you have doctors who are completely absorbed with the pursuit of money. On the other hand you have doctors who can truly say that they are not at all concerned about their income. To the former, I would ask the question, why not go into business, chances are you could make a lot more than in medicine (bunny trail: I think the answer is a formula: middle class/lower class smart student sees 7 years of work = almost guaranteed 100,000 dollars per year for life)

In truth, I think that most doctors fall somewhere in between. I'm on pace to rack up $160,000 of debt and someday I'm going to have a wife and family to support. It's through taking a reasonable look at finances that I am able to say, yes I can stick this out and someday I can pay off my loans and live very comfortably. Does that make me a selfish person--if I drive a new car every five years and live in a million dollar house while many in the world are starving, I think the answer is yes. How do we keep from sliding down the slippery slope into unmitigated greed and waste? If we could answer that question then maybe we could decrease the frequency of outright malpractice.

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