OT: What is essential during a pandemic?
My coworker shared a story that is a nightmare of our current reality.
Her daughter is a college senior who lives 1,000 miles away with her significant other. She spent Saturday in the ER with nausea, vomiting, fever, and lower right abdominal pain.
The ER lost her CT scan, and then sent her home with oral antibiotics. Apparently appendectomy is an "elective procedure."
This hospital has practically no COVID patients, but furloughed much of its staff because they have classified almost all medical visits and procedures as "elective."
After finding another hospital nearby (which managed not to lose her scan) she was again turned away. This is after being told that she would have gone into the OR a hundred out of a hundred times, if not for the pandemic.
She is doing okay now after a couple days of antibiotics. Maybe the doctors and hospital administrators made the right decision?
At the end of the day, I just don't know what is essential in this country anymore.
April 20th, 2020 at 11:02 PM ^
Water, Power, Food. Very little else is really essential.
April 20th, 2020 at 11:05 PM ^
As a lefty, I believe health care is a human right. Yet now, public health experts (in the US and around the world) have inadvertently taken away health care access to millions.
I've been drifting more left as I get older, but I can't understand the "health care is a human right" argument. It's something that requires specialized knowledge - which, itself, requires specialized schooling. Which, in turn, requires cost - someone pays for that schooling, in order to get paid for providing that service.
It doesn't matter whether you prefer single payer, private, or some combination of both (should we ever see good faith negotiation again). You don't need someone with specialized training to partake in free speech. You don't need someone with specialized training to shoot a gun. You don't need someone with specialized training to join religion.
But you must have someone with specialized training to receive decent medical care. I just don't see how this is a basic "human right". I mean, everyone has access to a shaman of some flavor, right? So that?
Health care shouldn't be available based on the blind luck of the circumstances you are born into. Which is essentially what we have right now.
https://www.who.int/mediacentre/news/statements/fundamental-human-right/en/
I think when people say that, they are not saying that it is not costly or even easy. They are saying that in a modern society, we should treat people who become ill, regardless of whether they can afford it. Especially so when considering the fact that many (not all) illnesses are not the fault of the patient (e.g., most forms of cancer).
The U.S. actually already does this, for the most part, just very inefficiently. For example, if you are sick and walk into an ER, you will (very likely) get treated. Why? Because many would deem it inhumane to turn away a sick person from a hospital, just because they couldn't pay for it.
I think your reading of the constitution (and bill of rights) is also a bit narrow, to be honest. For example, take the sixth amendment, which calls for (among other things) the "the right to a speedy and public trial". There is a lot of cost involved with running our entire judicial system. Should we give up on it, though, because it requires expertise and specialization?
They are saying that in a modern society, we should treat people who become ill, regardless of whether they can afford it.
That's not too far from the status quo in this country:
In 1986 Congress enacted the federal Emergency Medical Treatment and Active Labor Act (EMTALA) in response to a surge of “patient dumping” by hospitals that refused to treat individuals who were unable to pay for medical care. Under EMTALA, all hospitals that participate in Medicare and their physicians are duty bound to stabilize and provide medical screening examinations for each patient who comes to the facility for emergency care, regardless of the patient’s ability to pay.
https://journalofethics.ama-assn.org/article/obligation-provide-services-physician-public-defender-comparison/2006-05
If people want to talk about expanding that to nonemergent situations, that's one thing but you need to be clear in the language you use if you want to be taken seriously.
A much more pressing issue is people who are "too rich" to get medicare type coverage but "too poor" to cover the huge out of pocket that some policies require leading to ruin after an episode of poor health.
I do well and have pretty decent health insurance (though my UM insurance was a lot better) but I pay about $1200 a month on top of whatever my employer pays AND THEN my out of pocket, which I always hit, is around $2000. Nearly 10% of my pre-tax income is spent on healthcare every single year.
This is a fair reply... And I do agree that all people should be treated if they become ill. I took the OP statement at face value (from my POV) - as saying that everyone should be given health insurance as a human right. Perhaps that was my mistake in looking at it? Probably so...
Yeah, our health care system is horribly inefficient. There are so many ways it could be improved, but I'm not sure there are many ways left in how it can be made more complicated or opened to institutional fraud. Ahh, who am I kidding? I'm sure some people can always come up with new ways of cheating the 'system'... But this is a very different conversation.
FWIW, I don't really keep an opinion about they type of health system we have. I'm good with the way it is - a mix of private and public insurances. I'd also be good with single payer. I do not think fully private is workable - far too many would never see a doctor. Ever. The big problem is that nobody will perform an honest negotiation to affect meaningful change. The ACA was rammed through - barely - by a House and Senate both Dem owned, with a Dem President. Today's Legislature wouldn't even hold a conversation on the subject! IMO, the whole focus on single payer crap with the Dem Primaries was nothing more than an ideological exercise in futility, and a gigantic waste of time. With the current state of 'negotiating' between the parties, any effective legislation of health care (or guns, or anything else) is off the table.
Care to define "rammed through" as regards to the passage of the ACA?
https://www.snopes.com/fact-check/aca-versus-ahca/
April 21st, 2020 at 10:41 AM ^
"The ACA was rammed through - barely - by a House and Senate both Dem owned, with a Dem President."
I'm not sure why you're asking that question - you can just read what I typed, rather than what you want to read. What you want to see gives you cause for argument. What I actually wrote does not... The approval votes were very close, and along strict party lines. Had Congress been split, or the President from a different party, the ACA would not have become law.
In fact, the entire paragraph I wrote said - or intimated - NOTHING about secrecy, which is the only point of your Snopes link. Stop trying to pick a fight where there is none. (BTW, I happen to think the ACA has been good, and that GOP attempts to neuter it are foolish and vindictive - despite that my private insurance costs have gone up while its quality has gone down.)
Especially so when considering the fact that many (not all) illnesses are not the fault of the patient (e.g., most forms of cancer).
I strongly disagree with this statement. Not all, but many, if not most illnesses are the fault of the patient. Don’t wear your seatbelt, drive too fast or while intoxicated, smoke, vape, drink to excess, eat yourself obese and consume harmful foods (meat, dairy, eggs, fat, oily, etc) and you are contributing to your own ill health.
Type 2 diabetes is reversible with proper diet (no drugs needed). Most heart disease and many cancers are food related. How many people needing knee or hip replacement surgery have been carrying around and extra 30-50 pounds most of their lives?
I'm sure you have a copious number of links to peer-reviewed academic papers backing up all of these claims, right? Please, share those with us so we can all have the benefit of your greater knowledge.
April 21st, 2020 at 10:37 AM ^
Yes, Dr. Gregor (How Not To Die) is a great starting point. Also, he could google Marc Ramirez (former Michigan linebacker) and read about his family’s history of Type 2 diabetes.
April 21st, 2020 at 11:45 AM ^
I think you are overlooking that diet and lifestyle have a lot to do with economic advantage. But setting that aside, what's your suggestion for folks with Alzheimers, Type 1 Diabetes, Multiple Sclerosis, Rheumatoid Arthritis, Parkinsons, Lupus...? Diet change? If you don't have health insurance, being diagnosed with one of these is frequently a sentence to both rationed/inadequate care and bankruptcy.
I saw an interesting podcast with Joe Rogan where he interviewed a guy who wrote a book on living with traditional Native American tribes. I can't remember his name, but I'll try to locate it. He found many never wanted to return. His loose theory is that humans evolved to be social in order to overcome the challenges of a hunter/gatherer society, ie to find food, create shelters, give birth to the next generation, etc. Going through these challenges forces those in a group to work together and help one another for the group to survive. Meaning, the challenges of survival have value to the ability to have a cohesive community. However, the more successful our current society becomes, the less people need one another to survive and the more selfish people become. Without worry of survival people have the freedom to worry about things like money in their accounts and nicer stuff. This creates anxiety, depression, and a lost sense of community. It basically makes us unhappy. Even with the lack of modern healthcare, nice cars, and big houses, they found themselves happier. They felt a part of a community that gave to others and didn't have the opportunity to always put themselves first and realized that was a preferable way to live. IDK, just made me think of that. Maybe there are benefits to not having a system that encourages individuality, competitiveness amongst each other, and personal gain above the good of the group.
April 21st, 2020 at 10:13 AM ^
That touches on a change I'm hopeful will be brought on by this event; we need to completely re-evaluate how we live and function as a society. We put priority on the exact wrong things, for the benefit of a very few at the top. We have all been lied to, and brainwashed since birth. It's a huge problem.
April 21st, 2020 at 10:53 AM ^
Interesting stuff, that seems to make a lot of sense. I would be interested in the name if you are able to find it.
Sebastian Junger. Here's the link to the Rogan podcast episode with him
https://www.youtube.com/watch?v=R04K0jLMZ1Y
I'm not sure if this is what you're getting at but it reminds me of EMpire of the Summer Moon about Quanah Parker and Comanches. It's one of my favorite books and I highly recommend it. The Western classic "The Searchers" is based on the story of Quanah Parker's mother - a white girl who was captured by the Comanches as a child and grew up among them.
But, the author mentions a similar phenomenon - when Comanches and other Native American tribes defeated an opposing tribe or a group of settlers in battle they would often take children, teenagers and occasionally some adults as prisoners (they usually killed the men and young babies). The Native Americans would treat them as slaves for the most part but eventually the captives would become part of the tribe and the community, And in many cases - when the captives encountered rescue squads who were looking for them - they did not want to go back to white colonial/American society and often refused to go.
There's tons of other fascinating things in that book as well.
April 21st, 2020 at 12:52 AM ^
Power is not essential. Humans survived for thousands of years without electricity.
Who said anything about electricity!?
You know I shun fancy things like electricity
Power is needed for water in out infrastructure
Stop it. Suggesting that modern society could continue unaffected without electricity because previous humans cultures did is a myopic argument. Essential in the context of this argument has to mean more than just food, water, and air. The social order is only maintained as long as the basic status quo is maintained, and that includes things like electricity and heat and indoor plumbing.
That's not what essential means.
"I like my air conditioning but don't like going to work so power is essential but going to work is not" is a looney tunes argument.
If maintaining the social order is essential, then keeping businesses open so that we don't put 20 million people out of work is essential.
This is exactly what happens in America when you do not practice fast food medicine.
April 20th, 2020 at 11:07 PM ^
your coworker's daughter's life is essential. the hospitals were wrong, very wrong. they take an oath that in essence means to do no wrong. what they did was clearly wrong. [insert a political leader you don't like] was wrong to order/organize/scare/create the conditions that made that happen.
April 21st, 2020 at 12:26 AM ^
The medical experts below have weighed in. It seems, like everything in life, it's not "clearly wrong" but instead nuanced and complicated to assess.
Many of our experts are trying to do their best on a population level, but any decision will lead to suffering for many individuals.
April 21st, 2020 at 12:31 AM ^
and i agree with the comments in general that surgery isn't always the right thing, but wouldn't the minimum standard still be observation and likely admittance to the hospital, even if the surgery go-no-go decision was delayed some?
April 21st, 2020 at 12:57 AM ^
No, unfortunately that might be the worst decision. Hospitals are where germs go to find a new home. If she's already sick, leaving her in a room, near other sick patients may make things infinitely worse.
Trust the doctors - that's why they pay for the expensive malpractice insurance (and why they go through so much schooling/training, but harder to break the dour mood with that). Sometimes appendectomy is the "easy" "cure" but if two different hospitals said, "it's just infected, it doesn't _NEED_ to come out", well, the odds are they won't both get it wrong. Could they? Of course, nothing is absolute, but the odds are that two different sets of doctors who say the same thing completely independently are probably right.
Awesome!
I'll show this post to my wife who was supposed to have surgery on April 10 to fix a very painful and debilitating quality of life issue and it got cancelled.
I'll also remember your post when I'm trying to comfort her every night at 2-3 AM when she wakes up in excruciating pain and ends up crying herself back to sleep absolutely exhausted.
We'll also remember your post for when she does get to have her surgery, it will likely be more complicated as her condition will have deteriorated since the original date of the surgery.
Yes -- trust the doctors and politicians!
I have some pretty sweet painkillers I can spare.
Just putting that out there.
That's what she was offered but didn't want it to become habit forming so told em no.
There are some powerful pain killers that are not habit forming. But many of them take a while to be effective and have other side effects.
Tough life lesson you are learning. Life isn't fair.
Other things are taking a priority in our hospitals.
We can't pacify everyone during this time, there will be people who suffer.
Only those with the right connections will have the ability to bypass the new rules set in place.
This is truly survival of the fittest, we can't save everyone.
April 21st, 2020 at 10:03 AM ^
Other things are taking a priority in our hospitals.
This is the part that is confusing me. They don’t need the operating room for C-19 patients, they don’t need the surgical teams for C-19 (many hospitals are laying them off) and I guess they don’t need the beds since they just closed a Beaumont hospital in Michigan and have very few patients in the two field hospitals that the military just built. I guess it must be the shortage of PPE.
I think it’s time for our leaders to take another look at the “no nonessential procedures “ ban, at least on a county by county basis.
April 23rd, 2020 at 10:42 PM ^
I don't trust politicians, and I'm comfortable thinking - as mentioned above, that the doctors would have preferred to remove it, but were stopped by politicians.
I'm not saying that the call to leave her sick was the clear right one - I'd prefer the hospitals make these decisions. Will some get it right and some get it wrong? Yep, but some countries are getting things right and some wrong. It's easy in retrospect to point blame, Hatter's a pro at it.
All my post was trying to imply is that the doctors made the BEST call they could out of field of bad choices. I have to trust them, if you stop trusting them then your wife never has the surgery even after normality returns, congratulations, you've sentenced her to live the rest of her life in agony. Yay for whining on MGoBlog instead of finding ways to help her pain issues....
April 20th, 2020 at 11:08 PM ^
They should have treated her
April 20th, 2020 at 11:11 PM ^
Be interested to see what the mgoblog MDs have to say, but there is a fair amount of literature that suggests many appendectomies are not neccesary.
https://www.statnews.com/2018/09/25/appendicitis-antibiotics-surgery-often-not-needed/
If antibiotics treated the problem, isn’t it a good thing she didn’t have to have surgery?
April 20th, 2020 at 11:15 PM ^
As a non-practicing MD with minimal surgery knowledge, this is very interesting. It would be fascinating to see what paradigms of medicine are challenged and changed by circumstance during this period.
April 20th, 2020 at 11:25 PM ^
I had an appendectomy 18 years ago. In my follow-up appointment the dr actually suggested to me that in retrospect they were overly aggressive and probably didn’t need to take it out. That is actually the reason I googled to check it out. I was wondering if mine was an isolated case or pretty common. Unfortunately as a patient, once you are in the ER, it becomes really difficult to question the treatment being recomended.
April 20th, 2020 at 11:31 PM ^
My sister dodged an appendectomy with antibiotics.
There are significant risks with any surgery, so if the condition is treatable without cutting me open, don't cut me open.
Had the thing burst, they would have taken it out, regardless of the rona situation.
April 20th, 2020 at 11:59 PM ^
Speaking as someone in the medical field:
This is exactly what would happen. Appendicitis is more often than not treated through surgery because it could get worse and if the appendix bursts it can cause sepsis (bacterial infection throughout the body; very bad). However, if current tests indicate that it is not likely to burst because it is mild/uncomplicated, then antibiotics is a good way to treat it. That still comes with risks though as some people don’t respond to antibiotics or they can have recurrent appendicitis.
In the current climate, if her case became worse, she would have been taken for surgery. Hospitals are trying to minimize procedures that don’t need to happen right now because they want all supplies and resources dedicated to addressing corona. Once that is taken care of, there is still going to be a huge backlog of elective surgeries and it will take a while for the health care system to catch up.
That happened to me in the fall of 2003. I got the abdominal pain / fever / nausea, and my doctor suspected appendicitis. But having no medical insurance, we had to try the antibiotics route. A month later my appendix ruptured, causing such severe abdominal pain that I doubled over while driving to work, and passed out when I got home. When I came to two hours later, I called my doctor, he ordered me to go to Beaumont, and they performed an emergency appendectomy.
I was in the hospital for almost six days so that the infection could clear up. The doctor told me later that if they had been able to operate in a non-emergency situation, I could have been home in a couple of days. I know I would have preferred that.
April 21st, 2020 at 12:03 AM ^
This is true. I guess it's just the lack of choice here.
My understanding is that, as an individual, you would much rather have an operation on a non-emergent appendicitis than take antibiotics, have it recur, burst, and operate then. It looks like the studies are showing that may happen in a higher percent of cases than the risk of dying from rona.
April 21st, 2020 at 12:25 AM ^
you are the MD here, but wouldn't the normal procedure to have been to at least observe her for X hours there at the hospital and perform further tests, if not actually admit her even if they didn't make the operation decision right away? that would seem to be the minimum standard which they didn't meet, even if the surgery decision was correctly suspended pending further results and evidence - what do you think tai?
April 21st, 2020 at 12:29 AM ^
I left residency during my intern year. It's been 3 years since then. I'm an MD in name only. Landed very solidly on my feet, but still on my journey to find the right career for me.
I don't know the specifics of 1) if it were to burst despite abx, how long would that take (days, weeks, months, years?) or 2) what are odds that it will burst? or 3) is sending them home on abx standard of care?
To be clear, in the study you linked elsewhere in this thread, complications related to delaying treatment to try antibiotics first happened in a grand total of 0 cases. So it doesn't seem that studies are showing what you say they're showing, Doc.
April 20th, 2020 at 11:34 PM ^
Infant IHR is also mostly unnecessary. Maybe we will find that out for real now.
April 20th, 2020 at 11:14 PM ^
I can’t speak to this exact circumstance, but it’s not so clear cut about how necessary appendectomy truly is in certain situations.