Notes 5

These are notes linked to from other pages on this site


Linked to from medical information release

Creating a record
Usually, at the beginning of an appointment with a doctor, a nurse asks why you are there. What you tell her might not get written down accurately, especially if it contains information that is critical of someone else in medicine. A nurse would be unlikely to write down "patient believes Dr. SoAndSo removed the wrong organs."

Sometimes the only way to get information into the record is to write it down, hand it to them and ask for it to be included in the record. That can be regarded as confrontational and can undermine your ability to get diagnosed accurately, depending on how you present it and what the situation is.

It does not have to have that effect. It doesn't have to be the action of someone who doesn't trust them. It can be someone merely trying to be organized and involved in her or her own healthcare.

If the note is one sentence on a piece of paper small enough to be scotch taped into a chart, it can be an attempt to achieve order and thoughtfulness by a person trying to be proactive about healthcare.

This can backfire, but it also can be seen as being especially cooperative. For instance, if traveling to a new facility out-of-town, writing down and mailing information in advance (relevant concerns, medical history, opinions of previous doctors) can seem as being especially helpful. In addition, it is supposed to become part of the record. And successfully did become so for me, though not every time. Who is going to make them do it if they don't want to? (HIPPA laws have eroded the ability of patients to do this).

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Linked to from citizen oversight

They will resign themselves
I spoke to a member of a state house of representatives who raised his voice when vocalizing his complaints about events surrounding the death of a member of his family in a hospital. Yet he never filed a complaint with his state board. If medicine were sensitive to its patients, it would be alarmed and work to understand why, and to figure out how to remedy that in the future.

When people as intelligent and as civically involved as elected politicians do not file complaints, someone should be alarmed about why, unless deflecting and discouraging the filing of complaints is one of the ways that they deal with the load.

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It is discussed
Marie Dotseth of the Minnesota Department of Health reported to the National Summit on Medical Errors and Patient Safety Research that "if the current culture of secrecy within the medical profession fails to change, there will be problems with under-reporting in any mandatory reporting system, thus minimizing its effectiveness." She wrote that patients are dying needlessly due to a flawed system.

She also wrote that the dearth of research on patient safety leaves policymakers and other officials incapable of offering any definitive answers.

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Linked to from freedom of speech

Equal protection
The Fourteenth Amendment of the Constitution of the United States in its subtitle says "Guarantees of Due Process and Equal Protection of the Laws. . ."

We are supposed to have equal protection before the law. How is it equal to put a cap on the amount for which patients can sue, but not put a cap on the amount for which providers can sue?

The Wisconsin Supreme Court ruled that their state’s cap on pain and suffering awards in medical malpractice cases violates the equal protection guarantees of their state constitution. The United States Constitution's fourteenth amendment says that "no state shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States." How else can you define giving special protection to one group of people?

It also says that no state shall "deny to any person within its jurisdiction the equal protection of the laws." The amount for which you can sue your provider is so low that it is not worth a lawyer's time to file the suit. But there is no limit on the amount for which your doctor can sue you merely for telling someone what he did. He can disable you on purpose and you won't be able to sue him or warn anyone about him.

Doesn't seem equal, does it? Seems the oposite of what we need to make patients safe too.

In 2012 the Missouri Supreme Court struck down a $350,000 limit on jury awards for "pain and suffering" in medical malpractice cases, saying the law violates a patient's right to a jury trial.

Missouri's cap on malpractice awards was established by a 2005 state law that was championed by Republicans as part of a "tort reform" push.

In 2012 in a 4-3 decision, the court said the cap "infringes on the jury's constitutionally protected purpose of determining the amount of damages sustained by an injured party," in cases involving medical errors.

If the well-being of patients actually were the primary interest of caregivers, they would have lobbied for limits that protect patients rather than providers from suits. Victims of adverse events in medicine frequently are afraid to speak because they have been threatened with suits. Without knowing about those events there is no way to fix medicine. And no one in medicine reports them. You cannot fix problems you do not know about. Patients are the only ones who would make it possible to know about them, but patients are isolated and threatened and sued into silence (see freedom of speech for patients).

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<Truth/ Justice/ Patient Safety>

The Centers for Disease Control says that 99,000 Americans die each year as a result of infections that were caught in hospitals. That's more deaths than are caused by auto accidents, plane crashes and house fires combined. Wouldn't it be nice if hospital personnel were willing to report the how and why of the catching of these infections so that the problems causing them could be worked on?