Tag: Patient safety

Should Police Officers Be First Responders For 911 Medical Calls

Mental Illness vs Terrorism

These days medical problems are  morphing into “national security” risks.

Muslims with mental illness, who commit violent acts, are diagnosed as ‘terrorists’ and their mental illness ignored. Black people with mental illness, who are a threat to themselves, maybe suicide, are now being killed by first responder cops who feel threatened by their color and illness.

So as more medical problems are misdiagnosed as national security risks, negative health outcomes increase.

What do we physicians do to honor the oath of doing no harm? By permitting first responders to harm mentally ill patients, we abandon our oath and add to poor outcomes and the mounting expense of healthcare.

Aren’t we the gatekeepers of healthcare? Shouldn’t we intervene when harm is done by those who are supposed to transport and help keep our patients healthy?

{I believe} There are no official statistics on the number of deaths or injuries caused by first responders.

Given the current environment, where cops ‘shoot to kill’ suicidal patients and those with flare ups of their mental illness, isn’t it time we track such?

If the medical community remains silent and blind to these egregious deviations in the standard of care, we will herald in a new era of medicine where harm is normal. A situation where medical error is the number one leading cause of death instead of a close third.

Lack of responsible oversight or statistics on LEO (Law Enforcement Officer) encounters with patients experiencing flare ups, or severe mental illness, has put patients at risk for death and worsening of their mental and physical ailments.

Simple interventions can go a long way. Straightforward respectful communication, on the part of first responders, can go a long way to averting bad outcomes.

Unfortunately, in most cases with bad outcomes, communication is poor. Attempts to get family members or friends involved, to de-escalate the situation, are now rarely sought.

Why? Is it better to just kill these patients who are in need of help?

Cops are first responders in the healthcare delivery system and as such should attempt to do no harm at all cost.  They chose to be police officers and are paid well for the service they are hired to perform.

Has the principle of mental illness care changed such that death by first responders is a more cost effective mode? Has imprisonment become a more secure environment for patients with mental illness? Where have all the State mental hospitals gone?

These are all problematic questions. We have a rise in mental and physical illnesses with poorer medical outcomes. And are we planning to exclude these patients from government statistics to make our health outcomes sound better than they actually are?

Misdiagnosing those with severe mental illness as terrorists, or threats to police security, leads to an escalation in problems. More power and money spent on law enforcement and less on effective treatment that could improve health outcomes.

Over 55 cents of each dollar goes to the DoD instead of money spent to better understand and treat people with mental illness humanely. We could target effective approaches to treat and de-escalate flare-ups so common in patients with severe mental illness.

Much debate has gone into First and Second Amendment rights. Let’s now face in earnest the reality around us.  A reality for which we have no metric or indicator to guide us when police officers administer inappropriate first responder care. A reality that unnecessarily mislabels patients and does harm when patients are treated as criminals.

I leave the reader with this last question: Should Police Officers be first responders for 911  medical calls?

Leave me your answer in the comments…

 

 

Finding Work Using Social Media

Out with the traditional, in with the new!

With social media everything is hashtags, viz.

  • #Overseasjobs
  • #Freelance
  • #Healthcarejobs
  • #Jobseekers
  • #Patientsafety
  • #Medicalerrors
  • #Malpractice
  • # PatientAdvocates

Let’s see if any of them is worth ($ literally!) the effort.

So I decided to advertise my services through the social media.

If employers are truly seeking talent and not cronies, then why not give all qualified, skilled and talented people a chance?

Armed with my LinkedIn profile and the Buffer app, I took the non-traditional path to finding paid work.

This is my second day. So far no bites, but it’s too early to call it quits.

Follow me as I explore social media as a viable option for job seekers.

Please chime in with your experiences and suggestions. Appreciated!

Freelancer Looking For Opportunities

Angela Crane, MD

Are Hospitals Deadly For Your Health?

MEDICAL ERRORS

Going to the doctor may be deadly for your health!

Recently published findings show medical errors are the third leading cause of death in the USA.

Rising medical errors are symptomatic of our ageing community. A culture where health care providers are chronically overworked and understaffed. A culture where working while ill is a sign of strength, responsibility and dedication. A culture where most of the work done for patients is not reimbursable.

Such is the culture of health care that contributes to medical error despite advances in technology and knowledge.

In 2013 medical errors caused 440,000 deaths in the USA: [ http://www.hospitalsafetyscore.org/newsroom/display/hospitalerrors-thirdleading-causeofdeathinus-improvementstooslow ] Medical error, defined as [ https://en.m.wikipedia.org/wiki/Medical_error ],  appears to be on the rise.

In 1999, the publication ‘First Do No Harm’ [ https://www.healthdesign.org/chd/research/first-do-no-harm ] did much shine a light on fundamental problems in medicine. Each year, medication errors alone harm 1.5 million American patients.

Tired, overworked health care providers often dismiss patient’s problems and  become magnets for medical errors. The problem of fatigue contributes to high burn out and suicide rates among doctors: [ http://www.thehappymd.com/blog/physician-burnout-rates-top-50-percent-in-usa / http://www.ncbi.nlm.nih.gov/pubmed/24448053 / http://www.medscape.com/viewarticle/838437 ]

Also, with the billing for services rendered, health care providers perform many services that are not renumerated. Many of these services are essential to the patient and require much time. Services such as communication with other providers involved in that patient’s care.

Reviewing of old records, lab tests and X-rays are not billable. Even the refill of medications, or advocating for patients to insurance companies, are not reimbursing, despite their necessity and the fact that these are done daily. Often several times throughout the day.

Unlike lawyers, doctors do not bill on an hourly rate. They are compensated only for the time spent directly face-to-face in patient care. This underestimates the numbers of hours physicians and nurses spend caring for their patients.

Finding coverage for sick healthcare providers is difficult and often results in rescheduling of patients.  That means fitting patients in already booked and hectic physician schedules. Other contributors to medical errors  include lack of communication and access to information. Another is incompetence, plus poorly supervised residents and interns performing the work of senior doctors.

Many reprimanded physicians continue in practice. Eighty percent of malpractice, and adverse or sentinel events, are committed by 20% of physicians. 80/20. Yet only a fraction ever lose their license, and if they do, they simply go next door.

Medical personnel are treated as super humans, expected to go without sleep plus care for patients with complex medical problems. Medical errors are the end result of this. This finding is no surprise and nothing new since the publication of ‘First Do No Harm’.

A medical team is responsible for your care. An error by one person can cause catastrophic problems.

Lack of communication, and lack of access to information, are two. And lack of coordination makes three elements that contribute greatly to medical errors.

Errors will always occur, of course, but they will be much more likely when one is tired and there are no mechanisms in place to intercept errors.

Again unlike lawyers, doctors are not paid to call patients or to do research on patient problems. That needs to change.  We need to stop discounting the time doctors spend doing non-direct care.  Doctors should be compensated for all work done caring.

Just changes in the above will go a long way in reducing medical error.

To close, a very sad read of six physicians who felt so overwhelmed they took their own lives:

https://www.idealmedicalcare.org/blog/physician-suicide-letters-answered-a-sneak-peek-inside-my-new-book/

&nb

IT’S NOT ALWAYS DEPRESSION!

IT’S NOT ALWAYS DEPRESSION!

Diminished activity, fatigue, weight gain and little interest in activities that once brought delight.

With normal laboratory findings, most doctors would diagnose depression.

It’s not always depression!

Other physical ailments presenting similarly make the history and physical pertinent, as well as understanding culture and the differences in the clinical narrative due to culture.

To simply say it is depression, without a thorough review of all symptoms, is to jeopardize the health of patients. Plus not appreciate the impact of culture on health outcomes.

Unfortunately, nowadays, that is the case. Most doctors don’t dig deeper and many have forgotten the relevance of a good history and physical. The latter now relegated to cursory scope on the chest and back.

Such is the state of medicine today in the United States! I know because I have been a physician for all my career.

The above symptoms are actually due to visual problems. Mine!

Diminished vision can affect ones ability to function. Presenting similar to depression as well as leading to secondary complications of depression.

[ Link to Visual problems http://www.health.harvard.edu/newsletter_article/the-quirky-brain-how-depression-may-alter-visual-perception ]

By not recognizing the primary problem as visual, misdiagnosis and unnecessary medications follow, as well as deterioration in vision and functional capacity.

Unfortunately, the medical textbooks do not tell doctors this. Many lazily believe those symptoms signal depression until stated otherwise, despite the fact that depression is a diagnosis made after other illnesses are excluded. This is not done, hence the massive over-prescribing of antidepressants.

[ Link with data http://www.drugwatch.com/2015/07/29/drug-abuse-in-america/ ]

Patients typically tell their stories to non-doctors at least 2 to 4 times before they see an actual physician. (And in many poor communities patients will not visit or see their doctor.) Still the narrative and details charted rarely reflect the patient’s complaints, leading to misdiagnosis. Here repetition of the patient’s history does not breed knowledge or accuracy.

Why does this happen?

In a nutshell, over reliance on technology to make the diagnosis compounded by a bureaucratic and arcane workflow. Also treating symptoms while ignoring the root cause.

Medical staff are often under-trained and over-worked. The importance of accurate charting (of the patient’s narrative) lost in time, ignorance and even arrogance.

The end result is this: many patients are over medicated and misdiagnosed.

The recent epidemic of opioid overdoses is an example where doctors treat symptoms without making diagnoses. Opioids were over prescribed, especially in Emergency Departments where toothaches were routinely treated with Penicillin and 15-30 pills of Percoset. Doctors became legalized drug dealers! One study showed in 2012, doctors prescribed enough narcotics for every person in the United States to have a 30 day supply.

Now the pendulum has swung in the opposite direction: pain is treated suspiciously. Everyone is an addict until proven otherwise.

What is the solution?

One solution is Community Medicine. Studies demonstrate that medical outcomes, or health outcomes, are determined in the community.

Over 50% of outcomes are determined in the community. That means lifestyle or culture is very important as well as the environment (which actually has a great impact on lifestyle) to managing diseases. Genetics accounted for 30% of health outcomes and a doctor’s office visit 15%.

Using technology to facilitate accurate diagnosis is good, but technology should not be the gold standard alone for diagnosing. The history and physical still remain pertinent and relevant. The absence of radiographic or laboratory findings does not exclude pathology.

Most importantly, doctors need to know the patient’s community, and be engaged with that circle, to understand and improve the health outcomes of their patients.

What do you think?

Do you have any other solutions?

Police Violence: Use of Tasers For Walking


“A lawsuit has been filed on behalf of the family, including the 7 month old son, of 24 year old Gregory Towns, who died after being tased 13 times in 29 minutes. Two officers repeatedly shocked this man’s body for a total of 47 seconds… while unarmed and handcuffed.”


“Police found Towns sitting down and out of breath after a short foot chase. He asked officers at least ten times to be allowed to rest before going with them, according to AJC. The cops then decided to use their weapons as a cattle prod to force the weak man to walk, instead of just letting him catch his breath.”


“While we often ask “why didn’t that cop use a taser instead of his gun?”, it is important to remember that while a person is less likely to die from a taser shock than a gun shot, they are still a weapon, and still often unnecessary and lethal.”

Read more at http://thefreethoughtproject.com/man-dies-taser-13-times-cattle-prod/#Qk5v1TKX1JTpDtdM.99


Using tasers to hasten the arrest process for injured citizens who have difficulty breathing has no place in American medicine. I doubt the manufacturer of tasers would make such recommendations to any law enforcement official. There are no medical indications for tasers.

Someone who is having difficulty breathing needs an ambulance. Any fool knows that.

This is wrongful death due to the off-label use of tasers. The police did not act in accordance with standard practice or protocols for tasers.

“ Personnel should consider that exposure to the ECW [Taser]  for longer than 15 seconds (whether due to multiple applications or continuous cycling) may increase the risk of death or serious injury.”  (3)  

Police are not allowed to make medical decisions, yet they are (with uniformly poor outcomes) increasing fatalities and disability cases.

Systemic violence within law enforcement serves to compound the burgeoning unlawful, unethical, and inhumane actions that lead to physical and mental disorders. When a disorder is exploited by law enforcement for profit or abuse, it can only be described as an act of terrorism.

A public health emergency exists for people with depression, anxiety, PTSD, and Asperger syndrome. People with mental and developmental disorders may not understand commands screamed at them by an irate officer pointing a gun, and the wrong reaction could be fatal.

The medical community cannot stand by and watch patients slaughtered, knowing that they are at very high risk for police violence and its associated morbidity and mortality.

Gregory Town tasered to death

Related Stories:

1.  Aspergers Teens and Driving a Car

http://www.myaspergerschild.com/2011/07/aspergers-teens-and-driving-car.html

2.  How should police handle people with autism?

http://autism.voirici.net/?p=375

3.  TASER guidelines updated for first time since 2005

 http://www.policeone.com/police-products/less-lethal/TASER/articles/3590368-TASER-guidelines-updated-for-first-time-since-2005/

Doctors with Crystal Balls

Do they belong together?
Do they belong together? Doctors and Crystal Balls

Doctors with Crystal Balls

by Angela Grant

It is terrible to be a patient and not be heard. Terrible to be in need, and that need ignored. Apathy seems to rhyme with this culture of domineering minds. Men of medicine who lack skills of listening miss the story, miss the diagnosis. Still clueless, they dismiss you. If only those doctors saw the hidden gem: the art and science in the words of the history and physical findings.

Now I am left to float wandering aimlessly about because listening, even purchased, is never in vogue particularly when god almighty gave doctors crystal balls. Use it, use it now, tell me why I feel so ill; can’t move my foot at will. Waited I did, patiently for this important exam… I saw the male resident who knew immediately. Oh yes, and his senile, attending in the role of supervisor came in for a ride.   The resident had the latest technology crystal ball plus an attending  and training from the best of them all. To my chagrin, his faulty ball, customized for clueless idiots with malicious gall, dismissed my symptoms as unreal despite the physical findings: my inability to move a foot,  an important finding. When did medicine rely on crystal balls and unsupervised residents to make ‘the calls’?

Almost as if I have to learn to communicate anew, to make doctors understand the mind and the body can be one. A problem in the mind or body can cause pathology. Why did this problem occur? They did not help instead attempted to create another.  My real problem: Oh… it’s not your field; pass it on for another to add-on.   Incomplete diagnoses, only speculations, data based on the average. Have you not figured out that I, like most, am not the average? Why so many die from common treatable problems?   Millions, ignored, whilst you doctors with crystal balls create mental hysteria.

My Medical Journal All Medical Journal Posts & Videos 20131227-080027.jpg 20131227-080741.jpg

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aAngryBlackLady at the Inhumane and Harmful Care Received at Tufts Medical Center ED

Have you ever tweeted a story? I am going to try to tweet my 17 hours stay at Tufts Medical Center. The link will take you to my tweets #aAngryBlackLady

aAngryBlackLady

This is my story! My story about how multi-factorial –—age, race, ethnicity, gender, perceived alcoholism. perceived mental disorder, disability and racism resulted in discrimination and malpractice at Tufts Medical Center Emergency Department.

Data received from Tuft’s attorney exempt from public disclosure is shown.  I received nothing from the court nor did I sign any form agreeing to such terms; I do not feel bounded by them.  Moreover, why should their employees be protected and not me?  I received my medical records with  the names of the providers responsible for my lack of care in the ED redacted (crossed-out).  Why?   Clearly, they had reason to hide their names.

They LIED, and I did not know their identities until a month before an appeal hearing with MCAD.  The crew who laughed mockingly at me knew all my identifiers and I was not allowed to know the names of the people who abused me in the ED at Tuft Medical Center.

Are health care providers not required to show their identity ? Tufts Patient Bill of Rights stated clearly all employees are required to identify themselves.   Why was my medical records redacted to conceal the names of my medical providers?  

Conflicting Stories Between Boston EMS and Tufts Medical Center ED

The EMS run sheet is available  below.   EMS documentation directly conflicts Tufts Medical Center ED.

  EMS  obtained a history and performed a physical without  difficulty.  Yet  Tufts Medical Center  ED so-called professionals was unable.  The doctor and the nurse all lied stating they could not obtain a history  because I was allegedly “uncooperative.”   Then went on to fabricate   the usual  black stereotype history without knowing anything about me;  based solely on my color, gender,  age,  disability, medications and the fact that I stated I had a glass of wine which meant I was an alcoholic.

An Aside:  At no point in any corespondence did Tufts staff or any representative acknowledge or address me by my title, DR.   I  worked  over 20 years  in the EDs.  MY CV enclosed.  Also, in  Littler’s (Tufts Medical Center Attorney) letter,  I am not addressed or recognized as a physician.  As a matter of fact, the crew in the ED became sadistic when I finally told them I was ER physician and  hoped it would stop the brutality,  but it did not.

The LIE Exposed

Tufts Medical Center sworn legal documents state I was “shouting” racial slang.   How could I shout with shattered fractures on both sides of my jaw plus a dislocated of of my TMJ as well as a bleeding chin laceration.

Also, note that I am described as uncooperative, unruly, and belligerent.  This is inconsistent with the ability to start a hep lock after multiple sticks, draw at least 5-6 tubes of blood including a type and cross-match for urgent surgery.   Then send me to radiology where I was alone with the tech who performed  a Head CT, a C-Spine, and facial films without sedation or difficulty.   This is Impossible without sedation  or restraints.

There are other contradictory statements by Tufts Medical Center, none supported by EVIDENCE–a fact ignored by the State of MA, represented by MCAD.      More disturbing are the conflicts of interest and the lack of documentation or any investigation with a decision of insufficient evidence.

Had a full medical evaluation been performed in the ED as is routinely done, an admission to telemetry for syncope along with an EKG and a physical exam with a history would have detected my fatigue that day and recent onset of palpitations.  However the crew laughed when I tried to provide that history.  Then ignored me completely by leaving me alone without addressing my pain or wound.

Had I received appropriate  care, a second admission would have been spared:  A  hypertensive encephalopathy  with right sided weakness and aphasia.  Even asimple discharge instructions could have averted this second admission which left me with residual symptoms.   Discharge instructions that included holding   medications until PCP follow up, blood pressure monitoring and communication with my PCP or neurologist at MGH.

I received none of that. I experienced why minority women regardless of education or status have higher infancy death  rates than  all of women despite social  class.

 

 

#discrimination #malpractice #patientsafety #civilrights #patients  #hospitals #physicians

Littler Document

Failure-to-Listen-in-red.nice

Related Articles:

MY MCAD HEARING TODAY https://failuretolisten.com/2014/01/21/my-mcad-hearing-today/

LIES AND PERJURY: THE LITTLER DOCUMENT https://failuretolisten.com/2014/01/23/lies-and-perjury-the-littler-document/

WHICH CHART IS MY REAL CHART? https://failuretolisten.com/2014/01/16/which-chart-is-my-real-chart/

Link will take you to my twitter feeds —  start on October 31,  2013 (bottom up).

EMS run sheet: note bleeding and possible loss of consciousness
EMS run sheet: note bleeding and possible loss of consciousness Note no mention of being uncooperative. I walked from my apartment to the gurney outside the building. Also note the low blood sugar in the 50’s

image

Interesting, I could shout profanities with bilateral open fractures as well as a TMJ dislocation ,  all pointing to significant head trauma despite a normal CT scan and MRI.  I could not open my mouth, they couldn’t understand why, they figured I must be drunk and abusing my medications.   No one  entertained any other diagnoses.  No one re-evaluated  me during my 17-hour stay at the  Tufts Medical Center Emergency Department.    And I do not care what documents they forge or conjure!  But no one sees this but me…

 

They ignored me and when they didn’t, they laughed and made fun of me.  Unfortunately I could not identify the nurses nor the incompetent Indian doctor in a line up.   But their names are finally available to me after attempts by Tufts to deny me full medical records despite repeated request.  After over year late,  I received another record that was different from the first medical record as well as not inclusive of the first medical record.  The  following link is a video of me showing the difference in medical records.   https://failuretolisten.com/2014/01/16/which-chart-is-my-real-chart/

 

A power point will follow later next week along with more information on Littler’s relationship with senior management at MCAD.

 

Revised 1/03/2015