More on Ebola

1. Today, driving to work, I heard NPR’s report of how Facebook founder Mark Zuckerberg, and his wife, had a revelation that third world countries have poor sanitation facilities and this fact relates to the out of control Ebola epidemic in West Africa. This apparently occurred while Zuckerberg was traveling in India, and moved him to pledge $25 million for immediate use for public health work in West Africa. Right after that, NPR reported that world stock markets were falling as the business community realized that the Ebola crisis might affect their bottom lines. This is all good news. As I predicted earlier this week, as soon as the captains of industry who give our political “leaders” their marching orders, get concerned about losing money, there will be an intense effort to stem the spread of Ebola. Zuckerberg is young. He has been too busy making money and meeting with political leaders to know what the Third World looks like. Zuckerberg’s lack of knowledge about sanitation in the Third World is not surprising. I hope he was told not to shake anyone’s left hand there. For those of you who don’t know, the left hand is used instead of toilet paper.
2. Some comments about defensive medicine. It strikes me that what all the experts and population are calling for now is defensive medicine to stop and monitor Ebola. Things like checking lymphocyte counts daily in people exposed to Ebola victims and close monitoring of temperatures. “Defensive medicine” has been the pejorative term used by the business community and their lackeys in the press and legislatures to rail against lawyers who represent victims in malpractice actions against doctors and hospitals who don’t follow “protocols.” As in they didn’t follow the protocol or train nurses in the use of the proper protocol to treat Ebola and now the entire city is exposed. What the critics of current Ebola practices at Texas Health Presbyterian Hospital are calling for is “defensive medicine.” This brings to mind an observation taught to me by the late Harry Schwartz – economist and New York Times editorial page writer – that peoples’ concerns for health care costs are inversely proportional to how sick they are. And Mittler’s corollary: and how scared they are of the Ebola epidemic. When all you worry about is the common cold or indigestion, you think that all the public health measures and expensive specialists are frivolous (like all lawsuits) and a waste of your hard earned tax dollars, that could be better spent on Dallas Cowboy jerseys or dog sweaters. But when the Ebola virus threatens, people want daily blood tests, specialized treatment centers, a fleet of jets to transport victims, and hot and cold running infection disease specialists to save their lives.
3. Less is more: The mantra of so many medical journal editors, like Rita Redberg of JAMA Internal Medicine is that “less is more.” Greedy doctors doing too many unnecessary testing and the need for managed care executives to rein them in. How many medical journal editors are calling for HMO executives to take over the management of the Ebola crisis? The public wants the biggest experts and the best facilities money can buy? Take a poll: How many of you would trust Kaiser or Humana to run the national Ebola response team? Would that number approach zero or be zero? How many in the public trust Texas Health Presbyterian Hospital to run their Accountable Care Organization?
4. My impeccable source tells me that yesterday an elective heart valve replacement surgery was cancelled at Texas Health Presbyterian Hospital in Dallas due to reasons not explained to the patient.
5. This past Monday, 10 orthopedic surgeries were cancelled at one northside San Antonio hospital due to several operative room personnel not showing up. The doctor who told me about that could get no explanation as to why this happened. He was upset because one of his patients was already in the operating room holding area being prepped for surgery when the cancellations were announced. Do you think that hospital will “self-report” to the Texas regulatory agency that monitors hospital quality? You can be sure that if any surgeon cancelled at the last minute and that surgeon wasn’t a big hospital admitter, he or she would be hauled before a peer review committee. BTW, that won’t happen in this instance because most of the surgeries involved one surgeon who is a big Accountable Care Organization medical politician at that institution. So, patient inconvenience is the only fallout, and who cares about that?

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