nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Thursday, November 1, 2007


Senators suggest creating federal agency to fight MRSA.

ABC World News (10/31, story 10, 2:45, Gibson) reported, "On Capitol Hill today, senators proposed creating a federal office to battle" MRSA. "There's been alarm across the nation since health officials announced two weeks ago that more people were dying from MRSA than from AIDS." During a Congressional hearing, Sen. Orrin Hatch (R-Utah) said that MRSA is "[a] public health issue that should scare everyone, each one of us in this country."

Doc D: this is very interesting. I agree that drug-resistant infections are a problem that requires attention, but remember the original article that said 19K people died of “all” drug resistant infections (not just MRSA)? Let’s assume that there is under-reporting of these infections and deaths, as some media have suggested, and adjust the figures upward by 50%. So now we have 27.5K deaths. This is still a very low number. By comparison there were 60K deaths from influenza in the most recent year for which there are data, and death rates from drug-resistant infections don’t even appear on the list of significant causes of death. But we’ve got a nationwide panic going on, with everything from schools, private gyms, restaurants, and other gathering places being shut down to be scrubbed. Bacteria, some pathogenic, are ever-present in everything we touch or come into contact with…but there has to be a source: and that source is a person. So, I say scrub away…the first student carrier will re-populate the school’s bacterial fauna within days. If we put this much effort into more fruitful endeavors like ensuring universal immunization, we would save about ten times as many lives.

If you want to do something useful, teach your kids to wash their hands, especially after coming into contact with “public” surfaces, or before eating. And practice what you preach. This interrupts the chain of transmission, and reduces the spread. And, remember that hospitals are where the sick people are, and where the bad germs get concentrated.

Oh, and the “more than AIDS” comment. Remember when predictions were that most of country would get AIDS? Actually, our treatment of the disease has improved so much that most people don’t die like they did in the early years. Survival rates of 10-20 years are becoming common., and there’s actually a sub-population of AIDS victims, who are under intense study, whose disease never seems to progress.

Like the “bomb” in the fifties, we appear to need a deep-seated fear of the unknown to target our anxieties. There’s a fascinating psychological element to this whole story.

Physicians less likely to accept responsibility for errors if liability threats loom.

In the Wall Street Journal's (10/31) Health Blog, Jacob Goldstein wrote, "The 21st century doctor is supposed to be all about transparency, but legal liability, that seemingly eternal bugbear, continues to weigh on the profession." Recently, there has been much discussion about the benefits of physicians admitting their errors and apologizing to patients. Patients feel validated, and typically accept much smaller settlements as part of the process. Currently, Massachusetts is considering legislation which states that "if a doctor apologizes to a patient and admits making a mistake, the statements couldn't be used in court." Other states have already adopted similar legislation. However, "not everybody's on board, especially the lawyers," notes the Journal. They argue that physicians "should be held responsible" if they "cause harm." While many advocate "full disclosure," Massachusetts physicians maintain that "if the threat of liability remains," most healthcare providers will not admit to errors.

Doc D: I’ve always had mixed feelings about this. I’ve had patients that I developed a trust with, and who trusted me, that I wouldn’t hesitate to say I had made a mistake. There are others who brought an attitude to the doctor-patient relationship that made me wary of them: some were resentful of the “power” over them they thought I had, or didn’t like needing to seek help, or had had bad experiences in the past (real or imagined). Sometimes it was just a personal thing: mutual dislike (although we get trained to disregard personal feelings, you can’t totally ignore a gut reaction). This latter group I was very careful with, not to give them an opening they could take advantage of. It’s a shame that medicine has to be practiced so defensively…when people complain that their doctor doesn’t engage with them, or is impersonal, it’s my guess that this is what’s going on.

My advice is, find a doctor you can work with, develop mutual trust. If a diagnosis or treatment doesn’t make sense, be forthright with needing an explanation. But be wary of any doctor who always just does what you want them to: they won’t stand up to you when you’re wrong.

As always, opinions are my own.


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