An EP's Dim View of Medical Advances

[docB]

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Is it just me? I basically view dialysis as a way to die slightly slower. I think gastric bypass is an outlet for people to commit suicide by surgeon. Ditto organ transplantation. I know that I have these attitudes because I only see the complication riddled treatment failures that come to the ER. Is this me only?

 

[fuegorama]

G-tube in a late-late-late stage 80 sumthin' y.o. Alzheimers patient. As a nurse in the facility where this "medical care " occurred, I queried the attending surgeon as to reasons. The classic reply, "I was put here by God to extend life".

There is a special circle of hell waiting for that one.

 

[Apollyon]

Is it just me? I basically view dialysis as a way to die slightly slower. I think gastric bypass is an outlet for people to commit suicide by surgeon. Ditto organ transplantation. I know that I have these attitudes because I only see the complication riddled treatment failures that come to the ER. Is this me only?

I was thinking about this last week - we see the ones going down in flames, but there are a bunch more that are living at home, that we don't see. But then, I thought about the ones that are staying at home, and how many of them probably have hellish lives.

But, when I was a student, I met a doc who was the first to show that you could live for 40+ years on dialysis. Now, where I'm at, we have a guy that is a dialysis patient who comes to the ED as a social event. He's there so frequently, one attending introduced him to her husband when they passed each other in the hall.

The transplanted people I see as miracles - and I've given up on a lot of humanity.

 

[WilcoWorld]

The classic reply, "I was put here by God to extend life". QUOTE]

Is this a common view? I should hope not. It seems to me that certain measures taken to extend life miss the point of, "First, do no harm."

As for transplants & gastric bypass; certain transplants are tremendously sucessful & bypass has cured diabetes in & returned dignity to some people who had lost all hope. There are miserable failures also, but couldn't the same be said for the treatment of strep throat with penicillin? (anaphylactic shock)

That being said, I do find certain academic endeavors to resemble cruel & unusual punishment more than they resemble science & compassion.

 

[roja]

G-tube in a late-late-late stage 80 sumthin' y.o. Alzheimers patient. As a nurse in the facility where this "medical care " occurred, I queried the attending surgeon as to reasons. The classic reply, "I was put here by God to extend life".

There is a special circle of hell waiting for that one.

very very special. Perfereably one with lots of tubes coming out of that one.



I actually had a patient come in for detox a while back. she had started binge drinking a year ago after having a gastric bypass and losing a bunch of weight. She was having a hard time coping with the weight loss.

 

[flighterdoc]

very very special. Perfereably one with lots of tubes coming out of that one.



I actually had a patient come in for detox a while back. she had started binge drinking a year ago after having a gastric bypass and losing a bunch of weight. She was having a hard time coping with the weight loss.

I had a similar exchange - my reply was "I hope you're afforded just as much care when you need it".

 

[dlung]

Hmm. sounds like there's a few public health converts in the making...

Here's a fun fact: With the exception of antibiotics, every major improvement in life expectancy in the past century (ie increases scale of years and decades, not fractions of years) has been due to public health interventions -- public works, nutrition, immunizations, etc.

 

[DrQuinn]

I had a 72 year old gastric bypass patient a few days ago... she had the surgery done a year ago and is now having complications.

She was 71, with NO comorbid diseases! Weighed ~ 250 pounds. She has fake breasts and tattooed eyeliner or makeup or whatever. Now she's dealing with these horrible complications from the bypass surgery that I dont' think she ever needed. Who would do surgery on a 70 year old obese patient with NO comorbid disease, and an obvious fetish for permanent surgery? Ugh.

Q

 

[FoughtFyr]

Hmm. sounds like there's a few public health converts in the making...

Here's a fun fact: With the exception of antibiotics, every major improvement in life expectancy in the past century (ie increases scale of years and decades, not fractions of years) has been due to public health interventions -- public works, nutrition, immunizations, etc.

Hey don't leave out the public health in EM advances! The best, altough not often thought of, is primary prevention in motor vehicle crash trauma (seat belts, air bags, traffic barriers, traffic planning, and good ol EMS - which, I know, is secondary prevention!)

Am I the only geek here who read "Death on the Highways" (the congressional white paper form the 70's that helped create EMS)?

- H

 

[Febrifuge]

Dunno, but if somebody could rustle up a link, you would not be the only one to read it--

[Feb does a quick Google search]

There is also something called "Accidental Death and Disability: The Neglected Disease of Modern Society," and it came out in 1966 from the National Academy of Sciences. It's available (for purchase, I guess) here: http://www.nap.edu/catalog/9978.html

Lame. I want free stuff! Anybody better at this (or have more time than I do right now)?

 

[margaritaboy]

I have been made a serious believer in the seat belt. I am convinced that there are few preventative measures one can take in life that pay the dividends that a seatbelt does in an MVA.

Hey DocB, here is a patient that may give you hope, and also one that you and I are unlikely to see in our EM practices: My father had a kidney transplant and is working, self-sufficient, contributing to society etc. Some medicine has turned out OK. Though I hear what you are saying 100%, try to remember the patients whom you will seldomly see, but give some medical interventions a good name.

 

[WilcoWorld]

Hmm. sounds like there's a few public health converts in the making...

Here's a fun fact: With the exception of antibiotics, every major improvement in life expectancy in the past century (ie increases scale of years and decades, not fractions of years) has been due to public health interventions -- public works, nutrition, immunizations, etc.

No doubt, the impact of Public Health is of great importance. However, I think that this statistic is misleading at worst, a non-conclusion at best. I mean, is it any surprise that the interventions that are applied on the largest scale will have the largest impact? It comes as no shock to me that immunizing millions saves more lives than does surgery on hundreds, or even thousands.

 

[DocM]

Hmm. sounds like there's a few public health converts in the making...

Here's a fun fact: With the exception of antibiotics, every major improvement in life expectancy in the past century (ie increases scale of years and decades, not fractions of years) has been due to public health interventions -- public works, nutrition, immunizations, etc.

Very true. Unfortunately the good that has been done by public health has been down played, practically ingnored. Clamping aorta's and organ tx's are more glamorous.

 

[dlung]

No doubt, the impact of Public Health is of great importance. However, I think that this statistic is misleading at worst, a non-conclusion at best. I mean, is it any surprise that the interventions that are applied on the largest scale will have the largest impact? It comes as no shock to me that immunizing millions saves more lives than does surgery on hundreds, or even thousands.

Good observation. However, I think your conclusion supports my point. This illustrates the disparity in cost-effectiveness between public health/preventive medicine interventions and acute therapeutics. With the same money, I would argue that a community would gain more quality life years by hundreds/thousands of immunizations vs a single CABG + f/u care.

More rudimentry examples. On the micro-level, I'd rather spend the money on targeted nationwide flu vaccines vs the tens of thousands of cases influenza pneumonia. Or, as already mentioned, how about good BP and DM control vs decades of dialysis? On the macro-level, this should cause some consideration of where government and grant funding goes -- if it's distributed appropriately or not.

This is great stuff -- tons of really touchy subjects to argue about. 😀

But this is tough. There are some really hard health care policy decisions to be made in the future when the feces finally hits the fan.

 

[flighterdoc]

Hmm. sounds like there's a few public health converts in the making...

Here's a fun fact: With the exception of antibiotics, every major improvement in life expectancy in the past century (ie increases scale of years and decades, not fractions of years) has been due to public health interventions -- public works, nutrition, immunizations, etc.

The biggest impact on overall health has been a) garbage collection b) waste collection and treatment (sewers) and c) clean water supplies. The rest is noise overall.

So, any automotive (garbage truck) or civil engineering converts? LOL

 

[flighterdoc]

No doubt, the impact of Public Health is of great importance. However, I think that this statistic is misleading at worst, a non-conclusion at best. I mean, is it any surprise that the interventions that are applied on the largest scale will have the largest impact? It comes as no shock to me that immunizing millions saves more lives than does surgery on hundreds, or even thousands.

And the cost of immunization programs is really, amazingly low. I've been on a couple of (secular) medical missionary expeditions to Africa and S. America where we would offer DPT and polio vaccinations at a cost of about a buck a person (with donated labor). We'd go and spend a plesant days work in a villiage somewhere, innoculate 400-500 people (and by doing so, saving the lives of 8-10 at LEAST), for a very nominal cost.

 

[MoosePilot]

Is it just me? I basically view dialysis as a way to die slightly slower. I think gastric bypass is an outlet for people to commit suicide by surgeon. Ditto organ transplantation. I know that I have these attitudes because I only see the complication riddled treatment failures that come to the ER. Is this me only?

Ok, I've got some perspective on this as the husband to one heart transplant patient and the son-in-law of another. Both passed away in the last year, unfortunately.

Both of my family members would have died within months of their transplant if they hadn't gotten them. My father-in-law got 12 additional years of life. They were relatively healthy years, too. He got to see his daughter married, graduate from college, see me commission, and get my pilot wings. My wife had problems with her first transplant. She was in and out of the hospital for some of the time. She had to have a second transplant and after that she had some steroid-induced myopathy and was in a wheel chair for awhile. Once she got out of the wheel chair, her main problem was migraines. She finally got those cleared up this summer and was very happy with few to no health problems for the last few months of her life. I told her once recently that she was very strong and I don't think I could do what she did. She told me she didn't think that was really the case, but that she didn't have a choice and the extra time was worth it, no matter what the negatives. She got an extra 6 years. For us that was enough to take us from 4 years of marriage to 10. They were good years. I know it's a huge cost for one small outcome, but to those who are part of it, it's very, very special.

So you see the downside exclusively. Remember the extra time and what that can mean to a family. My take away lesson is that transplants should be a definite last resort, but once you reach that last resort they're a wonderful thing.

 

[fuegorama]

So you see the downside exclusively. Remember the extra time and what that can mean to a family. My take away lesson is that transplants should be a definite last resort, but once you reach that last resort they're a wonderful thing.

I'm in the middle of a pulmonary disease block. It's basically a daily dose of crappy, progressive rides to death.

Mixed with a past career in seeing the end-stage of many of these monster diseases, I can definitely see a fatalistic spiral in the making.

Thanks for your post. It's a great to hear a "modern-miracle" beneficiary's perspective.

 

[Neuron]

Ok, I've got some perspective on this as the husband to one heart transplant patient and the son-in-law of another. Both passed away in the last year, unfortunately.

Both of my family members would have died within months of their transplant if they hadn't gotten them. My father-in-law got 12 additional years of life. They were relatively healthy years, too. He got to see his daughter married, graduate from college, see me commission, and get my pilot wings. My wife had problems with her first transplant. She was in and out of the hospital for some of the time. She had to have a second transplant and after that she had some steroid-induced myopathy and was in a wheel chair for awhile. Once she got out of the wheel chair, her main problem was migraines. She finally got those cleared up this summer and was very happy with few to no health problems for the last few months of her life. I told her once recently that she was very strong and I don't think I could do what she did. She told me she didn't think that was really the case, but that she didn't have a choice and the extra time was worth it, no matter what the negatives. She got an extra 6 years. For us that was enough to take us from 4 years of marriage to 10. They were good years. I know it's a huge cost for one small outcome, but to those who are part of it, it's very, very special.

So you see the downside exclusively. Remember the extra time and what that can mean to a family. My take away lesson is that transplants should be a definite last resort, but once you reach that last resort they're a wonderful thing.

Moose, I'm sorry for your loss. Thanks for sharing.

 

[Sessamoid]

Is it just me? I basically view dialysis as a way to die slightly slower.

We definitely get a skewed view. We see the disasters and non-complliant patients almost exclusively. My grandmother was on dialysis for years waiting for a kidney. It's been over 10 years since her kidney transplant, and she's still doing quite well.

 

[booradley5]

Is it just me? I basically view dialysis as a way to die slightly slower. I think gastric bypass is an outlet for people to commit suicide by surgeon. Ditto organ transplantation. I know that I have these attitudes because I only see the complication riddled treatment failures that come to the ER. Is this me only?

Sorry, but the data just don't support you on this one for dialysis vs. transplantation....

From the US Renal Data Service Annual Report 2004 (All the data on hospitalization and mortality starts on Pg. 20):

"Seventytwo percent of transplant patients survive at least five years, compared to 33?34 percent of those on dialysis."

 

[docB]

Sorry, but the data just don't support you on this one for dialysis vs. transplantation....

From the US Renal Data Service Annual Report 2004 (All the data on hospitalization and mortality starts on Pg. 20):

"Seventytwo percent of transplant patients survive at least five years, compared to 33?34 percent of those on dialysis."

The data don't support me on what? I didn't say that one was better than the other or not. I said they both suck and fill the ED with train wrecks.