As a family doctor I receive a lot of reports from emergency room visits, consultations and hospitalizations. Many such reports include a dozen or more blood tests, several x-rays and several prescriptions.
Ideally I would read all these reports in some detail and be more than casually familiar with what happens to my patients.
But how possible is it really to do a good job with that task?
How much time would I need to spend on this to do it well?
Is there any time at all set aside in the typical primary care provider’s schedule for this task?
I think the answers to these questions are obvious and discouraging, if not at least a little bit frightening.
10 years ago I wrote a post titled “If You Find It, You Own It” and that phrase constantly echoes in my mind. You would hope that an emergency room doctor who sees an incidental abnormal finding during a physical exam or in a lab or imaging report would either deal with it or reach out to someone else, like the primary care provider, to pass the baton – making sure the patient doesn’t get lost to followup.
When Samuel Morse left his New Haven home to paint a portrait of the
Maquis du Lafayette in Washington DC, it was the last time he would see his
pregnant wife. Shortly after his arrival in Washington, his wife developed
complications during childbirth. A messenger took several days on horseback to
relay the message to Mr Morse. Because the trip back to New Haven took several
more, his wife had died by the time he arrived at their home. So moved was he by the tragedy of lost time
that he dedicated the majority of the rest of his life to make sure that this
would never happen to anyone again. His subsequent work on the telegraph and in
particular the mechanism of communication for the telegraph resulted in Morse
code – the first instantaneous messaging system in the world.
Mr Morse’s pain is not foreign to us in the 21st century. We feel the loss of new mothers so deeply that, when earlier this year new statistics on the rate of maternal death were released and suggested that American women died at three times the rate of other developed countries during child birth, doctors, patient advocates, and even Congress seemed willing to move heaven and earth to fix the problem. As someone who cares for expectant mothers at high risk for cardiovascular complications, I too was moved. But beyond the certainty of the headlines lay the nuance of the data, which seemed to tell a murkier story.
First at issue was the presentation of the data. Certainly, as a rate
per live births, it would seem that the United States lagged behind other OECD
countries – our maternal mortality rate was between 17.2 and 26.4 deaths per
100,000 live births, compared to 6.6 in the UK or 3.7 in Spain. But this
translated to approximately 700 maternal deaths per year across the United
States (among approximately 2.7 million annual births). While we would all agree
that one avoidable maternal death is one too many, the low incidence means that
small rates of error could have weighty implications on the reported results.
For instance, an error rate of 0.01% would put the United States in line with
other developed countries.
Surely, the error rate could not account for half the reported
deaths, right? Unfortunately, it is difficult to estimate how close to reality
the CDC reported data is, primarily because the main source data for maternal
mortality is a single question asked on the application for death certificates.
The question asks whether the deceased was pregnant at the time of death,
within 42 days of death, or in the 43 to 365 days prior to death. While
pregnancy at the time of death may be easy to assess, the latter two categories
are subject to significantly more error.
In the 2020 Summer Olympics, we will undoubtedly see large, red circles down the arms and backs of many Olympians. These spots are a side-effect of cupping, a treatment originating from traditional Chinese medicine (TCM) to reduce pain. TCM is a globally used Complementary and Alternative Medicine (CAM), but it still battles its critics who think it is only a belief system, rather than a legitimate medical practice. Even so, the usage of TCM continues to grow. This led the National Institute of Health (NIH) to sponsor a meeting in 1997 to determine the efficacy of acupuncture, paving the way in CAM research. Today, there are now over 50 schools dedicated to teaching Chinese acupuncture in the US under the Accreditation Commission for Acupuncture & Oriental Medicine.
While TCM has seen immense growth and integration around the globe throughout the last twenty years, other forms of CAM continue to struggle for acceptance in the U.S. In this article we will focus on Native American/Indigenous traditional medical practices. Indigenous and non-Indigenous patients should not have to choose between traditional and allopathic medicine, but rather have them working harmoniously from prevention to diagnosis to treatment plan.
It was not until August of 1978 that federally recognized tribal members were officially able to openly practice their Indigenous traditional medicine (the knowledge and practices of Indigenous people that prevent or eliminate physical, mental and social diseases) when the American Indian Religious Freedom Act (AIRFA) was passed. Prior to 1978, the federal government’s Department of Interior could convict a medicine man to a minimum of 10 days in prison if he encouraged others to follow traditional practices.
It is difficult to comprehend that tribes throughout the U.S. were only given the ability to openly exercise their medicinal practices 41 years ago when the “healing traditions of indigenous Native Americans have been practiced on this continent for 12,000 years ago and possibly for more than 40,000 years.”
Since the passage of AIRFA, many tribally run clinics and hospitals are finding ways to incorporate Indigenous traditional healing into their treatment plans, when requested by patients.
As I was getting ready for bed last night a friend shared a tweet that immediately caught my attention.
The tweet was of a
paper that has just been published online, titled “Does physician gender
have a significant impact on first-pass success rate of emergency endotracheal
intubation?” and showed the abstract which began,
It is unknown whether female physicians can perform equivalently to male physicians with respect to emergency procedures.
Understandably, this got the backs up of a
lot of people, myself included. Who on earth thinks that’s a valid question to
be researching in this day and age? Are we really still having to battle
assumptions of female inferiority when it comes to things like this? Who on
earth gave this ethics approval, let alone got it though peer review?
I then took a deep breath and asked myself
why a respected journal, The American Journal of Emergency Medicine,
would publish such idiocy. Maybe there was something else going on. The best
way to find out is to read the paper so I got a copy and started reading. The
first thing that struck me was the author affiliations – both are associated
with hospitals in Seoul, South Korea. The second author had an online profile,
he is a Clinical Professor of Emergency Medicine. I couldn’t find the first
author anywhere which made me think they are probably quite early in their
career. The subject matter wasn’t something I could imagine a male early career
researcher being interested in so figured they are probably female (not knowing
Korean names I couldn’t work out if the name was feminine or masculine).