09:54 – Kit sales have been slower than expected for the last month or so. Yesterday was the first time in a month that we shipped five kits in one day. Our original goal for 2013 was to double 2012 units and revenue. For a while earlier this year, it looked like we might quadruple sales year-on-year, and that may still happen. But even if it doesn’t, doubling or tripling sales year-on-year is nothing to complain about.
Yesterday, we shipped the last CK01B chemistry kit we had in stock, so I spent some time building another batch. That puts us in good shape on both chemistry kits, the biology kit, and the life science kit. But we also just shipped the last forensic science kit we had in stock, so today I’ll build another batch of those.
10:38 – Interesting juxtaposition. One of the front-page stories in this morning’s paper was about Wake Forest Baptist Medical Center here in Winston-Salem. US News & World Report recently completed a study that evaluated 4,806 hospitals nation-wide on 16 aspects of adult care. The top tier for each of the categories was defined as being in the top 50 of all hospitals evaluated. Only 147 hospitals (3%) had a top-tier rating in even one of the 16 categories. Wake Forest had top-tier ratings in 12 of the 16 categories. Among North Carolina hospitals, only Duke University Medical Center did better, with 13 top-tier ratings. Nationwide, only 12 hospitals had more top-tier ratings than Wake Forest.
So then, as usual, I headed for my office and checked my regular on-line news sites, starting with telegraph.co.uk. Their front page story was about Britain’s National Health Service: NHS inquiry: thousands of patients died amid ‘fundamental breaches of care’
Of course, no one in Britain uses the NHS if they can possibly afford to go private, but even so. Numerous NHS patients have died as a result of unspeakably abysmal care. NHS has literally allowed many patients to starve to death or die of thirst because they literally forgot to feed and water them. You probably think I’m exaggerating. I’m not. And this is exactly what our president wants us to have. ObamaCare is just another word for NHS.
I’ve heard stories about the NHS too but recently deceased Scottish author Iain Banks thought highly of them:
http://www.iain-banks.net/2013/04/03/a-personal-statement-from-iain-banks/
“Lastly, I’d like to add that from my GP onwards, the professionalism of the medics involved – and the speed with which the resources of the NHS in Scotland have been deployed – has been exemplary, and the standard of care deeply impressive. We’re all just sorry the outcome hasn’t been more cheerful.”
The sad fact that most people do not realize, is that buried in Obama Care is the eventual total elimination of any private care option. At least the NHS allows for those who can pay the choice. We will soon have no choice.
We are seeing a slowdown in the economy even down here in hot Texas. The bright shining marketplace is in homes which are now going for $105/$110 per ft2.
According to that Socialist rag, The Wall Street Journal, medical errors kill 98,000 people a year in this country. http://online.wsj.com/article/SB10000872396390444620104578008263334441352.html
The NHS may not be the model, but neither is our current (non) system. When our sons, now in their twenties, were 3 and six months old, I had what was supposed to be outpatient hernia surgery. Because the anesthesiologist screwed up, I inhaled some stomach contents and ended up with pneumonia and spent three days in the hospital strapped to an IV. The surgeon, with an impeccable bedside manner, called my wife and told her there was a problem and said “he’s young and healthy, he’ll recover”. Fortunately, I did recover with no apparent long-term effects. Nobody would admit any mistakes. I don’t think this is uncommon.
Doctors are resistant to change. In “The Checklist Manifesto”, Atul Gawande, a physician, discusses his attempts to get physicians to follow simple checklists and work more as a team. When he was able to do so, medical mistakes were significantly reduced. Yet he could not get many physicians to follow proven methods. There was an example in the book about the use of checklists in saving the life of a child who had “drowned”.
Doctors complain about lawyers suing them for medical errors. Only a small percentage of people harmed by medical errors ever sue. Doctors need to clean up their act.
Rick in Portland
I agree our current system is broken. I think we need to fix it. Doctors like Atul Gawande, not politicians, are the ones to fix it. This surgery center is leading a revolution in health care pricing by coming up with one price that includes everything and publishing that price on the Internet. Ironically, because of government regulations, they don’t take Medicare or Medicaid.
I don’t know what is dumber about this, the article or that this woman is an “Ivy League Professor”:
http://dailycaller.com/2013/07/16/irate-ivy-league-professor-calls-god-a-white-racist-god-after-zimmerman-verdict/
America’s finest educational system. More Marketing and Women’s Studies please.
On the WSJ article, doctors don’t criticize each other in public for a couple of reasons. The most common is fear of being sued.
My wife is an anesthesiologist and she’s seen many a “Dr. Hodad” in the OR. But she won’t say anything. She’s not a surgeon, so it would be hard to defend herself from a libel suit. In fact, a Hodad-type didn’t properly brief a patient about postop discomfort and my wife ended up defending a complaint in front of the Texas board. It cost us $1500 in malpractice deductable and a lot of sleepless nights. She was vindicated by the board and her care was deemed proper.
Another reason is being sued for restraint of trade. If a surgeon goes public about another surgeon’s skills, he can be sued for restraint of trade by the target – “He was trying to drive me out of business.”
The only groups with any power are the hospitals and the patients. If a physician gets too many malpractice claims or sustained complaints at the state licensing board, nobody will cover them. And without coverage, no hospital will allow them on staff. Hospitals can do internal reviews of complications and near misses, and decide to not renew a doctor’s admitting rights. NB: the AMA and other medical societies are powerless to discipline doctors – that went away in the 60s due to restraint of trade lawsuits filed against them.
Anesthesia is one of the fields that is at the forefront of putting patient safety first. They have a program where every malpractice claim against an anesthesiologist is examined after it is closed. From this trends and “lessons learned” are developed and communicated to doctors. It’s resulted in many updates to the standard of care guidelines. They are also big on checklists.
The NHS has its problems, but I wouldn’t say it’s worse on balance than the US’s system.
Singapore’s the model I’d like to follow, but fear that would require a great social change.
Banks’ comments on NHS have to be taken with a grain of salt. By the time his cancer was diagnosed, he was pretty much past treatment. He might have been able to get state-of-the-art chemo here in the US (at a place like MD Anderson Cancer Institute in Houston) that’s not available from NHS.
The NHS has its problems, but I wouldn’t say it’s worse on balance than the US’s system.
By most measures it’s a lot worse. We don’t have patients dying in hospital in the US due to malnutrition. We also have treatments that NHS won’t cover because they say it’s not worth it.
99% of my video work for lawyers is in the area of medical ‘mistakes’. There are plenty of them, and a good many have already been before the state insurance and medical boards, and fault—if any—has been found, so the lawsuit is to establish the fault in court and assign financial consequences. In Indiana, an accused doctor has to defend himself separately, first against the medical board, second with the state department of insurance, then again in court if somebody sues—which almost always happens if someone is found at fault by the medical board, as it is the patient or his estate that usually starts the process. No wonder malpractice insurance is such a huge expense that it forces doctors to work in groups these days; none can afford what it costs to insure themselves in individual practice anymore.
However, on the other side, I can say that—during the last 4 years I have been working in this field—the record of what goes on in the operating room has been stiffened dramatically with the implementation of 100% computer, paperless operations. Somebody in the OR is entering just about every step taken by anyone in the room, including noting people who enter/leave the room during the operation, with time-stamps automatically recorded, and drugs and operating implements being recorded into the computer by barcode readers before a package is opened. I would not be surprised if operations started being recorded via computer-assisted video in the not too distant future. Accountability is being elevated—at least around me. The days of hand-written charting are gone.
The same is true for nursing care on the hospital floor. The thoroughness of care and contemporaneous record-keeping is amazing.
By no means do I claim my work is a representative sample, but my own observation is that patient problems I hear about in my work, repeatedly seem to come from a doctor in surgery handing the patient over entirely to a different set of people, who then make mistakes in analyzing the patient’s recovery from the operation—or the effectiveness of the operation altogether. Something seemingly small appears as a problem, subsequent nurses and doctors do not assess properly or act quickly—or both,—and the problem snowballs, causing significant harm. Post-op internal bleeding that is not quickly caught, seems a recurring problem that should not be a problem with proper follow-up—at least it seems to me. I would advocate that doctors performing surgery should be responsible for sticking closely with the patient for a few days, until it is crystal clear that there are no unusual complications. My work is most often with cases where the operations end up not going normally for one reason or another,—but it is not always evident in surgery that there was a problem.
Nevertheless, overall, I remember the time when a trip to the hospital usually meant you were likely not coming back out alive. No one in my grandparents’ generation went willingly to the hospital. Wow, have times changed during my lifetime. As my doctor daughter in-law says: these days they can take care of almost anything unless you have a constitution that is not normal for one reason or another.
There may be problems in the US system, but from my perspective, they are being dealt with by improved procedures and accountability. It is amazing to watch that happen.
http://dailycaller.com/2013/07/16/irate-ivy-league-professor-calls-god-a-white-racist-god-after-zimmerman-verdict/
They have found Don King’s child!
He might have been able to get state-of-the-art chemo here in the US (at a place like MD Anderson Cancer Institute in Houston) that’s not available from NHS.
MDACC does miracles (my wife had a 5 year re-occurance rate of 65%, she is at 7+ years and doing great) but they cannot cure everyone. The editor of our local paper went to MDACC in desperation about a year ago for stage 4 breast cancer and passed away last week.
MDACC also does specialty radiation and has a proton gun that seems to be doing a awesome job in addition to their state of art chemo treatments. My wife actually gained weight during her six months of chemo at MDACC to her dismay.
ech wrote:
“Banks’ comments on NHS have to be taken with a grain of salt. By the time his cancer was diagnosed, he was pretty much past treatment. He might have been able to get state-of-the-art chemo here in the US (at a place like MD Anderson Cancer Institute in Houston) that’s not available from NHS.”
Perhaps so, and Banks was certainly well to the left politically, so he might have wanted to give a left wing cause a boost. But perceptions often change when it is your own life that is at stake.
It’s my understanding that Banks’ cancer had spread so far that it was inoperable and he was given just months to live, period.
“We also have treatments that NHS won’t cover because they say it’s not worth it.”
Objectively, that may be correct. Banks was 58-59 when he died so he had 20+ years of quality time and book writing in him. But, as our host has said, some people shouldn’t have a lot of money spent keeping them alive.
Chuck wrote:
” No wonder malpractice insurance is such a huge expense that it forces doctors to work in groups these days; none can afford what it costs to insure themselves in individual practice anymore.”
10-15 years ago here in Oz the number of malpractice suits against obstetricians became so high, and their insurance rates so great, that many just quit the field, becoming straight gynecologists, or retiring. There was a lot of resentment in this, as insurers would often settle a contentious case rather than let it go to trial. They made the point that, statistically speaking, there are always going to be some bad outcomes in that type of procedure, regardless of the quality of care.
I read of a case in Adelaide a decade ago where two women had their blood tested for type, the nurse mixed the two results up, and a woman (type O) was given type A blood in an operation and died. Took them a while to work out what must have happened. This is one of the things I fear and why I try to avoid hospitals.
@Lynn: Unfortunately, that professor is pretty clearly an affirmative action hire. It’s good that the article goes on to demonstrate this by discussing her lousy rating as a teacher.
I’ve probably mentioned before that I went to graduate school with a Hispanic woman. She was clearly unqualified to be in a top-ten CS program, but was passed through because of her double minority status. She knew this, and flat out stated that she intended to exploit her double minority status for everything it was worth in her career. Other women in the program (those who actually deserved to be there) found this awful, as it cast doubt on their qualifications.
Affirmative action is so totally counterproductive, so damaging to minorities that one ought to see it as malice. Sadly, it’s just well-intentioned incompetence.
She knew this, and flat out stated that she intended to exploit her double minority status for everything it was worth in her career.
I
worked withworked at a place where one of the ones receiving a paycheck was female, black and in a wheelchair. She did nothing all day except eat lunch and bitch at others to get out of her way as she rammed them with her wheelchair. But she could not be fired.It was a government contract awarded to an 8A (small disadvantaged minority firm) and she was pure gold to the contractor. Her status kept their numbers in the range needed to keep the contract. Even though their bids were higher than other companies, the company’s hiring of such people (only one person) was praised and thus contracts were awarded. The only reason the company got the contract was because of her triple minority status.
Meanwhile the others that were truly doing the work had to absorb the workload of this individual. The resentment was quite high but no one dared say anything as any comments about her productivity, rudeness and general abrasive behavior would be met with discrimination charges and possible termination for the complaining individual.