Saturday, April 28, 2018

Alfie Evans: A Reasonable Economic Decision Disguised as a Horrific Moral Determination

The tragic case of Alfie Evans has roiled Great Britain and the world. Alfie was a 2 year old child in the United Kingdom with an unknown degenerative brain disease who eventually deteriorated to the point that he required life support- his brain had become mostly liquid, and he could not see, speak, or hear. Alder Hey hospital decided his condition was terminal and irreversible, and wanted to stop further treatment. His parents disagreed, and wanted to transfer care to another hospital in Italy which was willing to accept him. Alder Hey went to court, arguing that it was better that the child be allowed to die because keeping him alive was cruel and harmful. They ultimately won, and Alfie Evans passed away. This has sparked a great outcry, particularly among the pro-life movement in the US. And indeed, the idea that the state can literally declare that death is better than life for anyone should be horrifying to everyone.

But the decision to take Alfie off life support was a reasonable and ethical one- if it was justified as being fair to all patients. It is even a reasonable one for individual doctors to conclude that further treating a patient in front of them is harmful and not ethical. But when court decided it had the right to decide that the child should die rather than live, it became an abomination.

Monday, April 16, 2018

"Gun Control" Ideas that Might Actually Pass and Reduce Mass Shootings, From a Doctor and a Gun Owner

I am a resident physician in General Surgery at the Baylor College of Medicine, and I work and train a great deal at Ben Taub- one of only two Level I trauma centers in Houston, and thus one that sees an extraordinary number of Houston's victims of gun violence. But I am also a gun-owner, who took up shooting in the Boy Scouts. And, I am the son of immigrants who refuse to touch firearms, but yet who were free to immigrate to America because of their invention. Like most of Houston, I am thus a study of contradictions, and this gives rise to some unique ideas and perspectives on how to prevent mass shootings and gun violence that may actually find support from both sides in this divided time.

The Resident: Learn the Lessons, Laugh at Everything Else

A new medical TV show, The Resident, made a big splash in the social media- largely for a perceived negative portrayal of physicians.  One EM physician even published a long editorial on NBC news condemning it as reducing trust in the entire medical profession.  The creator of the show, Amy Holden Jones, has been viciously attacked on twitter for the show, and even accused of causing patient deaths by decreasing trust in the medical establishment.

Wednesday, July 26, 2017

The LA Times's crucifixion of Dr. Puliafito is not appropriate, and has left the most important question unanswered

Two weeks ago the LA Times broke a story that Dr. Carmen Puliafito, former Dean of the Keck School of Medicine of USC, had been abusing drugs and keeping company with a group of younger individuals who engaged in drug use and illicit activity.  Much of this activity occurred while he was Dean, and it is a shocking story- a 66 year-old titan of the field of ophthalmology, renowned for inventing a device that revolutionized the field and forging both the 1st and 2nd ranked programs in the country (University of Miami's Bascom-Palmer and previously USC's Doheny before its split)- found partying with a prostitute and her friends while taking methamphetamine and other drugs.

Sunday, April 9, 2017

As an Intern, I Support the ACGME's Increased Duty Hour Limits

Last month, the ACGME formally increased its work-hour limits for resident physicians, a change that was widely covered in the press.

This decision has also been significantly mis-reported.  While it may seem like all residents will now work for longer hours, in reality, only first year interns will be allowed to work longer 24 hour shifts, where the previous maximum was 16- a limit adopted in 2011.  2nd year and up, the restrictions will not change: 24 hour shifts, no more often than every 3rd day, with an 80 hour per week average which were the restrictions adopted in 2003.

Friday, December 16, 2016

A Response to the Volume Pledge

Dr. Pronovost is a leading figure in the patient safety movement, and is someone I greatly admire.  His work with surgical checklists is touted by Dr. Atul Gawande as having saved more lives than any researcher in the past decade.  However, I disagree with his latest initiative- to get hospitals who perform certain procedures at very low rates to stop performing them altogether.

On the surface, it seems like a perfect idea- hospitals that perform few surgeries of a certain type usually have worse outcomes and higher patient mortality than hospitals that perform many of them, a fact that has been known for decades.  However, the issue is more complex than it first appears.

Friday, December 2, 2016

How Much is a Human Life Worth: A Question we Need to Answer

With the election of Donald Trump, there has been much speculation about his plans for the ACA- speculation that rose again after the announcement that Dr. Tom Price, MD, is to be appointed as his Secretary of Health and Human Services.  But the reality is that any health plan in the United States- Trumpcare, Pricecare, Obamacare, Hillarycare, and someday perhaps Warrencare or Bidencare will not work because of our collective failure as a society to answer a question that every foreign health system has answered in some way: